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Khajeh N, Mohaqeqi Kamal S H, Ahmadi S, Azadi F, SoleimanvandiAzar N. (2026). Responsiveness of Rehabilitation Centers at the University of Social Welfare and Rehabilitation Sciences from the Perspective of Service recipients. refahj. 25(99), : 6 doi:10.32598/refahj.25.99.1369.7
URL: http://refahj.uswr.ac.ir/article-1-4437-en.html
URL: http://refahj.uswr.ac.ir/article-1-4437-en.html
Nazanin Khajeh 
, Seyed Hossein Mohaqeqi Kamal * , Sina Ahmadi , Farhad Azadi , Neda SoleimanvandiAzar
, Seyed Hossein Mohaqeqi Kamal * , Sina Ahmadi , Farhad Azadi , Neda SoleimanvandiAzar
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Extended Abstract
Introduction
Responsiveness is a critical and fundamental component of a people-centered healthcare system. It reflects the extent to which a health system meets the population’s legitimate, non-medical expectations regarding their interaction with the system (Vandam et al., 2020). These “reasonable expectations” are grounded in widely accepted social principles, legal standards, and ethical norms (Gohari et al., 2024). In any social system, including healthcare, there exists a social contract where society expects its members to receive appropriate physical and psychological care, making the pursuit of responsiveness an inherent social goal (Piroozi et al., 2016). Furthermore, responsiveness is not a static measure; it is intricately related to individuals’ place of residence (Chao et al., 2017) and the broader social characteristics of the community (Keyvanlo, 2020).
Incorporating the perspectives of service recipients is paramount for assessing processes and empowering all stakeholders involved in service delivery. This participatory approach creates opportunities for meaningful involvement in both service provision and critical decision-making. This principle holds exceptional significance in the context of rehabilitation services, as it directly aligns with the global advocacy for participation, empowerment, equal opportunities, and social integration for persons with disabilities. To ensure service quality, equitable distribution, and financial accessibility, organizations must actively seek and incorporate client feedback and satisfaction levels. This is especially crucial for rehabilitation, which is inherently a long-term and continuous process. A service recipient’s satisfaction or dissatisfaction with the quality of care can directly influence their motivation and behavior in adhering to and completing their rehabilitation program (Hatami-Zadeh et al., 2008).
The importance of health system responsiveness is magnified within rehabilitation services. These services directly impact the quality of life of individuals with physical, mental, or sensory disabilities and play a vital role in their ability to engage in social interactions and daily activities. Given that individuals requiring rehabilitation typically need continuous and specialized care, the system’s responsiveness can directly affect service quality, access to essential resources and social support, and ultimately, the overall satisfaction of those receiving care (Piroozi et al., 2025).
Despite its importance, the rehabilitation sector has received comparatively less research and policy focus than other areas of the healthcare system (Khezri et al., 2019). A review of studies on health system responsiveness in Iran reveals two key gaps: first, research in this area has been limited and scattered, and second, the existing studies have primarily focused on welfare centers, the Red Crescent, and private organizations. Notably, the rehabilitation centers affiliated with the University of Social Welfare and Rehabilitation Sciences (USWRS)—considered a national hub for rehabilitation—have not been systematically evaluated. USWRS operates key facilities including Razi and Rofeideh hospitals, as well as the Asma and Nezam Mafi rehabilitation centers, which provide specialized services to various beneficiary groups. Therefore, this study aims to fill this significant gap by comprehensively assessing the responsiveness of USWRS rehabilitation centers from the perspective of their service recipients.
Methods
This study employed a descriptive-analytical, cross-sectional design. The research population consisted of all individuals receiving services in 2024 from the rehabilitation centers of the University of Social Welfare and Rehabilitation Sciences in Tehran. A sample was drawn from three specific centers: the Nezam Mafi and Asma centers (representing outpatient services) and Rofeideh Hospital (representing inpatient services). Using a convenience sampling method and with necessary coordination, 384 participants were recruited over a three-month period from early July to late September 2024. Questionnaires were distributed equally across all three centers to ensure balanced representation.
The primary data collection instrument was the 25-item Health System Responsiveness questionnaire of the World Health Organization. This validated tool assesses eight core dimensions: dignity, autonomy, confidentiality, communication, prompt attention, choice of provider, quality of basic amenities, and access to social support networks. Responses are captured on a 5-point Likert scale ranging from 1 (Very Poor) to 5 (Very Good). Consequently, the average score for each dimension and the overall responsiveness score falls between 1 and 5. For interpretation, an average score below 2.5 is considered poor, between 2.5 and 3.5 is average, and above 3.5 is good (Qin et al., 2022). The questionnaire’s validity and reliability for the Iranian context have been established in prior research by Fathi et al. and Khezri et al. Its content validity was confirmed with a Content Validity Index (CVI) of 0.91 based on feedback from 11 rehabilitation specialists. Reliability, tested via the test-retest method across four centers with a two-week interval, showed a strong correlation coefficient of 0.83 and a Cronbach’s alpha of 0.77 (Khezri et al., 2019). All statistical analyses were performed using SPSS software version 22.
Findings
The age of participants ranged from 3 to 78 years, with a mean age of 34.28 years (±25.08). Half of the participants (194 individuals) were single, and 28.4% (109 individuals) held a high school diploma. The majority, 79.4% (305 individuals), were outpatients, while 20.6% (79 individuals) were inpatients.
The overall mean responsiveness score for the entire sample was 3.85 out of 5. Analysis of the eight specific dimensions revealed that confidentiality received the highest score (3.91), while access to social support networks received the lowest score (3.73).
A comparative analysis showed that outpatients reported a significantly higher overall responsiveness score compared to inpatients. Furthermore, outpatients rated all individual dimensions of responsiveness more highly than inpatients did. This difference was statistically significant for the total score and for all dimensions except for the social support dimension.
Significant differences were also observed between the three studied centers. The Asma center received the highest mean responsiveness score (4.04), followed by the Nezam Mafi center (3.90), and finally Rofeideh Hospital (3.71).
The study also examined the relationship between responsiveness scores and key demographic variables. The results indicated that responsiveness was significantly higher among women, married individuals, and those covered by health, social, or supplementary insurance. However, no statistically significant relationship was found between responsiveness scores and the participants’ employment status or education level.
Discussion
The findings of this study demonstrate that the evaluation of health system responsiveness, including the scores across its various dimensions, is influenced by a complex interplay of factors. These include the specific operational and cultural characteristics of each rehabilitation center, the demographic profile of the service recipients, and broader social and cultural contexts. The results underscore several critical points for policy and practice.
Firstly, the consistently low score for the social support dimension across all centers and patient groups demands urgent and special attention. This indicates a systemic weakness in providing the psychosocial support and community integration resources that are essential for holistic rehabilitation. Strengthening this dimension requires targeted policymaking and the development of integrated support programs.
Secondly, the identified disparities highlight the need for a more tailored and equity-focused approach. The lower responsiveness reported by inpatients, single individuals, and those without comprehensive insurance suggests that these groups may face additional barriers or have unmet needs within the current service model. Rehabilitation centers must develop strategies to better address the specific vulnerabilities and circumstances of these populations.
In conclusion, enhancing responsiveness in rehabilitation services is a multifaceted challenge. It requires moving beyond a one-size-fits-all model to one that is sensitive to the distinct needs of different service recipient groups and institutional settings. By focusing on strengthening social support systems and implementing targeted interventions for underserved groups, the University of Social Welfare and Rehabilitation Sciences—and similar institutions—can significantly improve service quality, increase recipient satisfaction, and more fully realize the principles of a people-centered, equitable, and effective rehabilitation system. These findings provide a concrete evidence base for administrators and policymakers to guide these essential improvements.
Ethical Consideration
This work was approved by the Ethics Review Committee at University of Social Welfare and Rehabilitation Sciences in Iran (IR.USWR.REC.1403. 023).
Authors’ contributions
SHMK and NKH contributed to the study design. NKH was responsible for data collection and literature review. Data analysis and drafting of the manuscript were performed by SA; while SHMK, NS, and FA critically reviewed the manuscript. All authors read and approved the final version of the manuscript.
Funding
No funding was received for conducting this study.
Conflicts of interest
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Chao, J., B. Lu, H. Zhang, L. Zhu, H. Jin and P. J. B. h. s. r. Liu (2017). «Healthcare system responsiveness in jiangsu province, China. BMC health services research, 17: 1-7. https://pubmed.ncbi.nlm.nih.gov/28086950/
Gohari, T., S. H. Mohaqeqi Kamal, A. S. Frouzan, S. Ahmadi and M. Araban (2024). «Health System Responsiveness Status: Study of Slum Areas of Ahvaz. Social Welfare Qurterly, 23(91): 253-278. https://refahj.uswr.ac.ir/browse.php?a_id=4224&sid=1&slc_lang=en&html=1
Hatami-Zadeh, N., P. Ja›fari, R. Vameghi and A. Kazem-Nezhad (2008). «Client Satisfaction of Public and Private Rehabilitation Day Centers in Kordestan Province. Archives of Rehabilitation, 9(3): 69-74. https://rehabilitationj.uswr.ac.ir/article-1-294-en.html
Keyvanlo Zahra, F. S., Barghamadi Bita, Keykhosravani Aghlalah, Sabzevari Nagmeh, Nematshahi Mahbobeh (2020). «The Study of the Most Important Aspectsns of Responsiveness from the Point of View of Referring to Sabzevar Health Centers.» Journal of Sabzevar University of Medical Sciences 26(6): 817-825. https://jsums.medsab.ac.ir/article_1257.html?lang=en
Khezri, A., M. S. Khanjani and K. J. A. o. R. Abdi (2019). «Comparison of responsiveness status of rehabilitation services organization from the perspective of services recipients. Archives of Rehabilitation, 20(3): 270-285. https://rehabilitationj.uswr.ac.ir/article-1-2524-en.html
Piroozi, B., A. Mohamadi Bolban Abad and G. Moradi (2016). «Assessing Health System Responsiveness after the Implementation of Health System Reform: A Case Study of Sanandaj, 2014- 2015 %J Iranian Journal of Epidemiology.» 11(4): 1-9. https://irje.tums.ac.ir/article-1-5826-en.pdf
Piroozi, B., A. Shokri, H. Safari, A. Mohammadi Bolbanabad, S. Hematpour, R. Rahimi, J. Adabi and J. J. I. J. o. H. G. Mahmodpour (2025). «Health system responsiveness from perspective of people with disabilities in west of Iran: a quantitative study.» International Journal of Health Governance, 30(1), 32-43. http://sjku.muk.ac.ir/browse.php?a_code=A-10-1604-3&sid=1&slc_lang=en
Qin, L., S. Chen, X. Feng, B. Luo and Y. Chen (2022). Patient-perceived health system responsiveness of the epilepsy management project in Rural China during the period of COVID-19. Healthcare, MDPI. http://172.16.255.254:8090/httpclient.html
Vandan, N., J.-H. Wong, W.-J. Gong, P.-F. Yip and D.-T. J. P. H. Fong (2020). «Health system responsiveness in Hong Kong: A comparison between South Asian and Chinese patients’ experiences». Public Health, 182: 81-87. https://pubmed.ncbi.nlm.nih.gov/32200074/
Introduction
Responsiveness is a critical and fundamental component of a people-centered healthcare system. It reflects the extent to which a health system meets the population’s legitimate, non-medical expectations regarding their interaction with the system (Vandam et al., 2020). These “reasonable expectations” are grounded in widely accepted social principles, legal standards, and ethical norms (Gohari et al., 2024). In any social system, including healthcare, there exists a social contract where society expects its members to receive appropriate physical and psychological care, making the pursuit of responsiveness an inherent social goal (Piroozi et al., 2016). Furthermore, responsiveness is not a static measure; it is intricately related to individuals’ place of residence (Chao et al., 2017) and the broader social characteristics of the community (Keyvanlo, 2020).
Incorporating the perspectives of service recipients is paramount for assessing processes and empowering all stakeholders involved in service delivery. This participatory approach creates opportunities for meaningful involvement in both service provision and critical decision-making. This principle holds exceptional significance in the context of rehabilitation services, as it directly aligns with the global advocacy for participation, empowerment, equal opportunities, and social integration for persons with disabilities. To ensure service quality, equitable distribution, and financial accessibility, organizations must actively seek and incorporate client feedback and satisfaction levels. This is especially crucial for rehabilitation, which is inherently a long-term and continuous process. A service recipient’s satisfaction or dissatisfaction with the quality of care can directly influence their motivation and behavior in adhering to and completing their rehabilitation program (Hatami-Zadeh et al., 2008).
The importance of health system responsiveness is magnified within rehabilitation services. These services directly impact the quality of life of individuals with physical, mental, or sensory disabilities and play a vital role in their ability to engage in social interactions and daily activities. Given that individuals requiring rehabilitation typically need continuous and specialized care, the system’s responsiveness can directly affect service quality, access to essential resources and social support, and ultimately, the overall satisfaction of those receiving care (Piroozi et al., 2025).
Despite its importance, the rehabilitation sector has received comparatively less research and policy focus than other areas of the healthcare system (Khezri et al., 2019). A review of studies on health system responsiveness in Iran reveals two key gaps: first, research in this area has been limited and scattered, and second, the existing studies have primarily focused on welfare centers, the Red Crescent, and private organizations. Notably, the rehabilitation centers affiliated with the University of Social Welfare and Rehabilitation Sciences (USWRS)—considered a national hub for rehabilitation—have not been systematically evaluated. USWRS operates key facilities including Razi and Rofeideh hospitals, as well as the Asma and Nezam Mafi rehabilitation centers, which provide specialized services to various beneficiary groups. Therefore, this study aims to fill this significant gap by comprehensively assessing the responsiveness of USWRS rehabilitation centers from the perspective of their service recipients.
Methods
This study employed a descriptive-analytical, cross-sectional design. The research population consisted of all individuals receiving services in 2024 from the rehabilitation centers of the University of Social Welfare and Rehabilitation Sciences in Tehran. A sample was drawn from three specific centers: the Nezam Mafi and Asma centers (representing outpatient services) and Rofeideh Hospital (representing inpatient services). Using a convenience sampling method and with necessary coordination, 384 participants were recruited over a three-month period from early July to late September 2024. Questionnaires were distributed equally across all three centers to ensure balanced representation.
The primary data collection instrument was the 25-item Health System Responsiveness questionnaire of the World Health Organization. This validated tool assesses eight core dimensions: dignity, autonomy, confidentiality, communication, prompt attention, choice of provider, quality of basic amenities, and access to social support networks. Responses are captured on a 5-point Likert scale ranging from 1 (Very Poor) to 5 (Very Good). Consequently, the average score for each dimension and the overall responsiveness score falls between 1 and 5. For interpretation, an average score below 2.5 is considered poor, between 2.5 and 3.5 is average, and above 3.5 is good (Qin et al., 2022). The questionnaire’s validity and reliability for the Iranian context have been established in prior research by Fathi et al. and Khezri et al. Its content validity was confirmed with a Content Validity Index (CVI) of 0.91 based on feedback from 11 rehabilitation specialists. Reliability, tested via the test-retest method across four centers with a two-week interval, showed a strong correlation coefficient of 0.83 and a Cronbach’s alpha of 0.77 (Khezri et al., 2019). All statistical analyses were performed using SPSS software version 22.
Findings
The age of participants ranged from 3 to 78 years, with a mean age of 34.28 years (±25.08). Half of the participants (194 individuals) were single, and 28.4% (109 individuals) held a high school diploma. The majority, 79.4% (305 individuals), were outpatients, while 20.6% (79 individuals) were inpatients.
The overall mean responsiveness score for the entire sample was 3.85 out of 5. Analysis of the eight specific dimensions revealed that confidentiality received the highest score (3.91), while access to social support networks received the lowest score (3.73).
A comparative analysis showed that outpatients reported a significantly higher overall responsiveness score compared to inpatients. Furthermore, outpatients rated all individual dimensions of responsiveness more highly than inpatients did. This difference was statistically significant for the total score and for all dimensions except for the social support dimension.
Significant differences were also observed between the three studied centers. The Asma center received the highest mean responsiveness score (4.04), followed by the Nezam Mafi center (3.90), and finally Rofeideh Hospital (3.71).
The study also examined the relationship between responsiveness scores and key demographic variables. The results indicated that responsiveness was significantly higher among women, married individuals, and those covered by health, social, or supplementary insurance. However, no statistically significant relationship was found between responsiveness scores and the participants’ employment status or education level.
Discussion
The findings of this study demonstrate that the evaluation of health system responsiveness, including the scores across its various dimensions, is influenced by a complex interplay of factors. These include the specific operational and cultural characteristics of each rehabilitation center, the demographic profile of the service recipients, and broader social and cultural contexts. The results underscore several critical points for policy and practice.
Firstly, the consistently low score for the social support dimension across all centers and patient groups demands urgent and special attention. This indicates a systemic weakness in providing the psychosocial support and community integration resources that are essential for holistic rehabilitation. Strengthening this dimension requires targeted policymaking and the development of integrated support programs.
Secondly, the identified disparities highlight the need for a more tailored and equity-focused approach. The lower responsiveness reported by inpatients, single individuals, and those without comprehensive insurance suggests that these groups may face additional barriers or have unmet needs within the current service model. Rehabilitation centers must develop strategies to better address the specific vulnerabilities and circumstances of these populations.
In conclusion, enhancing responsiveness in rehabilitation services is a multifaceted challenge. It requires moving beyond a one-size-fits-all model to one that is sensitive to the distinct needs of different service recipient groups and institutional settings. By focusing on strengthening social support systems and implementing targeted interventions for underserved groups, the University of Social Welfare and Rehabilitation Sciences—and similar institutions—can significantly improve service quality, increase recipient satisfaction, and more fully realize the principles of a people-centered, equitable, and effective rehabilitation system. These findings provide a concrete evidence base for administrators and policymakers to guide these essential improvements.
Ethical Consideration
This work was approved by the Ethics Review Committee at University of Social Welfare and Rehabilitation Sciences in Iran (IR.USWR.REC.1403. 023).
Authors’ contributions
SHMK and NKH contributed to the study design. NKH was responsible for data collection and literature review. Data analysis and drafting of the manuscript were performed by SA; while SHMK, NS, and FA critically reviewed the manuscript. All authors read and approved the final version of the manuscript.
Funding
No funding was received for conducting this study.
Conflicts of interest
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Chao, J., B. Lu, H. Zhang, L. Zhu, H. Jin and P. J. B. h. s. r. Liu (2017). «Healthcare system responsiveness in jiangsu province, China. BMC health services research, 17: 1-7. https://pubmed.ncbi.nlm.nih.gov/28086950/
Gohari, T., S. H. Mohaqeqi Kamal, A. S. Frouzan, S. Ahmadi and M. Araban (2024). «Health System Responsiveness Status: Study of Slum Areas of Ahvaz. Social Welfare Qurterly, 23(91): 253-278. https://refahj.uswr.ac.ir/browse.php?a_id=4224&sid=1&slc_lang=en&html=1
Hatami-Zadeh, N., P. Ja›fari, R. Vameghi and A. Kazem-Nezhad (2008). «Client Satisfaction of Public and Private Rehabilitation Day Centers in Kordestan Province. Archives of Rehabilitation, 9(3): 69-74. https://rehabilitationj.uswr.ac.ir/article-1-294-en.html
Keyvanlo Zahra, F. S., Barghamadi Bita, Keykhosravani Aghlalah, Sabzevari Nagmeh, Nematshahi Mahbobeh (2020). «The Study of the Most Important Aspectsns of Responsiveness from the Point of View of Referring to Sabzevar Health Centers.» Journal of Sabzevar University of Medical Sciences 26(6): 817-825. https://jsums.medsab.ac.ir/article_1257.html?lang=en
Khezri, A., M. S. Khanjani and K. J. A. o. R. Abdi (2019). «Comparison of responsiveness status of rehabilitation services organization from the perspective of services recipients. Archives of Rehabilitation, 20(3): 270-285. https://rehabilitationj.uswr.ac.ir/article-1-2524-en.html
Piroozi, B., A. Mohamadi Bolban Abad and G. Moradi (2016). «Assessing Health System Responsiveness after the Implementation of Health System Reform: A Case Study of Sanandaj, 2014- 2015 %J Iranian Journal of Epidemiology.» 11(4): 1-9. https://irje.tums.ac.ir/article-1-5826-en.pdf
Piroozi, B., A. Shokri, H. Safari, A. Mohammadi Bolbanabad, S. Hematpour, R. Rahimi, J. Adabi and J. J. I. J. o. H. G. Mahmodpour (2025). «Health system responsiveness from perspective of people with disabilities in west of Iran: a quantitative study.» International Journal of Health Governance, 30(1), 32-43. http://sjku.muk.ac.ir/browse.php?a_code=A-10-1604-3&sid=1&slc_lang=en
Qin, L., S. Chen, X. Feng, B. Luo and Y. Chen (2022). Patient-perceived health system responsiveness of the epilepsy management project in Rural China during the period of COVID-19. Healthcare, MDPI. http://172.16.255.254:8090/httpclient.html
Vandan, N., J.-H. Wong, W.-J. Gong, P.-F. Yip and D.-T. J. P. H. Fong (2020). «Health system responsiveness in Hong Kong: A comparison between South Asian and Chinese patients’ experiences». Public Health, 182: 81-87. https://pubmed.ncbi.nlm.nih.gov/32200074/
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Received: 2025/02/2 | Accepted: 2025/11/1 | Published: 2026/01/27
Received: 2025/02/2 | Accepted: 2025/11/1 | Published: 2026/01/27
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Social Welfare Quarterly
Social Welfare Quarterly, Social Welfare Research Department, University of Social Welfare and Rehabilitation, Daneshjoo Blvd, Evin, Tehran, Iran, 19857-13834
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Website: http://refahj.uswr.ac.ir
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