This article outlines the implementation and use of a large wireless instrumentation solution to collect data over a long time period of a few years for three collective residential buildings. The sensor network consists of a variety of 179 sensors deployed in building common areas and in apartments to monitor energy consumption, indoor environmental quality, and local meteorological conditions. The collected data are used and analyzed to assess the building performance in terms of energy consumption and indoor environmental quality following major renovation operations on the buildings. Observations from the collected data show energy consumption of the renovated buildings in agreement with expected energy savings calculated by an engineering office, many different occupancy patterns mainly related to the professional situation of the households, and seasonal variation in window opening rates. The monitoring was also able to detect some deficiencies in the energy management. Indeed, the data reveal the absence of time-of-day-dependent heating load control and higher than expected indoor temperatures because of a lack of occupant awareness on energy savings, thermal comfort, and the new technologies installed during the renovation such as thermostatic valves on the heaters. Lastly, we also provide feedback on the performed sensor network from the experiment design and choice of measured quantities to data communication, through the sensors’ technological choices, implementation, calibration, and maintenance. Residential buildings account for a third of the overall energy consumption and greenhouse gas emissions in Europe . Thus, tSensors and monitoring data are a key solution  to diagnIn addition, sensor networks have been used in several domains such as user behaviors , testingIndustrial programs such as PROFEEL (characterizing the impact of retrofit actions) or Agence Parisienne du climat . Industrial projects deploy a large number of sensors on a large number of buildings. They target the development of operative methods and broadcast the acquired knowledge for professionals from the construction and energy sectors. Because of the significant budget and human resources involved, monitoring and data analysis opportunities are superior to academic projects.Academic research projects. These projects focus on specific smaller-scale case studies. The academic research digs deeper into the specificity and details of a given case study and instrumentation method.However, the literature shows that the many aspects of energy-related behaviors and IEQ are difficult to target all at once and with a high level of detail ,8, especWe summarize in Indoor air temperature and relative humidity are the most common measurements, supposedly because of the availability of simple components for such measurements. COe review , the autIt is also important to highlight that the number of deployed sensors is usually quite small due to limited human resources and the cost of commercial solutions. This raises two questions regarding the replicability of the work, since technologies might not be interoperable, and the conclusions of the results, because of the small number of measurements and case studies. Herein, a large number of 179 sensors were deployed in common areas and in apartments of three renovated buildings to monitor a wide variety of parameters.The first objective of this article is to technically detail all the steps from the design, implementation of the sensors, communication protocols, data analysis, and to provide feedback for future deployments of wireless sensor networks in buildings. It can be noted that the study of building energy performance requires several months of good-quality data. However, the question of ensuring calibration over time is not raised in reviewed studies focusing on sensor network designs. Calibration is not mentioned at all in application studies while this should be an important point to address, especially for long-term monitoring campaigns, when some sensors exhibit measurement drift over time. The second objective of the article is to highlight the benefits of sensor monitoring for occupants, landlords, and engineers and researchers.In the present research article, we report a field experiment involving the deployment of a wireless sensor network for measuring energy, IEQ, and energy-related behaviors in three social housing buildings in the metropolitan area of Paris. The collected data are then used to assess the performance of retrofit actions, to obtain a better understanding of occupant comfort and usage and to propose practical recommendations in view of reducing energy consumption. First, we present the materials and methods in In the context of case studies of buildings equipped with sensor networks, we report the following works ,22,23,24The case study is a group of three existing and occupied residential buildings located in Seine-et-Marne, in the greater Paris area. The three buildings built in 1974 have sixty-three social housings, for a total living area of 3825 m, and B3 . They haThe instrumentation campaign at the building scale is deployed on energy systems, in shared areas, and in an eight-apartment sample. The distribution of instrumented housings is presented in Marne-et-Chantereine Habitat, also built at the same time a new building located nearby and where the current boiler is now located.All three studied buildings underwent an extensive energy retrofit from July 2020 to July 2021. The landlord, The building envelope was fully insulated, including outdoor walls and ceilings and walls that separate heated areas from nonheated areas. The roof was not modified since its existing thermal features were sufficient for the current energy efficiency requirements. The ground floor, above the crawl space, was not insulated since it could not be properly accessed during the retrofit. All windows, glazed doors, outdoor doors, and apartment entrance doors were changed. An entrance air lock was also created at the main entrance of the buildings.Marne-et-Chantereine Habitat opted for a more cost-effective solution. A furnace was built in their new building and connected to the extended geothermal heating network of the city. Ventilation was replaced by a new humidity-sensitive simple-flow CMV  in each building and new extraction units were installed in apartments.Heating and DHW production systems were already central. Prior to retrofit actions, heating and domestic hot water were produced by a neighborhood furnace using natural gas. The furnace served the three buildings as well as dozens of other social collective housing buildings owned by another landlord. During the retrofit, Common areas of the building do not have any heaters or ventilation. Appliances include lifts (only for B2 and B3) and occupancy-driven lighting with a timer. In housing, heaters were replaced with new models including a thermostatic valve, and the main hot water pipes were insulated, as well as part of the secondary piping circuit. Electric systems and switchboards were rehabilitated.There are four types of apartments in the three studied buildings, with a main bedroom/living room or one, two, and three bedrooms. The architectural features of the housings are similar within and between buildings. There are four apartments per floor, except for the ground floor, with three apartments, and the last floor, with two apartments. Each housing is located in a corner of a floor and has a single orientation: northwest, northeast, southeast, or southwest.Apartment energy meters (resp. water meters) include electricity and natural gas (resp. tap and hot water). Natural gas is only used for cooking but some apartments have electrical cooking appliances and do not use natural gas. Heaters are located in each room, except in the bathroom and water closet; apartments on the last floor have a heater in the bathroom. Controlled Mechanical Ventilation (CMV) extraction units are located in the bathroom, the water closet, and the kitchen.The instrumented eight-housing sample was selected to account for a diversity of sizes, locations in the buildings, orientations, and residents’ profiles and is summarized in Step 1: instrumentation in common areas and building-scale measurements, including the IEQ, the occupants’ behavior in common areas, the building-scale electricity and thermal energy consumption monitoring, and the weather station;Step 2: instrumentation in households, including the IEQ, occupants’ behavior and energy consumption .Wireless sensor networks, deployed for research purposes, focus on different energy end-uses and parameters, both at the building and household levels. Measurements are divided into four categories: (i) the energy consumption with thermal energy, electricity, and natural gas, (ii) the IEQ , (iii) the occupants’ behaviors, and (iv) the local weather. Energy consumption monitoring is one of the main goals of this study. Energy sources include electricity, thermal energy for heating and domestic hot water, and natural gas for cooking. IEQ focuses on parameters that depict the occupants’ comfort  and the The full solution deployment took over two and a half years from January 2019 to July 2021. Sensors and communication protocols from the first step were also used as a test phase to highlight practical issues and conclude on the use of sensors for specific data acquisition. We should note that the proposed network does not have automatic error correction or repair capabilities. In the following sections, preparation of the sensor network is briefly summarized, and the sensor network is detailed for each type of measurement. Common areas and housings are discussed separately. Data communication and storage are described in a separate section.A design brief was created to specify the needs and purpose of the instrumentation. It is a reference document for all actors of the sensor network deployment, either from the research team or contractors providing equipment and sensors. It evolved through discussions with the contractors to fit the reality of the IoT market regarding existing instrumentation solutions and costs.Once the design brief was ready, three actions were led simultaneously. First, households willing to participate in the experiment were recruited. This was one of the major challenges of the research project since the participation of residents was voluntary. In exchange for their participation, collected data are returned to residents with a dedicated overview of their apartment and energy consumption. Only nine housings agreed to participate, which was later reduced to eight housings since one family moved out of their apartment during the measurement campaign and was not replaced.The recruitment campaign has highlighted that most residents did not give significant attention or make substantial efforts toward energy efficiency, either because they were not aware of the topic or because they were mostly focused on the retrofit of their apartment in terms of comfort. A few households were also concerned with the use and security of their data and electrosensitivity issues.The relationship between the landlord and other project actors;The communication means and documents regarding the research project and the residents;Collected data usage: potential use outside of the European Union (resulting in modified regulations), storage specifications, data transmission means, and residents’ personal data transferred to the landlord—both the researchers and the landlord are responsible for collected data use, since the data are related to residents living in the landlord’s buildings, despite data being processed by the research team only;A written residents’ agreement.Then, the objective was to select one or several contractors to provide sensor network solutions. The strategy was to keep the number of involved contractors to a minimum, to minimize potential project management issues. After a large survey, thirteen contractors provided a commercial offer. Four contractors were immediately disqualified due to budget constraints. Seven contractors moved into a second round to refine their offer based on the detailed needs of the project. Two contractors were finally selected to provide the equipment, instrumentation installation, partial management of the sensor network and the weather station. Part of the setup, the installation, and the supervision were performed by our research team. Finally, we focused on the communication with the French CNIL organization . It was required to provide all details of the project related to data collection, analyses, and future use, to protect the residents’ privacy. CNIL advised on potential warnings and provided recommendations. For similar projects, if a declaration on data usage is mandatory, the implementation of recommendations is not. For the present project, most comments concerned the following:The sensor network is entirely wireless and it relies on two different communication protocols. The first protocol is GPRS , a standard data package communication protocol. The second protocol is LoRaWAN (Long Range Wide Area Network). It is a radio communication protocol commonly used for smart city applications  and reliOperated LoRaWAN networks are managed by national telecommunication companies. This option has a major benefit with a simple and straightforward implementation. Communicating devices are declared online and a fee is applied for each communicated data point. Data preprocessing such as identifying missing data, treating duplicates, and formatting, is performed on the operator’s servers. However, operated LoRaWAN networks are constrained regarding bandwidth usage, which limits potential applications . For the implementation of an operated LoRaWAN network, gateways are used as data communication relays to the operators’ servers.Private LoRaWAN networks rely on the same technology but the network is a local network. LoRaWAN communication is implemented between sensors and a dedicated gateway. The gateway decodes radio packages and transfers the data to a private server using the internet. Hence, there is no constraint regarding data acquisition. However, each sensor is connected to a specific gateway with a higher risk of data loss in case of a malfunction, and the initial investment cost is more significant than with operated networks, specifically because of the cost of the gateways.The main part of the sensor network relies on the LoRaWAN protocol as illustrated in Prior to data storage, part of the collected data is preprocessed through network servers. The GPRS and operated LoRaWAN network are processed through Objenious , the natCollected data are initially stored on separate servers due to sensor technologies and deployment management during the research project. The largest part of the data is stored on FTP (file transfer protocol) servers except for data from the LoRaWAN private network supporting the window opening detection sensors. Window-related data collection is event-driven. Therefore, an HTTP (hypertext transfer protocol) server is needed. Data processing is performed to store all collected data on a single FTP server  twoImplemented thermal meters use ultrasonic water flow probes that do not require an intrusive integration into the water circuit. They are simply installed on the water pipes. Ultrasonic meters measure the time needed by an ultrasonic impulsion to move from the sending probe to the receiving probe through the water pipes. Knowing the traveling time and depending on the inner diameter, outer diameter, and material of the pipe, the water flow is assessed. Temperature probes are located on the outside of the pipe and are insulated from the surrounding environment.Thermal energy meters available on the IoT market are not communicating meters, and it is necessary to add a pulse sensor . As for Thermal energy consumption data are collected for relatively large-time-range analyses . Hence, an hourly acquisition and transmission time-step is established for all thermal energy meters using the operated LoRaWAN network.Housings: Thermal energy in apartments is characterized considering heaters and DHW pipes, but it is more difficult to characterize for building-scale data acquisition. Ideally, measurements for both end-uses should be performed on the main hot water pipes with thermal energy meters. However, these pipes can hardly be accessed and such an instrumentation setup would be too expensive for consideration.Contact temperature sensors  are instFor DHW, the same sensor given in 4.Gaz Reseau Distribution France) and collects consumption data. A pulse sensor is used on Gazpar meters .Common areas: In common areas of the buildings, IEQ is characterized through Indoor Air Temperature (IAT) and relative humidity measurements. For each building, three sensors are installed: one on the ground floor, one on the intermediate floor and one on the last floor. Preferably, these sensors would be installed at a height of 1.50 m. However, since sensors are installed in corridors, they need to be out of sight and reach. Sensors are located under the ceiling, on the structure of the stairs f.The data acquisition time-step is set to one hour. No sudden variations in temperature and humidity are expected, apart from doors or windows that could be opened near the sensors. Data are communicated with an hourly time-step using the LoRaWAN operated network.Housings: IEQ measurements in housings are IAT, relative humidity, brightness, COntration , and occntration .Another sensor measures the contact temperature of the inner surface of walls. The sensor is the same as for heaters and DHW. These data aim to assess the radiant temperature of walls, which is a relevant parameter regarding indoor comfort; even though the air temperature might be sufficiently high, if the surrounding walls are excessively cold, it affects the feeling of comfort . These d6.Occupants’ behavior.Common areas: Occupants’ behavior characterization in building common areas is performed with infrared presence detectors  positionHousings: Occupants’ behavior in households is characterized through presence detection in the apartments (from the same multimeasurement sensor used for IEQ monitoring ) and winWindow opening detection is monitored with contact sensors . Data acMore details on the exact location of the sensors inside a specific apartment can be found in .In this section, the collected data from the wireless sensor network are analyzed to verify the expected building energy performance after renovation and indoor environmental quality and to obtain a better understanding of occupancy and usage.Before the retrofit actions, energy performance diagnosis (EPD) was performed for the three buildings by an engineering office. The bad grade of “D” was given as their total estimated primary energy demand ranged from In conclusion, the deployed wireless sensor network allows us to verify that the performance target for heating consumption was achieved.Heating patterns are characterized using indoor air temperature and heater temperature measurements. Indoor temperature measurements show that the obtained measurements are much higher than the recommended 19 °C setpoint temperature. Indeed, the average indoor temperatures in the apartment living room range from 21.4 °C for B1/2 to 24.9 °C for B3/0 for the 2021–2022 heating season. As shown in Despite the fact that the three residential buildings are previously retrofitted with a brand new heating system, the analysis results show that there is no water logic management of the heating system. Indeed, there is no difference between day and night temperatures in the apartment a, which During the renovation operations, thermostatic valves that can be manually controlled by the occupants were installed on the heaters of the apartments. Nevertheless, the residents were not aware of the good use of this new system and they had no indication of their housing indoor air temperature. Consequently, discussions with occupants revealed that they never modify the thermostatic valve position except when thermal discomfort due to excessive temperature was felt, especially in the bedroom. In conclusion, the deployed monitoring system identified weaknesses in the building energy management, i.e., higher than the standard air temperature in apartments and the absence of heat regulation at night. Basic indoor temperatures should be provided in the apartments and the landlord should organize information campaigns to raise the occupants’ awareness of energy savings and their thermal comfort and to help them in the use of the newly deployed thermostatic valves.Building occupancy can be a predominant energy driver leading to DHW consumption, window opening, dissipated power from appliance use, etc. Occupancy is deduced from presence detectors in the living room of the apartments. Clustering is performed to extract the main occupancy profiles for each instrumented apartment. The clustering process is adapted from previous works of the authors on daily load profile characterization . The meaConcerning the electric dissipated power, it is deducted from electric power demand at the apartment scale, measured on smart electricity meters. To conclude, using the monitoring data in studied buildings and the clustering, we gain a better understanding of occupancy patterns and overall electric equipment usages, which can be valuable for building energy modeling in view of having more realistic thermal dynamics simulations and energy predictions.Natural ventilation is pictured by window opening. Window opening data are processed to produce daily profiles with an opening duration for each hourly time slot of the day. Daily profiles are then aggregated for each month. The data show that this behavior is mostly season-driven as for the example of the living room in B1/2 . WindowsTo study the impact on air quality of a low window opening duration, which is encountered in fall and winter seasons, we analyze COFeedback on the deployed sensor network is presented from the experimental design and choice of measured quantities to data communication, through sensor technological choices, implementation, calibration, and maintenance.Installation conditions and environment. The case study is a group of three existing buildings built in 1974. The integration of a sensor network in existing buildings is more difficult than that in a newly built or recently built structure. Another difficulty is that buildings are occupied. Hence, the sensor network must be as minimally intrusive as possible. Nevertheless, necessary maintenance can still disturb inhabitants and data collection may be disturbed by inhabitants . Finally, retrofit actions are conducted during part of the instrumentation process, which results in several issues.Targets of the sensor network. Because the sensor network targets a large range of measurements, it is necessary to mix many different technologies of sensors, data acquisition, communication, and storage. These technologies are not always fully compatible and result in additional challenges for long-term project maintenance. Additionally, the sensor network relies on IoT objects. We observed that the current IoT market is more fitted for large-scale deployment strategies over approximately one year than for high-precision measurements and long-term monitoring.Project management. From the design brief to the installation and long-term maintenance, the sensor network requires optimized management, specifically regarding third parties, such as volunteering housings and contractors. Participants are essential to the project, since the results entirely depend on a sufficient amount and diversity of collected field data. Contractors also play a significant role. They usually provide “plug-and-play” management; sensors are provided, set up, installed, and maintained. However, most IoT contractors are energy managers who delegate installation and maintenance tasks to other contractors and have limited field knowledge. Hence, it is very time-consuming to solve any technical issue.The deployment of our sensor network provides valuable feedback on the main achievements and difficulties in the implementation of an instrumentation solution. Critical points to take into account can be summarized in three categories and are further described in :InstallaIn addition to the published results , the insThe objective of our sensor network was to provide an exhaustive characterization of energy consumption, IEQ, and inhabitants’ energy-driving behaviors in an occupied and retrofit group of three existing buildings. We achieved a significant challenge with the monitoring of twenty different parameters in housings, common areas, and energy systems by deploying a total of 170 sensors in the three renovated buildings (144 in apartments and 26 in common areas) and by collecting data for over three years. The implementation of the sensor network resulted in a significant amount of collected data that provided extensive knowledge on the operation of the studied buildings. Nevertheless, the sensor network still highlights several gaps that leave room for improvements.Characterization of the occupants’ behavior is performed with presence detection and window/glazed door opening detection. Presence detection is achieved using a single sensor. One single presence detection sensor for each household limits the data acquisition strategy. The location of the sensor in the living room also constrains data analyses, despite the fact that volunteers declared spending most of their time in this specific room. Sensors perform presence detection but they cannot count the number of occupants in the room. To cope with these constraints, in terms of instrumentation, there would be complementary solutions, such as using additional sensors for presence detection in different rooms and monitoring of the entrance door opening. However, additional sensors would increase costs and potentially undermine inhabitant privacy protection. Housing occupancy can be deduced from other measurements, including COComfort and indoor environment characterization can be improved as well. In the present study, it includes indoor air temperature, relative humidity, CO quality   is an option. Instead of counting the number of pulses, it collects the same data as those sent to the electricity network administrator . However, this technology was not available with the expected specifications through the contractors we selected and it would have been complicated to install and supervise these sensors on our own.The instrumentation solution aims to efficiently monitor the targeted measurements. However, sensor technologies can be discussed. For instance, pulse technology is a simple, affordable, and efficient means to collect energy consumption data. Meters with pulse output produce one pulse for each unit of consumed energy. The aggregated number of pulses for a given time-step is the information communicated by a pulse sensor connected to an energy meter. However, this technology does not provide the precision of meter readings and rounds the energy consumption for each time-step. Hence, electricity and thermal energy consumption monitoring can be improved. For the former, TIC technology  or missing data. These are related to different identified causes, such as:We observed that an efficient means to reduce the loss of data is to implement an automated data collection checking system. This was tested on part of our sensor network, with daily verification of the amount of collected data for a group of sensors, comparing the size of the daily data packages to the size of a normal data package, when there are no missing data. This solution could be further improved with a dedicated detailed process to check the amount of data received for each individual sensor, and to send warning e-mails in case of a suspected data loss.We presented in this article the implementation and use of a wireless sensor network for energy monitoring for residential buildings’ energy performance assessment. All the steps are technically detailed from the design, deployment of sensors, communication protocols, and the data analysis to provide feedback for future deployments of wireless sensor networks in buildings. The proposed wireless sensor network was implemented in a field experiment covering three collective residential buildings located in the metropolitan area of Paris. The sensor network consists of large number of 179 sensors on a long-time monitoring period of a few years and a wide variety of parameters such as energy consumption, indoor environment quality, occupants’ behavior, and local meteorological conditions. The collected data are used to assess the performance of the buildings after refurbishment in terms of energy consumption and indoor environmental quality and to accurately characterize occupant behaviors and usages that are of particular interest to enrich building energy models. Observations from the collected data show energy consumption of the renovated buildings in agreement with expected energy savings calculated by an engineering office, many different occupancy patterns mainly related to the professional situation of the households, and seasonal variation in window opening rates. On the one hand, the CO


Based on the career theory of Cognitive Information Processing (CIP), we selected scale items from literature reviews and expert guidance. The scale consisted of 28 items with 4 factors . To test the scale’s factor structure, we used confirmatory factor analysis (CFA), and the model was modified according to CFA results. The second-order confirmatory factor analysis was applied to the model of the scale to prove the rationality of the total score. The internal consistency were evaluated using Cronbach’s alpha coefficients. In addition, the composite reliability (CR) and average variance extraction (AVE) of the scale were also calculated to test the convergent validity. After related analyses, the scale was proved to have good psychometric properties, which can be used to measure junior high school students’ career planning level in information technology course from the aspects of interest, ability, values, and personality. The effect of the first-order confirmatory factor analysis model constructed in this study is not ideal. Therefore, on this basis, a second-order confirmatory factor analysis model is constructed in combination with existing literatures, and the rationality of the model is verified through data, which highlights the novelty of this study. It is necessary to carry out career planning education and measure the level of career planning in primary and secondary schools. Because in China, the current educational philosophy holds that the starting point for students’ career planning should be during university education, and students are offered career planning courses when they face problems obtaining employment. However, for students at this stage, the study time of career planning is too tight to improve the level of career planning, and it cannot play a corresponding auxiliary role in the process of students seeking jobs. Therefore, career education should start from the more basic grade. It is very necessary to carry out formal and orderly career education to students in the process of their growth or to carry out conscious career education penetration to students in other disciplines . As ChinChinese college students’ career planning education originates from the Western career guidance theory system. Since the introduction of higher education into China, college students’ career planning education has been rapidly applied to the employment education of Chinese college students, providing corresponding guidance and planning for college students who are about to prepare for employment . CollegeCognitive information processing (CIP) here refers to the vast area inside cognitive psychology that approaches human perception from the standpoint that a human is an active information processing participant . CIP theThe information technology education is to provide students with relevant and rigorous educational experiences to enhance their career awareness in the field of information technology  develop a career planning level scale for use by junior high school students taking information technology course; and (b) provide students with targeted career guidance according to the test results to improve their level of awareness of the vocational application of their information technology course.As far as we know, there are relatively few scales based on CIP-based career theory development to test the career planning level of students in junior high school information technology courses. This research fills this gap, which is where the innovation of this paper lies. In addition, helping students in junior high school information technology course understand their career plans is also conducive to stimulating their learning interest and motivation, and is also of great significance in improving academic performance and career planning levels.The Psychology of Careers in 1957, in which he proposed that “career is the process of all positions that a person experiences in one’s life (p. 20).” He discussed the twelve basic propositions and five development periods of career development, thus laying the foundation for the theoretical framework of career development  management course. Information technology course is practical course which pays attention to social reality, social needs, and social problems; is close to the real lives of students; and aims to help students solve practical problems. Students in junior high school must pass information technology course, which play an important role in the progress of students’ learning and social development. The core literacy of the information technology discipline consists of four aspects: information awareness, computational thinking, digital learning, and information responsibility . JudgingIn China, in order for students to comprehend and master the fundamental knowledge and abilities of information technology, information technology course in primary and secondary schools need to inspire learners’ interests and attitudes toward learning. Students can make full use of information technology to solve the problems, such as information collection and processing, software operation and document processing, and the use of programming to solve real life problems, which would also improve their capacity for original thought .In 1975, the American scholar Fintzy once pointed out that the continuous integration of careers education into discipline teaching is the most feasible and meaningful way to apply careers education . InformaIn China, career and technical education is an important part of post-secondary education and an important channel to increase employment and promote economic development . In geneTo sum up, combining the training objectives of careers education with information technology can not only cultivate students’ career planning ability, but also improve their information literacy, which will provide students with inspiration when it comes to their future career planning.In order to better compile the scale, this study draws on the current relatively mature career theories, such as CIP theory.CIP is a theory of career problem solving and decision making developed by a research team at Florida State University . CIP theIn the early 1980s, Peterson creatively applied CIP theory to career counseling for the leading research group in the field of cognitive psychology and created an information processing pyramid model at the information processing level . The CIPMore than 180 empirical studies have built on CIP theory and demonstrated its applicability in occupational intervention research . CIP theTherefore, designing a career planning assessment scale based on CIP theory can help students understand their career planning level and have a positive impact on students’ career decision-making status and skills, their knowledge of the next steps, and their sense of career experience.In the existing career planning measurement scales, the sample measured by this type of scales mostly concentrated in high schools, especially in colleges, and there are currently few career planning scales for junior high school students. In addition, existing career planning scales mostly measure the influencing factors of professional career planning, the mediating role of self-efficacy on students’ career planning, obstacles in students’ career planning, and the role of various teaching methods in vocational or university majors, etc., .Based on the above, this study focuses on designing a scale to measure the level of students’ career planning with the information technology course as the context and junior high school students as the research sample. To a certain extent, it is innovative, making up for the lack of current career planning scales for junior high school students and information technology course-specific backgrounds.ageM = 13.48, SD = 0.914, boyN = 126) to test the scale using cluster sampling method. These students come from different places with different backgrounds and can represent middle school students in Jinan. Their guardians signed a form to give consent for the students’ participation in the study. The research received ethical approval from the Ethics Board of the authors’ institution. Guardian of the children completed consent forms after being advised that the data they submitted was private and confidential. We certify that all participants in our study gave their consent for us to utilize their data for academic research and publication.In this study, we selected students from a middle school in Jinan, Shandong, China, and randomly selected 252 students  As the mature theoretical support, a review of the literature relating to CIP theory was carried out ; (2) we In order to verify the rationality of the generated items and the validity of the questionnaire, we carried out discrimination analysis, item-total analysis and confirmatory factor analysis, respectively. The career planning scale developed in this study is based on CIP theory. Because the four factors and the corresponding items are proposed before analyses, just like previous scholars, this study only conducted confirmatory factor analysis .p < 0.05). Therefore, no items needed to be deleted at this stage.The sample results were divided into high group and low group according to the score of top 27% and bottom 27% . As showThe analysis of correlation between item and total score aims to examine the relationship between each item and the total score of the scale. Items that were not significantly correlated with the total score of the scale were not desirable and were therefore removed from the scale . After aAs mentioned above, because the four factors and the corresponding items are proposed before analyses, exploratory factor analysis was not performed, and this study only conducted confirmatory factor analysis .χ2/df = 2.36, CFI = 0.797, TLI = 0.777, RMSEA = 0.109). According to the revised proposal, we made corresponding corrections to the original model, putting Q16 in factor 1, and linking Q20 with Q21, thus obtaining a new model. As illustrated in n = 115). The standardized factor loadings, which are depicted in When the CFA was conducted for the first time, we found that the indicators derived from the analysis showed that the original model  did not fit well (According to n = 115) as the subjects, a second-order CFA was conducted for this model, as shown in Based on the first-order CFA, we found that the correlation coefficient between the four factors was at a high level, so we speculated that there was a common high-order factor for these four factors. Therefore, on the basis of the first-order CFA, taking sample A (As shown in From the correlation matrix among the various dimensions listed in n = 137) again. The results of the second-order CFA for sample B . This is the main theoretical source and basis of our questionnaire compilation . FinallyAlthough this study provides a measuring tool for the career planning of junior high school students taking information technology courses, there are still some limitations in the research process.First of all, the sample of this study is limited with participants mainly recruited from a province in eastern China. Therefore, the results may not be universal in the case of large economic and cultural differences nationwide.Second, the scale was produced in China, and the values dimension item in the scale is likely to be influenced by Chinese culture, so it is uncertain whether the measurement standard will change in different cultural contexts; therefore, it is necessary to apply relevant research designs in different cultural contexts to improve the application of the scale.Finally, due to the influence of COVID-19 in recent years there have been employment difficulties. The emergence of the epidemic might have a certain influence on students’ career planning. This study did not treat it as a potential factor; future research needs to explore the potential impact of epidemics and other factors.In addition, we will continue to collect evidences on criterion-related validity in subsequent studies.Based on CIP theory, we developed a career planning scale suitable for use in junior high school information technology course. After related analyses, the scale developed was shown to have good psychometric properties, which can be used to measure junior high school students’ career planning level in information technology course from the aspects of interest, ability, values, and personality. What’s more, this study proved that the existence of the second order model of the questionnaire, which means a common factor explains the variance of the four dimensions.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by Shandong Normal University. Written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin.PW, TL, ZW, XW, JJ, JX, XS, and BD contributed to the study conception and design. XW, XS, and JX performed the material preparation, data collection and analysis. TL wrote the first draft of the manuscript. JJ contributed to drafting the literature review, discussion. PW, ZW, and BD as well as all authors commented on previous editions of the manuscript and the overall editing of the manuscript. All authors contributed to the article and approved the submitted version.This research is supported by the “Special Creation and Integration” Characteristic Demonstration Curriculum Construction Project of shandong Normal University in 2021 [grant no. SDNU2021ZCRH025], and the project of Jiangsu Pro vincial Key Constructive Laboratory for Big Data of Psychology and Cognitive Science [grant no. 72592062001G], and Weifang Institute of Technology 2022 annual university-level humanities and social science project [grant no. SK-X202203].The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Sport is an evidence-based strategy for improving mental and physical health, and climbing is a type of sport that may positively impact both. The aim of this study is to test the effect of a manualized, psychosocial group climbing intervention on the well-being, distress, self-efficacy, and social cohesion of adolescents in Lebanon. In addition, the mechanisms behind psychological changes will be investigated. (2) Methods: In this mixed-methods waitlist-controlled study, we are allocating a minimum of 160 participants to an intervention (IG) or a control group (CG). The primary outcome is overall mental well-being (WEMWBS) after the 8-week intervention. Secondary outcomes include distress symptoms , self-efficacy , and social cohesion. Potential mechanisms of change and implementation factors are being investigated through qualitative interviews with a subgroup of 40 IG participants. (3) Conclusions: The results may contribute to knowledge of sports interventions and their effects on psychological well-being and will provide insights regarding low-intensity interventions for supporting adolescent refugees and host populations in conflict-affected settings. The study was prospectively registered at the ISRCTN platform . ISRCTN13005983. Lebanon is severely burdened by an ongoing economic crisis, political gridlock, hyperinflation, unemployment, and an outdated infrastructure. Problems have been significantly amplified by the 2020 port explosion and the COVID-19 pandemic. In an attempt to protect an already underfinanced healthcare system, the Lebanese government enforced a strict lockdown that may have saved lives from COVID-19, but led to an exacerbated crisis in addition to the already struggling economy, and interrupted education for approximately 1.5 million children .In the Bekaa region of Lebanon, where most Syrian refugees reside, the situation for both the Lebanese host community and Syrian refugees has deteriorated throughout the ongoing economic crisis. Nearly 70% of income-generating household members in the Bekaa are children between the ages of 4 and 18 years, and therefore, around 40% of Syrian refugee children are not enrolled in any type of schooling .Adverse living conditions, human rights violations, and ongoing stressors have a detrimental effect on mental health. Children and adolescents are an especially vulnerable group . ConsideIn nonhumanitarian settings, the positive effects of sport and physical activity have been widely researched. Regular participation in physical activity and sport is associated with improvements in symptoms of depression in adults  and adolClimbing as therapy has been shown to reduce symptoms of depression in adults in at least two studies involving randomized controlled trials ,41 and hThe aim of the study is to test the effectiveness of a climbing intervention among adolescent locals and refugees living in the Bekaa region of Lebanon. We hypothesized that the climbing intervention will have a beneficial effect on participants’ psychological well-being. Additionally, we are investigating the impact of the intervention on, and the relationships between, self-efficacy, psychological distress, participants’ perceptions of other nationalities , and social cohesion.To gain insight into the modes of action and potential benefits that are specific to culture and living conditions as well as barriers and facilitators of the intervention, we are conducting qualitative interviews with a subsample of participants, balanced for age, sex, and intervention subgroup.Psychological well-being is being measured with the WEMWBS . The parSymptom severity of distress, self-efficacy, and social cohesion outcomes are being measured. Additionally, qualitative interviews are being conducted with at least 30 members of the IG and analyzed using content analysis as described by Mayring .The research is designed as a waitlist-controlled trial, with the implementation of a manualized climbing intervention for Lebanese adolescents and adolescent refugees living in the Bekaa region of Lebanon. The plan is for the CG not to receive any study-specific intervention while the IG receives the intervention, but the CG members will be invited to participate in an upcoming cycle of the climbing program. Members of the CG will, therefore, be offered the same intervention as the IG after their waiting period. For the individual participant, the study duration will be up to approximately 12 weeks with 8 weeks of intervention see , followeThe target population of the study includes adolescents (refugees and those from the host community) living in the Bekaa valley in Lebanon.Between the ages of 14 and 19;Informed consent for participation in the study from adolescents as well as legal guardians (adult relatives), particularly for data collection, pseudonymized data storage, and analysis;Availability and the ability to come to the climbing intervention and to participate in the data collection;Living in the area limited by Zahle (N), Deir Zenoun, Marj (S), and Qab Elias/Bouarej (W).Inclusion criteria:Physical contraindications ;BMI < 18.5 or >35.Exclusion Criteria:To provide access to the climbing program to as many adolescents as possible and to ensure high representativeness of the sample, the adolescents are being recruited through several outreach channels . Informational material is being distributed and events are being held in schools and refugee camps to inform adolescents about the climbing program. A social media campaign is also being launched. Parents or  guardians can use an online form to apply to participate in the program and, thereby, provide informed consent. If the inclusion criteria are met, the adolescents are then invited to attend a first trial session to determine whether they want to participate. If they are interested in participating, inclusion and exclusion criteria are verified by the study personnel, and the adolescents and their parents are asked to provide written informed consent. The written informed consent of the parents/legal guardians are gathered through personal communication between a trained staff member of ClimbAID and the respective guardian to make sure that every participant and their legal guardians understand the study conditions.Since 2017, the “Climbing for Peace” project of the Swiss nonprofit organization ClimbAID has been using climbing as a tool to build inclusive communities, improve mental well-being, and address social problems in projects with young people from host and refugee communities in Lebanon. The PSS program “YouCLIMB” investigated in this study is based on climbing therapy and experiential education. It was developed to improve the physical and mental well-being of young people and to help them develop social and life skills. The activities are being led by four local facilitators who are trained by a certified climbing instructor (Swiss J + S Course Instructor Sport Climbing). In addition to the sport-specific training, the coaches are trained in PSS facilitation, child protection, and mental health first aid and are supervised by a social worker and a climbing therapist.Each session begins with a welcome, a reminder of the group rules, and an introduction to the theme and goals of the session. After a breathing meditation exercise, there is a warm-up routine, which is jointly led by the group. In the activity part of the session, the group works through experiential climbing activities and games that are designed to convey and experience the objectives of the session. Session 3, for example, features the game “Three-legged Climbing” to demonstrate the module topic of teamwork and cooperation. In this game, two players are connected by a string at their ankles and must work together to climb on a climbing wall. Success requires full focus, empathy, clear communication, trust, and respect—all elements of teamwork and cooperation.Sessions 5 and 6 focus on communication and conflict resolution, providing theoretical insights such as the “four sides of communication” by Friedemann Schulz von Thun  and “comThe CG initially receives no climbing intervention, but all participants are rewarded with 100,000 LBP (between $2.80 and $3.60 USD depending on the daily rate) after completing the posttest. After completing the IG-CG climbing cycle (8 weeks), participants in the CG will also be given an opportunity to participate in the YouCLIMB program.Due to culture-specific requirements and for organizational reasons, stringent randomization is not possible. For example, due to school exams, many participants are limited to only one of the three cycles. Some female participants are only allowed to participate if they are accompanied by another member of the family. To navigate this and to increase adherence to the intervention, the timing of the intervention  can be self-selected by participants, providing they are available at each time point when data are being collected. In addition, we are accommodating special requirements . Out of the actual eligible applicants, about 20% stated that their availability was limited to one of the three cycles. We are allowing such applicants to self-select the timing of their participation, thereby determining their classification as either CG or IG participants.Remaining participants are being allocated randomly. First, each applicant is being assigned a random number by using Microsoft Excel’s “=RAND” function. Then, applicants are being allocated to the CG or IG based on the parity of the random number’s thousandth digit, whereby if the thousandth digit is even, the applicant is allocated to the CG, otherwise the participant is allocated to the IG. Power calculation was performed using G*Power software   and the control group. Including the waitlist-control group (which will be offered the intervention after the study period), up to a total of 160 adolescents should thus be provided with a climbing program. Data collection is being conducted in groups of up to 12 participants with trained study personnel. Paper questionnaires are given to the participants. All literate participants are asked to fill out the questionnaires on their own. For those with reading difficulties, the questions are read aloud, and the response options are explained. The study personnel are trained not to influence the answers. All participants sit as far from each other as is necessary to safeguard their anonymity. All participants are informed that no one  apart from ClimbAID will be given information about their answers. The trained study personnel have the same cultural background (Syrian or Lebanese) as the participants to reduce misunderstandings due to different Arabic dialects. Complete data collection is also planned for dropouts, if available.Overall mental well-being is measured with the Arabic version of the WEMWBS  at both time points of the study. The WEMWBS consists of 14 items covering the emotional and functional aspects of mental well-being. Sum scores range from 14 to 70 with higher scores indicating higher overall mental well-being. An improvement of 3 to 8 points is regarded as clinically relevant . Psychological distress is measured with the Arabic version of the K-6 Distress Scale ,50. The Self-efficacy is measured with the Arabic version of the general self-efficacy scale (GSE) . The GSESocial cohesion is measured with a five-item set and an additional single-item measure from the ARK Regular Perception Survey. This survey is used specifically to analyze social tension throughout Lebanon. The items were modified to fit the situation experienced by adolescents. The five-item set uses a 5-point Likert scale ranging from 1 (very disagreeable) to 5 (very agreeable) to ask how agreeable five different scenarios are. The questions always refer to members of the other nationality, and the scenarios involve playing with or attending school with children of the other nationality, living next door to or sharing a workplace with a member of the other nationality, or having a family member who marries someone of the other nationality. In the additional single-item measure, participants are asked to rate how much they agree with the phrase: “Lebanese and Syrians share many values and have compatible lifestyles” on a 4-point Likert scale ranging from 1 (strongly agree) to 4 (strongly disagree) [Sociodemographic data: sex, age, school enrollment, nationality, living conditionsPhysical activityMedical conditionsClimbing experienceThe following variables are recorded as possible variables of influence or confounding variables in the questionnaire format:In addition, qualitative data are being gathered from at least 30 participants in the intervention groups. The sample is balanced according to age and sex, and participation is voluntary. These data are being collected via semi-structured qualitative interviews by trained personnel who are not involved in the intervention to investigate the acceptance and factors that affect the climbing program. The interview guidelines focus on the categories Reach, Effectiveness, and parts of the implementation according to the RE-AIM scheme by Holtrop et al. . It is dAll data collectors and qualitative interviewers, as well as the facilitators are thoroughly trained for their respective tasks by the study headquarter and the ClimbAID organization. Treatment adherence is documented with detailed session protocols. Quantitative data and all identifiable data remain within the ClimbAID organization. Only members of ClimbAID have access to the lists of the participants’ names and codes. All analyses are conducted on pseudonymized data. Published material will not contain any patient-identifying information.p ≤ 0.05. Mixed ANOVAs (time × group) will be used to determine differences between the groups. Additionally, regression analyses will be used to test the hypotheses and check for possible confounders. Differences between groups will be determined before analysis, and if there are significant differences in important sociodemographic variables, appropriate statistical methods  will be used. Secondary outcomes will be tested in an exploratory fashion with t tests for independent samples.The data analyses will be performed with the “IBM SPSS Statistics 28” software. To assess the quality of the group allocation, the baseline data from the intervention and control groups will be examined for statistically significant differences. All data will be investigated for plausibility. Participants who drop out of the study but are still available for the posttest will be interviewed subsequently. A missing data evaluation will be carried out, and missing values will be imputed with EM-Imputation . The priQualitative interviews will be analyzed with content analysis as described by Mayring , adherinThe authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. All procedures involving human participants were approved by the responsible Ethics Committee of the Antonine University Baabda . Informed consent is being obtained from all study participants before they enroll in the study. For minors, consent is being obtained along with written parental or caregiver consent. When the data are analyzed and the results of the study are published, the names and identities of the participants will not be used. Participants are free to leave the study at any time without supplying a reason and with no further consequences.In case of an accident requiring medical treatment during the intervention, the participant will be taken to an appropriate medical care provider. Fees will be paid by ClimbAID and the insurance of its Lebanese partner Arcenciel (owner of the land and the facility).Mild AEs in the IG: all sorts of bruises or scratches or other minor superficial injuries that are transient and do not require treatment;Moderate AEs: injuries that are transient but require medical treatment, such as ligament ruptures or sprains, broken bones in legs or arms;Severe adverse events (SAEs): severe head injuries, spinal cord injuries, death, suicide attempts.Definition of adverse events (AEs): Termination rules: If an SAE occurs in the IG during the intervention, the program will be terminated if the intervention is determined to be directly responsible for the SAE.In the case of moderate AEs, the intervention will be terminated if there are three more AEs in the intervention than in the waitlist group, if the AEs are determined to be a direct result of the intervention. Mild AEs will be recorded but will not result in the termination of the program.This is the first study to investigate the effect of a psychosocial bouldering intervention with adolescent refugees. The intervention is being carried out in Lebanon, which is one of the countries with the highest per capita intake of refugees  and willThe results of the study may contribute to knowledge about sport interventions and their effects on psychological well-being. Knowledge regarding novel, low-threshold intervention to support adolescent refugees residing in disadvantaged surroundings is urgently needed. The climbing intervention has a slight risk of injury, comparable to the risk involved in other sport interventions. In previous studies conducted by our own research group with around 5000 bouldering hours, no severe adverse events have occurred. Nevertheless, any accidents and potential AEs, including suicidal behavior or accidents resulting in injuries, will be documented by the trainers/facilitators for the IG and by the study headquarters for the CG. Regular interim evaluations will be made, and in the case of SAEs in the IG, the intervention will be terminated. As with any activity involving transportation in a motor vehicle, there is always a risk of injury, permanent damage, or death from accidents. The responsible NGO always tries to keep the risk of accidents as low as possible and therefore only works with reliable and trustworthy transportation service providers who comply with the relevant legal provisions and safety regulations. Participants are brought by exclusive buses to and from the intervention, and the bus driver is accompanied by ClimbAID staff to provide a safe environment for all participants, especially female participants. In the case of an AE requiring medical treatment, ClimbAID will cover the patient’s costs, thus ensuring adequate treatment.The strengths of the study are the large sample size, the existence of a control group, the mixed-methods approach, the use of manualized treatment options, the naturalistic setting, and therefore, the pragmatic nature of the evaluation of a real-world program. One limitation is the lack of randomization. In this specific study, randomization may also have been a limitation because it may have resulted in the exclusion of female participants for cultural reasons. Being female in a refugee context is a risk factor for mental distress, especially depression . Syrian Another potential limitation is that the bouldering intervention cannot be blinded with respect to facilitators or participants. All outcome measures are self-assessed and, therefore, are also not blinded. Third, in the absence of exclusion criteria regarding possible diagnoses or levels of psychological distress, it is possible that we will obtain a heterogeneous sample, with the associated advantages of a naturalistic design and low-threshold intervention and the disadvantages of potentially diluted intervention effects.The study is expected to contribute knowledge on the implementation of a psychosocial boulder intervention and its impact on psychological well-being, stress and self-efficacy among adolescent refugees. This can also generate knowledge about the implementation of low-threshold interventions to support adolescent refugees and the host population, as well as social cohesion in conflict-affected areas.


The concept of customer satisfaction is gaining hold in all corporate sectors worldwide, and a satisfaction survey is used as a tool to discover service problems and as a chance for customers to rate their experience with health care services. A high degree of patient satisfaction with the services given has been found in numerous studies conducted in Malaysian public health care facilities. However, there is limited information available on caregiver satisfaction with pediatric clinics run by the Ministry of Health (MoH) of Malaysia.This was the first research performed at a public hospital’s pediatric clinic, which was the first hospital to adopt the public-private-partnership model under the MoH, with the aim of discovering the prevalence and factors affecting the satisfaction of caregivers at the national referral center.Cross-sectional research using the standard self-administered SERVQUAL questionnaire was conducted among caregivers accompanying their children to the clinic. The questionnaire consists of 16 paired statements to evaluate their expectations and experiences with the clinic services.A total of 459 caregivers were involved in this study with a majority aged between 30 and 39 years . Caregivers from the Indian community  and lower income groups , and those with lower educational backgrounds  were more likely to be satisfied with the quality of pediatric clinic services. Housewives/househusbands , on the other hand, appeared less likely to be satisfied with the services provided during their visit to the clinic. Looking at overall patient satisfaction, 50.5% (n=232) of caregivers demonstrated satisfaction with the quality of services, compared to 49.5% (n=227) of dissatisfied respondents.This paper suggests that, although most caregivers are satisfied with the services, greater emphasis must be placed on delivering reliable service in response to the MoH’s mission to provide quality and integrated people-centered health services in Malaysia. Consumer satisfaction plays an increasingly important role in reforming health care quality and delivery in general across the United States and Europe . The IntPatient satisfaction serves as an objective indicator of experiences, health outcomes, and trust with the health care system, representing whether the care provided has satisfied the patient’s needs and expectations . BesidesThe Ministry of Health (MoH) of Malaysia began its quality assurance program in the 1980s and has implemented many initiatives to improve the quality of health care delivery and enhance customer satisfaction, which includes the Client’s Charter and the acculturation of corporate values among employees who are caring, professional, and exercise teamwork . MalaysiThe government has continuously committed itself to health care equity and accessibility, with the public health sector financing almost 95% of the cost of treatment and subsequently providing access to health care for more than 90% of its population . MalaysiMany studies conducted at public health care facilities in Malaysia have shown a high level of patient satisfaction with the services provided . HoweverThis cross-sectional study was conducted at the Tunku Azizah Hospital, Kuala Lumpur, Malaysia. Participants were caregivers to children seen with an appointment at the clinic. Exclusion criteria were foreign nationals, refusal to participate, cognitively unsound, caregivers who could not read, and patient visiting for the first time. Only participants who met the eligibility criteria and agreed to participate in the study were enrolled.The minimum sample size required was 364, which was calculated using the Raosoft (2004) online sample size calculator with a 95% confidence level, 0.5 SD, margin of error (CI) of 5%, and population size of 6714 (the monthly patient average). A total of 600 questionnaires were distributed to the clinic, and we received 502 responses, giving a rate of 83.7%. Of these 502 responses, 43 were unusable and were excluded from this study, and the remaining 459 (91.4%) questionnaires were analyzed. Some 2238 patients were registered for an appointment at the clinic during this data collection period.This study was conducted at the hospital’s Paediatric Specialist Clinic by convenience sampling using a self-administered structured questionnaire. Every third registering caregiver was identified and given the questionnaires after seeing the doctor and while waiting for the date of their next consultation. Upon completing the questionnaire, participants were instructed to put it into an enclosed envelope. The sealed envelope is then passed to the nurse at the clinic counter.Participants were recruited for 7 working days from September 3 to 12, 2019, upon receiving approval from the Medical Research and Ethics Committee . The goals and advantages of the study were explained in a verbal and written form attached to the questionnaires. Participants were assured of confidentiality in their involvement and that this would not have an effect on their treatment. They were reassured that their personal data would not be stored or used in any way possible and that their responses would only be used to enhance healthcare services. Informed consent was obtained from parents or guardians who agreed to participate. Following this study, only the data collection, findings and conclusions of this research have been published and any personal information collected from the participants is subject to confidentiality.The principal researcher and two nurses were responsible for this data collection. This was part of a hospital-level survey assessing satisfaction among caregivers attending the clinic using the SERVQUAL instrument. SERVQUAL was initially developed for use in the marketing industry . The SERThere are nine dimensions in this SERVQUAL tool, which includes the five original characteristics: tangibles, reliability, responsiveness, assurance, and empathy. Service outcomes and three other dimensions were included, including the core values of the MoH corporate culture: caring service, teamwork, and professionalism . The curThe first part of the survey, which addressed the demographics of the respondents, was modified to include demographics of pediatric patients visiting the clinics. Sociodemographic data included independent variables such as the caregiver’s age, gender, race, marital status, education, employment sector, and household income level. These followed by age and gender of the child (patient), relationship with the caregiver, subspecialty that is being visited, waiting time, and the main problem encountered at the clinic during their visit.The second section included the SERVQUAL tool, which contains 16 statements related to the respondents’ expectations on quality of service and 18 statements concerning their perception (experience) with the quality of service delivered. A 5-point Likert scale was used, ranging from “strongly disagree” (1) to “strongly agree” (5), with no verbal labels for scale points 2 through 4.The data were coded, entered in Excel (Microsoft Corporation), and analyzed using SPSS version 21 (IBM Corp). Primary data on 459 responses were analyzed to examine satisfaction with services provided at the clinic. Sociodemographic characteristics of caregivers and patients and patient’s clinic visits were analyzed using descriptive analysis.Each component from the satisfaction questionnaire was analyzed using a chi-square test. To describe caregivers’ and patients’ demographic profiles, a descriptive model with frequencies and percentages were developed. The median score of expectations and perceptions of caregivers and the mean gap scores for 16 paired items were evaluated. The difference in the mean values of perception and expectation for each component determined the caregiver’s satisfaction. This methodology assesses service quality by measuring the discrepancy (gap) between caregivers’ perceptions and expectations . “P” reflects the perception of the caregivers, and “E” refers to expectations of service delivery before encountering the actual service ,25. If tP=.04 was considered to be statistically significant.Scores of four and five were considered to be satisfied, and the percentages were determined, while the other scores were considered to be dissatisfactory for the expectations and perception components. The Wilcoxon signed ranked test was used to make a comparison of distributions of expectations and perceptions. A logistic regression model was used to estimate the odds ratio (OR) and 95% CI for overall satisfaction level. The mean was computed for all gap scores of 16 paired statements, and an average of zero and higher is considered satisfied. The sociodemographic characteristics of respondents and patients are summarized in Crude and adjusted ORs (AORs) with 95% CIs of the factors associated with the overall satisfaction of caregivers with the quality of services provided are demonstrated in Looking into the overall satisfaction of the patients with the quality of service encountered at the Paediatric Specialist Clinic, it can be derived that 50.5% (n=232) of caregivers demonstrated satisfaction with the quality of services, as opposed to 49.5% (n=227) of the respondents being unsatisfied.Tunku Azizah Hospital is the first public-private-partnership (PPP) project in Malaysia under the MoH, using the private finance initiative (PFI) model. This facility was initially known as the Kuala Lumpur Women and Children Hospital but was renamed in January 2020 to commemorate the present Queen. The hospital started operations in phases from February 2019, and the Paediatric Specialist Clinic was the first to offer its services to the public. To our best knowledge, this is the first paper that discusses the factors affecting overall caregivers’ satisfaction and identifies areas of dissatisfaction in a pediatric clinic run by MoH in Malaysia.As can be seen from the results of the analysis, there was a negative satisfaction gap in all dimensions, suggesting that none surpassed the expectations of the caregivers. This result is also consistent with another study carried out in Singapore  using a Overall, 50.5% (n=232) of caregivers were satisfied with the pediatric clinic and the quality of services provided during this study period. This result is in contrast with another study by Aniza et al  that wasThere was evidence that respondents with lower educational levels and household income, and those of the Indian community have better satisfaction with health care services at the clinic. Several authors have found that demographic characteristics, such as gender, age, and education, were strongly linked to respondent’s satisfaction. Although satisfaction levels were not significantly associated between age and gender in this study, their prevalence in other studies was significant, where males were found to be more satisfied than female respondents ,29. AnotThis study found a statistically significant inverse association between the level of education and the satisfaction of caregivers, which is comparable to other studies, indicating that respondents who were less educated were more satisfied than those with higher education -35. ThisOne interesting observation from this study is that the housewives/househusbands had a relatively lower satisfaction level at the clinic, which is similar to another published study . This coIn this research, all statements and dimensions revealed negative satisfaction scores indicating that none met the expectations of the caregivers. However, caregivers’ experiences from this study point out that the staff in the clinic had shown politeness and good work discipline, and that the public toilets were clean. Caregivers were the least satisfied with the waiting time and had concerns with services not being provided at the promised time. A study conducted in France also suggested dissatisfaction among patients with waiting times . The MoHThe respondents also pointed out better than expected experience with the visual appeal of the health care infrastructure. As this facility is a PPP project, it has integrated certain nonconventional elements into its architecture and design that reflect sociocultural, economic, professional, and aesthetic priorities. This reflects and reinforces contemporary concepts of patienthood and caring, and projects the implementation of patient-centeredness.Caregivers’ satisfaction with services can be assessed based on the following service attributes as highlighted by Parasuraman et al . The fivCaregivers had the highest expectation for service outcomes, and they also had the best experience with the outcome of their visits to the outpatient clinic, which indicates that they were pleased with the consultations or treatments they got. However, the “reliability” dimension needs to be substantially enhanced, as this had the most substantial satisfaction gap. The care providers should focus on reducing the waiting time in the clinic and mobilizing resources to enhance customer satisfaction further. While the “tangibles” dimension had the lowest satisfaction gap over all other dimensions, it is equally important to clean, maintain, and gleam the building premises. Maintaining the building premises is essential to maintain the properties and protect the inhabitants of the building. Proper building maintenance ensures that the building and the environment remain secure, clean, and safe to function.There were some limitations to this study. First, we carried out our study at a tertiary, national referral center run by consultants, trained specialists, and postgraduate trainees, which differs from those in primary public clinics, which are mostly run by medical officers without postgraduate qualifications. Therefore, the results of our study cannot be generalized to reflect the performance of other clinics in this region. Since the questionnaires used were self-administered, patients who were illiterate were not recruited. Besides, convenience sampling, while unavoidable, is another drawback to this research due to the high probability of bias in sampling. Hence, the findings may not be generalized to the broader population. Additionally, not all aspects of the services, such as pharmacy and prescription drugs, have been evaluated in this study. These factors have been found to influence patient satisfaction significantly ,40. ThisWe believe that future surveys with questionnaires should avoid using all positively expressed statements to assess service quality. It would mitigate the overall bias if there were a combination of positive and negative framed statements . AdditioThe purpose of this paper is to demonstrate how caregivers’ perspectives are influenced by various aspects of clinic services, as well as to assess the differences between what they expect and what they experience when engaging with a public health care facility. The study looked at data from a survey that measured caregiver opinions across several dimensions and found that the service outcome dimension was assigned the highest weight, and the pediatric clinic met expectations. In addition, respondents from lower income groups, Indian ethnicity, and those with less education were more appreciative of the services offered.Regardless, consistent measures must be put in place to increase customer satisfaction, which will strengthen health care delivery standards. The incorporation of patient-centered care as a strategic investment goal, as well as the development and implementation of constructive, organized strategies that involve frontline clinicians in the process of improving caregiver satisfaction, will benefit hospital management. Routine satisfaction assessments should be conducted using improvised questionnaires or other tried-and-true methods to identify unsatisfactory domains that require substantial improvements. These measures will ensure that the services provided are in line with the MoH’s mission of providing quality integrated, people-centered health care to the masses. Future studies may be able to compare additional hospitals that use the PFI model, as well as provide more information about the variations discovered in this study.