A cross-sectional study to assess the mother’s perception on the service quality at Anganwadi centers under Integrated Child Development Service scheme in a field practice area of a tertiary care hospital

A cross-sectional study to assess the mother’s perception on the service quality at Anganwadi centers under Integrated Child Development Service scheme in a field practice area of a tertiary care hospital | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A cross-sectional study to assess the mother’s perception on the service quality at Anganwadi centers under Integrated Child Development Service scheme in a field practice area of a tertiary care hospital Sandeep A Mishra, Aarti Sahare, Nidhi Pradeep Sastry, Dhananjay Kumar Singh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7164342/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Lack of proper nutrition during the first 1,000 days of a child’s life can result in stunted growth of the child, which is irreversible and associated with impaired cognitive ability and reduced school and work performance. ICDS scheme was started by the Government of India for improvement in maternal and child health through the Anganwadi workers (AWWs) and the focal point of delivery of services are the Anganwadi Centre (AWC) . Objectives : The current study was conducted to assess the mother’s perception on the service quality at Anganwadi centres under integrated child development service scheme, to measure the gap between mother’s perceptions and expectations on service quality and to study the socio demographic profile of the study participants. Materials and methods : We carried out a cross sectional study in among 69 mothers at Anganwadi centres coming under field practice area of a tertiary care hospital between December 2020 to November 2021. We used Servqual questionnaire to measure mother’s perception regarding service quality at Anganwadi centre and their expectations. Results : The results showed that along the entire dimension, gap score came out to be negative which indicates service quality perceived by mothers is poor. The mean difference between Perception and Expectation scores was statistically significant (P value <0.05) in all dimensions. Conclusion : The negative gap shows that the expectations of mothers were beyond their perception of the current situation, so there is a lot of space to improve and reach client satisfaction and desired healthcare services. Mothers Perception ICDS Anganwadi Service quality Figures Figure 1 Figure 2 INTRODUCTION The first 1000 days of a child’s life are extremely crucial and lack of proper nutrition this period can result in stunted growth of the child, which is irreversible and associated with impaired cognitive development and reduced performance at school and work.[1] Undernutrition can further lead to increased severity of infections and delayed, eventually progressing to death in some cases. Nearly 50% of deaths among children under the age of five in India are linked to undernutrition. According to National Family Health Survey 5 (NFHS-5), the prevalence of stunting, wasting, and underweight among under-5 children in India is 35.5%, 19.3%, and 32.1%, respectively.[2] Regarding Global Hunger Index in 2022, India ranked 107th out of the 125 countries with a score of 29.1. It’s key indicators are: child wasting, child stunting, undernourishment and child mortality rate. Undernourishment was 16.3% in 2022 as per Global Hunger Index reports. Nutrition plays a key role in this aspect. [3] Launched on October 2, 1975, the Integrated Child Development Services (ICDS) scheme is implemented by the Ministry of Women and Child Development, Government of India. It was introduced to improve maternal and child health through Anganwadi Centres (AWCs), which serve as the primary hubs for delivering various services by Anganwadi Workers (AWWs).[4] The scheme primarily focuses on improving the health and nutritional well-being of children below six years of age. Key services provided include immunization, regular health check-ups, supplementary nutrition, and referral services for young children, along with support for pregnant and nursing mothers. Additionally, children between 3 and 6 years are offered non-formal pre-school education, and women aged 15–45 years, along with adolescent girls aged 11–18 years, are given guidance on health and nutrition.[5] By 2022, a total of 13.96 lakh Anganwadi Centres (AWCs) were functioning across the country. These centres, operating under the Integrated Child Development Services (ICDS) scheme, are tasked with delivering supplementary nutrition to eligible beneficiaries. To identify malnutrition in children, updated WHO growth standards and baby weighing scales were introduced. In the case of pregnant and lactating women, adult weighing scales are used to track weight throughout pregnancy and postpartum. Additionally, AWCs conduct pre-school education activities for young children and should therefore be equipped with age-appropriate activity books, child assessment cards, and sufficient educational materials. Immunization and health check - up services are also provided by the anganwadi centres.[6] The program is implemented by a trained group of workers known as Anganwadi Workers (AWWs), who are selected from within the local community. They undergo four months of training in areas such as health, nutrition, and child care. Each AWW manages an Anganwadi Centre (AWC) and operates under the guidance of a supervisor known as the Mukhya Sevika. An additional helper supports the AWW in carrying out the day-to-day activities at the centre.[7] There are limited studies in India which focus on the involvement of mothers in ICDS activities and their expectation and involvement in acquiring services provided under the scheme. The SERVQUAL model questionnaire has been used in several studies including the banking sector, retail sector, health care sector in hospital setting etc. The model has not been used frequently in provision of services relating to health in the community setting. Hence this study will be undertaken to assess the mother’s perception on the service quality at the Anganwadi centres attached to field practice area of tertiary care hospital, to measure the gap between mother’s perceptions and expectations on service quality and to study the socio demographic profile of the mothers. MATERIALS AND METHODS Study setting and study participants : We conducted this cross sectional study in Anganwadi centers which came under the field practice area of a tertiary care hospital in Mumbai, from December 2020 to November 2021. Anganwadi centres are the focal point of delivery of services provided under the ICDS scheme. Mothers of those children who were up to 6 years of age and who were registered at the Anganwadi centers for more than 3 months were included in the study, while mothers who did not wish to participate were excluded. Sample size and sampling technique : We calculated sample size based on a previous study where 4.7% of the mothers said that the overall services of Anganwadi centers were of good quality.[8] So, taking prevalence (p) was taken 4.7% with 5% margin of error and 95% confidence interval. The sample size estimated was 69, hence 69 mothers fulfilling inclusion criteria were included in the study. There were 30 Anganwadi centers in the study area. Out of which 7 centers were selected by simple random technique (lottery method). After applying inclusion and exclusion criteria, 10 mothers were selected from each 6 Anganwadi centers and 9 mothers were selected from the last centre by simple random technique (Lottery method). Data collection: We obtained ethical approval for the study from the Institute Ethics Committee. The mothers were explained the purpose of study and written informed consent was obtained prior to participation. Face to face interview was conducted on the mothers using pre-designed, pre-tested, semi - structured questionnaire (adapted from the SERVQUAL model) in a language the respondent understands, after answering all their doubts, if any, regarding the study. The interview schedule consisted of questions regarding socio- demographic profile of the mothers, perceptions regarding services at Anganwadi centres under ICDS scheme and expectations regarding services at Anganwadi centres under ICDS scheme. The Servqual model was used in the study. It is a questionnaire containing 5 dimensions (Tangibility, reliability, Responsiveness, Assurance, Empathy) which has 22 statements.[9],[10] The model was adapted in our study and the questions were framed according to our objectives. In the first part, the questionnaire was used to measure mother’s perception regarding services provided at Anganwadi Centre. The perception was plotted on the 7-point LIKERT’s scale, where 1 was strongly disagree and 7 was strongly agree. In the second part, the same set of questionnaires was used to measure mother’s expectations with regards to services provided at Anganwadi Centre. The expectation was plotted on the 7- point LIKERT’s scale where 1 was strongly disagree and 7 was strongly agree. The mean perception score for each statement was calculated The mean expectation score for each statement was calculated Gap score was calculated for each statement and finally average gap scores was calculated. Statistical analysis : Data was entered in MS Excel 2019 and was analyzed using SPSS version 22 software. Qualitative data was expressed in terms of frequency and percentage. Quantitative data was expressed in terms of mean. To compare mother’s perception and expectations, paired-t test was used. P value less than 0.05 was considered statistically significant. RESULTS Table 1: Socio-demographic profile of the mothers (N=69) Socio-demographic profile Frequency Percentage Age 19 to 35 years 54 78.3 36 to 55 years 15 21.7 Religion Hindu 24 34.8 Muslim 45 65.2 Education Diploma/Graduate 05 07.2 Primary/middle/high school 26 37.7 Illiterate 38 55.1 Occupation Professional/Semiprofessional 02 02.9 Skilled/semiskilled 06 08.7 Unskilled 12 17.4 Unemployed 49 71.0 Family type Nuclear 28 40.6 Joint 41 59.4 Per capita monthly income (Modified B.G. Prasad classification) Class I 01 01.4 Class II 02 02.9 Class III 10 14.5 Class IV 52 75.4 Class V 04 05.8 Table 1 shows socio demographic profile of the mothers. It was found that among the 69 study participants included in the study, 54 (78.3%) were in 19 to 35 years age group whereas 15 (21.7%) were in 36 to 55 years of age group. 24 (34.8%) participants were Hindu by religion and 45 (65.2%) were Muslims. Majority participants 38 (55.1%) were illiterates, 26 (37.7%) had studied upto primary/middle/high school whereas 5 (7.2%) had studied upto Diploma or Graduation. Regarding occupation, it was seen that majority 49 (71%) were unemployed. 41 (59.4%) participants belonged to a joint family and 28 (40.6%) belonged to nuclear family. Figure 1 shows the distance of Anganwadi centre from home. It can be seen that 54 (78.3%) resided within 200 metres to 500 metres while 15 (21.7%) resided at a distance of 600 metres and beyond. Figure 2 shows number of children. Maxmimum study participants, that is 29 (42%) had 2 children. Table 2: The mean Perception and Expectation of the mothers on service quality at Anganwadi centers Statement Dimension Mothers’ perception of service quality (Mean) Mothers’ expectation of service quality (Mean) Gap score t-test P value 1.There are modern looking equipment’s at Anganwadi Centre (AWC) Tangibles TA1 3.24 4.53 -1.29 -3.767 <0.001 2.The Physical facilities at AWC are visually appealing TA2 3.72 5.34 -1.62 -6.064 <0.001 3.The Anganwadi workers (AWW)s appears neat TA3 5.26 6.07 -0.81 -8.954 <0.001 4.The materials in AWC are visually appealing TA4 3.72 5.34 -1.62 -6.064 <0.001 5.AWWs provides facilities on time as promised ReliabilityRL1 3.66 5.69 -2.02 -14.655 <0.001 6.AWWs shows interest in solving problems of the beneficiaries RL2 4.24 4.95 -0.71 -4.634 <0.001 7. AWWs perform correct services at the first time itself RL3 4.42 4.86 -0.44 -2.648 0.010 8.AWWs provides services on time as promised RL4 3.66 5.69 -2.02 -14.65 <0.001 9.AWWs maintain error free records RL5 4.47 4.76 -0.29 -2.090 0.040 10.AWWs inform the mothers regarding the time for service delivery Responsiv-eness RS1 4.88 5.60 -0.72 -6.769 <0.001 11.AWWs provides prompt services to beneficiaries RS2 4.56 5.59 -1.02 -9.424 <0.001 12.AWWs are always willing to help the beneficiaries RS3 5.72 6.20 -0.47 -7.895 <0.001 13.AWWs responds to the beneficiaries at any time RS4 5.72 6.20 -0.47 -7.895 <0.001 14.Mothers are comfortable with the behaviour of the AWWs Assurance AS1 4.79 5.30 -0.50 -5.693 <0.001 15.Mothers feel safe in taking services from AWWs AS2 4.65 5.21 -0.56 -9.402 <0.001 16.AWWs respond politely at every occasion AS3 4.78 5.84 -1.05 -8.218 <0.001 17.AWWs are having proper knowledge to respond to the questions of mothers AS4 5.24 6.00 -0.75 -14.42 <0.001 18.Individual attention is given by the AWWs to every beneficiary Empathy EM1 3.52 4.72 -1.20 -8.274 <0.001 19.Working hours of AWWs are convenient to the beneficiaries EM2 4.92 5.62 -0.69 -4.413 <0.001 20.AWWs shows personal concern to each beneficiary EM3 3.52 4.72 -1.20 -8.274 <0.001 21.AWWs are committed in providing best services to the beneficiary EM4 4.14 5.66 -1.52 -25.121 <0.001 Table 2 shows Perception and Expectation of the mothers on service quality at Anganwadi centers. Average gap scores for Tangible items, that is (TA1+ TA2+TA3+TA4)/4 was -1.335. Average gap scores for Reliability items was -1.096. Average gap scores for Responsiveness items was -0.670. Average gap scores for Assurance items was -0.715. Average gap scores for Empathy items was -1.162. Overall service quality, that is (TA+RL+RS+AS+EM)/5 was -0.9956. The results showed that along the entire dimension, gap score came out to be negative which shows that the service quality perceived by mothers is poor and hence no satisfaction with the delivery of services provided under the program. In terms of individual statements, the gap was most regarding provides services being on time as promised (-2.02) followed by hysical facilities and materials at AWC each being visually appealing (-1.62 each). The gap was lowest regarding maintaining error free records (-0.29). The least mean gap score was seen in Responsiveness and the highest mean gap score was seen in the Tangible dimension. The mean difference between Perception and Expectation scores was statistically significant P value (<0.05) in all dimensions. DISCUSSION This was a cross sectional study to assess the mother’s perception on the service quality at Anganwadi centres under integrated child development service scheme, to measure the gap between mother’s perceptions and expectations on service quality. The SERVQUAL model was used to assess the service quality. In our study, along the entire dimension, the gap score was negative. The negative gap shows that the expectations of mothers was beyond their perception of the current situation. Our findings were consistent with findings by Bhatnagar C et al.[ 11 ] This shows that mothers are not satisfied with the service quality at the Anganwadi centres. In a study by Ram PV et al, where 1.4% of mothers were well satisfied about 35.6% were poorly satisfied with the services provided by ICDS centres and Anganwadi workers.[ 12 ] The gap between the perception and expectation can also be attributed to the fact that the study was conducted during the Covid 19 pandemic period. ICDS services include pre-schooling services, supplementary nutrition, health and nutrition awareness, referral services, immunization, and health check-ups provided through a network of 1.4 million Anganwadi Centers (AWCs) run by Anganwadi workers (AWWs) and Anganwadi helpers in India.[ 13 ] During the Covid 19 pandemic, Anganwadi workers also assisted the local administration in community surveillance, creating awareness as well as other work assigned to them from time to time which could have affected the perception on service quality provided at the Anganwadi centres. Newer methods need to be incorporated using modern technology to provide better services and meet expectations of mothers. Integrating more maternal and child health programmes with ICDS can improve the range of services provided. The study also has some limitations. We involved only those participants who came under the field practice area of medical college. Hence sample size was low, so generalization of the result might not be accurate. Since the study was conducted during Covid − 19 pandemic, the perception might differ after all services were streamlined. CONCLUSION There was a negative gap in the perception and expectation of mothers, hence there is a lot of space to improve and reach client satisfaction and desired healthcare services. Anganwadi centers should be equipped with efficient and modern equipment, services should be provided at the promised time, and at the shortest possible time to the beneficiaries, staff and service providers should be available when beneficiaries come to the center, they should know up-to-date knowledge and skills. Digital media should be used for improving nutritional status of children and regular feedback from both mothers and Anganwadi workers should be taken online to be able to make necessary improvements. While forming objectives of programmes, it is recommended to involve parents for their opinions as well in order to understand the expectations better and increase compliance towards the programme. Additionally, it is also essential to integrate more maternal and child health programmes with ICDS to improve the range of services provided. Declarations CONFLICT OF INTEREST : There are no conflicts of interest. Funding No funding Ethical approval and accordance : IEC approval obtained by INSTITUTIONAL ETHICS COMMITTEE (IEC)-III, Relating to Biomedical and Health Research (BHR). Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India. (IEC(III)/OUT/593/2020). The study adhered to the national guidelines of conducting research Clinical Trial Number Not applicable Consent to publish : Not applicable Human ethics and Consent to participate – The mothers were explained the purpose of study and written informed consent was obtained prior to participation. Data Availability Statement - The datasets generated during and/or analysed during the current study are not publicly available but are available from the corresponding author on reasonable request. Author Contribution DAM - Literature search, data collection, reviewAS- Literature search, data collection, manuscript preparationNPS - Manuscript preparation, data analysisDKS - Manuscript preparation, data analysis, review Data Availability The datasets generated during and/or analysed during the current study are not publicly available but are available from the corresponding author on reasonable request. References Dixit P, Gupta A, Dwivedi LK, Coomar D. Impact Evaluation of Integrated Child Development Services in Rural India: Propensity Score Matching Analysis. SAGE Open. 2018;8(2). Measures to address malnutrition [Internet]. Gov.in. [cited 2025 Jan 23]. Available from: https://pib.gov.in/PressReleasePage.aspx?PRID=1848643 Global Hunger Index. India [Internet]. Global Hunger Index (GHI) - peer-reviewed annual publication designed to comprehensively measure and track hunger at the global, regional, and country levels. 2024 [cited 2025 Jan 23]. Available from: https://www.globalhungerindex.org/india.html Integrated Child Development Services (ICDS) Scheme. Available from https://wcd.nic.in/integrated-child-development-services-icds-scheme [cited on 2024 Jan 12] Sachdev Y, Dasgupta J. Integrated Child Development Services (icds) scheme. Med J Armed Forces India [Internet]. 2001;57(2):139–43. Available from: http://dx.doi.org/10.1016/S0377-1237(01)80135-0 Sansad.in. [cited 2025 Jan 23]. Available from: https://sansad.in/getFile/loksabhaquestions/annex/1712/AS324.pdf?source=pqals Chudasama RK, Patel UV, Kadri AM, Mitra A, Thakkar D, Oza J. Evaluation of integrated Child Development Services program in Gujarat, India for the years 2012 to 2015. Indian J Public Health [Internet]. 2016;60(2):124–30. Available from: http://dx.doi.org/10.4103/0019-557X.184544 Mehedi Rehman H, Patel SP, Agarwal M, Singh VK, Mahour P, Resident J. Utilization and Parental Perception towards Anganwadi Services in Rural Lucknow-A Cross Sectional Study. Int J Heal Sci Res. 2017;7:22 Iwaarden J, Ton, Leslie, Millen R. Applying SERVQUAL to Web sites: an exploratory study. International Journal of Quality & Reliability Management. 2003;20:919–35. Sharifirad G, Farzanegan P, Pirzadeh A, Shamsi M. Quality gap in primary health care services in Isfahan: women′s perspective. J Educ Health Promot ;1(1):45. Bhatnagar C, Bhadra S. Study of Service Provisions of Anganwadi Workers (AWWs) and Views of Mothers about Integrated Child Development Services (ICDS) Scheme. International Journal of Arts, Humanities and Management Studies 2015;1(8):10-22 Ram PV, Dasgupta A, Pal J, Parthasara-Thi R, Biswas R, Naiya S. A Cross Sectional Study on Client Satisfaction of Anganwadi Centres under Integrated Child Development Services (ICDS) Scheme in a Slum of Kolkata. National Journal of Community Med. 2014;5(1):88–92. Khandelwal S, Mehra M, Singh A. Impact on public health nutrition services due to COVID-19 pandemic in India: A scoping review of primary studies on health and social security determinants affecting the first 1000 days of life. Int J Environ Res Public Health [Internet]. 2022;19(21):13973. Available from: http://dx.doi.org/10.3390/ijerph192113973 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7164342","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":496731676,"identity":"abe0fd48-0279-4644-bae6-133fc1b292f9","order_by":0,"name":"Sandeep A Mishra","email":"","orcid":"","institution":"King Edward Memorial Hospital and Seth G.S. 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Nearly 50% of deaths among children under the age of five in India are linked to undernutrition. According to National Family Health Survey 5 (NFHS-5), the prevalence of stunting, wasting, and underweight among under-5 children in India is 35.5%, 19.3%, and 32.1%, respectively.[2] Regarding Global Hunger Index in 2022, India ranked 107th out of the 125 countries with a score of 29.1. It\u0026rsquo;s key indicators are: child wasting, child stunting, undernourishment and child mortality rate. Undernourishment was 16.3% in 2022 as per Global Hunger Index reports. Nutrition plays a key role in this aspect. [3]\u003c/p\u003e\n\u003cp\u003eLaunched on October 2, 1975, the Integrated Child Development Services (ICDS) scheme is implemented by the Ministry of Women and Child Development, Government of India. It was introduced to improve maternal and child health through Anganwadi Centres (AWCs), which serve as the primary hubs for delivering various services by Anganwadi Workers (AWWs).[4] The scheme primarily focuses on improving the health and nutritional well-being of children below six years of age. Key services provided include immunization, regular health check-ups, supplementary nutrition, and referral services for young children, along with support for pregnant and nursing mothers. Additionally, children between 3 and 6 years are offered non-formal pre-school education, and women aged 15\u0026ndash;45 years, along with adolescent girls aged 11\u0026ndash;18 years, are given guidance on health and nutrition.[5]\u003c/p\u003e\n\u003cp\u003eBy 2022, a total of 13.96 lakh Anganwadi Centres (AWCs) were functioning across the country. These centres, operating under the Integrated Child Development Services (ICDS) scheme, are tasked with delivering supplementary nutrition to eligible beneficiaries. To identify malnutrition in children, updated WHO growth standards and baby weighing scales were introduced. In the case of pregnant and lactating women, adult weighing scales are used to track weight throughout pregnancy and postpartum. Additionally, AWCs conduct pre-school education activities for young children and should therefore be equipped with age-appropriate activity books, child assessment cards, and sufficient educational materials. Immunization and health check - up services are also provided by the anganwadi centres.[6]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe program is implemented by a trained group of workers known as Anganwadi Workers (AWWs), who are selected from within the local community. They undergo four months of training in areas such as health, nutrition, and child care. Each AWW manages an Anganwadi Centre (AWC) and operates under the guidance of a supervisor known as the Mukhya Sevika. An additional helper supports the AWW in carrying out the day-to-day activities at the centre.[7]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere are limited studies in India which focus on the involvement of mothers in ICDS activities and their expectation and involvement in acquiring services provided under the scheme. The SERVQUAL model questionnaire has been used in several studies including the banking sector, retail sector, health care sector in hospital setting etc. The model has not been used frequently in provision of services relating to health in the community setting. Hence this study will be undertaken to assess the mother\u0026rsquo;s perception on the service quality at the Anganwadi centres attached to field practice area of tertiary care hospital, to measure the gap between mother\u0026rsquo;s perceptions and expectations on service quality and to study the socio demographic profile of the mothers.\u0026nbsp;\u003c/p\u003e"},{"header":"MATERIALS AND METHODS ","content":"\u003cp\u003e\u003cstrong\u003eStudy setting and study participants :\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe conducted this cross sectional study in Anganwadi centers which came under the field practice area of a tertiary care hospital in Mumbai, from December 2020 to November 2021. Anganwadi centres are the focal point of delivery of services provided under the ICDS scheme. Mothers of those children who were up to 6 years of age and who were registered at the Anganwadi centers for more than 3 months were included in the study, while mothers who did not wish to participate were excluded. \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size and sampling technique\u003c/strong\u003e :\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe calculated sample size based on a previous study where \u0026nbsp;4.7% of the mothers said that the overall services of Anganwadi centers were of good quality.[8] So, taking prevalence (p) was taken 4.7% with 5% margin of error and 95% confidence interval. The sample size estimated was 69, hence 69 mothers fulfilling inclusion criteria were included in the study. There were 30 Anganwadi centers in the study area. Out of which 7 centers were selected by simple random technique (lottery method). After applying inclusion and exclusion criteria, 10 mothers were selected from each 6 Anganwadi centers and 9 mothers were selected from the last centre by simple random technique (Lottery method).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection:\u003c/strong\u003e We obtained ethical approval for the study from the Institute Ethics Committee. The mothers were explained the purpose of study and written informed consent was obtained prior to participation. Face to face interview was conducted on the mothers using pre-designed, pre-tested, semi - structured questionnaire (adapted from the SERVQUAL model) in a language the respondent understands, after answering all their doubts, if any, regarding the study. The interview schedule consisted of questions regarding socio- demographic profile of the mothers, perceptions regarding services at Anganwadi centres under ICDS scheme and expectations regarding services at Anganwadi centres under ICDS scheme. The Servqual model was used in the study. It is a questionnaire containing 5 dimensions (Tangibility, reliability, Responsiveness, Assurance, Empathy) which has 22 statements.[9],[10] The model was adapted in our study and the questions were framed according to our objectives. \u0026nbsp;In the first part, the questionnaire was used to measure mother\u0026rsquo;s perception regarding services provided at Anganwadi Centre. The perception was plotted on the 7-point LIKERT\u0026rsquo;s scale, where 1 was strongly disagree and 7 was strongly agree. In the second part, the same set of questionnaires was used to measure mother\u0026rsquo;s expectations with regards to services provided at Anganwadi Centre. The expectation was plotted on the 7- point LIKERT\u0026rsquo;s scale where 1 was strongly disagree and 7 was strongly agree. The mean perception score for each statement was calculated The mean expectation score for each statement was calculated Gap score was calculated for each statement and finally average gap scores was calculated.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis :\u003c/strong\u003e Data was entered in MS Excel 2019 and was analyzed using SPSS version 22 software. Qualitative data was expressed in terms of frequency and percentage. Quantitative data was expressed in terms of mean. To compare mother\u0026rsquo;s perception and expectations, paired-t test was used. P value less than 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eTable 1: Socio-demographic profile of the mothers (N=69)\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eSocio-demographic profile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e19 to 35 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e78.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e36 to 55 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e21.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eReligion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eHindu\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e34.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e65.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eDiploma/Graduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e07.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003ePrimary/middle/high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e37.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e55.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eProfessional/Semiprofessional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e02.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eSkilled/semiskilled\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e08.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eUnskilled\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e17.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e71.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eFamily type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eNuclear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e40.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eJoint\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e59.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003ePer capita monthly income (Modified B.G. Prasad classification)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eClass I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e01.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eClass II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e02.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eClass III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e14.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eClass IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e75.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eClass V\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e05.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1 shows socio demographic profile of the mothers. It was found that among the 69 study participants included in the study, 54 (78.3%) were in 19 to 35 years age group whereas 15 (21.7%) were in 36 to 55 years of age group. 24 (34.8%) participants were Hindu by religion and 45 (65.2%) were Muslims. Majority participants 38 (55.1%) were illiterates, 26 (37.7%) had studied upto primary/middle/high school whereas 5 (7.2%) had studied upto Diploma or Graduation. Regarding occupation, it was seen that majority 49 (71%) were unemployed. 41 (59.4%) participants belonged to a joint family and 28 (40.6%) belonged to nuclear family.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFigure 1 shows the distance of Anganwadi centre from home. It can be seen that 54 (78.3%) resided within 200 metres to 500 metres while 15 (21.7%) resided at a distance of 600 metres and beyond. Figure 2 shows number of children. Maxmimum study participants, that is 29 (42%) had 2 children. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2: The mean Perception and Expectation of the mothers on service quality at Anganwadi centers\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eStatement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;Dimension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eMothers\u0026rsquo; perception of \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; service quality\u003c/p\u003e\n \u003cp\u003e(Mean)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eMothers\u0026rsquo; expectation of \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;service quality\u003c/p\u003e\n \u003cp\u003e(Mean)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003eGap\u0026nbsp;\u003c/p\u003e\n \u003cp\u003escore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003et-test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.There \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; are modern looking equipment\u0026rsquo;s at Anganwadi Centre (AWC)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eTangibles\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;TA1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e3.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e4.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-3.767\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2.The Physical facilities \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;at AWC are visually appealing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;TA2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e3.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e5.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-1.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-6.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e3.The Anganwadi workers (AWW)s appears neat\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;TA3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e5.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e6.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-8.954\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e4.The materials in AWC are visually appealing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;TA4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e3.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e5.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-1.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-6.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e5.AWWs provides facilities on time as promised\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eReliabilityRL1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e3.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e5.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-2.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-14.655\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e6.AWWs shows interest in solving problems of the beneficiaries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;RL2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e4.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e4.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-4.634\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e7. AWWs perform correct services at the first time itself\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eRL3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e4.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e4.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-2.648\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e8.AWWs provides services \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; on time as promised\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;RL4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e3.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e5.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-2.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-14.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e9.AWWs maintain error free records\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;RL5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e4.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e4.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-2.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e10.AWWs\u003c/p\u003e\n \u003cp\u003einform \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; the mothers regarding \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; the time for service\u003c/p\u003e\n \u003cp\u003edelivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eResponsiv-eness\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; RS1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-6.769\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e11.AWWs\u003c/p\u003e\n \u003cp\u003eprovides prompt services \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;to\u003c/p\u003e\n \u003cp\u003ebeneficiaries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; RS2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-9.424\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e12.AWWs are always willing to \u0026nbsp;help the\u003c/p\u003e\n \u003cp\u003ebeneficiaries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;RS3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e5.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e6.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-7.895\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e13.AWWs responds to the beneficiaries at any time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;RS4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e5.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e6.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-7.895\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e14.Mothers are comfortable with the behaviour of the AWWs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eAssurance\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;AS1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e4.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e5.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-5.693\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e15.Mothers feel safe in taking services from AWWs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;AS2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e4.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e5.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-9.402\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e16.AWWs respond politely at every occasion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;AS3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e4.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e5.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-8.218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e17.AWWs are having proper knowledge to respond to the questions of mothers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;AS4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e5.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e6.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-14.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e18.Individual attention \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;is given by the AWWs to every beneficiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eEmpathy\u003c/p\u003e\n \u003cp\u003eEM1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e3.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e4.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-8.274\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e19.Working hours \u0026nbsp; \u0026nbsp;of AWWs are convenient to the beneficiaries \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;EM2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e4.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e5.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-4.413\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e20.AWWs shows personal concern to each beneficiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eEM3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e3.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e4.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-8.274\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e21.AWWs are committed in providing best services to the\u003c/p\u003e\n \u003cp\u003ebeneficiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;EM4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-1.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-25.121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2 shows Perception and Expectation of the mothers on service quality at Anganwadi centers. Average gap scores for Tangible items, that is (TA1+ TA2+TA3+TA4)/4 was -1.335. Average gap scores for Reliability items was -1.096. Average gap scores for Responsiveness items was -0.670. Average gap scores for Assurance items was -0.715. Average gap scores for Empathy items was -1.162. Overall service quality, that is (TA+RL+RS+AS+EM)/5 was -0.9956. The results showed that along the entire dimension, gap score came out to be negative which shows that the service quality perceived by mothers is poor and hence no satisfaction with the delivery of services provided under the program. In terms of individual statements, the gap was most regarding provides services being \u0026nbsp; on time as promised (-2.02) followed by hysical facilities and materials at AWC each being visually appealing (-1.62 each). The gap was lowest regarding maintaining error free records (-0.29). The least mean gap score was seen in Responsiveness and the highest mean gap score was seen in the Tangible dimension. The mean difference between Perception and Expectation scores was statistically significant P value (\u0026lt;0.05) in all dimensions.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis was a cross sectional study to assess the mother\u0026rsquo;s perception on the service quality at Anganwadi centres under integrated child development service scheme, to measure the gap between mother\u0026rsquo;s perceptions and expectations on service quality. The SERVQUAL model was used to assess the service quality. In our study, along the entire dimension, the gap score was negative. The negative gap shows that the expectations of mothers was beyond their perception of the current situation. Our findings were consistent with findings by Bhatnagar C et al.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] This shows that mothers are not satisfied with the service quality at the Anganwadi centres. In a study by Ram PV et al, where 1.4% of mothers were well satisfied about 35.6% were poorly satisfied with the services provided by ICDS centres and Anganwadi workers.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] The gap between the perception and expectation can also be attributed to the fact that the study was conducted during the Covid 19 pandemic period. ICDS services include pre-schooling services, supplementary nutrition, health and nutrition awareness, referral services, immunization, and health check-ups provided through a network of 1.4\u0026nbsp;million Anganwadi Centers (AWCs) run by Anganwadi workers (AWWs) and Anganwadi helpers in India.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] During the Covid 19 pandemic, Anganwadi workers also assisted the local administration in community surveillance, creating awareness as well as other work assigned to them from time to time which could have affected the perception on service quality provided at the Anganwadi centres. Newer methods need to be incorporated using modern technology to provide better services and meet expectations of mothers. Integrating more maternal and child health programmes with ICDS can improve the range of services provided. The study also has some limitations. We involved only those participants who came under the field practice area of medical college. Hence sample size was low, so generalization of the result might not be accurate. Since the study was conducted during Covid \u0026minus;\u0026thinsp;19 pandemic, the perception might differ after all services were streamlined.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThere was a negative gap in the perception and expectation of mothers, hence there is a lot of space to improve and reach client satisfaction and desired healthcare services. Anganwadi centers should be equipped with efficient and modern equipment, services should be provided at the promised time, and at the shortest possible time to the beneficiaries, staff and service providers should be available when beneficiaries come to the center, they should know up-to-date knowledge and skills. Digital media should be used for improving nutritional status of children and regular feedback from both mothers and Anganwadi workers should be taken online to be able to make necessary improvements. While forming objectives of programmes, it is recommended to involve parents for their opinions as well in order to understand the expectations better and increase compliance towards the programme. Additionally, it is also essential to integrate more maternal and child health programmes with ICDS to improve the range of services provided.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eCONFLICT OF INTEREST :\u003c/h2\u003e\n\u003cp\u003eThere are no conflicts of interest.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eNo funding\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eEthical approval\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eand accordance\u003c/strong\u003e:\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eIEC approval obtained by INSTITUTIONAL ETHICS COMMITTEE (IEC)-III, Relating to Biomedical and Health Research (BHR). Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India. (IEC(III)/OUT/593/2020). The study adhered to the national guidelines of conducting research\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e:\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003eHuman ethics and Consent to participate \u0026ndash;\u003c/h2\u003e\n\u003cp\u003eThe mothers were explained the purpose of study and written informed consent was obtained prior to participation.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eData Availability Statement -\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe datasets generated during and/or analysed during the current study are not publicly available but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eDAM - Literature search, data collection, reviewAS- Literature search, data collection, manuscript preparationNPS - Manuscript preparation, data analysisDKS - Manuscript preparation, data analysis, review\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe datasets generated during and/or analysed during the current study are not publicly available but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDixit P, Gupta A, Dwivedi LK, Coomar D. Impact Evaluation of Integrated Child Development Services in Rural India: Propensity Score Matching Analysis. SAGE Open. 2018;8(2).\u003c/li\u003e\n\u003cli\u003eMeasures to address malnutrition [Internet]. Gov.in. [cited 2025 Jan 23]. Available from: https://pib.gov.in/PressReleasePage.aspx?PRID=1848643 \u003c/li\u003e\n\u003cli\u003eGlobal Hunger Index. India [Internet]. Global Hunger Index (GHI) - peer-reviewed annual publication designed to comprehensively measure and track hunger at the global, regional, and country levels. 2024 [cited 2025 Jan 23]. Available from: https://www.globalhungerindex.org/india.html \u003c/li\u003e\n\u003cli\u003eIntegrated Child Development Services (ICDS) Scheme. Available from https://wcd.nic.in/integrated-child-development-services-icds-scheme [cited on 2024 Jan 12]\u003c/li\u003e\n\u003cli\u003eSachdev Y, Dasgupta J. Integrated Child Development Services (icds) scheme. Med J Armed Forces India [Internet]. 2001;57(2):139\u0026ndash;43. Available from: http://dx.doi.org/10.1016/S0377-1237(01)80135-0 \u003c/li\u003e\n\u003cli\u003eSansad.in. [cited 2025 Jan 23]. Available from: https://sansad.in/getFile/loksabhaquestions/annex/1712/AS324.pdf?source=pqals \u003c/li\u003e\n\u003cli\u003eChudasama RK, Patel UV, Kadri AM, Mitra A, Thakkar D, Oza J. Evaluation of integrated Child Development Services program in Gujarat, India for the years 2012 to 2015. Indian J Public Health [Internet]. 2016;60(2):124\u0026ndash;30. Available from: http://dx.doi.org/10.4103/0019-557X.184544 \u003c/li\u003e\n\u003cli\u003eMehedi Rehman H, Patel SP, Agarwal M, Singh VK, Mahour P, Resident J. Utilization and Parental Perception towards Anganwadi Services in Rural Lucknow-A Cross Sectional Study. Int J Heal Sci Res. 2017;7:22\u003c/li\u003e\n\u003cli\u003eIwaarden J, Ton, Leslie, Millen R. Applying SERVQUAL to Web sites: an exploratory study. International Journal of Quality \u0026amp; Reliability Management. 2003;20:919\u0026ndash;35.\u003c/li\u003e\n\u003cli\u003eSharifirad G, Farzanegan P, Pirzadeh A, Shamsi M. Quality gap in primary health care services in Isfahan: women\u0026prime;s perspective. J Educ Health Promot ;1(1):45. \u003c/li\u003e\n\u003cli\u003eBhatnagar C, Bhadra S. Study of Service Provisions of Anganwadi Workers (AWWs) and Views of Mothers about Integrated Child Development Services (ICDS) Scheme. International Journal of Arts, Humanities and Management Studies 2015;1(8):10-22\u003c/li\u003e\n\u003cli\u003eRam PV, Dasgupta A, Pal J, Parthasara-Thi R, Biswas R, Naiya S. A Cross Sectional Study on Client Satisfaction of Anganwadi Centres under Integrated Child Development Services (ICDS) Scheme in a Slum of Kolkata. National Journal of Community Med. 2014;5(1):88\u0026ndash;92. \u003c/li\u003e\n\u003cli\u003eKhandelwal S, Mehra M, Singh A. Impact on public health nutrition services due to COVID-19 pandemic in India: A scoping review of primary studies on health and social security determinants affecting the first 1000 days of life. Int J Environ Res Public Health [Internet]. 2022;19(21):13973. Available from: http://dx.doi.org/10.3390/ijerph192113973 \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Mothers, Perception, ICDS, Anganwadi, Service quality","lastPublishedDoi":"10.21203/rs.3.rs-7164342/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7164342/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground : \u003c/strong\u003eLack of proper nutrition during the first 1,000 days of a child’s life can result in stunted growth of the child, which is irreversible and associated with impaired cognitive ability and reduced school and work performance. ICDS scheme was started by the Government of India for improvement in maternal and child health through the Anganwadi\u003cem\u003e workers (AWWs) \u003c/em\u003eand the focal point of delivery of services are the \u003cem\u003eAnganwadi Centre (AWC)\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives :\u003c/strong\u003e The current study was conducted to assess the mother’s perception on the service quality at Anganwadi centres under integrated child development service scheme, to measure the gap between mother’s perceptions and expectations on service quality and to study the socio demographic profile of the study participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and methods :\u003c/strong\u003e We carried out a cross sectional study in among 69 mothers at Anganwadi centres coming under field practice area of a tertiary care hospital between December 2020 to November 2021. We used Servqual questionnaire to measure mother’s perception regarding service quality at Anganwadi centre and their expectations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults :\u003c/strong\u003e The results showed that along the entire dimension, gap score came out to be negative which indicates service quality perceived by mothers is poor. The mean difference between Perception and Expectation scores was statistically significant (P value \u0026lt;0.05) in all dimensions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion : \u003c/strong\u003eThe negative gap shows that the expectations of mothers were beyond their perception of the current situation, so there is a lot of space to improve and reach client satisfaction and desired healthcare services.\u003c/p\u003e","manuscriptTitle":"A cross-sectional study to assess the mother’s perception on the service quality at Anganwadi centers under Integrated Child Development Service scheme in a field practice area of a tertiary care hospital","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-08 17:55:07","doi":"10.21203/rs.3.rs-7164342/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dd43266f-8fa2-4756-80ba-34c9326a97fc","owner":[],"postedDate":"August 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-25T10:09:09+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-08 17:55:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7164342","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7164342","identity":"rs-7164342","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}