Perceived effects of accreditation on education quality and health-related job outcomes: scales validation and correlates in Lebanon

Abstract

Background

This study examines the impact of program accreditation on education quality and career outcomes among students and graduates of health-related disciplines in Lebanon. In the absence of a national accrediting body, many universities seek international accreditation. Additionally, the study validates four scales measuring factors influencing university choice and perceptions of accreditation.

Methods

A cross-sectional study was conducted between September and December 2023, enrolling 642 participants, including students and graduates from Lebanese health-related programs. Four validated scales included: Reasons for Choosing University Program (RCUP, 14 items), Perception of University Program Accreditation (PUPA, 12 items), Perceived Impact on Education Quality (PI-AQE, 27 items), and Perceived Impact on Career Outcomes (PI-ACO, 9 items). Principal component analysis with Promax rotation assessed construct validity. Bivariate analyses (t-tests and ANOVA) examined relationships between scales and participant characteristics. Multivariate analysis of covariance (MANCOVA) adjusted for sociodemographic and university-related factors, while multiple regression explored predictors of time to employment for graduates.

Results

Students from three universities reported significantly lower RCUP scores, indicating weaker motivations for their program choice. Clear communication of accreditation status correlated positively with RCUP (β = 1.097, p = 0.004). Pharmacy students scored higher on RCUP (β = 2.412, p = 0.002). Higher income levels (β = 1.829, p = 0.020) and awareness of accreditation (β = 2.348, p = 0.004) were linked to more favorable PUPA scores. Females (β = 4.981, p = 0.002) and high-income individuals (β = 3.777, p = 0.040) anticipated a stronger impact on PI-AQE. Graduates, particularly those with a PhD (β = 4.755, p = 0.042) or a Bachelor’s degree (β = 2.557, p = 0.003), expressed more positive PI-ACO perceptions. Conversely, uncertainty about accreditation was associated with lower PI-ACO scores (β = -3.019, p = 0.004). Notably, university accreditation status (β = -0.355, p = 0.011) and longer professional experience (β = -0.274, p = 0.010) were significantly linked to a shorter time to employment.

Conclusion

This study validates tools for assessing accreditation’s impact on Lebanese health education. Findings emphasize that accreditation status, program choice, and demographics significantly shape perceptions of education quality and career prospects. Effective communication about accreditation may enhance career readiness and suggest potential benefits for employment prospects. These findings emphasize the importance of accreditation as a strategic tool for advancing health education quality and optimizing career prospects in the healthcare sector.

Introduction

Ensuring high-quality education in health professions is paramount, as graduates play a vital role in delivering optimal patient care [1, 2]. Accredited programs provide a comprehensive and up-to-date curriculum, equipping students with the necessary knowledge and skills to excel in the healthcare sector [3,4,5]. Accreditation signifies a program's commitment to continuous improvement, transparency, and meeting professional standards [6, 7]. This, in turn, fosters student success by opening doors to scholarships, facilitating credit transfer between institutions, and ensuring graduates possess the qualifications sought by employers [7,8,9,10,11]. Accreditation plays a role in maintaining the quality and relevance of the curriculum by assessing and updating it according to professional practice standards and the evolving needs of the healthcare industry [12,13,14]. It also supports the growth and professional development of faculty and staff members [12, 13]. Further, accredited institutions offer research prospects where students can benefit from research facilities, experienced faculty members, and collaborative projects that expand their knowledge and drive innovation [15,16,17]. The accreditation of health-related academic programs demonstrates significant regional variations in frameworks, standards, and implementation approaches. The Americas have developed a comprehensive and well-established system through interstate collaboration, emphasizing quality assurance and educational standards through established bodies [18, 19], while Europe's journey toward accreditation has been more gradual, marked by a 65-year lag behind the U.S., influenced by market liberalization and inter-state cooperation [18]. Africa has shown progress through initiatives like the tropEd network, which focuses on establishing common standards and quality assurance mechanisms across diverse institutions [20].

In Lebanon, despite universities obtaining initial permission from the Ministry of Education and Higher Education (MEHE) to operate, a national quality agency for program accreditation is lacking [21]. This gap has prompted Lebanese health-related academic programs to actively seek accreditation from recognized international bodies, as a means to ensure quality standards and global recognition.

Similarly, Arab nations have made significant strides in implementing accreditation processes to standardize healthcare education [22,23,24]. Regional and national accreditation bodies evaluate various aspects of programs, guaranteeing adherence to set benchmarks [25,26,27,28,29]. Many universities in the Middle East, including Lebanon, Qatar, Jordan, and Oman, actively seek international accreditation to ensure global competitiveness of their graduates and their ability to contribute to advancements in healthcare [30,31,32,33,34,35,36,37].

When choosing a university, students consider various factors, with program accreditation playing a pivotal role. It signifies adherence to quality standards and aligns with other considerations such as university rankings, faculty expertise, and research opportunities [38,39,40,41]. University ranking systems like QS and Times Higher Education provide valuable information to students seeking informed decisions about their education [42, 43].

Despite the importance of program accreditation in Lebanon, there is currently a lack of research on student and graduate awareness and perceptions regarding accreditation and its impact on their education and career outcomes in health professions such as medicine, pharmacy, nursing, dentistry, and nutrition [44,45,46]. This knowledge gap highlights the need for further investigation to understand the true effects of program accreditation on educational quality and job prospects for health professionals in Lebanon. This study aimed to validate four measurement scales that assess university choice factors, accreditation perception, and the perceived impact of accreditation on educational quality and career outcomes among Lebanese health domain students and graduates, while also examining the correlations between these perceptions and employment outcomes.

Methods

Study design and participant recruitment

A cross-sectional study design was employed to further validate the developed scales and assess the perspectives of students and graduates. Data collection occurred between September and December 2023. The target population consisted of two main categories: first, university students who are currently enrolled as undergraduates in health-related disciplines at various Lebanese universities; second, healthcare professionals who graduated from Lebanese universities within the past 10 years.

Snowball sampling was the primary recruitment strategy in this study, specifically chosen to overcome the limitations of traditional methods, such as random sampling from university records or contacting healthcare institutions, in reaching health profession students and graduates [47]. The process began with carefully selected"seed"participants who met the eligibility criteria and played a key role in referring other qualified participants from their professional networks [48].

This approach leveraged existing relationships within the healthcare field, facilitating access to participants who might have been difficult to reach through conventional methods while fostering trust through peer referrals [47, 48]. The questionnaire was administered as an online survey created using Google Forms, ensuring easy access and completion. The introductory page outlined the study’s purpose, eligibility requirements, and included a mechanism for participants to share the survey link with others.

Participants were encouraged to distribute the link to classmates, colleagues, and relevant social media groups or professional associations. As new participants completed the survey, they too were encouraged to share the link within their own networks. This referral process created a snowball effect, gradually expanding the participant pool from the initial"seeds"to a more diverse sample across various health disciplines.

Participation in the study was entirely voluntary and involved no incentives. To ensure privacy and confidentiality, all collected data were anonymized and de-identified.

Scale development and content validity

The study employed the Delphi technique, a structured communication method developed by the RAND Corporation in the 1950 s [49], which is widely used in healthcare research to achieve consensus through systematic, interactive rounds of expert consultation [50, 51]. A modified Delphi approach was used in this study to develop a consensus-based list of items evaluating the impact of program accreditation in health professions education [52]. The process involved a multidisciplinary panel of thirteen academics with extensive experience (minimum of 10 years) in teaching, research, quality assurance, and accreditation within health professions, including pharmacy, medicine, nutrition, nursing, and physical therapy. This diverse panel ensured a comprehensive perspective on the subject.

Delphi Process was as follows:

1. 1.

Round 1 – Initial Item Generation and Focus Group Discussion

The first phase began with a comprehensive literature review to identify key items related to the impact of accreditation in health professions education. These items formed the basis for a structured discussion among the expert panel in a focus group setting. Panelists were encouraged to critically evaluate the proposed items, suggest modifications, and propose additional items based on their expertise and experiences.

1. 2.

Round 2 – Online Assessment and Item Refinement

Following the focus group discussion, a refined list of items was compiled and distributed to the expert panel via an online survey. Panelists were asked to rate the importance and relevance of each item using a Likert scale. Statistical analysis was performed to assess consensus, with a predetermined agreement threshold of 90% for item retention.

1. 3.

Consensus and Finalization

Items that did not reach the 90% consensus threshold were reconsidered, revised, or eliminated based on expert feedback. The final set of items represented the collective agreement of the panel on key factors influencing accreditation outcomes in health professions education.

This rigorous process resulted in four distinct scales: Reasons for Choosing a given University/Program (RCUP – 14 items), Perception of University/Program Accreditation (PUPA – 12 items), Perceived Impact of University/Program accreditation on the quality of education (PI-AQE – 27 items), and Perceived Impact of University/Program Accreditation on Career Outcomes (PI-ACO – 9 items). Each scale utilized a 5-point Likert format (1 = strongly disagree to 5 = strongly agree) to assess respondents'attitudes and perceptions.

Ethics approval

The Research Ethics Committee at INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban) approved the study protocol under the reference number (2023REC-013-INSPECT-10–09).

Sample size

The minimum sample size for the study was 384 participants, calculated using Epi Info 7 for a population-based survey. Alpha was set at 5% and beta at 20% [53]. The calculation was performed with a 5% confidence limit to yield a 95% confidence interval, with the design effect set to 1, given that no cluster sampling was used [53].

Questionnaire

The study questionnaire was developed in English and designed to be completed in approximately 10 min. This self-administered questionnaire served to assess the perspectives of both university students and graduates from health professions programs in Lebanon regarding program accreditation. The questionnaire was divided into four key sections.

The first section focused on gathering basic demographic information about the participants. This included standard details like age, gender, and university affiliation. For students, their major field of study was captured, while graduates provided information on their professional status and work experience. Additionally, the researchers employed the household crowding index [54] as a measure of socioeconomic status. This index calculates the number of people residing in the participant's household divided by the number of rooms (excluding kitchens and bathrooms).

Moving beyond demographics, Section 2 delved into the various factors that influenced participants'decisions when choosing a university and specific program. The questionnaire likely explored a range of potential influences, such as the reputation and ranking of the university, whether the program was accredited, the specific curriculum content and course offerings, the qualifications and expertise of the faculty, the availability of research opportunities for students, the support services offered by the university (e.g., financial aid), the quality of campus facilities, and finally, the career prospects associated with the chosen program.

Section 3 shifted the focus to program accreditation itself. Here, the questionnaire aimed to assess participants'level of awareness and understanding of program accreditation. The specific questions likely explored their knowledge of accreditation bodies operating in the region, the importance they placed on program accreditation when making their university and program choices, and their perceived benefits of program accreditation for both students and graduates.

Finally, Section 4 addressed the perceived impact of program accreditation on educational quality and career outcomes. This section likely explored how participants believed accreditation influenced the quality of education they received or will receive. It likely also investigated their perceptions of how accreditation might impact their job opportunities and career advancement prospects after graduation.

Statistical analysis

The data were analyzed using SPSS software version 25(IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp; 2017). Descriptive analysis used counts and percentages for categorical variables and mean and standard deviation for continuous measures.

A Principal component analysis technique (PCA) using the Promax rotation was conducted to assess the construct validity of the suggested scales. The Kaiser–Meyer–Olkin (KMO) and Bartlett’s test of sphericity were calculated to ensure the model’s adequacy. Additionally, Cronbach’s alpha values were calculated for every scale to assess their internal consistency (reliability). These scales were deemed normally distributed, as verified by the visual inspection of the histogram, while the skewness and kurtosis were below |1.96|.

The bivariate analysis was conducted by taking the four scales as the dependent variables. The independent-sample t-test was used to compare the means of scales between two groups, whereas the ANOVA test was used to compare three or more means. The Pearson correlation test was used to correlate continuous variables. Bonferroni correction was applied for multiple testing; the corrected alpha was obtained by dividing 0.05 by the number of comparisons to be tested, yielding a significance level below 0.002 in the bivariate analysis [55]. After that, a multivariate analysis of covariance (MANCOVA) was carried out to compare the four scales between the type of profession (student vs. graduate) adjusted for age, gender, major of the study, monthly income, name of university, years to find a job, highest degree, accreditation status, being aware of accrediting agency, communication or promotion about accreditation by the university. In addition, a multiple regression was conducted to assess the correlates of the time between graduation and employment after ensuring the absence of co-linearity, homoscedasticity, normality of the residues, and the linear relationship. A p-value less than 0.05 was considered significant.

Results

Sociodemographic characteristics

A total of 642 health students and graduates participated in the study; their mean age was 23.3 years (± 5.167). The majority were not married (90.7%), females (81%), undergraduate students (75.4%), specializing in pharmacy (60.3%), and residing in Beirut (34.9%) and Mount Lebanon (33.5%). Income was well distributed across categories and Lebanese regions. Appendix Table 1 presents the detailed sociodemographic data characteristics.

Employment characteristics

Regarding work experience, most respondents were students not working (56.4%), followed by working students (21.3%). Among those who were employed, the majority had less than two years of work experience (14.3%) and were working in the same field of their study major (32.7%). Furthermore, the majority (20.9%) of healthcare professionals took less than one year to find a job and were practicing in Lebanon (36.1%) (Appendix Table 2).

Sociodemographic and professional characteristics

In the bivariate analysis, most undergraduate respondents were pharmacists (75%), while nutritionists were the most represented among graduates (27.8%). A similar percentage of graduates had either a Bachelor’s or a Master’s degree as the highest level of education (P < 0.001). Most graduates were from the Lebanese University (34.9%) and were currently working full-time in their main field of study (61.4%). The majority lived in Lebanon and secured a job within one year of graduation (34.8%). Almost the same number of graduates had less than two years of work experience. All other differences between students and graduates are listed in Table 1.

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Scale validation and description

Construct validity and factor analysis

A factor analysis was run to assess the construct validity of all concepts. Items related to every scale could be extracted with Promax rotation. All items loaded appropriately on their respective factors (domains), and no variable showed low factor loading (< 0.3), low communality (< 0.3), or over-correlation with each other (r > 0.9). The KMO measures of sampling adequacy were satisfactory for all models, ranging from 0.500 to 0.956, with a significant Bartlett’s test of sphericity (P < 0.001). The percentage of explained variance ranged from 53.65% to 87.7%. Table 2 presents the Promax rotated matrix of factor analysis of the four scales used in this study. The final validated scales related to the Choice of University/Program and Perception of Accreditation comprised three domains each. Regarding the Impact of University/Program accreditation on the quality of education, it included two domains, while all the items in the Impact of University/Program accreditation on career outcomes formed one component.

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Reliability measures

The internal consistency of all items and domains was confirmed by measuring Cronbach’s alpha. The overall values of the complete scales were very good (0.839) to excellent (0.981). Further examination within each domain showed values ranging from 0.661 to 0.795 in the RCUP scale and 0.781 to 0.893 in the PUPA scale. The excellent values of 0.967 and 0.969 were recorded for each domain in the PI-AQE and the PI-ACO (Table 2).

Structural validity

All items were significantly correlated with their respective domains, with all P-values < 0.001. All domains were significantly correlated with each other and with the total scales (P < 0.001). Table 3 presents the Pearson correlation analysis. Finally, the mean scores of the four included scales were 38.21 ± 4.26 (RCUP), 50.54 ± 6.96 (PUPA), 117.04 ± 16.06 (PI-AQE), and 38.62 ± 5.75 (PI-ACO).

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Difference of scores according to participants’ characteristics: Bivariate analysis

In the bivariate analysis, higher means of RCUP scores were notably linked to the profession of being a pharmacist (P < 0.001), having a higher income, and engaging in a field related to one’s university degree (P = 0.038). Additionally, increased scores on the same scale were associated with higher levels of education (P = 0.003), awareness of accreditation, and regular exposure to communication or promotion related to the university (P < 0.001).

Higher means were also detected for PUPA in females (P = 0.06) and were similar between those who affirmed that their university/program was accredited and those who denied it (51.8 ± 6.53 vs.. 51.5 ± 6.76; P < 0.001). The same was also observed in the mean scores of PUPA, where higher scores were associated with awareness of accreditation and regular exposure to communication or promotion related to the university (P < 0.001).

Regarding the influence of PI-AQE score, elevated mean scores were observed among females (P = 0.004), individuals with a higher level of education (P = 0.043), and those in fields of study other than pharmacy (P = 0.01). Additionally, higher mean scores were linked to the affirmation of accreditation and regular exposure to university-related communication or promotion (P < 0.05). Similar trends were noted in the variation of mean scores for the PI-ACO, with the only distinction being a higher score among those who denied accreditation for their university/program. Further details of the bivariate analysis for various scales are presented in Table 4.

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Multivariable analysis

Difference of scores between students and graduates

The means of the scales, compared between students and graduates, were adjusted over age, gender, study major, monthly income, university name, years to find a job, highest degree, accreditation status, awareness of the accrediting agency, and communication or promotion of accreditation. The adjusted means are shown in Fig. 1. No significant difference was found among student or graduate groups for RCUP or PI-AQE. For PUPA, a borderline higher mean was found for students, while for IP-ACO, a significantly higher mean score was found for students compared to graduates (39.26 vs. 36.66, p = 0.015).

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Additionally, as shown in Table 5, the MANCOVA models were reported, taking the four scales as the dependent variables and the professional status as the independent variables, adjusted over age, gender, study major, monthly income, university name, years to find a job, highest degree, accreditation status, awareness of the accrediting agency, and communication or promotion of accreditation.

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Considering the RCUP scale as the dependent variable, the results showed that being a pharmacist (Beta = 2.41), being fully aware of the accrediting agency (Beta = 1.03), hearing any communication or promotion about university/program accreditation status (Beta = 1.09) were significantly associated with higher quality education scores. However, being in UL (Beta = −3.05), LIU (Beta = −2.77), and BAU (Beta = −2.45) was significantly associated with lower RCUP scores.

Taking the PUPA as the dependent variable, the results showed that a higher income (Beta = 1.82), having postgraduate degrees (Beta = 6.53), being aware of the accrediting agency (Beta = 2.34), having heard any communication or promotion of university/program accreditation status (Beta = 1.35), and being a female (Beta = 1.81) were significantly associated with higher perception scores. However, not being sure whether or not the university is accredited/trying to get accredited (Beta = −4.05) was significantly associated with lower PUPA scores.

Considering the impact of PI-AQE as the dependent variable, the results showed that having a high income (Beta = 3.77) and being a female (Beta = 4.98) were significantly associated with higher scores. Regarding PI-ACO, being a graduate (Beta = 2.60), being a female (Beta = 1.55), having a higher income (Beta = 1.40), and holding a bachelor’s (Beta = 2.55) or a Ph.D. (Beta = 4.75) degree as the highest attainment were significantly associated with higher scores. However, being unsure whether or not the university is accredited/attempting to get accredited (Beta = −3.01) was significantly associated with lower scores.

Multivariable analysis of time between graduation and employment (for graduates)

Having graduated from the Lebanese University (Beta = −0.30) or an accredited university (Beta = −0.56), being unsure whether or not the university is accredited/attempting to get accredited (Beta = −0.47), and having more years of experience (Beta = −0.15) were significantly associated with a lower time between graduation and employment (Table 6).

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Discussion

In this study, the content and structure of four scales related to university/program choice, perception of accreditation, and the perceived impact of accreditation on educational quality and career outcomes were appropriately validated. The findings demonstrated robust factorial structures and strong reliability, establishing these scales as effective tools for assessing key factors influencing participants’ choices and career paths within the Lebanese context. The results highlighted the complex interplay among perceptions of accreditation, university characteristics, and individual backgrounds.

Accreditation: a double-edged sword

While a generally positive perception of accreditation (PUPA) and its impact on education quality (PI-AQE) and career outcomes (PI-ACO) was observed amongst participants, the reasons guiding their university choice (RCUP) were surprisingly limited. This limitation may signify that students are choosing universities based on a narrow set of factors, such as geographical proximity, reputation, financial aspects, or influence, rather than a comprehensive evaluation of available programs, specialties, or educational experiences which was reported in similar studies conducted in Italy and Indonesia [56, 57]. This reflects a potential shortcoming in Lebanese universities'ability to differentiate themselves and effectively market their programs.

The analysis revealed that the LU (public university), LIU, and BAU scored lower on the RCUP compared with other private universities. Interestingly, universities that effectively communicated their accredited status seemed to perform better on this novel scale, suggesting a crucial link between transparent communication, institutional reputation, and student choice [37]. Students prefer accredited universities because they anticipate higher satisfaction and better career outcomes, such as rapid integration into the labor market and higher entry-level annual salaries, which was also reported in previous studies in Britain, Colombia, U.S.A., and Cyprus [58,59,60,61,62,63].

Nuances in pharmacy student decisions

The study uncovered a distinct pattern among pharmacy students. Those who hailed from universities with more varied program options (as indicated by higher RCUP scores) displayed a more nuanced decision-making process when selecting their chosen path. This highlights the effectiveness of the employed scales in capturing the subtle variations within student decision-making, revealing the influence of program diversity beyond the mere presence of accreditation. Understanding these dynamics is crucial for institutions and policymakers seeking to enhance the effectiveness and communication of accreditation processes within the educational landscape.

Demographics and educational background shape perceptions

Significant correlations emerged between demographic and educational factors and their influence on perceptions of accreditation. Participants with higher income levels, those holding Ph.D. or Bachelor's degrees (compared to lower levels of education), and female respondents exhibited more favorable views of accreditation, suggesting that greater exposure to higher education and an understanding of accreditation processes contribute to more positive perceptions. Similarly, studies in Saudi Arabia [64] and Qatar [6] have shown that administrators, faculty members, and students value accreditation, particularly when linked to recognized national or international standards, despite concerns such as increased workload. In this study, participants uncertain about their institution’s accreditation status had lower perceptions of its impact on career outcomes, likely due to a lack of awareness about its importance [61,62,63]. In Lebanon, private universities with high tuition fees often emphasize their accreditation, which may explain the positive perceptions among higher-income participants. Additionally, the higher proportion of female participants with favorable views on accreditation could reflect broader gender-based differences in valuing quality education, as noted in similar studies, such as one conducted in China [65].

Job search duration: a complex picture

The study's findings on job search duration highlighted several important trends. Graduates from accredited universities, those with substantial work experience, and students from Lebanese University (UL) secured employment more quickly, reflecting the perceived value of accreditation, practical experience, and institutional reputation. Employers often favor these individuals due to their perceived competence and reduced need for extensive training, facilitating their faster integration into the workforce [66].

Notably, UL students, often from lower socioeconomic backgrounds due to the absence of tuition fees, also experienced shorter job search times, possibly due to their willingness to accept lower-paying positions to secure employment quickly. This mirrors trends in other low-wage labor markets in the U.S, where financial necessity drives individuals to accept less favorable job conditions [67]. However, the specifics of the jobs obtained by participants were not explored in this study, underscoring the need for further research into the impact of socioeconomic background on job search strategies and employment outcomes.

Additionally, the generally prolonged job search duration observed in recent years may indicate market saturation or a reduced capacity of healthcare establishments to absorb new graduates. This highlights the need for universities to produce practice-ready, specialized professionals with diverse skill sets to meet evolving market demands, as previously suggested in the literature [44].

Finally, this study is the first one in Lebanon to offer valuable insights into the complex network of factors that shape student decisions and career paths in various health sectors. It emphasizes the significance of program diversity in conjunction with accreditation, the influence of demographics and educational background on perceptions, and the intricate relationships among accreditation, experience, and socioeconomic status in job search outcomes. Furthermore, the study findings were based on the high reliability and validity of the scales employed to evaluate student and graduate perspectives on program accreditation.

Despite the findings of the study, several limitations must be acknowledged. First, the cross-sectional design of the study limits causal interpretations, restricting the ability to infer temporal relationships between accreditation status and perceived educational or career outcomes. Longitudinal studies are warranted to assess how these perceptions evolve over time and their long-term impact on career trajectories.

Second, the use of snowball sampling, although effective in reaching participants across various health-related disciplines, may introduce selection bias. This method relies on initial participants to recruit others, potentially resulting in a sample that is not fully representative of the broader student and graduate population in Lebanon. As such, the findings should be interpreted with caution, particularly when generalizing to students from unrepresented regions or disciplines. Future studies employing probability-based sampling techniques could mitigate this limitation and provide more representative insights.

Third, the reliance on self-reported measures for perceptions of accreditation and educational outcomes may be susceptible to social desirability bias or recall bias. Participants may have provided responses that reflect perceived expectations rather than their true experiences. The incorporation of objective measures, such as academic performance metrics or employment records, in future research would enhance the reliability of the findings.

Lastly, the study's focus on Lebanese universities. Hence, variations in accreditation processes and educational standards across countries may yield different perceptions and outcomes. Future studies across multiple regions would be instrumental in validating the scales and exploring the broader applicability of the findings.

Conclusion

This study aims to enhance the understanding health education quality by developing and validating four comprehensive measurement scales to assess university and program choice, perceptions of accreditation, and its impact on educational quality and career outcomes. The findings revealed that Lebanese students and graduates perceive accreditation as a driver for quicker employment and enhanced career prospects, particularly among those from accredited programs. Socioeconomic factors such as higher income and advanced education were associated with more positive views of accreditation, highlighting its perceived importance in health education. Effective communication about accreditation status was also linked to better-informed university choices, emphasizing the role of transparency in influencing student decisions. These validated scales offer tools for evaluating accreditation's impact and provide insights for institutions and policymakers to enhance communication strategies and support mechanisms. Future research can extend the application of these instruments to diverse contexts, strengthening the understanding of accreditation's role in health professions education.

Data availability

Data is provided within the manuscript or supplementary information files.

Abbreviations

RCUP:

Reasons for Choosing University/ Program

PUPA:

Perception of University /Program Accreditation

PI-AQE:

Perception of the Impact of University/ Program Accreditation on the Quality of Education

PI-ACO:

Perception of the Impact of University/ Program Accreditation on Career Outcomes

MEHE:

Ministry of Education and Higher Education

UL:

Lebanese University

LIU:

Lebanese International University

BAU:

Beirut Arab University

USJ:

Saint Joseph University

LAU:

Lebanese American University

NDU:

Notre Dame University-Louaize

MANCOVA:

Multivariate Analysis of Covariance

PCA:

Principal Component Analysis

KMO:

Kaiser–Meyer–Olkin

SD:

Standard Deviation

SPSS:

Statistical Package for the Social Sciences

INSPECT-LB:

Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban

SDGs:

Sustainable Development Goals

QS:

Quacquarelli Symonds (University Rankings)

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