Overall satisfaction of health care users with the quality of and access to health care services: a cross-sectional study in six Central and Eastern European countries

Health Care Utilization and Perceived Quality of Care in a Colombian Indigenous Health Organization

Indigenous governance of health care has increasingly been advocated among Indigenous peoples in many countries. However, there is limited research that has empirically examined its benefits. In 2020/21, we conducted a survey of 2113 Indigenous Wayuu individuals in Colombia who received services from the Indigenous Wayuu led health care insurance organization Anas Wayuu and its network of service providers, and Wayuu individuals who received services from non-Indigenous health insurance organizations. We compared their health care utilization and perception of quality of care. A main finding of the study was that Anas Wayuu enrollees were more than twice as likely to access health care than enrollees from non-Indigenous health insurance organizations, even when controlling for the demographic and health characteristics. The study provided compelling evidence suggesting that Anas Wayuu, being an Indigenous led health organization improves access to, and quality of care, among Indigenous health service recipients.

Regional Epidemiological Study on the Dental Status of the First Permanent Molar in Romanian Schoolchildren

Background/Objectives: Dental caries remains a significant public health challenge in Romania, with recent studies reporting a prevalence of 40% in children's permanent teeth, with 90% of cases untreated. This study aimed to evaluate the dental status of the first permanent molars in children aged 11-12 years. Methods: This cross-sectional study was conducted over 12 months at the Integrated Center for Dental Medicine in Târgu Mureș and two private clinics in Transylvania. A total of 516 children, aged 11-12 years, were examined using the ICDAS II classification. Data on carious lesions and dental treatments performed were collected. Results: Of the 2064 first permanent molars examined, 57.99% had carious lesions, fillings, or extractions, while 41.28% were free from caries. Among the affected molars, 41.71% had untreated caries, 9.30% were filled, and 6.25% were sealed. Boys showed a significantly higher prevalence of advanced lesions (ICDAS 4-6) compared to girls. Caries predominantly affected the pits and fissures (87.46%). Conclusions: This study reveals a high prevalence of carious lesions in first permanent molars and a low rate of treatment. The findings emphasize the need for improved oral health education, increased access to dental care, and the development of national strategies to prevent and treat dental caries in children.

Public satisfaction with the Ethiopian healthcare system: a mixed methods approach

Introduction

The satisfaction of the public with the healthcare system of Ethiopia is a crucial but unanswered question. This is an essential issue since recent trends indicate that the demographic and epidemiological makeup of the population is changing. Therefore, the aim of this study was to assess the overall satisfaction of the public with the Ethiopian healthcare system in Addis Ababa, Ethiopia, in 2022.

Methods

A community-based convergent parallel mixed methods study was conducted. Bivariable and multivariable logistic regression analyses were used to determine the factors associated with public satisfaction. A 95% confidence interval along with a p < 0.05 was deemed sufficient to declare a significant association. For the qualitative component, we used thematic analysis.

Results

The vast majority, 77.2% (95% CI: 76.18-78.22%), of respondents were dissatisfied with the existing healthcare system. Moreover, Community-Based Health Insurance (CBHI) enrollment (2.35; 95% CI: 1.32-4.19), poor linkage to social capital (0.46; 95% CI: 0.25-0.83), poor access to healthcare services (0.39; 95% CI: 0.21-0.76), and absence of satisfactory responses to complaints (0.11; 95% CI: 0.04-0.27) were significantly associated with public dissatisfaction.

Conclusion

Public satisfaction with the Ethiopian healthcare system is notably low and is affected by various factors, including enrollment in the CBHI, linkage to social capital, accessibility to healthcare, and satisfactory response to issues. Therefore, the Ethiopian government should focus on expanding CBHI coverage, improving access to healthcare services, and developing an immediate compliant solution strategy.

Continuous Electrocardiographic Monitoring for 24 Hours Before Death in Patients with Terminal Cancer

BACKGROUND

Purposeless physiological monitoring at the end-of-life is not recommended. However, studies on how families feel regarding the death of patients with terminal cancer without continuous electrocardiographic monitoring (CEM) are lacking.

OBJECTIVES

To explore the impact on the quality of care and the feelings and psychological distress experienced by families when CEM is not used during the 24 hours preceding a patient's death.

METHODS

In this multicenter cross-sectional, self-report questionnaires were distributed to 1087 bereaved families at Japanese specialized palliative care units in 2018.

RESULTS

Out of 671 responses, 394 valid responses were analyzed. Families of nonmonitored patients (NM-group) accounted for 79.2%, while those with bedside electrocardiogram monitoring (MB-group) and remote nurse station monitoring (MC-group) comprised 11.9% and 8.9%, respectively. In the NM-group, 85.5% expressed satisfaction without CEM, which was more than 10% lower than other groups. While 14% in the NM-group desired patient monitoring, families who received adequate explanations about CEM had lower proportions compared to the MB-group (P = .021). Univariate analyses showed no significant differences in evaluations of the quality of care and families' psychological distress (mean scores of Overall Care Satisfaction, Care Evaluation Scale, Good Death Inventory, Brief Grief Questionnaires) across all groups.

CONCLUSION

While the majority of NM-group were satisfied with their patient's care without CEM, the proportion of dissatisfied families was higher than in other groups. Although not using CEM is not a major hindrance to end-of-life care for patients with terminal cancer, providing sufficient explanations may be important for satisfactory care.

Community members' perceptions of community health workers in Melusi, Tshwane, South Africa

BACKGROUND

 Community health workers (CHWs) play an important role in health promotion through health campaigns and home visits, and provide linkage to care and support patient management. In the informal settlements, CHWs identify health challenges and help residents to access healthcare facilities.

AIM

 This study aimed to explore the perception held by the community members regarding CHWs' contribution to health promotion in Melusi informal settlements within the Tshwane district.

SETTING

 The study was conducted in Melusi informal settlement situated in Pretoria west in South Africa.

METHODS

 Descriptive exploratory qualitative research methods were used, with open and closed-ended questions during individual interview sessions. Participants were purposefully selected in collaborating with the community leaders and using CHWs' data to identify individuals with direct interaction with CHWs.

RESULTS

 Participants praised CHWs' communication skills, engagement strategies, and ability to provide valuable health services. Community members expected CHWs to provide healthcare services, educational support, advocacy for health issues and guidance on well-being. Barriers such as community resistance, a lack of privacy and difficulties in reaching households were noticed. However, CHWs were commended for their impact on well-being, offering health services, emergency support, food assistance and improved healthcare accessibility.

CONCLUSION

 The study indicates that community members have positive perceptions of CHWs. This highlights the significant role of CHWs in promoting health and well-being within the community.Contribution: This study provides insights into community perceptions of CHWs in informal settlements, emphasising their impact on community well-being. It provides a basis for their effectiveness and support in delivering health services in the informal settlement.

Sociodemographic Data and Factors That Influence Patient Satisfaction with the Occupational Health Service of the Tete Provincial Hospital, Mozambique, 2022

The quality of the health services offered are very important to guarantee access to quality health and promote well-being for all, at all ages, as recommended in the Sustainable Development Goals 2030. This study aims to assess the degree of satisfaction of users of the Occupational Health Service of the Tete Provincial Hospital. A cross-sectional study was conducted. The data was collected between September 15th and December 20th, 2022, for 335 participants through a self-administered questionnaire. Descriptive statistics was used to describe the data. Overall satisfaction was 87.5% (293/335). Participants age, gender, marital status, and level of education were associated with overall satisfaction (p < 0.001). The factors that influence the satisfaction of users of the Occupational Health Service were the cleanliness of the hospital, opening hours, ease of care, speed and waiting time. The satisfaction of users of the Occupational Health Service of the Tete Provincial Hospital was high.

Exploring the interplay between food security and antenatal care utilization among pregnant women in Southern Ethiopia: Insights from an institution-based cross-sectional study

Background

Ensuring the satisfaction of pregnant women with antenatal care is crucial for positive pregnancy outcomes and their engagement with emerging technologies and alternative care models. Maintaining high satisfaction during the antenatal period significantly impacts the well-being of both the expectant mother and the unborn child. Despite the recognized importance of antenatal care satisfaction, comprehensive information on satisfaction levels and influencing factors in the specific study area is lacking. Therefore, this study aims to assess antenatal care service satisfaction and associated factors among pregnant women in Arba Minch town, southern Ethiopia.

Methods

We conducted an institution-based cross-sectional study among 418 pregnant women from December 2022 to January 30, 2023, using a systematic sampling method. Data were collected using the Kobo Toolbox and analyzed with SPSS Version 26. The threshold for statistical significance was set at a p-value of less than 0.05.

Results

Out of 418 participants, 54.3% (95% CI=49.4-60.4) expressed satisfaction with antenatal care services. Factors significantly associated with women's satisfaction included: being unable to read and write (AOR=2.37; 95% CI: 1.97-3.80), being aged 25-29 years (AOR=3.20; 95% CI: 1.65-6.22), receiving antenatal care at a hospital (AOR=1.81; 95% CI: 1.05-3.12), having a previous history of antenatal visits (AOR=2.59; 95% CI: 1.26-5.30), a monthly income of 2500-5000 ETB (AOR=1.44; 95% CI: 1.21-3.94), waiting times of less than 30 min (AOR=2.59; 95% CI: 1.52-4.41), maintaining a positive attitude towards antenatal care (AOR=2.50; 95% CI: 1.05-3.65), and having a secure food source (AOR=2.06; 95% CI: 1.13-3.78).

Conclusion

Over 54% of participants were satisfied with antenatal care services. To improve satisfaction levels, recommended strategies include enhancing healthcare infrastructure, establishing maternity waiting areas, reducing waiting times, and expanding services to remote areas.

Variation in follow-up for children born very preterm in Europe

BACKGROUND

Children born very preterm (<32 weeks of gestation) face high risks of neurodevelopmental and health difficulties compared with children born at term. Follow-up after discharge from the neonatal intensive care unit is essential to ensure early detection and intervention, but data on policy approaches are sparse.

METHODS

We investigated the characteristics of follow-up policy and programmes in 11 European countries from 2011 to 2022 using healthcare informant questionnaires and the published/grey literature. We further explored how one aspect of follow-up, its recommended duration, may be reflected in the percent of parents reporting that their children are receiving follow-up services at 5 years of age in these countries using data from an area-based cohort of very preterm births in 2011/12 (N = 3635).

RESULTS

Between 2011/12 and 22, the number of countries with follow-up policies or programmes increased from 6 to 11. The policies and programmes were heterogeneous in eligibility criteria, duration and content. In countries that recommended longer follow-up, parent-reported follow-up rates at 5 years of age were higher, especially among the highest risk children, born <28 weeks' gestation or with birthweight <1000 g: between 42.1% and 70.1%, vs. <20% in most countries without recommendations.

CONCLUSIONS

Large variations exist in follow-up policies and programmes for children born very preterm in Europe; differences in recommended duration translate into cross-country disparities in reported follow-up at 5 years of age.

Assessment of population satisfaction with medical care in conflict conditions

In the context of health care reform, the primary task is to ensure the delivery of high-quality medical services and good end results in the performance of individual physicians, structural units, and general medical services. The healthcare sector is one of the most socially significant spheres of functioning in every country. The problem of conflicts presents special social importance in this field, as a result of the rather close relationship between doctor and patient. The main objective of this study was to determine patients' satisfaction with the quality of healthcare at the primary level. The survey was conducted using an electronic questionnaire. The sample consisted of 1,146 residents of Chernivtsi and the Chernivtsi region, aged 18-56 and older. Almost half of the respondents (42.5%) offered a neutral overall rating of the quality of medical services at the primary care level. Only 25.5% gave a positive valuation of the quality of health care services they received, while 32% gave a negative evaluation. Patients' actions, opinions, and ideas shape and complement industry policies and the way they are implemented. In this context, if a dialogue is established among the main actors in the healthcare system, improvements in the system can be achieved, which will lead to better health and quality of life for people in the future.

Satisfaction with primary health care in Ukraine in 2016-2020: A difference-in-differences analysis on repeated cross-sectional data

The aim of this study is to examine the general satisfaction with primary health care services in Ukraine among service users and nonusers before and after the implementation of the capitation reform in 2017-2020. Data from a repeated cross-sectional household survey 'Health Index. Ukraine' in 2016-2020 were used. The survey had a sample size of over 10 000 participants per survey round. Effects were estimated using difference-in-differences methods based on matched samples. Our findings show that in general, respondents are 'rather satisfied' with the services of district/family doctors and pediatricians. Satisfaction with family doctors comprised 72.1 % (users) and 69.2 % (nonusers) in 2016; and 75.3 % and 71.9 % in 2020. For pediatrician services, these shares were 73.6 % (users) and 71.1 % (nonusers) in 2016; 74.7 % and 70.2 % in 2020. Our study also revealed an increase in satisfaction with the district/family doctor over time. However, this does not seem to be due to the reform. The results for pediatrician services were mixed. Why satisfaction with primary care is fairly high and slightly increasing over time is unclear. However, we offer several possible explanations, such as low expectations of primary health care, subjective perception of quality of health care services, improved access and affordability, and general improvements in primary health care settings not directly linked to the reform.

Barriers to access adequate maternal care in Romania, Bulgaria, and Moldova: A cross-country comparison

BACKGROUND

Eastern European health system indicators (e.g., number of health workers and care coverage) suggest well-resourced maternity care systems, but maternal health outcomes compare poorly with those in Western Europe. Often, poor maternal health outcomes are linked to inequities in accessing adequate maternal care. This study investigates access-related barriers (availability, appropriateness, affordability, approachability, and acceptability) to maternity care in Romania, Bulgaria, and Moldova.

METHODS

This cross-country study (n = 7345) is based on an online survey where women who received maternity care and gave birth in 2015-2018 in Bulgaria (n = 4951), Romania (n = 2018), and Moldova (n = 376) provided information on their experiences with the care received. We used regression analysis to identify factors associated with accessing maternity care across the three countries.

RESULTS

Results show high rates of cesarean births (CB) and a low number of antenatal and postnatal care visits. Informal payments and use of personal connections are common practices. Formal and informal out-of-pocket payments create a financial burden for women with health complications. Women who had health complications, those who gave birth by cesarean, and women who gave birth in a public facility and had fewer antenatal check-ups, were more likely to describe facing access-related barriers.

CONCLUSIONS

This study identifies several barriers to high-quality maternity care in Romania, Bulgaria and Moldova. More attention should be paid to the appropriateness of care provided to women with complicated pregnancies, to those who have CBs, to women who give birth in public facilities, and to those who receive fewer antenatal care visits.

High Healthcare Use at Age 5 Years in a European Cohort of Children Born Very Preterm

OBJECTIVES

To describe parent-reported healthcare service use at age 5 years in children born very preterm and investigate whether perinatal and social factors and the use of very preterm follow-up services are associated with high service use.

STUDY DESIGN

We used data from an area-based cohort of births at <32 weeks of gestation from 11 European countries, collected from birth records and parental questionnaires at 5 years of age. Using the published literature, we defined high use of outpatient/inpatient care (≥4 sick visits to general practitioners, pediatricians, or nurses, ≥3 emergency room visits, or ≥1 overnight hospitalization) and specialist care (≥2 different specialists or ≥3 visits). We also categorized countries as having either a high or a low rate of children using very preterm follow-up services at age 5 years.

RESULTS

Overall, 43% of children had high outpatient/inpatient care use and 48% had high specialist care use during the previous year. Perinatal factors were associated with high outpatient/inpatient and specialist care use, with a more significant association with specialist services. Associations with intermediate parental educational level and unemployment were stronger for outpatient/inpatient services. Living in a country with higher rates of very preterm follow-up service use was associated with lower use of outpatient/inpatient services.

CONCLUSIONS

Children born very preterm had high healthcare service use at age 5 years, with different patterns for outpatient/inpatient and specialist care by perinatal and social factors. Longer follow-up of children born very preterm may improve care coordination and help avoid undesirable health service use.

General and Vulnerable Population’s Satisfaction With the Healthcare System in Urban and Rural Areas: Findings From the European Social Survey

Introduction: Access to the healthcare system when patients are vulnerable and living outside metropolitan areas can be challenging. Our objective was to explore healthcare system satisfaction of urban and rural inhabitants depending on financial and health vulnerabilities.

Methods: Repeated cross-sectional data from 353,523 European citizens (2002–2016). Multivariable associations between rural areas, vulnerability factors and satisfaction with the healthcare system were assessed with linear mixed regressions and adjusted with sociodemographic and control factors.

Results: In unadjusted analysis, the people who lived in houses in the countryside and those who lived in the suburbs were the most satisfied with the healthcare system. In the adjusted model, residents living in big cities had the highest satisfaction. Financial and health vulnerabilities were associated with less satisfaction with the healthcare system, with a different effect according to the area of residence: the presence of health vulnerability was more negatively correlated with the healthcare system satisfaction of big city inhabitants, whereas financial vulnerability was more negatively correlated with the satisfaction of those living in countryside homes.

Conclusion: Vulnerable residents, depending on their area of residence, may require special attention to increase their satisfaction with the healthcare system.

Determinants of Antenatal Care Service Satisfaction among Women in Ethiopia: A Systematic Review and Meta-Analysis

Background. Antenatal care service satisfaction is a measure of the degree to which a woman seeking care is happy with the antenatal care service provided to her. Thus, this systematic review and meta-analysis aims to identify factors that determine antenatal care service satisfaction among women in Ethiopia. Methods. PubMed, Hinari, and Google Scholar were systematically searched for eligible studies. In addition, national university digital libraries were also searched. The Joanna Briggs Institute’s (JBI) critical appraisal tools were used to assess the quality of the included articles. The Cochrane Q-statistics and I2 tests were used to assess heterogeneity among the included studies. Publication bias was assessed using Egger’s test. Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. The extracted data were analyzed using STATA version 14 software and the results were presented using the forest plot. Results. Of the 274 articles identified through the systematic search of the literature, 13 studies fulfilling the inclusion criteria were included in this meta-analysis. First antenatal care visit (AOR: 0.62 and 95% CI: 0.40, 0.96), women waited <60 min (AOR: 1.87 and 95% CI: 1.40–2.50), women whose privacy was maintained (AOR: 3.91 and 95% CI: 1.97–7.77), women treated respectfully (AOR: 5.07 and 95% CI: 2.34–10.96), and unplanned pregnancies (AOR = 0.28 and 95% CI: 0.10–0.77) were significantly associated with antenatal care service satisfaction. Conclusion. The study assessed the determinants of antenatal care service satisfaction in Ethiopia. First antenatal care visit, waiting time (<60 min) to see the care provider, maintenance of privacy, respectful treatment, and pregnancy unplanned were found to be determinants of antenatal care service satisfaction. Counseling a woman to comply with a minimum required antenatal care visits and compassionate and respectful maternity care will increase maternal satisfaction with the antenatal care services.

Impact of the Introduction of Accreditation Standards on the Satisfaction of Patients in Cardiology Departments

Background: It can be presumed that introducing accreditation standards and obtaining national accreditation by a hospital should translate into increased patient satisfaction. The aim was to analyze the impact of introducing accreditation standards on patient satisfaction in cardiology departments. Methods: 1080 patients, who were hospitalized in four cardiological wards (W1–W4) between 2009–2015, were asked to complete a 22-item questionnaire that assessed the level of their satisfaction with their medical care. 58 questionnaires were excluded because of incomplete data. The hospital was accredited in 2013. Results: In 3 of the 4 wards, a statistically higher total score (the patient was more satisfied) in the period after the accreditation (2013–2015) compared to the period before the accreditation (2009–2012) was as follows: W1 (80.37 ± 6.54 vs. 83.85 ± 5.9; p = 0.0004), W2 (79.95 ± 7.62 vs. 81.46 ± 8.2: p = 0.0376), W4: (78.84 ± 7.94 vs. 84.91 ± 5.57; p = 0.0376); in one ward, there was no statistical difference: W3 (80.11 ± 8.42 vs. 81.07 ± 8.15; p = 0.3284). A significant difference was found in the number of points for the total assessment that were collected for all of the analyzed departments throughout the entire period (2009–2015)–W1: p = 0.0032; W2: p = 0.0176; W3: p = 0.0313 and W4: p < 0.0001). The medium-term rate of the change of the total score decreased after the accreditation. Conclusion: Preparing a hospital for a national accreditation program brought significant benefits for patients in a long-term observation.

A Step towards Understanding and Tackling Health Inequalities: The Use of Secondary Prevention Services and the Need for Health Promotion in a Rural Setting

Poland has recently intensified its health promotion in an effort to extend healthy life expectancy and reduce health inequalities. Our aim was to reach a deprived rural population, increase its health literacy, and explore its use of and barriers to cancer screening and public health care. A CBPR study was conducted in one of the poorest districts in Wielkopolska region, Poland, among 122 beneficiaries of health education workshops. A self-developed questionnaire was used. The reported barriers to participation in cancer screening included: lack of time, lack of need, or feeling healthy (32.8%); long waiting times (17.2%); fear of costs (9%). Physicians seldom recommended screening to their patients. Only 7.4% of respondents had ever received dermatoscopy. Among women, 18.2% did not perform any breast exams and 25% had never had smear tests. Diagnostics was often financed out of pocket (thyroid ultrasound = 58.1%; smear test = 48.5%; breast ultrasound = 36.8%). The health system needs mentioned by participants included better access to physicians (65.6%), promotion of free screening tests (54.9%), and access to public health programmes (22.1%). There is an urgent need to translate national strategies into action. Health promotion and better access to care must become priorities in deprived areas, while primary care providers should become key figures in delivering these services.

Perceived quality of HIV care and client satisfaction across different service providers in Ukraine

BACKGROUND

Prior studies have shown that high client satisfaction and quality of services are important drivers of uptake and retention in human immunodeficiency virus (HIV) care. Study objectives were to assess the perceived quality of HIV services, satisfaction and associated factors across different types of health facilities in Ukraine.

METHODS

We conducted a cross-sectional study among 649 individuals receiving HIV services across 47 health facilities in three regions of Ukraine. Primary outcomes were satisfaction and perceived quality of services measured along five dimensions: accessibility, user-friendliness, privacy and confidentiality, comprehensiveness (separately for testing and treatment services). Quality dimensions were constructed by confirmatory factor analysis. Links between quality dimensions, satisfaction and related factors were measured by structural equation modelling.

RESULTS

Median scores for accessibility, user-friendliness, privacy and confidentiality, comprehensiveness of services and overall satisfaction ranged from 0.75 to 1 out of 1. User-friendliness was the main determinant associated with satisfaction (total effect: β = 0.515, P < 0.001). Satisfaction was higher at primary healthcare centres (direct effect: β = 0.145, P < 0.001; indirect effect through accessibility: β = 0.060, P < 0.001), narcological/tuberculosis dispensaries (direct effect: β = 0.105, P = 0.006; indirect effect through accessibility: β = 0.060, P < 0.001) and hospitals (indirect effects through user-friendliness and accessibility: β = 0.180, P < 0.001) when compared to acquired immune deficiency syndrome centres.

CONCLUSIONS

User-friendliness is a key driver of client satisfaction with HIV services in Ukraine. Decentralization of services, together with improved training and supervision for provider-client interactions may provide important levers to improve client satisfaction with HIV services and enrolment and retention in the cascade of HIV services.

Developing a Scale Measuring Patient Expectations and Service Quality of Hospitals in India during COVID-19

This paper develops a scale that measures the perceived service quality of hospitals during a pandemic. To develop the scale, data from 206 respondents from India, was subjected to exploratory and confirmatory factor analysis. The newly developed scale was named PAND-SERVQUAL, which includes factors namely, assistance, facility & layout, trust, empathy, promptness, and knowledge. The resulting scale is likely to be useful for researchers exploring service quality research and health care quality as well. Findings will facilitate understanding patient's expectations regarding the service quality of hospitals during a pandemic.Supplemental data for this article is available online at https://doi.org/10.1080/00185868.2021.1939827 .

Health system responsiveness: a systematic evidence mapping review of the global literature

BACKGROUND

The World Health Organisation framed responsiveness, fair financing and equity as intrinsic goals of health systems. However, of the three, responsiveness received significantly less attention. Responsiveness is essential to strengthen systems' functioning; provide equitable and accountable services; and to protect the rights of citizens. There is an urgency to make systems more responsive, but our understanding of responsiveness is limited. We therefore sought to map existing evidence on health system responsiveness.

METHODS

A mixed method systemized evidence mapping review was conducted. We searched PubMed, EbscoHost, and Google Scholar. Published and grey literature; conceptual and empirical publications; published between 2000 and 2020 and English language texts were included. We screened titles and abstracts of 1119 publications and 870 full texts.

RESULTS

Six hundred twenty-one publications were included in the review. Evidence mapping shows substantially more publications between 2011 and 2020 (n = 462/621) than earlier periods. Most of the publications were from Europe (n = 139), with more publications relating to High Income Countries (n = 241) than Low-to-Middle Income Countries (n = 217). Most were empirical studies (n = 424/621) utilized quantitative methodologies (n = 232), while qualitative (n = 127) and mixed methods (n = 63) were more rare. Thematic analysis revealed eight primary conceptualizations of 'health system responsiveness', which can be fitted into three dominant categorizations: 1) unidirectional user-service interface; 2) responsiveness as feedback loops between users and the health system; and 3) responsiveness as accountability between public and the system.

CONCLUSIONS

This evidence map shows a substantial body of available literature on health system responsiveness, but also reveals evidential gaps requiring further development, including: a clear definition and body of theory of responsiveness; the implementation and effectiveness of feedback loops; the systems responses to this feedback; context-specific mechanism-implementation experiences, particularly, of LMIC and fragile-and conflict affected states; and responsiveness as it relates to health equity, minority and vulnerable populations. Theoretical development is required, we suggest separating ideas of services and systems responsiveness, applying a stronger systems lens in future work. Further agenda-setting and resourcing of bridging work on health system responsiveness is suggested.

Partnership between Primary Health and Social Care Services in the Long-Term Care of Older People with Dementia: A Vignette Study

Dementia is considered to be a significant cause of disability and dependency for older people worldwide and it raises difficulties in providing adequate formal and informal assistance. Research on the experience of long-term care (LTC)services for older people with dementia is scarce in Eastern European countries. This study aimed to understand the system of care for older people with dementia from the perspective of health and social care workers providing LTC services in Lithuania. A total of 72 primary health care and social care professionals from public and private institutions in Kaunas city participated in this study. One-to-one interviews were conducted with family physicians, community nurses, psychiatrists, psychiatric nurses, and social workers. A vignette situation of 2 fictitious patients with dementia and their informal caregiver was discussed during the interviews. Data were analyzed using thematic analysis by induction approach. The data revealed 2 main themes: LTC provision trajectory, and three-dimensional relationship perception in realization of LTC activities. LTC provision trajectory reflected activities performed as a response to the described situation embracing formal procedures for the endorsement of LTC needs as well as the range of LTC services. The three-dimensional perception of relationships in LTC services' implementation reflected the participants' personal approach toward LTC, relationship with different specialists, and the informal caregiver. Our study revealed the potential of complex measures that could be instrumental for the refinement of the caregiving process. First, a change in the additional care requirements endorsement logic is needed, shifting focus from medical diagnosis to functional abilities assessment. Second, to establish clear procedures for formal cooperation between the health and social care sectors in the trajectory of LTC service provision. Finally, to find an adequate balance between LTC and institutional care by creating a more comprehensive range of LTC services. A more consistent and coordinated delivery of services by both health and social care sectors seems to be an untapped resource for the improvement of the LTC potential.

Google Trends for Pain Search Terms in the World's Most Populated Regions Before and After the First Recorded COVID-19 Case: Infodemiological Study

BACKGROUND

Web-based analysis of search queries has become a very useful method in various academic fields for understanding timely and regional differences in the public interest in certain terms and concepts. Particularly in health and medical research, Google Trends has been increasingly used over the last decade.

OBJECTIVE

This study aimed to assess the search activity of pain-related parameters on Google Trends from among the most populated regions worldwide over a 3-year period from before the report of the first confirmed COVID-19 cases in these regions (January 2018) until December 2020.

METHODS

Search terms from the following regions were used for the analysis: India, China, Europe, the United States, Brazil, Pakistan, and Indonesia. In total, 24 expressions of pain location were assessed. Search terms were extracted using the local language of the respective country. Python scripts were used for data mining. All statistical calculations were performed through exploratory data analysis and nonparametric Mann-Whitney U tests.

RESULTS

Although the overall search activity for pain-related terms increased, apart from pain entities such as headache, chest pain, and sore throat, we observed discordant search activity. Among the most populous regions, pain-related search parameters for shoulder, abdominal, and chest pain, headache, and toothache differed significantly before and after the first officially confirmed COVID-19 cases (for all, P<.001). In addition, we observed a heterogenous, marked increase or reduction in pain-related search parameters among the most populated regions.

CONCLUSIONS

As internet searches are a surrogate for public interest, we assume that our data are indicative of an increased incidence of pain after the onset of the COVID-19 pandemic. However, as these increased incidences vary across geographical and anatomical locations, our findings could potentially facilitate the development of specific strategies to support the most affected groups.

Parents' ratings of post-discharge healthcare for their children born very preterm and their suggestions for improvement: a European cohort study

BACKGROUND

Follow-up of very preterm infants is essential for reducing risks of health and developmental problems and relies on parental engagement. We investigated parents' perceptions of post-discharge healthcare for their children born very preterm in a European multi-country cohort study.

METHODS

Data come from a 5-year follow-up of an area-based cohort of births <32 weeks' gestation in 19 regions from 11 European countries. Perinatal data were collected from medical records and 5-year data from parent-report questionnaires. Parents rated post-discharge care related to their children's preterm birth (poor/fair/good/excellent) and provided free-text suggestions for improvements. We analyzed sociodemographic and medical factors associated with poor/fair ratings, using inverse probability weights to adjust for attrition bias, and assessed free-text responses using thematic analysis.

RESULTS

Questionnaires were returned for 3635 children (53.8% response rate). Care was rated as poor/fair for 14.2% [from 6.1% (France) to 31.6% (Denmark)]; rates were higher when children had health or developmental problems (e.g. cerebral palsy (34.4%) or epilepsy (36.9%)). From 971 responses, 4 themes and 25 subthemes concerning care improvement were identified.

CONCLUSIONS

Parents' experiences provide guidance for improving very preterm children's post-discharge care; this is a priority for children with health and developmental problems as parental dissatisfaction was high.

IMPACT

In a European population-based very preterm birth cohort, parents rated post-discharge healthcare as poor or fair for 14.2% of children, with a wide variation (6.1-31.6%) between countries. Dissatisfaction was reported in over one-third of cases when children had health or developmental difficulties, such as epilepsy or cerebral palsy. Parents' free-text suggestions for improving preterm-related post-discharge healthcare were similar across countries; these focused primarily on better communication with parents and better coordination of care. Parents' lived experiences are a valuable resource for understanding where care improvements are needed and should be included in future research.

Assessment of the content, usability, and benefits of the WeChat-based programme for dog bite victims in China: A prospective observation study

WeChat in China has been used for public health education and the prevention of diseases. This study introduced a WeChat-based program for rabies prevention and evaluated the users' satisfaction with the program using the technology acceptance model.An online satisfaction questionnaire was used to survey 315 users who had followed the WeChat official account in China, and their satisfaction scores were assessed and analyzed.The users were generally satisfied with the WeChat-based program as an educational and instructional tool with the mean satisfaction score for each item ranging from 3.9 to 4.6 out of a maximum of 5.0 and the total mean satisfaction score of 41.5 out of a maximum of 50.0 (SD = 4.3). Urban users showed more satisfaction than rural users (P = .03). Users who were satisfied also reported that they intended to recommend WeChat to others (P = .00).Findings from the present study indicated that WeChat was considered a useful educational and instructional tool for dog-bite victims among young and urban population. This model of a WeChat-based program for rabies prevention should be expanded to other areas in China.

Predictors of Client Satisfaction Among Recent Users of Health Services in Lagos, Nigeria

Client satisfaction is an important measure of quality of care as it provides information on how well health service providers meet clients' values and expectations. The study was cross-sectional and analytical in nature. Data were obtained with the use of an interviewer-administered questionnaire. Respondents (n = 994) were a subset of a larger group of community members recruited for a study on quality of health care who had used a health facility for care within 3 months prior to data collection. A total of 94% of clients were satisfied with services received although client satisfaction rates were higher with private than public health facilities. Waiting time of less than 20 minutes (adjusted odds ratio [AOR] = 9.35, 95% confidence interval [CI] = 2.08-41.67), cheap cost of all services received (AOR = 7.58, 95% CI = 1.95-29.41), and the ability of the health care provider to offer explanations clearly to clients (AOR = 6.21, 95% CI = 1.90-20.41) were predictors of client satisfaction. However, the use of a government-owned hospital (AOR = 0.23, 95% CI = 0.08-0.63) was predictive of client dissatisfaction. Only service characteristics were predictive of client satisfaction. Improvement in service delivery is recommended.

Antecedents of use of e-health services in Central Eastern Europe: a qualitative comparative analysis

Background

The objective of this paper is to identify the key conditions that positively affect the use of e-health services in Central Eastern Europe (CEE) countries. CEE countries after the political and economic transformation in 1989/90 implemented slightly different national health care models. The research question of the study is: how do the various institutional conditions at the national level affect the use of e-health services in CEE countries?

Methods

The e-health description was derived from papers indexed in Web of Science and Scopus. The data for computation were collected from the 2015 global survey by the WHO Global Observatory for eHealth. We used a narrative literature review in order to identify key terms associated to e-health and conditions for the implementation of e-health services. The search terms were “e-health” and “*” where * was particular thematic section of e-health according to WHO GOeH. The inclusion criterion was relevance of the paper to e-health and searched phase. Eligibility criteria for countries for being described as CEE countries: Estonia, Lithuania, Latvia, Poland, Hungary, Romania, Bulgaria, Czech Republic, Slovenia, and Croatia (we omitted Slovakia from the analysis because this country was not covered by the WHO Survey). We applied qualitative comparative analysis (QCA) to analyse the necessary order of conditions. The dependent variable of the study is the national rate of use of e-health services.

Results

QCA shows that legal medical jurisdiction, teleprogramme and electronic health records supplemented by adequate training constitute critical conditions to achieve success in e-health implementation.

Conclusions

We conclude that the more formalised a framework for e-health service delivery is, the more likely it will be used. Therefore formalisation fosters the diffusion, dissemination and implementation of e-health solutions in this area. Formalisation must be accompanied by tailored training for health care professionals and patients. Our analyses are related only to the paths of e-health implementation in CEE countries thus consequently the findings and conclusions cannot be directly applied to other countries. The limitations of this study are related the absence of a broader context of e-health development, including the development of ICT infrastructure and ICT literacy.

Prevalence and factors associated with health insurance coverage in resource-poor urban settings in Nairobi, Kenya: a cross-sectional study

OBJECTIVE

To determine the prevalence of health insurance and associated factors among households in urban slum settings in Nairobi, Kenya.

DESIGN

The data for this study are from a cross-sectional survey of adults aged 18 years or older from randomly selected households in Viwandani slums (Nairobi, Kenya). Respondents participated in the Lown scholars' study conducted between June and July 2018.

SETTING

The Lown scholars' survey was nested in the Nairobi Urban Health and Demographic Surveillance System in Viwandani slums in Nairobi, Kenya.

PARTICIPANTS

A total of 300 randomly sampled households participated in the survey. The study respondents comprised of either the household head, their spouses or credible adult household members.

PRIMARY OUTCOME MEASURE

The primary outcome of this study was enrolment in a health insurance programme. The households were classified into two groups: those having at least one member covered by health insurance and those without any health insurance cover.

RESULTS

The prevalence of health insurance in the sample was 43%. Being unemployed (adjusted OR (aOR) 0.17; p<0.05; 95% CI 0.06 to 0.47) and seeking care from a public health facility (aOR 0.50; p<0.05; 95% CI 0.28 to 0.89) was significantly associated with lower odds of having a health insurance cover. The odds of having a health insurance cover were significantly lower among respondents who perceived their health status as good (aOR 0.62; p<0.05; 95% CI 1.17 to 5.66) and those who were unsatisfied with the cost of seeking primary care (aOR 0.34; p<0.05; 95% CI 0.17 to 0.69).

CONCLUSIONS

Health insurance coverage in Viwandani slums in Nairobi, Kenya, is low. As universal health coverage becomes the growing focus of Kenya's 'Big Four Agenda' for socioeconomic transformation, integrating enabling and need factors in the design of the national health insurance package may scale-up social health protection.

The Effects of Healthcare Quality on the Willingness to Pay More Taxes to Improve Public Healthcare: Testing Two Alternative Hypotheses from the Research Literature

The research literature discusses two opposite hypotheses regarding the possible effects of healthcare quality on the willingness to pay more taxes to improve public healthcare. One hypothesis theorizes that a lower quality of public healthcare may weaken the willingness to pay more taxes towards improving it. Another hypothesis posits that a low quality of public healthcare may strengthen the willingness to pay more taxes towards improving it. We tested both hypotheses on a diverse sample of 27 post-communist countries within Eurasia and Southern and Eastern Europe over a period of five years. We apply a binary logistic model for each country under investigation. The model is estimated by regressing the willingness to pay more taxes on six dimensions of quality, while controlling for covariates and the dummy for 2016. We found empirical support for both hypotheses, and hence none of the hypotheses gleaned from the literature is a clear "winner." However, we also found that the situation is less straightforward and more nuanced than is usually acknowledged within the literature. Our findings also suggest the effect is specific with respect to both a quality dimension and a country tested.

The Evidence and Future Potential of WeChat in Providing Support for Chinese Parents of Pediatric Patients Undergoing Herniorrhaphy

Introduction: Based on the current medical environment in China, this study developed a WeChat-based health education program for parents of children undergoing day surgery herniorrhaphy and evaluated the users' satisfaction of its usage by adapting the technology acceptance model. Methodology: A descriptive quantitative online design with a researcher-developed Satisfaction Questionnaire was used to survey 198 users in the university-affiliated hospital in China. Results: The users were generally satisfied with the program. The users living in urban areas obtained higher satisfaction (β coefficient = 1.763, p = .006). The users who were satisfied showed high intention to recommend WeChat to other parents. Discussion: In general, WeChat users found the educational program useful, and similar educational intervention can be expanded to other areas in China.

Exploring pathways to outpatients' satisfaction with health care in Chinese public hospitals in urban and rural areas using patient-reported experiences

Background

This study aimed to measure outpatients’ general satisfaction with and experiences of different aspects of health care in Chinese public hospitals and to investigate to what extent general satisfaction could be explained by patients’ experiences in public hospitals located at urban and rural areas.

Methods

Data on 4782 outpatients were derived from a patient survey in 9 city-level (urban) and 16 county-level (rural) public hospitals across China in 2016. According to Donabedian’s model, questions on patients’ experiences were categorized into six aspects under “structure” and “process”, with general satisfaction representing “outcome”. The Chi-square tests were used to test the differences in patients’ experiences and general satisfaction between urban and rural areas. The Partial Least Squares Structural Equation Modeling (PLS-SEM) was used to estimate effects of patients’ experiences on general satisfaction.

Results

Compared with respondents in rural areas, there were significantly higher percentages of respondents in urban areas reporting satisfaction and positive experiences in most aspects. As manifested by the path coefficients in PLS models, the positive effect of professional competence (0.197) on general satisfaction was the most significant in respondents at urban areas, followed by communication and information (0.183), and caring attitudes and emotional support (0.174). Among respondents at rural areas, the positive effect of environment facilities (0.199) was the most significant, followed by caring attitudes and emotional support (0.188), and professional competence (0.179). The PLS models explained 44.9 and 46.0% of variations in patient satisfaction at urban and rural areas, respectively.

Conclusions

Levels of patient satisfaction and experiences at Chinese public hospitals were higher in urban than in rural areas. Outpatients’ experiences of professional competence, caring attitudes and emotional support were strongly related to their satisfaction in both settings. However, among respondents in urban areas, experiences of communication and information were more strongly related to satisfaction, whereas among respondents in rural areas, experiences of environment and facilities were more strongly related to satisfaction.

Electronic supplementary material

The online version of this article (10.1186/s12939-019-0932-3) contains supplementary material, which is available to authorized users.

Equity in the quality of hospital services in Iran

Background: Providing fair access to high-quality healthcare services is one of the most important goals of health systems. This study was conducted between 2012 and 2013 to determine the level of equity in the quality of hospital services in Iran. Methods: In this cross-sectional study, 1,003 patients were chosen from 100 hospitals in Iran with multi-stage random cluster sampling. Concentration index was calculated to determine equity of healthcare quality from patients' viewpoint. Furthermore, the equity of hospital services' quality was investigated from experts' perspective by calculating Gini index based on the hospitals' accreditation scores. Analyzing the related factors was done by logistic regression. The significance level was set at α=0.05. Data were analyzed using Excel v.2010, SPSS v.21, and Stata v.8. Results: There was a significant inequity in the quality of hospital services in both patients' and experts' point of view. In fact, concentration index (95% confidence interval) for the quality of healthcare was significant, 0.128 (0.080, 0.176), indicating better quality of services for those with higher economic status from patients' point of view. Furthermore, Gini index (95% confidence interval) for hospitals' accreditation scores was 0.166 (0.156, 0.176), meaning that there was inequity in hospital services quality from experts' point of view. Conclusion: The significant inequality observed in the quality of hospital care based on the economic status of the patients highlights the necessity of the supportive policies aiming at reduction of this condition.

Development of Pharmacy Practice in European Countries-The Polish Perspective

Polish pharmacy practice and the distribution of medicinal products in some European countries are still going through a significant transformation. Changes postulated by the pharmacists should strengthen their role, and the place of community pharmacies in the health care system in the context of—among others—the introduction and popularization of pharmaceutical care. Subsequently, these efforts may essentially ensure the professional independence of the pharmacists. The introduction of pharmaceutical care to the pharmacy practice in all European countries will help to improve the quality of patient care and treatment outcomes, and will lead to a better allocation of available resources. Herewith, we present an important voice in the international debate, showing the current changes in the pharmacy practice in Poland, a European Union (EU)-member from 2004. Indeed, this paper presents the perspective of the country in which the position of pharmaceutical care is not well-established, and the role of the pharmacist is still limited to dispensing medicinal products, more than decade after it joined EU.

Patients' perceptions of healthcare professionalism-a Romanian experience

Background

The main objective of this cross sectional study was to assess the psychometric properties of a new research instrument. The secondary aim was to analyze patients’ levels of dissatisfaction with the professionalism of medical staff.

Methods

A social survey questionnaire was created and administered online. The instrument consisted of two scales: the 30-item patient dissatisfaction scale and the 10 items institutional scale. In this article, we assessed only the patient dissatisfaction scale. The research population includes 1838 subjects. The statistical procedures used were descriptive statistics, Pearson’s correlation, and factorial analyses with the SPSS.19 software. The internal consistency of the instrument was determined using the Cronbach’s alpha coefficient. We used a principal component analysis to investigate the factorial validity of the scale.

Results

The patients’ scale of dissatisfaction obtained an alpha Cronbach score of 0.81. Three latent factors corresponding to three dimensions of dissatisfaction emerged from the data: medical staff’s ability to communicate, medical staff’s hygiene, as well as sanitary and privacy conditions within the hospital. The first factor explained 43.47% of the variance in patient dissatisfaction, the second factor explained 10.24%, and the third factor explained 7.59%; overall, the three factors explained 61.30% of the total variance.

Conclusion

The Romanian healthcare system has an organization and management structure which has shown few changes since the communist period. Our study indicates that although more than 25 years have passed since the political regime changed in Romania and the introduction of a different system of social care, there have been no corresponding changes in the medical staff’s mentality or in the way that patients are approached. The present assessment of patient dissatisfaction is not a strictly theoretical exercise; it also represents a valuable instrument for healthcare system management.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-017-2412-z) contains supplementary material, which is available to authorized users.

Looking Through the Patients' Eyes: Measuring Patient Satisfaction in a Public Hospital

Objective:

Patient satisfaction is a personal evaluation of health-care services that is often used as an indicator of quality of care. The aim of this study was to identify aspects of hospital care that affect patient satisfaction by examining the structural and convergent validity of an in-house questionnaire.

Methods:

The sample consisted of 3320 patients discharged from an Italian public hospital. The questionnaire included items exploring communication with nurses and physicians, pain management, quality of accommodation, and discharge information. Data were analyzed using the Rasch model.

Results:

From the patients’ perspective, the number of response options was excessive and the questionnaire proved to have both medical and accommodation dimensions. Patients, on average, gave higher satisfaction scores to the medical dimension over the accommodation dimension. Higher satisfaction was associated with kindness and courtesy of the nursing staff, doctors’ courtesy, and the quality of bed linen.

Conclusion:

The results support the administration of the questionnaire but suggest change in the hospital’s analytical procedures in order to match the drivers of satisfaction as seen by the patients.