E-ISSN:2349-4166
P-ISSN:2349-4158

Research Article

Assessment

Public Health Review - International Journal of Public Health Research

2016 Volume 3 Number 2 March-April
Publisherwww.medresearch.in

Assessment of client satisfaction among HIV/AIDS patients attending selected ART centers of Indore and Ujjain division of MP

Rai S.1*, Yesikar V.2, Dixit S.3, Sharma S.4, Saroshe S.5, Patel J.6
DOI: https://doi.org/10.17511/ijphr.2016.i2.03

1* Shailesh Rai, Resident, Department of Community Medicine, M.G.M. Medical College, Indore, Madhya Pradesh, India.

2 Veena Yesikar, Associate Professor, Department of Community Medicine, M.G.M. Medical College, Indore, Madhya Pradesh, India.

3 Sanjay Dixit, Professor & Head, Department of Community Medicine, M.G.M. Medical College, Indore, Madhya Pradesh, India.

4 Shiv Shankar Sharma, Associate Professor, Department of General Medicine, M.G.M. Medical College, Indore, Madhya Pradesh, India.

5 Satish Saroshe, Assistant Professor, Department of Community Medicine, M.G.M. Medical College, Indore, Madhya Pradesh, India.

6 Jaya Patel, Medical Officer, MY Hospital, Indore, Madhya Pradesh, India.

Background: ART centers are the corner stone for providing care to HIV patient and it is very essential part of HIV/AIDS control programme in India. Objectives: To study the satisfaction level of Beneficiaries and Attendants of the Children receiving care at ART centers. Methodology: A cross-sectional study was conducted with the help of Pre-designed, Pre-tested, Semi-structured questionnaire for Beneficiaries and legal guardian of Children receiving care at ART centers to assess the satisfaction level for services, using Likert Scale and PSQ-18 during the period between 01 January 2015 – 31 October 2015 .Simple random sampling for selection of ART centers and Sequential sampling for the Beneficiaries and legal guardian of the Children receiving care at ART centers. A total of 110 patients were included in the study. Results: In study sites, satisfaction with behaviour of staff was highest, 92 % and only 5 % were dissatisfied, 90 % of clients were satisfied with infrastructure and facilities, 83.6% of clients were satisfied with communication and interpersonal manner, lowest satisfaction 45%was observed for ART side effects and tolerance. On basis of PSQ18 Questionnaire the mean score for General Satisfaction was 3.18 (SD 0.71), Technical Quality 2.89 (SD 0.84), Interpersonal Manner 3.08 (SD 0.81), Communication 3.00(SD 0.85), Financial Aspects was 2.67 (SD 0.91), Time Spent during the visit, 2.99 (SD 0.92), for Accessibility and Convenience 2.52 (SD 0.91). Conclusions: overall Satisfaction level of beneficiaries was good, although there were some places for improvement i.e. traveling, waiting area.

Keywords: HIV patient, AIDS, Satisfaction, ART, PSQ18, Likert Scale

Corresponding Author How to Cite this Article To Browse
Shailesh Rai, Resident, Department of Community Medicine, M.G.M. Medical College, Indore, Madhya Pradesh, India.
Email: 		Rai S, Yesikar V, Dixit S, Sharma SS, Saroshe S, Patel J. Assessment of client satisfaction among HIV/AIDS patients attending selected ART centers of Indore and Ujjain division of MP. Public Health Rev Int J Public Health Res. 2016;3(2):59-64.
Available From
https://publichealth.medresearch.in/index.php/ijphr/article/view/32

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2016-03-04 2016-03-14 2016-03-22 2016-04-01
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
No Nil Yes 7%

© 2016 by Shailesh Rai, Veena Yesikar, Sanjay Dixit, Shiv Shankar Sharma, Satish Saroshe, Jaya Patel and Published by Siddharth Health Research and Social Welfare Society. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

Public Health Review - International Journal of Public Health Research 2016;3(2)59
Rai S. et al: Assessment of client satisfaction among HIV/AIDS

Introduction

India has an estimated 2.39 million people living with HIV/AIDS. The free ART initiative under NACP II was launched on 1st April 2004 at eight institutions in six high prevalent states and the National Capital Territory of Delhi. Since then, it has been scaled up in a phased manner.

As on March 2012, a total of 355 ART centres are functional in 31 States and Union Territories and more than 5,16,000 patients are receiving antiretroviral treatment (ART) at these centres. In addition, another 25,000 – 30,000 patients are receiving free ART in the Private sector.

In order to expand the access to second line treatment, 25 ART centres in the country have been upgraded as "ART Plus" centres and capacitated to provide second line/alternative first line treatment to eligible PLHIV [1].

Current epidemic Scenario (2011) of HIV in India is adult prevalence (%) 0.27 (male 0.32, female 0.22), no. of People Living With HIV/AIDS (PLHA ) 20,88,638 , no. of Children Living With HIV/AIDS (CLHA) 145446, no. of new infection 116459, no. of AIDS related deaths 147729, no of ART centres 425, total no of PLHA on 1st line ART 726824 (cumulative) [2].

In Madhya Pradesh adult HIV prevalence(%) 0.09 (male 0.10, female 0.07), no of PLHA 40450, no of CLHA 3789,no of new infection 2387, no of Acquired Immune Deficiency Syndrome (AIDS) related deaths 3325, no of ART centres 15, total no of PLHA on 1st line ART (cumulative) 10458, no of PLHA registered 2580 [3].

Second Line ART was rolled out in the country on 1st January 2008 on a pilot basis in 2 centres of Excellence and later on expanded to all 10 Centres of Excellence. In order to expand the access to second line treatment, 25 ART centres in the country have been upgraded as "ART Plus" centres and capacitated to provide second line/alternative first line treatment to eligible PLHIV. Currently nearly 5000 PLHIV are receiving free second Line ART/ alternative first line ART and this scheme is being expanded in a need based manner [2].

Figure 1: - Distribution of PLHIV in Select States, 2015 [4]

public_32_01.jpg

Material and Methods

Cross-sectional study was conducted in selected ART centres of Indore and Ujjain administrative division on Madhya Pradesh. In present study, ART centres running in Medical Colleges i.e. M.G.M. Medical College Indore & R.D. Gardi Medical College Ujjain And randomly selected two ART centres (District Hospital) from the Administrative Divisions of Indore and Ujjain of M.P. State ART centre Khandwa (Indore Division) & ART centre Mandsaur (Ujjain Division) were the study sites.

Simple random sampling for selection of ART centres from the Administrative Divisions of Indore and Ujjain of M.P. State. The Beneficiaries and legal guardian of the Children receiving care at ART centres present on the day of study (visit) were interviewed using Sequential sampling. Adults, children aged 11-18 yr and legal guardian of children (aged 10 yr and below) who are receiving care for at least last six months from the ART centre, who have documented evidence of registration with ART centre and gave written informed consent for participation in study were included in the study.

Written informed consent was obtained from the study subjects and legal guardians of the CLHIV. Data was collected with the help of Pre-designed, Pre-tested, Semi-structured questionnaire was used for Beneficiaries and legal guardian of Children receiving care at ART centres so as to assess the satisfaction level of services from ART centres (Client Satisfaction) using likert scale[2] and PSQ 18 (Patient Satisfaction Questionnaire) [5] maintaining required confidentiality.

Study period was from January 2015 to October 2015. The data collected were analyzed through Likert scale PSQ-18 (Patient Satisfaction Questionnaire) and were presented in table formats, pie charts and histograms which were obtained using Excel and some using SPSS (Statistical Package for Social Science).

Public Health Review - International Journal of Public Health Research 2016;3(2)60
Rai S. et al: Assessment of client satisfaction among HIV/AIDS

Kruskal-Wallis Test was applied and p value was calculated where ever required & considered significant when it is < 0.05.

Results

Assessment of Client (Beneficiary) Satisfaction: With the help of a pre designed questionnaire and PSQ 18, the client satisfaction was assessed, in which 110 participants were included.

Table 1:

A. Satisfaction for ART Centre Infrastructure and Facilities
  Indore (n=40) Khandwa (n=10) Ujjain (n=40) Mandsaur (n=20) Total (n=110)
Satisfy 37(92.5%) 8(80%) 35(87.5%) 19(95%) 99(90%)
Neutral 1 1 2 0 4
Dissatisfy 2(5%) 1(10%) 3(7.5%) 1(5%) 7(6.36%)
B. Satisfaction for Behaviour of Staff
Satisfy 38(95%) 9(90%) 37(92.5%) 17(85%) 101(91.8%)
Neutral 0 1 1 1 3
Dissatisfy 2(5%) 0 2(5%) 2(10%) 6(5%)
C. Satisfaction for Communication and Interpersonal Manner
Satisfy 35(87.5%) 9(90%) 33(82.5%) 15(75%) 92(83.6%)
Neutral 1 0 1 2 4
Dissatisfy 4(10%) 1(10%) 6(15%) 3(15%) 14(12.7%)
D. Satisfaction for ART Side Effects and Tolerance
Satisfy 15(37.5%) 6(60%) 17(42.5%) 12(60%) 50(45.4%)
Neutral 3 1 2 2 8
Dissatisfy 22(55%) 3(30%) 21(52.5%) 6(30%) 52(47.2%)

For infrastructure and facilities provided by ART centres, 90 % of clients were satisfied and only 6% were dissatisfied (p value= 0.555).

Satisfaction with behaviour of staff was highest of about 92 % and only 5 % were dissatisfied. (p value= 0.624)

83.6% of clients were satisfied with communication and interpersonal manner in ART centres and 12.7% were dissatisfied. (p value = 0.652)

Around 45% beneficiaries were satisfied with the ART side effects and 47% were dissatisfied. (p value = 0.204)

Table 2:-Statistics for PSQ-18 Subscales and Constituents Items

S. N. PSQ-18 Subscales and Constituents Items MEAN SD
General Satisfaction (MEAN =3.18, SD=0.71)
1. The medical care I have been receiving is just about perfect 3.65 0.62
2. I am dissatisfied with some things about the medical care I receive 2.72 0.85
Technical Quality(MEAN=2.89, SD=0.84)
3. I think my doctor’s office has everything needed to provide complete medical care 3.61 0.64
4. Sometimes doctors make me wonder if their diagnosis is correct 2.02 0.68
5. When I go for medical care, they are careful to check everything when treating and examining me 3.50 0.72
6. I have some doubts about the ability of the doctors who treat me 2.45 0.65
Interpersonal Manner(MEAN=3.08,SD=0.81)
7. Doctors act too businesslike and impersonal towards me 2.15 0.74
8. My doctors treat me in a very friendly and courteous manner 4.02 0.35
Communication(MEAN=3.00, SD=0.85)
9. Doctors are good about explaining the reason for medical tests. 3.02 0.78
10. Doctors sometimes ignore what I tell them 2.97 0.69
Financial Aspects(MEAN=2.67, SD=0.91)
11. I feel confident that I can get the medical care I need without being set back financially 3.15 0.79
12. I have to pay for more of my medical care than I can afford 2.19 0.67
Time Spent with Doctor(MEAN=2.99, SD=0.92)
13. Those who provide my medical care sometimes hurry too much when they treat me 2.10 0.85
14. Doctors usually spend plenty of time with me 3.87 0.87
Accessibility and Convenience(MEAN=2.52, SD=0.91)
15. I have easy access to the medical specialists I need 2.91 0.89
16. Where I get medical care, people have to wait too long for emergency treatment 2.01 0.79
17. I find it hard to get an appointment for medical care right away 2.21 0.75
18. I am able to get medical care whenever I need it 3.68 0.68

Public Health Review - International Journal of Public Health Research 2016;3(2)61
Rai S. et al: Assessment of client satisfaction among HIV/AIDS

A total of 110 patients attending ART center were included in the study. The mean score for General Satisfaction was 3.18 (SD 0.71), for Technical Quality 2.89 (SD 0.84), for the Interpersonal Manner 3.08 (SD 0.81), for Communication 3.00(SD 0.85), for Financial Aspects was 2.67 (SD 0.91) and for Time Spent during the visit, the mean score was 2.99 (SD 0.92). The mean score for Accessibility and Convenience was found to be 2.52 (SD 0.91).

Results indicated that satisfaction levels were highest for General Satisfaction (mean score = 3.18) followed by Interpersonal Manner (mean score = 3.08) and lowest for Accessibility and Convenience (mean score = 2.52) and Financial Aspects (mean score = 2.67).

Table 3: - Scoring for client satisfaction based on PSQ 18

S.N. PSQ-18 SUBSCALES Obtained Score Maximum score %
1. General Satisfaction 6.37 10 63.7
2. Technical Quality 11.58 20 57.9
3. Interpersonal Manner 6.17 10 61.7
4. Communication 5.99 10 59.9
5. Financial Aspects 5.34 10 53.4
6. Time Spent with Doctor 5.97 10 59.7
7. Accessibility and Convenience 10.81 20 54.05

Level of satisfaction for General Satisfaction was 63.7%, Technical Quality 57.9%, Interpersonal Manner 61.7%, Communication 59.9%, Financial Aspects 53.4%, Time Spent with Doctor 59.7% and Accessibility and Convenience 54.05%.

Figure-2: - PSQ 18 subscale score, Doughnut Chart

public_32_02.jpg

Pre designed questionnaire based on Likert scale was used and findings based on that were, as follows:

Satisfaction with behaviour of staff was highest of about 92 % and only 5 % were dissatisfied.

90 % of clients were satisfied with infrastructure and facilities provided by ART centres and only 6% were dissatisfied. 83.6% of clients were satisfied with communication and interpersonal manner in ART centres and only 12.7% were dissatisfied. The lowest satisfaction was observed for ART side effects and tolerance which was 45%.

The satisfaction level was much better in comparison to the draft report on Independent evaluation of NACP by A Consortium of John Hopkins University, USA, Indian Institute of Health Management Research, Jaipur & Indian Institute of Management Calcutta6, in which the client satisfaction with ART services were as follows Satisfaction for Facilities available was 30.9%, for Information given by provider was 93.4%, for Communication (time spent and behaviour) was 85.5%, for Confidentiality maintained by provider was 58.3%, For Treatment was 70.4% and for Reception by the medical staff was 70.9%.

In the present study client satisfaction was also assessed on the basis of PSQ18 Questionnaire. The findings of PSQ18 survey were: a total of 110 patients attending ART centre were included in the study. The mean score for General Satisfaction was 3.18 (SD 0.71), for Technical Quality 2.89 (SD 0.84), for the Interpersonal Manner 3.08 (SD 0.81), for Communication 3.00(SD 0.85), for Financial Aspects it was 2.67 (SD 0.91) and for Time Spent during the visit, the mean score was 2.99 (SD 0.92). The mean score for Accessibility and Convenience was found to be 2.52 (SD 0.91).

These results were similar with the study conducted by Vishav Chander et al [7] in a antiretroviral therapy center at Zonal Hospital, Hamirpur, Results indicated that satisfaction levels were highest for interpersonal relations (mean score = 3.25) followed by general satisfaction (mean score = 3.22) and lowest for financial aspects (mean score = 2.38) and accessibility and convenience (mean score = 2.59). A study from Ethiopia to know the reasons for HIV/AIDS patients satisfaction with pharmacy revealed that 82.5% of HIV/AIDS patients indicated long waiting period as a major reason for their dissatisfaction; 93.33% of the respondents preferred to get their pharmacy service within a shorter span, 18.02% wanted a comfortable waiting hall, 14.32% expected staff’s politeness, 5.18% insisted for sufficient number of ART units, 8.88% wanted adequate supply of ART drugs, and 21.48% wanted cleanliness [8].

Public Health Review - International Journal of Public Health Research 2016;3(2)62
Rai S. et al: Assessment of client satisfaction among HIV/AIDS

In a study conducted in New York on 29 (30%) clients of Gay Men's Health Crisis (GMHC), satisfaction was “mentioned in connection with one or more major sources: convenience, positive relationship with physician, and limited out of pocket expenses.” [9].

In contrast, dissatisfaction was found to be associated with both global and specific situations. There was general dissatisfaction with the “limited and inefficient HIV/AIDS services”, the lack of knowledge about HIV/AIDS and the lack of compassion for and prejudice against people with HIV/AIDS.

A study was conducted among 85 clients attending a specialized NHS care clinic in London, England, to assess the health and social needs & views and opinions on services of HIV/AIDS care consumers and to compare these to responses among providers of HIV/AIDS care. The authors concluded that when compared with the lack of attention and services to their social needs, HIV/AIDS patients were generally satisfied with the services dedicated to their health needs [10].

It was observed in present study that, for financial aspect based on PSQ 18 mean score was 2.67 (SD 0.91) which was low. One of the reasons for low satisfaction level was the transportation charges as the patients came from distant places.

In present study beneficiaries of ART centres did not get the transport reimbursement as compared with other states like Delhi, Gujarat, Tamil Nadu and Karnataka where the reimbursement of travel charges will be provided based on the details that are already provided in the ART register. [11] In Madhya Pradesh no such system exists which shows the discrepancies in policy making.

Conclusion

Overall Satisfaction level of beneficiaries (client ) was good in present study although there were some places for improvement like Patients from villages and distant places have to travel long distances as the most of the centres were in the cities/ district place, waiting area , provision of traveling expenditure reimbursement.

Reference

  1. National AIDS Control Programme Phase-IV. 2012-2017 strategy document.
  1. National AIDS Control Programme Operational Guidelines for Art Services July 2012.
  2. STATE FACT SHEETS. India’s voice against AIDS Department of AIDS Control Ministry of Health & Family Welfare. Government of India. March 2014. Available from:
  3. India HIV Estimations 2015. TECHNICAL REPORT National AIDS Control Organisation India’s voice against AIDS Ministry of Health & Family Welfare Government of India. National Institute of Medical Statistics Indian Council of Medical Research (Department of Health Research) Ministry of Health & Family Welfare Government of India.
  4. Patient Satisfaction Questionnaire.
  5. Draft Report on Independent Evaluation of NACP. A Consortium of John Hopkins University, USA, Indian Institute of Health Management Research. Jaipur Indian Institute of Management Calcutta Submitted to National AIDS Control Organization Ministry of Health and Family Welfare Government of India New Delhi. 2007.
  6. Chander V, Bhardwaj AK, Raina SK, Bansal P, Agnihotri RK. Scoring the medical outcomes among HIV/ AIDS patients attending antiretroviral therapy center at Zonal Hospital, Hamirpur, using Patient Satisfaction Questionnaire (PSQ-18). Indian J Sex Transm Dis. 2011;32(1)19–22.
  7. Karunamoorthi K, Rajalakshmi M, Babu SM, Yohannes A. HIV/AIDS patient's satisfactory and their expectations with pharmacy service at specialist antiretroviral therapy (ART) units. Eur Rev Med Pharmacol Sci. 2009;13;331–9.
  8. Halkitis PN, Dooha SM. The Perceptions and Experiences of Managed Care by HIV-Positive Individuals in New York City. AIDS Public Policy J. 1998;13;75–84.

Public Health Review - International Journal of Public Health Research 2016;3(2)63
Rai S. et al: Assessment of client satisfaction among HIV/AIDS
  1. Beedham H, Wilson-Barnett J. HIV and AIDS care- consumers' views on needs and services. J Adv Nurs. 1995;22(4)677-86.
  1. dna News. People with HIV to be transported free for treatment. IST-dna. Jan 2013.

Public Health Review - International Journal of Public Health Research 2016;3(2)64