Assessing the generalizability of client experience measurement tools in low- and middle-income countries: a narrative review

The experiences of people who interact with a health system form a key component of overall quality of care in that system. Yet, client experience is rarely reflected in how health systems are designed and assessed. To make meaningful progress on delivering high-quality patient-centered care, health systems actors need valid measures of client experience of care. However, no cross-cutting measure of client experience of care exists at present that could facilitate measurement and benchmarking across multiple health service areas. We conducted a phased literature search using multiple scholarly databases to identify peer-reviewed articles detailing the development, validation, or adaptation of measures relating to the concept of client experience in sexual and reproductive health care, HIV, primary care, noncommunicable disease management, and health services management and marketing. Measure domains were thematically analyzed and mapped against domains of an existing client experience of care framework-effective communication, respect and dignity, and emotional support. We identified 73 articles that met inclusion criteria and that recounted the development, validation, or adaptation of 61 different measures of health care quality and responsiveness. Numerous measures exhibited significant overlap with an existing conceptual framework for client experience, but few measures were used across health areas. Content of many of the measures identified in this review mapped closely to domains that appear in an existing framework for client experience of care, including effective communication, respect and dignity, and emotional support. These findings support the notion that developing a generalizable measure of client experience of care could be technically feasible.