Abstract
Abstract
The adoption of digital health solutions (DHS) in outpatient care is hindered by uncertainty regarding their non-clinical effects and a lack of validated instruments for standardized evaluation. Health care service quality (HCSQ) provides a theoretically grounded framework for assessing these effects, but no validated HCSQ-based instrument has been established. This study aimed to quantitatively validate DigiHEALTHQUAL and compare a theory-derived model structure with a data-derived alternative. We conducted a cross-sectional online survey among 1085 adult patients in Germany with experience using one of four DHS: online appointment booking, digital anamnesis, video consultation, or electronic health records. Psychometric validation included internal consistency analyses, confirmatory factor analysis (CFA), exploratory factor analysis (EFA), and comparative model evaluation. The refined theory-derived seven-factor model excluding general satisfaction demonstrated good model fit and strong internal consistency, although discriminant validity between dimensions was limited. EFA yielded a more parsimonious four-factor structure with a dominant process-related factor. High inter-factor correlations supported a higher-order HCSQ structure. Overall, DigiHEALTHQUAL showed validity for assessing non-clinical DHS effects on HCSQ in outpatient care in Germany and supports standardized DHS evaluation in research and practice.