|Year : 2016 | Volume
| Issue : 3 | Page : 325-330
A cross-sectional study on patient satisfaction in an Urban Health Care Centre of Siliguri Municipal Corporation, Darjeeling, West Bengal
Sasthi Narayan Chakraborty1, Sharmistha Bhattacherjee2, Md Abdur Rahaman1
1 Department of Community Medicine, IQ City Medical College, Durgapur, West Bengal, India
2 North Bengal Medical College, Siliguri, West Bengal, India
|Date of Web Publication||17-May-2016|
Sasthi Narayan Chakraborty
IQ City Medical College, Durgapur, West Bengal
Source of Support: None, Conflict of Interest: None
Background: Patient satisfaction can be explored which may draw attention of the health care providers, administrators, and health policy makers, in order to monitor the performance, determine patients' needs, plan the development of services, and provide evidence to support the applications for financial support and expenditure. Aims and Objectives: To assess the level of satisfaction of patients regarding the different aspects of health care in an Urban Health Care Centre of Siliguri Municipal Corporation, Darjeeling, West Bengal and to identify the reasons of dissatisfaction among patients in that urban health care center. Materials and Methods: A cross-sectional survey on 102 patients with a Patient Satisfaction Questionnaire-18 was done. Systematic random sampling was adopted to draw samples. Results: Overall satisfaction was 73.1% with a mean value of 3.655. Highest satisfaction was in general satisfaction, and the lowest was in time spent with doctors Conclusion: Mean score and percentage of the patient satisfaction was high in that Urban Health Centre. Only matter of concern was time spent with the doctor. Doctor's time, lack of facility and poor quality of services were the major reasons for dissatisfaction among a few dissatisfied patients.
Keywords: Cross-sectional, patient satisfaction, Siliguri Municipal Corporation, urban, West Bengal
|How to cite this article:|
Chakraborty SN, Bhattacherjee S, Rahaman MA. A cross-sectional study on patient satisfaction in an Urban Health Care Centre of Siliguri Municipal Corporation, Darjeeling, West Bengal. Med J DY Patil Univ 2016;9:325-30
|How to cite this URL:|
Chakraborty SN, Bhattacherjee S, Rahaman MA. A cross-sectional study on patient satisfaction in an Urban Health Care Centre of Siliguri Municipal Corporation, Darjeeling, West Bengal. Med J DY Patil Univ [serial online] 2016 [cited 2022 Oct 3];9:325-30. Available from: https://www.mjdrdypu.org/text.asp?2016/9/3/325/182502
| Introduction|| |
One of the four principles of primary health care, community participation,  can be done by any means such as active participation in running health program, planning a program, implementation during various health activities, and giving feedback to health care providers.
Patient satisfaction survey, an important tool to get feedback from the people, is a means of measuring the effectiveness of health care delivery in a particular area. It reveals the strengths and weaknesses regarding the services provided in the health sector. The data gathered through measuring the patient satisfaction reflects care delivered by staffs and health care providers and can serve as a tool in decision-making. Patient satisfaction surveys can be tools for learning; they can give proportion to problem areas and a reference point for making management decisions. They can also serve as a means of holding health care providers accountable - Health care providers can be compelled to show that they have acceptable levels of patient satisfaction.  Thus the issues/aspects of satisfaction and dissatisfaction can be explored which may draw attention of the health care providers and administrators in order to monitor performance, determine patients' needs, plan the development of services, and provide evidence to support applications for financial support and expenditure.
Various studies have been done in India including West Bengal, in an attempt to reveal facts or domains of satisfaction or dissatisfaction regarding various health services or utilities.  Some of them were conducted in rural areas,  some in urban; some revealed overall satisfaction,  some regarding the improvement of patient satisfaction done by intervention.  A hospital based study conducted by Ogunfowokan and Mora in 2012, on time, expectation and satisfaction: Patients' experience at National Hospital Abuja, Nigeria, revealed that the reduction in patient-clinic encounter time and meeting patients' previsit expectations could significantly improve the patient satisfaction after clinic visit encounters at the general outpatient department (OPD). 
Similar type of a study conducted by Ziaei et al. in 2011 using Patient Satisfaction Questionnaire-18 (PSQ-18), on determinants of patient satisfaction with ophthalmic services, revealed that among 550 selected patients, the average satisfaction score, measured, was 4.05 ± 1.1 from a maximum of 5. 
As patient satisfaction regarding various health services or utilities varies from the tools of measurements, setting to setting, areas to areas, ethnic group to ethnic groups, this study will be conducted to reveal new facts regarding the patient satisfaction or dissatisfaction in Urban Health Care Centre of Siliguri of Darjeeling district, West Bengal, so that it may improve or change or strengthen our current practice of providing health care or services.
- To assess the level of satisfaction of patients regarding the different aspects of health care in an urban health care center of Siliguri Municipal Corporation, Darjeeling, West Bengal
- To identify the reasons for dissatisfaction among patients in an urban health care center of Siliguri Municipal Corporation, Darjeeling, West Bengal.
| Materials and Methods|| |
An observational cross-sectional study was carried out from October 2012 to December 2012 in Matrisadan, an Urban Health Care Centre, situated in Dabgram, Siliguri, run by Siliguri Municipal Corporation, West Bengal. All the patients attending OPDs were included in the study population. Patients are visiting OPD but advised to be admitted in in-patient department; already interviewed earlier or previous day during data collection period; and who refused to give consent were excluded from the study. In addition, staffs/health care provider/health workers of that urban health center were also not included.
Based on a study conducted by Kumari et al.  in Lucknow district, India, it was seen that overall satisfaction regarding one outcome variable (doctor patient communication) is 60% and applying suitable formula  for a cross-sectional study, sample size come out to be 92. Assuming 10% of nonresponse rate, which comes to be 10, final sample size was 102. The samples were drawn in a systematic random sampling. A single digit random number was selected using random number table that came out to be 4. So, a fourth patient at the exit point was interviewed as the first subject, and then every fifth patient was interviewed consecutively using a pretested schedule was conducted in OPDs after obtaining consent from respondents. In case of children, their attendants were interviewed.
The schedule consisting of three parts and important part to mention was a second part. It included different OPD visit and type of visit that is, for the first time or consecutive times to the OPDs by the patients and questions regarding the patient satisfaction, based on PSQ-18 developed by Marshall and Hays  which has been widely used in various studies. ,, The questionnaire comprehensively measures the patient satisfaction with the 18 items which yields seven domains of patient satisfaction, that were general satisfaction (2 items, that were item 3 and 17), interpersonal manner (2 items, that were item 10 and 11), communication (2 items, that were item 1 and 13),technical quality (4 items, that were item 2, 4, 6, and 14), financial aspects (2 items, that were item 5 and 7), time spent with doctor (2 items, that were item 12 and 15), and accessibility and convenience(4 items, that were item 8, 9, 16, and 18). Those items were asked in such a way that they were statements of opinion, since each was accompanied by five response categories from strongly agree, agree, uncertain, and disagree to strongly disagree. Some PSQ-18 items were worded so that agreement reflected satisfaction with health care, whereas other items were worded so that the agreement reflected dissatisfaction with the health care.
Prior to the study, ethical approval was taken from the Institutional Ethics Committee of North Bengal Medical College.
Analysis of data
After collecting all the data, data entry was done in IBM SPSS Version 20. Data was organized and presented by applying principles of descriptive statistics'. Analysis of the data was done by IBM Statistical Package for Social Sciences version 20 (SPSS 20). Satisfaction was determined by mean scores. Continuous data was tested for significance by t-test and ANOVA. As no significance was found t-test, and ANOVA results were not given in the result section. Linear regression analysis was done to find out the relationship between continuous dependent variable with other independent variables.
PSQ-18 yields for each of the seven different subscales; general satisfaction (2 items), interpersonal manner (2 items), technical quality (4 items), financial aspects (2 items), time spent with doctor (2 items), and accessibility and convenience (4 items). All items were scored from one to five so that high scores reflect satisfaction with health care. After item scoring, items within each scale was averaged together to create the 7 subscale scores. The scoring system was given below: All items were scored in such a way so that high scores reflected satisfaction with health care facility, which was given in [Table 1]. After scoring, scale score was done in the following way [Table 2], based on a study conducted by Holikatti et al.  on patient satisfaction with psychiatric services in Cuttack. Scale score represents the average for all items in the scale that was answered.
|Table 2: Calculation of level of satisfaction in terms of different domains of patient satisfaction|
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| Results and Analysis|| |
[Table 3] shows a mean score of each domains of patient satisfaction. Mean satisfaction is the highest for general satisfaction (3.814), followed by technical quality (3.713), communication (3.672), financial aspects (3.642), interpersonal manner (3.637), accessibility and convenience (3.62), and least in time spent with doctor (3.485). Overall satisfaction was 73.1% with a mean value of 3.655.
|Table 3: Distribution of study population according to their satisfaction to the urban health center (n = 102)|
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[Table 4] shows mean scores of 7 domains of patient satisfaction and overall satisfaction in relation to sociodemographic variables and different OPD and type of OPD visit by the patients. The table also reveals that maximum of patients belonged to 40-59 years of age (32.4%) followed by ≥60 years (21.6%) and least among 13-19 years (7.8%). The proportion of female patient was much more (60.8%) than males. The table also shows a majority of patient's attending the health center were Hindus (59.8%) followed by Muslims (28.4%). The table also reveals 18.3% of the study populations are illiterate while 72.6% were literate. The majority of the population belongs to social Class III (37.3%), IV (25.5%), and V (10.8%). Most of the patient visited to gynecology and obstetrics (G and O) OPD (47.1%), followed by medicine (40.2%) and pediatrics (12.7%) OPD. The table also shows an equal number of visit to the health center for the first time (50%) and follow-up visit (50%).
|Table 4: Distribution of study population according to sociodemographic variables and different domains of patient satisfaction (n = 102)|
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[Table 5] shows linear regression analysis between the overall satisfaction as the dependent variable and independent variables such as age, gender, religion, education, SE class, different OPD visit, and type of visit. Linear regression equation was, overall satisfaction = 3.775 − 0.002 × age + 0.113 × Gender + 0.015 × religion − 0.013 × education − 0.001 × socioeconomic class − 0.019 × different OPD visit − 0.127 × type of OPD visit. However, the model could explain the variation of overall satisfaction in only 1.8% of the cases.
[Table 6] shows 40.9% of the patient blames inadequate doctor's time for their dissatisfaction, followed by lack of facility (31.8%) and poor quality of services (27.3%), respectively.
|Table 5: Linear regression analysis showing relation of overall satisfaction with other variables|
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|Table 6: Distribution of dissatisfi ed study subjects according to the reason of dissatisfaction|
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| Discussion|| |
The need to improve quality of healthcare delivery is increasing, and a major component of quality of health care is patient satisfaction. Furthermore, the patient satisfaction is critical to how well patients do; research has identified a clear link between patient outcomes and patient satisfaction scores. The present study deals with the patient satisfaction in an Urban Health Care Centre in the City of Siliguri, West Bengal.
Patient satisfaction was calculated with the help of PSQ-18. It was found that the overall satisfaction regarding the Urban Health Care Centre was 73.1% with the mean score of 3.655. The level of satisfaction in the current study was much higher than in many studies such as Holikatti et al.  (55.3%), Moemen  (mean 2.96), and Asraf et al.  (satisfaction 61%); however, the satisfaction level was low in comparison to study by Ziaei et al.  (mean 4.0).
The mean score of general satisfaction was 3.814, highest among seven domains of patient satisfaction. When compared with the studies conducted by Holikatti et al.  and Moemen,  it was found that in the present study, all the domains (general satisfaction, technical quality, interpersonal manner, communication, financial aspects, time spent with doctor, accessibility, and convenience) had higher score.
The study population comprised of more females (60.8%) than males which may be due to the fact that female oriented services such as G and O, pediatrics, were more regular on that particular health center. This finding was consistent with a similar type of study conducted by Ogunfowokan and Mora  in a general OPD of Nigeria which showed majority of the study population comprises of females (54.1%). It was seen that in 40-59 years of age group the study population was maximally distributed (32.4%), which was very close with a study conducted by Moemen  in 2008 in Alexandria University which showed 32.6% of study population among 40-60 years age group.
Regarding distribution of the study population according to other sociodemographic variables, it was seen that majority of study participants were Hindus (59.8%), literate (72.6%), and belonged to socioeconomic Class III (37.3%) according to modified BG Prasad scale.
While studying different OPD visit made by the patients it was found that most of the them had visited G and O OPD (47.1%), followed by medicine (40.2%) and pediatrics (12.7%) OPD, respectively. It might be due to the fact that female patients attended the health center more than the males as the clinic remains open during the daytime when most of the males are at work. It was a very interesting finding that 50% of patient visited the health center for the first time, and 50% patient visited for follow-up.
The pattern of satisfaction in different domains according to different sociodemographic variables does not show any particular trend. This is quite opposite to the findings of a study done by Tucker and Kelley, which shows patients' satisfaction differed significantly along age, rank, gender, education, individually.  In another study by Quintana et al. in Spain age, gender, the level of education, and marital status were found to be the predictors of patient satisfaction with hospital health care. 
Linear regression with overall satisfaction with sociodemographic variables showed no significant association and this study finding was consistent with studies conducted by Hall and Dornan,  Crow et al.  which revealed that there was no significant association between the patient satisfactions with sociodemographic variables, however, a study conducted by Bahramoour and Zolala  in Iran revealed significant association between religion and patient satisfaction.
When enquired about the reasons for dissatisfaction, it was seen that 40.9 % of the patients blamed inadequacy of the doctor's time, followed by lack of facility (31.8%) and poor quality of services (27.3%) respectively. In a study done in Poland among 361 respondents, the main categories of patient dissatisfaction were deficiencies in the primary health care system, deficiencies in organization and quality of services and deficiencies in care providers' attitudes, skills and work. 
The main limitation of the present study is its observational nature. Also, the attitude of health workers to the patients, which was not examined, could affect the level of satisfaction of the patients. Future research can be done that will incorporate healthcare workers' attitude into the factors determining patient satisfaction.
| Conclusion|| |
Patient satisfaction was quite good in Dabgram Urban Health Centre of Siliguri Municipal Corporation. Among the different domains of measurements of patient satisfaction, only time spent with doctor was low. Doctor's time, lack of facility and poor quality of services were the main reasons for dissatisfaction among few dissatisfied patients. The present study also revealed that sociodemographic variables or previous exposure had no influential role in determining patient satisfaction. The study findings can aid in the development of targeted, objectively prioritized programs for the improvement of health care delivery in such canters.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]
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