A Donabedian-based instrument for measuring parental satisfaction in pediatric dental care: scale development and validation

Background: Parental satisfaction is a key indicator of healthcare quality in pediatric dentistry and influences service utilization and continuity of care. However, theory-based instruments specifically designed for pediatric dental services remain limited. This study aimed to develop and validate a parental satisfaction scale for pediatric dental care based on the Donabedian structure–process–outcome model. Methods: This methodological study followed established scale development and validation procedures. An initial item pool was generated through literature review and expert consensus and refined through content validation. The final scale was administered to parents of children receiving care at a university pediatric dental clinic (N = 442). Exploratory factor analysis was conducted on one subsample (n = 229), followed by confirmatory factor analysis on an independent subsample (n = 213). Model fit was evaluated using multiple fit indices. Internal consistency, convergent validity, and discriminant validity were assessed using Cronbach’s alpha, McDonald’s omega, composite reliability (CR), average variance extracted (AVE), and the heterotrait-monotrait ratio (HTMT). Results: The final instrument consisted of 24 items and demonstrated a stable four-factor structure: Professional Care and Communication, Service Delivery, Outcome, and Accessibility. Confirmatory factor analysis supported both first-order and hierarchical second-order structures. Model fit indices indicated a good fit (comparative fit index (CFI) = 0.982, Tucker-Lewis index (TLI) = 0.980, root mean square error of approximation (RMSEA) = 0.078, standardized root mean square residual (SRMR) = 0.042). Internal consistency was high for the overall scale (Cronbach’s α = 0.95; ω = 0.97) and good to excellent across subscales (α = 0.81–0.94). Convergent and discriminant validity were supported. Conclusions: This study presents a theory-driven instrument for assessing parental satisfaction with pediatric dental services, and preliminary psychometric validation supports its use for evaluating service quality and informing research, quality improvement, and public health planning.

Patient satisfaction; Pediatric dentistry; Health service research; Healthcare quality; Donabedian model

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