Academic journal article Bulletin of the World Health Organization

Patients' Perception and Satisfaction with Health Care Professionals at Primary Care Facilities in Trinidad and Tobago

Academic journal article Bulletin of the World Health Organization

Patients' Perception and Satisfaction with Health Care Professionals at Primary Care Facilities in Trinidad and Tobago

Article excerpt

Voir page 359 le resume en francais. En la pagina 359 figura un resumen en espanol.

In Trinidad and Tobago, primary care services are provided by 101 health centres funded by the state. In 1994 the health services were decentralized to create five regional health authorities. Since then there has been a shift in emphasis towards the provision of primary care of high quality, including preventive services. A substantial improvement in the delivery of primary care is required, together with increased community participation.

Clearly, feedback from patients is vital if deficiencies are to be identified and improvements achieved. In many developing countries, primary care services are fully financed by the state, and the people who use them are mostly the poor, elderly, uneducated and unemployed. These people have the greatest difficulty in evaluating what is provided because, as a rule, they have no basis for comparison. Consumers make judgements about quality by assessing factors they can appraise, such as courtesy, responsiveness, attentiveness and perceived competence.

Information and opinions were sought from people using health centre services concerning usage, efficiency, and ways of improving the running of the facilities. Data were obtained in a survey of 1451 users throughout Trinidad and Tobago. A significant proportion of the participants were illiterate, so self-administered questionnaires were not appropriate, and trained personnel therefore conducted interviews on regular clinic days. The research instrument consisted of sections on:

* personal details, e.g. age, sex, education, ethnicity, occupation and religion;

* assessment of doctors;

* assessment of nurses;

* assessment of pharmacists.

A sample of health centres was selected to represent the major areas in each county. A sample of adult patients was chosen from each of the selected centres, its size reflecting the population in the area concerned. These patients were selected in hypertension, diabetes, heart disease and antenatal clinics. Arrangements were made in advance with the administrators, and questions were put to the patients as they awaited their consultations.

Personal details

In this matter, 8.6% of the interviewees were in full-time employment; 11.0% were in part-time employment and 80.4% were unemployed.

Of the respondents, 24.1% were male and 75.9% were female.

The proportions of respondents aged under 20, 21-30, 31-40, 41-50, 51-60 and over 60 years were 9.5%, 18.9%, 17.2%, 15.3%, 13.7%, and 25.4% respectively.

Through an open-ended question the occupational status of the main wage-earner in the family of each interviewee was determined: 0.6% were classified as professionals, 5.4% as middle professionals, 13.2% as having lower non-manual jobs, 16.4% as skilled manual workers, 15.6% as unskilled manual workers, and 48.8% as "other". The latter category included retired persons, housewives, unemployed people and individuals whose occupational status was not known.

Some primary education was claimed by 31.8% of the respondents, and 24.1% said they had completed their primary education; 10.7% had received some secondary education and 21.8% had completed their secondary education; 1.4% had undergone some university education and 0.4% had completed a university education; 9.8% were categorized as "other" with regard to education.

Regarding ethnicity, 40.8% were African, 40.8% were Indian, 0.3% were Oriental, 15.6% were of mixed background and 2.5% had other ethnic backgrounds.

Assessment of doctors

Courtesy and consideration

Satisfaction with the courtesy and consideration shown by doctors was expressed by 75% of the interviewees. The level of satisfaction increased with the age of the patients (Table 1).

Table 1. Degree of satisfaction with courtesy and consideration shown by doctors

Degree of satisfaction      Ages of patients (years)
                         <20     21-30   31-40   41-50

Satisfied (%)             69. … 
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