# Quality Assessment Indicators for Well-Child Care in Primary Health Care: A Scoping Review of Global Trends, Standardization, and Dimensions of Care

## TL;DR

The paper finds that quality indicators for well-child care in primary health care lack standardization and often ignore relational aspects like communication and family-centered care.

## Contribution

The study identifies a critical gap in the use of standardized and relational quality indicators for well-child care globally.

## Key findings

- Most studies use non-standardized indicators focusing on structural and clinical aspects.
- Relational dimensions like communication and family-centered care are rarely included.
- A standardized core set of indicators is urgently needed for global comparability and quality improvement.

## Abstract

What are the main findings?
Most studies assessing well-child care quality in Primary Health Care (PHC) use heterogeneous and non-standardized indicators, mainly focusing on structural and clinical aspects.Relational dimensions—such as communication, satisfaction, and family-centered care—are rarely included, limiting a comprehensive evaluation of service quality.

Most studies assessing well-child care quality in Primary Health Care (PHC) use heterogeneous and non-standardized indicators, mainly focusing on structural and clinical aspects.

Relational dimensions—such as communication, satisfaction, and family-centered care—are rarely included, limiting a comprehensive evaluation of service quality.

What are the implications of the main findings?
There is an urgent need to develop and validate a standardized core set of comprehensive indicators that integrate structural, clinical, and relational components.Linking these indicators to national information systems (e.g., e-SUS) can strengthen evidence-based management and advance the monitoring of child health goals aligned with the 2030 Agenda for Sustainable Development.

There is an urgent need to develop and validate a standardized core set of comprehensive indicators that integrate structural, clinical, and relational components.

Linking these indicators to national information systems (e.g., e-SUS) can strengthen evidence-based management and advance the monitoring of child health goals aligned with the 2030 Agenda for Sustainable Development.

Background/Objectives: Well-child care plays a critical role in promoting child health and monitoring growth and development within Primary Health Care (PHC), in line with international frameworks such as the WHO Global Strategy and the UN Sustainable Development Goals (SDGs). However, the absence of standardized quality indicators limits comparability across studies and hinders continuous improvement worldwide. This study aimed to map and analyze the indicators used to assess the quality of well-child care in global PHC settings. Methods: A scoping review was conducted following PRISMA-ScR and Joanna Briggs Institute methodological guidance, with a pre-registered protocol. Comprehensive searches were performed in May 2025 across fourteen databases and two gray literature sources, without language or time restrictions. Eligible studies assessed quality indicators for well-child care among children up to 5 years, 11 months, and 29 days. Two independent reviewers performed study selection and data extraction. Results: From 6052 records, 62 studies met inclusion criteria. Out of them, most (68%) used composite indicators, primarily from pre-existing tools (67%). While structural and clinical indicators—such as immunization and service accessibility—were predominant, there was a critical absence of relational indicators focusing on patient–provider interaction. This lack of standardization and neglect of the relational dimension significantly hinders international comparability and the assessment of family-centered care quality. Conclusions: Developing and validating a core set of standardized, comprehensive, and context-sensitive indicators integrating structural, clinical, and relational dimensions is essential. These should be linked to information systems to enable robust national and international comparison, strengthen evidence-based management, and drive continuous quality improvement to achieve the 2030 Agenda goals. These findings provide a foundation for policymakers to develop standardized monitoring tools that prioritize neglected relational aspects of care.