Indonesian client satisfaction questionnaire-18 for evaluating AI-assisted diabetic retinopathy screening in primary care: reliability and patient satisfaction

Yeni Dwi Lestari; Ratna Sitompul; Indah Suci Widyahening; Dicky Levenus Tahapary; Prasandhya Astagiri Yusuf; Muhammad Bayu Sasongko; Pandu Riono; Gratcheva Alexandra; Aritha Wulan; Handhika Dhio; Saleha Sungkar; Clifford Attkisson

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Indonesian client satisfaction questionnaire-18 for evaluating AI-assisted diabetic retinopathy screening in primary care: reliability and patient satisfaction

Author: Yeni Dwi Lestari ¹ ; Ratna Sitompul ² ; Indah Suci Widyahening ³ ; Dicky Levenus Tahapary ⁴ ; Prasandhya Astagiri Yusuf ⁵ ; Muhammad Bayu Sasongko ⁶ ; Pandu Riono ⁷ ; Gratcheva Alexandra ⁸ ; Aritha Wulan ⁹ ; Handhika Dhio ¹⁰ ; Saleha Sungkar ¹¹ ; Clifford Attkisson ¹²
Author Information

1. Doctoral Program in Medical Science, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
2. Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
3. Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
4. Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
5. Department of Medical Physiology and Biophysics, Faculty of Medicine, Universitas Indonesia, Jakarta; Medical Technology, Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
6. Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Sardjito Hospital, Yogyakarta, Indonesia
7. Department of Epidemiology, Faculty of Public Health, Universitas Indonesia, Jakarta, Indonesia
8. Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
9. Tanjung Priok Primary Health Center, Jakarta, Indonesia
10. Pasar Rebo Primary Health Center, Jakarta, Indonesia
11. Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
12. Tamalpais Matrix Systems, LLC, The Bristol, Chicago
Publication Type:Journal Article
Keywords: artificial intelligence; diabetic retinopathy; patient satisfaction; primary health care; surveys and questionnaires
MeSH: artificial intelligence; diabetic retinopathy; patient satisfaction; primary health care; surveys and questionnaires
From: Medical Journal of Indonesia 2026;35(2):133-140
CountryIndonesia
Language:English
Abstract: BACKGROUND :Diabetic retinopathy (DR) is a leading cause of preventable blindness. However, Indonesia lacks a comprehensive screening program. Artificial intelligence (AI)-assisted screening in primary health care (PHC) is a promising solution. Patient satisfaction is crucial for ensuring the participation and sustainability of such programs. This study aimed to adapt Indonesian version of evaluate client satisfaction questionnaire-18 (CSQ-18) and evaluate its acceptability.
METHODS :This study was conducted from August 5–29, 2024 at 2 public PHCs in Jakarta. Patients with diabetes underwent DR screening, which included fundus photography and an AI-based grading system (RADR). Referable cases were graded secondarily by ophthalmologists. Satisfaction was assessed from November 10–20, 2024 using the Indonesian-translated CSQ-18, adapted through forward-backward translation, expert review, and pilot testing. Reliability was assessed using Cronbach’s alpha, validity was evaluated using Pearson’s correlation, and satisfaction scores were summarized as descriptive statistics.
RESULTS :Of 300 selected participants, 216 completed telephone or in-person interviews. The Indonesian CSQ-18 demonstrated a strong internal consistency (Cronbach’s alpha = 0.886). All items showed acceptable item-total correlations. The mean (SD) satisfaction score was 60.19 (5.50) of 72, with a median of 59, indicating high patient satisfaction. Most participants expressed positive perceptions of screening duration, accessibility, and provider competence, although awareness-related items scored slightly lower. Potential interviewer bias and nonresponse may have affected the findings.
CONCLUSIONS :The Indonesian CSQ-18 is a reliable tool for assessing patient satisfaction with DR screening. These findings confirm the feasibility and acceptability of AI-assisted DR screening at the PHC level, supporting its potential for broader implementation in Indonesia.
Full text:202610211036580785335-2-8503-Yeni-Dwi-Lestari_xmp.pdf