Calitatea Vieții

Validation and Adaptation of the HEALTHQUAL-KZ Questionnaire for Comprehensive Healthcare Quality Assessment in Public−Private Partnerships

Maira S. Alimbetova — 2025-06-28

The assessment of healthcare quality and patient satisfaction in public−private partnerships (PPPs) remains a critical but underexplored area, that has been identified as a priority by international health organizations. These metrics are essential for evaluating healthcare management models and shaping systems that meet population needs.

This study aimed to develop a scientifically valid and culturally adapted version of the HEALTHQUAL questionnaire for Kazakhstan, based on the rigorous linguistic adaptation of the Portuguese version.

Materials and Methods: The adaptation process involved translating the HEALTHQUAL-KZ questionnaire into Russian and Kazakh and then conducting a comprehensive validation process to ensure cultural and contextual relevance. To assess content and external validity, data from 100 randomly selected medical records were drawn from the integrated medical information system (MIS) at the Almaty Multidisciplinary Clinical Hospital, representing cases treated both three years before and three years after the PPP (Patient Protection Program) implementation. The adapted questionnaire's reliability was confirmed through Cronbach's alpha (α > 0.7) for internal consistency and Spearman's rank correlation coefficient for test-retest reliability. These measures ensured the methodological robustness of the study.

Results: The HEALTHQUAL-KZ questionnaire, which was validated, consists of 25 questions divided into five domains, demonstrated high reliability in all domains, as supported by Cronbach's Alpha and Spearman's rank correlation. The average completion time was approximately 12 minutes and 35 seconds. No significant correlation was found between demographic factors (age, education) and satisfaction levels, confirming the objectivity of the tool.

Conclusion: This study presents the first validated adaptation of the HEALTHQUAL questionnaire for the healthcare context in Kazakhstan, offering a reliable instrument for assessing healthcare quality and patient satisfaction in PPP models. The significance of this research lies in its innovative methodological approach, providing a framework that can be transferred and adapted to other countries with similar healthcare systems and challenges. While it has local relevance, this work also contributes to the global discussion on improving healthcare through PPPs by offering a model for adapting healthcare quality assessment tools across cultures. This framework has the potential to standardize quality metrics and enable meaningful comparisons between diverse healthcare settings, advancing the field of healthcare research.

Ethnic and Linguistic Differences in the COVID-19 Mortality in Rural Localities in Moldova

Maxim Slav — 2025-06-28

The COVID-19 pandemic revealed a visible discrepancy in mortality levels between countries, regions, and populations depending on their socioeconomic and demographic characteristics. Scientific literature shows the influence of individual, behavioural and institutional factors on COVID-19 outcomes, including risk of death. Additionally, state institutions seemed to have a crucial influence on COVID-19 mortality depending on their capacity to respond timely to population health challenges by reducing the risk of death and unnecessary disease sequelae. This research is conducted based on a hypothesis that people respond to the COVID-19 crisis depending on the information available in their mother tongue and their usually spoken language, which ultimately leads to a discrepancy in COVID-19 mortality between populations by characteristics of ethnolinguistic groups (ethnicity, mother tongue, and usually spoken language). Thus, by employing a linear regression model, we compared the level of COVID-19 mortality among the main ethnicities in Moldova. Our results revealed a significantly higher mortality level in the Russian-speaking population. We speculate that our results can be explained by the influence of external, often Russian-language, misinformation about COVID-19. This likely contributed to greater vaccine hesitancy, particularly regarding western-made vaccines. Additionally, higher levels of institutional mistrust among ethnic minorities in Moldova, combined with limited institutional capacity to communicate effectively with these communities, may have further reinforced this trend. The results could serve the central and local authorities in implementing targeted health policies to diminish health inequalities among populations by socioeconomic and ethnolinguistic characteristics.

Autoreprezentarea persoanelor cu dizabilități în contextul ghidării în carieră: cazul Republicii Moldova

Natalia Cojocaru — 2025-06-28

This article explores the issue of self-advocacy among young people with disabilities in the Republic of Moldova in the context of career guidance. While self-advocacy is internationally recognized as a crucial element in promoting the rights of people with disabilities and facilitating their access to the labor market, in the Republic of Moldova, this concept is relatively new and under-researched. Existing studies in the field of career guidance primarily focus on barriers such as physical and informational accessibility, discriminatory attitudes, and stereotypes toward people with disabilities, with little attention given to self-advocacy. In this context, the article examines the challenges and opportunities for self-advocacy within career guidance, emphasizing the need for its integration into professional orientation processes. The role of self-advocacy in improving employment prospects for people with disabilities is highlighted, as well as the importance of developing appropriate educational and support strategies to enhance their capacity to express and defend their interests in the labor market.

The research questions explored in the article include: What are the perceptions of people with disabilities regarding career guidance? What are the main barriers they face in the career guidance process? What role do public institutions, non-governmental organizations, and families play in supporting the self-advocacy of people with disabilities in this context? What are the benefits of career guidance for their self-advocacy? How does self-advocacy influence their access to career guidance opportunities?

The article draws upon the findings of the study "Policies and Practices of Career Guidance for Young People with Disabilities in the Republic of Moldova," conducted on a representative national sample comprising 1 111 young people with disabilities, aged between 14 and 35 years. These findings were supplemented with insights from individuals with disabilities who are members of self-advocacy groups, their support persons, and representatives from civil society, collected through qualitative research methods.