Abstract
Background:
Access to healthcare is a critical determinant of individual and population health outcomes. However, few validated tools exist to evaluate healthcare access among Arabic-speaking populations.
Objectives:
This study aimed to validate the Arabic version of the Perception of Access to Health Care Services Questionnaire (PAHSQ) and assess its psychometric properties, including reliability and construct validity, using factor and Rasch analyses.
Design:
A cross-sectional study was conducted with 485 participants (53.4% female) recruited from hospitals and pharmacies in Jordan.
Methods:
Confirmatory factor analysis (CFA) and Rasch analysis were employed to evaluate the construct validity and item performance of the 30-item, six-factor model. Internal consistency was assessed using Cronbach’s alpha.
Results:
The Arabic PAHSQ exhibited strong psychometric properties. CFA confirmed the suitability of the six-factor model (χ²/df = 3.2, RMSEA = 0.07, CFI = 0.93, TLI = 0.92). Cronbach’s alpha values for the six dimensions ranged from 0.82 to 0.93. Rasch analysis demonstrated acceptable infit and outfit values for all items, with item thresholds correctly oriented. Key findings highlighted significant disparities in healthcare access, particularly among participants with low income and no insurance coverage.
Conclusions:
The Arabic PAHSQ is a reliable and valid tool for assessing healthcare access among Arabic-speaking populations. Its use can inform targeted interventions, guide resource allocation, and support health equity initiatives. Further research should explore its applicability across diverse Arabic-speaking regions and incorporate qualitative methodologies to capture more subtle access barriers.
Keywords
Introduction
Healthcare centers, including hospitals, clinics, and community health organizations, form the backbone of public health infrastructure. These centers have the potential to significantly enhance the scope and quality of healthcare services available to communities. Access to health care is a complex global issue and is recognized as a fundamental human right. 1 Additionally, it is a critical determinant of health outcomes for individuals and communities. Access encompasses not only the availability of healthcare services but also the ability of individuals to utilize these services effectively. As such, access to healthcare is one of the key public policy issues in setting priorities and evaluating the performance of healthcare systems. 2 Health equality requires that all individuals and populations have access to quality healthcare services. Therefore, facilitating and maintaining individual access to essential health services is one of the most important strategies for achieving social justice in national healthcare systems. 3 Key considerations include the distribution of healthcare facilities, the availability of transportation, insurance coverage, and cultural competency among healthcare providers. By examining these dimensions, gaps in service delivery can be identified, and targeted interventions proposed to improve access, particularly for underserved populations. This approach also enhances preparedness for future public health challenges.
Ultimately, improving access to healthcare centers is essential for reducing health disparities, enhancing quality of life, and promoting health equity across diverse communities. This comprehensive analysis aims to contribute valuable insights to inform policy, practice, and future research in the healthcare access field, through questionnaires. Numerous studies have shown that improved access to healthcare is associated with better health outcomes, lower mortality rates, and reduced health disparities. 4 Accordingly, this research explores the multifaceted nature of healthcare access, focusing on geographic, socioeconomic, and systemic factors that influence individuals’ ability to obtain timely and appropriate care.
According to the Institute of Medicine, 5 barriers to healthcare access can significantly hinder individuals’ ability to receive timely and appropriate care, leading to poorer health outcomes and increased healthcare costs. This highlights the importance of using questionnaires to systematically assess access issues across different populations.
Healthcare access questionnaires can cover a range of topics, such as insurance coverage, distance to healthcare facilities, cultural and linguistic barriers, and patients’ perceptions of the quality of care received. 6 For example, the Behavioral Risk Factor Surveillance System (BRFSS) includes questions that assess barriers to healthcare access among various demographics, providing valuable data for public health initiatives. Healthcare access questionnaires are structured tools designed to gather information about individuals’ experiences and barriers related to obtaining healthcare services. 7 These questionnaires aim to evaluate various dimensions of access, including availability, affordability, acceptability, and accessibility of healthcare resources. 8 By capturing this information, researchers and policymakers can identify disparities and formulate strategies to enhance healthcare delivery systems. One key objective of such questionnaires is to identify access barriers by capturing the specific obstacles that different populations encounter, such as geographical distance, financial limitations, or cultural concerns. 9 In addition to identifying barriers, these tools play a crucial role in evaluating healthcare utilization patterns. Understanding how frequently individuals seek care and the reasons behind their healthcare choices can reveal gaps in service provision. 10 Furthermore, healthcare access questionnaires help in assessing patient experiences and satisfaction levels, offering insights into the quality of interactions between patients and healthcare providers.11,12 Healthcare access questionnaires assess health needs by identifying the health needs of different populations to inform targeted interventions and resource allocation. 13 These questionnaires are also valuable for analyzing demographic variations in healthcare access. Socioeconomic status, ethnicity, and age can all impact how individuals engage with healthcare services. 14 These tools also measure health outcomes by evaluating the impact of access on health outcomes, which can provide insights into the effectiveness of programs and policies. 15 Finally, they facilitate continuous improvement by offering feedback mechanisms for healthcare providers to refine services based on patient input and needs. 16 Overall, these questionnaires aim to enhance understanding of healthcare access dynamics and inform efforts to create a more equitable and effective healthcare system.
While healthcare access has been extensively studied in many contexts, Arabic-speaking populations remain underrepresented in the literature. The assessment of healthcare access in Arabic-speaking populations is particularly critical due to unique structural and sociocultural barriers that influence healthcare experiences. Variability in healthcare systems across the region contributes to disparities in service availability, with some countries offering well-funded public healthcare while others rely heavily on private-sector provisions, leading to inequitable access. 17 Additionally, significant differences in health insurance coverage further exacerbate inconsistencies in access, as many individuals in Arabic-speaking countries remain uninsured or underinsured, limiting their ability to seek timely and adequate care. 18 Cultural factors, including gender preferences in healthcare provision and language barriers for non-Arabic-speaking medical staff, further complicate accessibility and utilization of services. 19
Despite the availability of validated instruments for measuring healthcare access in other languages, there is a notable lack of standardized tools specifically designed for Arabic-speaking individuals. While healthcare access has been extensively studied in many linguistic and cultural contexts, Arabic-speaking populations remain underrepresented in the development of validated access measurement tools. Existing surveys, such as the BRFSS, include questions related to healthcare access but are not tailored to Arabic-speaking populations, limiting their applicability. Moreover, while validated Arabic-language tools exist for assessing health literacy and chronic disease management,20,21 no widely accepted instrument comprehensively evaluates healthcare access using a multidimensional approach. This gap points to a need for developing an Arabic-language tool that accounts for regional healthcare structures, sociocultural preferences, and systemic barriers unique to Arabic-speaking populations.
Existing measures often fail to capture the full range of challenges faced by this population, limiting the ability to assess access disparities comprehensively. Addressing this gap, the present study aimed to validate an Arabic version of the Perception of Access to Health Care Services Questionnaire (PAHSQ), ensuring that it effectively evaluated the six key dimensions of healthcare access: availability, accessibility, affordability, accommodation, acceptability, and awareness. In developing a linguistically and culturally appropriate tool, this study sought to provide a robust means of assessing and addressing healthcare inequities among Arabic-speaking populations.
Materials and Methods
Study Design and Participants
This cross-sectional study was conducted between July and December 2024. Participants were recruited from a private, military, and governmental hospital in the capital, Amman, as well as a university hospital in Irbid, a northern city. Additionally, pharmacies in both cities served as recruitment sites. The study’s purpose was explained to participants, who were given the option to complete the electronic questionnaire using either a researcher-provided tablet or their own electronic devices. The researchers detailed the study aims and confirmed the confidentiality, anonymity, and voluntary nature of participation, and requested that the participants sign an informed consent form. The electronic questionnaire also included the same information in the introductory section followed by a consent from where the participants were requested to click on the “I agree” option as a consent to participate. To be eligible, participants had to be Jordanian and at least 18 years old. Any subject who was not Jordanian or aged younger than 18 or did not provide a written consent form was excluded from the study. Ethical approval was obtained from the Research Ethics Committee of the Al-Zaytoonah University of Jordan (Ref#2024/6/22, dated 1/6/2024). The research adhered to the Declaration of Helsinki.
Study Instrument
The Perception of Access to Health Care Services Questionnaire (PAHSQ) 22 was selected after thorough literature review. The questionnaire is based on the five dimensions proposed by Penchansky and Thomas’ 23 model of access, with an additional sixth dimension proposed by Saurman. 1 Thus, the questionnaire is composed of 30 items distributed across six domains: (1) availability, (2) accessibility, (3) affordability, (4) accommodation, (5) acceptability, and (6) awareness. The response scale for the 30 items ranged from 0 (“strongly disagree”) to 5 (“strongly agree”). Additionally, a sociodemographic data sheet was completed by the participants. The data sheet included questions about age, sex, education level, marital status, average monthly income, insurance status, and healthcare provider sector.
Tool Validation
An expert panel, including two clinical pharmacists and two public health specialists, evaluated and confirmed the PAHSQ’s content validity. A forward-backward translation into Arabic was performed by four professional interpreters. The translation process adhered to the Brislin principle 24 to ensure the accuracy of the translation. A pilot study was conducted with 30 randomly selected patients to ensure the clarity, simplicity, relevance, and suitability of the questions, as well as the adequacy of the response scale (available in the Supplemental Material). The participants confirmed that the questions and response options were clear, relevant, and appropriate. The data from the pilot study was not included in the final statistical analysis. Internal consistency was assessed by computing Cronbach’s alpha. Confirmatory factor analysis (CFA) and Rasch analysis were performed to assess the construct validity of the questionnaire.
Sample Size Calculation
A participant-to-item ratio approach was utilized to compute the minimum required sample size, with a suggested ratio of 10:1. 25 As the questionnaire included 30 items, the minimum required sample size was 300.
Statistical Analysis
Statistical analyses were conducted using the Statistical Package for the Social Sciences (SPSS) version 26, Jamovi version 2.3.28, and R-studio version 2024.04.2 with the Test Analysis Modules (TAM). The continuous variables were presented as medians with interquartile ranges (IQRs), while categorical variables were presented as frequencies and percentages. CFA was used to assess the suitability of the study data for the construct suggested by the original research. Several indices were computed and assessed to evaluate the construct validity, including the Comparative Fit Index (CFI), Goodness-of-Fit Index (GFI), minimum discrepancy (χ2/df), Root Mean Square Error of Approximation (RMSEA), Standardized Root Mean Squared Residual (SRMR), and Tucker-Lewis Index (TLI). Acceptable thresholds for these fit indices include χ2/df values below 5, indicating a good fit. RMSEA and SRMR values of 0.08 or below are considered indicative of a reasonable fit. TLI values close to one suggest an excellent fit, with a value of one representing a perfect fit. Similarly, CFI and GFI values of one denote a perfect fit, while values of 0.95 or higher indicate an excellent fit, and values of 0.9 or higher are deemed reasonable. 26 Factor loadings were calculated and assessed, and the internal consistency of each factor was evaluated by computing Cronbach’s alpha values.
A multifactorial Rasch analysis was conducted to evaluate the tool’s appropriateness. Person-separation and item-separation reliability were calculated, and infit/outfit statistics were generated, with acceptable mean square values (MSQ) for infit and outfit ranging from 0.5 to 1.5. 27 Furthermore, item locations and thresholds were computed, and a Wright map was produced.
Results
A total of 485 individuals participated in this study. The median age of the participants was 33 years (IQR: 25-45). The majority of the participants were females (53.4%). More than half of the participants did not have children (56.2%), and 73% had a university degree or higher. Most participants did not work in the healthcare sector (55.1%). Furthermore, 49% had a monthly income of less than 500 JD, 42.3% had public/military health insurance coverage, and 29.8% did not have insurance (see Table 1).
Sociodemographic characteristics of the sample.
Table 2 presents participants’ responses to the questionnaire items. Respondents expressed mixed opinions regarding accessibility. A substantial proportion felt that services were inadequately provided at the health center, with 32.6% strongly disagreeing and 22.3% disagreeing. Concerns were also raised about the distance and travel time required to reach the health center, as more than half of the respondents disagreed that these were appropriate. Transportation difficulties were another issue, with 51% reporting challenges in getting to and from the health center. Perceptions of service availability were somewhat more positive. While 39% of participants agreed that essential health services were available, 23.7% strongly disagreed. However, concerns about staffing levels persisted, as over 62% of respondents disagreed that the number of healthcare staff was sufficient. This finding suggests a perception of overcrowding and long wait times.
Questionnaire items and response distributions.
Many respondents expressed concerns regarding the acceptability of care and their interactions with healthcare workers. More than half either disagreed or remained neutral when asked whether healthcare workers listened to them, allocated sufficient time, or adequately addressed their needs. Trust in the treatment team was similarly divided, with 45.6% disagreeing or remaining neutral, while 34.9% expressed agreement. Additionally, nearly 60% of respondents felt that their requests for same-sex healthcare professionals were not adequately considered. Affordability emerged as a significant concern. Nearly half (49.7%) agreed that cost was a major barrier to accessing healthcare, underscoring financial constraints as a key limiting factor.
Accommodation was a significant challenge, particularly in scheduling appointments and receiving timely care. More than half of respondents (56.7%) found it difficult to book an appointment, and 57.3% felt that wait times were inadequate. Similarly, 67.4% disagreed that they could discuss health concerns over the phone, highlighting a lack of telehealth options. Awareness also emerged as an area needing improvement. Nearly half (49.3%) of respondents found the health education provided to be unclear, and over 46% felt that healthcare workers did not adequately ensure their understanding. Additionally, more than 50% either disagreed or remained neutral regarding whether their personal circumstances, such as marital status and cultural differences, were taken into account.
CFA was conducted to assess the six-factor model suggested in the original questionnaire (Table 3). The results indicated that the 30-item six-factor model was suitable for the present study. Satisfactory indices confirmed the model’s fit to the data: χ2/df = 3.2, RMSEA = 0.07, SRMR = 0.05, NFI = 0.9, CFI = 0.93, and TLI = 0.92. Cronbach’s alpha values for Accessibility, Availability, Acceptability, Affordability, Accommodation, and Awareness were 0.91, 0.82, 0.93, 0.86, 0.88, and 0.92 respectively. The highest factor loadings were observed for Q3 and Q4, in the Accessibility scale, while the lowest factor loadings were found for Q22 in Accommodation and Q14 in Acceptability.
Item factor loadings, standard errors, and Cronbach’s alpha values.
Rasch Model
The values for the items’ infit and outfit are presented in Table 4, with all values falling within the acceptable range (0.5-1.5). The highest infit value was observed for Q15, while the lowest was for Q6. Furthermore, the first threshold of Q27 and Q15 was identified as the easiest, whereas the fourth threshold for Q22 and Q1 was notably more challenging. All item thresholds were correctly oriented. The Wright map, shown in Figure 1, indicates that participants were distributed across all difficulty levels within the six domains, with most participants falling in the middle range. The item thresholds demonstrated a wide range of item difficulties.
Rasch analysis: item fit, item location, and thresholds.
Wright map of the Rasch analysis. The left panel displays the respondents’ ability levels across the six factors, while the right panel shows the item difficulty levels.
Discussion
This study aimed to validate the Arabic version of the Perception of Access to Health Care Services Questionnaire (PAHSQ) and assess its psychometric properties. The findings demonstrate that the 30-item, six-factor model is suitable for evaluating healthcare access among Arabic-speaking populations. The model’s satisfactory fit indices and high internal consistency across all domains, confirm its robustness and reliability. These results align with existing literature highlighting the utility of multidimensional tools in understanding healthcare access barriers.1,23 Such tools have been shown to be instrumental in identifying gaps in healthcare systems and informing interventions. Similarly, Hoseini-Esfidarjani et al, 22 emphasize the importance of multidimensional approaches in assessing perceived access to healthcare, noting that comprehensive tools enable a detailed understanding of access barriers across diverse populations.
The six dimensions of access evaluated in this study—availability, accessibility, affordability, accommodation, acceptability, and awareness—reflect the complexity of healthcare access. Availability was a significant concern, with many participants reporting dissatisfaction regarding the adequacy of healthcare staffing and the accessibility of essential medical resources. This finding is consistent with prior studies highlighting shortages in medical personnel as a major barrier to healthcare access in the region. 22 Accessibility was another key issue. Long travel times, difficulties in transportation, and inconvenient facility locations were frequently cited as obstacles, aligning with research that has documented geographic barriers in Middle Eastern and North African healthcare systems. 18
The findings on affordability highlight the significant financial constraints faced by many participants, with nearly half indicating that cost was a major barrier to accessing care. This result reflects broader regional trends where out-of-pocket expenses remain a major impediment to equitable healthcare access, particularly for uninsured populations. 28 Accommodation was also an area of concern. Participants reported difficulties in scheduling appointments and dissatisfaction with wait times, highlighting systemic inefficiencies in service delivery. These findings align with previous studies suggesting that healthcare infrastructure in certain Arabic-speaking countries struggles to meet growing demand. 17 Regarding acceptability, the study found that interactions with healthcare providers often failed to meet patients’ cultural and communication expectations. Many participants expressed concerns about not being listened to or given enough time during consultations, and a significant portion indicated that their preference for same-sex healthcare providers was not considered. This aligns with previous literature emphasizing the role of cultural competency in improving patient satisfaction and engagement. 19 Finally, awareness emerged as another critical area for improvement. A considerable proportion of respondents found health education unclear, and many felt that healthcare providers did not ensure their comprehension of medical advice. These results support previous findings indicating that health literacy remains a pressing challenge in Arabic-speaking populations. 21
Prior research has demonstrated that each dimension contributes to the overall experience of accessing healthcare services, particularly in regions with resource limitations. Hoseini-Esfidarjani et al, 22 highlighted how tools based on the Penchansky and Thomas framework, coupled with the awareness dimension proposed by Saurman, are well-suited for examining access challenges in a structured manner. 22 The dissatisfaction reported in this study regarding staff availability and communication barriers aligns with findings from other settings, where structural and interpersonal factors have been shown to disproportionately affect vulnerable populations.11,16
The sociodemographic profile of the study participants highlighted significant disparities, with a substantial proportion earning less than 500 JD per month and approximately 30% lacking health insurance. These findings align with prior research demonstrating the influence of socioeconomic factors on healthcare access. A previous study 14 identified similar disparities, where income and insurance status were critical determinants of access, particularly for lower-income groups who faced additional challenges in affordability and service utilization. These findings suggest that addressing these systemic inequities is essential for improving outcomes and reducing disparities.
The psychometric validation of the Arabic PAHSQ was robust. Cronbach’s alpha values for all dimensions exceeded commonly accepted thresholds, indicating high internal consistency and supporting the reliability of the tool. These findings are comparable to those reported by Hoseini-Esfidarjani et al, 22 whose Persian-language questionnaire also demonstrated strong reliability metrics across access dimensions. Additionally, the application of Rasch analysis provided evidence of the tool’s construct validity. The Wright map revealed a balanced distribution of item difficulty levels, confirming that the tool is capable of effectively measuring diverse aspects of healthcare access. Wehrli et al, 29 have similarly noted the importance of ensuring robust psychometric properties in access-related tools to enable their application across varied contexts.
The findings of this study have practical implications for healthcare policy and practice. The validated Arabic PAHSQ provides a reliable means of assessing barriers to healthcare access among Arabic-speaking populations, particularly in settings where such tools are limited. The dissatisfaction with staff availability and communication highlighted in this study point to a need for targeted interventions, including capacity-building and cultural competence training for healthcare providers. The tool’s strong psychometric properties also make it a valuable resource for longitudinal research, as they allow for the evaluation of interventions aimed at improving healthcare access and equity.
Limitations
While this study provides useful insights and a validated tool for assessing healthcare access among Arabic-speaking populations, several limitations must be acknowledged. First, the cross-sectional design inherently limits the ability to establish causal relationships between perceived access barriers and health outcomes. Longitudinal studies would be beneficial in exploring how access perceptions evolve over time and how these changes influence healthcare utilization and outcomes.
Second, the Jordanian sample, although representative of a specific Arabic-speaking context, may not capture the diverse cultural, socioeconomic, and healthcare system variations across other Arabic-speaking regions. For instance, disparities in healthcare infrastructure, funding models, and insurance coverage in countries with differing income levels or geopolitical challenges could result in differing barriers to access. Future studies should incorporate multi-country or regionally diverse samples to enhance the tool’s applicability and identify patterns specific to different subpopulations.
Lastly, while the psychometric properties of the PAHSQ were rigorously evaluated, the reliance on quantitative methods alone may have overlooked more subtle aspects of access. For example, participants’ experiences with stigma, discrimination, or systemic inequities, which are factors not always captured quantitatively, could provide important insights into barriers to healthcare. Incorporating qualitative methods, such as in-depth interviews or focus groups, could complement these findings by exploring the subjective dimensions of access and offering a more holistic understanding of the challenges faced by underserved Arabic-speaking populations.
Conclusion
This study successfully validated the Arabic version of the PAHSQ, demonstrating its robustness as a multidimensional tool for assessing healthcare access. The 30-item, six-factor model exhibited strong psychometric properties, including high internal consistency and construct validity, making it a reliable instrument for understanding the barriers faced by Arabic-speaking populations. The tool provides a comprehensive framework for identifying disparities and evaluating healthcare systems’ performance. The findings highlight significant gaps in healthcare access, particularly among participants with lower income and limited insurance coverage, emphasizing the critical role of socioeconomic factors in shaping access to healthcare services. Dissatisfaction with staff availability and communication further shows the need for systemic interventions aimed at improving service delivery and cultural competence within healthcare systems.
The validated Arabic PAHSQ represents a significant step forward in addressing the paucity of tools tailored to Arabic-speaking contexts. Future research should expand its use across diverse regions and integrate qualitative methodologies to capture the more subtle experiences of individuals facing access barriers. In doing so, this work contributes to the broader effort to reduce health disparities and promote health equity within and beyond Arabic-speaking populations.
Footnotes
Appendix
إستبيان سهولة الحصول على الرعاية الصحة
| المحور | البند | ﻻ اواﻓﻖ ﺑﺷدة | ﻻ اواﻓﻖ | محايد | أوافق | اواﻓﻖ ﺑﺷدة | |
|---|---|---|---|---|---|---|---|
| إمكانية الوصول | 1 | الخدمات الصحية التي أحتاجها متوفرة لدى المركز الصحي | |||||
| 2 | المسافة من المركز الصحي إلى منزلي مناسبة | ||||||
| 3 | الذهاب من وإلى المركز الصحي سهل بالنسبة لي | ||||||
| 4 | الوقت المطلوب للوصول إلى المركز الصحي مناسب | ||||||
| التوافر | 5 | الخدمات الصحية التي أحتاجها مثل(التطعيم ، رعاية الأم و الطفل ، تخطيط |
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| 6 | المرافق الصحية تلبي الإحتياجات الصحية للمرضى | ||||||
| 7 | اختيار الموظفون في المركز الصحي يتناسب مع عدد المرضى و احتياجاتهم : | ||||||
| القبول | 8 | جودة الخدمات الصحية مقبولة | |||||
| 9 | يلبي فريق المركز الصحي احتياجات المرضى بطرق مختلفة : | ||||||
| 10 | يستمع فريق المركز الصحي بعناية لما أقوله | ||||||
| 11 | فريق المركز الصحي يقدموا لي الوقت الكافي | ||||||
| 12 | أثق بما يقوله الطبيب أو الممرض بشأن صحتي | ||||||
| 13 | يأخذ العاملون في المركز الصحي بعين الإعتبار حرية اختياري لان يكون |
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| 14 | أثق بالفحوصات التشخيصية مثل فحص سرطان عنق الرحم والقولون في |
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| 15 | يتعامل فريق المركز الصحي معي بإحترام | ||||||
| 16 | فريق الخدمة الصحية على علم بثقافة المرضى المجتمعية ويتواصلون معهم |
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| القدرة على تحمل التكاليف | 17 | أراجع أولاً طبيب عام لحل أي مشكلة صحية لدي | |||||
| 18 | أستخدم خدمات متخصصة و شبه متخصصة بالمركز الصحي بطلب من |
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| 19 | تشكل التكلفة عائقاً أمام استخدام الخدمات الصحية في المركز الصحي | ||||||
| التكيف | 20 | من السهل حجز موعد في المركز الصحي | |||||
| 21 | الوقت المتوقع لتلقي الخدمات التي أحتاجها مناسب | ||||||
| 22 | أستطيع مناقشة المشاكل الصحية والتغيرات في حالتي عبر الهاتف مع فريق |
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| 23 | ساعات عمل المركز الصحي العام مناسبة لتلقي الخدمات من المركز | ||||||
| 24 | مساحة المركز الصحي مناسبة لتلقي الخدمات الصحية | ||||||
| 25 | يوفر المركز الصحي تسهيلات مثل الكراسي المتحركة، والمشايات، وما إلى |
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| التوعية | 26 | أستطيع أن أفهم الارشادات و المعلومات والتعليمات الصحية المقدمة لي في |
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| 27 | يعبرون فريق الخدمة الصحية عن المعلومات التي أحتاجها بلغة بسيطة دون |
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| 28 | تواصل فريق الخدمة الصحية(الطبيب، الممرضة، القابلة، الخ) مناسب مع |
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| 29 | يحاول الفريق الخدمة الصحية التأكد من أنني أفهم بشكل كامل المعلومات |
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| 30 | يأخذ فريق الخدمة الصحية ظروف معيشتي في الإعتبار ، مثل (الحالة |
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Acknowledgements
The authors would like to thank the study participants for their time and input.
Ethical Considerations
Ethical approval was obtained from the Research Ethics Committee of the Al-Zaytoonah University of Jordan (Ref#2024/6/22, dated 1/6/2024). The research adhered to the Helsinki Declaration.
Author Contributions
Conceptualization, W.Q., A.H., and A.J.; methodology, W.Q.; software, J.E., and A.H.; validation, W.Q., and A.J.; formal analysis, S.A. and R.A.; investigation, L.A. and R.A.; resources, A.H., and L.A.; data curation, A.H. and L.A.; writing—original draft preparation, A.H., J.E., A.J., L.A., R.A., F.A., and S.A.; writing—review and editing, A.J and W.Q.; visualization, S.A.; supervision, A.J.; project administration, F.A. All authors have read and agreed to the published version of the manuscript.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Researchers supporting project number (RSP2025R235), King Saud University, Riyadh, Saudi Arabia.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.