Service quality perception in nutritional care in Chile: a study from the user’s perspective
DOI:
https://doi.org/10.14306/renhyd.30.1.2627Keywords:
Nutritionist, Service Quality, SERVPERF, SERVQUAL, Public/Private Health InstitutionsAbstract
Introduction: In Chile, the high prevalence of overnutrition establishes the dietitian's intervention as a fundamental pillar of the healthcare system. The effectiveness of this professional depends not only on technical competence but also on the quality of the service as perceived by users, a crucial factor for long-term adherence and outcomes. Objective: To compare the perceived service quality reported by users attending follow-up appointments with nutritionists in the public and private healthcare systems in Chile.
Methods: A non-experimental, cross-sectional study was conducted on users aged 18-60 years who were treated by nutritionists in the Maule Region, Chile (n=380). Digital surveys based on the SERVQUAL (21 items) and SERVPERF (22 items) instruments were administered.
Results: Private care obtained significantly higher SERVPERF scores (p<0.001) in 21 out of 22 items, with the greatest differences observed in Empathy (Δ=0.65) and Assurance (Δ=0.58). A negative global gap (-0.21) was identified using the SERVQUAL model, which was more pronounced in the public sector (-0.31 vs. -0.13 in the private sector). Dissatisfaction increased with age.
Conclusion: The findings highlight the need to improve service quality in the public sector to meet patient expectations and reduce perception gaps.
Downloads
References
(1) OECD Health at a Glance 2023: OECD Indicators. Paris; 2023.
(2) MINSAL Encuesta Naciona de Salud 2016-2017: primeros resultados. [accedido 4 enero 2024]. Disponible en: https://www.minsal.cl/wp-content/uploads/2017/11/ENS-2016-17_PRIMEROS-RESULTADOS.pdf.
(3) Zhou X-D, Chen Q-F, Yang W, Zuluaga M, Targher G, Byrne CD, et al. Burden of disease attributable to high body mass index: an analysis of data from the Global Burden of Disease Study 2021. eClinicalMedicine. 2024;76, doi: 10.1016/j.eclinm.2024.102848. DOI: https://doi.org/10.1016/j.eclinm.2024.102848
(4) Ministerio de Salud, Gobierno de Chile Estrategia para detener la aceleración del sobrepeso y obesidad en la niñez y adolescencia 2023-2030. Chile: Ministerio de Salud; 2024.
(5) Ipsos Health Service Report Monitor Global de la Salud IPSOS. Global Advisor,; 2024.
(6) Labraña T AM, Durán F E, Soto A D Competencias del nutricionista en el ámbito de atención primaria de salud. Revista chilena de nutrición. 2005;32(3):239-46, doi: 10.4067/S0717-75182005000300009. DOI: https://doi.org/10.4067/S0717-75182005000300009
(7) Ferrand S, Onfray MP, Medina MG, Ferrand S, Onfray MP, Medina MG Actualización del rol del nutricionista clínico: Estándares de práctica. Revista chilena de nutrición. 2021;48(3):437-46, doi: 10.4067/s0717-75182021000300437. DOI: https://doi.org/10.4067/s0717-75182021000300437
(8) Ministerio de Salud, Gobierno de Chile Informes Encuestas. EPI – Departamento de Epidemiologia. [accedido 1 abril 2025]. Disponible en: https://epi.minsal.cl/resultados-encuestas/.
(9) Religioni U, Barrios-Rodríguez R, Requena P, Borowska M, Ostrowski J Enhancing Therapy Adherence: Impact on Clinical Outcomes, Healthcare Costs, and Patient Quality of Life. Medicina (Kaunas). 2025;61(1):153, doi: 10.3390/medicina61010153. DOI: https://doi.org/10.3390/medicina61010153
(10) Arístegui I, Dorigo A, Bofill L, Bordatto A, Lucas M, Cabanillas GF, et al. Obstáculos a la adherencia y retención en los sistemas de salud público y privado según pacientes y personal de salud. Actual SIDA Infectol. 2014;22(86):71-80.
(11) Herrera Atton D, Olivi A, Reyes Cabrera P, García Ubillo V, Veloz Baeza A, Veintimilla Carrión KS, et al. Determinantes sociales de la adherencia terapéutica en usuarios del programa de salud cardiovascular de atención primaria de salud en Chile. Rev Panam Salud Publica. 2025;49:e133, doi: 10.26633/RPSP.2025.133. DOI: https://doi.org/10.26633/RPSP.2025.133
(12) Becerril-Montekio V, Manuel A Sistema de salud de Chile. Salud Pública de México. 2011;53(Supl. 2):S132-43. DOI: https://doi.org/10.1590/S0036-36342011000500003
(13) Gobierno de Chile Ministerio de Salud Fondo Nacional de Salud (FONASA). Modalidad Libre Elección. [accedido 17 julio 2025]. Disponible en: https://adjuntos.fonasa.gob.cl/sites/fonasa/prestadores/modalidad-libre-eleccion.
(14) Carvalho JMS, Rodrigues N Perceived Quality and Users’ Satisfaction with Public–Private Partnerships in Health Sector. Int J Environ Res Public Health. 2022;19(13):8188, doi: 10.3390/ijerph19138188. DOI: https://doi.org/10.3390/ijerph19138188
(15) A’aqoulah A, Kuyini AB, Albalas S Exploring the Gap Between Patients’ Expectations and Perceptions of Healthcare Service Quality. Patient Prefer Adherence. 2022;16:1295-305, doi: 10.2147/PPA.S360852. DOI: https://doi.org/10.2147/PPA.S360852
(16) Aravena L P, Inostroza P M ¿Salud Pública o Privada? Los factores más importantes al evaluar el sistema de salud en Chile. Revista médica de Chile. 2015;143(2):244-51, doi: 10.4067/S0034-98872015000200012. DOI: https://doi.org/10.4067/S0034-98872015000200012
(17) Goldstein E El sistema de salud en Chile y la Atención Primaria de Salud municipal, Marco para un debate sobre desmunicipalización. Biblioteca del Congreso Nacional; 2018.
(18) Castro Méndez NP Riesgos Psicosociales y Salud Laboral en Centros de Salud. Ciencia & trabajo. 2018;20(63):155-9, doi: 10.4067/S0718-24492018000300155. DOI: https://doi.org/10.4067/S0718-24492018000300155
(19) Mella PFO, Narváez CG Análisis del sistema de salud chileno y su estructura en la participación social. Saúde debate. 2023;46:94-106, doi: https://doi.org/10.1590/0103-11042022E407. DOI: https://doi.org/10.1590/0103-11042022e407
(20) Caamaño AJ, Romero YR, Fuentealba NG Evaluación de la calidad de servicio en centro de salud familiar en Chile. Horizontes Empresariales. 2010;9(2):51-72, doi: 10.22320/hem.v9i2.2032. DOI: https://doi.org/10.22320/hem.v9i2.2032
(21) Cronin JJ, Taylor SA Measuring Service Quality: A Reexamination and Extension. Journal of Marketing. 1992;56(3):55-68, doi: 10.2307/1252296. DOI: https://doi.org/10.1177/002224299205600304
(22) Zeithaml VA, Parasuraman A, Berry LL Calidad total en la gestión de servicios. Diaz de Santos; 1993.
(23) Carrillat FA, Jaramillo F, Mulki JP The validity of the SERVQUAL and SERVPERF scales: A meta‐analytic view of 17 years of research across five continents. International Journal of Service Industry Management. 2007;18(5):472-90, doi: 10.1108/09564230710826250. DOI: https://doi.org/10.1108/09564230710826250
(24) Sharka R, Sedayo L, Morad M, Abuljadayel J Measuring the impact of dental service quality on revisit intention using an extended SERVQUAL model. Front Oral Health. 2024;5:1362659, doi: 10.3389/froh.2024.1362659. DOI: https://doi.org/10.3389/froh.2024.1362659
(25) Carbajo Martín L, Párraga-Martínez I, Rosado Cabral JJ, Beltrán Romero LM, Bernabeu Wittel M Validación de la herramienta SERVPERF para el análisis de calidad en la atención en urgencias con la ecografía clínica. Aten Primaria. 2025;57(6):103204, doi: 10.1016/j.aprim.2024.103204. DOI: https://doi.org/10.1016/j.aprim.2024.103204
(26) Jakupovic V, Solakovic S, Celebic N, Kulovic D Reliability and Validity of Modified Service Quality Instrument (SERVQUAL) in Patients’ Motivation to Adhere to Insulin Therapy. Mater Sociomed. 2018;30(1):53-7, doi: 10.5455/msm.2018.30.53-57. DOI: https://doi.org/10.5455/msm.2018.30.53-57
(27) Tavakol M, Dennick R Making sense of Cronbach’s alpha. Int J Med Educ. 2011;2:53-5, doi: 10.5116/ijme.4dfb.8dfd. DOI: https://doi.org/10.5116/ijme.4dfb.8dfd
(28) Vaidya V, Partha G, Karmakar M Gender differences in utilization of preventive care services in the United States. J Womens Health (Larchmt). 2012;21(2):140-5, doi: 10.1089/jwh.2011.2876. DOI: https://doi.org/10.1089/jwh.2011.2876
(29) Labeit A, Peinemann F, Baker R Utilisation of preventative health check-ups in the UK: findings from individual-level repeated cross-sectional data from 1992 to 2008. BMJ Open. 2013;3(12):e003387, doi: 10.1136/bmjopen-2013-003387. DOI: https://doi.org/10.1136/bmjopen-2013-003387
(30) Yarifard K, Abdi Z, Jaafaripooyan E Factors Affecting the Utilization of Preventive Health Services by Middle-Aged Population: A Scoping Review. Iran J Public Health. 2025;54(3):554-66, doi: 10.18502/ijph.v54i3.18248. DOI: https://doi.org/10.18502/ijph.v54i3.18248
(31) Gobierno de Chile, Biblioteca Nacional de Chile La construcción social de lo masculino en Chile (1850-1950) - Memoria Chilena. Memoria Chilena: Portal. [accedido 30 julio 2025]. Disponible en: https://www.memoriachilena.gob.cl/602/w3-article-100662.html.
(32) Mendoza-Catalán G, Almonte-Becerril M, Jiménez-Osorio AS, Ángel-García J, Estrada-Luna D, Rodríguez-Santamaría Y, et al. Machismo and Marianismo Associated With the Risk of Type 2 Diabetes in Indigenous Mexican Adults. J Prim Care Community Health. 2025;16:21501319251357500, doi: 10.1177/21501319251357500. DOI: https://doi.org/10.1177/21501319251357500
(33) Troncoso P C, Astudillo O A, Troncoso Q G Factores sociales que condicionan la asistencia de mujeres a la consulta nutricional. Revista chilena de nutrición. 2011;38(1):8-14, doi: 10.4067/S0717-75182011000100001. DOI: https://doi.org/10.4067/S0717-75182011000100001
(34) Pezoa M, Rojas C Propuesta Metodológica para Medir Calidad Percibida y Satisfacción en la Atención de Salud Hospitalaria. Gobierno de Chile, Superintendencia de Salud; 2011.
(35) Kruse FM, Stadhouders NW, Adang EM, Groenewoud S, Jeurissen PPT Do private hospitals outperform public hospitals regarding efficiency, accessibility, and quality of care in the European Union? A literature review. Int J Health Plann Manage. 2018;33(2):e434-53, doi: 10.1002/hpm.2502. DOI: https://doi.org/10.1002/hpm.2502
(36) eatrightPRO.org - Academy of Nutrition and Dietetics. [accedido 8 enero 2026]. Disponible en: https://www.eatrightpro.org/.
(37) Ruiz-Moral R, Gavilán-Moral E, Angel Pérula De Torres L, Jaramillo-Martín I ¿Cuáles son las expectativas de los pacientes cuando acuden a una consulta de atención primaria y qué piensan los médicos sobre ellas? Rev Calid Asist. 2008;23(2):45-51, doi: 10.1016/S1134-282X(08)70469-X. DOI: https://doi.org/10.1016/S1134-282X(08)70469-X
(38) Liss DT, Uchida T, Wilkes CL, Radakrishnan A, Linder JA General Health Checks in Adult Primary Care: A Review. JAMA. 2021;325(22):2294-306, doi: 10.1001/jama.2021.6524. DOI: https://doi.org/10.1001/jama.2021.6524
(39) Weinhold I, Gurtner S Rural - urban differences in determinants of patient satisfaction with primary care. Soc Sci Med. 2018;212:76-85, doi: 10.1016/j.socscimed.2018.06.019. DOI: https://doi.org/10.1016/j.socscimed.2018.06.019
Additional Files
Published
How to Cite
Issue
Section
License
Copyright (c) 2020 José Luis Pino Villalón, Alonso Torres, María José Jorquera, Camila Belén Pérez
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
This journal 