Factors associated with older adults’ satisfaction with primary health care services in Isfahan, Iran: a cross-sectional study

Population aging has substantially increased the demand for accessible, high-quality primary healthcare services worldwide. As older adults are among the most frequent users of healthcare services, understanding their experiences and satisfaction is essential for improving healthcare quality and supporting healthy aging. This study aimed to assess the level of satisfaction among older adults attending comprehensive health service centers in Isfahan and to identify demographic factors associated with their satisfaction. A community-based cross-sectional study was conducted among 385 adults aged 60 years and older attending comprehensive health service centers in Isfahan, Iran, in 2023. Participants were selected using a multistage cluster sampling method. Data were collected using a researcher-developed questionnaire based on the SERVQUAL framework, comprising three domains: physical environment, healthcare personnel, and service delivery process. The questionnaire demonstrated satisfactory content validity and internal consistency. Descriptive statistics, Mann–Whitney U and Kruskal–Wallis tests, Spearman correlation, and multivariable linear regression were used for the analyses. Cluster bootstrap procedures were used to account for the clustered sampling design. Overall, participants reported favorable levels of satisfaction with healthcare services across all three domains. Satisfaction was highest in the healthcare personnel domain (78%). Delivery processes were also favorable, whereas the lowest satisfaction was observed for the physical environment, availability of blood assessment equipment, and age-friendly physical infrastructure. In multivariable analyses, female gender and middle-school, diploma, and university education (vs. illiteracy) were associated with lower physical-domain satisfaction. Living with a spouse (vs. living without a spouse) was associated with lower personnel-domain satisfaction. In the process domain, working (vs. unemployed) and diploma-level education (vs. illiteracy) were associated with lower satisfaction, whereas a greater number of children was associated with higher satisfaction. Older adults were generally satisfied with the healthcare services, particularly interactions with healthcare personnel. However, improvements in physical infrastructure, age-friendly facilities, and essential diagnostic equipment are needed to further enhance service quality.