Mahasin Ali Al-Taha, Omran S. Habib, Kareem Al- Imara and Alim AH Yacoub. Consumers' satisfaction with healthcare services in Basrah. The Medical Journal of Basrah University 2003;21:94-98

1. Consumers' satisfaction with health care
services in Basrah*
Mahasin Ali Al-Taha, Omran S. Habib, Kareem Al- Imara and Alim AH Yacoub
Introduction
Patient satisfaction has been recognized as an essential component of several
measures by which the quality of care is assessed. Many investigators and
policymakers feel that its role in the assessment of quality of care is crucial(1,2)
.
Donabedian has stated that "achieving and producing health and satisfaction is the
ultimate validator of the quality of care" (2)
. The study of patient's satisfaction, aims in
general, at determining the effect of satisfaction on patient behaviour in care seeking
process, compliance with prescribed care and maintenance of relationship with care
providers. In addition, satisfaction can be used as an indicator of perceived quality of
care and can help the providers to understand patient point of view within the context
of doctor-patient encounter (2)
There are numerous typologies of patient satisfaction, but the available measures
assess only a limited number of dimensions of care. Those most frequently used
measures are relating patient satisfaction to the personal aspect of care, the technical
quality of care, accessibility and availability of care, continuity of care, patient
convenience, physical setting, financial consideration and efficacy (1)
.
Factors related to patient satisfaction (1)
Personal factors
A-Sociodemographic characteristics: such as: age, sex, social class. Older patients
tend to report higher levels of satisfaction than do younger patients and that women
tend to be more satisfied than men. In addition, patients with higher incomes and
more education tend to be less satisfied with clinics probably because of their higher
expectation.
B-Physical and psychological health: prior to receiving care, may cause patients to be
more or less satisfied.
C-Attitudes and expectations: patients also tend to be more satisfied if their provider's
behaviour conformed to their expectations. Expectations, however, differ greatly
among patients and may be a function of personality, social and cultural values and
the context in which care is received.
Factors related to health care provision
A- Related to structure: The organization of care accessibility, availability
,convenience of care ,and continuity of care, are found to be positively related to
satisfaction (1)
.Waiting time is also found to be an important factor, the shorter the
waiting time, the more will be the satisfaction with care provided (3)
.
B- Related to process: Technical competence of the providers and the interpersonal
aspect of care are also related to patient satisfaction .Many researchers have found
that patients tend to be more satisfied if they perceive their physicians to be caring
and sensitive to their needs.
*Aversion was published as: Al-Taha MA, Habib OS. Women satisfaction about antenatal
care. The Medical Journal of Basrah University 2003; 21: 94-98.

2. C- Related to outcome: Some studies found that perceived improvement in health was
a predictor of patient satisfaction (1)
.
Different methods have been used to assess patient satisfaction, including questions
and patient interviews, scaling for patient satisfaction, tape recording for patient-
doctor interaction, and others. However, the most commonly used methods, are
questionnaires and opinions of consumers regarding factors they like or dislike, their
knowledge, expectation and anticipated use. These are being obtained by patient
interviews (4-6)
.
To quantify consumer s satisfaction with different aspects of health care provided in
Basrah, a number of studies were carried out in this context and some of the
approaches and results of few of these studies are presented in this chapter.
The aim of these studies was to assess the perceived quality of care provided from
consumers
Study one: Women satisfaction with prenatal care
A systemic random sample of currently pregnant and lactating women attending for
maternal care was studied. The sample included one third of attending women, the
starting point being randomly selected. A total of 266 was obtained. Clinic exit
interview was the method adopted and used to assess satisfaction. Women were
interviewed on two days per week for a period of 6 months (January to June 1999).
Women were interviewed immediately following consultation in the reception area
and just before leaving the centre.
A structured questionnaire was used and included questions on sociodemographic
variables such as age of the women, occupation and education, and on their
satisfaction with different aspects of care, including:
-Satisfaction with accessibility of services.
-Satisfaction with continuity of care. -
Satisfaction with humanity of doctors and other staff:
-Satisfaction with comprehensiveness of services.
-Satisfaction with provision of health education.
-Satisfaction with some services provided.
-Satisfaction with the time spent.
-Overall satisfaction with health services.
The measurement scale of satisfaction for all those items was based on a three point
Likert Scale (1= satisfied, 2= fairly satisfied and 3= not satisfied) (3,4)
.
Sample characteristics
The age of the women sampled ranged from 14-45 years with a mean of 25.96.1
years. Most of them (59.0%) were in the age group (20-29) years. Regarding their
educational level, 5.6% of them were illiterate, 43.3% had an education below
intermediate level, 26.7% had an intermediate level and 24.4% had a high level
(secondary and higher education). Occupation wise, being a housewife, constituted
88.7%, governmental employees (4.9%) and professionals including teachers (6.4%.)
Satisfaction with different aspects of care: (Table 1)
Satisfaction with accessibility

3. Nearly 85% of women were either satisfied or fairly satisfied with accessibility to the
health centre, while only 15% thought that it was far from their houses.
Satisfaction with continuity of care
More than half of the women (58.3%) were satisfied with continuos presence of the
same doctor during consultation, while 36.5% revealed that doctor was not always
available and only 5.3% did not find a doctor at the time of their visits. On the other
hand, 91.4% of women were satisfied with the continuous presence of nurses and
other health staff in the centre. It was also found that all women attending for
antenatal care (100%) were given monthly appointments, but only 91.0% were
satisfied with being seen in the same dates, and 4.0% of the women thought that the
use of appointment systems was inappropriate.
Satisfaction with humanity of health care providers
The majority of women (99.3%) and (93.3%) were satisfied with the human attitude
of doctors and other health staff respectively.
Satisfaction with comprehensiveness of services
About 66.9% of the women reported that antenatal care provided was comprehensive
and sufficient, that they would not need to seek care from other sources like private
clinics or hospitals.
Satisfaction with health education provision
Only 36% of women were satisfied with the health education provided by the staff,
41.4% were fairly satisfied, while (22.6%) reported that they received no health
education of any type during their visits .About (50%) of those satisfied and fairly
satisfied in this aspect, thought that their health knowledge has increased.
Satisfaction with services provided
Nearly 79% of the women expressed satisfaction with some of the provided services
.All of them (100%) were satisfied with the vaccination provided, 85.3% were
satisfied with doctor's care, while 58.6% reported satisfaction with investigation and
only 51.1% were satisfied with the offered treatment.
Satisfaction with time spent
The study demonstrated a low level of satisfaction with time spent in the centre. Only
11.3% of the women were satisfied with the overall time spent, 59.4% were fairly
satisfied, while 29.3% perceived it as long waiting time. Only 8.3% were satisfied
with waiting time for being registered and handed the antenatal records by the
registration staff, while 7.1% were satisfied with waiting time for being seen and
consulted by the doctor, while 65.4% and 63.9% were fairly satisfied with waiting
time for registration and consultation respectively.
Overall satisfaction with services
About three quarters of women (74.1%) expressed positive views and general
satisfaction about obtaining antenatal care in Abulkhasib health centres, 21.4% were
fairly satisfied while only 4.5% were not satisfied.
The areas of deficiency recognized by women are summarized in Table –2- and were
mostly related to insufficient drugs (85.2%), deficient medical examination (46.6%)
insufficient investigations (43.2%), lack of sufficient medical staff (39.8%),

4. overcrowding (28.4%) and inappropriate appointments or postponements (27.3%).
Other reasons for dissatisfaction in this aspect, represented structural deficiencies.
Table 3 demonstrates stepwise multiple regression analysis to predict variables
associated with overall satisfaction. It shows that overall satisfaction was significantly
and positively associated with the satisfaction with the following: comprehensiveness
of services, doctor's care, health education, waiting time for consultation, services
provided, availability of a doctor, treatment offered and availability of a nurse. The
total R2
was 0.747
Table 1: Distribution of women according to their satisfaction with different aspects
of antenatal care (n=266)
Aspects of care
Women who were
Not satisfied Fairly satisfied Satisfied
No. % No. % No. %
Immunization
Humanity of doctors
Humanity of staff
Availability of a nurse
Monthly appointments
Doctor's care
Services provided
Overall satisfaction
Comprehensivenessof services
Availability of doctors
Investigations
Treatment
Health education
Accessibility
Overall time spent
Registration time
Consultation time
0
0
3
2
11
14
3
12
14
14
37
64
60
40
78
70
77
0
0
1.1
0.8
4.1
5.3
1.1
4.5
5.3
5.3
13.9
24.1
22.6
15.0
29.3
26.3
28.9
0
2
15
21
13
25
54
57
74
97
73
66
110
161
158
174
170
0
0.8
5.6
7.9
4.9
9.4
20.3
21.4
27.8
36.5
27.4
24.8
41.4
60.5
59.4
65.4
63.9
266
264
248
243
242
227
209
197
178
155
156
136
96
65
30
22
19
100
99.3
93.3
91.4
91.0
85.3
78.6
74.1
66.9
58.3
58.6
51.1
36.1
24.5
11.3
8.3
7.1
Table 2: Recognized deficiencies as stated by consumers (n=88)
Recognized deficiencies No. %
Deficient drugs
Deficient medical examinations
Deficient investigations
Lack of sufficient medical staff
Overcrowding
Poor appointments or postponements
No chairs in the reception
Male nurse only
Lack of ultrasound
Antenatal examination were not on daily basis
Lack of private place for examination
Lack of sonic aid
75
41
38
35
25
24
10
5
5
5
5
3
85.2
46.6
43.2
39.8
28.4
27.3
11.3
5.7
5.7
5.7
5.7
3.4

5. Lack of cover sheets
Lack of toilets
Lack of water
Lack of cleanliness
3
2
2
2
3.4
2.3
2.3
2.3
Study two: Quality of care in surgical wards
The study was an attempt in the direction of evaluative efforts of quality of care in
surgical wards in the three main hospitals in Basrah City Al-Sadr Teaching Hospital,
Basrah General Hospital and Al-Mawanie General Hospital). The quality was
assessed with respect to patients satisfaction with care provided through direct
interviews. A total of patients were involved in the study. The results revealed minor
variations among hospitals. Consumers were satisfied with professional competence
of surgeons regarding diagnosis. They were very unsatisfied with information
disclosed to them about the type of operation, the expected postoperative
complications, expected duration of stay in hospital, surgical details and preoperative
education. On the other hand,
Consumers were satisfied with postoperative follow up visits, but dissatisfied with
prescriptions and postoperative management of pain. Consumers were satisfied with
nursing care but not with observation of IV fluid administration. They were less
satisfied with ancillary services. Table 3 gives an over all view of satisfaction with
care in surgical care in the three hospitals.
Table 3. Extent of patient satisfaction with surgical care in Basrah hospitals 1998.
Hospital Degree of satisfaction as expressed by patients
Doctor care Nursing care Ancilary care
Al-Sadr
Basrah General
Al-Mawanie
100%
94%
94%
96%
89%
94%
96%
87%
100%
Discussion
These and other relevant studies have provided insights into the milieu in which care
is provided and highlighted consumer's satisfaction towards specific components of
the health care in Basrah. Regarding antenatal care, eight dimensions of care were
studied. It was found that about three-quarters (74.1%) of women were generally
satisfied, while 21.4% were fairly satisfied and 4.5% were not satisfied. The overall
satisfaction was relatively good, probably because it was assessed by a single
question, while in case of multiple and specific questions, the respondents tend to
show more dissatisfaction.
The educational level of women might affect their satisfaction towards health
services. In this study, women with higher education were less satisfied as compared
to women with lower education. This might be explained by the difference in
women's expectations. In Al Turki study of patient satisfaction towards health
services provided by PHC centres in Saudi Arabia (7)
, the association of education
with satisfaction was significant, while in another study in the same place, it was not
significant (8)
.

6. This study showed a high level of satisfaction with humanity of medical team and the
doctor-patient relationship. This may be a real state, but it is possible that women
might have avoided criticism of the staff. At the same time 85% were satisfied with
doctor's care. The last result might suggest that satisfaction with humanity of medical
team is substantive.
Continuity of care is considered as a very important motivating factor for attending
antenatal care everywhere. Only about half of the women (58.3%) were satisfied with
continuous presence of doctors in charge. This is a universal problem because of
temporary absence or transfer of staff from one place to another. It is a well-
recognized cause of patient dissatisfaction with care (7)
and very likely to be a cause of
inadequate care utilization.
Delay and long waiting time is another factor for dissatisfaction, 29.3% of women in
this study were unsatisfied. This is similar to AL-Turki study (7)
where 28.8% of
attending patients to PHC centres in Saudi Arabia were dissatisfied with waiting time.
Similarly, satisfaction level regarding health education aspect was low. This finding is
similar to that shown by other studies (7-10)
. This can be attributed to lack of health
education resources and/or poor communication and advice.
These results agree with the results of a study of women's satisfaction with antenatal
care in North England. It was found that women were generally satisfied with
antenatal care, but factors which cause dissatisfaction were: lack of continuity of care,
quality of advice and waiting time (11)
.
Drug supply is always considered as an important factor for satisfaction. In the
present study 24% of women were unsatisfied with drugs and tonics supplied. In the
study of women's satisfaction about antenatal care in other governorates in Iraq, the
major reason for dissatisfaction was insufficient drugs(12)
. This is a complicated issue
because it is related to restriction of drug availability due to sanctions as well as to the
tendency of people to relate health to drug consumption.
Dissatisfaction was also expressed against the laboratory investigations in 14% of
women. This dissatisfaction is expected and probably substantive since laboratory
investigations were poor in PHC centres.
In general, this study showed almost similar overall satisfaction with services as
expressed in a similar study conducted in AlQurna, north of Basrah(8)
in which 73%
of antenatal care attendants were generally satisfied with services, but slightly lower
than those reported in the study conducted in other governorates in Iraq (12) where
82.2% of women were satisfied in general with services.
To improve antenatal care performance in primary health care centres , the authors
recommend redistribution or reallocation of medical staff according to the actual
need, establishment of better appointment system and time management , involvement
of staff in continuous educational programmes and encouraging provision of different
methods of health education ; and improving the logistic supply of antenatal care units
especially those that coincide with consumer’s expectations. Planners and high
authority leaders need to consider patients’ opinion and their reasons of unsatisfaction
while planning to improve health services. The adoption of the family health model
might be the solution towards better care and more consumer satisfaction.
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