Patient�s Satisfaction and Associated Factors towards Outreach Mental Health Services at Health Centers Addis Ababa, Ethiopia 2017

Abstract

Background: Patient satisfaction is the psychological state that results from confirmation, disconfirmation, or expectations with reality. There is lack of data about Patient satisfaction level and associated factors in the study setting.

Objectives: The aim of this study was to assess patient satisfaction and associated factors to wards outreach mental health services at health centers Addis Ababa.

Methods: Institution based cross-sectional quantitative study was used. Validated and standardized questionnaire and tools were used to collect the data. Systematic random sampling was used following face-to-face interview approach. Epi data and SPSS version 20 statistical software were used for data entry and analysis respectively. Binary logistic regressions were fitted to identify factors associated with outcome variable.

Result: The overall prevalence of satisfaction was found to be 57%. Being female (AOR=2.41 95% CI: (1.24-4.65), being rural residence (AOR=4.15 95% CI: (1.84- 9.35), distance greater than 5 km (AOR=3.21 95% CI: (2.0-7.52) and poor wealth index (AOR=2.5 95% CI: (1.25- 8.25) were associated with dissatisfied.

Conclusion and Recommendation: The overall prevalence of satisfaction is lower than other findings. It better to consider better service provision to increase satisfaction level and address the contributing factors of dissatisfaction during intervention plan.

Keywords: Satisfaction; Patient; Dissatisfaction; Amanuel mental specialized hospital; Mental health

Background

Statement of the problem

Patient�s satisfaction can be defined as the extent of an individual experience compared with his or her expectations. It is the psychological state that results from confirmation or disconfirmation of expectations with reality [1]. It patients satisfaction as �a health care recipient�s reaction to salient aspects of the contexts, process and result of service experience [1]. Client satisfaction with treatment processes may influence, and be influenced by treatment outcomes. Clients who are not satisfied with a service may have worse out comes than others because they miss more appointments, leave against advice or fail to follow treatment plans [2]. Patient satisfaction should be indispensable to assessment of quality as to design and measurement of health care systems [3].

Patient�s satisfaction, in particular, is subdivided in to orientation toward care and conditions of care, in which the orientation towards care represents the patients response from the use of health centers in view of their hope and expectation, and the conditions of care represent specific conditions including the method of treatment, the location of the health care institution, the waiting time, the payment and the treatment results [4].

Consequently, dissatisfied patient may not considered psychologically or socially well and thus the goal of clinician has not been attained, patient�s satisfaction can be affected by many factors, among them, difficulty to locate different section easily, long waiting time preceding consultation of physician, shortage of waiting facilities, consultation time, health providers behavior�s like politeness, showing respect to the patient, flexible payment option, easily accessibility and availability of care provider, medical outcome are among the main one [2].

Despite these realities, the health care provider in developing countries seems to be ignoring the importance of patient satisfaction regarding health services [5]. Medical and psychiatric outcome indicates whether the patient consider the service to be adequate and appropriate, whether as emotional reaction related to such things as responsiveness, respect and politeness of the care provider [6]. It is important for clinician to let patients to express their view of care and incorporate these views into provided care [2]. Thus scarcity of literature made it difficult to find research examining patient satisfaction with clinician services in developing countries.

In other words, even though patient satisfaction is a measure of quality, no clear interpretation of satisfaction measures and associated factors [6]. Patients are the best source of information about health centers system, communication, educating and management process. They are the source of information about whether they were treated with dignity and respect. Their experiences often reveal how a health center is operating and can stimulate important insight to kind of changes that are needed to close chasm between the care provided and the care should be provided [7]. Patient satisfaction evaluations are excellent opportunity to involve patients in the process of evaluating the given services and program [2].

Patients should be allowed to define their own priority and evaluating their care accordingly, rather than having those criteria selected by professionals. Satisfaction studies give some idea for provider of care how they would have to modify their provision of services in order to make their patients more satisfied [5]. Unlike clinical process measures. It reflects the patients� personal response to an evaluation of care. Patient satisfaction is the only available measure of personal impact of the full spectrum of the care process [8].

Studies of quality of medical care importance are increasing in importance as a component of health research. Consumer opinion of services is being taken in to account in assessment of quality. Thus evaluating quality of medical care involves the measurement of its benefits to patients and community at large [5]. Study conducted in Birmingham, UK, showed that waiting time was significant among studied variables affecting patient satisfaction with the ward round. Age, number of people present and length of ward round did not appear to be significant factors in affecting patient satisfaction were not significant [9].

Stepwise regression showed that 32% of the variability of the total score can be explained by the waiting time, the diagnosis and whether or not the patient had met their consultant before their first ward round. A higher total score is therefore associated with shorter waiting times, psychotic rather than neurotic diagnoses, and meeting the consultant before the first ward round [9].

Study conducted in Italy reveals that, the satisfaction with services expressed by outpatients and their relatives was good, with the exception of poor satisfaction with information about treatment and involvement in the treatment program. The satisfaction of inpatients and their relatives was significantly lower, with the issue of information giving by staff appearing particularly critical. Among patients, variables associated with dissatisfaction were being an inpatient, having a diagnosis of psychosis, being in contact with services for more than 6 years, and being single. Among relatives, being female and being the relative of an inpatient were associated with dissatisfaction. For both patients and relatives, receiving inpatient care was the strongest predictor of dissatisfaction [10] Comparative cross-national study conducted in five European countries among 404 schizophrenia patients using European version of the Verona Service Satisfaction Scale (VSSS-EU) showed satisfaction with psychiatric service ranges from 39.3% in London to 80.4% in Copenhagen. Lower levels of total service satisfaction were associated with being retired/ unemployed, having more severe psychopathology, having more unmet needs and living alone [7].

While another study done in Northern London (n=59) using patient Satisfaction Questionnaire 18(PSQ-18) reported only 12% patients felt that they had been given enough information. 51% of patients (30 of 59) felt that they received help quickly enough at the onset of the illness. Patients born abroad were significantly more satisfied than those born in Britain, irrespective of ethnicity [11].

A qualitative study done in England showed fear of violence, communication with staff, lack of autonomy, participants� conceptions and expectations were factors that affect patient satisfaction [12].

Study done on patient satisfaction from Zurich, Switzerland using Larsen�s Client Satisfaction Questionnaire (CSQ-8) among 161 participants indicated that patients with Somatoform, eating, and personality disorders were less satisfied than patients with affective, anxiety, and adjustment disorders. Patients treated with a combination of psychotherapy and pharmacotherapy was numerically but not statistically more satisfied than patients treated with psychotherapy alone. Symptom reduction and changes in the interpersonal domain were important outcomes associated with patient satisfaction [13].

A cross-sectional study done in Geneva, Switzerland among twelve public outpatient psychiatric clinics (n=707) using CSQ-8 reported global satisfaction rate was 93.1%. Female gender, not single, financial resources (not receiving a disability pension or other social aid), not presenting a psychotic disorder, and attending a specialized program were variables having significant association with high satisfaction [14].

A triangulation study from Europe measuring satisfaction of patients with an emergency psychiatric service (n=55) using client Satisfaction Questionnaire 8 (CSQ-8) revealed that 35% had low level of satisfaction, 29% a medium level and 36% high level of satisfaction. Respondents expressed dissatisfaction with waiting times for assessment, communication by staff, and inadequate provision of information regarding service [15]. In a retrospective study done in America and Canada universities indicated 44.8% of anxiety disorder patients (n=1004) were very satisfied with their mental health care. Significant predictor of satisfaction was type of quality of psychotherapy while higher education and greater anxiety severity were significantly associated with lower likelihood of being satisfied [8].

A cross-sectional study in German among 40 Obsessive Compulsive Disorder (OCD) patients with VSSS-54 item questionnaire indicated that a significant association has been found between the age of onset and satisfaction, with more dissatisfaction in the dimensions of professional skills and behavior, married OCD patients were significantly more satisfied with the type of intervention they got [16].

A cross-sectional survey conducted in university hospital, Ireland among 162 respondents using CSQ-8 reported overall satisfaction of patients� to the psychiatric service they received was 90%. Less than 38% of respondents report that the outpatient service had met their needs [10].

A 36-month follow-up study among 469 eating disorder patients� from Sweden using Treatment Satisfaction Scale (TSS), showed that 77% overall satisfaction with 38% highly satisfied. Factors found to be significantly associated were patient experiences of treatment interventions, levels of eating disorder psychopathology and psychiatric symptoms, and negative interpersonal profiles [17]. A cross-sectional study from the same country among 2552 patients using Consumer Satisfaction Rating Scale-self-rating version (Cons at-P) indicated with increasing social function, the better were patients� Satisfaction (35).

Another qualitative study done in Lund university hospital outpatient and inpatient psychiatric setting, Sweden reported establishment and quality of helping relationship that makes patients felt understood by the staff constitute good psychiatric care (36). A cross-sectional study conducted in India (n=60) using PSQ-18 reported 50 (57%) of patient satisfied with the psychiatric service received. Greatest level of satisfaction was noted in interpersonal aspects (71.4%) and time spent with doctors (62.4%). Patients with depression had the highest score of satisfaction followed by those with anxiety disorder, bipolar, and the least was with schizophrenia patients. Age, employment and education were socio demographic variables significantly associated with satisfaction. Satisfaction is significantly more in female patients, and that of communication was more in males. Older group (age 35-60 years) had significantly higher satisfaction scores in technical quality of the professionals, interpersonal manner, and time of waiting with doctors, whereas significantly lower score in financial aspects than younger.

A cross-sectional study conducted in Pakistan (n=240) showed 90.7% of patients� treated for mental health problem satisfied with the service they receive. Significant factor that had association with satisfaction was age where younger participants were more satisfied than elders (37).

Another study from Doha, Qatar (n=1054) reported overall satisfaction of 49 %. The satisfaction level was significantly higher in educated Qatari (185; 49%) and Arab expatriate (333; 69.3%) patients (38).

A study conducted in Jimma Hospital shows that the overall patient satisfaction is 57.1% [10] and the percentage of users satisfied with health care services increased progressively with increased in age of an interviewee, but decreased with increased educational status of interviewee. Satisfaction decreased with increased in length of waiting time. There was also significant association between satisfaction and perceived length of time spent with health care provider for physical examination and consultation, with longer time spent associated with higher satisfaction level [10]. The study conducted in west showa, central Ethiopia, showed that interpersonal processes including perceived empathy, perceived technical competency, non-verbal communication and patient enablement significantly influence patient satisfaction [18].

This study also showed that the mean consultation duration for the patients was 6.26 minutes whereas the mean expected consultation duration was 14.02�6.73 minutes. It reveals about 81.3% of the consultations lasted for less than the mean expected consultation duration [18]. According to study conducted in Jimma Hospital the most frequently encountered problems affecting utilization on the day of visit were due to failure to collect prescribed medications, from hospital pharmacy (36.3%), long waiting time preceding consultation (20.4%), and failure to locate different units easily (15.5%) [18].

In a survey undertaken in private clinics in Addis Ababa, high rates of satisfaction (64-99%) were found in all aspects of medical care except affordability of service charges [12].

Justification

Mental health is one of the most disadvantaged health programs in Ethiopia, both in terms of facilities and trained workers. Few institutions provide psychiatric services by specialist doctors and other psychiatric professionals in the country [19]. The modern approach to health care seeks to engage attention of both patients and public in developing health care services and equity of access [20].

Satisfied patients are more likely to comply with medical treatment and ought to have a better outcome compare to psychiatric treatment. Therefore, assessing patients� satisfaction helps to improve medical and psychiatric treatment outcome [20]. Assessment of patients satisfaction at out patient psychiatry department in the health centers or investigating some variables that had not been previously researched, as well as the mentioned variables has great importance to improve and change service delivered for patient Focusing on identifying factors that affects patient satisfaction with mental health services could be important to important to improve the service delivering experience.

Mental health service is given in the twenty health centers, which are found in the ten-sub city at Addis Ababa. In collaboration with Amanuel mental specialized hospital, Ethiopian federal ministry of health and Addis Ababa health beareu.

Effort was made to improve mental health service and integrate over all medical and psychiatric health services. The above-mentioned health centers are providing mental health service. In addition to medical service and patients were referred from hospital to their nearby health facility to seek mental health service. That is why I have research interest to patients satisfaction towards mental health service�s at health centers Addis Ababa.

In addition there was no similar research done in Ethiopia. It helps to improve treatment-seeking behavior of people. It serves as a source of data/information for who work in the area of mental health service and those who will conduct further studies on the issue under scrutiny. It will enrich the existing literature in the field of mental health. Knowing about patients it satisfaction helps to identify mental service gaps in the health centers and to improve and solve mental health service gaps.

Objectives

General objectives: To asses patients dissatisfaction and associated factors towards outreach mental health service�s at health centers Ababa, Ethiopia 2017.

Specific objectives: To determine magnitude patients dissatisfaction with mental health services at health centers Addis Ababa.

To identify factors associated with patient dissatisfaction about mental health services at health centers Addis Ababa.

Methods

Study design and period

Institutional based cross sectional study was used employed from October 10-November 10/2017 G.C.

Study area

Addis Ababa is the capital city of Ethiopia In 2003, the charter of Addis Ababa city government, proclamation No.1/1995 E.C, divided the city in to ten sub cities.

Among health centers available in each sub city, we used 20 health centers from 10 sub cities [21]. Participants of this study were selected from ten sub city 20 health centers, which render outpatient mental health services through systematic random sampling technique.

Source population

Patients who were visited the OPD for the need of mental health services in selected health centers at Addis Ababa, Ethiopia 2017.

Study population

Patients who delivered mental health service at outpatient during data collection period.

Sample size determination

The sample size was calculated using single population proportion formula by assuming the following assumptions. Where n is sample size, z is level of confidence =1.96 in normal distribution and p is proportion from previous studies. As the proportion is not known, this study used p=50%, q=1-p, (1-0.5)=0.5 and margin of error which is d=0.05.

    

    

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