ArticleBMC medical education2026
The Syrian Health Care Scale: a novel instrument for assessing physician-delivered care in crisis contexts.
Article in BMC medical education, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe Syrian healthcare system has faced profound disruptions due to prolonged conflict, resulting in major challenges to delivering quality patient care. Recognising the need for a culturally and contextually relevant assessment tool, this study introduces the Syrian Health Care Scale (SHCS), a novel instrument designed to evaluate the quality of physician-delivered care from a multidimensional perspective.
methodsA cross-sectional study was conducted in July 2024 with a sample of 103 physicians across Syria. The SHCS, a 20-item self-report instrument, encompasses affective, behavioural, and cognitive dimensions of patient-centred care, using a 7-point Likert response format with both positively and negatively worded items. Internal consistency was assessed via Cronbach’s alpha, while item validity was examined using Pearson correlation. Independent samples t-tests and ANOVA were used to explore differences by gender and years of clinical experience. Additionally, Exploratory Factor Analysis (EFA) was conducted to evaluate the scale’s dimensional structure.
resultsThe SHCS demonstrated acceptable internal reliability (Cronbach’s alpha = 0.753). Factor analysis revealed a three-factor structure corresponding to the intended affective, behavioural, and cognitive domains, explaining 36.4% of the total variance and indicating a satisfactory structural performance of the scale. Several items showed strong loadings on their expected domains, supporting the scale’s conceptual validity. While male physicians scored significantly higher in the behavioural dimension (p = 0.036), no significant differences were observed in total scores based on gender or years of experience. Notably, a majority of participants (67.96%) scored in the 'Below Standard' category, underscoring substantial gaps in healthcare delivery under crisis conditions.
conclusionThe SHCS demonstrates acceptable reliability and preliminary validity for assessing physician-delivered care in conflict-affected settings. Its multidimensional design offers a nuanced evaluation of healthcare provision, making it a valuable tool for guiding policy, clinical training, and future research. The confirmed factor structure, along with the explained variance and score distribution of participating physicians, provides a strong foundation for subsequent confirmatory validation and broader application in resource-limited contexts.
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