Understanding international university students' perceptions of healthcare service quality: development and validation of a new scale

PURPOSE: This study aimed to develop and validate a context-sensitive scale to assess international university students' perceptions of healthcare service quality in Türkiye, with particular attention to access, service delivery and expectation alignment. DESIGN/METHODOLOGY/APPROACH: A descriptive, cross-sectional survey design was employed. Following established scale development procedures, an item pool was generated based on a literature review, expert evaluation and pilot testing. The final 15-item scale was administered online to 286 international university students. Exploratory and confirmatory factor analyses were conducted using IBM SPSS and AMOS to examine the scale's psychometric properties. FINDINGS: The analyses supported a three-factor structure comprising positive perception, service and infrastructure quality and meeting expectations. The scale demonstrated acceptable construct validity and internal consistency (a = 0.865), with satisfactory model fit indices (CMIN/DF = 3.491; SRMR = 0.0798). Overall mean scores clustered around the neutral response category, suggesting cautious or uncertain evaluations of healthcare services, which may reflect multiple factors including system unfamiliarity, response style tendencies or variability in prior healthcare expectations. Significant differences were observed across selected socio-demographic variables. ORIGINALITY/VALUE: Rather than proposing entirely new theoretical constructs, this study offers a context-sensitive measurement tool that operationalizes established healthcare service quality domains specifically for international university students. While generic instruments like SERVQUAL are widely used, they often fail to capture the unique challenges faced by internationally mobile populations, such as language barriers, system unfamiliarity and culturally shaped expectations. By addressing this measurement gap, the proposed scale provides a more precise diagnostic tool for universities and healthcare providers to identify areas of uncertainty and improve service delivery for diverse student populations.