ed.4 To date, few published work is available about this subject5 and the use of instrument in this empiri- cal work is little,6-8 while much work has been done on the measurement of patient satisfaction9-11 and quality of care.11-14 Responsiveness is different from patient satisfaction and quality of care as it covers health system as a whole, focuses on non-medical aspects of healthcare and evaluates individuals expe- riences; in contrast, satisfaction is usually limited to a specific healthcare setting such as hospital and con- siders both medical and non-medical aspects, and rep- resents a complex mixture of perceived needs, expec- tations and experience of care.5 Quality of care is also a broad concept which includes technical, process, structural and outcome aspects. Some of the interper- sonal dimensions of quality of care have, therefore, been useful in defining the dimensions of responsive- ness, but it is claimed that no single quality of care framework incorporates all the domains considered important to responsiveness.15 The WHO framework for responsiveness identi- fied a set of domains for the responsiveness concept based on review of patient satisfaction and quality of care literature.15 They selected the domains that were comprehensive, amenable to self report, and compa- rable within and across populations.15 Eight domains including "autonomy", "prompt attention", "confiden- tiality", "choice of provider", "dignity", "clarity of communication", "quality of basic amenities" were shared between outpatient and inpatient care, and the "social support" domain was considered relevant to inpatient care only. They were also further classified into two groups of 'respect for human rights' and 'cli- ent orientation'. Similar to many health systems, achieving adequate responsiveness remains a challenge for Iran's health system.16 In WHR2000, Iran health system ranked 100 in terms of responsiveness which indicated urgent need for special attention to healthcare responsiveness.4 In this study, we evaluated household views on respon- siveness of outpatient and inpatient services to their expectations in 2003, as well as the factors affecting responsiveness. We also assessed whether the WHO proposed domains were applicable for evaluating re- sponsiveness of health system in Iran. Materials and Methods A household survey was conducted in 2003. A repre- sentative sample of households in the 17th District of Tehran was enrolled. The District (population: Health system responsiveness 260000; households: 71000)17 is located in southern Tehran, Capital of Iran and has a relatively low soci- oeconomic status compared with the rest of Tehran.18 Two-stage cluster sampling approach was used for the survey. In the first stage, 64 clusters were identi- fied using a systematic sampling frame developed by Iran Statistics Center.19 Each cluster included up to 18 households. Then from each household, an adult indi- vidual who was 18 years or older was randomly se- lected by Kish Table method after completing the household roster. The original sample covered 1123 households, of which responsiveness questionnaire was completed for 773 households. Each household was approached for data at most 10 times. If no one was available af- ter 10 contacts, the household was substituted by a neighboring household. Responsiveness module of the World Health Survey (WHS) questionnaire, which is a valid, reliable and comparative instrument developed by WHO, was used to collect data. Re- sponsiveness module contains questions about "health services utilization", "importance of responsiveness domains from people view", and "people's view about responsiveness domain of outpatient and inpatient services which were used".20 All individual who had used outpatient health services in the past 12 months or inpatient services in the past 5 years were requested to answer the re- sponsiveness modules. It is of note that the study was approved by the Ethics Committee of the Teh- ran University of Medical Sciences. The participants signed or marked (if illiterate) the informed consent forms. KMO test (0.91 and 0.89 for outpatient and inpatient services respectively) showed that the sample size was adequate for Principal Component Analysis and Bartlett test indicated that PCA was suitable for our study. Results The number of responses depended on the rate of ser- vice utilization in the previous 12 months for outpa- tient care and 5 years for inpatient services. Our re- sults showed that out of 773 individual, 677 (87.5%) reported outpatient services utilization (including primary care, specialist care, dentistry) within past 12 months and 38.6% reported hospital utilization over the past 5 years. They mostly used governmental ser- vices, 58.5% and 89% for outpatient and inpatient care respectively (Table 1). WWW.ircmj.com Vol 13 May 2011 303