What question did this study set out to answer?

This study aimed to design and psychometrically evaluate a tool for assessing health system governance.

June 21, 2026

Design and psychometric evaluation of a health system governance assessment tool: a study in the Iranian context

RMRoya MalekzadehMazandaran University of Medical Sciences GAGhasem AbediMazandaran University of Medical Sciences EAEhsan AbediniUniversity of Mazandaran

Key Points

This study aimed to design and psychometrically evaluate a tool for assessing health system governance.
Mixed-methods design conducted in 2024
Questionnaire developed through literature review, expert interviews, and panel consultation
Construct validity assessed via exploratory and confirmatory factor analyses on 273 responses.
Initial questionnaire had 105 items, reduced to 90 after validity assessments
Exploratory factor analysis identified eight factors with KMO value of 0.925 and significant Bartlett's test (p < 0.0009)
Cronbach's alpha was 0.831, indicating acceptable internal consistency.

Abstract

Purpose Health system governance significantly influences system performance and the achievement of sustainable health goals. However, there is still no consensus regarding its dimensions and measurement tools. The present study aimed to design and psychometrically evaluate a tool to assess health system governance. Design/methodology/approach This mixed-methods study was conducted in 2024. The initial version of the questionnaire was developed through a literature review, qualitative content analysis of interviews with 22 experts, and expert panel consultation. Content validity was assessed by 10 experts, and face validity was evaluated by 10 participants. Construct validity was determined through exploratory factor analysis (EFA) using SPSS 24, and confirmatory factor analysis (CFA) using AMOS 24, with responses from 273 individuals familiar with health system governance in Iran. Internal consistency was measured using Cronbach's alpha, and test-retest reliability was assessed on 25 individuals from the target group. Findings The initial questionnaire included 105 items, developed through a literature review and expert interviews. After content and face validity assessments, 15 items were removed. The final 90-item questionnaire was then subjected to construct validity testing. The KMO value was 0.925, and Bartlett's test was significant (p 0.0009). Exploratory factor analysis (EFA) identified eight factors with positive eigenvalues, and all items showed factor loadings above 0.40 and were retained. Confirmatory factor analysis (CFA) indicated acceptable factor loadings across all dimensions, with P-values within acceptable ranges. Cronbach's alpha was 0.831, and external reliability was confirmed (ICC = 0.91, p 0.001). Originality/value The developed questionnaire demonstrates acceptable validity and reliability and can be utilized to assess health system governance. The findings are expected to support policymaking, effective resource organization, intersectoral collaboration, and stakeholder engagement.

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