Background: During COVID-19 pandemic, Bangladesh tried to combat the crisis with its limited capability and resources at different tiers of health systems. This study aimed to assess patient satisfaction with the healthcare quality of Madhupur Upazila Health complex (MUHC) during COVID-19 pandemic.   

Methods: This study followed a cross-sectional quantitative design. Using a structured questionnaire, developed based on a modified SERVQUAL model, data were collected during December 2021–March 2022 from systematically (every fourth attendee) chosen 120 patients (N=120) of the MUHC of Tangail, Dhaka, Bangladesh. Descriptive statistics summarized the socio-demographic characteristics and patient satisfaction levels. Pearson’s correlation analysis examined the relationships among variables, while multiple regression analysis identified factors associated with patient satisfaction.  

Results: The study identified a moderate level of patient satisfaction (2.95 ± .829) with overall healthcare services of the MUHC. The SERVQUAL factors, accessibility (3.07 ± .904), reliability (3.18 ± .888), tangibility (3.05 ± .721), responsiveness (3.08 ± .857), and empathy (3.08 ± .834) received moderate patient satisfaction. Pearson’s correlation analysis indicated that all variables, except accessibility, were significantly correlated (p<.01). A hierarchical regression analysis showed that only reliability and responsiveness are significantly associated with patient satisfaction (p<.01) in model 1 (R2 = .731, F (5, 114) = 62.102, P < .001, F change P<.001) and model 2 (R2 = .744, F (4, 110) = 35.558, P < .001, F Change P>.001). Note that, the inclusion of socio-demographic variables (age, sex, education, and income) in Model 2 did not significantly improve the model’s predictive power, nor were these variables significantly associated with patient satisfaction. 

Conclusion: The MUHC’s healthcare the quality did not meet the adequate level of patient satisfaction, specifically during COVID-19 pandemic. Immediate policy interventions are required to enhance the quality of health services across all service quality dimensions.

Alam, M. A., Haque, M. N., Saha, S., Haque, H. S., Clara, A. A., & Sultana, Y. (2022). Preventive Behaviour of Adults and Its Predictors in Response to COVID-19 Pandemic in Rural Bangladesh: Findings from a Community Survey. Bangladesh Medical Research Council Bulletin, 47(1), 9–16. https://doi.org/10.3329/bmrcb.v47i1.55805

Al‐Borie, H. M., & Damanhouri, A. M. S. (2013). Patients’ satisfaction of service quality in Saudi hospitals: A SERVQUAL analysis. International Journal of Health Care Quality Assurance, www.jegh.daffodilvarsity.edu.bd JEGH. 2025 July; 12(2): 16-31 26(1), 20–30. https://doi.org/10.1108/09526861311288613

Alkharusi, H. (2022). A descriptive Analysis and Interpretation of Data from Likert Scales in Educational and Psychological Research. Indian Journal of Psychology and Education, 12(2), 13–16. Allahham, L., Mouselli, S., & Jakovljevic, M. (2022). The quality of Syrian healthcare services during COVID-19: A HEALTHQUAL approach. Frontiers in Public Health, 10, 970922. https://doi.org/10.3389/fpubh.2022.970922

Al-Neyadi, H. S., Abdallah, S., & Malik, M. (2018). Measuring patient’s satisfaction of healthcare services in the UAE hospitals: Using SERVQUAL. International Journal of Healthcare Management, 11(2), 96–105. https://doi.org/10.1080/20479700.2016.1266804

AlOmari, F. (2021). Measuring gaps in healthcare quality using SERVQUAL model: Challenges and opportunities in developing countries. Measuring Business Excellence, 25(4), 407–420. https://doi.org/10.1108/MBE-11-2019-0104

Alshowkan, A., & Shdaifat, E. (2025). Fear of Missing Out, Social Media Addiction, and Personality Traits Among Nursing Students: Cross-Sectional Study. JMIR Nursing, 8, e71502–e71502. https://doi.org/10.2196/71502

Al-Zaman, Md. S. (2020). Healthcare Crisis in Bangladesh during the COVID-19 Pandemic. The American Journal of Tropical Medicine and Hygiene, 103(4), 1357–1359. https://doi.org/10.4269/ajtmh.20-0826

Amos, D., Au-Yong, C. P., & Musa, Z. N. (2021). Enhancing the role of facilities management in the fight against the COVID-19 (SARS-CoV-2) pandemic in developing countries’ public hospitals. Journal of Facilities Management, 19(1), 22–31. https://doi.org/10.1108/JFM-06-2020-0034

Andaleeb, S. S., Siddiqui, N., & Khandakar, S. (2007). Patient satisfaction with health services in Bangladesh. Health Policy and Planning, 22(4), 263–273. https://doi.org/10.1093/heapol/czm017

Ashraf, A., Chowdhury, S., & Streefland, P. (1982). Health, disease and health-care in rural Bangladesh. Social Science & Medicine, 16(23), 2041–2054. https://doi.org/10.1016/0277 9536(82)90160-5

BBS. (2024). Population and Housing Census 2022 (Census Report No. 1; p. 43). Bangladesh Bureau of Statistics (BBS). https://bbs.portal.gov.bd/sites/default/files/files/bbs.portal.gov.bd/page/b343a8b4_956b_45ca_ 872f_4cf9b2f1a6e0/2024-01-31-15-51-b53c55dd692233ae401ba013060b9cbb.pdf

Begum, F., Said, J., Hossain, S. Z., & Ali, Md. A. (2022). Patient satisfaction level and its determinants after admission in public and private tertiary care hospitals in Bangladesh. Frontiers in Health Services, 2, 952221. https://doi.org/10.3389/frhs.2022.952221

Begun, J. W., & Jiang, H. J. (2020). Health care management during Covid-19: Insights from complexity science. NEJM Catalyst Innovations in Care Delivery, 1(5). https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0541

BMA. (2022). District Wise Total Number of Affected Doctor, Nurse & Staff. Bangladesh Medical Association (BMA). https://bma.org.bd/covid 19/Total%20Affected%20Doctor,%20Nurse%20&%20Staff.pdf

BMA. (2023). List of Doctors Death Doctors due to COVID-19. Bangladesh Medical Association (BMA). https://bma.org.bd/covid 19/List%20of%20Death%20Doctors%20Due%20to%20COVID-19_Detail.pdf

Burgard, S. A., & Lin, K. Y. (2013). Bad Jobs, Bad Health? How Work and Working Conditions Contribute to Health Disparities. American Behavioral Scientist, 57(8), 1105–1127. https://doi.org/10.1177/0002764213487347

Croasmun, J. T., & Ostrom, L. (2011). Using Likert-Type Scales in the Social Sciences. Journal of Adult Education, 40(1), 19–22. 

Das, S. R., Kibria, M. G., Ali, M. I., & Chowdhury, A. A. (2023). Physical Health Problems Among Healthcare Professionals During The Covid-19 Pandemic In Bangladesh: A Cross-Sectional Study. DIU Journal of Allied https://doi.org/10.36481/diujahs.v10i1.hq9pev36 DGHS. (2024). COVID-19 Dynamic Health Sciences, Dashboard for 10(01), 24–33. Bangladesh. https://dashboard.dghs.gov.bd/pages/covid19.php

DGHS. (2025). Upazila Health Complex Scoring (Version Online) [Dataset]. https://dashboard.dghs.gov.bd/pages/hss_menu_facility.php?facilitytype_id=29&division_id= &district_id=

Dijk, M. V., Visschedijk, J., & Van Der Kwaak, A. (2003). ‘Client satisfaction’—Guidelines for assessing the quality of leprosy services from the clients’ perspective. Leprosy Review, 74(2), 112–119. https://doi.org/10.47276/lr.74.2.112

Fatokun, O., Magunga, B. T., Oranye, N., & Selvaraja, M. (2024). Public awareness, risk perceptions and behaviour towards antibiotic use in food-producing animals and antimicrobial resistance in Malaysia: A cross-sectional study. Preventive Veterinary Medicine, 228, 106224. https://doi.org/10.1016/j.prevetmed.2024.106224

Ferdousi, M. J. (2015). Patient satisfaction with community clinic care: Facility and household based survey in a sub-district in Bangladesh. Mediscope, 1(1), 23–28. https://doi.org/10.3329/mediscope.v1i1.21633

Frank, K. (2022). Difficulties accessing health care in Canada during the COVID-19 pandemic: Comparing individuals with and without chronic conditions. Statistics Canada. https://doi.org/https://www.doi.org/10.25318/82-003-x202201100002-eng

Green, S. B. (1991). How Many Subjects Does It Take To Do A Regression Analysis. Multivariate Behavioral Research, 26(3), 499–510. https://doi.org/10.1207/s15327906mbr2603_7

Gulzar, L. (1999). Access to Health Care. Image: The Journal of Nursing Scholarship, 31(1), 13–19. https://doi.org/10.1111/j.1547-5069.1999.tb00414.x

Hair, J. F., Babin, B. J., Anderson, R. E., & Black, W. C. (2019). Multivariate data analysis (Eighth edition). Cengage Learning. 

Islam, A. (2014). Health System in Bangladesh: Challenges and Opportunities. American Journal of Health Research, 2(6), 366. https://doi.org/10.11648/j.ajhr.20140206.18

Islam, S., Islam, R., Mannan, F., Rahman, S., & Islam, T. (2020). COVID-19 pandemic: An analysis of the healthcare, social and economic challenges in Bangladesh. Progress in Disaster Science, 8, 100135. https://doi.org/10.1016/j.pdisas.2020.100135

Kaufmann, J.-E., Stubbe, J. H., Nelissen, R. G., & Gademan, M. G. (2024). Perspectives of Ballet Dancers on Causes of Their Injuries and Implementation of Injury Preventive Measures by Ballet Teachers and Masters. Medical Problems of Performing Artists, 39(2), 93–107. https://doi.org/10.21091/mppa.2024.2007

Kendzerska, T., Zhu, D. T., Gershon, A. S., Edwards, J. D., Peixoto, C., Robillard, R., & Kendall, C. E. (2021). The Effects of the Health System Response to the COVID-19 Pandemic on Chronic Disease Management: A Narrative Review. Risk Management and Healthcare Policy, Volume 14, 575–584. https://doi.org/10.2147/RMHP.S293471

Khalid, A., & Ali, S. (2020). COVID-19 and its Challenges for the Healthcare System in Pakistan. Asian Bioethics Review, 12(4), 551–564. https://doi.org/10.1007/s41649-020-00139-x

Khandakar, Md. S. A. (2014). Rural Health Care System and Patients’ Satisfaction towards Medical Care in Bangladesh: An Empirical Study. Journal of Business Studies, XXXV(2), 83–102. 

Kumar, A., Rajasekharan Nayar, K., & Koya, S. F. (2020). COVID-19: Challenges and its consequences for rural health care in India. Public Health in Practice, 1, 100009. https://doi.org/10.1016/j.puhip.2020.100009

Kumar, R., & Pal, R. (2018). India achieves WHO recommended doctor population ratio: A call for paradigm shift in public health discourse! Journal of Family Medicine and Primary Care, 7(5), 841. https://doi.org/10.4103/jfmpc.jfmpc_218_18

Lal, A., Erondu, N. A., Heymann, D. L., Gitahi, G., & Yates, R. (2021). Fragmented health systems in COVID-19: Rectifying the misalignment between global health security and universal health coverage. The Lancet, 397(10268), 61–67. https://doi.org/10.1016/S0140-6736(20)32228-5

Levin, A. T., Owusu-Boaitey, N., Pugh, S., Fosdick, B. K., Zwi, A. B., Malani, A., Soman, S., Besançon, L., Kashnitsky, I., Ganesh, S., McLaughlin, A., Song, G., Uhm, R., Herrera-Esposito, D., De Los Campos, G., Peçanha Antonio, A. C., Tadese, E. B., & Meyerowitz-Katz, G. (2022). Assessing the burden of COVID-19 in developing countries: Systematic review, meta-analysis and public policy implications. BMJ Global Health, 7(5), e008477. https://doi.org/10.1136/bmjgh-2022-008477

Liu, Y., Lee, J. M., & Lee, C. (2020). The challenges and opportunities of a global health crisis: The management and business implications of COVID-19 from an Asian perspective. Asian Business & Management, 19(3), 277–297. https://doi.org/10.1057/s41291-020-00119-x

Lupu, D., & Tiganasu, R. (2022). COVID-19 and the efficiency of health systems in Europe. Health Economics Review, 12(1), 14. https://doi.org/10.1186/s13561-022-00358-y

Mahejabin, F., Khan, R. F., & Parveen, S. (2016). Patients Satisfaction with Services Obtained from a Health Care Centre in Rural Bangladesh. Delta Medical College Journal, 4(2), 77–82. https://doi.org/10.3329/dmcj.v4i2.29377

Mehari, E. A., Muche, E. A., Gonete, K. A., & Shiferaw, K. B. (2021). Treatment Satisfaction and Its Associated Factors of Dolutegravir Based Regimen in a Resource Limited Setting. Patient Preference and Adherence, Volume 15, 1177–1185. https://doi.org/10.2147/PPA.S308571

MHFW. (2020). National Preparedness and Response Plan for COVID-19, Bangladesh. Ministry of Health and Family Welfare (MHFW). http://www.mohfw.gov.bd/index.php?option=com_docman&task=doc_download&gid=2335 9&lang=en

Mohiuddin, A. K. (2020). An extensive review of patient health-care service satisfaction in Bangladesh. Adesh University Journal of Medical Sciences & Research, 2(1), 5–16.

Nokrek, T. T., Uddin, N., Acter, T., Akhter, A., Sultana, A., & Chowdhury, A. I. (2022). Clinical Features of COVID-19 in Bangladesh During Its Initial and Epidemic Phases. Journal of Emerging Global Health, 9(1 & 2), 49–62. 

Ooi, K., Lin, B., Tan, B., & Yee‐Loong Chong, A. (2011). Are TQM practices supporting customer satisfaction and service quality? Journal of Services Marketing, 25(6), 410–419. https://doi.org/10.1108/08876041111161005

Paintsil, E. (2020). COVID-19 threatens health systems in sub-Saharan Africa: The eye of the crocodile. Journal of Clinical Investigation, 130(6), 2741–2744. https://doi.org/10.1172/JCI138493

Parag, D. D. D., Alam, U. K., Noor, I. N., Barman, N., Hossain, M. S., Alo, A. P., Podder Irani, S., & Nahid Tammi, N. (2024). Satisfaction of pregnant women regarding antenatal care at the selected Upazilla Health Complexes during COVID-19 pandemic. International Journal of Research in Medical Sciences, 12(6), 1898–1903. https://doi.org/10.18203/2320 6012.ijrms20241534

Parasuraman, A., Zeithaml, V. A., & Berry, L. L. (1985). A Conceptual Model of Service Quality and Its Implications for Future Research. Journal of Marketing, 49(4), 41–50. https://doi.org/10.1177/002224298504900403

Parasuraman, A., Zeithaml, V. A., & Berry, L. L. (1994). Reassessment of Expectations as a Comparison Standard in Measuring Service Quality: Implications for Further Research. Journal of Marketing, 58(1), 111–124. https://doi.org/10.1177/002224299405800109

Rahman, M. S., Rahman, M. M., Gilmour, S., Swe, K. T., Krull Abe, S., & Shibuya, K. (2018). Trends in, and projections of, indicators of universal health coverage in Bangladesh, 1995–2030: A Bayesian analysis of population-based household data. The Lancet Global Health, 6(1), e84 e94. https://doi.org/10.1016/S2214-109X(17)30413-8

Rashid, H. A., Akhter, N., Rasheduzzaman, A., Mahmud, H. M., Banik, R., Amin, S. S., & Amin, M. R. (2023). Service availability and readiness assessment of COVID-19 disease management at different tiers of health service delivery in Bangladesh: Service availability and readiness assessment of COVID-19. Bangladesh Medical Research Council Bulletin, 48(2), 160–171. https://doi.org/10.3329/bmrcb.v48i2.62303

Rumi, M. H., Makhdum, N., Rashid, Md. H., & Muyeed, A. (2021). Patients’ Satisfaction on the Service Quality of Upazila Health Complex in Bangladesh. Journal of Patient Experience, 8, 237437352110340. https://doi.org/10.1177/23743735211034054

Setia, M. (2016). Methodology series module 3: Cross-sectional studies. Indian Journal of Dermatology, 61(3), 261. https://doi.org/10.4103/0019-5154.182410

Shaikh, B. T., Mobeen, N., Azam, S. I., & Rabbani, F. (2008). Using SERVQUAL for assessing and improving patient satisfaction at a rural health facility in Pakistan. Eastern Mediterranean Health Journal = La Revue De Sante De La Mediterranee Orientale = Al-Majallah Al-Sihhiyah Li-Sharq Al-Mutawassit, 14(2), 447–456.

Siddique, A. B., Nath, S. D., Mohammad Rasel, S., Roy, C., Monim, M. M., & Amin, M. Z. (2024). Unraveling patient satisfaction, associated factors, and dissatisfaction reasons in the provision of health care services for rural communities in Bangladesh: A cross-sectional investigation. Clinical Epidemiology and the Global Health, 29, 101724. https://doi.org/10.1016/j.cegh.2024.101724

Slavitt, A. (2020). The COVID-19 Pandemic Underscores the Need to Address Structural Challenges of US Health Care System. JAMA Health Forum, 1(7), e200839. https://doi.org/10.1001/jamahealthforum.2020.0839

Tang, J. W., Caniza, M. A., Dinn, M., Dwyer, D. E., Heraud, J.-M., Jennings, L. C., Kok, J., Kwok, K. O., Li, Y., Loh, T. P., Marr, L. C., Nara, E. M., Perera, N., Saito, R., Santillan-Salas, C., Sullivan, S., Warner, M., Watanabe, A., & Zaidi, S. K. (2022). An exploration of the political, social, economic and cultural factors affecting how different global regions initially reacted to the COVID-19 pandemic. Interface Focus, 12(2), 20210079. https://doi.org/10.1098/rsfs.2021.0079

Tuczyńska, M., Staszewski, R., Matthews-Kozanecka, M., Żok, A., & Baum, E. (2022). Quality of the Healthcare Services During COVID-19 Pandemic in Selected European Countries. Frontiers in Public Health, 10, 870314. https://doi.org/10.3389/fpubh.2022.870314

Uddin, N., Acter, T., Chowdhury, A. I., Rashid, H.-A., & Sarwer, Md. N. (2022). Epidemiological Surveillance of COVID-19 Outbreak in Bangladesh: A Public Health Concern. Journal of Emerging Global Health, 9(1 & 2), 11–22. 

WHO. (2024). WHO COVID-19 dashboard. World Health Organization Data. http://data.who.int/dashboards/covid19/cases