title: Reliability and validity of a Mental Health System Responsiveness Questionnaire in Iran.
abstract: BACKGROUND
  The Health System Responsiveness Questionnaire is an instrument designed by the World Health Organization (WHO) in 2000 to assess the experience of patients when interacting with the health care system. This investigation aimed to adapt a Mental Health System Responsiveness Questionnaire (MHSRQ) based on the WHO concept and evaluate its validity and reliability to the mental health care system in Iran.
  
  
  METHODS
  In accordance with the WHO health system responsiveness questionnaire and the findings of a qualitative study, a Farsi version of the MHSRQ was tailored to suit the mental health system in Iran. This version was tested in a cross-sectional study at nine public mental health clinics in Tehran. A sample of 500 mental health services patients was recruited and subsequently completed the questionnaire. Item missing rate was used to check the feasibility while the reliability of the scale was determined by assessing the Cronbach's alpha and item total correlations. The factor structure of the questionnaire was investigated by performing confirmatory factor analysis (CFA).
  
  
  RESULTS
  The results showed a satisfactory feasibility since the item missing value was lower than 5.2%. With the exception of access domain, reliability of different domains of the questionnaire was within a desirable range. The factor loading showed an acceptable unidimentionality of the scale despite the fact that three items related to access did not perform well. The CFA also indicated good fit indices for the model (CFI=0.99, GFI=0.97, IFI=0.99, AGFI=0.97).
  
  
  CONCLUSIONS
  In general, the findings suggest that the Farsi version of the MHSRQ is a feasible, reliable, and valid measure of the mental health system responsiveness in Iran. Changes to the questions related to the access domain should be considered in order to improve the psychometric properties of the measure.
authors: Social Determinants of Health Research Centre, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Department of Public Health and Clinical Medicine, Umeå International School of Public Health, Umeå University, Umeå, Sweden; asforouzan@gmail.com.
authors: Ameneh S
authors: AS
authors: Forouzan
authors: Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
authors: Hassan
authors: H
authors: Rafiey
authors: Ageing and Living Conditions Programme, Centre for Population Studies, Umeå University, Umeå, Sweden; Department of Social Work, Umeå University, Umeå, Sweden.
authors: Mojgan
authors: M
authors: Padyab
authors: Department of Social Work, Umeå University, Umeå, Sweden.
authors: Mehdi
authors: M
authors: Ghazinour
authors: Social Determinants of Health Research Centre, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
authors: Masoumeh
authors: M
authors: Dejman
authors: Department of Public Health and Clinical Medicine, Umeå International School of Public Health, Umeå University, Umeå, Sweden.
authors: Miguel S
authors: MS
authors: Sebastian
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D008605:Mental Health Services / Q000592:standards* / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires
keywords: Iran; Mental Health System; Questionnaire; Reliability; Responsiveness; Validity