Abstract
Purpose
Diabetes is a prevalent chronic disease requiring long-term, patient-centered care. Patient satisfaction is a key indicator of healthcare quality that enhances treatment adherence and outcomes. This study evaluates satisfaction levels among diabetic patients attending university care centers in Iran and analyzes trends and influencing factors.
Methods
This study used data from the National Program for Prevention and Control of Diabetes (NPPCD) in Iran collected from March 2018 to June 2021. Satisfaction was assessed in Likert scale in four domains: treatment and follow-up by medical staff, physical health and complication management, personal and social relationships, and participation and education. A total of 392,269 records were analyzed, with results presented according to age, gender, disease duration, and year of visit.
Results
Treatment and follow-up by medical staff had the highest satisfaction (33.78% completely satisfied, 53.56% satisfied), while satisfaction with personal and social relationships was the lowest (14.43% completely satisfied, 46.71% satisfied). Longer disease duration correlated with lower satisfaction.
Conclusion
While satisfaction with treatment was highest, personal and social relationship support needs improvement. Holistic interventions and continuous evaluation can enhance patient care quality and outcomes.
Keywords: Diabetes care, Patient satisfaction, Healthcare quality, National program for prevention and control of diabetes (NPPCD)
Introduction
Diabetes is one of the most prevalent chronic diseases and a major global health challenge [1]. According to 10th edition of International Diabetes Federation Diabetes Atlas, the number of adults with diabetes in Middle East and North Africa (MENA) region is expected to reach 95 million by 2030 [2], representing one of the largest relative increases worldwide [3]. In Iran, a Middle Eastern country, the prevalence and burden of this disease are high and continue to increase [4–6].
Despite advances in understanding the mechanisms of diabetes and its management, the rates of complications including retinopathy, kidney disease, and heart disease and mortality continue to rise [1, 7]. Evidence shows that high-quality medical care can reduce these complications in diabetic patients. Therefore, these patients require a long-term care plan focused on early identification and control of complications as well as disease progression [8].
However, recent data highlight a gap between the expected and actual quality of diabetes care [9]. While advancements in medical science and treatment protocols have enhanced therapeutic approaches, these protocols have also become increasingly complex. Today, managing chronic conditions like diabetes, is considered a “team effort.” This effort requires not only the presence of professionals from various specialties, but also places the patient and their family at the center of the team [8]. This coordinated, multidisciplinary approach increases the likelihood of successful interventions for chronic diseases [10].
Given the lifelong nature of diabetes, patients frequently visit healthcare centers, making adherence to the treatment essential and challenging, with potential disruptions [11]. Studies suggest that increasing patient satisfaction with the healthcare services is strongly correlated with motivation for treatment [12], and enhances patients’ likelihood of adhering to their treatment plans, returning for follow-up visits, and achieving better disease control [13, 14].
Patient satisfaction with treatment and follow-up is defined as their perception of how well their needs and expectations are met during interactions with healthcare services [15]. Key factors influencing satisfaction include the patient-provider relationship and the accessibility and usability of healthcare services, which are also essential indicators of healthcare quality [15, 16].
Limited information exists on this topic in Iran. Two separate studies [17, 18] conducted in 2013 and 2014 aimed to assess diabetic patients’ satisfaction with healthcare services. However, given changes in policies, new programs, and evolving societal expectations, reliance solely on older studies is insufficient for understanding current trends. This multi-center research with broader timeline and larger sample, evaluates satisfaction levels among diabetic patients attending university care centers between 2016 and 2021. Understanding satisfaction and its determinants can lead to changes that improve care delivery, and disease management.
Methods and material
Study design and population
This study is part of a broader investigation into patient satisfaction and outcomes in diabetes care. The data were derived from the National Program for Prevention and Control of Diabetes (NPPCD) in Iran, a nationwide initiative implemented through diabetes clinics in 31 university hospitals. Using data from this national program provided us with a robust and representative dataset. Patient records were collected annually according to the Iranian solar calendar from 1397 to 1400, where each year begins on approximately March 21 of the corresponding Gregorian year and ends on March 20 of the following year (from March 2018 to 2021 in standardized formats), coordinated by the Treatment Deputy of the Ministry of Health and Medical Education. The target population included diabetic patients with active medical records in the studied treatment centers during this time period, for whom satisfaction-related questions had been completed.
Tools and measurement
Variables were calculated based on predefined definitions. Satisfaction was assessed in four domains: treatment and follow-up interventions by medical staff, physical health and management of disease complications (e.g., pain, tingling, frequent urination, infections), personal (marital) and social relationships (work-related interactions, costs, and diabetes outcomes), and participation and education on health improvement (self-care and diabetes awareness). A Likert scale ranging from “completely satisfied” to “completely dissatisfied” was used to measure satisfaction in these domains. Data for satisfaction were collected from March 2018 to March 2021.
Statistical analysis
Data for each year of study gathered separately and cleaning was also performed separately for each file to ensure consistency. The datasets were then merged into a unified database, followed by additional cleaning and structural review. After merging the datasets from 2015 to 2021, 611,664 records were available. Of these, 392,269 records included data related to the four satisfaction domains, as satisfaction questions were introduced in 2018. Data prior to 2018 were excluded from the analysis due to the absence of satisfaction-related variables. Descriptive analyses were conducted using Statistical Package for the Social Sciences (SPSS) software version 26. Frequency and 95% confidence intervals calculated for satisfaction levels across variables.
Ethical consideration
The research adhered to the principles outlined in the Declaration of Helsinki. It received approval from the Ethical Review Committee at the Tehran University of Medical Sciences under the registration number IR.TUMS.THC.REC.1401.043.
Results
This study included a total of 392,269 participants with diabetes. Patients were categorized in four age group, including below 50, between 50 and 60, between 60 and 65, and older than 65 years old: 97,851 (24.94%), 126,273 (32.19%), 70,875 (18.07%), and 97,217 (24.78%) respectively. 129,969 (33.13%) were male and 262,300 (66.86%) were female. 127,149 (32.41%) had diabetes for less than five years, 119,476 (30.45%) had diabetes for between five to ten years, and 145,644 (37.12%) had diabetes for more than ten years. Data collection spanned about four years, with the highest proportion of participants, 153,628 (39.2%), recorded in 1398 (2019–2020). The least proportion of patients participated in 1400, 22,901 patients and only %5.83. In 1397 and 1399, 114,354 (%29.15) and 101,386 (%25.84) patients participated.
Levels of satisfaction assessed across four domains are shown in Table 1. The highest level of complete satisfaction was reported for treatment and follow-up by medical staff (33.8%, 95% CI: 33.6-33.9%), followed by participation and education on self-care and diabetes awareness (20.3%, 95% CI: 20.2-20.5%). Conversely, complete satisfaction was lowest for physical health management (16.5%, 95% CI: 16.4-16.6%) and personal/social relationships (14.4%, 95% CI: 14.3-14.5%). Dissatisfaction levels, including “unsatisfied” and “completely unsatisfied,” were highest for physical health (5.4%, 95% CI: 5.4-5.6%) and social relationships (6.2%, 95% CI: 6.1-6.3%).
Table 1.
Level of satisfaction in four domains (Number, percentage, confidence interval)
| Level of Satisfaction with | State of treatment and follow-up of treatment interventions by the medical staff | Physical health and control of disease complications | Personal (marital) and social relationships | Participation and education on how to improve health | |||
|---|---|---|---|---|---|---|---|
| Completely Satisfied |
132,518(33.78%) (33.63–33.93%) |
64,812(16.52%) (16.41–16.64%) |
56,600(14.43%) (14.32–14.54%) |
79,746(20.33%) (20.2-20.46%) |
|||
| Satisfied |
210,101(53.56%) (53.4-53.72%) |
214,754(54.75%) (54.59–54.9%) |
183,242(46.71%) (46.56–46.87%) |
201,299(51.32%) (51.16–51.47%) |
|||
| Almost Satisfied |
43,882(11.19%) (11.09–11.29%) |
91,590(23.35%) (23.22–23.48%) |
124,510(31.74%) (31.6-31.89%) |
99,389(25.34%) (25.2-25.47%) |
|||
| Unsatisfied |
5298(1.35%) (1.31–1.39%) |
18,903(4.82%) (4.75–4.89%) |
24,362(6.21%) (6.14–6.29%) |
10,398(2.65%) (2.6–2.7%) |
|||
| Completely Unsatisfied |
470(0.12%) (0.11–0.13%) |
2210(0.56%) (0.54–0.59%) |
3555(0.91%) (0.88–0.94%) |
1437(0.37%) (0.35–0.39%) |
|||
Satisfaction levels varied across groups which are shown in Tables 2, 3 and 4, and 5. Males reported higher complete satisfaction with treatment and follow-up (34.6%, 95% CI: 34.4-34.9%) compared to females (33.4%, 95% CI: 33.2-33.5%). Participants with shorter disease durations (< 5 years) expressed greater complete satisfaction in all domains, particularly in treatment and follow-up (35.0%, 95% CI: 34.7-35.3%). Age-wise, satisfaction generally decreased in older groups, with those over 65 years reporting lower levels of complete satisfaction in physical health (15.6%, 95% CI: 15.3-15.8%) and social relationships (13.4%, 95% CI: 13.2-13.6%).
Table 2.
Level of satisfaction with the state of treatment and follow-up of treatment interventions by the medical staff (Number, percentage, 95% confidence interval)
| Age | Completely Satisfied |
Satisfied | Almost Satisfied | Unsatisfied | Completely Unsatisfied |
|---|---|---|---|---|---|
| < 50 y |
33,637(34.38%) (34.08–34.67%) |
52,058(53.2%) (52.89–53.51%) |
10,629(10.86%) (10.67–11.06%) |
1387(1.42%) (1.34–1.49%) |
140(0.14%) (0.12–0.17%) |
| 50–60 y |
42,467(33.63%) (33.37–33.89%) |
67,820(53.71%) (53.43–53.98%) |
14,143(11.2%) (11.03–11.37%) |
1706(1.35%) (1.29–1.41%) |
137(0.11%) (0.09–0.13%) |
| 60–65 y |
23,911(33.74%) (33.39–34.08%) |
37,902(53.48%) (53.11–53.84%) |
8021(11.32%) (11.08–11.55%) |
945(1.33%) (1.25–1.42%) |
96(0.14%) (0.11–0.16%) |
| > 65 y |
32,489(33.42%) (33.12–33.72%) |
52,292(53.79%) (53.48–54.1%) |
11,082(11.4%) (11.2–11.6%) |
1257(1.29%) (1.22–1.36%) |
97(0.1%) (0.08–0.12%) |
| Gender | |||||
| Male |
45,019(34.64%) (34.38–34.9%) |
68,775(52.92%) (52.65–53.19%) |
14,113(10.86%) (10.69–11.03%) |
1892(1.46%) (1.39–1.52%) |
170(0.13%) (0.11–0.15%) |
| Female |
87,499(33.36%) (33.18–33.54%) |
141,326(53.88%) (53.69–54.07%) |
29,769(11.35%) (11.23–11.47%) |
3406(1.3%) (1.26–1.34%) |
300(0.11%) (0.1–0.13%) |
| Duration of disease | |||||
| < 5 y |
44,500(35%) (34.74–35.26%) |
67,764(53.29%) (53.02–53.57%) |
13,397(10.54%) (10.37–10.71%) |
1381(1.09%) (1.03–1.14%) |
107(0.08%) (0.07–0.1%) |
| 5–10 y |
43,114(36.09%) (35.81–36.36%) |
61,370(51.37%) (51.08–51.65%) |
13,138(11%) (10.82–11.17%) |
1703(1.43%) (1.36–1.49%) |
151(0.13%) (0.11–0.15%) |
| > 10 y |
44,904(30.83%) (30.59–31.07%) |
80,967(55.59%) (55.34–55.85%) |
17,347(11.91%) (11.74–12.08%) |
2214(1.52%) (1.46–1.58%) |
212(0.15%) (0.13–0.17%) |
| Year | |||||
| 1397 |
33,708(29.48%) (29.21–29.74%) |
63,418(55.46%) (55.17–55.75%) |
15,355(13.43%) (13.23–13.63%) |
1683(1.47%) (1.4–1.54%) |
190(0.17%) (0.14–0.19%) |
| 1398 |
53,086(34.55%) (34.32–34.79%) |
80,663(52.51%) (52.26–52.76%) |
17,498(11.39%) (11.23–11.55%) |
2220(1.45%) (1.39–1.5%) |
161(0.1%) (0.09–0.12%) |
| 1399 |
37,456(36.94%) (36.65–37.24%) |
53,485(52.75%) (52.45–53.06%) |
9173(9.05%) (8.87–9.22%) |
1180(1.16%) (1.1–1.23%) |
92(0.09%) (0.07–0.11%) |
| 1400 |
8268(36.1%) (35.48–36.73%) |
12,535(54.74%) (54.09–55.38%) |
1856(8.1%) (7.75–8.46%) |
215(0.94%) (0.81–1.06%) |
27(0.12%) (0.07–0.16%) |
| Total |
132,518(33.78%) (33.63–33.93%) |
210,101(53.56%) (53.4-53.72%) |
43,882(11.19%) (11.09–11.29%) |
5298(1.35%) (1.31–1.39%) |
470(0.12%) (0.11–0.13%) |
Table 3.
Level of satisfaction with physical health and control of disease complications (pain, tingling, hyperhidrosis, infection, etc.) (Number, percentage, 95% confidence interval)
| Age | Completely Satisfied |
Satisfied | Almost Satisfied | Unsatisfied | Completely Unsatisfied |
|---|---|---|---|---|---|
| < 50 y |
16,971(17.34%) (17.11–17.58%) |
55,841(57.07%) (56.76–57.38%) |
20,731(21.19%) (20.93–21.44%) |
3872(3.96%) (3.83–4.08%) |
436(0.45%) (0.4–0.49%) |
| 50–60 y |
20,962(16.6%) (16.4-16.81%) |
68,599(54.33%) (54.05–54.6%) |
29,920(23.69%) (23.46–23.93%) |
6102(4.83%) (4.71–4.95%) |
690(0.55%) (0.51–0.59%) |
| 60–65 y |
11,759(16.59%) (16.32–16.87%) |
37,999(53.61%) (53.25–53.98%) |
17,061(24.07%) (23.76–24.39%) |
3579(5.05%) (4.89–5.21%) |
477(0.67%) (0.61–0.73%) |
| > 65 y |
15,117(15.55%) (15.32–15.78%) |
52,292(53.79%) (53.48–54.1%) |
23,860(24.54%) (24.27–24.81%) |
5341(5.49%) (5.35–5.64%) |
607(0.62%) (0.57–0.67%) |
| Gender | |||||
| Male |
22,091(17%) (16.79–17.2%) |
71,821(55.26%) (54.99–55.53%) |
29,386(22.61%) (22.38–22.84%) |
5896(4.54%) (4.42–4.65%) |
775(0.6%) (0.55–0.64%) |
| Female |
42,721(16.29%) (16.15–16.43%) |
142,933(54.49%) (54.3-54.68%) |
62,204(23.71%) (23.55–23.88%) |
13,007(4.96%) (4.88–5.04%) |
1435(0.55%) (0.52–0.58%) |
| Duration of disease | |||||
| < 5 y |
21,697(17.06%) (16.86–17.27%) |
72,620(57.11%) (56.84–57.39%) |
27,292(21.46%) (21.24–21.69%) |
4875(3.83%) (3.73–3.94%) |
665(0.52%) (0.48–0.56%) |
| 5–10 y |
23,335(19.53%) (19.31–19.76%) |
62,055(51.94%) (51.66–52.22%) |
27,685(23.17%) (22.93–23.41%) |
5688(4.76%) (4.64–4.88%) |
713(0.6%) (0.55–0.64%) |
| > 10 y |
19,780(13.58%) (13.41–13.76%) |
80,079(54.98%) (54.73–55.24%) |
36,613(25.14%) (24.92–25.36%) |
8340(5.73%) (5.61–5.85%) |
832(0.57%) (0.53–0.61%) |
| Year | |||||
| 1397 |
16,569(14.49%) (14.29–14.69%) |
59,589(52.11%) (51.82–52.4%) |
30,394(26.58%) (26.32–26.83%) |
7057(6.17%) (6.03–6.31%) |
745(0.65%) (0.6–0.7%) |
| 1398 |
26,513(17.26%) (17.07–17.45%) |
83,214(54.17%) (53.92–54.42%) |
35,465(23.08%) (22.87–23.3%) |
7398(4.82%) (4.71–4.92%) |
1038(0.68%) (0.63–0.72%) |
| 1399 |
17,912(17.67%) (17.43–17.9%) |
58,450(57.65%) (57.35–57.96%) |
20,781(20.5%) (20.25–20.75%) |
3894(3.84%) (3.72–3.96%) |
349(0.34%) (0.31–0.38%) |
| 1400 |
3818(16.67%) (16.19–17.15%) |
13,501(58.95%) (58.32–59.59%) |
4950(21.61%) (21.08–22.15%) |
554(2.42%) (2.22–2.62%) |
78(0.34%) (0.27–0.42%) |
| Total |
64,812(16.52%) (16.41–16.64%) |
214,754(54.75%) (54.59–54.9%) |
91,590(23.35%) (23.22–23.48%) |
18,903(4.82%) (4.75–4.89%) |
2210(0.56%) (0.54–0.59%) |
Table 4.
Level of satisfaction with personal (marital) and social relationships (occupational relationships, the cost and outcome of diabetes) (Number, percentage, 95% confidence interval)
| Age | Completely Satisfied |
Satisfied | Almost Satisfied | Unsatisfied | Completely Unsatisfied |
|---|---|---|---|---|---|
| < 50 y |
14,928(15.26%) (15.03–15.48%) |
48,845(49.92%) (49.6-50.23%) |
27,500(28.1%) (27.82–28.39%) |
5908(6.04%) (5.89–6.19%) |
670(0.68%) (0.63–0.74%) |
| 50–60 y |
18,417(14.59%) (14.39–14.78%) |
58,436(46.28%) (46-46.55%) |
40,861(32.36%) (32.1-32.62%) |
7442(5.89%) (5.76–6.02%) |
1117(0.88%) (0.83–0.94%) |
| 60–65 y |
10,238(14.45%) (14.19–14.7%) |
31,733(44.77%) (44.41–45.14%) |
23,516(33.18%) (32.83–33.53%) |
4625(6.53%) (6.34–6.71%) |
763(1.08%) (1-1.15%) |
| > 65 y |
13,015(13.39%) (13.17–13.6%) |
44,209(45.47%) (45.16–45.79%) |
32,605(33.54%) (33.24–33.84%) |
6383(6.57%) (6.41–6.72%) |
1005(1.03%) (0.97–1.1%) |
| Gender | |||||
| Male |
19,456(14.97%) (14.78–15.16%) |
61,221(47.1%) (46.83–47.38%) |
40,021(30.79%) (30.54–31.04%) |
7954(6.12%) (5.99–6.25%) |
1317(1.01%) (0.96–1.07%) |
| Female |
37,144(14.16%) (14.03–14.29%) |
122,021(46.52%) (46.33–46.71%) |
84,489(32.21%) (32.03–32.39%) |
16,408(6.26%) (6.16–6.35%) |
2238(0.85%) (0.82–0.89%) |
| Duration of disease | |||||
| < 5 y |
18,510(14.56%) (14.36–14.75%) |
64,686(50.87%) (50.6-51.15%) |
36,576(28.77%) (28.52–29.02%) |
6439(5.06%) (4.94–5.18%) |
938(0.74%) (0.69–0.78%) |
| 5–10 y |
21,170(17.72%) (17.5-17.94%) |
53,531(44.8%) (44.52–45.09%) |
36,114(30.23%) (29.97–30.49%) |
7537(6.31%) (6.17–6.45%) |
1124(0.94%) (0.89-1%) |
| > 10 y | 16,920(11.62%) | 65,025(44.65%) | 51,820(35.58%) | 10,386(7.13%) | 1493(1.03%) |
| (11.45–11.78%) | (44.39–44.9%) | (35.33–35.83%) | (7-7.26%) | (0.97–1.08%) | |
| Year | |||||
| 1397 |
15,037(13.15%) (12.95–13.35%) |
49,004(42.85%) (42.57–43.14%) |
39,490(34.53%) (34.26–34.81%) |
9361(8.19%) (8.03–8.34%) |
1462(1.28%) (1.21–1.34%) |
| 1398 |
23,167(15.08%) (14.9-15.26%) |
72,543(47.22%) (46.97–47.47%) |
48,222(31.39%) (31.16–31.62%) |
8442(5.5%) (5.38–5.61%) |
1254(0.82%) (0.77–0.86%) |
| 1399 |
15,254(15.05%) (14.83–15.27%) |
49,974(49.29%) (48.98–49.6%) |
29,967(29.56%) (29.28–29.84%) |
5492(5.42%) (5.28–5.56%) |
699(0.69%) (0.64–0.74%) |
| 1400 |
3142(13.72%) (13.27–14.17%) |
11,721(51.18%) (50.53–51.83%) |
6831(29.83%) (29.24–30.42%) |
1067(4.66%) (4.39–4.93%) |
140(0.61%) (0.51–0.71%) |
| Total |
56,600(14.43%) (14.32–14.54%) |
183,242(46.71%) (46.56–46.87%) |
124,510(31.74%) (31.6-31.89%) |
24,362(6.21%) (6.14–6.29%) |
3555(0.91%) (0.88–0.94%) |
Table 5.
Level of satisfaction with participation and education on how to improve health (self-care and diabetes awareness) (Number, percentage, 95% confidence interval)
| Age | Completely Satisfied |
Satisfied | Almost Satisfied | Unsatisfied | Completely Unsatisfied |
|---|---|---|---|---|---|
| < 50 y |
20,086(20.53%) (20.27–20.78%) |
52,003(53.15%) (52.83–53.46%) |
22,872(23.37%) (23.11–23.64%) |
2495(2.55%) (2.45–2.65%) |
395(0.4%) (0.36–0.44%) |
| 50–60 y |
26,139(20.7%) (20.48–20.92%) |
64,298(50.92%) (50.64–51.2%) |
32,129(25.44%) (25.2-25.68%) |
3280(2.6%) (2.51–2.69%) |
427(0.34%) (0.31–0.37%) |
| 60–65 y |
14,581(20.57%) (20.28–20.87%) |
35,653(50.3%) (49.94–50.67%) |
18,574(26.21%) (25.88–26.53%) |
1815(2.56%) (2.44–2.68%) |
252(0.36%) (0.31–0.4%) |
| > 65 y |
18,940(19.48%) (19.23–19.73%) |
49,313(50.72%) (50.41–51.04%) |
25,796(26.53%) (26.26–26.81%) |
2805(2.89%) (2.78–2.99%) |
363(0.37%) (0.34–0.41%) |
| Gender | |||||
| Male |
27,158(20.9%) (20.67–21.12%) |
66,824(51.42%) (51.14–51.69%) |
31,898(24.54%) (24.31–24.78%) |
3599(2.77%) (2.68–2.86%) |
490(0.38%) (0.34–0.41%) |
| Female |
52,588(20.05%) (19.9–20.2%) |
134,475(51.27%) (51.08–51.46%) |
67,491(25.73%) (25.56–25.9%) |
6799(2.59%) (2.53–2.65%) |
947(0.36%) (0.34–0.38%) |
| Duration of disease | |||||
| < 5 y |
25,755(20.26%) (20.03–20.48%) |
69,178(54.41%) (54.13–54.68%) |
28,686(22.56%) (22.33–22.79%) |
3057(2.4%) (2.32–2.49%) |
473(0.37%) (0.34–0.41%) |
| 5–10 y |
28,567(23.91%) (23.67–24.15%) |
59,332(49.66%) (49.38–49.94%) |
28,091(23.51%) (23.27–23.75%) |
3064(2.56%) (2.47–2.65%) |
422(0.35%) (0.32–0.39%) |
| > 10 y |
25,424(17.46%) (17.26–17.65%) |
72,789(49.98%) (49.72–50.23%) |
42,612(29.26%) (29.02–29.49%) |
4277(2.94%) (2.85–3.02%) |
542(0.37%) (0.34–0.4%) |
| Year | |||||
| 1397 |
22,204(19.42%) (19.19–19.65%) |
56,290(49.22%) (48.93–49.51%) |
31,626(27.66%) (27.4-27.92%) |
3582(3.13%) (3.03–3.23%) |
652(0.57%) (0.53–0.61%) |
| 1398 |
34,233(22.28%) (22.07–22.49%) |
77,203(50.25%) (50-50.5%) |
37,687(24.53%) (24.32–24.75%) |
4080(2.66%) (2.58–2.74%) |
425(0.28%) (0.25–0.3%) |
| 1399 |
19,042(18.78%) (18.54–19.02%) |
55,096(54.34%) (54.04–54.65%) |
24,645(24.31%) (24.04–24.57%) |
2317(2.29%) (2.19–2.38%) |
286(0.28%) (0.25–0.31%) |
| 1400 |
4267(18.63%) (18.13–19.14%) |
12,710(55.5%) (54.86–56.14%) |
5431(23.72%) (23.16–24.27%) |
419(1.83%) (1.66-2%) |
74(0.32%) (0.25–0.4%) |
| Total |
79,746(20.33%) (20.2-20.46%) |
201,299(51.32%) (51.16–51.47%) |
99,389(25.34%) (25.2-25.47%) |
10,398(2.65%) (2.6–2.7%) |
1437(0.37%) (0.35–0.39%) |
As shown in Tables 2, 3 and 4, and 5, there were fluctuations in satisfaction levels over the study period. Participants surveyed in 1399 (2020–2021) reported the highest levels of complete satisfaction in treatment and follow-up (36.9%, 95% CI: 36.7-37.2%). Satisfaction in physical health was more consistent but lowest in 1397 (52.1%, 95% CI: 51.8-52.4%) and highest in 1399 (54.3%, 95% CI: 54.0-54.7%). Personal and social relationship satisfaction remained relatively stable, with only minor year-to-year variation.
Discussion
In this study, most participants were female, aged between 50 and 60 years old, and had diabetes since more than ten years ago. Time of data collection had an overlap with the COVID-19 pandemic in 1399 (from spring 2020), and number of participants in 1400 were the least, and relatively low, as the data was collected only in the spring of 2021.
The highest satisfaction among four domains was observed in treatment and follow-up by medical staff, while the lowest was related to personal and social relationships. The high satisfaction levels in treatment and follow-up suggest that healthcare providers are meeting patients’ expectations effectively in this domain. However, lower satisfaction rates in other domains highlights the need for a more holistic approach to patient care that addresses broader aspects of well-being, especially in older populations.
High levels of satisfaction with treatment and follow-up in Iran aligns with previous research. For instance, a cross-sectional study on patient satisfaction with the Diabetes Control and Prevention Program in Tehran by Tayefi et al., 68% of patients had high satisfaction, particularly in continuity of care, the professionalism of staff, and service effectiveness [18]. Similarly, Najafi et al. reported 87.9% satisfaction among type 2 diabetes patients in Isfahan [17]. This high rate of satisfaction is also seen in some other health-care services in Iran, such as family physician and governmental clinics in South‑West of Iran [19], and the urban family physician program in Fars and Mazandaran provinces [20].
Despite statistically significant differences in satisfaction levels with treatment across age groups, based on the number of patients in different satisfaction levels and study population, the clinical impact is probably minimal. This finding suggests that age does not substantially influence satisfaction in this domain. In contrast, other studies have identified a direct relationship between age and strong satisfaction level of treatment [21, 22]. For instance, a study in Tanzania found that younger patients were less satisfied with diabetes care compared to older individuals [23]. A study on diabetic patients in Jordan showed the same results [24].
In other domains, satisfaction varied more noticeably across age groups. Satisfaction with physical health and complication management showed statistically significant differences exceeding 1% between patients under 50 years of age and older groups. Based on the differences and number of patients, this statistical difference is relatively significant in clinical practice. This may be attributed to the duration of the disease and age-related physical complications. A similar trend was observed in satisfaction with personal and social relationships and satisfaction with participation and education in health promotion, where younger patients (< 50 years) reported higher satisfaction levels compared to older groups. As a study on elderly has shown, strong life satisfaction level is significantly associated with higher levels self-perceived health and physical functioning [25]. So, younger individuals who likely have better physical conditions, higher motivation, and fewer limitations have stronger levels of satisfaction. Simultaneously, according to Kim et al. strongest levels of life satisfaction led to better subsequent outcomes in psychosocial well-being and physical health [26]. So, a bidirectional association between satisfaction and physical and mental health contributing to a positive cycle of health enhancement should be considered in healthcare planning.
Gender differences in satisfaction were minimal, with overlapping 95% confidence interval in some domains and differences of less than 1% across all domains. So, while statistically significant due to the large sample size, these differences were not clinically meaningful. This suggests that care provision, follow-up, access to services, and challenges faced by diabetic patients are generally independent of gender. However, findings from other regions reveal mixed results. For instance, studies in Shiraz reported greater satisfaction among men with healthcare [27]. Similarly, studies in Jordan and Egypt showed stronger treatment satisfaction levels in men [24, 28]. On the other side, research from Italy and Malaysia presented contrasting trends regarding gender-related satisfaction [14, 29]. Also, a study in Abha, Saudi Arabia to assess patients’ satisfaction with the care provided at the Chronic Diseases Clinic, showed higher proportions of dissatisfaction among male diabetics [30]. These differences might be due to differences in gender roles and societal expectations across cultures [22].
A significant inverse relationship was observed between satisfaction levels in all four domains and the duration of diabetes. Satisfaction decreased significantly as the duration of diabetes increased from less than 5 years to 5–10 years and beyond 10 years. This decline may be linked to age-related factors, prolonged disease-related complications, reduced resilience, and greater fatigue with treatment regimens. Patients and their families may also struggle to maintain adherence over time. Previous studies on life satisfaction and chronic disease support this observation, by reporting that having a chronic disease is related to life dissatisfaction [31], with different predictors based on the particular disease [32].
Temporal trends revealed a steady increase in satisfaction levels across all domains over the study years, peaking in 1399 (2020–2021), potentially reflecting improvements in healthcare delivery or policy changes during that period under programs like NPPCD. Such efforts have positively influenced patient perceptions of care quality, despite COVID-19 outbreak in the country. However, incomplete data from 1400 might contribute to underestimation of pandemic-related health and health system changes in a longer period of time, leading to seemingly stronger satisfaction levels despite possible long-term decline.
Patient satisfaction is a key outcome in healthcare, reflecting the quality of care provided. It influences health outcomes, serves as an essential measure of care quality, and plays a vital role in evaluating and managing healthcare systems. The findings of this study provide significant insights into the determinants of patient satisfaction in diabetes care, highlighting the need to designing specific interventions to enhance resilience and capacity in patients and their families, integrating psychosocial support and social work services into diabetes care programs, providing tailored and more effective interventions based on the duration of diabetes, and focusing more on elderly patients to improve satisfaction through targeted services and care. Also, as these interventions are being implemented, continuing periodic satisfaction assessments to monitor trends and identify impactful factors should be done to ensure systematic efforts to enhance patient satisfaction and care outcomes. Although this study is the first nationwide investigation with a large sample size examining the satisfaction levels of diabetic patients, certain limitations may affect its results.
Conducting multi-center studies involves the use of multiple observers, which can lead to variability in patient evaluations. Satisfaction was assessed using single-item questions for each domain, which may reduce internal validity compared to multi-item scales. Additionally, patients’ perceptions of satisfaction may have been influenced by subjective biases. Although training sessions were conducted within the NPPCD framework to standardize caregivers’ explanations of expected responses for each satisfaction domain, this limitation may still have played a role in shaping the results. Overlap of COVID-19 outbreak in Iran and time of this study and limited data of 1400 are other limitations of this study. Future research should explore regional and demographic variations to provide deeper understanding of satisfaction determinants while considering noticeable changes in other sectors of healthcare, as changes that took place in the pandemic.
Conclusion
Diabetic patients need long-term care plan to reach treatment goals. Patient satisfaction enhances disease management, and is a critical indicator of healthcare quality. Using NPPCD data from Iran, this study assessed satisfaction levels across four domains and identified key determinants. Satisfaction levels were not significantly related to gender. However, age groups showed significant differences in all domains except treatment satisfaction, with younger patients generally reporting higher satisfaction levels. All four satisfaction domains demonstrated an inverse relationship with the duration of diabetes. Although satisfaction trends show that ongoing interventions have positively influenced patient satisfaction, these findings emphasize the need for a more holistic approach to diabetes care. Such an approach should address broader aspects of well-being, particularly in domains like personal and social relationships, which exhibited the lowest satisfaction levels. Evaluation of patient satisfaction will help improve care delivery as satisfaction can be considered as an outcome of disease management and quality of care monitoring. Continuing systematic evaluation will lead to better care by identifying trends and suggesting evidence-based strategies.
Acknowledgements
This study has been funded and supported by Tehran university of Medical Sciences (TUMS); Grant no.1401-3-258-57833.
Author contributions
AM, AE and FGh conceived and designed the study. FGh was responsible for data acquisition and coordinated data access from Ministry of Health and Medical Education (MOHME). ND and EGh gathered and cleaned the data. AM performed the analysis. FH drafted the manuscript. All authors read, revised and approved the final manuscript.
Data availability
The datasets are available from corresponding author upon reasonable request.
Declarations
Ethics approval
The study was approved by the Ethical Review Committee at the Tehran University of Medical Sciences (IR.TUMS.THC.REC.1401.043).
Consent for publication
Not applicable.
Conflict of interest
The authors declare no conflict of interest regarding the publication of this paper.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets are available from corresponding author upon reasonable request.