Measuring hospital food service quality: Adaptation and validation of the SERVQUAL-HF scale

Abstract

Objective: To adapt and psychometrically evaluate the SERVQUAL-HF instrument for hospital food service quality assessment by validating its dimensional structure, reliability, and ability to identify key predictors of patient satisfaction.
Methods: This study uses the SERVQUAL framework to assess hospital food service quality, adding variables geared toward meal-specific aspects. A 7-point Likert-scale survey was performed in two hospitals to compare patient expectations to actual reality.
Results: Statistical validation, including multilinear regression and correlation analysis, revealed that responsiveness, food quality, perceived value, empathy, and meal variety are all significant predictors of customer satisfaction. SERVQUAL for Hospital Food Service (SERVQUAL-HF)’s dependability in assessing service quality across hospital settings was proven by a psychometric examination. The study emphasizes methodological modifications, such as the significance of empathy and perceived value, and suggests directions for future research in healthcare service measuring.
Conclusions: The findings add to the literature by improving the use of SERVQUAL in non-traditional hospital settings, ensuring comprehensive evaluation of patient-centered food service models.

Keywords

Food perception / Hospital food service / Instrument validation / Patient experience / Patient satisfaction / Service quality / SERVQUAL

ACKNOWLEDGEMENTS

The authors extend their sincere appreciation to the hospital administrators who facilitated data collection and ensured smooth access to the study population. Special thanks are due to the diet technicians and registered dietitians for their hands-on assistance and patient engagement, which significantly enriched the quality of the data. Above all, we are deeply grateful to the patients who generously shared their time and perspectives, making a meaningful contribution to this research and its broader implications for hospital food service evaluation.

AUTHORS CONTRIBUTIONS

Concept—T.S.G.B., K.J.M.; definition of intellectual content — T.S.G.B., K.J.M.; content — T.S.G.B.; literature search — T.S.G.B., K.J.M.; clinical studies — T.S.G.B., C.E.H., G.S.B.; experimental studies — T.S.G.B.; data acquisition — T.S.G.B.; data analysis — T.S.G.B., W.L.B.; statistical analysis— T.S.G.B., W.L.B.

FUNDING

This research did not receive external funding.

CONFLICTS OF INTEREST DISCLOSURE

The authors declare they have no conflicts of interest.

INFORMED CONSENT

Because the research involved anonymous survey responses, formal written consent was not required. Instead, patients received an informational form outlining the study’s purpose, procedures, and voluntary nature prior to participation.

ETHICS APPROVAL

The Publication Ethics Committee of the Association for Health Sciences and Education. The journal’s policies adhere to the Core Practices established by the Committee on Publication Ethics (COPE).

PROVENANCE AND PEER REVIEW

Not commissioned; externally double-blind peer reviewed.

DATA AVAILABILITY STATEMENT

All data generated for this study were used exclusively to address the stated research question and are not intended for public archiving. However, all analyzed data are transparently reported within the manuscript through summary statistics and response distributions. No additional datasets are available.

DATA SHARING STATEMENT

The raw survey data underlying this study are not publicly available due to the anonymous nature of data collection and institutional confidentiality requirements. De-identified datasets cannot be shared to ensure participant privacy.

OPEN ACCESS

This is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/4.0/).

COPYRIGHTS

Copyright for this article is retained by the author(s), with first publication rights granted to the journal.

References

[1] Keller HH, Xu Y, Dubin JA, et al. Improving the standard of nutrition care in hospital: mealtime barriers reduced with implementation of the Integrated Nutrition Pathway for Acute Care. Clinical Nutrition ESPEN. 2018; 28: 74-79. PMid: 30390896. https://doi.org/10.1016/j.clnesp.2018.09.075

[2] Osman NS, Md Nor N, Md Sharif MS, et al. Hospital food service strategies to improve food intakes among Inpatients: A systematic Review. Nutrients. 2021; 13(10): 3649. PMid: 34684649. https://doi.org/10.3390/nu13103649

[3] McCullough J. My meal intake tool (MMIT) and the mealtime audit tool (MAT)-criterion validity and inter-rater reliability testing of two novel tools for improving food intake in acute care. Master’s thesis, University of Waterloo; 2016. 1-123 p. Available from: https://uwspace.uwaterloo.ca/bitstream/handle/10012/10512/McCullough_James.pdf?sequence=3&isAllowed=y

[4] Ferreira J, Patel P, Guadagno E, et al. Patient experience or patient satisfaction? A systematic review of child- and family-reported experience measures in pediatric surgery. Journal of Pediatric Surgery. 2023; 58(5): 862-870. PMid: 36797113. https://doi.org/10.1016/j.jpedsurg.2023.01.015

[5] Banda S, Nkungula N, Chiumia IK, et al. Tools for measuring client experiences and satisfaction with healthcare in low-and middleincome countries: a systematic review of measurement properties. BMC Health Services Research. 2023; 23(1): 133. PMid: 36759840. https://doi.org/10.1186/s12913-023-09129-9

[6] Wildenbos GA, Jaspers MW, Schijven MP, et al. Mobile health for older adult patients: Using an aging barriers framework to classify usability problems. International Journal of Medical Informatics. 2019; 124: 68-77. PMid: 30784429. https://doi.org/10.1016/j.ijmedinf.2019.01.006

[7] Lai H, Gemming L. Approaches to patient satisfaction measurement of the healthcare food services: A systematic review. Clinical Nutrition ESPEN. 2021; 42: 61-72. PMid: 33745623. https://doi.org/10.1016/j.clnesp.2020.12.019

[8] Batbaatar E, Dorjdagva J, Luvsannyam A, et al. Determinants of patient satisfaction: A systematic review. Perspectives in Public Health. 2017; 137(2): 89-101. PMid: 27004489. https://doi.org/10.1177/1757913916634136

[9] Sitzia J, Wood N. Patient satisfaction: A review of issues and concepts. Social Science and Medicine. 1997; 45(12): 1829-1843. PMid: 9447632. https://doi.org/10.1016/S0277-9536(97)00128-7

[10] Vaz NFM. Patient Satisfaction. In, Rosiek-Kryszewska, A. and Leksowski, K. (Eds.). Healthcare Administration for Patient Safety and Engagement. IGI Global, PA: Hershey; 2018. 186-200 p. https://doi.org/10.4018/978-1-5225-3946-9.ch010

[11] Parasuraman A, Zeithaml VA, Berry LL. A conceptual model of service quality and its implications for future research., Journal of Marketing. 1985; 49(4): 41-50. https://doi.org/10.1177/002224298504900403

[12] Barros TSG, McCleary KJ, Beeson WL, et al. Assessing patient satisfaction in hospital food service with SERVQUAL: A crosssectional study. Journal of Hospital Administration. 2025; 14(2): 9-15. https://doi.org/10.63564/jha.v14n2p9

[13] Teas RK. Expectations, performance evaluation, and consumers’ perceptions of quality. Journal of Marketing. 1993; 57(4): 18-34. https://doi.org/10.1177/002224299305700402

[14] Asubonteng P, McCleary KJ, Swan JE. SERVQUAL revisited: A critical review of service quality. Journal of Services Marketing. 1996; 10(6): 62-81. https://doi.org/10.1108/08876049610148602

[15] Ghimire P, Ghimire P, Acharya M. SERVQUAL Questionnaire based Health Service Quality Assessment in a Private Hospital of Western Nepal. Journal of Nepal Health Research Council. 2020; 5(1):79-85. Available from: https://www.njmsmanipal.com.np/njms/index.php/njms/article/view/51

[16] Lu SJ, Kao HO, Chang BL, et al. Identification of quality gaps in healthcare services using the SERVQUAL instrument and importance-performance analysis in medical intensive care: a prospective study at a medical center in Taiwan. BMC Health Services Research. 2020; 20: 908. PMid: 32993641. https://doi.org/10.1186/s12913-020-05764-8

[17] Lee K, Salciuviene L. Modeling determinants of customer loyalty in services sector across different cultural contexts. Engineering Economics. 2018; 29(5): 580-590. https://doi.org/10.5755/j01.ee.29.5.17386

[18] Brown TJ, Churchill GA Jr., Peter JP. Improving the measurement of service quality. Journal of Retailing. 1993; 69(1): 127-139. https://doi.org/10.1016/S0022-4359(05)80006-5

[19] Ionas IG. Quantitative research by example. Creative Commons, version 1.0. 2019; 35-38. Available from: https://www.myrelab.com/static/book/QuantitativeResearchByExample.pdf

[20] Parasuraman A, Zeithaml VA, Berry LL. SERVQUAL: A Multiple- Item Scale for Measuring Consumer Perceptions of Service Quality. Journal of Retailing. 1988; 64(1): 12-40.

[21] Babakus E, Boller GW. An empirical assessment of the SERVQUAL scale. Journal of Business Research. 1992; 24(3): 253-268. https://doi.org/10.1016/0148-2963(92)90022-4

[22] Cardello AV. Food quality: relativity, context and consumer expectations. Food Quality and Preference. 1995; 6(3): 163-170. https://doi.org/10.1016/0950-3293(94)00039-X

[23] Theurer VA. Improving patient satisfaction in a hospital foodservice system using low-cost interventions:Determining whether a room service system is the next step. Master’s thesis, Utah State University; 2011. 1-51 p. Available from: https://digitalcommons.usu.edu/cgi/viewcontent.cgi?article=1029&context=gradreports

[24] Kahl J, Baars T, Bugel S, et al. Organic food quality: a framework for concept, definition and evaluation from the European perspective. Journal of the Science of Food and Agriculture. 2012; 92(14): 2760-2765. PMid: 22407871. https://doi.org/10.1002/jsfa.5640

[25] Teka M, Dihar G, Dana T, et al. Satisfaction with regular hospital foodservices and associated factors among adult patients in Wolaita zone, Ethiopia: A facility-based cross-sectional study. PLoS One. 2022; 17(3): e0264163. PMid: 35235592. https://doi.org/10.1371/journal.pone.0264163

[26] Volkert D, Beck AM, Cederholm T, et al. Management of malnutrition in older patients-current approaches, evidence and open questions. Journal of Clinical Medicine. 2019; 8(7): 974. PMid: 31277488. https://doi.org/10.3390/jcm8070974

[27] World Health Organization. WHO guidance for climate-resilient and environmentally sustainable health care facilities. World Health Organization, Geneva, Switzerland. 2020. Available from: https://www.who.int/publications/i/item/9789240012226

[28] Fan LH, Gao L, Liu X, et al. Patients’ perceptions of service quality in China: An investigation using the SERVQUAL model. PloS One. 2017; 12(12): e0190123. PMid: 29272312. https://doi.org/10.1371/journal.pone.0190123

[29] Hennchen B. Knowing the kitchen: Applying practice theory to issues of food waste in the food service sector. Journal of Cleaner Production. 2019; 225: 675-683. https://doi.org/10.1016/j.jclepro.2019.03.293

[30] IBM Corp. IBM SPSS Statistics for Windows, Version 29.0.1.0, IBM Corp., Armonk, NY; 2023. Available from: https://www.ibm.com/products/spss-statistics

[31] Weiss NA. Introductory statistics (7th ed.). Boston, MA: Pearson Addison Wesley; 2025. 508 p.

[32] A’aqoulah A, Kuyini AB, Albalas S. Exploring the gap between patients’ expectations and perceptions of healthcare service quality. Patient Preference and Adherence. 2022; 16: 1295-1305. PMid: 35645558. https://doi.org/10.2147/PPA.S360852

[33] Bozkurt Y, Kiliçarslan M. Evaluation of the Relationship Between Service Quality and Patient Satisfaction in Hospitals: Case of Acibadem Hospital. International Journal of Computational and Experimental Science and Engineering. 2021; 7(1): 13-24. Available from: https://www.acarindex.com/international-journal-of-computational-and-experimental-science-and-engineering/evaluation-of-the-relationship-between-service-quality-and-patient-satisfaction-in-hospitals-case-of-acibadem-hospital-1066259

[34] Fallon A, Gurr S, Hannan-Jones M, et al. Use of the Acute Care Hospital Foodservice Patient Satisfaction Questionnaire to monitor trends in patient satisfaction with foodservice at an acute care private hospital. Nutrition and Dietetics. 2008; 65(1): 41-46. https://doi.org/10.1111/j.1747-0080.2007.00219.x

[35] Rapo S, Mattson Sydner Y, Kautto E, et al. Exploring patient satisfaction with hospital foodservice: a Swedish study using the acute care hospital foodservice patient satisfaction questionnaire. Nutrition and dietetics. 2021; 78(5): 487-495. PMid: 33691342. https://doi.org/10.1111/1747-0080.12665

[36] Aminuddin NF, Vijayakumaran RK, Abdul Razak S. Patient Satisfaction with hospital foodservice and its impact on plate waste in public hospitals in East Malaysia. Hospital Practices and Research. 2018; 3(3): 90-97. https://doi.org/10.15171/hpr.2018.20

[37] Moya-Salazar J, Goicochea-Palomino EA, Porras-Guillermo J, et al. Assessing empathy in healthcare services: a systematic review of South American healthcare workers’ and patients’ perceptions. Frontiers in Psychiatry. 2023; 14: 1249620. PMid: 38076688. https://doi.org/10.3389/fpsyt.2023.1249620

[38] Chen AM. Same day access in healthcare: be quick, but don’t hurry. Journal of Hospital Management and Health Policy. 2024; 8: 27. https://doi.org/10.21037/jhmhp-24-55

[39] Kumar P, Bera S, Chakraborty S. An examination of the association between service convenience flexibility in healthcare delivery systems and patient satisfaction. South Asian Journal of Management. 2017; 24(4): 138-160.

[40] Al-Torky MA, Mohamed EA, Yousef FM, et al. Inpatients’ satisfaction with food services in Sohag University Hospital. The Egyptian Journal of Community Medicine. 2016; 34(2): 33-45. https://doi.org/10.21608/ejcm.2016.651

[41] Meesala A, Paul J. Service quality, consumer satisfaction and loyalty in hospitals: Thinking for the future. Journal of Retailing and Consumer Services. 2018; 40: 261-269. https://doi.org/10.1016/j.jretconser.2016.10.011