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01.12.2012 | Research article | Ausgabe 1/2012 Open Access

BMC Health Services Research 1/2012

Patient satisfaction in pediatric outpatient settings from the parents’ perspective - The Child ZAP: A psychometrically validated standardized questionnaire

BMC Health Services Research > Ausgabe 1/2012
Eva Maria Bitzer, Stephanie Volkmer, Marco Petrucci, Nikolaus Weissenrieder, Marie-Luise Dierks
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-6963-12-347) contains supplementary material, which is available to authorized users.

Competing interests

'The authors declare that they have no competing interests. NW is Member of the Board of German Association of Pediatric Physicians (BVKJ).

Authors’ contributions

EMB and MLD designed and oversaw the study, EMB and MP performed the statistical analysis, SV developed the questionnaire and organized the data collection, EMB, MLD and MP wrote the manuscript, NW recruited the participating physicians and critically revised the manuscript. All authors read and approved the final manuscript.



Patient surveys constitute a valuable source of information in patient-focused health care. The objective of this study was to develop and validate a standardized, patient centered, quantitative instrument to assess parent satisfaction in ambulatory pediatric care to be used in quality management and benchmarking activities, the Child-ZAP.


A preliminary version of the survey (38 items) was conducted in n = 19 pediatric practices. After psychometric testing a modified Child-ZAP was tested in a second survey (n = 20 new pediatric practices). Data from n = 979 patients were available for analysis.


The final version of the Child-ZAP contains eight dimensions, three "Child-Scales" and five "Parent-Scales". Confirmatory factor analysis confirms the three hypothesized child dimensions as well as the five parent dimensions. The factorial structure is confirmed in subgroups of younger and older children.


With satisfactory to good results for validity and reliability testing, the final Child-ZAP is applicable in pediatric ambulatory care for children of all age groups.
Additional file 1: Figure S1. Child ZAP: Confirmatory factor analysis of the "Child" scales (unrestricted baseline model). (PPT 252 KB)
Additional file 2: Figure S2. Child ZAP: Confirmatory factor analysis of the "Parent" scales (unrestricted baseline model). (PPT 306 KB)
Additional file 3: Figure S3. Child ZAP: Wait time at the practice. (DOC 85 KB)
Additional file 4: Figure S4 Child ZAP: Physician contact time. (DOC 81 KB)
Authors’ original file for figure 1
Authors’ original file for figure 2
Authors’ original file for figure 3
Authors’ original file for figure 4
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