Antenatal Patients Level of Satisfaction Toward Service Rendered by Health Workers in Selected Primary Health Centers of Ejigbo Local Government, Osun, State Nigeria.
Antenatal Patients Level of
Satisfaction Toward
Service Rendered by Health Workers in
Selected Primary Health Centers of Ejigbo Local Government, Osun, State Nigeria.
By
(1)
B.L Ajibade (RN, Ph.D, FWACN). Ladoke
Akintola University
of Technology, Ogbomoso, College of Health Sciences, Isale-Osun, Osogbo, Osun State.
(2)
Oladeji M.O (RN, MSc) Ladoke
Akintola University
of Technology, Dept of Nursing, Osogbo.
(3)
E.A. Oyedele (RN, M.Ed, FWACN). Dept of Nursing, University of Jos
(4)
Amoo P.O (RN,RM,MSc) Ladoke
Akintola University
of Technology, Dept of Nursing, Osogbo
(5)
MakindeO.Y(RN,RM,MSc) Ladoke
Akintola University
of Technology,Dept of Nursing,Osogbo
Correspondence
to:- Dr. B.L Ajibade, ladoke Akintola
University of Technology,
Ogbomoso c/o P.O BOX 1120, Osogbo
badelawal@yahoo.com
(08034067021).
ABSTRACT
Introduction:
Patients’ satisfaction is related to the extent to which general health care
needs and condition-specific needs are met. Evaluating to what extent patients
are satisfied with health services. In clinically relevance, are the satisfied
patients more likely to comply with treatment, take an active role in their own
care; to continue using medical care services and stay with health care
providers (where there are some choices), maintain the use of the
specific system and to recommend the services to others. Therefore this study
was aimed at assessing the level of satisfaction towards the care renders by
health workers to patients receiving ANC in some selected health centers of
Ejigbo Local government in Osun state, Nigeria.
Methodology:
This was a cross-sectional descriptive research conducted among 234 antenatal
patients attending the selected health centres between 10th
December, 2012 and 11th March, 2013. Multistage sampling technique
was employed in the selection of the health centers while simple random
technique was used to select the respondents at each clinic until the
calculated sample size was reached self-designed instrument consisting
of open and closed ended questionnaire was used. The reliability of the
instrument was 0.88 using Spearman Brown coefficient.
Results
In term of
satisfactory level 60.3% related that all the categories of staffers in the
various health centers greet them warmly and with dignity, more than half
(59.0%) also reported that health workers introduced themselves before
attending to them, thereby establishing good rapport. Privacy and
confidentiality were reported by 77.4 % of respondents not to be adequate while
48% of respondents felt the waiting time in the facility was long and there was
equally a relationship between the level of satisfaction and the interpersonal
relationship of health workers. Majority of the respondents (74%) were
satisfied with ANC services rendered. There was a relationship between the
level of satisfaction and the cleanliness of the facility.
Conclusion:
it was concluded that stake holder should provide competent health workers at
the health centers, consulting room should be provided with the screens and
periodic training should be carried out for the health workerss
Key Words
Antenatal
patient level of satisfaction, Ejigbo, Osun health workers
INTRODUCTION
Patients’
satisfaction is related to the extent to which general health care needs and
condition-specific needs are met1. Evaluating to what extent
patients are satisfied with health services is clinically relevant, as the
satisfied patients are more likely to comply with treatment, take an active
role in their own care to continue using medical care service and stay with a
health provider (where there are some choices), Maintain with a specific system
and to recommend the services to others2,3.
The 5th
millennium development goal aims at reducing material mortality by 75% by the
years 20154. According to the world health organization
(WHO), there was an estimated 358,000 maternal deaths globally in 2008.
Developing countries accounted for 99% of these deaths of which 3/5 occurred in
Sub-Saharan Africa where Uganda
lies. Abortion, obstetric Complications such as hemorrhage, dystocia, sepsis
and infections such as tuberculosis and HIV are the major causes of maternal
deaths in developing countries5. Although antenatal care
(ANC) is not in itself very effective in reducing maternal mortality, it
provides an entry for intervention which give health workers the opportunity to
detect these risky conditions and therefore refer for early management leading
to better maternal outcomes6. Evaluation of care must be
done, so as to improve accountability, to raise standard and quality of care,
to improve responsiveness to patients, to monitor health care, to improve
outcome of care7. The measurement of patients’ satisfaction
is a common component of many evaluations but it is a wholly subjective and
dynamic assessment of the quality of health care, and as such, is not a measure
of final outcome. This has inadvertently steered up some debates about using
client’s perspective in evaluation of the quality services. While many
stakeholders have viewed the client’s perspective as a meaningful indicator of
health services quality, others have dismissed the views of clients as too
subjective. For the latter point of view, how a client feels is important, even
though the provider’s assessment of reality may be different, because at a
minimum the subjective assessment of quality by clients, can still provide
useful input to help the provider understand and establish acceptable standards
of services8. Consumer assessment of interpersonal processes
of care during antenatal care provide important information about how well
clinicians satisfy the perceived needs of clients they serve. Furthermore,
perceived quality of care received in health facilities is directly
proportionately related to the use of health facilities9.
In spite of the global efforts to improve maternal health in the developing
countries, the present quality of maternal care as depicted by the magnitude of
the high maternal morbidity and mortality in this region makes the realization
of the millennium development goal for maternal health uncertain10.
Among the various pillars of safe motherhood, antenatal care remains one of the
interventions that have the potential to significantly reduce maternal
morbidity and mortality when properly conducted11. In a study
carried out in the Northern
State, during their visit
to health facility, most of the respondents felt their health concerns were
addressed by the health provider and majority of the personnel ranging from the
record staff to doctors greeted them very well at each of their visits12.
The patronage of ANC Services even at the grass-root is higher among the
literate portion of the population13. In Uganda the ANC services are
characterized by poor attendance, poor counseling services and poor client
provider relations, with the quality being worse in rural areas14,15.
The quality of ANC is critical in enabling women and health workers identify
risk and danger sign during pregnancy which should lead to appropriate action16.
Whether or not women can identify danger signs during pregnancy and act
appropriately depends on quality aspects such as depth of the information and
counseling given at an ANC visit17. Provision of quality ANC
service requires presence of relevant infrastructure adequate trained health
workers18. Infections control facilities, diagnostic
equipment, supplies and essential drugs19. In a study in Uganda,
majority of the clients interviewed rated ANC services as satisfactory.
Satisfaction with health workers attitude which has been found by other studies20.
Objectives: The
research study was premised on the following objectives:-
1.
To assess the level of satisfaction of respondents in term of reception
accorded them by the health worker.
2.
To determine the good interpersonal relationship between respondents and the
health workers.
3.
To evaluate the opinion of parents toward the time spent with health workers.
4.
To assess the level of satisfaction toward services to the respondents by
health workers.
5.
To assess of respondents are willing to return for ANC or rcorded the centre to
others.
Research
Questions: The following questions were answered by the
Research:
1.
What is the level of satisfaction toward the reception accorded the respondents
during the ANC visit?
2.
What is the level of satisfaction by respondents toward their interpersonal
relationship with health workers?
3.
What is the opinion of patients toward time spent with health workers?
4.
What is the level of satisfaction toward services render to respondents by the
health workers?
5.
Will the respondent be willing to come for ANC or recommend the ANC to another
person?
Hypothesis: Two
(2) null hypotheses were tested at 0.05 level of significance.
1.
There is no relationship between time spent with health worker and level of
satisfaction by respondents.
2.
There is no relationship between the cleanliness of health facilities and the
respondents’ level of satisfaction.
Methodology
Setting:-
The study was carried out at Ejigbo Local Government which was created in 1954.
It was one of the oldest local government areas to be in existence in Osun State,
South West of Nigeria. It has the boundaries with Surulere Local Government of
Oyo State in the West, Olaoluwa Local Government in the North, Egbedore Local
Government in the East and Afijio Local Government of Oyo State in the South.
It has the population of 132,515 by the 2006 population census. The people are
predominantly farmers with Petit Trading. The people are well travelled to
places like Ivory Coast, Ghana, Togo
and Lome. It
has 34 active health centres with one comprehensive health centre. It has
eleven (11) wards.
Study
design: A Cross-sectional descriptive design was used to assess
Antenatal clients’ level of satisfaction toward the services rendered at the
health centers in Ejigbo, Osun State,
Nigeria between
December 2012 and March 2013.
Study
Population: The study was carried out among pregnant women attending
antenatal clinic at the Comprehensive health centre, Ejigbo. To be included in
the study they should have registered for ANC with at least two (2) visits and
they must signify interest to participate in the study.
Sample
Size Determination: Rule of thumb was adopted in determining the sample
size for the purpose of this study, 84% was picked as the high rate of clinic
attendance by the pregnant women. The sample size was calculated using the
formula.
|
Z2pq
(d)2
Where
n = sample size
Z = 1.96,
standard deviation set at 95%
P = 0.84
proportion of clients satisfied with services among primary health care centre
was 81.4%
q = 1-P =
1-0.186
d = 0.05 degree of
precision
= (1.96)
(0.814) (0.186) 2 = 234
(0.05) 2
Therefore, the
sample size should be 234.
Sampling
technique:- A multistage sampling technique was used in selecting the
required sample size. In the first stage, the list of all the eleven (11) wards
in the Ejigbo Local Government was obtained out of which three wards were
selected randomly through balloting. From the three selected wards, the list of
all the primary or comprehensive health centre’s was obtained. One PHC/CHC in
each of the three selected wards was then randomly selected through balloting.
Based on client sitting arrangement at each clinic visit, the sample was
selected on the basis of turn out of patient until required sample size was
attained.
Selected
respondents were organized and administered with the research instrument. The
illiterate among them were assisted with the translation of the instrument.
Each respondent spent not more than one (1) hour in filling the questionnaire.
Data
Collection Method:- Self-design instrument generated through literature
review with the reliability of 0.88 using spearman Brown analysis.
Questionnaire was used to collect information from the respondents. The
Questionnaire was Semi-structured both open and closed ended. The data
collection was between December 15th, 2012 and March 11th 2013.
Data
Analysis:-
Data collected
were collated and analyzed using statistical product and service solutions
(SPSS) window version 21. The research questions were answered using
descriptive analysis inform of frequencies, tables and percentage while the two
hypotheses were tested using chi-square (x2) analysis at 0.05 level
of significance.
Ethical
Consideration:- Informed consent of the respondents through the
information in the instrument and through verbal communication. The approval of
the local government service commission was received through the chairman of
local government and the Kabiyesi/Baale of the involved wards.
RESULTS
Table 1 - demographic data:
A total of 234 questionnaires were administered to the antenatal women
attending the selected health centre in the Ejigbo Local Government. Out of the
population 64.5% had the ages range between 15-24 years, while 5.6% were
between 35 and 45 years old. Illiterate accounted for 1.7% respondents with
secondary level of education was 38.9%. In term of tribe (table 1), 77.4% of
the respondents were Yoruba because Ejigbo is majorly Yoruba speaking area.
With Special reference to the type of reception accorded the respondents by the
health workers (table 2) 60.3% of the respondents reported to have been warmly
received by health workers, while 39.7% reported poor reception 59% of the
respondent reported that the health-workers gave self introduction while 41%
refused to introduce themselves to the respondents. 29.5% of respondents were
informed of what to expect from health workers while 70.5% were not informed.
88.9% of respondent reported that health workers gave them opportunity to ask
questions while 11.1% reported that the opportunity was not given to them to
ask questions. 86.3% of respondent affirmed that their questions were well
answered; only 13.7% reported that their questions were not well answered. 56%
of respondents reported that the procedures were explained to them; while 44%
reported that procedures were not explained to them (table 2).
In
term of interpersonal relationship with respondents, (table 3), 64.1% of
respondents was satisfied with interpersonal relationship of the health
workers, only 2.6% was not satisfied while 33.3% of respondents was not sure.
With reference to maitaining the confidentiality and privacy during the visit
to the clinic, 22.6% reported that thier confidentiality and privacy were
protected the while 77.4% reported that their confidentiality/privacy was not
maintained (table 3).
31.2% of respondents reported a very long waiting time with health workers, 48.3%
reported a long waiting time and 20.5 reported an accurate waiting time in the
centre’s (table 3). Virtually all respondents 97% intended to return to the
centre for ANC, only 3% intended not to return to the centre (table 4). In the
same vain, 98.3% reported that they will recommend the centres to others for
ANC, while 1.7 reported that they will not recommend the centre to others
(table 4). Considering the level of satisfaction with services rendered in
health centres (table 5) 19.2 reported that they were very satisfied, 55.5%
were satisfied, 22.2% were neutral while only 1.7% were dissatisfied and the
same percentage was equally very dissatisfied. On the reasons for satisfaction
(table 5) 84.4% based their satisfaction on the competence of staff, while 15.6
based their satisfaction on friendliness of staffers. In testing the
hypotheses, there was significant relationship between time spent by patients
and the level of satisfaction (table 6), equally, there was a relationship
between the cleanliness of facilities at the health centres and the level of
satisfaction.
DISCUSSION
Out
of the 234 respondents sampled, 94.4%of them were within the reproductive age
range of between 20-34 years. As this is the most fertile period in a woman’s
life span, other studies too would, as expected have a similar finding. In the
South-western part of Nigeria,
a study confirms this, with 81.3% of the respondents falling within the same
age range12, 13.
Greater than
two-third of the respondents (73.9%) had some form of formal education, 24.4%
had vocational education and only 1.7% of the respondents had no formal
education. This implies that the patronage of ANC services even at the
grass-roots was higher among the literate portion of the population 3,
12, 13.
During
their visit to the health facility, most of the respondents, 64.1% felt their
health concerns were addressed by the health provider, although greater than a
third of the respondents (33.3%) could not really say if their health concerns
were addressed and only 2.6% respondents felt their health concerns were not
address. The large number of those who don’t know if their health issues were
addressed could be attributed to the fact that the clients patronizing the PHC
are mostly those who are otherwise normal, with only those with physiologic
changes, experienced by all pregnant women.
During
their visit to the health facility, majority of respondents reported that
staffers, ranging from the records staff to the nurses and the doctors
displayed positive attitude, as 60.3% said they were greeted warmly and with
dignity while 59% indicated that staffers introduced themselves. This is an
important aspect as most clients were reffered by others because a favorable
atmosphere was created for them and this also influences
their will to continue patronage of the services in the PHC12, 13, 14.
All
respondents rated client/ health care provider interaction satisfactory in
different aspects, as they believed that providers were interest in their
condition, listening to them, understanding their concerns and being
comfortable talking to them. On the other hand, majority of respondents (77.4%)
reported that their privacy and confidentiality were not maintained during the
consultation with the health provider3, 12, 13.
Most
respondents (97%) were willing to return to the health facility again to
patronize ANC Services, in the same vein, 98.3% of the respondents were willing
to recommend the ANC Services to others. Reason adduced for this effect
included staffers friendliness (15.6%) while 84.4 reported that their reason
was based on presence of competent staffers12,13.
Considering
their level of satisfaction to services provided, 74.0% were satisfied with
services received while only 4.0% were not satisfied12, 13,15,16.
Based on the
finding of the study, significant relationship was found to exist between the
level of satisfaction and time spent with health providers, equally significant
relationship was found between cleanliness of the facility and satisfaction of
patients 13, 14, 15.
Conclusion:
Majority of clients attending Antenatal care in the selected health centres in
Ejigbo Local Government were satisfied with the different aspects of their
interaction with health providers in the facilities although, they felt that
health workers did not protect their privacy and confidentiality during the
clinic visits. Therefore, more consulting room should be provided and provision
of screens should be considered as paramount. Therefore, more consulting room
should be provided and provision of screens should be considered as very
paramount.
Recommendations
1.
State and LGA should employ more skilled staff in order to reduce wasting time.
2.
Their must be continuous training of the staffers in interpersonal
communication.
3.
LGA in collaboration with the state should provide more consulting rooms and
screens to improve the maintenance of patient’s privacy and confidentiality.
Tables
Table 1
Demographic Data of patients attending PHC for ANC
|
Variable
|
Frequency
|
Percentage
|
|
AGE
|
|
|
|
15-24
|
151
|
64.5
|
|
25-34
|
70
|
29.9
|
|
35-45
|
13
|
05.6
|
|
Total
|
234
|
100
|
|
Educational status
|
|
|
|
Illiterate
|
04
|
01.7
|
|
Vocational Training
|
57
|
24.4
|
|
Primary
|
67
|
28.6
|
|
Secondary
|
91
|
38.9
|
|
Tertiary
|
15
|
06.4
|
|
Total
|
234
|
100
|
|
Tribe
|
|
|
|
Yoruba
|
181
|
77.4
|
|
Hausa
|
4
|
01.7
|
|
Ibo
|
2
|
0.9
|
|
Others
|
47
|
20.1
|
|
Total
|
234
|
|
|
Religion
|
|
|
|
Islam
|
102
|
43.6
|
|
Christianity
|
132
|
56.4
|
|
Total
|
234
|
100
|
Table 2 - Nature of reception Accorded the Patient
|
VARIABLE
|
FREQUENCY
|
PERCENTAGE
|
|
Corrected
warmly with dignity
|
|
|
|
Yes
|
141
|
60.3
|
|
No
|
93
|
39.7
|
|
Total
|
234
|
100
|
|
Staff
introduced him/herself
|
|
|
|
Yes
|
138
|
59
|
|
No
|
96
|
41
|
|
Total
|
234
|
100
|
|
Staffers
explained what to expect
|
|
|
|
Yes
|
69
|
29.5
|
|
No
|
165
|
70.5
|
|
Total
|
234
|
100
|
|
Health care
provider encouraged me to ask question.
|
|
|
|
Yes
|
208
|
88.9
|
|
No
|
26
|
11.1
|
|
Total
|
234
|
100
|
|
My
questions answered completely
|
|
|
|
Yes
|
202
|
86.3
|
|
No
|
32
|
13.7
|
|
Total
|
234
|
100
|
|
Explained
procedure to me before it is carried out.
|
|
|
|
Yes
|
131
|
56
|
|
No
|
103
|
44
|
|
Total
|
234
|
100
|
Table 3: Patient’s level of
satisfaction with Health Working interpersonal relationship.
|
VARIABLE
|
FREQUENCY
|
PERCENTAGE
|
|
Satisfied with health
workers interpersonal relationship
|
|
|
|
Satisfied
|
150
|
64.1
|
|
Dissatisfied
|
6
|
2.6
|
|
No Idea
|
78
|
33.3
|
|
Total
|
234
|
100
|
|
My privacy
and confidentiality
|
|
|
|
Yes
|
53
|
22.6
|
|
No
|
181
|
77.4
|
|
Total
|
234
|
100
|
|
I am
satisfied with time spent with the health workers
|
|
|
|
Just right
|
229
|
97.9
|
|
Too long
|
5
|
2.1
|
|
Total
|
234
|
100
|
Table 4:
Willingness of clients to return or recommend the health centre to others.
|
VARIABLE
|
FREQUENCY
|
PERCENTAGE
|
|
Will return
|
|
|
|
Yes
|
227
|
97
|
|
No
|
7
|
3
|
|
Total
|
234
|
100
|
|
Will
recommend the facility to others
|
|
|
|
Yes
|
230
|
98.3
|
|
No
|
4
|
1.7
|
|
Total
|
234
|
100
|
Table 5: Level of satisfaction
to the services rendered.
|
VARIABLE
|
FREQUENCY
|
PERCENTAGE
|
|
Level of
satisfaction
|
|
|
|
Very satisfied
|
45
|
19.2
|
|
Satisfied
|
120
|
55.1
|
|
Neutral
|
52
|
22.2
|
|
Dissatisfied
|
4
|
1.7
|
|
Very
dissatisfied
|
4
|
1.7
|
|
Total
|
234
|
100
|
|
Reasons for
satisfaction
|
|
|
|
Health
centered manned by competent workers
|
146
|
84.4
|
|
Friendliness
of workers
|
88
|
15.6
|
|
Total
|
234
|
100
|
Table 6:
Relationship between time spent with health care provider and the level of
satisfaction.
|
|
Level
of Satisfaction
|
|||||
|
Time Spent
|
VS
|
S
|
N
|
DS
|
VD
|
Total
|
|
< 10 minutes
|
38
|
122
|
43
|
4
|
4
|
211
|
|
11 – 15 minutes
|
7
|
6
|
----
|
----
|
-----
|
13
|
|
16 – 20 minutes
|
---
|
---
|
4
|
---
|
---
|
04
|
|
> 20 minutes
|
---
|
---
|
3
|
---
|
---
|
03
|
|
No idea
|
---
|
---
|
3
|
---
|
---
|
03
|
|
Total
|
45
|
128
|
53
|
4
|
4
|
234
|
X2 =
43.4 df =
12 
= 0.05
= 0.05
Key to table 6 and 7
VS
- Very Satisfied
S
- Satisfied
N
- Neutral
DS
- Dissatisfied
VD
- Very dissatisfied.
Table 7: Relationship between
the facilities cleanliness and level of satisfaction.
|
|
Level
of Satisfaction
|
|||||
|
Cleanliness
|
VS
|
S
|
N
|
DS
|
VD
|
Total
|
|
Very Clean
|
21
|
19
|
18
|
---
|
---
|
48
|
|
Clean
|
18
|
63
|
20
|
---
|
---
|
101
|
|
Fairly clean
|
6
|
43
|
23
|
4
|
4
|
80
|
|
Dirty
|
---
|
3
|
2
|
---
|
---
|
05
|
|
Total
|
45
|
128
|
53
|
4
|
4
|
234
|
X2 =
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= 0.05
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