James Y. Greene

The impact of clinical encounter events on patient and physician satisfaction

Abstract This study explored levels of patient and physician satisfaction as a function of events which occur during the clinical encounter. Data which are directly observable (verbal and nonverbal) and obtainable through interviews were considered. Eighty-eight encounters were observed over a one-week period at an outpatient clinic of a university-affiliated hospital. Participants were interviewed subsequent to each interaction. Multiple discriminant analysis showed encounters viewed by patients as relatively unsatisfactory to be characterized by greater distance between parties during information gathering, increased amounts of feedback, highly active physicians, and physicians who were on call. Satisfied patients had encounters marked by increased physician use of (1) nonverbal encouragement, (2) questions about family and social situations, and (3) expressions of continuity from previous visits. Physicians were less satisfied in encounters in which they were active, felt pressed to other medical commitments, and were on call. The most positive physician assessments occurred when patients were seen as compliant and where humor and nonverbal encouragement were used during the interaction. These data suggest variables which are generally amenable to change if physicians are made aware of their potential impact.

Health beliefs and smoking behavior.

Smoking histories and beliefs about smoking were obtained on 120 ex- and current smokers. Ex-smokers view smoking as a serious health problem, did not report having a physician recommend they stop, and feel personally susceptible to its adverse effects. Moderate smokers (0-10/day) also view smoking as serious, but do not see themselves as vulnerable to its adverse effects. The data suggest that certain attitudes can discriminate between groups of current smokers, as well as smokers from ex-smokers.

Patient attitudes toward health care: Expectations of primary care in a clinic setting

Abstract Patient satisfaction, defined as the degree to which patient expectations of health care areperceived as being fulfilled, has received increased emphasis in the evaluation of quality of care. To initiate research in this area, expectations of patients receiving care at an outpatient department of a teaching hospital were assessed. Patient expectations were found to be generally high. A factor analysis identified three dimensions of patient expectations: (1) the role of the provider; (2) mutual patient-physician responsibilities; and (3) the convenience of the services. The patient appeared to be subordinate and passive in his/her relationship with the physician. Patient expectations of non-physician providers were oriented toward personal qualities; for physicians, however, concern was with both competence and personal qualities. Cost of health services was not associated with the dimension of convenience.

Can raters consistently evaluate the content of focus groups

Focus groups are increasingly being used to provide insights to researchers and policy makers. These data complement quantitative approaches to understanding the world. Unfortunately, quantitative and qualitative methodologies have often been viewed as antithetical, rather than complementary, strategies. While focus groups can clearly generate rich information that is unobtainable through other quantitative methods, it is important to determine the degree to which different raters can consistently extract information from transcripts. Thus, our goal was to quantify agreement in the interpretation of transcripts from patient and physician focus groups, using decision-making in ischemic heart disease as a model. We used data from focus groups with both patients and physicians that sought to identify factors affecting diagnostic and treatment decisions in ischemic heart disease. Three raters independently reviewed transcribed audiotapes from focus groups of patients with ischemic heart disease, as well as focus groups of physicians who care for these patients. We found that raters could not distinguish between major and minor factors reliably. More troubling, however, is that consistency regarding the apparently straightforward judgment as to the mere presence or absence of a factor was difficult to achieve. In particular, the three raters of each transcript failed to agree on between one third and one half of the factors. This reasonably high level of disagreement occurred despite the raters: (1) having generated the individual factors themselves based upon their reading a random sample of actual transcripts and (2) being trained in the use of rating forms (including standard definitions of themes). These data suggest that if a single rater evaluates focus group transcripts, as is commonly done, judgments may not be reproducible by other raters. Moreover, a single rater may not extract all important information contained in the transcripts.

HIV/AIDS and cultural practices in western Kenya: the impact of sexual cleansing rituals on sexual behaviours

This paper reports on an exploratory study examining the role of sexual cleansing rituals in the transmission of HIV among the Luo community in western Kenya. Data were collected using both in‐depth interviews and focus group discussions. The study population consisted of 38 widows, 12 community elders and 44 cleansers. Data were collected on non‐behavioural causes, behavioural causes and behavioural indicators associated with sexual rituals. Content analysis revealed five central themes: the effect of the ritual on sexual behaviours; factors contributing to the continued practice of the ritual, including a sub‐theme on the commercialization of the ritual; the inseparable relationship between the sanctity of sex, prosperity and fertility of the land; and the effects of modernization on the ritual, including a sub‐theme on the effects of mass media on HIV‐prevention awareness campaigns. Causal factors of unchanging sexual behaviours are deeply rooted in traditional beliefs, which the community uphold strongly. These beliefs encourage men and women to have multiple sexual partners in a context where the use of condoms is rejected and little HIV testing is carried out.