The expectation-perception gap in primary healthcare quality: a study of Iranian older adults

Primary healthcare (PHC) is essential for an effective national health system. Evaluating the quality of PHC services is crucial for designing targeted interventions that can maintain and improve the health of older populations. This study aims to assess the expectation-perception gap in the quality of health services provided to older adults in both urban and rural comprehensive health centers throughout Qazvin Province, Iran. This cross-sectional descriptive-analytical study was conducted on 557 older adults residing in Qazvin Province, Iran. A multi-stage sampling method was used to select the older adults. Data were collected using a demographic checklist and the Service Quality Model (SERVQUAL) scale over three months from August to October 2024. Questionnaires were completed through face-to-face interviews at urban and rural comprehensive health centers of Qazvin Province, Iran. Data analysis was performed using a paired t-test and a multiple regression model. The study included a total of 557 older adults, with a mean age of 67.97 ± 6.56 years. The results showed a negative gap across all six dimensions of the SERVQUAL scale. The largest mean gap was found in the tangibles (− 3.11) and the “responsiveness” (-2.46) dimensions, while the smallest gap appeared in the reliability dimension (− 1.91). Older adults living closer to healthcare centers (β = -0.35, 95% CI: -0.52, -0.32, P < 0.001), Farsi-speaking elders compared to other ethnic groups (β = -0.12, 95% CI:-2.28, -0.44, p = 0.004), and those with good (β = -0.13, 95% CI:-6.00, -1.37, p = 0.002) and bad (β = -0.09, 95% CI:-6.77, -0.57, p = 0.020) economic status compared with those with moderate economic status reported lower expectations for PHC service quality. In contrast, employed older adults had lower expectations than housewives (β = -0.09, 95% CI:-7.83, -0.42, p = 0.029). The study identified significant gaps between older adults’ expectations and perceptions of PHC quality across all the SERVQUAL dimensions, particularly in the tangibles and responsiveness. To address these gaps, it is recommended to upgrade healthcare facilities and equipment, enhance staff training in responsive and patient-centered communication, establish routine feedback mechanisms with a focus on socially and economically vulnerable groups, and implement culturally tailored outreach strategies for ethnic minorities.