Sudhakar Morankar

Determinants of satisfaction with health care provider interactions at health centres in central Ethiopia: a cross sectional study.

BackgroundIn primary health care, provider-patient interaction is fundamental platform and critically affects service delivery. Nevertheless, it is often ignored in medical research and practice and it is infrequently subjected to scientific inquiry, particularly in Ethiopia. This study aimed to assess patient satisfaction with health care provider interactions and its influencing factors among out-patients at health centers in West Shoa, Central Ethiopia.MethodsA cross sectional facility based study was conducted on 768 out-patients of six health centers in West Shoa Zone, Central Ethiopia. The total sample size was allocated to each of the six health centers based on patient flow during the ten days prior to the start of data collection. Pre-tested instruments were used for data collection and the data were analyzed using SPSS version 16.0 statistical software. Factor score was computed for the items identified to represent the satisfaction scale by varimax rotation method. Using this regression factor score, multivariate linear regression analysis was performed and the effect of independent variables on the regression factor score was quantified.ResultsSeventy three percent of the respondents perceived that providers empathy was good and 35% complained that providers were not technically competent enough. In addition, 82% of the respondents rated non-verbal communication by the providers to be good, very good or excellent on a five-point ordinal scale. Regardless of the process, only 34.1% of the patients implied that the consultations made a difference in understanding their illness and coping with it. Generally speaking, 62.6% of the patients reported that they have been satisfied with their visit. Perceived empathy, perceived technical competency, non-verbal communication, patient enablement, being told the name of once illness, type and frequency of visit, knowing the providers and educational status were main independent predictors of patient satisfaction in this study. Furthermore, very good empathy (Beta = -4.323), fair non-verbal communication (Beta = -0.188), fewer expectations met (Beta = -0.169) and disagreement to technical competency (Beta = -0.156) had greater negative influence on patient satisfaction. On the other hand, excellent non-verbal communication (Beta = 0.114) and being told the name of once illness (0.109) had pronounced positive influence on patient satisfaction.ConclusionThe present study showed that interpersonal processes including perceived empathy, perceived technical competency, non-verbal communication and patient enablement significantly influence patient satisfaction. Therefore, health care providers should work towards improving the communication skill of their professionals along with having technically competent workers which could possibly affect the perception of the patient about all of the variables identified as independent predictors of patient satisfaction in this study.

Predictors of perceived empathy among patients visiting primary health-care centers in central Ethiopia

BACKGROUND Empathy is crucial to the achievement of patient centeredness consultations. However, it has not been frequently studied particularly in resource-limited settings. OBJECTIVE To identify predictors of patient reports indicating greater empathy among providers during patient visit to primary health-care facilities. PARTICIPANTS A cross-sectional study was conducted to assess the level of satisfaction among 768 out-patients, who consecutively visited six health centers in central Ethiopia. Patients were recruited from health centers under study based on proportional to size allocation. Multiple linear regression was used to assess the relationship between empathy scores and other patient factors. RESULTS The mean perceived empathy score was 31.34 ± 8.37 (range of possible values: 10-50). Patient-related factors that were negatively associated with perceived empathy were Tigre and Guraghe ethnicity [β = -4.45; 95% confidence interval (CI) = -6.86 to -2.03], Wakefena religion (β = -2.09; 95% CI = -3.82 to -0.35), lack of privacy during consultation (β = -1.62; 95% CI = -2.57 to -0.68), involvement of family in consultation (β = -1.45; 95% CI = -2.17 to -0.12) and not revealing ones own private issues (β = -1.25; 95% CI = -2.17 to -0.33). Positive associations with provider empathy scores were found for those who reported knowing their provider (β = 2.42; 95 CI = 1.70 to 4.13), non-verbal communication (β = 0.88; 95% CI = 0.80 to 0.96) and perceived technical competency (β = 0.12; 95% CI = 0.05 to 0.19). CONCLUSIONS Perceived empathy in this study was lower than the findings reported in earlier studies. Health-care providers committed to the delivery of patient-centered care should take note of the determinants of better empathy as perceived by their clients.

Determinants of patient enablement at primary health care centres in central Ethiopia: a cross-sectional study

Abstract Background Patient enablement is associated with behaviours like treatment adherence and self-care and is becoming a well-accepted indicator of quality of care. However, the concept of patient enablement has never been subjected to scientific inquiry in Ethiopia. Objectives The aim of this study was to determine the degree of patient enablement and its predictors after consultation at primary health care centres in central Ethiopia. Method Data were collected from 768 outpatients from six primary health care centres in central Ethiopia during a cross-sectional study designed to assess patient satisfaction. Consecutive patients, 15 years or older, were selected for the study from each health centre. Multinomial logistic regression was performed to identify predictors of patient enablement using SPSS (version 16.0). Results The study showed that 48.4% of patients expressed an intermediate level of enablement, while 25.4% and 26.2% of the patients expressed low and high levels of patient enablement, respectively. Four models were developed to identify predictors of patient enablement. The first model included socio-demographic variables, showing that residence, educational status and occupational status were significantly associated with patient enablement (p < 0.05). This model explained only 20.5% of the variation. The second and third models included institutional aspects, and perceived doctor–patient interaction and information sharing about illness, respectively. They explained 31.1% and 64.9% of the variation. The fourth model included variables that were significantly associated with patient enablement in the first, second and third models and explained 72% of the variation. In this model, perceived empathy and technical competency, non-verbal communication, familiarity with the provider, information sharing about illness and arrangement for follow-up visits were strong predictors of patient enablement (p < 0.05). Conclusion The present study revealed specific predictors of patient enablement, which health care providers should consider in their practice to enhance patient enablement after consultation.

Modeling the probability of giving birth at health institutions among pregnant women attending antenatal care in West Shewa Zone, Oromia, Ethiopia: A cross sectional study

BACKGROUND Although ante natal care and institutional delivery is effective means for reducing maternal morbidity and mortality, the probability of giving birth at health institutions among ante natal care attendants has not been modeled in Ethiopia. Therefore, the objective of this study was to model predictors of giving birth at health institutions among expectant mothers following antenatal care. METHODS Facility based cross sectional study design was conducted among 322 consecutively selected mothers who were following ante natal care in two districts of West Shewa Zone, Oromia Regional State, Ethiopia. Participants were proportionally recruited from six health institutions. The data were analyzed using SPSS version 17.0. Multivariable logistic regression was employed to develop the prediction model. RESULTS The final regression model had good discrimination power (89.2%), optimum sensitivity (89.0%) and specificity (80.0%) to predict the probability of giving birth at health institutions. Accordingly, self efficacy (beta=0.41), perceived barrier (beta=-0.31) and perceived susceptibility (beta=0.29) were significantly predicted the probability of giving birth at health institutions. CONCLUSION The present study showed that logistic regression model has predicted the probability of giving birth at health institutions and identified significant predictors which health care providers should take into account in promotion of institutional delivery.

Perceptions and experiences related to health and health inequality among rural communities in Jimma Zone, Ethiopia: a rapid qualitative assessment

BackgroundThe Safe Motherhood Research Project studies the implementation and scale-up of maternal, newborn and child health (MNCH) initiatives in Jimma Zone, Ethiopia. This qualitative rapid assessment study was undertaken to explore community perceptions and experiences related to health, health inequality and other MNCH themes.MethodsWe conducted 12 focus group discussions and 24 in-depth interviews with community stakeholder groups (female and male community members, Health Extension Workers, members of the Women Development Army and Male Development Army, and religious leaders) across six rural sites in Jimma Zone. Data were analyzed through thematic coding and the preparation of content summaries by theme.ResultsParticipants described being healthy as being disease free, being able to perform daily activities and being able to pursue broad aspirations. Health inequalities were viewed as community issues, primarily emanating from a lack of knowledge or social exclusion. Poverty was raised as a possible contributor to poor health, however, participants felt this could be overcome through community-level responses. Participants described formal and informal mechanisms for supporting the disadvantaged, which served as a type of safety net, providing information as well as emotional, financial and social support.ConclusionsUnderstanding community perceptions of health and health inequality can serve as an evidence base for community-level initiatives, including MNCH promotion. The findings of this study enable the development of audience-centered MNCH promotion activities that closely align with community priorities and experiences. This research demonstrates the application of rapid qualitative assessment methods to explore the context for MNCH promotion activities.

Effect of mHealth in improving antenatal care utilization and skilled birth attendance in low- and middle-income countries: a systematic review protocol

REVIEW QUESTION/OBJECTIVE The objective of this review is to identify and synthesize the best available evidence on the effect of mobile health (mHealth) interventions in antenatal care utilization and skilled birth attendance in low- and middle-income countries.More specifically, the review questions are as follows.

Coverage of child health services in rural districts of Ethiopia with the health services extension program

Improving access to health care services has been advocated widely since the Declaration of Alma-Ata. Despite the efforts to realize this in Ethiopia it is only in the year 2003 that the intention to take the package of essential health services to the kebele level (smallest administrative unit) was realized through the introduction of the Health Services Extension Program (HSEP). The objective of this study was to explore whether introduction of HSEP has improved the coverage of child health services in the rural areas of Jimma Zone. A cross sectional study was conducted in three randomly selected districts of Jimma Zone Southwest Ethiopia. The data collection was undertaken during the months of May June and July 2009. A structured questionnaire was used to interview female heads of sampled households from nine kebeles randomly selected in three Woredas (districts). Data were collected on the socio-demographic characteristics use of health posts child vaccination and childhood diarrhea. Checklists were used for record review. Data obtained were analysed using statistical package for social sciences (SPSS) V14. Only 64.0% of the kebeles had functional health posts although another 32.0% of the kebeles in the zone had health posts under construction. However most (93.7%) of the kebeles in the zone already had two health extension workers (HEWs) assigned. Vaccination coverage as measured by DPT3 was 67.9% and 10% of the under-two year old children included in this survey had diarrhoea during the past two weeks. Of the 34 (51.5%) mothers who sought help during diarrhoeal attacks 12 (35.3%) of them went to the health post. The first places of treatment seeking were health centres and health posts with equal proportion for both (43.5%). Treatment was sought within a day or two after commencement of diarrhoea for 70.6% of the children. Thirty nine (69.7%) of the 56 children who were given recommended fluids received oral rehydration solution (ORS) or homemade solution. In addition to continuing efforts to improve coverage there is a need to ensure that activities are linked with follow up of vaccination early treatment seeking and proper home management of diarrhoea.

Efficacy of narrative exposure therapy in the treatment of children and adolescent patients with posttraumatic stress disorder: a systematic review protocol

Review question/objective The objective of this review is to identify the efficacy of narrative exposure therapy in the treatment of children and adolescent patients with posttraumatic stress disorder. Background The most prominent disorder related to traumatic experiences is posttraumatic stress disorder (PTSD) that has specific symptoms which occur in response to trauma exposure as determined by the Diagnostic Staticall Manual (DSM). Among individuals exposed to trauma, approximately 25% to 30% develop PTSD with the rate of the disorder depending on the experience of trauma.1 PTSD is often caused by traumatic events like sexual abuse, physical maltreatment, car accidents, criminal attacks, bombings, rape or torture.2 It has been estimated that most Americans (81.7%) will be exposed to a trauma during their lifetime3 and 6.8% will meet criteria for PTSD at some point in their lives.4 Epidemiologic community surveys in war‐torn areas found PTSD point prevalence rates between 15% and 50% among different refugee populations.5 Studies have suggested functional impairment occurs in traumatized children including problems with cognitive and school performance. A survey on trauma‐related impairment in children in Sri Lanka showed that 25% of the severe trauma experienced children met the criteria for a diagnosis of PTSD. The traumatized children reported problems with their daily life such as problems in school performance, social withdrawal, depressive symptoms and poor physical health.6 Randomized controlled treatment trials have revealed that trauma‐focused treatments can effectively ease symptoms in patients who suffer from PTSD.2,7 Narrative exposure therapy (NET) was recently developed as a standardized, short‐term treatment that focuses exclusively on the reconstruction of episodic trauma memory through a detailed and emotional narration of the biography, with particular emphasis on the traumatic events and a focus on achieving habituation to the emotional responses at the end. Therefore, this treatment can potentially preclude a mixture of therapeutic methods such as the application of both psychotherapy and pharmacotherapy in a single patient. University of Konstanz, Germany studied the efficacy of NET as evaluated in a randomized controlled trial in Sudanese refugees living in a Ugandan refugee settlement who were diagnosed as suffering from PTSD. The results indicated that NET is an approach that shows potential for the treatment of PTSD in refugees living in unsafe conditions.8 Instead of asking the patient to define a single event, which is difficult in repeated and multiple traumas, asking the patient to construct a narrative of their whole life with therapist assistance is encouraging.9 Thus, this idea indicates NET is better in assessing many traumatic life events in a patients life in a more timely and organized way than other psychotherapies. Since PTSD is a problem, there is no clear first choice treatment for the problem. Several randomized controlled trials have showed the efficacy of NET; however there is no existing evidence based review on this topic so this review will be important.