A Model of Satisfaction Promotion for Students of Hormozgan University of Medical Sciences in Iran

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http enrollment rate has increased, moving towards excessive centralism with the intensification of a small growth in the student population (6,7). However, increasing the enrollment rate does not indicate the quality of higher education services, since service satisfaction is the distinguishing factor in a competitive market. Therefore, student satisfaction is a determinant in evaluating higher education institutions (8). In this regard, the quantitative and qualitative improvement of different levels of services of the medical sciences universities, which deal with the treatment of patients in educational and medical centers, is one of the important concerns of education officials (9,10). Fujii and Lee stated that surveying students about their level of satisfaction with the quality of services is the most obvious way to measure the success of universities (11).
Numerous factors affect student satisfaction. The importance of student satisfaction has been studied from different perspectives in domestic and foreign studies (4,(12)(13)(14)(15)(16)(17). Therefore, considering the role and importance of the position of the medical sciences universities in manpower training and the role played by students in promoting community health, as well as the absence of a model of satisfaction promotion in these universities, this study was designed to present a model to improve the satisfaction of students of Hormozgan University of Medical Sciences in Iran.

Materials and Methods
This is an applied quantitative research. The statistical population of the present study consisted of students of Hormozgan University of Medical Sciences. The sample size was selected as a multi-stage cluster in order to collect quantitative data. Out of 1591 students, 380 were selected as the sample size using Cochran's formula. Data collection was performed using a researcher-made questionnaire scored based on a 5-point Likert scale (ranging from 5 = strongly agree to 1 = strongly disagree). To prepare the assessment tool, the researcher studied the issues and views on the basics and theoretical framework and used views of education management experts. To ensure the content validity, the questionnaire was sent to ten education management experts before being distributed, and its validity was calculated using the content validity ratio (CVR) method (0.81). The reliability of the questionnaire was calculated as 0.94 using Cronbach's alpha method.
For quantitative data analysis, the decision-making trial and evaluation laboratory (DEMATEL) method, importance-performance analysis (IPA), as well as MATLAB and Excel software were used. Table 1 shows the degree of importance and performance of each dimension of student satisfaction in Hormozgan University of Medical Sciences. The value of the performance threshold for the satisfaction of students was equal to 1.70 and the value of significance threshold was equal to 4.37.

Importance-Performance Analysis (IPA)
The IPA is as follows: The research dimension was in the acceptable quarter, which is very important for students' satisfaction. Although the university's performance in this dimension was weak, it was better than other dimensions of satisfaction. So, the university must continue the current strategy. Figure 1 show the educational dimension was in the acceptable quadrant. From the students' point of view, this dimension was very important for their satisfaction. Although the performance of the university in this dimension was weak, it was better than other dimensions of satisfaction. So, the university must continue the current strategy.
The welfare and support dimensions were in the quarter of weakness. These components were very important for the students, but the performance of the university in these dimensions was poor. So, the university must invest in these dimensions.
The administrative and managerial dimensions were in the quarter of indifference, indicating that although these dimensions were very important for the students, they were less important than other dimensions, and the university did not perform well in this regard.
The administrative and managerial dimensions were in the quarter of indifference, indicating that although these dimensions were very important for the students, they were less important than other dimensions, and the university did not perform well in this regard.
To determine the priority for improvement, the weight of qualitative characteristics was calculated. According to Wu et al (18), the gap between the value of significance and the performance of the j-factor multiplied by the value of its significance can indicate the weight of the qualitative characteristic of the jth. Table 2 shows the weight and normalized weight of the students' satisfaction dimensions. Now, the characteristics that have more normalized weight should be given higher priority for improvement. The weight calculated for the characteristics indicated that according to the amount of normal weight for each of the

Determining the Effectiveness of Student Satisfaction Components Using DEMATEL Method
The S matrix is formed, which represents the intensity of the relative effect of direct and indirect relationships ( Table 3).

Calculating the Threshold and Determining the Relationships Between Impact and Effectiveness
The threshold is equal to the first quarter of the total elements of the matrix S. The value of the first quarter for the matrix element S was equal to 0.227. Therefore, values less than 0.227 were assumed to be ineffective. So, the training dimension had little effects on the management, administrative, or supportive dimensions. Based on the calculations by Matlab 2020 software, the values of (R), (J), (R + J), and (RJ) were obtained (Table 4). Accordingly, the effect of the educational dimension (EDU) was equal to 1.405 and its effective value was equal to 2.032. Therefore, the amount of interaction (total effect and effectiveness) of this dimension was equal to 3.437.
Given that the value of the difference in effectiveness and its effectiveness was equal to -0.627, this dimension had a pure effectiveness. In other words, it affected the rest of them more than it affected the other dimensions. Information of other components is provided in Table 5. Figures 2, 3, 4, and 5 show the effect of the components relative to each other, the order of the effect of the dimensions relative to each other, the weight priority based on the interaction, and the priority based on the intensity of the net effect/effectiveness, respectively.
The weight and normal weight of each component of student satisfaction are shown in Table 6.
Finally, according to the data analysis and component weighting, the effectiveness of the final research model was presented ( Figure 6).

Discussion
This study aimed to present a model to improve the  The results showed that the research dimension was very important for students for their satisfaction and the performance of the university was appropriate in this dimension. Therefore, universities must maintain this dimension as it is. The welfare and management dimensions were at the expense of resources. These components were of little importance to students, but the performance of the university was high in these dimensions. This shows that the university had spent a lot of resources on these dimensions, which is not very important. Therefore, it is necessary to allocate a part of the costs and resources spent on these dimensions to improve the dimensions that provide satisfaction.
The administrative and educational components were in the quarter of indifference, indicating that these dimensions were not very important for students' satisfaction, and the university had not performed well in this regard. In other words, the university had a low performance in dimensions that were of low importance to students, which does not pose much of a problem.
The support services component was in the quarter of improvement and investment priorities. So, universities need to focus on this dimension for satisfaction. In other words, this dimension was very important for students' satisfaction but the performance of the university was low. Therefore, universities should focus on this dimension and improve their performance. As a result, support services have the highest priority for improvement and the welfare, managerial, educational, research, and administrative dimensions were in the next ranks for improvement, respectively. These results were in line with other studies that showed a clear relationship between the quality of the university environment and student satisfaction. Senobar et al, Bernasconi and Celis, and Lovenheim and Reynolds concluded that the existence of support facilities has a positive and significant effect on university choice (19)(20)(21).
Also, the findings of the analysis of causal relationships between dimensions showed that the managerial Table 4. Values of (J), (R), (R + J) and (R-J) dimension had the most interaction (impact and effectiveness), followed by the research, welfare, education, support, and administrative dimensions. The management dimension was the most effective dimension. According to R-J values, educational and research dimensions were the most effective dimensions, respectively. These results are in line with the study by Tabibi and Keyhan that identified and prioritized the components affecting academic satisfaction and learning of nursing students of Urmia Nursing School. The qualitative findings of researchers showed that six factors (personal characteristics, professional competence of professors, educational and research factors, management and administration, welfare and service facilities, and job and professional factors) affected academic satisfaction (16). Therefore, the findings of the present study can be considered in line with part of Tabibi and Keyhan's research. The findings of Alexander et al regarding the effect of using educational technologies on student satisfaction indicated that access to educational technologies and the quality of educational content affected student satisfaction. In the present study, education was recognized as an important dimension affecting student satisfaction (12). Therefore, the results of the present study are in line with the research by Alexandra et al. In a study, Chu et al assessed the satisfaction of management students at a university in southern Taiwan. The results showed that the quality of education, professors' mastery of the curriculum, students' evaluation methods, and students' evaluation are sub-components of the dimension of education in the present study, the results showed that these dimensions affect students' satisfaction, so the findings of the present study are consistent with the research of Chu et al (22). The research by Napitupulu et al (23) studying the factors affecting student satisfaction indicated that the quality of services had a positive and significant effect on student satisfaction.

Impact Effectiveness Interaction Effect / Cause
In the present study, an attempt was made to examine the impact of university services such as education, research, welfare, support, etc. on student satisfaction, and the results showed that the quality of these services was effective on student satisfaction (23). Therefore, the general results of the present study are in line with the results of the research by Napitupulu et al (23). In a field study, Zhai et al examined the factors affecting the satisfaction of Chinese university students. The results showed that the performance and behavior of faculty members, the performance of the faculty management, and the existence of the necessary facilities in the university were the most important predictors of student satisfaction (24). Therefore, the results of the present study are consistent with the research by Zhai et al.
In general, it should be said that Hormozgan University of Medical Sciences needs to satisfy students to reach the level of a desirable university, provide the services more desirably. Also, the staff and officials of the university     should pay more attention to this matter because the consequences of not having a program and negligence of officials and staff in providing services to learners will be felt by the whole community.