1
|
Atnafu A, Dellie E, Kebede A, Fetene SM, Haile TG, Alemu MB, Park J, Tefera S, Alene BM, Negash WD. Health system responsiveness and its associated factors for intrapartum care in conflict affected areas in Amhara region, Ethiopia: a cross-sectional study. BMJ Open 2024; 14:e082507. [PMID: 39059803 DOI: 10.1136/bmjopen-2023-082507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVE In Ethiopia, information about health system responsiveness (HSR) in conflict-affected areas is limited. No previous local study was conducted on the assessment of HSR at the community level. Hence, the study assessed HSR for intrapartum care in conflict-affected areas in Amhara region, Ethiopia. DESIGN Community-based cross-sectional study design. SETTING Wadila, Gayint and Meket districts, Amhara region, Ethiopia. PARTICIPANTS The participants were 419 mothers who gave birth in conflict-affected areas within the last 6 months. The study included all mothers who gave birth at health facilities but excluded those who delivered at home, critically ill or unable to hear. OUTCOME HSR was the outcome variable. In this regard, the study assessed how mothers were treated and the situation in which they were cared for in relation to their experience during the conflict. METHODS We conducted the study in the community, where we analysed eight domains of HSR to identify 30 measurement items related to intrapartum care responsiveness. The domains we looked at were dignity (4), autonomy (4), confidentiality (2), communication (5), prompt attention (5), social support (3), choice (3) and basic amenities (4). We used a multiple linear regression model to analyse the data, and in this model, we used an unstandardized β coefficient with a 95% CI and a p value of less than 0.05 to determine the factors significantly associated with HSR. RESULTS The findings of our study revealed that the overall proportion of HSR in intrapartum care was 45.11% (95% CI: 40.38 to 49.92). The performance of responsiveness was the lowest in the autonomy, choice and prompt attention domains at 35.5%, 49.4% and 52.0%, respectively. Mothers living in urban areas (β=4.28; 95% CI: 2.06 to 6.50), government employees (β=4.99; 95% CI: 0.51 to 9.48), those mothers stayed at the health facilities before delivery/during conflict (β=0.22; 95% CI: 0.09 to 0.35), those who were satisfied with the healthcare service (β=0.69; 95% CI: 0.08 to 1.30) and those who perceived the quality of healthcare favourable (β=0.96; 95% CI: 0.72 to 1.19) were more likely to rate HSR positively. On the other hand, joint decision-making for health (β=-2.46; 95% CI: -4.81 to -0.10) and hospital delivery (β=-3.62; 95% CI: -5.60 to -1.63) were negatively associated with HSR. CONCLUSION In the Amhara region of Ethiopia, over 50% of mothers living in areas affected by conflict reported that health systems were not responsive with respect to intrapartum care. Therefore, all stakeholders should work together to ensure that intrapartum care is responsive to conflict-affected areas, with a focus on providing women autonomy and choice.
Collapse
Affiliation(s)
- Asmamaw Atnafu
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Endalkachew Dellie
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adane Kebede
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Samrawit Mihret Fetene
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tsegaye G Haile
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Curtin School of Population Health, Curtin University, Curtin, WA, Australia
| | - Melaku Birhanu Alemu
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Curtin School of Population Health, Curtin University, Curtin, WA, Australia
| | - Jinha Park
- KOFIH Ethiopia Health Office, Addis Ababa, Ethiopia
| | | | - Bruhtesfa Mouhabew Alene
- Institute of Technology, Department of Biomedical Engineering, University of Gondar, Gondar, Ethiopia
| | - Wubshet Debebe Negash
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
2
|
Mental Health System Responsiveness during COVID-19 in People with Pre-Existing Psychiatric Disorders: Experiences from Iran. EPIDEMIOLOGIA 2023; 4:74-84. [PMID: 36810455 PMCID: PMC9944841 DOI: 10.3390/epidemiologia4010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 02/13/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
Mental health system responsiveness (MHSR) is one of the important indicators in measuring the performance of mental health systems. Recognizing this function can be effective in responding appropriately to the needs of People with Pre-Existing Psychiatric Disorders (PPEPD). This study aimed to investigate MHSR during the COVID-19 period in PPEPD in Iran. Using stratified random sampling, 142 PPEPD who were admitted to a Psychiatric Hospital in Iran one year before the onset of the COVID-19 pandemic were recruited for this cross-sectional study. Participants completed a demographic and clinical characteristics questionnaire as well as a Mental Health System Responsiveness Questionnaire through telephone interviews. The results show that the indicators of prompt attention, autonomy, and access to care were reported as the worst-performing and the confidentiality indicator as the best-performing. The type of insurance affected the access to care and the quality of basic amenities. MHSR has been reported to be poor in Iran in general and this problem worsened during the COVID-19 pandemic. Considering the prevalence of psychiatric disorders in Iran and the degree of disability of these disorders, structural and functional changes are needed for adequate MHSR.
Collapse
|
3
|
Zhou W, Xiao S, Xie G, Ouyang F, Luo B. A comparison of patient-reported quality between inpatient services for mental and physical health: A tertiary-hospital-based survey in China. Front Psychiatry 2023; 14:1090892. [PMID: 36846224 PMCID: PMC9949676 DOI: 10.3389/fpsyt.2023.1090892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/11/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND It is widely acknowledged that quality of mental health services is routinely worse than physical health services across countries. However, studies separately investigating mental health services often report high-level satisfaction, even comparing with physical health services. Therefore, this study aimed to compare patient-reported quality between inpatient services for mental and physical health in China. METHODS An inpatient survey was conducted among service users of mental and physical health services. Patient-reported quality was measured by the responsiveness performance questionnaire after patient discharge and based on patients' multiple experiences of hospitalization in the past 3 years. Chi-square tests were performed to compare the two patient groups' ratings on inpatient services for mental and physical health, and multivariate logistic regression was performed to adjust covariates in the group comparison. RESULTS Inpatient services for mental health were rated better than those for physical health on "treating with respect" (AOR = 3.083, 95% CI = 1.102-8.629) and "choosing a healthcare provider" (AOR = 2.441, 95% CI = 1.263-4.717). However, mental health services had poorer ratings on "asking patient's opinions" (AOR = 0.485, 95% CI = 0.259-0.910). For other responsiveness items, no significant difference was detected between the two types of inpatient services. CONCLUSION Mental health inpatient services provided by China's tertiary hospitals could perform as well as physical health inpatient services in most aspects and even better perform regarding dignity and choice of healthcare providers. However, neglecting patients' voices is more severe in inpatient services for mental health.
Collapse
Affiliation(s)
- Wei Zhou
- Research Center for Public Health and Social Security, School of Public Administration, Hunan University, Changsha, Hunan, China
| | - Shuiyuan Xiao
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Guanqing Xie
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Feiyun Ouyang
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Bihua Luo
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Metabolic Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| |
Collapse
|
4
|
Zhou W, Xiao S, Feng C, Yu Y, Wang D, Hu C, Liu X. Measuring the quality of mental health services from the patient perspective in China: psychometric evaluation of the Chinese version of the World Health Organization responsiveness performance questionnaire. Glob Health Action 2022; 15:2035503. [PMID: 35289731 PMCID: PMC8928838 DOI: 10.1080/16549716.2022.2035503] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Despite the large population of patients with mental disorders and the rapid development of mental health services in China, there are few evaluations of Chinese mental health services from the patient perspective. Relevant instruments with robust psychometric properties are lacking. Objective This study aimed to translate, adapt and validate the WHO responsiveness performance questionnaire for measuring the quality of hospital mental health services among Chinese patients. Methods The adaption of the translated questionnaire incorporated experts’ and patients’ opinions. For psychometric testing, 193 outpatients and 168 inpatients completed outpatient and inpatient modules, respectively. Results The adapted questionnaire adhered to the WHO framework of responsiveness domains, and just four items had some wording changes. Item missing rates were below 6%. Both the outpatient and inpatient modules had acceptable internal reliability (Cronbach’s α = 0.837 and 0.730) and most domains had desirable average inter-item correlation coefficients. The confirmatory factor analysis indicated an acceptable model fit for the inpatient module, while some goodness-of-fit indices for the outpatient module were a little outside of the recommended ranges. Except for ‘talking privately’ from the domain of confidentiality (both outpatient and inpatient modules) and ‘waiting time’ from the domain of prompt attention (the inpatient module), factor loadings of all other items were above 0.5. Conclusions The Chinese version of the responsiveness performance questionnaire has acceptable feasibility, reliability, and validity in general and it can be used to measure, assess and improve the quality of mental health services in China.
Collapse
Affiliation(s)
- Wei Zhou
- Research Center for Public Health and Social Security, School of Public Administration, Hunan University, Changsha, China
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Caixia Feng
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.,Teaching Department, Liuzhou People's Hospital, Liu Zhou, China
| | - Yu Yu
- Division of Prevention and Community Research & the Consultation Center, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Dan Wang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Cheng Hu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.,Department of Public Health, Zhuzhou Central Hospital, Zhuzhou Central Hospital, Zhuzhou, China
| | - Xiang Liu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| |
Collapse
|
5
|
Kelley AT, Incze MA, Baylis JD, Calder SG, Weiner SJ, Zickmund SL, Jones AL, Vanneman ME, Conroy MB, Gordon AJ, Bridges JF. Patient-centered quality measurement for opioid use disorder: Development of a taxonomy to address gaps in research and practice. Subst Abus 2022; 43:1286-1299. [PMID: 35849749 PMCID: PMC9703846 DOI: 10.1080/08897077.2022.2095082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background: Evidence-based treatment is provided infrequently and inconsistently to patients with opioid use disorder (OUD). Treatment guidelines call for high-quality, patient-centered care that meets individual preferences and needs, but it is unclear whether current quality measures address individualized aspects of care and whether measures of patient-centered OUD care are supported by evidence. Methods: We conducted an environmental scan of OUD care quality to (1) evaluate patient-centeredness in current OUD quality measures endorsed by national agencies and in national OUD treatment guidelines; and (2) review literature evidence for patient-centered care in OUD diagnosis and management, including gaps in current guidelines, performance data, and quality measures. We then synthesized these findings to develop a new quality measurement taxonomy that incorporates patient-centered aspects of care and identifies priority areas for future research and quality measure development. Results: Across 31 endorsed OUD quality measures, only two measures of patient experience incorporated patient preferences and needs, while national guidelines emphasized providing patient-centered care. Among 689 articles reviewed, evidence varied for practices of patient-centered care. Many practices were supported by guidelines and substantial evidence, while others lacked evidence despite guideline support. Our synthesis of findings resulted in EQuIITable Care, a taxonomy comprised of six classifications: (1) patient Experience and engagement, (2) Quality of life; (3) Identification of patient risks; (4) Interventions to mitigate patient risks; (5) Treatment; and (6) Care coordination and navigation. Conclusions: Current quality measurement for OUD lacks patient-centeredness. EQuIITable Care for OUD provides a roadmap to develop measures of patient-centered care for OUD.
Collapse
Affiliation(s)
- A. Taylor Kelley
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Vulnerable Veteran Innovative Patient-aligned Care Team (VIP), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Michael A. Incze
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jacob D. Baylis
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Vulnerable Veteran Innovative Patient-aligned Care Team (VIP), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Spencer G. Calder
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Vulnerable Veteran Innovative Patient-aligned Care Team (VIP), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Saul J. Weiner
- Center of Innovation for Complex Chronic Healthcare, Jesse Brown VA Chicago Health Care System, Chicago, Illinois, USA
- Division of Academic Internal Medicine and Geriatrics, Department of Medicine, The University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Susan L. Zickmund
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Audrey L. Jones
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Vulnerable Veteran Innovative Patient-aligned Care Team (VIP), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Megan E. Vanneman
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Molly B. Conroy
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Adam J. Gordon
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Vulnerable Veteran Innovative Patient-aligned Care Team (VIP), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - John F.P. Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
6
|
Does Health System Responsiveness Differ between Insured and Uninsured Outpatients in Primary Health Care Facilities in Asagirt District, Ethiopia? A Cross-Sectional Study. ADVANCES IN PUBLIC HEALTH 2022. [DOI: 10.1155/2022/3857873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background. An effective designation of health facilities improves the facility’s ability to respond to patients’ legitimate expectations. Limited evidence exists regarding the association between health system responsiveness and financial fairness in Sub-Saharan Africa, particularly in Ethiopia. The purpose of the study was, therefore to evaluate the health system responsiveness among insured and uninsured outpatients in primary healthcare facilities and determine the association between health insurance and health system responsiveness among outpatients. Methods. A facility-based cross-sectional study was conducted between March 30 and April 30,2021. The study sampled 423 participants using a systematic random sampling technique, and the data was collected with structured and pretested questionnaires administered by interviewers. Responsiveness was measured using the short version of the World Health Organization’s multicountry responsiveness survey, which has seven dimensions including autonomy, communication, confidentiality, attention, dignity, choice, and amenities. Using quantile regression, a specific association between health insurance and the health system responsiveness index was examined, adjusting for sociodemographic, quality, and satisfaction-related factors. Results. Of a total of 417 outpatients, 70.74% had health insurance. There was no statistical difference in health system responsiveness among insured and uninsured outpatients. Possession of health insurance was not associated with responsiveness (−0.67; 95%CI: −1.59, 0.25). There was a statistically significant negative relationship between age and responsiveness (−1.33; 95% CI: −2.47, −0.19) among 30–39 year olds and (−1.66; 95% CI: −3.02, −0.32) among 40–49 year olds. However, there was a positive statistical association between responsiveness with urban residence (+1.33; 95%CI: 0.37, 2.29), perceived quality of healthcare (+2.96; 95%CI: 1.95, 4.05), and patient satisfaction (3; 95%CI: 1.94, 4.07). Conclusions. There was no difference in the responsiveness of the health system between insured and uninsured outpatients. All domains need further improvement, particularly those more closely related to patients’ concerns, such as waiting time to get service and choices of healthcare providers. Furthermore, health facility administrators and the government should enhance responsive healthcare services in parallel with quality improvement and patient satisfaction, based on feedback from service users for better performance.
Collapse
|
7
|
Zhou W, Xie G, Yu Y, Gong H, Xiao S. Patients' and family members' experiences of psychiatric inpatient services in China: a comparison based on a dyadic design. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2119-2129. [PMID: 35499765 DOI: 10.1007/s00127-022-02296-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Due to the family-oriented cultural and legal context in China, understanding the difference between patients' and family members' experiences of psychiatric services not only enriches perspectives of service quality assessment, but also promotes service utilization. This study aimed to compare experiences of psychiatric inpatient services between patients and their family members in China. METHODS The study included 126 dyads of patients and family members consecutively recruited from the psychiatric inpatient department in a large hospital in China. The responsiveness performance questionnaire was used to measure the experiences of psychiatric inpatient services after patient discharge. After adjusting reporting heterogeneity based on vignettes, dyad difference was examined by intraclass correlation coefficients (ICCs) and paired Wilcoxon signed-rank tests with Bonferroni correction in multigroup testing. Subgroup analyses were conducted within strata of four selected clinical and socio-demographic factors, to test their influence on difference pattern of experiences. RESULTS Poor consistency was found for all responsiveness items and the total scores among the 126 dyads and in most subgroup analyses (ICC < 0.6). Paired Wilcoxon signed-rank tests found that patients rated lower than their family members on the item of "asking user's opinions" in 126-dyad comparison (P < 0.05) and 3 subgroups related to severe mental disorders and income inequality after Bonferroni correction. CONCLUSION Results reveal inconsistent experiences of psychiatric inpatient services within families in China. Moreover, when making medical decisions, family members' opinions, rather than patients', are more frequently taken into consideration, especially on conditions where imbalanced decision-making power exists between patients and their family members. In the future, user experience improvement should pay equal attention to patients and family members, and the benefits of family involvement and patients' rights of shared decision-making should be carefully balanced.
Collapse
Affiliation(s)
- Wei Zhou
- Research Center for Public Health and Social Security, School of Public Administration, Hunan University, Changsha, Hunan, China.
| | - Guanqing Xie
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Yu Yu
- Division of Prevention and Community Research and The Consultation Center, Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Huihui Gong
- Research Center for Public Health and Social Security, School of Public Administration, Hunan University, Changsha, Hunan, China
| | - Shuiyuan Xiao
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| |
Collapse
|
8
|
Building from Patient Experiences to Deliver Patient-Focused Healthcare Systems in Collaboration with Patients: A Call to Action. Ther Innov Regul Sci 2022; 56:848-858. [PMID: 35854183 PMCID: PMC9356929 DOI: 10.1007/s43441-022-00432-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/30/2022] [Indexed: 11/03/2022]
Abstract
Patients’ experiences of their diagnosis, condition, and treatment (including the impact on their lives), and their experiences surrounding expectations of care, are becoming increasingly important in shaping healthcare systems that meet the evolving needs and priorities of different patient communities over time; this is an ongoing goal of all healthcare stakeholders. Current approaches that capture patient experiences with data are fragmented, resulting in duplication of effort, numerous requests for information, and increased patient burden. Application of patient experience data to inform healthcare decisions is still emerging and there remains an opportunity to align diverse stakeholders on the value of these data to strengthen healthcare systems. Given the collective value of understanding patient experiences across multiple stakeholder groups, we propose a more aligned approach to the collection of patient experience data. This approach is built on the principle that the patients’ experiences are the starting point, and not just something to be considered at the end of the process. It must also be based on meaningful patient engagement, where patients are collaborators and decision makers at each step, thereby ensuring their needs and priorities are accurately reflected. The resulting data and evidence should be made available for all stakeholders, to inform their decision making and healthcare strategies in ways that meet patient priorities. We call for multi-stakeholder collaboration that will deliver healthcare systems and interventions that are better centered around and tailored to patient experiences, and that will help address patients’ unmet needs.
Collapse
|
9
|
Negash WD, Tsehay CT, Yazachew L, Asmamaw DB, Desta DZ, Atnafu A. Health system responsiveness and associated factors among outpatients in primary health care facilities in Ethiopia. BMC Health Serv Res 2022; 22:249. [PMID: 35209882 PMCID: PMC8867670 DOI: 10.1186/s12913-022-07651-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background Health system responsiveness is defined as the outcome of designing health facility relationships so that they are familiar and responsive to patients’ universally legitimate expectations. Even though different strategies have been implemented to measure responsiveness, only limited evidence exists in Sub-Saharan Africa. In Ethiopia, information about health system responsiveness among outpatients is limited. Assessing responsiveness could help facilities in improving service delivery based on patient expectations. Objective The study aimed to assess health system responsiveness and associated factors among outpatients in primary health care facilities, Asagirt District, Ethiopia, 2021. Methods Facility-based cross-sectional quantitative study was implemented between March 30 and April 30/2021. A systematic random sampling technique was employed to select 423 participants, and interviewer-administered data were collected using structured and pretested questionnaires. Both bivariable and multivariable logistic regressions were employed to identify factors associated with health system responsiveness. Adjusted Odds Ratio with their corresponding 95% CI was used to declare factors associated with health system responsiveness. A p-value less than 0.05 was used to declare significant statistical variables. Results The overall health system responsiveness performance was 66.2% (95% CI: 61.4—70.7). Confidentiality and dignity were the highest responsive domains. Health system responsiveness was higher among satisfied patients (AOR: 9.9, 95% CI: 5.11–19.46), utilized private clinics (AOR: 8.8, 95% CI: 4.32–18.25), and no transport payment (AOR: 1.7, 95% CI: 1.03–2.92) in the study setting. Conclusion Overall, health system responsiveness performance was higher than a case-specific study in Ethiopia. To improve the health systems responsiveness and potentially fulfil patients’ legitimate expectations, we need to facilitate informed treatment choice, provide reasonable care within a reasonable time frame, and give patients the option of consulting a specialist. Aside from that, enhancing patient satisfaction, using input from service users, Collaboration, and exchanging experiences between public and private facilities will be important interventions to improve HSR performance.
Collapse
Affiliation(s)
- Wubshet Debebe Negash
- Department of Health Systems and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
| | - Chalie Tadie Tsehay
- Department of Health Systems and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Lake Yazachew
- Department of Health Systems and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Desale Bihonegn Asmamaw
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Dawit Zenamarkos Desta
- Department of Health Systems and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Department of Health Systems and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
10
|
Health insurance and health system (un) responsiveness: a qualitative study with elderly in rural Tanzania. BMC Health Serv Res 2021; 21:1140. [PMID: 34686182 PMCID: PMC8532322 DOI: 10.1186/s12913-021-07144-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 10/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Health insurance (HI) has increasingly been accepted as a mechanism to facilitate access to healthcare in low and middle-income countries. However, health insurance members, especially those in Sub-Saharan Africa, have reported a low responsiveness in health systems. This study aimed to explore the experiences and perceptions of healthcare services from the perspective of insured and uninsured elderly in rural Tanzania. Method An explanatory qualitative study was conducted in the rural districts of Igunga and Nzega, located in western-central Tanzania. Eight focus group discussions were carried out with 78 insured and uninsured elderly men and women who were purposely selected because they were 60 years of age or older and had utilised healthcare services in the past 12 months prior to the study. The interview questions were inspired by the domains of health systems’ responsiveness. Qualitative content analysis was used to analyse the data. Results Elderly participants appreciated that HI had facilitated the access to healthcare and protected them from certain costs. But they also complained that HI had failed to provide equitable access due to limited service benefits and restricted use of services within schemes. Although elderly perspectives varied widely across the domains of responsiveness, insured individuals generally expressed dissatisfaction with their healthcare. Conclusions The national health insurance policy should be revisited in order to improve its implementation and expand the scope of service coverage. Strategic decisions are required to improve the healthcare infrastructure, increase the number of healthcare workers, ensure the availability of medicines and testing facilities at healthcare centers, and reduce long administrative procedures related to HI. A continuous training plan for healthcare workers focused on patients´ communication skills and care rights is highly recommended. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07144-2.
Collapse
|
11
|
Kim J, Yang KH, Choi AR, Kang MY, Kim HJ, Lee H, Lee JY. Healthcare quality assessments: no guarantees of same outcomes for different socio-economic stroke patients. Int J Qual Health Care 2021; 33:6271471. [PMID: 33961032 DOI: 10.1093/intqhc/mzab081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 05/07/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Healthcare quality assessment is being conducted in many countries. Although improving health equity is one of the major objectives of medical quality assessment, it is not clear whether different socio-economic statuses show the same health outcomes even in the same medical quality hospitals. No study has directly compared the health outcomes of different socio-economic statuses in the same hospitals nationwide. OBJECTIVE To determine whether the mortality rate of acute stroke patients differs according to socioeconomic status. METHODS This study was a retrospective, observational study of patients who were subject to acute stroke quality assessment in 2013. A total of 10 399 stroke cases were included in the study. When evaluating the mortality rate, the researchers analysed 10 228 cases, after excluding 171 cases that were measured twice for the same person. The levels of socio-economic status were divided according to the use of medical benefits, either National Health Insurance (NHI) for general population or Medical Aid (MA) for the vulnerable. The primary outcomes measured according to socio-economic status were in-hospital mortality rate and 1-year follow-up mortality rate of stroke patients. The secondary outcome was the composite performance score. RESULTS MA recipients had a higher in-hospital mortality rate (12.5 vs. 8.3%, P < 0.001) and 1-year follow-up mortality rate (14.9 vs. 10.8%, P < 0.001) than NHI subscribers. MA recipients had slightly lower scores than NHI subscribers (83.2 vs. 84.4, P = 0.02). In hospitals of the same grade, MA recipients had lower performance scores than NHI subscribers, although the difference was not statistically significant. CONCLUSIONS There is a difference in mortality and healthcare performance according to socio-economic status in stroke patients in Korea. Efforts to improve equity are needed, including the development and monitoring of equality indicators and developing policies for healthcare equity.
Collapse
Affiliation(s)
- Jayeun Kim
- Institute of Health and Environment, Seoul National University, Gwanak-ro, Gwanak-gu, Seoul 08826, Korea
| | - Ki Hwa Yang
- Health Insurance Review & Assessment Service, 101 Daehak-ro, Jongno-gu, Wonju-si 07061, Korea
| | - Ah Rum Choi
- Health Insurance Review & Assessment Service, 101 Daehak-ro, Jongno-gu, Wonju-si 07061, Korea
| | - Mi Yeon Kang
- Health Insurance Review & Assessment Service, 101 Daehak-ro, Jongno-gu, Wonju-si 07061, Korea
| | - Hyun Joo Kim
- Department of Nursing Science, Shinsung University 1, Daehak-ro, Jeongmi-myeon, Dangjin-si, Chungcheongnam-do 31801, Korea
| | - Hyejin Lee
- Department of Family Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea
| | - Jin Yong Lee
- Health Insurance Review & Assessment Service, 101 Daehak-ro, Jongno-gu, Wonju-si 07061, Korea.,Public Healthcare Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 07061, Korea.,Department of Health Policy and Management, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 07061, Korea
| |
Collapse
|
12
|
Gabrani J, Schindler C, Wyss K. Perspectives of Public and Private Primary Healthcare Users in Two Regions of Albania on Non-Clinical Quality of Care. J Prim Care Community Health 2021; 11:2150132720970350. [PMID: 33243061 PMCID: PMC7705804 DOI: 10.1177/2150132720970350] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Aiming to tackle the rise of non-communicable diseases and an ageing population, Albania is engaged in boosting primary healthcare services and quality of care. The patients’ perspectives on their experience with public and private providers are, however, missing, although their viewpoints are critical while shaping the developing services. Consequently, we analyze perceptions of users of primary healthcare as it relates to non-clinical quality of care and the association to sociodemographic characteristics of patients and the type of provider. Methods: A facility-based survey was conducted in 2018 using the World Health Organization responsiveness questionnaire which is based on a 4-point scale along with 8 non-clinical domains of quality of care. The data of 954 patients were analyzed through descriptive statistics and linear mixed regression models. Results: Similar mean values were reported on total scale of the quality of care for private and public providers, also after sociodemographic adjustments. The highest mean score was reported for the domain “communication” (3.75) followed by “dignity” (3.65), while the lowest mean scores were given for “choice” (2.89) and “prompt attention” (3.00). Urban governmental PHC services were rated significantly better than private outpatient clinics in “coordination of care” (2.90 vs 2.12, P < .001). In contrast, private outpatient clinics were judged significantly better than urban PHC clinics in “confidentiality” (3.77 vs 3.38, P = .04) and “quality of basic amenities” (3.70 vs 3.02, P < .001). “Autonomy” was reported as least important attribute of quality. Conclusion: While the perception of non-clinical care quality was found to be high and similar for public and private providers, promptness and coordination of care require attention to meet patient’s expectations on good quality of care. There is a need to raise the awareness on autonomy and the involvement of patients’ aspects concerning their health.
Collapse
Affiliation(s)
- Jonila Gabrani
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Kaspar Wyss
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| |
Collapse
|
13
|
Wambiya EOA, Otieno PO, Mutua MK, Donfouet HPP, Mohamed SF. Patterns and predictors of private and public health care utilization among residents of an informal settlement in Nairobi, Kenya: a cross-sectional study. BMC Public Health 2021; 21:850. [PMID: 33941131 PMCID: PMC8091493 DOI: 10.1186/s12889-021-10836-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/13/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Knowledge of health care utilization is important in low-and middle-income countries where inequalities in the burden of diseases and access to primary health care exist. Limited evidence exists on health seeking and utilization in the informal settlements in Kenya. This study assessed the patterns and predictors of private and public health care utilization in an urban informal settlement in Kenya. METHODS This study used data from the Lown scholars study conducted between June and July 2018. A total of 300 households were randomly selected and data collected from 364 household members who reported having sought care for an illness in the 12 months preceding the study. Data were collected on health-seeking behaviour and explanatory variables (predisposing, enabling, and need factors). Health care utilization patterns were described using proportions. Predictors of private or public health care use were identified using multinomial logistic regression with the reference group being other providers. RESULTS Majority of the participants used private (47%) and public facilities (33%) with 20% using other providers including local pharmacies/drug shops and traditional healers. In the model comparing public facilities vs other facilities, members who were satisfied with the quality of health care (vs not satisfied) were less likely to use public facilities (adjusted relative risk ratio (aRRR) 0.29; CI 0.11-0.76) while members who reported an acute infection (vs no acute infection) were more likely to use public facilities (aRRR 2.31; 95% CI 1.13-4.99) compared to other facilities. In the second model comparing private facilities to other facilities, having health insurance coverage (aRRR 2.95; 95% CI 1.53-5.69), satisfaction with cost of care (aRRR 2.08; CI 1.00-4.36), and having an acute infection (aRRR 2.97; 95% CI 1.50-5.86) were significantly associated with private facility use compared to other facilities. CONCLUSIONS The majority of urban informal settlement dwellers seek care from private health facilities. As Kenya commits to achieving universal health coverage, interventions that improve health care access in informal and low-resource settlements are needed and should be modelled around enabling and need factors, particularly health care financing and quality of health care.
Collapse
Affiliation(s)
- Elvis O. A. Wambiya
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya
| | - Peter O. Otieno
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya
| | - Martin Kavao Mutua
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya
| | - Hermann Pythagore Pierre Donfouet
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya
| | - Shukri F. Mohamed
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya
- Department of Global Health and Population, Lown Scholars Program, Harvard T.H. Chan School of Public Health, Boston, MA USA
| |
Collapse
|
14
|
van der Pijl MSG, Kasperink M, Hollander MH, Verhoeven C, Kingma E, de Jonge A. Client-care provider interaction during labour and birth as experienced by women: Respect, communication, confidentiality and autonomy. PLoS One 2021; 16:e0246697. [PMID: 33577594 PMCID: PMC7880498 DOI: 10.1371/journal.pone.0246697] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/23/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Respectful Maternity Care is important for achieving a positive labour and birth experience. Client-care provider interaction-specifically respect, communication, confidentiality and autonomy-is an important aspect of Respectful Maternity Care. The aim of this study was twofold: (1) to assess Dutch women's experience of respect, communication, confidentiality and autonomy during labour and birth and (2) to identify which client characteristics are associated with experiencing optimal respect, communication, confidentiality and autonomy. METHODS Pregnant women and women who recently gave birth in the Netherlands were recruited to fill out a validated web-based questionnaire (ReproQ). Mean scores per domain (scale 1-4) were calculated. Domains were dichotomised in non-optimal (score 1, 2,3) and optimal client-care provider interaction (score 4), and a multivariable logistic regression analysis was performed. RESULTS Of the 1367 recruited women, 804 respondents completed the questionnaire and 767 respondents completed enough questions to be included for analysis. Each domain had a mean score above 3.5. The domain confidentiality had the highest proportion of optimal scores (64.0%), followed by respect (53.3%), communication (45.1%) and autonomy (36.2%). In all four domains, women who gave birth at home with a community midwife had a higher proportion of optimal scores than women who gave birth in the hospital with a (resident) obstetrician or hospital-based midwife. Lower education level, being multiparous and giving birth spontaneously were also significantly associated with a higher proportion of optimal scores in (one of) the domains. DISCUSSION This study shows that on average women scored high on experienced client-care provider interaction in the domains respect, communication, confidentiality and autonomy. At the same time, client-care provider interaction in the Netherlands still fell short of being optimal for a large number of women, in particular regarding women's autonomy. These results show there is still room for improvement in client-care provider interaction during labour and birth.
Collapse
Affiliation(s)
- Marit S. G. van der Pijl
- Amsterdam University Medical Centre (UMC), Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam, The Netherlands
- * E-mail:
| | - Marlies Kasperink
- Amsterdam University Medical Centre (UMC), Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam, The Netherlands
| | - Martine H. Hollander
- Amalia Children’s Hospital, Department of Obstetrics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Corine Verhoeven
- Amsterdam University Medical Centre (UMC), Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam, The Netherlands
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, The Netherlands
| | - Elselijn Kingma
- Department of Philosophy, University of Southampton, Southampton, United Kingdom
- Department of Industrial Engineering & Innovation Sciences, Philosophy & Ethics, Technical University Eindhoven, Eindhoven, The Netherlands
| | - Ank de Jonge
- Amsterdam University Medical Centre (UMC), Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam, The Netherlands
| |
Collapse
|
15
|
Amani PJ, Tungu M, Hurtig AK, Kiwara AD, Frumence G, San Sebastián M. Responsiveness of health care services towards the elderly in Tanzania: does health insurance make a difference? A cross-sectional study. Int J Equity Health 2020; 19:179. [PMID: 33046058 PMCID: PMC7549195 DOI: 10.1186/s12939-020-01270-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Responsiveness has become an important health system performance indicator in evaluating the ability of health care systems to meet patients' expectations. However, its measurement in sub-Saharan Africa remains scarce. This study aimed to assess the responsiveness of the health care services among the insured and non-insured elderly in Tanzania and to explore the association of health insurance (HI) with responsiveness in this population. METHODS A community-based cross-sectional study was conducted in 2017 where a pre-tested household survey, administered to the elderly (60 + years) living in Igunga and Nzega districts, was applied. Participants with and without health insurance who attended outpatient and inpatient health care services in the past three and 12 months were selected. Responsiveness was measured based on the short version of the World Health Organization (WHO) multi-country responsiveness survey study, which included the dimensions of quality of basic amenities, choice, confidentiality, autonomy, communication and prompt attention. Quantile regression was used to assess the specific association of the responsiveness index with health insurance adjusted for sociodemographic factors. RESULTS A total of 1453 and 744 elderly, of whom 50.1 and 63% had health insurance, used outpatient and inpatient health services, respectively. All domains were rated relatively highly but the uninsured elderly reported better responsiveness in all domains of outpatient and inpatient care. Waiting time was the dimension that performed worst. Possession of health insurance was negatively associated with responsiveness in outpatient (- 1; 95% CI: - 1.45, - 0.45) and inpatient (- 2; 95% CI: - 2.69, - 1.30) care. CONCLUSION The uninsured elderly reported better responsiveness than the insured elderly in both outpatient and inpatient care. Special attention should be paid to those dimensions, like waiting time, which ranked poorly. Further research is necessary to reveal the reasons for the lower responsiveness noted among insured elderly. A continuous monitoring of health care system responsiveness is recommended.
Collapse
Affiliation(s)
- Paul Joseph Amani
- Department of Health Systems Management, School of Public Administration and Management, Mzumbe University, Morogoro, Tanzania.
- Epidemiology and Global Health, Umeå International School of Public Health, Umeå University, Umeå, Sweden.
| | - Malale Tungu
- Epidemiology and Global Health, Umeå International School of Public Health, Umeå University, Umeå, Sweden
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Anna-Karin Hurtig
- Epidemiology and Global Health, Umeå International School of Public Health, Umeå University, Umeå, Sweden
| | - Angwara Denis Kiwara
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gasto Frumence
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Miguel San Sebastián
- Epidemiology and Global Health, Umeå International School of Public Health, Umeå University, Umeå, Sweden
| |
Collapse
|
16
|
Development of a survey instrument to evaluate women's experiences of their maternity care. Women Birth 2020; 34:e396-e405. [PMID: 32800468 DOI: 10.1016/j.wombi.2020.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 06/11/2020] [Accepted: 07/23/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The process of developing a survey instrument to evaluate women's experiences of their maternity care is complex given that maternity care encapsulates various contexts, services, professions and professionals across the antenatal, intranatal and postnatal periods. AIM To identify and prioritise items for inclusion in the National Maternity Experience Survey, a survey instrument to evaluate women's experiences of their maternity care in the Republic of Ireland. METHODS This study used an adapted two-phase exploratory sequential mixed methods design. Phase one identified items for possible inclusion and developed an exhaustive item pool through a systematic review, focus groups and one to one interviews, and a gap analysis. Phase two prioritised the items for inclusion in the final item bank through a Delphi study and consensus review. FINDINGS Following iterative consultation with key stakeholder groups, a bank of 95 items have been prioritised and grouped within eight distinct care sections; care during your pregnancy, care during your labour and birth, care in hospital after the birth of your baby, specialised care for your baby, feeding your baby, care at home after the birth of your baby, overall care and you and your household. CONCLUSION Robust and rigorous methods have been used to develop a bank of 95 suitable items for inclusion in the National Maternity Experience Survey.
Collapse
|
17
|
Stewart Williams J, Myléus A, Chatterji S, Valentine N. Health systems responsiveness among older adults: Findings from the World Health Organization Study on global AGEing and adult health. Glob Public Health 2020; 15:999-1015. [PMID: 32200690 DOI: 10.1080/17441692.2020.1742365] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Health system responsiveness is an indicator that can be used for evaluating how well healthcare systems respond to people's needs in non-clinical areas such as communication, autonomy and confidentiality. This study analyses health system responsiveness from the perspective of community-dwelling adults aged 50 and over in China, Ghana, India, the Russian Federation and South Africa using cross-sectional data from the World Health Organization Study on global AGEing and adult health. The aim is to assess and compare how individual, health condition and healthcare factors impact differently on outpatient and inpatient responsiveness. Poor responsiveness is measured according to participants' responses to questions on a five-point Likert scale. Five univariate and multiple logistic regression models test associations between individual, health condition and healthcare factors and poor responsiveness. The final model adjusts for country. Key results are that travel time is a major contributor to poor responsiveness across all countries. Similarly there are wealth inequalities in responsiveness. However no clear difference in responsiveness was observed in presentations for chronic versus other types of conditions. This study provides an interesting baseline on older patients' perceived treatment within outpatient and inpatient facilities in five diverse low- and middle-income countries.
Collapse
Affiliation(s)
- Jennifer Stewart Williams
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden.,Research Centre for Generational Health and Ageing, Faculty of Health, University of Newcastle, Callaghan, Australia
| | - Anna Myléus
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden.,Family Medicine, Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Somnath Chatterji
- Department of Data and Analytics, World Health Organization, Switzerland
| | - Nicole Valentine
- Department of Public Health, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Social Determinants of Health, World Health Organization, Switzerland
| |
Collapse
|
18
|
Fernández-Pérez Á, Sánchez Á. Improving People's Self-Reported Experience with the Health Services: The Role of Non-Clinical Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:E178. [PMID: 31881806 PMCID: PMC6982150 DOI: 10.3390/ijerph17010178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 12/20/2019] [Accepted: 12/21/2019] [Indexed: 11/16/2022]
Abstract
The main aim of this study was to analyse the association between non-clinical factors and the self-reported experience of people with the main health services of the Spanish public healthcare system. Specifically, we analysed whether factors such as the treatment received from health staff, the confidence transmitted to the patient by the doctor, or waiting time for a diagnostic test had an influence on people reporting a more satisfactory experience with primary, specialised, and hospital care services. We used cross-sectional microdata from the Spanish Healthcare Barometer survey of 2015 comprising a sample of 7800 individuals. We applied a probit-adapted ordinary least squares estimation, which is one of the most widely used methods in recent studies on subjective well-being. Our findings suggest that individuals' interaction with non-clinical factors was positively correlated with the overall health services experience. Treatment received from health staff was one of the most relevant factors to ensure that individuals report a more satisfactory experience with primary care. Time devoted by physicians to each patient and waiting time for a non-emergency admission were the most correlated factors in specialised and hospital care services, respectively. This study could have implications for public policies. First, it shows policy-makers the influence of non-clinical factors when individuals rate their overall experience with the main health services in Spain. Second, it identifies the key factors where the health system could reallocate more public resources to improve people's experience and thus the health system responsiveness.
Collapse
Affiliation(s)
- Ángel Fernández-Pérez
- Department of Applied Economics, University of Granada (Spain), Faculty of Economics and Business Science, Campus Cartuja s/n, 18071 Granada, Spain;
| | | |
Collapse
|
19
|
Scheerhagen M, van Stel HF, Franx A, Birnie E, Bonsel GJ. The discriminative power of the ReproQ: a client experience questionnaire in maternity care. PeerJ 2019; 7:e7575. [PMID: 31799065 PMCID: PMC6884994 DOI: 10.7717/peerj.7575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/29/2019] [Indexed: 11/20/2022] Open
Abstract
Background The aim of the ReproQuestionnaire (ReproQ) is to measure the client’s experience with maternity care, following WHO’s responsiveness model. To support quality improvement, ReproQ should be able to discriminate best from worst organisational units. Methods We sent questionnaires to 27,487 third-trimester pregnant women (response 31%) and to 37,230 women 6 weeks after childbirth (response 39%). For analysis we first summarized the ReproQ domain scores into three summary scores: total score (all eight domains), personal score (four personal domains), and setting score (four setting domains). Second, we estimated the proportion of variance across perinatal units attributable to the ‘actual’ difference across perinatal units using intraclass correlation coefficients (ICCs). Third, we assessed the ability of ReproQ to discriminate between perinatal units based on both a statistical approach using multilevel regression analyses, and a relevance approach based on the minimally important difference (MID). Finally, we compared the domain scores of the best and underperforming units. Results ICCs ranged between 0.004 and 0.025 for the summary scores, and between 0.002 and 0.125 for the individual domains. ReproQ was able to identify the best and worst performing units with both the statistical and relevance approach. The statistical approach was able to identify four underperforming units during childbirth (total score), while the relevance approach identified 10 underperforming units. Conclusions ReproQ, a valid and efficient measure of client experiences in maternity care, has the ability to discriminate well across perinatal units, and is suitable for benchmarking under routine conditions.
Collapse
Affiliation(s)
- Marisja Scheerhagen
- Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Henk F. van Stel
- Department of Healthcare Innovation and Evaluation, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Erwin Birnie
- Erasmus School of Health Policy & Management, Department of Health Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Gouke J. Bonsel
- Department of Obstetrics and Gynecology, Academic Collaborative Maternity Care, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
20
|
Development of primary care assessment tool-adult version in Tibet: implication for low- and middle-income countries. Prim Health Care Res Dev 2019; 20:e94. [PMID: 32800017 PMCID: PMC6609993 DOI: 10.1017/s1463423619000239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Aim: To conduct advanced psychometric analysis of Primary Care Assessment Tool (PCAT) in Tibet and identify avenues for metric performance improvement. Background: Measuring progress toward high-performing primary health care can contribute to the achievement of sustainable development goals. The adult version of PCAT is an instrument for measuring patient experience, with key elements of primary care. It has been extensively used and validated internationally. However, only little information is available regarding its psychometric properties obtained based on advanced analysis. Methods: We used data collected from 1386 primary care users in two prefectures in Tibet. First, iterative confirmatory factor analysis examined the fit of the primary care construct in the original tool. Then item response theory analysis evaluated how well the questions and individual response options perform at different levels of patient experience. Finally, multiple logistic regression modeling examined the predicative validity of primary care domains against patient satisfaction. Findings: A best final structure for the PCAT-Tibetan includes 7 domains and 27 items. Confirmatory factor analysis suggests good fit for a unidimensional model for items within each domain but doesn’t support a unidimensional model for the entire instrument with all domains. Non-parametric and parametric item response theory analysis models show that for most items, the favorable response option (4 = definitely) is overwhelmingly endorsed, the discriminability parameter is over 1, and the difficulty parameters are all negative, suggesting that the items are most sensitive and specific for patients with poor primary care experience. Ongoing care is the strongest predictor of patient satisfaction. These findings suggest the need for some principles in adapting the tool to different health system contexts, more items measuring excellent primary care experience, and update of the four-point response options.
Collapse
|
21
|
Evaluating Primary Health Care Performance from User Perspective in China: Review of Survey Instruments and Implementation Issues. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16060926. [PMID: 30875833 PMCID: PMC6466226 DOI: 10.3390/ijerph16060926] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/04/2019] [Accepted: 03/11/2019] [Indexed: 12/28/2022]
Abstract
This review aims to summarize the progress of patient evaluation studies focusing on primary health care (PHC) in China, specifically in relation to survey instruments and implementation issues. Eligible studies published in English or Chinese were obtained through online searches of PubMed and China National Knowledge Infrastructure. A descriptive reporting approach was used due to variations in the measurements and administration methods between studies. A total of 471 articles were identified and of these articles; of those 91 full-text articles were included in the final analysis. Most studies used author-developed measurements with five-point Likert response scales and many used the Chinese translations of validated tools from other countries. Most instruments assessed the physical environment, medical equipment, clinical competency and convenience aspects of PHC using a satisfaction rating instead of care experience reporting. Many studies did not report the sampling approach, patient recruitment procedures and survey administration modes. The patient exit survey was the most commonly used survey implementation method. The focus on the structural dimensions of PHC, inconsistent wording, categories of response options that use satisfaction rating, and unclear survey implementation processes are common problems in patient evaluation studies of PHC in China. Further studies are necessary to identify population preferences of PHC in China in order to move towards developing Chinese value-based patient experience measurements.
Collapse
|
22
|
Chiou SJ, Lee PC, Chang YH, Huang PS, Lee LH, Lin KC. Assessment of patient experience profiles and satisfaction with expectations of treatment effects by using latent class analysis based on a national patient experience survey in Taiwan. BMJ Open 2019; 9:e023045. [PMID: 30852529 PMCID: PMC6429738 DOI: 10.1136/bmjopen-2018-023045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Health system responsiveness is a complicated issue that guides researchers wishing to design an efficient methodology for enhancing understanding of perspectives regarding healthcare systems. This study examined the relationship between patient experience profiles and satisfaction with expectations of treatment effects. DESIGN This was a cross-sectional study. We used eight items obtained from latent class analysis to develop patient experience profiles. SETTING Primary care users in Taiwan. PARTICIPANTS This study conducted an annual National Health Insurance survey in Taiwan and sampled from those who had experience with the medical service in primary care clinics in 2015. PRIMARY OUTCOME MEASURE Respondents were asked to indicate the extent of their satisfaction with their expectation of treatment effects (or symptom improvement). RESULTS The proportions of participants in groups 1-4 were 34%, 24%, 29% and 12%, respectively. Patients in good health were more satisfied with their expectations of treatment effects (OR 1.639, p=0.007). Furthermore, group 4 (-eAll) were less satisfied with their expectations of treatment effects than those in the other three groups (ORs: group 1 (+eAll): 9.81, group 2 (-CwR): 4.14 and group 3 (-CnR): 4.20). CONCLUSIONS The results revealed that experiences of poor accessibility and physician-patient relationships affected the patients' expectations. Therefore, greater accessibility and more positive physician-patient relationships could lead to higher patient satisfaction with their expectations of treatment effects. Furthermore, the findings could assist authorities in targeting specific patients, with the objective of improving their healthcare service experience. They could also serve as a mechanism for improving the quality of healthcare services and increase accountability in healthcare practices.
Collapse
Affiliation(s)
- Shang-Jyh Chiou
- Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Pei-Chen Lee
- Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yu-Hsuan Chang
- Planning, National Health Insurance Admission, Taipei, Taiwan
| | - Pei-Shan Huang
- Planning, National Health Insurance Admission, Taipei, Taiwan
| | - Li-Hui Lee
- Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Kuan-Chia Lin
- Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|
23
|
Wang W, Maitland E, Nicholas S, Haggerty J. Determinants of Overall Satisfaction with Public Clinics in Rural China: Interpersonal Care Quality and Treatment Outcome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050697. [PMID: 30818750 PMCID: PMC6427360 DOI: 10.3390/ijerph16050697] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/08/2019] [Accepted: 02/22/2019] [Indexed: 01/17/2023]
Abstract
The primary health care quality factors determining patient satisfaction will shape patient-centered health reform in China. While rural public clinics performed better than hospitals and private clinics in terms of patient perceived quality of primary care in China, there is little information about which quality care aspects drove patients’ satisfaction. Using a World Health Organization database on 1014 rural public clinic users from eight provinces in China, our multiple linear regression model estimated the association between patient perceived quality aspects, one treatment outcome, and overall primary health care satisfaction. Our results show that treatment outcome was the strongest predictor of overall satisfaction (β = 0.338 (95% CI: 0.284 to 0.392); p < 0.001), followed by two interpersonal care quality aspects, Dignity (being treated respectfully) (β = 0.219 (95% CI: 0.117 to 0.320); p < 0.001) and Communication (clear explanation by the physician) (β = 0.103 (95% CI: 0.003 to 0.203); p = 0.043). Prompt attention (waiting time before seeing the doctor) and Confidentiality (talking privately to the provider) were not correlated with overall satisfaction. The treatment outcome focus, and weak interpersonal primary care aspects, in overall patient satisfaction, pose barriers towards a patient-centered transformation of China’s primary care rural clinics, but support the focus of improving the clinical competency of rural primary care workers.
Collapse
Affiliation(s)
- Wenhua Wang
- Department of Family Medicine, McGill University, Montreal, QC H3T 1M5, Canada.
| | - Elizabeth Maitland
- University of Liverpool Management School, University of Liverpool, Liverpool L697ZH, UK.
| | - Stephen Nicholas
- School of Management and School of Commerce, Tianjin Normal University, Tianjin 300074, China.
- Guangdong Research Institute for International Strategies, Guangdong University of Foreign Studies, Guangzhou 510420, China.
- TOP Education Institute, Sydney, NSW 2015, Australia.
- University of Newcastle Business School, Newcastle, NSW 2308, Australia.
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Montreal, QC H3T 1M5, Canada.
| |
Collapse
|
24
|
Wang W, Loban EK, Dionne E. Public Hospitals in China: Is There a Variation in Patient Experience with Inpatient Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E193. [PMID: 30641915 PMCID: PMC6352089 DOI: 10.3390/ijerph16020193] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 11/16/2022]
Abstract
In China, public hospitals are the main provider of inpatient service. The Chinese public hospital reform has recently shifted towards health care organizations and delivery to improve health care quality. This study analyzes the variation of one of the dimensions of health care quality, patient-centeredness, among inpatients with different socioeconomic status and geographical residency in China. 1471 respondents who received inpatient care in public hospitals were included in our analysis. Patient-centeredness performance was assessed on the dimensions of Communication, Autonomy, Dignity, and Confidentiality. Variations of inpatient experience were estimated using binary logistic regression models according to: residency, region, age, gender, education, income quintile, self-rated health, and number of hospital admissions. Our results indicate that older patients, and patients living in rural areas and Eastern China are more likely to report positive experience of their public hospital stay according to the care aspects of Dignity, Communication, Confidentiality and Autonomy. However, there remains a gap between China and other countries in relation to inpatient experience. Noticeable disparities in inpatient experience also persist between different geographical regions in China. These variations of patient experience pose a challenge that China's health policy makers would need to consider in their future reform efforts.
Collapse
Affiliation(s)
- Wenhua Wang
- Department of Family Medicine, McGill University, Montreal, Quebec H3T 1M5, Canada.
| | | | - Emilie Dionne
- Department of Family Medicine, McGill University, Montreal, Quebec H3T 1M5, Canada.
| |
Collapse
|
25
|
Natal C, Suarez TV. [Health system responsiveness. How do citizens see us? How do staff see us?]. J Healthc Qual Res 2019; 34:48-50. [PMID: 30392892 DOI: 10.1016/j.jhqr.2018.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 06/08/2023]
Affiliation(s)
- C Natal
- Área Sanitaria VIII, Servicio de Salud del Principado de Asturias, Langreo, Asturias, España.
| | - T V Suarez
- Área Sanitaria VIII, Servicio de Salud del Principado de Asturias, Langreo, Asturias, España
| |
Collapse
|
26
|
Scheerhagen M, Birnie E, Franx A, van Stel HF, Bonsel GJ. Measuring clients' experiences with antenatal care before or after childbirth: it matters. PeerJ 2018; 6:e5851. [PMID: 30515354 PMCID: PMC6266936 DOI: 10.7717/peerj.5851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 10/01/2018] [Indexed: 11/20/2022] Open
Abstract
Background When clients’ experiences with maternity care are measured for quality improvement, surveys are administered once, usually six weeks or more after childbirth. Most surveys conveniently cover pregnancy, childbirth and postnatal care all in one. However, the validity of measuring the experiences during pregnancy (antenatal experiences) after childbirth is unknown. We explored the relation between the measurement of antenatal experiences late in pregnancy but prior to childbirth (‘test’ or gold standard) and its retrospective measurement after childbirth (retrospective test). Additionally, we explored the role of modifying determinants that explained the gap between these two measurements. Methods and Findings Client’s experiences were measured by the ReproQuestionnaire that consists of an antenatal and postnatal version, and covers the eight WHO Responsiveness domains. 462 clients responded to the antenatal and postnatal questionnaire, and additionally filled out the repeated survey on antenatal experiences after childbirth. First, we determined the association between the test and retrospective test using three scoring models: mean score, equal or above the median score and having a negative experience. The association was moderate for having any negative experience (absolute agreement = 68%), for the median (absolute agreement = 69%) and for the mean score (ICC = 0.59). Multiple linear and logistic regression analysis for all three scoring models revealed systematic modifiers. The gap between antenatal and postnatal measurement was (partly) associated with clients’ experiences during childbirth and postnatal care and by professional discontinuity during childbirth but unrelated to the perceived health outcome. Conclusions The antenatal experiences should be measured before and not after childbirth, as the association between the antenatal experiences measured before and after childbirth is moderate.
Collapse
Affiliation(s)
- Marisja Scheerhagen
- Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands.,Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Erwin Birnie
- Department of Obstetrics and Gynecology, Academic Collaborative Maternity Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Henk F van Stel
- Julius Center for Health Sciences and Primary Care, Department of Healthcare Innovation and Evaluation, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gouke J Bonsel
- Department of Obstetrics and Gynecology, Academic Collaborative Maternity Care, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
27
|
Assessing Trend of Health System Responsiveness in Iran Using Household Survey (Before and After the Implementation of Health Transformation Plan). HEALTH SCOPE 2018. [DOI: 10.5812/jhealthscope.63866] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
28
|
Joarder T, George A, Ahmed SM, Rashid SF, Sarker M. What constitutes responsiveness of physicians: A qualitative study in rural Bangladesh. PLoS One 2017; 12:e0189962. [PMID: 29253891 PMCID: PMC5734771 DOI: 10.1371/journal.pone.0189962] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 12/05/2017] [Indexed: 11/18/2022] Open
Abstract
Responsiveness entails the social actions by health providers to meet the legitimate expectations of patients. It plays a critical role in ensuring continuity and effectiveness of care within people centered health systems. Given the lack of contextualized research on responsiveness, we qualitatively explored the perceptions of outpatient users and providers regarding what constitute responsiveness in rural Bangladesh. An exploratory study was undertaken in Chuadanga, a southwestern Bangladeshi District, involving in-depth interviews of physicians (n = 17) and users (n = 7), focus group discussions with users (n = 4), and observations of patient provider interactions (three weeks). Analysis was guided by a conceptual framework of responsiveness, which includes friendliness, respecting, informing and guiding, gaining trust and optimizing benefits. In terms of friendliness, patients expected physicians to greet them before starting consultations; even though physicians considered this unusual. Patients also expected physicians to hold social talks during consultations, which was uncommon. With regards to respect patients expected physicians to refrain from disrespecting them in various ways; but also by showing respect explicitly. Patients also had expectations related to informing and guiding: they desired explanation on at least the diagnosis, seriousness of illness, treatment and preventive steps. In gaining trust, patients expected that physicians would refrain from illegal or unethical activities related to patients, e.g., demanding money against free services, bringing patients in own private clinics by brokers (dalals), colluding with diagnostic centers, accepting gifts from pharmaceutical representatives. In terms of optimizing benefits: patients expected that physicians should be financially sensitive and consider individual need of patients. There were multiple dimensions of responsiveness- for some, stakeholders had a consensus; context was an important factor to understand them. This being an exploratory study, further research is recommended to validate the nuances of the findings. It can be a guideline for responsiveness practices, and a tipping point for future research.
Collapse
Affiliation(s)
- Taufique Joarder
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Department of International Health (Health Systems), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Asha George
- School of Public Health, University of Western Cape, Cape Town, South Africa
| | - Syed Masud Ahmed
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Sabina Faiz Rashid
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Malabika Sarker
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| |
Collapse
|
29
|
Wang W, Maitland E, Nicholas S, Loban E, Haggerty J. Comparison of patient perceived primary care quality in public clinics, public hospitals and private clinics in rural China. Int J Equity Health 2017; 16:176. [PMID: 28974255 PMCID: PMC5627445 DOI: 10.1186/s12939-017-0672-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 09/26/2017] [Indexed: 11/20/2022] Open
Abstract
Background In rural China, patients have free choice of health facilities for outpatient services. Comparison studies exploring the attributes of different health facilities can help identify optimal primary care service models. Using a representative sample of Chinese provinces, this study aimed to compare patients’ rating of three primary care service models used by rural residents (public clinics, public hospitals and private clinics) on a range of health care attributes related to responsiveness. Methods This was a secondary analysis using the household survey data from World Health Organization (WHO) Study on global AGEing and adult health (SAGE). Using a multistage cluster sampling strategy, eight provinces were selected and finally 3435 overall respondents reporting they had visited public clinics, public hospitals or private clinics during the last year, were included in our analysis. Five items were used to measure patient perceived quality in five domains including prompt attention, communication and autonomy, dignity and confidentiality. ANOVA and Turkey’s post hoc tests were used to conduct comparative analysis of five domains. Separate multivariate linear regression models were estimated to examine the association of primary care service models with each domain after controlling for patient characteristics. Results The distribution of last health facilities visited was: 29.5% public clinics; 31.2% public hospitals and; 39.3% private clinics. Public clinics perform best in all five domains: prompt attention (4.15), dignity (4.17), communication (4.07), autonomy (4.05) and confidentiality (4.02). Public hospitals perform better than private clinics in dignity (4.03 vs 3.94), communication (3.97 vs 3.82), autonomy (3.92 vs 3.74) and confidentiality (3.94 vs 3.73), but equivalently in prompt attention (3.92 vs 3.93). Rural residents who are older, wealthier, and with higher self-rated health status have significantly higher patient perceived quality of care in all domains. Conclusions Rural public clinics, which share many characteristics with the optimal primary care delivery model, should be strongly strengthened to respond to patients’ needs. Better doctor-patient interaction training would improve respect, confidentiality, autonomy and, most importantly, health care quality for rural patients.
Collapse
Affiliation(s)
- Wenhua Wang
- School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan, Hubei Province, 430071, People's Republic of China. .,Department of Family Medicine, McGill University, Hayes Pavilion, Suite 4764, 3830 Avenue Lacombe, Montreal, Quebec, H3T 1M5, Canada.
| | - Elizabeth Maitland
- School of Management, Australian School of Business, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Stephen Nicholas
- School of Management and Commerce, Tianjin Normal University, West Bin Shui Avenue, Tianjin, 300074, People's Republic of China.,Guangdong Research Institute for International Strategies, Guangdong University of Foreign Studies, 2 Baiyun North Avenue, Baiyun, Guangzhou, Guangdong, 510420, People's Republic of China.,School of International Business, Beijing Foreign Studies University, 19 North Xisanhuan Avenue, Haidian, Beijing, 100089, People's Republic of China.,University of Newcastle, Newcastle, NSW, 2308, Australia
| | - Ekaterina Loban
- Department of Family Medicine, McGill University, Hayes Pavilion, Suite 4759, 3830 Avenue Lacombe, Montreal, Quebec, H3T 1M5, Canada
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Hayes Pavilion, Suite 4767, 3830 Avenue Lacombe, Montreal, Quebec, H3T 1M5, Canada
| |
Collapse
|
30
|
van der Kooy J, Birnie E, Valentine NB, de Graaf JP, Denktas S, Steegers EAP, Bonsel GJ. Quality of perinatal care services from the user's perspective: a Dutch study applies the World Health Organization's responsiveness concept. BMC Pregnancy Childbirth 2017; 17:327. [PMID: 28962611 PMCID: PMC5622418 DOI: 10.1186/s12884-017-1464-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 08/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The concept of responsiveness was introduced by the World Health Organization (WHO) to address non-clinical aspects of service quality in an internationally comparable way. Responsiveness is defined as aspects of the way individuals are treated and the environment in which they are treated during health system interactions. The aim of this study is to assess responsiveness outcomes, their importance and factors influencing responsiveness outcomes during the antenatal and delivery phases of perinatal care. METHOD The Responsiveness in Perinatal and Obstetric Health Care Questionnaire was developed in 2009/10 based on the eight-domain WHO concept and the World Health Survey questionnaire. After ethical approval, a total of 171 women, who were 2 weeks postpartum, were recruited from three primary care midwifery practices in Rotterdam, the Netherlands, using face-to-face interviews. We dichotomized the original five ordinal response categories for responsiveness attainment as 'poor' and good responsiveness and analyzed the ranking of the domain performance and importance according to frequency scores. We used a series of independent variables related to health services and users' personal background characteristics in multiple logistic regression analyses to explain responsiveness. RESULTS Poor responsiveness outcomes ranged from 5.9% to 31.7% for the antenatal phase and from 9.7% to 27.1% for the delivery phase. Overall for both phases, 'respect for persons' (Autonomy, Dignity, Communication and Confidentiality) domains performed better and were judged to be more important than 'client orientation' domains (Choice and Continuity, Prompt Attention, Quality of Basic Amenities, Social Consideration). On the whole, responsiveness was explained more by health-care and health related issues than personal characteristics. CONCLUSION To improve responsiveness outcomes caregivers should focus on domains in the category 'client orientation'.
Collapse
Affiliation(s)
- Jacoba van der Kooy
- Division of Obstetrics & Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Erwin Birnie
- Division of Obstetrics & Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department Obstetrics & Gynaecology, Academic Collaboration Maternity Care Services, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, the Netherlands
| | - Nicole B Valentine
- World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland.,Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Johanna P de Graaf
- Division of Obstetrics & Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Semiha Denktas
- Division of Obstetrics & Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Division of Obstetrics & Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Gouke J Bonsel
- Division of Obstetrics & Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department Obstetrics & Gynaecology, Academic Collaboration Maternity Care Services, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, the Netherlands.,Rotterdam Midwifery Academic (Verloskunde Academie Rotterdam), Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| |
Collapse
|
31
|
An Approach to measuring Integrated Care within a Maternity Care System: Experiences from the Maternity Care Network Study and the Dutch Birth Centre Study. Int J Integr Care 2017; 17:6. [PMID: 28970747 PMCID: PMC5624115 DOI: 10.5334/ijic.2522] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Introduction: Integrated care is considered to be a means to reduce costs, improve the quality of care and generate better patient outcomes. At present, little is known about integrated care in maternity care systems. We developed questionnaires to examine integrated care in two different settings, using the taxonomy of the Rainbow Model of Integrated Care. The aim of this study was to explore the validity of these questionnaires. Methods: We used data collected between 2013 and 2015 from two studies: the Maternity Care Network Study (634 respondents) and the Dutch Birth Centre Study (56 respondents). We assessed the feasibility, discriminative validity, and reliability of the questionnaires. Results: Both questionnaires showed good feasibility (overall missing rate < 20%) and reliability (Cronbach’s Alpha coefficient > 0.70). Between-subgroups post-hoc comparisons showed statistically significant differences on integration profiles between regional networks (on all items, dimensions of integration and total integration score) and birth centres (on 50% of the items and dimensions of integration). Discussion: Both questionnaires are feasible and can discriminate between sites with different integration profiles in The Netherlands. They offer an opportunity to better understand integrated care as one step in understanding the complexity of the concept.
Collapse
|
32
|
Chao J, Lu B, Zhang H, Zhu L, Jin H, Liu P. Healthcare system responsiveness in Jiangsu Province, China. BMC Health Serv Res 2017; 17:31. [PMID: 28086950 PMCID: PMC5237227 DOI: 10.1186/s12913-017-1980-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 01/04/2017] [Indexed: 11/25/2022] Open
Abstract
Background The perceived responsiveness of a healthcare system reflects its ability to satisfy reasonable expectations of the public with respect to non-medical services. Recently, there has been increasing attention paid to responsiveness in evaluating the performance of a healthcare system in a variety of service settings. However, the factors that affect the responsiveness have been inconclusive so far and measures of improved responsiveness have not always thoroughly considered the factors. The aim of this study was to evaluate both the responsiveness of the healthcare system in Jiangsu Province, China, the factors that influence responsiveness and the measures of improved responsiveness considering it, as determined by a responsiveness survey. Methods A multistage, stratified random sampling method was used to select 1938 adult residents of Jiangsu Province in 2011. Face-to-face interviews were conducted using a self-designed questionnaire modeled on the World Health Organization proposal. The final analysis was based on 1783 (92%) valid questionnaires. Canonical correlation analysis was used to assess the factors that affect responsiveness. Results The average score of all responsiveness-related domains in the surveyed healthcare system was satisfactory (7.50 out of a maximum 10.0). The two highest scoring domains were dignity and confidentiality, and the two lowest scoring domains choice and prompt attention. The factors affecting responsiveness were age, regional economic development level, and geographic area (urban vs. rural). The responsiveness regarding basic amenities was rated worse by the elderly than by younger respondents. Responsiveness ranked better by those with a poorer economic status. Choice in cities was better than in rural regions. Conclusions The responsiveness of the Jiangsu healthcare system was considered to be satisfactory but could be improved by offering greater choice and providing more prompt attention. Perceptions of healthcare system responsiveness differ with age, regional economic development level, and geographic area (urban vs. rural). Measures to increase the perceived level of responsiveness include better service at higher level hospitals, shorter waiting time, more hospitals in rural regions, an improved medical environment, and provision of infrastructures that makes the medical environments more comfortable. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-1980-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jianqian Chao
- Department of Medical insurance, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Boyang Lu
- Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Hua Zhang
- Department of Medical insurance, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Liguo Zhu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Hui Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Pei Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing, Jiangsu, China.
| |
Collapse
|
33
|
Awoke MA, Negin J, Moller J, Farell P, Yawson AE, Biritwum RB, Kowal P. Predictors of public and private healthcare utilization and associated health system responsiveness among older adults in Ghana. Glob Health Action 2017; 10:1301723. [PMID: 28578615 PMCID: PMC5496095 DOI: 10.1080/16549716.2017.1301723] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 02/27/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Previous studies investigating factors associated with healthcare utilization by older Ghanaians lack distinction between public and private health services. The present study examined factors associated with public and private healthcare service use, and the resulting perceived health system responsiveness. OBJECTIVES To identify factors associated with public and private healthcare utilization among older adults aged 50 and older in Ghana; and to compare perceived differences in health system responsiveness between the private and public sectors. METHODS Cross-sectional data was analyzed from the World Health Organization Study on global AGEing and adult health (SAGE) Wave 1 in Ghana. Using Andersen's conceptual framework, public and private outpatient care utilization was examined using multinomial logistic regression to estimate and identify predictor variables associated with the type of outpatient healthcare facility accessed. Health system responsiveness was compared using chi-square tests. RESULTS Of 2517 respondents who used outpatient care in the 12 months preceding interview, 51.7% of respondents used a public facility, 17.8% a private facility, and 30.5% used other facilities. Older age group, higher education and higher wealth were associated with the use of private outpatient healthcare services. Using public outpatient care facilities was associated with having health insurance. Respondents with two or more chronic conditions were more likely to use public and private outpatient care than other facilities. Perceived health system responsiveness was better in private for-profit than in public and private not-for-profit healthcare facilities. CONCLUSIONS This study suggested that higher wealth and multimorbidity were significant predictors of public and private outpatient healthcare utilization; however, health insurance was a predictor only for the use of public facilities. Future mixed-method studies could further elucidate factors influencing the choice of public and private outpatient healthcare use.
Collapse
Affiliation(s)
- Mamaru Ayenew Awoke
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Monitoring, Evaluation and Research Unit, Amref Health Africa, Addis Ababa, Ethiopia
| | - Joel Negin
- School of Public Health, University of Sydney, Sydney, Australia
| | - Jette Moller
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Penny Farell
- School of Public Health, University of Sydney, Sydney, Australia
| | - Alfred E. Yawson
- Department of Community Health, University of Ghana, Accra, Ghana
| | | | - Paul Kowal
- Research Centre for Gender, Health & Ageing, University of Newcastle, Newcastle, Australia
- SAGE, World Health Organization, Geneva, Switzerland
| |
Collapse
|
34
|
Scheerhagen M, van Stel HF, Tholhuijsen DJC, Birnie E, Franx A, Bonsel GJ. Applicability of the ReproQ client experiences questionnaire for quality improvement in maternity care. PeerJ 2016; 4:e2092. [PMID: 27478690 PMCID: PMC4950561 DOI: 10.7717/peerj.2092] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 05/08/2016] [Indexed: 12/17/2022] Open
Abstract
Background. The ReproQuestionnaire (ReproQ) measures the client's experience with maternity care, following the WHO responsiveness model. In 2015, the ReproQ was appointed as national client experience questionnaire and will be added to the national list of indicators in maternity care. For using the ReproQ in quality improvement, the questionnaire should be able to identify best and worst practices. To achieve this, ReproQ should be reliable and able to identify relevant differences. Methods and Findings. We sent questionnaires to 17,867 women six weeks after labor (response 32%). Additionally, we invited 915 women for the retest (response 29%). Next we determined the test-retest reliability, the Minimally Important Difference (MID) and six known group comparisons, using two scorings methods: the percentage women with at least one negative experience and the mean score. The reliability for the percentage negative experience and mean score was both 'good' (Absolute agreement = 79%; intraclass correlation coefficient = 0.78). The MID was 11% for the percentage negative and 0.15 for the mean score. Application of the MIDs revealed relevant differences in women's experience with regard to professional continuity, setting continuity and having travel time. Conclusions. The measurement characteristics of the ReproQ support its use in quality improvement cycle. Test-retest reliability was good, and the observed minimal important difference allows for discrimination of good and poor performers, also at the level of specific features of performance.
Collapse
Affiliation(s)
- Marisja Scheerhagen
- Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Obstetrics and Gynecology, Academic Collaborative Maternity Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Henk F van Stel
- Julius Center for Health Sciences and Primary Care, Department of Health Technology Assessment, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Dominique J C Tholhuijsen
- Institute of Health Policy and Management, Erasmus University Rotterdam , Rotterdam , The Netherlands
| | - Erwin Birnie
- Department of Obstetrics and Gynecology, Academic Collaborative Maternity Care, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynecology, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Gouke J Bonsel
- Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Obstetrics and Gynecology, Academic Collaborative Maternity Care, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
35
|
Askari R, Arab M, Rashidian A, Akbari-Sari A, Hosseini SM, Gharaee H. Designing Iranian Model to Assess the Level of Health System Responsiveness. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e24527. [PMID: 27247795 PMCID: PMC4884272 DOI: 10.5812/ircmj.24527] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 10/26/2014] [Accepted: 11/17/2014] [Indexed: 11/16/2022]
Abstract
Background: Given the rapid pace of changes in community health needs and the mission of healthcare organizations to provide and promote the community’s health, the growing need to increase health system responsiveness to people as a key element of observance and fulfillment of justice is felt more than ever. Objectives: This study was aimed at designing the native model of responsiveness for Iran and to validate the aspects of the proposed model. Materials and Methods: Our study had a cross-sectional design and was a validation study performed in 2014. In order to define and identify responsiveness model aspects, the first phase recorded the views of 200 key informants from 19 provinces of Iran. Snowball sampling was used to select experts (based on WHO guideline). Then, the opinions of 18 comments were received from service recipients in the form of three focus group discussions and were analyzed by the frame framework analysis (interviewed recipients were selected using the purposive sampling method). Finally, in order to confirm the model’s efficacy, a responsiveness questionnaire with 7 aspects (domains) and 52 indicators (items) obtained from the initial proposed model was answered by 600 members of the selected families in the two provinces of Fars and Yazd. A multi-stage cluster sampling approach was used for the household survey. The results were analyzed by the Confirmatory Factor Analysis (CFA) test and through the use of Lisrel software. Results: Confirmatory Factor Analysis, based on the results of the key informant survey and group discussions, showed that according to quantities of GFI = 0.91, CFI = 0.93, NFI = 0.91, RMSEA = 0.074, SRMR = 0.061 and Hoelter (CN) = 178.54 in outpatient services and where GFI = 0.89, CFI = 0.91, NFI = 0.86, RMSEA = 0.064, SRMR = 0.053 and Hoelter (CN) = 158.93 for inpatient services, seven factors (F) (dignity, informed choice, confidentiality, patient training and informing, access to services, quality of basic amenities, and access to social support) are the main determinants of the responsiveness model and proposed model validity. Conclusions: Given the comprehensiveness of presented aspects and indicators in this proposed model and its validity test, the aforementioned responsiveness model can be considered a suitable model to use when assessing the levels of health system responsiveness in Iran.
Collapse
Affiliation(s)
- Roohollah Askari
- Department of Health Care Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Arab
- Department of Health Care Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran
- Corresponding Author: Mohammad Arab, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-9125262737, Fax: +98-3516238555, E-mail:
| | - Arash Rashidian
- Department of Health Care Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran
| | - Ali Akbari-Sari
- Department of Health Care Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran
- Utilization Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Seyed Mostafa Hosseini
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Hojat Gharaee
- Health Center of Hamedan, Hamadan University of Medical Sciences, Hamadan, IR Iran
| |
Collapse
|
36
|
Valentine NB, Bonsel GJ. Exploring models for the roles of health systems' responsiveness and social determinants in explaining universal health coverage and health outcomes. Glob Health Action 2016; 9:29329. [PMID: 26942516 PMCID: PMC4778385 DOI: 10.3402/gha.v9.29329] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 10/27/2015] [Accepted: 10/27/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Intersectoral perspectives of health are present in the rhetoric of the sustainable development goals. Yet its descriptions of systematic approaches for an intersectoral monitoring vision, joining determinants of health, and barriers or facilitators to accessing healthcare services are lacking. OBJECTIVE To explore models of associations between health outcomes and health service coverage, and health determinants and health systems responsiveness, and thereby to contribute to monitoring, analysis, and assessment approaches informed by an intersectoral vision of health. DESIGN The study is designed as a series of ecological, cross-country regression analyses, covering between 23 and 57 countries with dependent health variables concentrated on the years 2002-2003. Countries cover a range of development contexts. Health outcome and health service coverage dependent variables were derived from World Health Organization (WHO) information sources. Predictor variables representing determinants are derived from the WHO and World Bank databases; variables used for health systems' responsiveness are derived from the WHO World Health Survey. Responsiveness is a measure of acceptability of health services to the population, complementing financial health protection. RESULTS Health determinants' indicators - access to improved drinking sources, accountability, and average years of schooling - were statistically significant in particular health outcome regressions. Statistically significant coefficients were more common for mortality rate regressions than for coverage rate regressions. Responsiveness was systematically associated with poorer health and health service coverage. With respect to levels of inequality in health, the indicator of responsiveness problems experienced by the unhealthy poor groups in the population was statistically significant for regressions on measles vaccination inequalities between rich and poor. For the broader determinants, the Gini mattered most for inequalities in child mortality; education mattered more for inequalities in births attended by skilled personnel. CONCLUSIONS This paper adds to the literature on comparative health systems research. National and international health monitoring frameworks need to incorporate indicators on trends in and impacts of other policy sectors on health. This will empower the health sector to carry out public health practices that promote health and health equity.
Collapse
Affiliation(s)
| | - Gouke J Bonsel
- Department of Public Health, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Division Mother & Child, University Medical Center Utrecht, Utrecht, The Netherlands;
| |
Collapse
|
37
|
Forouzan S, Padyab M, Rafiey H, Ghazinour M, Dejman M, San Sebastian M. Measuring the Mental Health-Care System Responsiveness: Results of an Outpatient Survey in Tehran. Front Public Health 2016; 3:285. [PMID: 26858944 PMCID: PMC4728407 DOI: 10.3389/fpubh.2015.00285] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/21/2015] [Indexed: 12/04/2022] Open
Abstract
As explained by the World Health Organization (WHO) in 2000, the concept of health system responsiveness is one of the core goals of health systems. Since 2000, further efforts have been made to measure health system responsiveness and the factors affecting responsiveness, yet few studies have applied responsiveness concepts to the evaluation of mental health systems. The present study aims to measure responsiveness and its related domains in the mental health-care system of Tehran. Utilizing the same method used by the WHO for its responsiveness survey, responsiveness for outpatient mental health care was evaluated using a validated Farsi questionnaire. A sample of 500 public mental health service users in Tehran participated and subsequently completed the questionnaire. On average, 47% of participants reported experiencing poor responsiveness. Among responsiveness domains, confidentiality and dignity were the best performing factors while autonomy, access to care, and quality of basic amenities were the worst performing. Respondents who reported their social status as low were more likely to experience poor responsiveness overall. Attention and access to care were responsiveness dimensions that performed poorly but were considered to be highly important by study participants. In summary, the study suggests that measuring responsiveness could provide guidance for further development of mental health-care systems to become more patient orientated and provide patients with more respect.
Collapse
Affiliation(s)
- Setareh Forouzan
- Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden; Social Determinants of Health Research Centre, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mojgan Padyab
- Ageing and Living Conditions Programme, Centre for Population Studies, Umea University, Umea, Sweden; Department of Social Work, Umea University, Umea, Sweden
| | - Hassan Rafiey
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | | | - Masoumeh Dejman
- Social Determinants of Health Research Centre, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Miguel San Sebastian
- Department of Public Health and Clinical Medicine, Umea University , Umea , Sweden
| |
Collapse
|
38
|
Witvliet MI, Stronks K, Kunst AE, Mahapatra T, Arah OA. Linking Health System Responsiveness to Political Rights and Civil Liberties. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2015; 45:622-42. [DOI: 10.1177/0020731415585980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Responsiveness is a dimension of health system functioning and might be dependent upon contextual factors related to politics. Given this, we performed cross-national comparisons with the aim of investigating: 1) the associations of political factors with patients’ reports of health system responsiveness and 2) the extent to which health input and output might explain these associations. World Health Survey data were analyzed for 44 countries (n = 103 541). Main outcomes included, respectively, 8 and 7 responsiveness domains for inpatient and outpatient care. Linear multilevel regressions were used to assess the associations of politics (namely, civil liberties and political rights), socioeconomic development, health system input, and health system output (measured by maternal mortality) with responsiveness domains, adjusted for demographic factors. Political rights showed positive associations with dignity (regression coefficient = 0.086 [standard error = 0.039]), quality (0.092 [0.049]), and support (0.113 [0.048]) for inpatient care and with dignity (0.075 [0.040]), confidentiality (0.089 [0.043]), and quality (0.124 [0.053]) for outpatient care. Positive associations were observed for civil liberties as well. Health system input and output reduced observed associations. Results tentatively suggest that strengthening political rights and, to a certain extent, civil liberties might improve health system responsiveness, in part through their effect on health system input and output.
Collapse
Affiliation(s)
- Margot I. Witvliet
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Karien Stronks
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Anton E. Kunst
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Tanmay Mahapatra
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Onyebuchi A. Arah
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
- UCLA Center for Health Policy Research, Los Angeles, California, USA
| |
Collapse
|
39
|
Scheerhagen M, van Stel HF, Birnie E, Franx A, Bonsel GJ. Measuring client experiences in maternity care under change: development of a questionnaire based on the WHO Responsiveness model. PLoS One 2015; 10:e0117031. [PMID: 25671310 PMCID: PMC4324965 DOI: 10.1371/journal.pone.0117031] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 11/20/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Maternity care is an integrated care process, which consists of different services, involves different professionals and covers different time windows. To measure performance of maternity care based on clients' experiences, we developed and validated a questionnaire. METHODS AND FINDINGS We used the 8-domain WHO Responsiveness model, and previous materials to develop a self-report questionnaire. A dual study design was used for development and validation. Content validity of the ReproQ-version-0 was determined through structured interviews with 11 pregnant women (≥28 weeks), 10 women who recently had given birth (≤12 weeks), and 19 maternity care professionals. Structured interviews established the domain relevance to the women; all items were separately commented on. All Responsiveness domains were judged relevant, with Dignity and Communication ranking highest. Main missing topic was the assigned expertise of the health professional. After first adaptation, construct validity of the ReproQ-version-1 was determined through a web-based survey. Respondents were approached by maternity care organizations with different levels of integration of services of midwives and obstetricians. We sent questionnaires to 605 third trimester pregnant women (response 65%), and 810 women 6 weeks after delivery (response 55%). Construct validity was based on: response patterns; exploratory factor analysis; association of the overall score with a Visual Analogue Scale (VAS), known group comparisons. Median overall ReproQ score was 3.70 (range 1-4) showing good responsiveness. The exploratory factor analysis supported the assumed domain structure and suggested several adaptations. Correlation of the VAS rating and overall ReproQ score (antepartum, postpartum) supported validity (r = 0.56; 0.59, p<0.001 Spearman's correlation coefficient). Pre-stated group comparisons confirmed the expected difference following a good vs. adverse birth outcome. Fully integrated organizations performed slightly better (median = 3.78) than less integrated organizations (median = 3.63; p<0.001). Participation rate of women with a low educational level and/or a non-western origin was low. CONCLUSIONS The ReproQ appears suitable for assessing quality of maternity care from the clients' perspective. Recruitment of disadvantaged groups requires additional non-digital approaches.
Collapse
Affiliation(s)
- Marisja Scheerhagen
- Erasmus Medical Centre, Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, The Netherlands
| | - Henk F. van Stel
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Department of Health Technology Assessment, Utrecht, The Netherlands
- * E-mail:
| | - Erwin Birnie
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Arie Franx
- University Medical Center Utrecht, Division Women and Baby, Department of Obstetrics, Utrecht, The Netherlands
| | - Gouke J. Bonsel
- Erasmus Medical Centre, Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, The Netherlands
| |
Collapse
|
40
|
van der Kooy J, Valentine NB, Birnie E, Vujkovic M, de Graaf JP, Denktaş S, Steegers EAP, Bonsel GJ. Validity of a questionnaire measuring the world health organization concept of health system responsiveness with respect to perinatal services in the Dutch obstetric care system. BMC Health Serv Res 2014; 14:622. [PMID: 25465053 PMCID: PMC4265356 DOI: 10.1186/s12913-014-0622-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 11/19/2014] [Indexed: 12/16/2022] Open
Abstract
Background The concept of responsiveness, introduced by the World Health Organization (WHO), addresses non-clinical aspects of health service quality that are relevant regardless of provider, country, health system or health condition. Responsiveness refers to “aspects related to the way individuals are treated and the environment in which they are treated” during health system interactions. This paper assesses the psychometric properties of a newly developed responsiveness questionnaire dedicated to evaluating maternal experiences of perinatal care services, called the Responsiveness in Perinatal and Obstetric Health Care Questionnaire (ReproQ), using the eight-domain WHO concept. Methods The ReproQ was developed between October 2009 and February 2010 by adapting the WHO Responsiveness Questionnaire items to the perinatal care context. The psychometric properties of feasibility, construct validity, and discriminative validity were empirically assessed in a sample of Dutch women two weeks post partum. Results A total of 171 women consented to participation. Feasibility: the interviews lasted between 20 and 40 minutes and the overall missing rate was 8%. Construct validity: mean Cronbach’s alphas for the antenatal, birth and postpartum phase were: 0.73 (range 0.57-0.82), 0.84 (range 0.66-0.92), and 0.87 (range 0.62-0.95) respectively. The item-own scale correlations within all phases were considerably higher than most of the item-other scale correlations. Within the antenatal care, birth care and post partum phases, the eight factors explained 69%, 69%, and 76% of variance respectively. Discriminative validity: overall responsiveness mean sum scores were higher for women whose children were not admitted. This confirmed the hypothesis that dissatisfaction with health outcomes is transferred to their judgement on responsiveness of the perinatal services. Conclusions The ReproQ interview-based questionnaire demonstrated satisfactory psychometric properties to describe the quality of perinatal care in the Netherlands, with the potential to discriminate between different levels of quality of care. In view of the relatively small sample, further testing and research is recommended. Electronic supplementary material The online version of this article (doi:10.1186/s12913-014-0622-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jacoba van der Kooy
- Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Room Hs-408, Erasmus MC, PO Box 2040, Rotterdam, CA 3000, The Netherlands.
| | - Nicole B Valentine
- World Health Organization, Social Determinants of Health - Public Health, Environmental and Social Determinants of Health, Family, Women's and Children's Health, Avenue Appia 20, Geneva, 1211, Switzerland. .,Department of Public Health, Erasmus MC, PO Box 2040, Rotterdam, CA 3000, The Netherlands.
| | - Erwin Birnie
- Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Room Hs-408, Erasmus MC, PO Box 2040, Rotterdam, CA 3000, The Netherlands. .,Institute of Health Policy and Management, Erasmus University Rotteram, PO Box 1738, Rotterdam, DR 3000, The Netherlands.
| | - Marijana Vujkovic
- Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Room Hs-408, Erasmus MC, PO Box 2040, Rotterdam, CA 3000, The Netherlands.
| | - Johanna P de Graaf
- Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Room Hs-408, Erasmus MC, PO Box 2040, Rotterdam, CA 3000, The Netherlands.
| | - Semiha Denktaş
- Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Room Hs-408, Erasmus MC, PO Box 2040, Rotterdam, CA 3000, The Netherlands.
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Room Hs-408, Erasmus MC, PO Box 2040, Rotterdam, CA 3000, The Netherlands.
| | - Gouke J Bonsel
- Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Room Hs-408, Erasmus MC, PO Box 2040, Rotterdam, CA 3000, The Netherlands. .,University of Applied Sciences, Midwifery Academy Rotterdam (Verloskunde Academie Rotterdam), Dr. Molewaterplein 40, Rotterdam, GD 3015, The Netherlands. .,Department of Public Health, Erasmus MC, PO Box 2040, Rotterdam, CA 3000, The Netherlands.
| |
Collapse
|
41
|
Röttger J, Blümel M, Fuchs S, Busse R. Assessing the responsiveness of chronic disease care - is the World Health Organization's concept of health system responsiveness applicable? Soc Sci Med 2014; 113:87-94. [PMID: 24852659 DOI: 10.1016/j.socscimed.2014.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 04/07/2014] [Accepted: 05/09/2014] [Indexed: 10/25/2022]
Abstract
The concept of health system responsiveness is an important dimension of health system performance assessment. Further efforts have been made in recent years to improve the analysis of responsiveness measurements, yet few studies have applied the responsiveness concept to the evaluation of specific health care delivery structures. The objective of this study was to test the World Health Organization's (WHO's) responsiveness concept for an application in the evaluation of chronic disease care. In September and October 2012 we conducted four focus groups of chronically ill people (n = 38) in Germany, in which participants discussed their experiences and expectations regarding health care. The data was analyzed deductively (on the basis of the WHO responsiveness concept) and inductively using directed content analysis. Ten themes related to health system responsiveness and one theme (finances) not directly related to health system responsiveness, but of high importance to the focus group participants, could be identified. Eight of the ten responsiveness themes are consistent with the WHO concept. Additionally, two new themes were identified: trust (consultation and treatment are not led by any motive other than the patients' wellbeing) and coordination (treatment involving different providers is coordinated and different actors communicate with each other). These findings indicate the suitability of the WHO responsiveness concept for the evaluation of chronic disease care. However, some amendments, in particular an extension of the concept to include the two domains trust and coordination, are necessary for a thorough assessment of the responsiveness of chronic disease care.
Collapse
Affiliation(s)
- Julia Röttger
- Berlin Centre for Health Economics Research and Department of Health Care Management, Technische Universität Berlin, Strasse des 17, Juni 135, 10623 Berlin, Germany.
| | - Miriam Blümel
- Berlin Centre for Health Economics Research and Department of Health Care Management, Technische Universität Berlin, Strasse des 17, Juni 135, 10623 Berlin, Germany
| | - Sabine Fuchs
- Berlin Centre for Health Economics Research and Department of Health Care Management, Technische Universität Berlin, Strasse des 17, Juni 135, 10623 Berlin, Germany
| | - Reinhard Busse
- Berlin Centre for Health Economics Research and Department of Health Care Management, Technische Universität Berlin, Strasse des 17, Juni 135, 10623 Berlin, Germany
| |
Collapse
|
42
|
Lima TJVD, Arcieri RM, Garbin CAS, Moimaz SAS, Saliba O. Humanização na atenção básica de saúde na percepção de idosos. SAUDE E SOCIEDADE 2014. [DOI: 10.1590/s0104-12902014000100021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O objetivo deste estudo foi analisar a percepção do idoso quanto ao cuidado humanizado na atenção básica de saúde, com enfoque sobre os aspectos do atendimento ambulatorial que interferem na qualidade do atendimento. Para isso, realizou-se um estudo do tipo transversal, abrangendo todas as unidades básicas de saúde de um município do interior do Estado de São Paulo, por meio de entrevistas dirigidas aos idosos que frequentavam essas unidades. O instrumento utilizado foi desenvolvido pela Organização Mundial da Saúde (OMS), que, em busca de maior objetividade para a avaliação da qualidade do cuidado à saúde, propôs o conceito de responsividade, para referir-se aos elementos não diretamente ligados ao estado de saúde, e sim aos envolvidos no atendimento acolhedor e resolutivo com responsabilidade e vínculo. Dessa forma, os domínios de responsividade avaliados foram: pronta atenção, dignidade, comunicação, autonomia, escolha dos profissionais, confidencialidade e estrutura física e conforto. Os resultados foram analisados através do software Epi Info 3.5.2. Verificou-se que alguns domínios da atenção em saúde, altamente valorizados pelos idosos, tiveram desempenho bem inferior, como: Autonomia, em que apenas 54,4% tiveram liberdade para tomar decisões sobre sua saúde ou tratamento; e Comunicação, em que 67,6% não obtiveram informações sobre outros tipos de tratamentos ou exames e 79,2% não tiveram oportunidade para esclarecimentos quanto às dúvidas sobre o tratamento. Sugere-se, portanto, mudanças nos serviços de atenção básica à saúde prestados, principalmente quando se trata de idosos, uma população especial que necessita receber uma assistência diferenciada.
Collapse
Affiliation(s)
| | | | | | | | - Orlando Saliba
- Universidade Estadual Paulista Júlio de Mesquita Filho, Brasil
| |
Collapse
|
43
|
Kuis EE, Hesselink G, Goossensen A. Can quality from a care ethical perspective be assessed? A review. Nurs Ethics 2013; 21:774-93. [DOI: 10.1177/0969733013500163] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Ethics-of-care theories contain important notions regarding the quality of care; however, until now, concrete translations of the insights into instruments are lacking. This may be a result of the completely different type of epistemology, theories and concepts used in the field of quality of care research. Objectives: Both the fields of ‘ethics of care’ and ‘quality of care’ aim for improvement of care; therefore; insights could possibly meet by focusing on the following question: How could ethics-of-care theories contribute to better quality in care at a measurement level? This study reviews existing instruments with the aim of bridging this gap and examines the evidence of their psychometric properties, feasibility and responsiveness. Research design: A systematic search of the literature was undertaken using multiple electronic databases covering January 1990 through May 2012. Method and findings: Of the 3427 unique references identified, 55 studies describing 40 instruments were selected. Using a conceptual framework, an attempt was made to distinguish between related concepts and to group available instruments measuring different types of concepts. A total of 13 instruments that reflect essential aspects of ethics-of-care theory were studied in greater detail, and a quality assessment was conducted. Conclusion: Three promising qualitative instruments were found, which follow the logic of the patient and take their specific context into account.
Collapse
Affiliation(s)
| | - Gijs Hesselink
- Radboud University Nijmegen Medical Centre, The Netherlands
| | | |
Collapse
|
44
|
Peltzer K, Phaswana-Mafuya N. Patient experiences and health system responsiveness among older adults in South Africa. Glob Health Action 2012. [PMID: 23195515 PMCID: PMC3509423 DOI: 10.3402/gha.v5i0.18545] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background As populations age, health systems must adapt and develop approaches that meet the needs of older patients with increasing multiple chronic conditions. Understanding older populations’ perceptions of quality of care is critical to developing measures to increase the utilization of primary healthcare services. Using the data from the Global Study on Ageing and Adult Health (SAGE) survey, the current study aims to evaluate the degree of perceived responsiveness with outpatient and inpatient healthcare in South Africa. Methods We conducted a national population-based cross-sectional study with a sample of 3,840 individuals aged 50 years or older in South Africa in 2008. The questionnaire included sociodemographic characteristics, healthcare utilization and responsiveness, and other health variables. Results Healthcare utilization was 9% inpatient care in the past 3 years and 50% outpatient care in the past 12 months. The overall mean perceived responsiveness score for inpatient care was 71 and for outpatient care 69. According to the evaluation of inpatient care, autonomy and prompt attention showed the lowest while quality, confidentiality, and dignity showed the highest degree of perceived responsiveness among all the areas analyzed. Regarding outpatient care, prompt attention showed the lowest while quality, confidentiality, and dignity the highest degree of perceived responsiveness scores. Overall, perceived healthcare responsiveness was higher in private than in public inpatient and outpatient healthcare facilities. Multivariate analysis found that being from the White population group (OR=3.96, CI=1.54–19.19), not a public health facility (OR=0.34, CI=0.17–0.69), poor subjective health status (OR=0.53, CI=0.38–0.75) and having health insurance paying for the outpatient care visit (OR=3.39, CI=1.24–9.27) were associated with outpatient perceived healthcare responsiveness, whereas male gender (OR=0.36, CI=0.14–0.89), 80 years or older (OR=5.83, CI=1.11–30.63), being from the Indian or Asian population group (OR=8.97, CI=1.14–70.35) and not residing in a rural area (OR=0.28, CI=0.10–0.80) were associated with inpatient perceived healthcare responsiveness. Conclusion Prompt attention, autonomy, communication and access were identified as priority areas for actions to improve responsiveness of healthcare services in South Africa.
Collapse
Affiliation(s)
- Karl Peltzer
- HIV/AIDS/STI and TB Research Programme, Human Sciences Research Council, Pretoria, South Africa.
| | | |
Collapse
|
45
|
Peltzer K. Patient experiences and health system responsiveness in South Africa. BMC Health Serv Res 2009; 9:117. [PMID: 19602290 PMCID: PMC2716320 DOI: 10.1186/1472-6963-9-117] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 07/14/2009] [Indexed: 11/10/2022] Open
Abstract
Background Patients' views are being given more and more importance in policy-making. Understanding populations' perceptions of quality of care is critical to developing measures to increase the utilization of primary health care services. Using the data from the South African World Health Survey (WHS), the current study aims to evaluate the degree of health care service responsiveness (both out-patient and in-patient) and comparing experiences of individuals who used public and private services in South Africa. Methods A population-based survey of 2352 participants (1116 men and 1236 women) was conducted in South Africa in 2003, the WHS – as part of a World Health Organization (WHO) project focused on health system performance assessment in member countries. Results Health care utilization was among those who attended in-patient care 72.2% attended a public and 24.3% a private facility, and of those who attended out-patient care 58.7% attended a public and 35.7% a private facility. Major components identified for out-patient care responsiveness in this survey were highly correlated with health care access, communication and autonomy, secondarily to dignity, confidentiality and quality of basic amenities, and thirdly to health problem solution. The degree of responsiveness with publicly provided care was in this study significantly lower than in private health care. Overall patient non-responsiveness for the public out-patient service was 16.8% and 3.2% for private care. Discrimination was also one of the principal reasons for non-responsiveness in all aspects of provided health care. Conclusion Health care access, communication, autonomy, and discriminatory experiences were identified as priority areas for actions to improve responsiveness of health care services in South Africa.
Collapse
Affiliation(s)
- Karl Peltzer
- Health Promotion Research Unit, Social Aspect of HIV/AIDS and Health, Human Sciences Research Council, Pretoria, South Africa.
| |
Collapse
|
46
|
Valentine N, Darby C, Bonsel GJ. Which aspects of non-clinical quality of care are most important? Results from WHO's general population surveys of "health systems responsiveness" in 41 countries. Soc Sci Med 2008; 66:1939-50. [PMID: 18313822 DOI: 10.1016/j.socscimed.2007.12.002] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Indexed: 10/22/2022]
Abstract
Quality of care research has reached some agreement on concepts like structure, process and outcome, and non-clinical versus clinical processes of care. These concepts are commonly explored through surveys measuring patient experiences, yet few surveys have focused on patient, or "user", priorities across different quality dimensions. Population surveys on priorities can contribute to, although not replace participation in, policy decision making. Using 105,806 survey interview records from the World Health Organization's (WHO's) general population surveys in 41 countries, this paper describes the relative importance of eight domains in the non-clinical quality of care concept WHO calls "health systems responsiveness". Responsiveness domains are divided into interpersonal domains (dignity, autonomy, communication and confidentiality) and structural domains (quality of basic amenities, choice, access to social support networks and prompt attention). This paper explores variations in domain importance by country-level variables (country of residence, human development, health system expenditure, and "geographic zones") and by subpopulations defined by sex, age, education, health status, and utilization. Most respondents selected prompt attention as the most important domain. Dignity was selected second, followed by communication. Access to social support networks was identified as the least important domain. In general, convergence in rankings was stronger across subpopulations within countries than across countries. Yet even across diverse countries, there was more convergence than divergence in views. These results provide a ranking of quality of care criteria for consideration during health reform processes further to the usual emphasis on clinical quality and supply-side efficiency.
Collapse
Affiliation(s)
- Nicole Valentine
- Information, Evidence and Research Cluster, World Health Organization, Ave Appia 20, Geneva, Switzerland.
| | | | | |
Collapse
|