Medical Journal of Indonesia 2026;35(2):133-140

doi:https://doi.org/10.13181/mji.oa.268503

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

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

Affiliations

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Keywords

artificial intelligence; diabetic retinopathy; patient satisfaction; primary health care; surveys and questionnaires

Country

Indonesia

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.