Patient satisfaction and perceived quality of care: evidence from a cross-sectional national exit survey of HIV and non-HIV service users in Zambia

ABSTRACT

In this study, we report findings from exit surveys of patients receiving HIV and non-HIV services at a diverse sample of facilities across Zambia. We describe levels and variations in patients’ overall satisfaction, as well as their perceptions of specific interpersonal and technical aspects of care. Additionally, we examine how individual characteristics, facility-level factors, and perceptions of specific aspects of care relate to overall satisfaction, to highlight areas for potential interventions to improve patient satisfaction in Zambia.

METHODS

Indices of perceived quality of care were modeled using principal component analysis. Statistical associations between perceived quality of care and patient satisfaction were examined using random-effect ordered logistic regression models, adjusting for demographic, socioeconomic, visit, and facility characteristics.

RESULTS

Average satisfaction was 6.9 on a 10-point scale for non-HIV services and 7.3 for HIV services. Favorable perceptions of health personnel conduct were associated with higher odds of overall satisfaction for non-HIV (OR=3.53, 95% CI 2.34 to 5.33) and HIV (OR=11.00, 95% CI 3.97 to 30.51) visits. Better perceptions of resources and services were also associated with higher odds of satisfaction for both non-HIV (OR=1.66, 95% CI 1.08 to 2.55) and HIV (OR=4.68, 95% CI 1.81 to 12.10) visits. Two additional dimensions of perceived quality of care – health care delivery and accessibility of care – were positively associated with higher satisfaction for non-HIV patients. The odds of overall satisfaction were lower in rural facilities for non-HIV patients (OR 0.69; 95% CI 0.48 to 0.99) and HIV patients (OR=0.26, 95% CI 0.16 to 0.41). For non-HIV patients, the odds of satisfaction were greater in hospitals compared with health centers/posts (OR 1.78; 95% CI 1.27 to 2.48) and lower at publicly managed facilities (OR=0.41, 95% CI=0.27 to 0.64).

CONCLUSIONS

Perceived quality of care is an important driver of patient satisfaction with health service delivery in Zambia.

FUNDING

Bill & Melinda Gates Foundation – Disease Control Priorities Network (Investment # OPP51229)