Development and Validation of a Household Satisfaction Instrument for Malaysia’s Health Protection Programs

Household satisfaction is an essential measure of health protection programs (HPPs). However, a validated instrument tailored to Malaysia’s healthcare system is lacking. This study aimed to develop and validate an instrument to measure household satisfaction with HPPs, focusing on the PeKa B40 Scheme. This cross-sectional study was conducted in two phases: instrument development and validation. An initial pool of 70 items was generated, with 60 retained after content validation by seven experts (scale-CVI≥>0.8) and pre-tested for face validity. The instrument was piloted in Hulu Langat District, targeting Malaysian households aged 40 and above in the bottom 40% (B40) income group. Simple random sampling recruited 150 participants for Exploratory Factor Analysis (EFA) and 200 for confirmatory factor analysis. The psychometric evaluation assessed the test reliability (Cronbach’s alpha, composite reliability (CR)), construct validity, convergent validity (AVE) and discriminant validity. EFA identified an eight-factor model structure that accounted for 79.93% of the total variance. The final instrument retained 57 items exhibiting solid psychometric properties with adequate fit indices (Root mean square error of approximation = 0.061, Comparative fit index = 0.910, Tucker-Lewis index = 0.904, Chi-square/df = 2.918), CR 0.897-0.972, AVE 0.637-0.777 and established a discriminant validity. The present study developed and validated a reliable instrument tailored to measure household satisfaction with Malaysia’s HPPs using eight constructs: service delivery, accessibility, communication, governance, health literacy, knowledge level, cost and satisfaction.