Assessing Patient Satisfaction in Tertiary Hospitals: The Impact of Social Factors and the Adaptation of HCAHPS in China

Assessing Patient Satisfaction in Tertiary Hospitals: The Impact of Social Factors and the Adaptation of HCAHPS in China | 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 Assessing Patient Satisfaction in Tertiary Hospitals: The Impact of Social Factors and the Adaptation of HCAHPS in China Xintong Zhou, Lijuan Zhao, Tao Xin, Xiaoli Tian, Zhongqian Yang, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5910978/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background China's first standardized national patient satisfaction questionnaire, adapted from HCAHPS and detailed in the National Tertiary Public Hospital Performance Appraisal Operation Manual (2022), was introduced to assess healthcare quality nationwide. However, regional diversity raises concerns about its universal applicability, and differences between China’s and the U.S. social environments and healthcare systems necessitate further exploration of patient satisfaction factors. This study aims to evaluate the national satisfaction survey’s applicability in tertiary hospitals and identify key factors influencing inpatient satisfaction. Method A cross-sectional survey was conducted using the national standard satisfaction questionnaire at three tertiary general hospitals in Shenyang, Northeast China, between April 2022 and October 2023. Survey links were distributed via SMS 72 hours post-discharge or through QR codes during hospitalization for voluntary participation. Results A total of 2,535 valid responses were collected. Validity and reliability tests showed strong results (KMO = .940, Cronbach's Alpha = .874). Confirmatory Factor Analysis (CFA) indicated a well-fitting model, with five out of nine dimensions significant. These were ranked by standardized regression weight (SRW) as follows: Discharge Instruction (.58), Doctor Communication (.20), Nurse Communication (.11), Environment (.08), and Food (.05). CHAID decision tree analysis revealed key factors influencing patient satisfaction: Doctor Communication, Medicine Information and Discharge Instruction, Environment, and Food. Conclusion This study confirms that social factors such as the economy, 'filial piety' culture, and health insurance system significantly influence patient satisfaction. The pragmatic philosophy of the Chinese people prioritizes the determinants of patient satisfaction as follows: Doctor, Cost Details, and Living Conditions. While the intrinsic structure of the HCAHPS model is valid, certain item details may need to be modified to enhance its applicability within the Chinese patient population. Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 19 Apr, 2026 Reviewers agreed at journal 19 Apr, 2026 Reviews received at journal 14 May, 2025 Reviewers agreed at journal 14 May, 2025 Reviewers agreed at journal 13 May, 2025 Reviewers agreed at journal 08 May, 2025 Reviewers invited by journal 06 May, 2025 Editor assigned by journal 29 Apr, 2025 Editor invited by journal 09 Feb, 2025 Submission checks completed at journal 09 Feb, 2025 First submitted to journal 09 Feb, 2025 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. 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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-5910978","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":464428272,"identity":"f70387fd-8c68-4881-942b-988844990cdc","order_by":0,"name":"Xintong Zhou","email":"","orcid":"","institution":"Shenyang the Fourth People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xintong","middleName":"","lastName":"Zhou","suffix":""},{"id":464428273,"identity":"54580624-3406-4800-af69-b60ae755fc07","order_by":1,"name":"Lijuan Zhao","email":"","orcid":"","institution":"Office of the CPC, Shenyang the Tenth People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Lijuan","middleName":"","lastName":"Zhao","suffix":""},{"id":464428274,"identity":"2b22799e-ee6c-4ce1-a827-cb617761afd6","order_by":2,"name":"Tao Xin","email":"","orcid":"","institution":"Shenyang the Fourth People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tao","middleName":"","lastName":"Xin","suffix":""},{"id":464428275,"identity":"28e88486-c344-42fe-80da-ff7f933201b6","order_by":3,"name":"Xiaoli Tian","email":"","orcid":"","institution":"Shenyang Children’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiaoli","middleName":"","lastName":"Tian","suffix":""},{"id":464428276,"identity":"ac545f7a-7167-42ce-a8ba-95f39d2e8172","order_by":4,"name":"Zhongqian Yang","email":"","orcid":"","institution":"China Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhongqian","middleName":"","lastName":"Yang","suffix":""},{"id":464428277,"identity":"790c236d-12e0-4773-801c-358f78e1a864","order_by":5,"name":"K. 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However, regional diversity raises concerns about its universal applicability, and differences between China’s and the U.S. social environments and healthcare systems necessitate further exploration of patient satisfaction factors. This study aims to evaluate the national satisfaction survey’s applicability in tertiary hospitals and identify key factors influencing inpatient satisfaction.\nMethod A cross-sectional survey was conducted using the national standard satisfaction questionnaire at three tertiary general hospitals in Shenyang, Northeast China, between April 2022 and October 2023. Survey links were distributed via SMS 72 hours post-discharge or through QR codes during hospitalization for voluntary participation.\nResults A total of 2,535 valid responses were collected. Validity and reliability tests showed strong results (KMO = .940, Cronbach's Alpha = .874). Confirmatory Factor Analysis (CFA) indicated a well-fitting model, with five out of nine dimensions significant. These were ranked by standardized regression weight (SRW) as follows: Discharge Instruction (.58), Doctor Communication (.20), Nurse Communication (.11), Environment (.08), and Food (.05). CHAID decision tree analysis revealed key factors influencing patient satisfaction: Doctor Communication, Medicine Information and Discharge Instruction, Environment, and Food.\nConclusion This study confirms that social factors such as the economy, 'filial piety' culture, and health insurance system significantly influence patient satisfaction. The pragmatic philosophy of the Chinese people prioritizes the determinants of patient satisfaction as follows: Doctor, Cost Details, and Living Conditions. While the intrinsic structure of the HCAHPS model is valid, certain item details may need to be modified to enhance its applicability within the Chinese patient population.","manuscriptTitle":"Assessing Patient Satisfaction in Tertiary Hospitals: The Impact of Social Factors and the Adaptation of HCAHPS in China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-30 16:16:30","doi":"10.21203/rs.3.rs-5910978/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-20T02:20:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"189291139965036331162984404968059735763","date":"2026-04-20T00:32:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-14T06:50:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"153244386005556627517550429068285594215","date":"2025-05-14T05:27:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"208788777847821157964467615276306978733","date":"2025-05-13T06:45:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"73652058293681298065740562285792204844","date":"2025-05-08T08:50:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-06T07:33:39+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-29T17:39:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-02-10T03:34:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-02-09T12:53:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-02-09T12:51:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2a65da14-5f15-4159-9521-4ae6f3705605","owner":[],"postedDate":"June 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-06-30T16:16:30+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-30 16:16:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5910978","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5910978","identity":"rs-5910978","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}