|ORIGINAL RESEARCH REPORT
|Year : 2019 | Volume
| Issue : 3 | Page : 75-80
Patient satisfaction with services at public and faithbased primary health centres in Lagos State: A comparative study
Adedoyin O Ogunyemi1, Ayokunle A Ogunyemi2, Tolulope F Olufunlayo1, Tinuola O Odugbemi1
1 Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
2 Department of Obstetrics and Gynecology, Lagos State University Teaching Hospital, Lagos, Nigeria
|Date of Web Publication||3-Jul-2019|
Dr. Adedoyin O Ogunyemi
Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos
Source of Support: None, Conflict of Interest: None
Context: The primary health care is the first point of contact between a patient and the health-care system. The quality of services provided at public health facilities has gradually declined, precipitating the emergence of alternative service providers. Patient satisfaction is an important indicator for assessing the quality of care in health service provision. Aim: The aim of this study is to compare the patient's satisfaction among attendees at a public and a faith-based primary health center (PHC). Settings and Design: Study design involves comparative cross-sectional in PHCs. Materials and Methods: A total of 700 respondents were recruited consecutively from a public and a faith-based PHC. Data were collected using an adapted General Practice Assessment Questionnaire. Four domains of quality of care were assessed. Statistical Analysis Used: SPSS software version 17 was employed in the data analysis, and the level of significance was set at P < 0.05. Results: Affordability was the most important reason for the choice of a health facility by 47.0% of the public PHC patients, and this was higher than in 41.0% of the patients attending the faith-based PHC. The mean quality of care score was higher among the faith-based (0.90 ± 0.12) than in public (0.85 ± 0.21) PHC attendees (P < 0.001). Patients' satisfaction was higher among the respondents attending the faith-based PHC (P < 0.001). The factors significantly associated with high patient satisfaction among the public PHC attendees included older age, higher educational levels, being married, and perceived good quality of services, while for the faith-based PHC, it included the younger age group, higher levels of education, being married, and closeness to the facility (P < 0.001). Conclusion: Accessibility was scored lowest in both PHCs, while effectiveness was highest in the faith-based PHC. Patients' satisfaction was higher among those who attended the faith-based PHC. It is recommended aspects of accessibility such as waiting time should be a focus of health managers.
Keywords: Faith-based primary health center, patient satisfaction, public primary health center
|How to cite this article:|
Ogunyemi AO, Ogunyemi AA, Olufunlayo TF, Odugbemi TO. Patient satisfaction with services at public and faithbased primary health centres in Lagos State: A comparative study. J Clin Sci 2019;16:75-80
|How to cite this URL:|
Ogunyemi AO, Ogunyemi AA, Olufunlayo TF, Odugbemi TO. Patient satisfaction with services at public and faithbased primary health centres in Lagos State: A comparative study. J Clin Sci [serial online] 2019 [cited 2019 Sep 22];16:75-80. Available from: http://www.jcsjournal.org/text.asp?2019/16/3/75/262069
| Introduction|| |
Improving patient satisfaction of service quality has become a central concern to health managers and policy makers as it impacts positively on health-seeking behavior., Consequences of low-perceived quality of care include poor compliance with treatment and advice, failure to pursue follow-up care, and dissuading others from seeking care. Studies have found that patients' satisfaction with health-care services in Africa was one of the most important factors determining the utilization of such services.,,, In a public primary health center (PHC) in Ogun state, Nigeria, 36.0% of the respondents indicated good staff attitude as the aspects of service most liked and the least liked aspect of service was the lack of timeliness in 43.0% of respondents. Poor patient satisfaction has over the years resulted in loss of confidence in the public health-care delivery system in Nigeria.
Faith-based health services offer care as a means toward achieving efficient and ethical use of resources and to justify the support received from the local community. In recent times, faith-based organizations have occupied a niche in the provision of health-care services in Sub-Saharan Africa mostly to provide equity of access. Furthermore, there has been an explosion of faith-based health services in developing countries including Nigeria, with some countries reporting as high as 70% of all health services. In terms of quality, there is little evidence that faith-based health services are more efficient than public PHC and vice versa. Furthermore, the quality differences may be the result of higher resource levels and subsidized staff in one more than the other. The weaknesses of faith-based health services are seen in their potential isolation from national health policy and planning mainstream; subordination to an independent religious body with its own agenda; and dependence on government for qualified staff, for subsidy, and sometimes other resources as well.
On the other hand, public PHCs are the bedrock of the health system and a function of the health service delivery in any country. Over the years, the public PHCs have witnessed a gradual decline in standards and services rendered largely due to the poor funding of the health system. The effectiveness of this level of care varies from place to place in Nigeria and are often a reflection of the commitment of the stakeholders at the time since the National Health Act has not been implemented. This study, therefore, aimed to compare the satisfaction of patients and their perceived quality of care of the services rendered by the faith-based and public PHCs, respectively.
| Materials and Methods|| |
This was a comparative cross-sectional descriptive study conducted in two PHCs in a Local Council Development Area in Lagos State. A minimum sample size of 315 was calculated using the formula for the comparison of means of two independent groups and the prevalence of respondents with good satisfaction from a previous study. In determining an adequate and reliable minimum sample size, the formula of proportions of two independent groups was used. It is to demonstrate a difference between two proportions.
Where: n = minimum sample in each comparison group; u = the critical value corresponding to the power of the study at 80% = 0.84; v = percentage of normal distribution corresponding to a significance level of 5% = 0.96; P 1 = Estimated proportion of clients with good satisfaction in catholic PHC = 50% (assumed estimate since no previous study); P 2 = Estimated proportion of clients with good satisfaction in public PHC = 39% (derived from a previous study) A minimum sample size of 316 was calculated to be used for each group in the study, but the sample size to be used for this study will be 350 to make 10% provision for nonresponse.
The sample consisted of a total of 700 adult respondents of both genders attending a public PHC and a Catholic faith-based PHC. Only patients who attended the PHCs for the purpose of services from the immunization clinic, child welfare/nutrition clinic, antenatal care, and curative services in these centers were eligible to participate. Family planning patients of both facilities were excluded from the study because the faith-based PHC in this study did not offer the full complement of contraceptive services.
One of the five public primary healthcare centers was selected using simple random sampling (balloting) alongside the only Catholic primary healthcare center in the local council development area (LCDA). In both PHCs, the various clinics for the services are run from Monday to Friday every week. Each consenting patient was recruited consecutively and observed from the time he/she walked in until the services had been received. Each interview session began only after the patient had been completely attended to. The time of arrival and of exit of each patient recruited into the study was also recorded. This was carried out daily by two trained interviewers within 1 month until the desired sample size of 350 respondents for each PHC was reached. A pretested, validated, structured, interviewer-administered questionnaire General Practice Assessment Questionnaire, was adapted to collect information from respondents. It included 26 items on a Likert scale on the patient's perceived quality of care organized into four domains and scored as follows: “fully agree” and “agree” = 1, “fully disagree” and “disagree” = −1, and don't know'= 0. The domains addressed perceived quality in “accessibility,” “humaneness,” “effectiveness,” and “health education.” The mean score for each of the four domains was then calculated for the respective items. Overall satisfaction was assessed by a question asking how satisfied the respondents were with the services rendered in the facility. The SPSS (Statistical Package for Social Sciences) Version 17.0 (SPSS Inc., Chicago, IL) was used for data entry and analysis. The demographic and socioeconomic data were presented in the form of frequency tables and cross-tabulations. The Student's t-test was used to compare the mean scores between two groups. The Chi-square and Fisher's exact tests were used for comparison of associations between the various factors and the scales of patient satisfaction scores. The level of significance was set at P < 0.05. Ethical approval was obtained from the Health, Research, and Ethics Committee of the Lagos University Teaching Hospital, Lagos State. Permission to collect data was obtained from the Medical Officers-in-charge of each institution. Written informed consent was obtained from each respondent indicating their willingness to participate in the study.
| Results|| |
The sociodemographic characteristics of respondents of the two groups are reported in [Table 1]. In this study, the respondents who attended the faith-based PHC had a mean age of 29.6 ± 7.2 years and were older than the respondents in the public PHC group (27.2 ± 7.2 years). For the respondents attending both the public and faith-based PHCs, the reason for the choice of the facility was affordability followed by closeness to their residence. However, a lower proportion (40.6%) of respondents in the faith-based PHC compared to 47.1% of the respondents in attending the public PHC, reported affordability as the main reason for the choice of facility. The mean time spent by respondents in accessing services in the faith-based PHC was 132 ± 4.9 min and lower than the 140 ± 4.2 min spent in the public PHC and this difference was statistically significant (P < 0.001)[Table 2].
|Table 1: Sociodemographic and socioeconomic characteristics of respondents|
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|Table 2: Respondents reason for choice of facility, services sought, and time spent accessing service|
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Summary mean and standard deviation scores of four domains of the quality of care summaries are shown in [Table 3]. The mean quality of care score was 0.90 ± 0.12 among respondents attending the faith-based PHC. This was higher than the score of 0.85 ± 0.21 among public PHC attendees, and this difference was statistically significant (P < 0.001). The respondents in the faith-based PHC group scored significantly better in all domains than those attending the public PHC except in the domain for health education. For respondents in the faith-based PHC, effectiveness yielded the highest score (0.93 ± 0.11) followed by health education (0.92 ± 0.20), whereas for public PHC respondents, the highest score was for health education (0.96 ± 0.13) followed by effectiveness (0.91 ± 0.20). The quality-of-care scores of the four domains surveyed ranged from 0.68 ± 0.49 to 0.96 ± 0.13 with a mean score of 0.85 ± 0.21 in the public PHC group and 0.76 ± 0.35–0.91 ± 0.20 with a mean score of 0.90 ± 0.21 in the faith-based PHC group from a possible −1 to + 1. The lowest score in the public PHC group (0.68 ± 0.49) was the domain for accessibility, while the highest (0.96 ± 0.13) was in health education which assesses health workers providing health information and being listened to. The domain with the lowest score 0.76 ± 0.35 in the faith-based PHC group was also the domain for accessibility and the highest (0.93 ± 0.11) was in the effectiveness domain which assesses the various health workers competence and promptness. In the public PHC group, the older respondents were likely to be highly satisfied compared to the younger and this difference was statistically significant (P < 0.001). Those who were married also had better satisfaction than the single, separated, divorced, or widowed and this difference was statistically significant (P < 0.001). The respondents with a higher educational level were also significantly more satisfied (P < 0.001) [Table 4]. In the faith-based PHC, the younger age group, those married and patients with higher levels of education had better overall satisfaction levels (P < 0.001). There was no statistically significant relationship between the respondents' gender and satisfaction scores [Table 5].
|Table 4: Association between level of satisfaction and demographic variables among public primary health center attendees|
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|Table 5: Association between level of satisfaction and demographic variables among catholic primary health center attendees|
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| Discussion|| |
The most important reason for the respondent's choice of PHC facility was the affordability of the services among respondents attending both the public PHC (47.0%) and the faith-based PHC (41.0%). Affordability of health service is important if universal health coverage is to be achieved in Nigeria, considering that <5% of the population is covered by the National Health Insurance Scheme. With regards to the time spent accessing services in the health centers overall, the faith-based PHC users spent less time when compared to the public PHC group. The majority of respondents in the public and faith-based PHC (38.9% and 37.1%, respectively) spent between 2 and 3 h accessing services. This is less time spent when compared to a study done in a model public PHC in Ogun state where the highest proportion of patients (33.1%) spent 3–4 h accessing services at the model PHC facility. However, in another public PHC in North Central Nigeria, more than one-third of the respondents (36.7%) waited for about 1–3 h to access services. Timeliness in the PHC in this study is poorer when compared to a PHC in Afghanistan, where 69.0% of the respondents spent less than an hour accessing services. Previous studies have found timeliness to be the strongest predictor of patient satisfaction in accessing healthcare.,
The quality of care scores range from 0 to 1 with the scores close to 1 meaning perceived good quality, while scores close to 0 are perceived to be of poor quality. The faith-based PHC scores were high and ranged from 0.76 to 0.93 with a mean score of 0.90 ± 0.21 higher than the Public PHC which ranged from 0.68 to 0.96 (mean 0.85 ± 0.21). In three (accessibility, humaneness, and effectiveness) of the four domains, the faith-based PHC scored higher and these differences were statistically significant. However, the public PHC scored higher in the health education domain, and this may not be a surprising finding in public health facilities where most clinic sessions begin with a health talk. Accessibility and continuity of services scored the lowest at both facilities. This is comparable to a cross-sectional survey done among attendees of a resource-thrift clinic and a resource-intensive clinic in the United Arab Emirates focused on six domains of quality of care in which accessibility and continuity were the lowest in both clinics. Similarly, a cross-sectional study conducted in three PHC centers in Saudi Arabia to assess patients' overall satisfaction with PHC services and their level of satisfaction reported the poorest level of satisfaction with continuity of care (56.3%). Continuity of care has been proven to improve clinical outcomes, cost-effectiveness, and patient satisfaction; however, it is often limited in practice due to structural reasons and personnel rotations. Some clinicians have argued that diverse input can be positive to patient care, but a balance is necessary.
Almost half (48.3%) of the respondents in the faith-based PHC were “highly satisfied” with the quality of care received in the health center higher than only 7.7% in the public PHC group. Ninety-one percent of the respondents in the public PHC were “satisfied” and this is similar to findings from a study in a public health center in South-East, Nigeria that assessed the satisfaction with the quality of maternal and child health services. Majority (90.6%) of respondents rated the services to be at least good. In another study on patients' perceptions of health-care delivery in rural Ghana, about 90% of the respondents were satisfied or very satisfied with the care given during their visit to the public health facility. Higher satisfaction rates by patients in the faith-based PHC in this study could be as a result of the timeliness and effectiveness as reported by the attendees.
Among the respondents from the public PHC, those who were older were more likely to be satisfied than the younger. Similarly, those who had secondary education and higher were also more satisfied than those with lower levels of education and this difference was statistically significant. A study has demonstrated that satisfaction with health services increases with age and this is because the older patients may be more empowered in the decision-making process, which is also in keeping with a higher educational status. There was no statistically significant relationship found between patients' satisfaction and their gender. This was similar to a study done in three PHCs in Saudi, patients of older age were more satisfied with PHC services than their younger counterparts (P < 0.001) and patients with lower education level were more satisfied (P < 0.001), but no relationship was found between patients' satisfaction and their gender in the study. Another study done in the United Arab Emirates showed that the older people felt the clinic was more comprehensive than the younger people (P = 0.009), and people with higher levels of education felt that the clinic service was less effective than those who were less educated (P = 0.007). The findings in the faith-based PHC were similar except that those who were younger were more satisfied, and this may be adduced to the younger age groups among the attendees found in this study.
| Conclusion|| |
Attendees of the faith-based PHC spent less time accessing services compared to those in the public PHC. The mean quality of care score was high (0.90 ± 0.12) out of a total possible score of 1 among respondents attending the faith-based PHC and higher than 0.85 ± 0.21 attending the public PHC. This difference was statistically significant (P = 0.001). In the quality of care domain, health education was scored highest in the public PHC, while effectiveness was highest in the faith-based PHC. Accessibility was scored lowest in both PHCs, while effectiveness was highest in the faith-based PHC. The overall satisfaction of respondents was higher among those attending the faith-based PHC. In the public PHC, older age groups, higher levels of education and being married were associated with being satisfied with health services. It is recommended aspects of accessibility such as waiting time, access to medical reports, appropriate staffing should be a focus of health managers to improve patient's satisfaction and their quality perception.
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Conflicts of interest
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]