Perception-Expectation and Therapeutic Justice at the Extra-local Scale: The Organizational Commitment of Mehraneh in Redefining a Cancer Patient-Friendly City

Background and Purpose: Cancer is one of the most pressing public health issues in urban societies, with increasing prevalence placing significant pressure on healthcare systems and social support infrastructures. Beyond being a personal health crisis, cancer is also a social and environmental challenge that underscores the growing need for therapeutic justice in cities. Patients diagnosed with cancer often face multiple layers of vulnerability due to the complexity of their healthcare and psychosocial needs. In this context, the concept of a "Cancer Patient-Friendly City" emerges as a novel and holistic approach to address inequalities in access to care and support services. Organizations like Mehraneh, which provide integrated support to cancer patients in Iran, play a crucial role in realizing this vision. This study seeks to evaluate how effectively Mehraneh’s services contribute to healthcare accessibility, service quality, and overall patient satisfaction in Zanjan city.
Methodology: This research employs a quantitative, survey-based methodology to assess the impact of Mehraneh’s activities on cancer patients' access to healthcare services and their perceptions of service quality. The primary aim is to understand patients’ expectations and perceptions regarding the healthcare and psychosocial support services they receive, with an emphasis on identifying the service quality dimensions that most influence their satisfaction. Data collection was conducted through a structured questionnaire based on the SERVQUAL model, which measures five key dimensions of service quality: tangibility, reliability, responsiveness, assurance, and empathy. The questionnaire was carefully designed to capture both the expected level of services and the actual perceived performance, enabling a gap analysis to identify specific areas requiring improvement. The target population consisted of cancer patients who received support from Mehraneh in 2024. Using a random sampling approach, 40 patients were selected from this group to participate in the study. Responses were analyzed statistically to explore correlations between various dimensions of service quality and levels of patient satisfaction. This method ensured a high level of objectivity and offered insights that could be generalized—within limits—to similar contexts involving NGO-led healthcare support.
Findings and Discussion: The analysis revealed that among the five dimensions of service quality, “assurance” and “reliability” had the most significant and direct effects on patient perceptions and expectations. These two components were repeatedly identified by participants as fundamental to their sense of trust and confidence in the services offered by Mehraneh. The assurance dimension—referring to the knowledge, professionalism, and respectful behavior of the organization’s staff—played a key role in making patients feel secure and valued. Similarly, the reliability dimension—relating to the organization’s consistency in delivering promised services accurately and on time—was essential in reinforcing a sense of stability and dependability. These findings highlight that trust-building mechanisms, anchored in these two dimensions, are critical for achieving patient satisfaction. Moreover, the results emphasize the strategic importance of aligning service delivery with patient expectations to close the perceived service gaps. For NGOs and community-based healthcare organizations, focusing on assurance and reliability can serve as an effective means to not only enhance satisfaction but also contribute to broader social goals, such as promoting equitable access to care and fostering therapeutic justice.
Conclusion: This study concludes that enhancing cancer patients’ trust and satisfaction plays a pivotal role in improving the overall quality of healthcare services and in advancing the ideal of therapeutic justice, especially in urban environments. For organizations like Mehraneh, which are committed to supporting vulnerable populations, paying strategic attention to assurance and reliability can yield long-term benefits. These include improving patient experiences, increasing adherence to care, and ultimately enhancing the quality of life for individuals battling cancer. The insights from this study provide valuable direction for healthcare policymakers and support organizations aiming to create more inclusive and patient-centered health systems.