Int
ern
at
i
onal
Journ
al of
P
u
bli
c Hea
lt
h S
c
ie
nce (IJPH
S)
Vo
l.
8
, No
.
4,
Dec
2019
, p
p.
4
0
6
~4
1
2
IS
S
N: 22
52
-
8806,
DOI: 10
.11
591/ij
phs.
v8
i
4.203
75
406
Journ
al
home
page
: htt
ps://
ww
w.i
aesco
re
.c
om
/j
our
nals/
ind
ex.
php/IJP
H
S
P
atient s
atisfa
ction and
associa
ted
factors
with ser
vices
provided
at outpati
ent dep
artments
Der
eje Mesfin, Tad
i
w
os G
inta
mo
Depa
rtment
o
f
P
ubli
c
Hea
l
th, Wolkit
e
Univer
si
t
y
Coll
ege
o
f
m
edicine a
nd
health
scie
n
ce
s,
Et
h
iopia
Art
ic
le
In
f
o
ABSTR
A
CT
Art
ic
le
history:
Re
cei
ved
Oct
22
, 201
9
Re
vised
N
ov
2
0
, 2
01
9
Accepte
d
Nov 27
, 201
9
As
king
pat
ie
n
ts
what
they
thi
nk
how
they
fe
el
a
bout
the
h
ealth
servic
e
t
h
e
y
have
r
ec
e
ive
d
is
an
important
ste
p
towar
ds
improving
the
qualit
y
of
ca
r
e
and
,
ensuring
that
lo
c
al
he
alth
servi
ces
are
m
eeting cl
i
ent
s ne
eds
and
e
xpec
t
at
ions
.
Faci
lit
y
-
b
ase
d
c
ross
-
sec
ti
onal
st
ud
y
w
as
condu
c
te
d
from
Apri
l
1
-
7,
2019
in
ran
dom
l
y
se
lect
ed
primar
y
hosp
it
al
s
found
in
G
ura
ghe
zone.
Th
ere
wer
e
266
ran
dom
l
y
sel
ecte
d
patient
s
w
ho
at
te
nd
ed
th
e
primar
y
hos
pit
al
s
were
par
ticipated
i
n
the
study
.
Da
ta
was
col
lecte
d
using
a
int
erv
i
ewe
r
-
administe
r
ed
struc
tu
red
quest
ionna
ir
e
and
an
aly
z
ed
using
SP
SS
ver
sion
21.
Mult
ipl
e
logi
st
ic
reg
r
ession
ana
l
y
s
is
used
to
ide
nti
f
y
p
red
ictors
of
pat
i
ent
sati
sf
ac
t
i
on.
The
ov
era
l
l
of
pat
ie
n
t
sati
sf
ac
t
ion
le
v
el
wit
h
the
health
servic
e
prov
ide
d
at
the
out
p
atien
t
depa
rtmen
ts
of
the
primar
y
ho
spita
ls
was
66.
5%
(95%
C.
I.
60.
8%
-
72.
2%).
wai
ting
ti
m
e
(AO
R
3.
65),
informing
pat
i
e
nts
about
c
ause
of
il
ln
ess
(AO
R,
2.
46)
and
wait
ing
area
cl
e
anl
in
ess
(AO
R
2.
33)
wer
e
a
m
ong
the
signif
ic
an
t
pre
d
ic
tors
of
patient
s
sati
sfa
c
ti
on.
Ack
nowledgi
ng
th
e
l
imita
ti
on
of
th
e cross
-
sec
ti
ona
l
s
tud
y
design
findi
ngs
of
thi
s
stud
y
indicate
th
at
wait
ing
t
ime,
te
lling
the
ca
use
of
il
lne
ss
,
cl
e
anl
in
ess of
th
e
wai
ti
ng
area ar
e
importan
t
pr
ed
ic
tors
of
pa
ti
en
t s
at
isfaction.
Ke
yw
or
d
s
:
Healt
h
se
rv
ic
e
Pati
ent sati
sfac
ti
on
Pr
im
ary ho
s
pital
Copyright
©
201
9
Instit
ut
e
o
f Ad
vanc
ed
Engi
n
ee
r
ing
and
S
cienc
e
.
Al
l
rights re
serv
ed
.
Corres
pond
in
g
Aut
h
or
:
Der
e
j
e Me
s
fin
,
Dep
a
rtm
ent o
f Pu
blic Heal
th
,
Wo
l
kite U
niv
e
rsity
Colle
ge o
f
M
edici
ne
and
H
eal
th
S
ci
enc
es,
Et
h
i
op
ia
Em
a
il
:
du
kess
on12
@g
m
ai
l.com
1.
INTROD
U
CTION
Pati
ent
sat
isfact
ion
is
an
i
m
po
rtant
an
d
desire
d
outc
om
e
of
healt
hcar
e
delive
ry,
an
d
it
can
sign
ific
a
ntly
aff
ect
patie
nt
outc
om
es
because
it
determ
ines
long
-
te
rm
retenti
on
of
th
e
patie
nts
a
nd
their
adh
e
re
nce
to
treatm
ent
reg
i
m
ens
[
1]
.
Ask
i
ng
patie
nts
w
hat
they
think
an
d
how
they
feel
about
healt
h
se
rv
ic
e
they
received
from
their
give
n
pro
vid
e
rs
a
nd
a
bout
the
way
it
was
delivered
it
is
an
i
m
po
rtant
asp
ect
fo
r
i
m
pr
ovin
g
the
qu
al
it
y
of
ca
re,
a
nd
t
o
ens
ur
e
t
hat
healt
h
ser
vices
pro
vid
e
d
local
ly
are
m
eeting
pa
ti
ents
needs
[
2]
.
Dif
f
eren
t
resea
rc
h
fin
dings
sho
we
d
that
that
patie
nts
sat
isfie
d
with
the
healt
h
serv
ic
e
pr
ov
i
de
d
are
m
or
e
li
kely
to
keep
util
iz
ing
healt
h
ser
vices
prov
i
ded
by
a
giv
e
n
healt
h
f
aci
li
ty
,
co
m
ply
with
treat
m
en
t
and
reco
m
m
end
at
ion
of
the
serv
ic
e
pro
vid
er
,
an
d
c
onti
nu
e
with
the
healt
h
care
prov
i
der
s
[
3]
.
Unde
rstan
ding
patie
nt’s
le
vel
of
sat
isfact
io
n
with
the
care
pro
vid
e
d
by
a
giv
e
n
healt
h
or
gan
iz
at
io
n
is
fi
rst
an
d
forem
os
t,
essenti
al
fo
r
im
pr
ov
i
ng
t
he
qua
li
ty
of
healt
h
serv
ic
e
del
iver
y
since
it
ind
ic
at
es
the
pro
vi
der
’
s
su
ccess
at
fu
l
f
il
li
ng
the
m
os
t
i
m
po
rtant
ex
pe
ct
at
ion
s
of
a
giv
e
n
patie
nt
[4
-
5]
.
Me
asu
rin
g
healt
hca
re
qual
it
y
and
im
pr
ovin
g
patie
nt
sat
isfac
ti
on
ha
ve
becom
e
increasing
l
y
i
m
po
rtant
am
ong
healt
hcar
e
pro
vid
er
s
an
d
us
ers
of
healt
hca
re.
This
is
m
ai
nly
due
to
the
fac
t
that
co
nsum
e
rs
a
re
beco
m
ing
inc
reasin
gly
m
or
e
knowle
dgeable
about
healt
h
ca
re
ser
vices
pro
vid
e
d
to
t
hem
and
the
e
ver
-
c
hangin
g
healt
h
care
m
ark
et
and
com
petit
ion
s
in
it
dem
and
s the
se
rv
ic
e
pro
vid
e
r t
o
un
der
sta
nd a
nd fulfil
l t
he
s
ophisti
cat
ed nee
ds
of their
p
at
i
ents
[
6]
.
Qu
al
it
y
of
h
e
al
th
ser
vices
us
e
d
to
be
c
om
m
on
ly
m
eas
ur
e
d
base
d
on
pro
fessio
nal
perform
ance
sta
nd
a
rds,
ho
wev
e
r
over
th
e
la
st
deca
de,
patie
nts'
pe
rc
eption
a
bout
healt
hcar
e
ha
s
bee
n
pr
e
dom
inantly
acce
pted
as
an
i
m
po
rtant
ind
ic
at
or
f
or
m
easur
in
g
qu
al
it
y
of
healt
h
care
an
d
a
crit
ic
al
co
m
po
ne
nt
of
Evaluation Warning : The document was created with Spire.PDF for Python.
In
t.
J.
Publi
c He
al
th Sci.
IS
S
N: 22
52
-
8806
P
atient
s
atisf
ac
ti
on
and ass
oc
iated fa
ct
or
s
wi
th service
s provide
d at
ou
t
pati
ent d
e
partm
ents
(
Dereje M
esf
in
)
407
perform
ance
i
m
pr
ov
em
ent
a
nd
se
rv
ic
e
effe
ct
iveness
[
7]
.
Re
cent
trends
chow
that
qu
al
it
y
assur
an
ce
an
d
m
anag
em
ent
as
well
as
ce
rtific
at
ion
proce
dures
th
rou
ghout
healt
h
ca
re
sys
tem
s
of
diff
e
re
nt
co
untrie
s
both
f
or
a
m
bu
la
tory
an
d
hos
pital
serv
ic
es
re
qu
ire
ou
tc
om
es
of
patie
nt
sat
isfa
ct
ion
sur
veys
as
a
m
ajo
r
cr
it
eria.
Data
from
su
ch
sur
veys
are
us
e
d
f
or
be
nc
hm
ark
ing
t
he
qu
al
it
y
of
t
he
serv
ic
e
pro
vide
d
by
a
giv
e
n
healt
h
orga
nizat
ion
and
c
omm
on
ly
the
resu
lt
s
m
ade
avai
la
ble
for
th
e
public
[8
-
9]
.
Sati
sfacti
on
i
s
a
m
ulti
-
di
m
ension
al
conce
pt that is par
t o
f
com
plex
m
od
el
[6]
an
d
there is
ab
sence
of
a s
olid conce
ptu
al
b
asi
s
and
co
ns
ist
ent
m
easur
em
ent
t
oo
l
for
c
on
s
um
er
sat
isfact
ion
ha
s
le
d,
ove
r
the
pa
st
te
n
y
ears,
t
o
a
proliferati
on
of
surv
ey
s
that
f
ocu
s
excl
us
iv
el
y
on
patie
nt
exp
e
rience
[10]
.
The
re
is
no
un
i
ver
sal
ly
acc
epted
way
on
how
t
o
def
i
ne
the
co
nc
ept
of
patie
nt
sat
isfact
ion
and
how
to
m
e
asur
e
it
dif
fer
e
nt
li
te
ratur
es
de
scribe
sat
isfa
ct
ion
i
n
healt
hcar
e
in
diff
e
re
ntly
.
Ac
cordin
g
t
o
Donab
e
dian'
s
qu
a
li
ty
m
easur
e
m
ent
m
od
el
,
pa
ti
ent
sat
is
facti
on
is
con
cei
ved
as
pa
ti
ent
-
re
ported
outc
om
e
[11]
.
Jacks
on
a
nd
A
hm
ed
consi
dered
patie
nt
sat
is
facti
on
as
a
ppe
ars
t
o
represe
ntati
on
of
patie
nts
at
ti
t
ud
e
s
to
wards
c
are
or
aspects
of
care
[
12
-
13]
.
O
n
t
he
oth
e
r
hand,
ot
her
aut
hors
def
i
ned
patie
nt
sat
isfact
ion
as
a
de
gree
of
c
ongrue
ncy
between
patie
nt
e
xp
ect
at
io
ns
of
ideal
care
a
nd
their
per
ce
ptio
ns
of
real care
r
ecei
ve
d
[14]
.
Pr
im
ary
ho
sp
i
ta
ls
sp
eci
al
ly
tho
se
f
ound
in
dev
el
op
i
ng
c
ountries
li
ke
Et
hiopia
a
re
pri
m
arily
est
ablished
for
purpose
of
i
np
at
ie
nt
se
rv
ic
e
and
no
m
uch
at
te
ntion
w
as
giv
e
n
f
or
patie
nts
w
ho
visit
ed
ou
t
patie
nts
de
pa
rtm
ents
since
tho
se
se
rv
ic
es can
be
delivere
d
by
healt
h
ce
nt
ers
an
d
healt
h
po
st
s
,
but
this
f
act
s
didn’t
st
op
pati
ents
f
r
om
at
te
n
ding
pr
im
ary
hosp
it
al
because
of
the
belie
f
that
qual
it
y
ser
vices
are
pr
ov
i
ded
at
ho
s
pital
le
vel
[15]
.
I
n
de
velo
ping
co
un
t
ries
patie
nts
perce
pt
ion
ab
ou
t
he
al
th
serv
ic
es
pro
vid
e
to
them
s
ee
m
s
to
be
giv
e
n
i
na
dequate
at
te
ntion
by
healt
h
c
are
m
anag
ers
[
16
]
in
ad
diti
on
healt
h
prof
e
ss
ion
al
s
fou
nd
t
o
ha
ve
bo
t
h
a
war
e
nes
s
an
d
a
de
qu
a
te
trai
ning
to
ad
dr
es
s
patie
nts’
e
xpect
at
ion
s
[
17
]
a
nd
these
a
nd
pa
ti
ents
sat
isfact
ion
s
urveys
ha
ve
rec
ei
ved
li
tt
le
at
te
ntion.
T
he
m
ai
n
ob
j
ect
ive
of
this
st
ud
stud
y
was
the
l
evel
of
patie
nts’
sat
isf
act
ion
it
s
a
sso
ci
at
ed
facto
r
s
fo
c
us
in
g
on
ou
t
patie
nts
dep
a
rtm
ents
of
pr
im
ary
ho
s
pital
s.
The
fi
nd
i
ngs
of
this
st
ud
y
hen
ce
will
con
t
rib
ute
to
im
pr
ov
e
the
qual
it
y
of
heal
th
ser
vices
pr
ov
i
ded
in the cli
nics.
2.
RESEA
R
CH
METHO
D
Faci
li
ty
-
based
cro
ss
-
sect
iona
l
stud
y
was
co
nducte
d
in
pr
im
ary
hosp
it
al
s
of
G
urag
he
zo
ne
,
Southe
rn
Et
hiopia.
T
he
stu
dy
was
c
onduct
ed
at
outpati
ent
dep
a
rtm
ents
of
thre
e
pri
m
ar
y
ho
s
pital
s
fou
nd
i
n
Gura
ge
zon
e
s
ou
t
hern,
Ethi
opia
from
Ap
ril
1
-
7,
2019.
G
ur
a
ge
zo
ne
is
locat
ed
157
kilom
e
te
rs
away
fr
om
Add
is
A
ba
ba
capit
al
of
the
country.
T
he
re
are
cu
rr
e
ntly
three
pri
m
ary
and
one
te
rtia
r
y
le
vel
ho
s
pital
s
in
Gura
gh
e
z
on
e n
am
ely,
Atat
Pr
im
ary
ho
sp
it
al
,
Butajira p
rim
ary
hosp
it
al
,
Bou
yi
e
pri
m
ary
ho
s
pital
and
Wolkit
e
Un
i
ver
sit
y
sp
e
ci
al
iz
ed
te
rtia
ry
ho
sp
it
al
,
w
hic
h
pro
vid
e
bot
h
inp
at
ie
nts
a
nd
outpati
ent
se
rv
ic
es
f
or
popula
ti
on
of
t
he
z
on
e
.
T
his
stu
dy
pri
m
aril
y
fo
c
us
e
d
on
the
sat
isfac
ti
on
sta
tus
of
t
he
patie
nts
w
ho
at
te
nded
out
patie
nt
dep
a
rtm
ents o
f
the a
bove
m
en
ti
on
ed
prim
ary
hosp
it
al
s.
Ther
e
ar
e
270
ran
dom
ly
selec
te
d
patie
nts
who
at
te
nd
e
d
outpati
ent
de
par
tm
ent
of
the
pr
im
ary
ho
s
pital
s
in
G
ur
a
ghe
z
on
e
,
Southe
rn
Ethi
op
ia
we
re
i
nclud
e
d
in
t
he
st
ud
y
after
pr
opor
ti
onal
al
loca
ti
on
of
the
fi
nal
sam
ple
s
iz
e
to
t
he
r
especti
ve
hospi
ta
ls
.
Stable
pa
ti
ents
w
ho
rec
ei
ved
ca
re
i
n
t
he
pr
im
ary
hosp
it
al
s
durin
g
stu
dy
per
i
od
a
nd
will
ing
to
par
ti
ci
pate
in
the
stu
dy.
Exit
inter
view
wa
s
m
ade
us
in
g
intervie
wer
-
ad
m
inist
ered
patie
nt
sat
isfact
ion
su
r
vey
quest
ionnaire
.
The
quest
io
nn
ai
re
c
onsist
ed
of
f
our
par
ts
.
The
first
pa
rt
of
the
quest
ionnaire
was
about
So
ci
o
-
dem
og
ra
phic
char
act
erist
ic
s
of
the
re
spo
ndents
.
The
sec
ond
pa
rt
of
t
he
instr
um
ent
assessed
r
easo
n
a
nd
patte
rn
of
patie
nts
visit
.
The
thi
rd
par
t
the
in
strum
ents
assessed
patie
nts
I
nteracti
on
with
the
Healt
h
care
prov
i
de
r.
T
he
f
ourth
par
t
of
the
i
nst
ru
m
ents
is
con
sist
s
Likert
-
scal
e
ty
pe
it
em
wh
ic
h
m
easur
ed
pe
rceive
d
le
vel
of
patie
nts
s
at
isfact
ion
d
if
f
eren
t
c
om
po
ne
nts
of
serv
ic
e
pro
vision.
Data
wer
e
c
he
eked
for
com
plete
ness
an
d
ac
cur
acy
an
d
e
ntered
a
nd
a
naly
zed
us
i
ng
S
PS
S
ver
si
on
21
so
ft
war
e
.
Desc
riptive
sta
ti
sti
c
s
wer
e
com
pu
t
ed
for
dif
fer
e
nt
stud
y
var
ia
bl
es.
An
ov
e
rall
sat
isfact
ion
m
eans
scor
e
of
2.
5
is
con
si
der
e
d
a
s
cut
-
off
valu
e
to
cat
egorize
patie
nts.
Ba
sed
on
that
ca
lc
ulate
d
m
ean
score
cut
-
po
i
nt
sco
r
es
patie
nts
w
ere
cl
assifi
ed
as
sat
isfie
d
(t
ho
s
e
w
ho
sco
red
overall
m
eans
sc
or
e
a
bove
or
equ
al
to 2
.
5)
a
nd
d
issat
isfie
d
(th
os
e
w
ho
sc
ored
cal
c
ul
at
ed
m
eans
sco
re
be
low
2.5).
Bi
vari
at
e
log
ist
ic
analy
sis
was
c
onduct
ed
to dete
rm
ine predict
ors
of p
at
ie
nt sati
sfacti
on.
3.
RESU
LT
A
N
D ANALY
SIS
3.1. S
ocio
-
de
mo
graphic ch
ara
c
teristics
of p
at
ie
n
ts
Am
on
g
the
t
ot
al
sa
m
ple
size
(n
=
270)
26
6
patie
nts
c
om
ple
te
d
the
quest
io
nn
ai
re
w
hich
m
akes
the
total
resp
onse
rate
98.
5%
.
More
tha
n
ha
lf
of
the
res
po
nd
e
nts
15
0
(56
.4
%
)
wer
e
bet
ween
the
a
ges
of
20
and 35 a
nd
(98
.1
%
) of t
he res
pondents
w
e
re
sing
le
as
s
how
n
in
Ta
ble 1.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SSN
:
2252
-
88
06
In
t.
J.
Publi
c He
al
th Sci. V
ol.
8
,
No.
4
,
Dece
m
ber
201
9
:
4
0
6
–
4
1
2
408
Table1
. Socio
-
dem
og
ra
ph
ic
c
har
act
erist
ic
s
of r
e
spo
nd
e
nts
So
cio
de
m
o
g
raph
i
c variables
Frequ
en
cy
(n=2
6
6
)
Percent
(%)
Ag
e ca
teg
o
ry(y
ear
s)
20
-
35
36
-
40
>6
5
150
100
16
5
6
.4
3
7
.6
6
.0
Total
266
100
Sex
Male
Fe
m
ale
157
109
5
9
.0
4
1
.0
Total
266
100
Mar
ital
Status
Sin
g
le
Mar
ried
161
105
6
0
.5
3
9
.5
Relig
io
n
Protes
tan
t
Ortho
d
o
x
Mus
li
m
Cath
o
lic
Oth
ers*
88
97
52
23
6
3
3
.1
3
6
.5
1
9
.5
8
.6
2
.3
Total
266
100
Ethn
icity
Oro
m
o
A
m
h
ara
Tigre
Gu
rage
Oth
ers **
84
62
27
48
45
3
1
.6
2
3
.3
1
0
.2
1
8
.0
1
6
.9
Total
266
100
*
(Adv
en
tists
and
W
ak
ef
ata), *
*
o
th
ers
(Hadi
y
a,
W
o
lk
ite,
Sid
a
m
a,
silt
e,
G
a
m
o
)
3.2.
Ins
tituti
onal
as
pec
ts an
d pat
tern
of
visit
Am
on
g
the
tot
al
resp
on
den
ts
,
175
(
65.8
%
)
respo
nd
e
nts
w
ere
fo
ll
ow
-
up
visit
or
s
wh
il
e
91
(34.2%
)
wer
e
ne
w
visit
or
s
.
62.0%
of
t
he
st
ud
y
par
ti
c
ipants
repo
rted
that
they
fou
nd
on
ly
s
om
e
of
the
pr
es
cribe
d
dru
gs
from
the
ho
s
pi
ta
l
ph
a
rm
acy
.
Con
ce
rn
i
ng
th
e
pe
rceive
d
durati
on
of
c
onsul
ta
ti
on
,
26.
3
of
the
patie
nts
re
porte
d
that
they
ha
d
long
c
on
s
ultat
ion
ti
m
e
than
they
e
xp
ect
ed,
wh
il
e
27.
4%
of
t
hem
consi
der
it
as
short.
As
s
how
n
i
n
T
able 2.
Table
2.
Insti
tuti
on
al
as
pects a
nd p
at
te
r
ns
of
visit
am
on
g pa
ti
ents
Variable
Frequ
en
cy
(n=2
6
6
)
Percent
(%)
Reas
o
n
f
o
r
v
isit
Illnes
s
236
8
8
.7
Oth
ers
30
1
1
.3
Total
266
100
Nu
m
b
e
r
o
f
vis
it wi
th
in
the last 2
4
m
o
n
th
s
On
e ti
m
e
Two ti
m
es
Three
ti
m
es
Fo
u
r
ti
m
e
or
m
o
re
91
94
48
33
3
4
.2
3
5
.3
1
8
.0
1
2
.4
Total
266
100
Perceived
wai
tin
g
ti
m
e to se
e ph
y
sici
an
Lon
g
Fair
Sh
o
rt
45
69
35
3
0
.2
4
6
.3
2
3
.5
Total
266
100
Perceived
con
su
ltatio
n
du
ration
Lon
g
Fair
Sh
o
rt
70
123
73
2
6
.3
4
6
.2
2
7
.4
Labo
ratory test
ord
ered
Labo
ratories tests
are
o
rder
ed
Labo
ratories tests
are
n
o
t ord
ered
149
117
5
6
.0
4
4
.0
Total
266
100
Av
ailab
ility
o
f
pre
scrib
ed
dru
g
s
All availab
le
So
m
e availab
le
No
n
e availab
le
84
165
17
3
1
.6
6
2
.0
6
.4
Total
266
100
Evaluation Warning : The document was created with Spire.PDF for Python.
In
t.
J.
Publi
c He
al
th Sci.
IS
S
N: 22
52
-
8806
P
atient
s
atisf
ac
ti
on
and ass
oc
iated fa
ct
or
s
wi
th service
s provide
d at
ou
t
pati
ent d
e
partm
ents
(
Dereje M
esf
in
)
409
3.3.
In
tera
c
ti
on
wi
th t
he
h
e
alth care
pr
ovider
Am
on
g
the
t
otal
nu
m
ber
of
the
res
ponde
nts
,
m
or
e
than
half
(
53.0
%
)
of
th
e
respo
nd
e
nts
r
eported
t
ha
t
the
prov
i
der
di
scusse
d
with
them
cause
of
their
il
lness
wh
il
e
63.
5%
of
the
respo
nd
e
nts
repor
te
d
th
at
they
wer
e
ad
vised
how
t
o
pr
e
ve
nt
the
re
-
oc
cu
rrence
of
their
il
lness.
Re
gardi
ng
pe
rceiv
e
d
e
m
pathy
14
2
(
53.
4%)
per
cei
ved
that
the
pro
vi
der
s
ha
ve
m
edium
lev
el
of
em
pathy
w
hile
94
(
35.
3%)
of
them
fe
el
that
the
provi
der
s
hav
e
lo
w
le
vel
of
em
pathy,
wh
il
e
the
rem
a
ining
30
(11.3
%)
belie
ve
tha
t
serv
ic
e
pro
vid
ers
ha
ve
a
hi
gh
le
vel
of em
pathy as sh
ow
n
in
Ta
ble 3
.
Table
3
.
Pati
en
t serv
ic
e
-
pro
vi
der inte
racti
on
a
m
on
g i
n o
utpa
ti
ent d
e
par
tm
ents
of
pri
m
ary
hosp
it
al
s
Variables
Frequ
en
cy
(n=2
6
6
)
Percentag
e
(%)
Patien
ts id
en
tity
is
co
n
f
ir
m
ed
b
y
servi
ce prov
id
er
211
7
9
.3
Patien
ts Ask
ed
abo
u
t their
m
ed
ic
atio
n
h
isto
ry
178
6
6
.9
Prov
id
er
d
iscu
ss
ed
with th
e
m
ab
o
u
t the caus
e of
y
o
u
r
ill
n
ess
141
5
3
.0
Prov
id
er
to
ld
the
m
to return
if
sy
m
p
t
o
m
s
gets
worse
170
6
3
.9
Prov
id
er
to
ld
eno
u
g
h
abo
u
t their tr
eat
m
e
n
t
153
5
7
.5
Prov
id
er
to
ld
the
m
way
s
of
prev
en
tin
g
f
u
tu
re
reoccu
rr
en
ce
169
6
3
.5
Perceived
level o
f
e
m
p
ath
y
Low
Mediu
m
Hig
h
94
142
30
3
5
.3
5
3
.4
1
1
.3
3.4.
Le
vel
of
pa
tie
nt’s s
at
is
fa
c
tion w
ith
d
ifferen
t
c
omponen
ts of ser
vi
ce pro
vision
Table
4
s
how
s
that
from
the
total
resp
on
de
nts
27.
4%
we
re
sat
isfie
d
with
t
he
cl
arit
y
of
the
instr
uctio
ns
giv
e
n
by
the
care
prov
i
der
on
in
vestigat
ion
s/
pr
e
scriptio
ns
;
w
hile
12
(
4.5%)
of
them
were
strongly
dissa
ti
sfied.
Ma
jo
riti
es
(51.9%)
wer
e
sat
isfie
d
with
the
cl
eann
e
ss
of
t
he
co
ns
ultat
io
n
room
;
wh
il
e
18
(
6.8
%)
we
re
str
ongly
dissati
sfi
ed.
Ov
e
rall
sat
isfact
ion
sc
ore
with
healt
h
serv
ic
e
prov
i
ded
i
n
the outpati
e
nt
dep
a
rtm
ent o
f
t
he prim
ary ho
s
pital
s w
as
66.
5%
at 9
5%
C
I (
60.8%
-
72.2%)
Table
4.
L
evel
of p
at
ie
nt sati
s
facti
on w
it
h di
ff
e
ren
t c
om
po
ne
nts
of
healt
h s
erv
ic
e
pro
vid
e
d
at
ou
t
patie
nt
de
pa
rtm
ents o
f
prim
ary ho
sp
it
al
s
Ch
arac
teristics
Stron
g
ly
d
iss
atisf
ied
N
(%)
Diss
atisf
ied
N
(%)
Neu
tral
N
(%)
Satisf
ied
N
(%)
Stron
g
ly
satis
f
ied
N
(%)
Clarity
of
ins
tructio
n
s g
iv
en
by
th
e service
p
rov
id
er
o
n
inv
esti
g
atio
n
s/p
rescr
ip
tio
n
s
1
2
(4.5
)
8
5
(32
.0)
9
1
(34
.2)
7
3
(27
.4)
5
(1.9
)
The a
m
o
u
n
t of
ti
m
e sp
en
t with serv
ic
e
p
rov
id
er
1
7
(6.4
)
5
1
(19
.2)
8
0
(30
.1)
1
1
7
(44
)
1
(0.4
)
Co
n
d
itio
n
(
co
m
f
o
r
t,
p
rivacy
etc
.)
of
t
h
e
co
n
su
ltatio
n
r
o
o
m
1
7
(6.4
)
4
9
(18
.4)
9
0
(33
.8)
1
0
1
(38
.0)
9
(3.4
)
Clean
n
ess
of
waiting
ar
ea
4
5
(16
.9)
6
6
(24
.8)
5
9
(22
.2)
8
8
(33
.1)
8
(3)
Clean
n
ess
of
con
s
u
ltatio
n
r
o
o
m
1
8
(6.8
)
3
7
(13
.9)
5
5
(20
.7)
1
3
8
(51
.9)
1
8
(6.8
)
Co
u
rtesy
and
r
esp
e
ct of
the p
rov
id
er
4
5
(16
.9)
6
6
(24
.8)
5
9
(22
.2)
8
8
(33
.1)
8
(3)
Proced
u
re
o
f
ph
y
sical ex
a
m
in
atio
n
1
5
(5.6
)
4
4
(16
.5)
9
5
(35
.7)
1
0
2
(38
.3)
1
0
(3.8
)
Ov
erall
w
aitin
g
tim
e
1
7
(6.4
)
6
2
(23
.3)
9
9
(37
.2)
8
3
(31
.2)
5
(1.9
)
3.6.
F
actors
associa
ted
wi
th pa
tient
s
at
isf
act
i
on
Bi
-
var
ia
te
lo
gi
sti
c
regressio
n
was
c
onduct
ed
betwee
n
so
ci
o
-
dem
og
ra
phy,
patte
rn
of
visit
,
interact
io
n
with
healt
h
s
erv
ic
e
prov
i
de
r
va
riables
a
nd
ove
rall
sat
isfact
io
n
sco
re.
Th
os
e
va
riab
le
s
with
P
<
0.05
at
bi
va
riat
e
analy
sis
wer
e
inclu
ded
in
m
ulti
ple
log
ist
ic
reg
re
ssi
on
s
.
Acc
ord
ing
to
the
ou
tc
om
es
of
m
ultiv
ariat
e
analy
sis
pati
ents
wait
ing
tim
e
was
am
on
g
si
gnific
ant
pred
ic
tors
of
pa
ti
ent’s
sat
is
facti
on.
Accor
dingly
,
pa
ti
ents
who
wa
it
ed
le
ss
than
or
eq
ual
to
30
m
inu
te
s
to
visit
serv
ic
e
prov
i
der
we
re
3.6
5
tim
es
m
or
e
sat
i
sfied
than
patie
nts
wait
ed
m
or
e
than
60
m
inu
te
s
(AOR
3.65,
95
%C
I:
1.58
-
8.4
6).
Pati
ents
who
per
cei
ved
t
he
wait
ing
a
rea
is
cl
ean
are
2.3
3
tim
es
satisfied
com
par
ed
to
t
ho
s
e
w
ho
pe
rc
ei
ved
the
wait
ing
a
rea
is
un
cl
ean
(
A
O
R
2.
33.
95%
C
I:
1.
34
-
4.7
7
)
.
Pati
ents
who
wer
e
tol
d
ab
out
the
cause
of
their
il
lness
we
re
2.4
6
m
or
e
sat
isfie
d
than
t
hose
pa
ti
ents
who
ha
dn’t
bee
n
t
old
a
bout
ca
us
e
of
their
il
lne
ss
(
AO
R
2.4
6.
95%
CI: 1.1
5
-
5.2
9)
.
As sh
own
in
T
able 5
.
Table
5.
Pr
e
dic
tors o
f pati
ent
sat
isfact
ion
i
n ou
t
patie
nt
dep
a
rtm
ents o
f pr
i
m
ary ho
s
pital
s
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SSN
:
2252
-
88
06
In
t.
J.
Publi
c He
al
th Sci. V
ol.
8
,
No.
4
,
Dece
m
ber
201
9
:
4
0
6
–
4
1
2
410
Exp
lan
ato
ry
variab
les
Patien
t satisf
actio
n
COR
(95
%C
I)
AOR(9
5
%C
I)
Satisf
ied
N (
%)
Diss
atisf
ied
N (
%)
Reg
istratio
n
pro
cess
was do
n
e ti
m
el
y
Ag
ree
Disag
ree
1
1
6
(65
.5)
6
1
(34
.5)
3
8
(42
.7)
5
1
(57
.3)
2
.55
(1.5
1
-
4
.30
)*
*
*
1
1
.42
(0.7
3
-
2
.75
)
1
W
aitin
g
ti
m
e to v
i
sit serv
ice prov
id
er
(in
m
in
u
tes)
≤3
0
31
-
60
60+
1
0
1
(57
.1)
4
8
(27
.1)
2
8
(15
.8)
2
8
(31
.5)
3
3
(37
.1)
2
8
(31
.5)
3
.61
(1.8
5
-
7
.05
)*
*
*
1
.46
(0.7
4
-
2
.89
1
3
.65
(1.5
8
-
8
.46
)*
*
1
.56
(0.6
6
-
3
.68
)
1
Labo
ratory test
ord
ered
Yes
No
4
8
(53
.9)
4
1
(46
.1)
6
9
(39
)
1
0
8
(61
)
1
.83
(
1
.09
-
3
.04
)*
1
1
.33
(0.7
0
-
2
.52
)
1
Av
ailab
ility
o
f
pre
scrib
ed
dru
g
s
All
So
m
e
No
n
e
6
6
(37
.3)
1
0
2
(57
.6)
9
(5.1
)
1
8
(20
.2)
6
3
(70
.8)
8
(9.0
)
3
.26
(1.1
0
-
9
.65
)*
1
.44
(0.5
3
-
3
.92
)
1
2
.28
(0.5
8
-
8
.94
)
1
.04
(0.2
9
-
3
.78
)
1
Do
es
p
rivacy
o
f
co
n
su
ltatio
n
r
o
o
m
ap
p
rop
riate
?
Yes
No
1
3
8
(78
)
3
9
(22
)
5
8
(65
.2)
3
1
(34
.8)
1
.89
(1.0
7
8
-
3
.3
2
)*
1
1
.03
(0.5
1
-
2
.09
)
1
Clean
lin
ess
of
waiting
ar
ea
Yes
No
1
4
6
(82
.5)
3
1
(17
.5)
6
0
(67
.4)
2
9
(32
.6)
2
.28
(1.2
6
-
4
.10
)*
*
1
2
.33
(1.3
4
-
4
.77
)*
1
Perceived
e
m
p
ath
y
Low
Mediu
m
Hig
h
5
3
(29
.9)
1
0
3
(58
.2)
2
1
(11
.9)
4
1
(46
.1)
3
9
(43
.8)
9
(10
.1)
1
2
.04
(1.1
8
-
3
.54
)*
1
.81
(0.7
5
-
4
.36
)
1
1
.73
(0.7
7
-
3
.91
)
1
.66
(0.4
4
-
6
.20
)
Intervi
ewed b
y
the
lang
u
ag
e y
o
u
un
d
erstand
Yes
No
1
5
2
(85
.9)
2
5
(14
.1)
6
7
(75
.3)
2
2
(24
.7)
1
.99
(1.0
5
-
3
.79
)*
1
1
.38
(0.6
4
-
2
.95
)
1
Ask
ed
m
ed
icatio
n
h
isto
ry
too
k
Yes
No
1
2
8
(72
.3)
4
9
(27
.7)
5
0
(56
.2)
3
9
(43
.8)
2
.04
(1.2
0
-
3
.47
)*
*
1
1
.49
(0.7
6
-
2
.96
)
1
Prov
id
er
to
ld
caus
e of
illnes
s
Yes
No
1
4
8
(83
.6)
2
9
(16
.4)
5
6
(62
.9)
3
3
(37
.1)
3
.01
(1.6
7
-
5
.40
)*
*
*
1
2
.46
(1.1
5
-
5
.29
)*
1
Prov
id
er
a to r
etu
r
n
if
sy
m
p
to
m
s g
ets
worse
Yes
No
4
9
(55
.1)
4
0
(44
.9)
1
2
1
(68
.4)
5
6
(31
.6)
1
.76
(1.0
4
-
2
.98
)*
1
1
.07
(0.5
3
-
2
.18
)
1
Prov
id
er
to
ld
y
o
u
h
o
w to p
reven
t r
eo
ccurrence o
f
y
o
u
r
i
lln
ess
Yes
No
1
2
3
(69
.5)
5
4
(30
.5)
4
6
(51
.7)
4
3
(48
.3)
2
.13
(1.2
6
-
3
.60
)*
*
1
1
.14
(0.5
6
-
2
.31
)
1
(*)
P
-
val
ue
<0.
05
,
(**)
P
-
val
ue
<0.01,
AO
R:
Adjust
ed
odd
r
atio,
COR: Crude odd
r
atio
4.
DISCU
SSI
ON
The
cu
rr
e
nt
st
ud
y
c
onduct
ed
in
the
OPD
of
pr
im
ary
hosp
it
al
s
of
Gur
agh
e
z
one
showe
d
that
the
ove
rall
sat
isfact
ion
sc
or
e
of
the
patie
nts
with
ser
vices
pro
vid
e
d
was
66.5%
at
95%
CI
(60.8%
-
72
.2
%
).
This
overall
sat
isfact
ion
le
vel
repor
t
is
low
com
par
ed
to
the
re
port
of
the
s
tud
ie
s
co
nduc
te
d
in,
Ho
s
pital
of
Wo
ll
ega
Orom
ia
reg
i
on
an
d
A
ssen
dabo
a
nd
Ji
m
m
a
Tow
n
an
d
Teachi
ng
Ho
s
pital
of
Is
fah
a
n
wh
ic
h
show
ed
91%,
85.
7%
a
nd
86%
res
pec
ti
vely
ov
erall
sat
isfact
ion
[
18
-
20]
but
the
fin
dings
is
com
par
able
with
st
ud
ie
s
c
onduct
ed
in
He
al
th
centers
in
central
Et
hiopia
w
hich
re
ported
ov
e
rall
pati
ent
sat
isfact
io
n
le
vel
of
62.6
%
[15]
.
This
diff
e
re
nc
e
m
igh
t
be
previ
ou
sly
li
ste
d
hosp
it
al
s
we
re
est
ablishe
d
pr
i
or
to
hos
pital
s
of
cov
e
re
d
by
th
e
stud
y
a
nd
a
re
well
eq
uipped
both
i
n
hum
an
resour
ce
an
d
ot
her
fac
il
ities.
Accor
di
ng
t
o
the
resu
lt
of
th
e
above
stu
dy
per
cei
ved
wait
ing
tim
e
to
visit
serv
ic
e
prov
i
der
s
,
inf
or
m
ing
the
cause
of
il
lness
and
cl
eanli
ne
s
s
of
wait
ing
a
r
eas
are
found
to
be
an
im
po
rtant
pr
e
dictor
of
patie
nt
sat
isfact
ion
.
L
ong
wait
ing
tim
e
to
receive
serv
ic
e
in
t
he
ho
s
pital
s
ne
ga
ti
vely
aff
ect
ed
patie
nt
sat
isfa
ct
ion
in
this
st
ud
y.
T
his
fi
nd
i
ng
is
consi
ste
nt
with
the
stu
die
s
co
nducte
d
in
Dif
fer
e
nt
ou
t
patie
nt
cl
inics
in
Et
hiopia
[19
,
21
-
22]
.
Con
ce
rn
i
ng
th
e
cl
eanli
ness
of
the
wa
it
ing
a
rea,
33.
0%
of
the
res
pondents
wer
e
sat
isfie
d
with
the
cl
ean
li
ness
of
the
wait
ing
area.
This
le
ve
l
of
sat
isfact
ion
with
re
gard
to
cl
eanli
ness
of
the
facil
it
ie
s
is
le
ss
co
m
par
e
d
fin
dings
from
stud
y
w
olait
a
Sodo
Un
i
ver
sit
y
Teaching
Hospita
l
and
O
P
D
of
Terti
ary
Ca
re
Hospita
l
in
India
repor
te
d
t
hat,
50.0%,
a
nd
55.
6%
of
the
pati
ents
wer
e
sat
isfie
d
res
pecti
ve
ly
[23
-
24]
.
T
his
dif
fere
nce
m
i
gh
t
be
du
e
to
t
he
int
rinsic
diff
e
re
nc
e
betwee
n
t
he
pr
im
ary
ho
s
pital
s
an
d
the
te
rtia
ry
le
vel
te
achin
g
ho
s
pital
s.
Accor
ding
to
f
ind
in
gs
of
this
stud
y
m
or
e
tha
n
half
(53.0%
)
of
the
patie
nts
wer
e
in
form
e
d
a
bout
the
ca
us
e
of
their
il
lness
wh
ic
h
is
le
ss
com
par
ed
t
o
the
fi
nd
i
ngs
of
a
stu
dy
cond
ucted
i
n
USA
w
he
re
72%
of
the
res
ponden
ts
repor
te
d
th
at
their
healt
h
care
pro
vid
e
rs
ga
ve
them
adequate
in
f
or
m
at
ion
ab
out
their
conditi
on
[25]
.
But
it
is
bette
r
com
par
ed
to
the
fin
dings
stud
y
co
nducte
d
in
pr
im
ary
healt
h
care
cente
rs
in
Evaluation Warning : The document was created with Spire.PDF for Python.
In
t.
J.
Publi
c He
al
th Sci.
IS
S
N: 22
52
-
8806
P
atient
s
atisf
ac
ti
on
and ass
oc
iated fa
ct
or
s
wi
th service
s provide
d at
ou
t
pati
ent d
e
partm
ents
(
Dereje M
esf
in
)
411
central
Ethi
opia
wh
e
reb
y
62.
6%
of
patie
nts
we
re
not
inf
or
m
ed
ab
out
the
cause
of
their
il
lness
wh
ic
h
translat
es to
b
e
a m
iss
ed
oppo
rtu
nity
f
or
healt
h
ed
ucati
on
[15]
.
5.
CONCL
US
I
O
N
In
ge
ne
ral,
th
e
overall
sat
is
facti
on
le
vel
of
patie
nts
wi
th
the
healt
h
care
se
rv
ic
es
pro
vid
e
d
at
ou
t
patie
nt
departm
ents
of
Guraghe
zo
ne
wa
s
su
bo
pti
m
al
.
Shor
t
wait
in
g
tim
e,
cl
eanli
ness
of
wait
in
g
ar
eas
and
discuss
i
ng
wit
h
patie
nts
a
bo
ut
the
cau
se
of
their
il
lness
wer
e
posit
ive
and
si
gnific
ant
pr
e
dictor
s
of
patie
nt
sat
isfact
ion
.
H
ence
op
ti
m
iz
in
g
patie
nt
wait
i
ng
tim
e
to
visi
t
healt
h
pro
fes
sion
al
s
w
ou
l
d
be
c
ru
ci
al
to
im
pr
ov
e
patie
nt
sat
isfac
ti
on
.
T
he
refore
hosp
it
al
m
a
nag
em
ents
an
d
serv
ic
e
pro
vi
der
s
sho
uld
w
ork
to
wa
rd
s
de
visin
g
a
strat
egy
to
r
edu
ce
wait
in
g
tim
e.
Fu
rthe
r
m
or
e
the
hospi
ta
l
m
anag
e
m
e
nt
sho
uld
w
ork
to
c
reate
cl
e
an
a
nd
com
fo
rtable
w
ai
ti
ng
areas
.
B
esi
des
that,
he
al
th
care
prof
e
ssion
al
s
s
houl
d
disc
us
s
with
their
pa
ti
ents
about
the
cause
an
d
treatm
ents
of
t
heir
il
lness
a
s
su
c
h
they
ca
n
im
pr
ov
e
the
sat
isfact
ion
le
vel
of
thei
r
pa
ti
ents.
Fu
rt
her
m
or
e
he
al
th
office
of
the
zo
ne
sho
uld
est
a
blish
a
m
echan
ism
for
a
re
gu
la
r
pa
ti
ent
sat
isfact
ion
s
urveys
as a fu
nd
am
ental
init
ia
ti
ve
for
the im
pr
ovem
ent of t
he heal
th se
rv
ic
e
qual
it
y.
ACKN
OWLE
DGME
NT
We
w
ould
li
ke
to
than
k
stu
dy
par
ti
ci
pa
nts
for
their
vol
unta
ry
pa
rtic
ipati
on
an
d
adm
inist
rato
rs
of
the hos
pital
s fo
r
their
coo
per
at
ion
.
REFERE
NCE
S
[1]
Natsa
y
i
Chim
bi
ndi,
T
il
l
Bä
rnigh
ause
n
and
Mari
e
-
Loui
se
Newel
l,
Pati
ent
sa
ti
sfa
ct
i
on
with
HIV
and
TB
tre
a
tment
i
n
a
public
progra
m
m
e
in
rura
l
K
waZ
ulu
-
Nat
al
:
e
vide
nc
e
from
patient
-
exi
t
int
e
rview
s.
BMC
Healt
h
Serv
ices
Re
s
earc
h
,
14(32):
p.
1472
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6963,
2014
.
[2]
Trus
t:
H.
c.
C
.
-
N.
W
.
L.
H.N.
and
O.s.
r
epor
t. 2004/
5
.
[3]
Ze
kar
i
y
as
Sahi
le
Nez
en
ega
1T
.
,
Patient
sat
isfactio
n
on
tube
r
cul
osi
s
tre
at
m
ent
servi
ce
and
adh
ere
nc
e
to
t
reatm
ent
i
n
publi
c
he
al
th
fac
i
li
t
ie
s
of
S
ida
m
a
zone
,
South
Et
hiopi
a
.
BMC
Health
Serv
ic
es
Res
earc
h
,
13(110):
p.
1472
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6963
,
2
013.
[4]
Ludmila
Mar
cinow
ic
z,
S.C.
a.
R
.
G.,
Pa
tient
sat
isfac
t
ion
with
hea
l
thc
ar
e
provi
ded
b
y
famil
y
doct
ors:
pr
im
a
r
y
dimensions a
nd
an
a
tt
empt
at t
y
p
olog
y
.
BMC
He
al
th
Services Res
ea
rch
,
9(63):
p.
1472
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6963,
200
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[5]
Huang
JA
,
L.
C.
,
Tsai
W
C,
Hu
W
H,
Yang
DW
,
Dete
rm
ini
ng
fa
ct
ors
of
pat
i
ent
sati
sfac
ti
on
for
fre
quent
users
o
f
emerge
nc
y
s
erv
i
ce
s in
a
m
edi
c
al
ce
nt
er.
Jo
u
rnal
o
f
ch
ine
semedi
cal ass
oci
ati
on
,
67(
8):
p.
403,
2004.
[6]
Ghizl
an
e
Soufi
1,
J.B
.
,
Salma
Him
m
ic
h1,
Sam
ir
Ahid2,
Me
hdi
Soufi1,
Aic
ha
Z
ekr
aou
i1
a
nd
and
R
edouan
e
Abouqal*1,
Pat
i
ent
sat
isfac
t
ion
in
an
a
cute
m
edi
ci
n
e
depa
r
tme
nt
in
Morocc
o
.
BMC
Hea
lt
h
Se
rvic
es
Rese
arc
h
.
10(149):
p.
1472
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