Psychometric properties of the 'Skala Kepuasan Interaksi Perubatan-11' to measure patient satisfaction with physician-patient interaction in Malaysia

Construct validity and psychosocial correlates of the Italian version of the 21-item Medical Interview Satisfaction Scale in primary care

BACKGROUND

Satisfaction with the medical interview has been rarely explored in primary care outside the UK, despite evidence suggesting that a trustful doctor-patient relationship is a key ingredient to facilitate treatment adherence and relief from illness-related distress.

AIMS

The aims of this study are to analyse the construct validity of the Italian version of the Medical Interview Satisfaction Scale (MISS-21) and its correlations with two outcome measures, the Inventory of Depressive Symptomatology - Self-Report and World Health Organization Quality Of Life Brief Version, in patients with mild-to-moderate depression, recruited in primary care practices.

METHOD

The factor structure underlying the MISS-21 was investigated with principal component analysis, and the internal consistency of the factors was evaluated with Cronbach's alpha. Network analysis was used to investigate the interrelationships among items. The importance of individual items in the network structure was determined with centrality analyses. Correlations of MISS-21 scores with changes in depression and quality of life were analysed with Spearman's correlation coefficient.

RESULTS

The MISS-21 proved to have a robust four-dimensional factor structure. Cronbach's alpha for the factors ranged from 0.77 to 0.93, suggesting good to excellent internal consistency. The four factors identified were positively correlated with improvement in depressive symptoms and three quality-of-life domains.

CONCLUSIONS

The MISS-21 has sound psychometric properties, and comprises four factors related to clinical outcomes, which makes it suitable for clinical and research applications. The central items in the network should be considered as possible targets for quality improvement interventions in primary care.

Perceived quality of care among people with type 2 diabetes mellitus in the north east region of peninsular Malaysia

BACKGROUND

People with type 2 diabetes mellitus (T2DM) are best managed by a chronic care model that is associated with enhanced quality of care and improved patient outcome. Assessing patients' perceived quality of care is crucial in improving the healthcare delivery system. Hence, this study determined the perceived quality of care among people with T2DM and explored its associations with (i) sociodemographic and clinical characteristics and (ii) types of healthcare clinics to guide future planning.

METHODS

A cross-sectional study involving 20 primary healthcare clinics in the North East Region of Peninsular Malaysia and people with T2DM as the sampling unit was conducted from February to May 2019. The pro forma checklist, interview-guided Skala Kepuasan Interaksi Perubatan-11, and Patient Assessment of Chronic Illness Care (Malay version; PACIC-M) questionnaire were used for data collection. Univariate analysis and linear regression were used to determine the status of perceived quality of care and the factors associated with the perceived quality of care, respectively.

RESULTS

Overall, data from 772 participants were analyzed. The majority was from the Malay ethnic group (95.6%) with a mean (standard deviation [SD]) glycated hemoglobin A1c (HbA1c) level of 8.91% (2.30). The median (interquartile range [IQR]) of the number of medical officers available at each clinic was 6 (7), with Family Doctor Concept (FDC) clinics having a higher number of medical officers than non-FDC clinics (p = 0.001). The overall mean (SD) PACIC-M score was 2.65 (0.54) with no significant difference between scores of patients treated in the two clinic types (p = 0.806). Higher perceived quality of care was associated with lower number of medical officers (adjusted regression coefficient [Adj.β], - 0.021; p-value [p], 0.001), and greater doctor-patient interaction in all domains: distress relief (Adj.β, 0.033; p, < 0.001), rapport (Adj.β, 0.056; p, < 0.001), and interaction outcome (Adj.β, 0.022; p, 0.003).

CONCLUSION

Although there was no significant difference found between clinic type, this study reflects that patients are comfortable when managed by the same doctor, which may support a better doctor-patient interaction. A larger specialized primary care workforce could improve diabetes care in Malaysia.

E-health system characteristics, medical performance and healthcare quality at UNRWA-Palestine health centers

Purpose

This study aims to investigate how e-health system characteristics (information quality, system quality, perceived ease of use, perceived usefulness) contribute to the enhancement of medical staff performance, patient care, and doctor–patient relationships at UNRWA-Gaza healthcare centers. It aims at testing an integrative single model comprising Technology Acceptance Model (TAM), D&M model and e-health system utilization.

Design/methodology/approach

This study followed the quantitative methodology and the deductive research approach. Data were collected from 241 medical staff who use the system employed in 19 different healthcare centers across the Gaza Strip. Partial least square/structural equation modeling technique was used to analyze the collected data and to test study hypotheses.

Findings

Study concluded that information quality of the adopted Health Information System (HIS) has both direct and indirect positive impact on staff performance, only direct positive impact on patient care and only positive indirect impact on doctor–patient relationship. System quality, on the other hand, was found to have negative direct impact and positive indirect impact on staff performance and has both direct and indirect positive impact on both doctor-patient relationship and patient care.

Research limitations/implications

Noteworthy that HIS has availability, speed and error detection and error prevention issues. It is recommended that these shortfalls be addressed together with improving user perception towards ease of use and usefulness of the system.

Practical implications

Management should also work to raise confidence in its medical staff to improve the effect of HIS on medical performance and patient care. It is also recommended that UNRWA should implement crowed management techniques such as queuing systems and on-phone booking to minimize patient waiting time.

Originality/value

The importance of the study stems from its context being conducted in a developing region (Gaza Strip-Palestine) which has a fragile economic, political and social environment with many other complexities. It is also conducted at United Nations Relief and Work Agency (UNRWA) healthcare centers, which provide medical services to Palestinian refugees. In addition, this study is among the few studies that address the impact of individual e-health success factors on both doctor-patient relationship and patient care constructs. Most previous studies concentrated on the impact of health system adoption as a whole on these two subject variables and one can hardly ever stop at studies that address effect of individual success factors on them. It also integrated both D&M system success model and TAM model with some additional amendments creating and tested a new model.

The EMPOWER-SUSTAIN e-Health Intervention to improve patient activation and self-management behaviours among individuals with Metabolic Syndrome in primary care: study protocol for a pilot randomised controlled trial

Background

Epidemiological studies conducted in various parts of the world have clearly demonstrated that metabolic syndrome (MetS) is an increasing global health problem, not only in Western societies but also in Asian populations. Web-based and mobile phone-based self-management applications have been proven to be effective in improving self-management behaviour of patients with MetS components (i.e., diabetes or hypertension). However, evidence is lacking in terms of their effectiveness specifically for patients with MetS. The aim of this pilot study is to evaluate the feasibility and potential effectiveness of the EMPOWER-SUSTAIN Self-Management e-Health Intervention in improving activation and self-management behaviours among patients with MetS. This paper presents the study protocol.

Methods

A pilot randomised controlled trial will be conducted in a university primary care clinic. A total of 232 patients aged 18–60 years with MetS will be recruited; 116 will be randomised to receive the EMPOWER-SUSTAIN intervention for 6 months, and another 116 patients will continue with usual care. The EMPOWER-SUSTAIN intervention is a multifaceted chronic disease management strategy based on the Chronic Care Model and persuasive technology theory. It consists of training primary care physicians, nurses and patients to use the EMPOWER-SUSTAIN web-based self-management mobile app, strengthening the patient–physician relationship and reinforcing the use of relevant clinical practice guidelines to guide management and prescribing. The primary outcome is the mean change in patient activation score using the Patient Activation Measure short form Malay version (PAM-13-M) questionnaire. The secondary outcomes include the changes in waist circumference, body mass index, blood pressure, patient physical activity level, eating behaviour, perception of chronic illness care, satisfaction with patient–physician interaction, and perceived absolute 10-year cardiovascular disease risk. Feasibility of implementing the intervention will be evaluated. This includes acceptability of the intervention, estimating the likely rate of participant recruitment and retention, appropriateness of the outcome measures, calculation of sample size, and the intervention’s potential effectiveness.

Conclusion

To our knowledge, this is the first study in Malaysia that aims to determine the feasibility of a multifaceted e-health intervention, as well as to indicate more useful aspects of this intervention for further exploration in a larger trial.

Trial registration

ClinicalTrials.gov, NCT04120779. Registered on 9 October 2019, protocol version 1.

Effects of FamilyDoctor Concept and Doctor-Patient Interaction Satisfaction on Glycaemic Control among Type 2 Diabetes Mellitus Patients in the Northeast Region of Peninsular Malaysia

The implementation of Family Doctor Concept (FDC) to restructure the primary healthcare systems in Malaysia were expected to enhance patient’s satisfaction on doctor-patient interaction and subsequently improved glycaemic control among Type 2 Diabetes Mellitus (T2DM) patients. Thus, this study aims to determine the difference in doctor-patient interaction satisfaction between T2DM patients attended FDC-implemented clinic vs non-FDC clinics, and to determine the association between FDC-implemented clinic and doctor-patient interaction satisfaction towards glycaemic control. A cross-sectional study was conducted throughout 10 districts in Kelantan from February until May 2019 using interview-guided Skala Kepuasan Interaksi Perubatan-11 (SKIP-11) and proforma checklist. Data were analyzed using SPSS ver.24. Chi-square statistic used to determine the difference in doctor-patient interaction satisfaction between both clinics type. Multiple logistic regression used to examine the association between FDC-implemented clinic and doctor-patient interaction satisfaction towards glycaemic control. Twenty primary health clinics involved, and 772 T2DM patients recruited. FDC clinics attendees has higher proportion of satisfaction (40.1%) compared to non-FDC attendees (33.7%) (p = 0.070). Multiple logistic regression confirmed the association of FDC-implemented health clinics (Adj. OR 1.63, p = 0.021), and doctor-patients interaction satisfaction (Adj. OR 1.77, p = 0.005) towards glycaemic control. Hence, strengthening of FDC in primary healthcare and improve the doctor-patient interaction satisfaction were essential to escalate good glycaemic control.

Enviropreneurial orientation in SME supply chains: construct measurement development

Purpose

The purpose of this paper is to propose a new model that is inclusive and practical because of the deficiencies in models for construct measurement. Further, the authors demonstrate the value of the proposed model by describing its application to the development and validation of a multi-dimensional construct, enviropreneurial orientation. Although used in the literature, enviropreneurial orientation had not been developed nor tested as a construct. The paper provides detailed explanation of development and validation processes exemplified by experiences of research into the factors that motivate individual enviropreneurial orientation among owner/managers in supply chains.

Design/methodology/approach

The authors review models of construct development and propose an eight step model to overcome the deficiencies in the existing models. The eight steps are: defining the construct; identifying its dimensions; generating measurement items for each dimension; pretesting the measurement items; collecting data; constructing scales; analysing reliability; and evaluating the relationships. Each step is explained through examples based on the authors’ experience in using the model to develop the new construct – enviropreneurial orientation.

Findings

All correlation results were positive and significant as were the multiple regression results with one exception, competitive aggressiveness.

Originality/value

The authors provide a practical model to guide new construct measurement development which can be used by researchers and research students for multi-dimensional constructs, especially they are constrained by time and financial resources. By using an example to demonstrate the applicability of the model, the authors go beyond the usual description of construct development models to make the proposed model more comprehensible and thus useful.

Patient satisfaction with doctor-patient interaction and its association with modifiable cardiovascular risk factors among moderately-high risk patients in primary healthcare

BACKGROUND

The outcomes of the physician-patient discussion intervene in the satisfaction of cardiovascular disease risk patients. Adherence to treatment, provision of continuous care, clinical management of the illness and patients' adjustment are influenced by satisfaction with physician-patient interaction. This study aims to determine the patient satisfaction with doctor-patient interaction and over six months after following prevention counselling, its associations with modifiable cardiovascular risk factors amongst moderately-high risk patients in a primary healthcare clinic in Kelantan, Malaysia.

METHODS

A prospective survey was conducted amongst patients with moderately-high cardiovascular risk. A total of 104 moderately-high risk patients were recruited and underwent structured prevention counselling based on the World Health Organization guideline, and their satisfaction with the doctor-patient interaction was assessed using 'Skala Kepuasan Interaksi Perubatan-11,' the Malay version of the Medical Interview Satisfaction Scale-21. Systolic blood pressure, total cholesterol and high-density lipoprotein cholesterol were measured at baseline and at a follow-up visit at six months. Descriptive analysis, paired t test and linear regression analyses were performed.

RESULTS

A total of 102 patients responded, giving a response rate of 98.1%. At baseline, 76.5% of the respondents were satisfied with the relation with their doctor, with the favourable domain of distress relief (85.3%) and rapport/confidence (91.2%). The unfavourable domain was interaction outcome, with satisfaction in only 67.6% of the respondents. Between the two visits, changes had occurred in total cholesterol (P = 0.022) and in systolic blood pressure (P < 0.001). Six months after the initial visits, no relationship existed between patient satisfaction scores and changes in modifiable cardiovascular risks.

DISCUSSION

The 'Skala Kepuasan Interaksi Perubatan-11' which represents a component of the interpersonal doctor-patient relationship can be used to assess improvements of the medical skills and in medical training to enhance the quality of therapeutic communication.