Investigating Reasons for High Patient Satisfaction Given Low Utilization of Health Care Services, Armenia, 2007: Qualitative Research

Abstract

Abstract Introduction: The quality of care from patient’s perspective is defined as patient/client satisfaction. Studies have revealed positive correlations between patient satisfaction and health care utilization: a more satisfied patient seeks health care more frequently. After declaring independence, the health care system in Armenia included poor physical conditions of facilities, outdated equipment, oversupply of workers, poor clinical skills, underutilized care, and inequalities between urban and rural resources. Data supports that utilization of health care services is low: 82% of people prefer self treatment; 57.0% of women have their first antenatal visit after four months of pregnancy in rural regions; in rural areas 16.0% of deliveries occur at home. Yet, satisfaction with health care services is high: 96.0% of interviewed women reported overall satisfaction with Maternal and Child Health (MCH) services; 91.0% and 95.5% of interviewers rated respectively nursing and physician care excellent or good. Data on patient satisfaction and utilization in Armenia do not support the accepted viewpoint that high satisfaction leads to high utilization. Methods: To investigate reasons for high satisfaction with MCH services given low utilization, a qualitative descriptive study was conducted in the marzes of Armavir, Ararat, Sisian, Aragatsotn and Vayk, Armenia. Data was collected via in-depth interviews. The target/study population was women who had had a delivery within the last 2 months in Sisian, Talin, Vedi, Armavir or Vayk Maternity. The sampling frame was the delivery registration books from these maternities. A semi-structured in-depth interview guide was developed in English, translated into Armenian, pre-tested, and revised accordingly. Two trained interviewers visited women at home and conducted 25 in-depth interviews. Detailed notes were taken during the interview and later transcribed in English. The transcripts were later coded by words, phrases and ideas, and analyzed by hand according to the following domains: health care seeking behavior, perception of quality and expectations from health care services, obstacles for reporting dissatisfaction, satisfaction with responsiveness of health care providers, satisfaction with the environment of health care facilities and satisfaction with technical competence of the providers. The research protocol was approved by the American University of Armenia’s Institutional Review Board. Results and discussion: Three key themes merged from the data: • Several reasons lead to reduced health seeking behavior: affordability and availability of the services, lack of trust towards providers and dissatisfaction with provided services, shortage of time and careless attitude of some people towards the concept of health. • Several factors hinder reporting dissatisfaction: sense of fear to be deprived of the services or conflicts with providers, close relationships in the community including with providers and lack of trust towards official bodies. • Quality perception and expectations from health care services are quite low. For the majority of respondents quality of the service is defined by (a) attitude of providers (b) environment of health facility, including renovation, availability of basic sanitary conditions, furniture and equipment. Some women directly reported that they recognize that the resources of marz facilities are limited and as a result they do not expect quality service. Recommendations: Based on the results of the study the following recommendations are made: • Conduct a similar study among women with even lower utilization of the services, for example, among women who deliver at home. v • Develop mechanisms and interventions that reduce informal payments for PHC and MCH services • Encourage providers to initiate counseling • Encourage providers to initiate postpartum care • Improve the access and availability of PCH and MCH services in rural communities