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. 2019 Sep 17;11(1):1884. doi: 10.4102/phcfm.v11i1.1884

Trends in patients’ overall satisfaction with healthcare delivery in Accra, Ghana

Stephen T Odonkor 1,✉, Charles Frimpong 2, Emmanuel Duncan 3, Carolyn Odonkor 4
PMCID: PMC6779968  PMID: 31588770

Abstract

Background

Patient satisfaction represents a key marker for the quality of healthcare delivery and is critical for smooth functioning of the healthcare system.

Aim

The aim of this study was to determine the levels of patient satisfaction with the quality of care they receive, and thus identify the key factors that influence patients’ overall satisfaction with healthcare.

Setting

The study was conducted across seven healthcare facilities in Greater Accra region.

Methods

The study employed a cross-sectional design to obtain data from 417 respondents between 01 November 2017 and 31 January 2018. Patient satisfaction within the context and setting of this study refers to the extent to which patients are happy with the healthcare services they receive. Statistical analysis was performed using Statistical Package for the social Sciences (SPSS) version 23.

Results

Female patients constituted 66.7% of the respondents, while 33.3% were male patients. Most of the participants had health insurance coverage (95.2%). Overall, 69.5% of the patients were satisfied with the level of care, 29.3% were somewhat satisfied and 1.2% were not satisfied. Female patients (86.0%) were more satisfied with the level of care they received compared to male patients (61.9%). Majority of the female patients (87.8%) indicated that they were treated with courtesy and respect. However, more than a half (51.8%) of male patients indicated they were not treated with courtesy and respect. Patient satisfaction negatively correlated with social status and age of the patients.

Conclusion

Measurement of patients’ satisfaction is important for healthcare delivery. It was clear from this study that there is still a gap in improving and managing patients’ satisfaction and expectation. All stakeholders must get involved to ensure timely and satisfactory healthcare delivery to all patients.

Keywords: Satisfaction, Healthcare, Patients, Quality, Expectation and rights

Introduction

The importance of patient satisfaction in healthcare delivery cannot be overemphasised. Patient satisfaction is a set of attitudes and perceptions of patients towards health services.1,2 It is the degree to which an individual regards healthcare as useful, effective and beneficial.3,4 In other words, it is the judgement of patients about their needs and expectations met by the care provided,5,6,7 or an evaluation based on the fulfilment of expectations of the user.4 Thus, satisfaction is a psychological state that results when the emotion surrounding disconfirmed expectations is coupled with consumer’s prior feelings about the consumption experience.8 It is actually determined by the interplay of two factors: patient expectations and experience of the real services. If the performance falls short of expectations, there is dissatisfaction, and if it matches the expectations, then vice versa.9 Patient satisfaction is therefore a match of expectations with experiences of the patient during a treatment process.10

Patient satisfaction represents a key marker for the quality of healthcare delivery and this internationally accepted factor needs to be studied repeatedly for smooth functioning of the healthcare system.11,12 It is worth noting that the World Health Organization in 1989 directed all member states to introduce regular assessment of the quality of their health services and to establish principles for quality assurance programmes.13 It is therefore important to evaluate the level, scope and quality of the delivery scheme for possible policy recommendation. A better appreciation of the factors pertaining to client satisfaction would result in implementation of custom made programmes according to the requirements of the patients, as perceived by patients and service providers.14 Patients are the best judges and their inputs are critical in the overall improvement of quality healthcare delivery system.15

In Ghana, the Institutional Care Division of Ghana Health Service has direct responsibility of ensuring healthcare quality. A qualitative analysis of satisfaction with medical services was conducted in 1997 and 2003 as part of the Core Welfare Indicator Questionnaire. It was found that satisfaction had increased from 57.0% in 1997 to 78.6% in 2003, indicating a 21 percentage point increase. However, the level of satisfaction was not scaled but simply defined for persons who consulted health practitioners and cited no problem with the health system.16,17

Several gaps exist within the patient satisfaction domain in Ghana. Although some work has been conducted, work still remains. For example, a holistic assessment of satisfaction across districts regarding the services of a given health provider is virtually non-existent. Yet, it is critical to have integrated information about patient satisfaction in order to aid policy directions and the likes. Secondly, previous studies have investigated into detail patient’s demographic characteristics in relation to patient satisfaction. However, the characteristics such as age, educational level, health status and amount of information conveyed by the health provider are significant predictors of healthcare satisfaction.18

The aim of this article is to first determine the levels of patient satisfaction with the quality of care they receive, and thus identify the key factors that influence patients’ overall satisfaction with healthcare. To achieve our objective, we sought to answer four main questions: (1) What are the satisfaction levels of patients receiving healthcare service? (2) Are there differences in service experiences of healthcare satisfaction between insured and non-insured patients? (3) What are the key factors that influence patients’ overall satisfaction with healthcare? and (4) Does socio-demographic characteristics influence a patient’s level of healthcare satisfaction?

Methods

Description of the study location

The study was conducted in the Greater Accra region, which lies on the south-eastern part of the country. The region occupies a total land area of 3245 km2, which makes it the smallest region of the 10 political regions in Ghana in terms of land size. It has a population density of 1235.8 people per square kilometre. The region is 90.5% urban, with an annual urban growth rate of 3.1%. It experiences more inflows of people from other parts of the country than people moving out the region. The doctor to patient ratio in the region is 1:10 450. Access to healthcare in the region is limited despite progress made by government in improving healthcare; public hospitals remain overcrowded and underfunded.

Study design and sample size

The study employed a cross-sectional design to obtain quantitative data. The study was carried out in seven healthcare facilities in the Greater Accra region of Ghana. A total of 550 questionnaires were distributed across the seven healthcare facilities in the Greater Accra region based on the proportion of the human population within the districts in which the health facilities are located. However, only 417 questionnaires were completely filled and returned, which gave a response rate of 75.81%.

Sampling technique

The study utilised a stratified sampling technique. The total number of respondents in the seven healthcare facilities was obtained through a proportional sampling to size method, based on population census figures within those districts. Thus, in selecting the respondents, sampling proportionate to size was used to determine the number of respondents to be interviewed from each healthcare facility. At the healthcare facility, patients who were present at the facility were considered for the study.

Data collection and procedure

Data collection study took place between November 2017 and January 2018. A standardised structured questionnaire designed to meet the objectives of this research was used for data collection. Field inspection of questionnaire data was carried out daily after the interview was conducted, and any errors were immediately verified and corrected. The survey instrument consisted of 23 questions, including socio-demographic characteristics of respondents, respondents’ experiences at the health facility, respondents’ overall satisfaction of the healthcare received and respondents’ ratings of their experience at the health facilities. The final instrument was administered to the subjects via a self-administered questionnaire method. It took approximately 25–35 minutes to complete the instrument.

Five experts in health measurement and evaluation assisted with the determination of face validity of the instrument. The average overall face validity was equal to 95%. Test reliability for internal consistency was performed using the Cronbach’s alpha test. It was equal to a reliability coefficient of 0.87, which is adjudged high reliability. Cronbach’s alpha is a measure that assesses the internal consistency of a set of scale or test items to ensure that they are all consistent in measuring the same attributes under investigation.

Data handling and analysis

The data were entered into a spreadsheet and later exported to SPSS version 23 and coded for analysis. The analysis included both descriptive and inferential statistics. Descriptive statistics (frequencies, means and standard deviations) were used to describe the variables of interest. Univariate analysis was used in obtaining the frequency of socio-demographic characteristics and other discrete variables of the study population. Data were analysed by contingency table except for t-tests as appropriate for continuous data (e.g. age). The chi-squared (χ2) tests were used to assess the bivariate relationships between these factors as well as for differences in proportions and for other categorical variables. Cramer’s V = 0.208 exact test was used to determine the strength of relationships. Post-hoc analysis was also carried out.19,20 All statistical tests were two-tailed and an alpha value of 0.05 or less was considered statistically significant.

Ethical considerations

Prior to data collection, respondents’ verbal consent was sought. The respondents were informed about the purpose of the study and were made aware that participation was voluntary and refusal to participate in the study would not affect them in anyway. They were assured of confidentiality and informed that they could withdraw from the study at any time and were at liberty not to answer any question they did not want to. All the respondents were advised that completing the survey implied informed consent to use the data for research purposes. In addition, all personal identifiers were removed in the summary data to ensure confidentiality.

Results

In total, 417 respondents were included in the analyses. Table 1 presents the demographic characteristics of the respondents. A higher proportion of respondents were women (n = 278), representing 66.7%, while 33.3% were men. The age of respondents ranged from below 29 to above 61 years, with the majority being below 29 years (69.5%).

TABLE 1.

Demographic characteristics of respondents.

Variable (n = 417) Male
 Female
 Significance level
N % N % X2 p df
Age (years)
≤ 29 98 33.8 192 66.2 - - -
30–40 19 32.8 39 67.2 - - -
41–50 8 19.0 34 81.0 - - -
51–60 12 52.2 11 47.8 - - -
≥ 61 2 50.0 2 50.0 - - -
Total 139 33.3 278 66.7 8.067 0.089 4
Religion
Christian 126 32.6 260 67.4 - - -
Islam 5 29.4 12 70.6 - - -
Traditionalist 8 57.1 6 42.9 - - -
Total 139 33.3 278 66.7 3.772 0.152 2
Ethnicity
Akan 104 30.2 240 69.8 - - -
Ga-Adangbe 13 40.6 19 59.4 - - -
Mole-Dagbon 3 60.0 2 40.0 - - -
Ewe 10 43.5 13 56.5 - - -
Others 9 69.2 4 30.8 - - -
Total 139 33.3 278 66.7 12.458 0.014 df = 4
Marital status
Single 106 31.3 233 68.7 - - -
Married 27 48.2 29 51.8 - - -
Divorced 5 33.3 10 66.7 - - -
Widow or widower 1 14.3 6 85.7 - - -
Total 139 33.3 278 66.7 7.374 0.061 3
Education
Basic 8 40.0 12 60.0 - - -
Secondary 13 33.3 26 66.7 - - -
Tertiary 116 32.6 240 67.4 - - -
Others 2 100.0 0 0.0 - - -
Total 139 33.3 278 66.7 4.490 0.213 3
Employment status
Self-employed 19 35.2 35 64.8 - - -
Employed 31 14.4 185 85.6 - - -
Unemployed 89 60.5 58 39.5 - - -
Total 139 33.3 278 66.7 84.084 0.000 2
First visit to health facility
Yes 71 55.5 57 44.5 - - -
No 68 23.5 221 76.5 - - -
Total 139 33.3 278 66.7 40.723 0.000 1
Health insurance
Yes 130 32.7 267 67.3 - - -
No 9 45.0 11 55.0 - - -
Total 139 33.3 278 66.7 1.287 0.257 1
Sector of Employment
Formal sector 56 26.7 154 73.3 - - -
Informal sector 29 19.6 119 80.4 - - -
Not applicable 54 91.5 5 8.5 - - -
Total 139 33.3 278 66.7 −106.678 0.000 2
Occupation
Teacher or lecturer 12 15.4 66 84.6 - - -
Banker 10 20.8 38 79.2 - - -
Driver 0 0.0 12 100.0 - - -
Others† 6 31.6 13 68.4 - - -
Student 96 51.6 90 48.4 - - -
Trader 15 20.3 59 79.7 - - -
Total 139 33.3 278 66.7 54.359 0.000 5
Social status
Upper class 19 13.7 30 10.8 - - -
Middle class 114 82.0 240 86.3 - - -
Lower class 6 4.30 8 2.9 - - -
Total 139 33.3 278 66.7 1.428 0.490 2
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†

, This included informal workers such as farmers, construction workers and so on.

The majority of respondents were Christians (92.6%), followed by Muslims (4.1%) and Traditionalists (3.4%). In terms of ethnicity, respondents identified themselves as Akans (82.5%), Ga-Adangbes (7.7%), Mole-Dagbons (1.2%), Ewes (5.5%) and from other ethnic groups not stated (3.1%).

Overall, 81.3% of all respondents reported that they were single at the time of the survey, 13.4% reported that they were married and 3.6% reported that they were divorced. A small percentage reported they are widowed (1.7%). The respondents were relatively well educated, with 85.4% having a tertiary education.

In terms of employment, half of the respondents were employed (51.8%) and almost equal number of respondents (50.4%) were working in the formal sector. Almost half (48.2%) were either self-employed or unemployed, and 35.5% of the respondents were working in the informal sector. The majority of respondents (69.3%) had visited the health facility at least once, while 30.7% were visiting for the first time.

Most of the participants had health insurance coverage (95.2%) and reported that they belonged to the middle class in terms of social status (84.9%).

The overall level of satisfaction of care received by patients as obtained from the data analysis is detailed below in Tables 2 and 3. Overall, 69.5% of the patients were satisfied with the level of care, 29.3% were somewhat satisfied and 1.2% were not satisfied. Majority of female patients (86.0%) were satisfied with the level of care they received as compared to the majority of male patients (61.9%) being somewhat satisfied with the level of care (Table 2).

TABLE 2.

Respondents’ overall satisfaction of the care they received.

Variable Satisfied
 Somewhat satisfied
 Not satisfied
 Significance level
N % N % N % X p Cramer’s V
Gender 108.264 0.000 0.510
Male 51 36.7 86 61.9 2 1.4 - - -
Female 239 86.0 36 12.9 3 1.1 - - -
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TABLE 3.

Relationship between satisfaction and health insurance.

Insurance status Satisfied
 Somewhat satisfied
 Not satisfied
N % N % N %
Insured 282 71.0 110 27.7 5 1.3
Non-insured 8 40.0 12 60.0 0 0.0
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Significance level: X = 9.675; p = 0.008; Cramer’s V = 0.152.

For patients who were insured, majority were satisfied with the level of care (71.0%), 27.7% were somewhat satisfied and 1.3% were not satisfied. For patients who were uninsured, the majority were somewhat satisfied (60.0%), 40.0% were satisfied and none indicated to be unsatisfied with the level of care received (Table 3).

Table 4 shows patients’ experience at various health facilities under study. From the table, it can be seen that the majority of patients recognised exceptional service provided by hospital staff (81.1%) and indicated that hospital staff listened carefully to them when they had a question or concern (86.1%). The same trend is seen in positive response to questions on examinations being performed at the right time (72.9%), privacy during examinations (85.1%), non-inducement of workers before being examined (93.5%) and satisfaction with reception (96.2%). However, the majority of patients (61.4%) indicated that they were not given adequate instruction or explanation before examinations were carried out on them.

TABLE 4.

Respondents’ experiences at the health facility.

Descriptions Male
 Female
Yes
 No
 Yes
 No
N % N % N % N %
Is there anyone you would like to recognise for exceptional service? 106 25.4 33 7.9 232 55.6 46 11.0
Did the staff listen carefully to you if you had a question or concern? 113 27.1 26 6.2 246 59.0 32 7.7
Did the staff treat you with courtesy and respect? 67 16.1 72 17.3 244 58.5 34 8.2
Was your examination performed at the right time? 73 17.5 66 15.8 231 55.4 47 11.3
Were you given privacy during your examination? 114 27.3 25 6.0 241 57.8 37 8.9
Were you given adequate instruction or explanation before the examination was carried out? 62 14.9 77 18.5 99 23.7 179 42.9
Was the waiting area comfortable? 61 14.6 78 18.7 153 36.7 125 30.0
Were you directed to where to be at any point in time? 107 25.7 32 7.7 103 24.7 175 42.0
Did you induce the workers before you were examined? 12 2.9 127 30.5 15 3.6 263 63.1
Were you satisfied with the way you were received? 127 30.5 12 2.9 274 65.7 4 1.0
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The majority of female patients (87.8%) indicated that they were treated with courtesy and respect. On the contrary, a higher proportion of male patients (51.8%) indicated otherwise. We also see differences in responses on receiving appropriate directions and comfort of waiting area among the two groups (Table 4).

Table 5 shows the correlation between patient satisfaction and selected demographic variables. From the table, it can be observed that patient satisfaction correlated positively with ethnicity and marital status. However, patient satisfaction negatively correlated with social status and age of the patients.

TABLE 5.

Correlation matrix and descriptive statistics of patient satisfaction and demographics.

Variables PS AG GE RE ET MS ED ES HS SS
Patient satisfaction (PS) 1.000 −0.099* 0.477** 0.118* 0.007 0.009 0.071 0.302** 0.130** −0.012
Age (AG) −0.099* 1.000 0.009 0.057 0.0450 0.478** −0.285** −0.311** −0.026 0.168**
Gender (GE) 0.477** 0.009 1.000 0.076 0.159** 0.037 −0.013 0.302** 0.056 −0.018
Religion (RE) 118.000* 0.057 0.076 1.000 −0.028 0.044 0.039 0.027 −0.060 −0.003
Ethnicity (ET) 0.007 0.045 0.159** −0.028 1.000 0.154** −0.091 −0.012 0.071 −0.188**
Marital status (MS) 0.009 0.478** 0.037 0.044 0.154** 1.000 −0.481** −0.229** −0.040 −0.063
Education (ED) 0.071 −0.285** −0.013 0.039 −0.091 −0.481** 1.000 0.232** −0.029 −0.081
Employment status (ES) 0.302** −0.311** 0.302** 0.027 −0.012 −0.229** 0.232** 1.000 0.043 −0.117*
Health insurance (HS) 0.130** −0.026 0.056 −0.060 0.071 −0.040 −0.029 0.043 1.000 −0.069
Social status (SS) −0.012 0.168** −0.018 −0.003 −0.188** −0.063 −0.081 −0.117* −0.069 1.000
Mean 1.320 27.700 1.330 1.110 1.390 1.260 2.820 2.220 1.050 1.920
Standard deviation 0.491 11.342 0.472 0.405 0.985 0.604 0.507 0.658 0.214 0.380
Kurtosis −0.093 3.438 −1.504 14.269 5.587 7.153 5.817 −0.750 16.107 3.278
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*

, Correlation is significant at the 0.05 level (2-tailed);

**

, Correlation is significant at the 0.01 level (2-tailed).

Discussions

The aim of this study was to determine the levels of patient satisfaction with the quality of care they receive, and thus identify the key factors that influence patients’ overall satisfaction with healthcare. The importance of patient satisfaction within the healthcare delivery system cannot be overemphasised. It is considered as an important outcome of the quality of healthcare.21 Getting views of the patients on the care services is a much realistic tool to evaluate and improve the healthcare services because it is based on direct experiences of the users.22,23,24

In this study, we found that patients were satisfied (69.5%) with the quality of care provided from the seven hospitals. This is similar to findings of patients’ satisfaction studies conducted in a regional hospital in Sunyani, Ghana and a clinic in Glasgow, United Kingdom, where the overall satisfaction of patients with quality of service provided was good.25,26 However, this is contrary to studies conducted in Tanzania, whereby a higher proportion of patients were dissatisfied with the quality of care provided.27,28

This study revealed that female patients’ satisfaction with level of quality of care is higher than that of male patients. Male patients perceived the quality of care received to be somewhat satisfactory (Table 2). A major reason for this observation may be attributed to the fact that men tend to be more impatient and concerned with the speed of the healthcare process than women. These observations suggest the need to target healthcare satisfaction and quality efforts differently for women and men. Thus, the speed of the healthcare process as well as interpersonal aspects of the care process with care providers may be most critical in improving male satisfaction.

The patients’ level of satisfaction was also found to significantly differ by health insurance status. A higher proportion of insured patients were satisfied with the level of healthcare received compared to the uninsured (71% vs. 40%). This was similar to findings from a patient satisfaction study conducted in Sunyani29 and could be attributed to quality of consultation given to each group of patients, waiting times and friendliness of staff towards each group of patients.29

Overall, the majority of patients were generally satisfied with their experience at the health facility (Figure 1). The results from the study demonstrate that the factors that influence overall satisfaction with quality of care are attentiveness to patient’s concern, timeliness of care, professionalism of healthcare staff, respect for patient privacy, comfort of patients and adequate patient knowledge of care being administered. However, there were negative responses from patients about their experiences in all seven hospitals, which revealed that dissatisfaction existed in all factors that influence patient experience and overall satisfaction with quality of care. The negative responses indicated that all patients’ expectations generally were not met. These findings suggest that there is more room for all seven hospitals to improve service quality in relation to these factors.

FIGURE 1.

FIGURE 1

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Respondents’ ratings of their experience at the health facilities.

Generally, it is worth noting that the participants were highly educated, mostly working and had health insurance. These factors could increase the patient expectation for healthcare services and thus their satisfaction with the same as well.

Understanding and measurement of service quality and patients’ satisfaction from the patient’s point of view is important for healthcare delivery because it forms an integral part of the provision of a better and more focused quality service for patients.25 Our findings can contribute to the understanding of how patients perceive certain aspects of quality of the healthcare services and feedback from surveys of this nature can be of considerable policy significance.

Limitations

This study utilised a cross-sectional design, which may present difficulties in ascertaining the direction of causality between the variables analysed. Therefore, caution needs to be taken in the interpretation of the findings with regard to causality. The study might be vulnerable to reporting bias, response bias and selection bias. However, we do not think that this would be a big problem in our study because we used a standardised questionnaire.

Recommendations

A follow-up study is recommended to be conducted among healthcare providers to assess the challenges they face with meeting expectations of patients and improving patient experience. This is important because if patient’s level of satisfaction on quality of care does not meet their standards, patients may decide to seek treatment somewhere else out of the formal health system that may lead to poor health seeking behaviours resulting in poor initial uptake of services, poor adherence, poor retention of services and at the end, this may contribute to high morbidity and mortality.

Finally, in future studies, the factors for patient satisfaction should be suggested by the patients themselves and not just part of a questionnaire, where the factors have already been mentioned. It is recommended that future studies start with qualitative data to identify patient satisfaction factors, and then a follow-up study to develop a validated optimal tool for patient satisfaction.

Conclusion

This study sought to determine the trends in patient satisfaction with the healthcare they receive, and thus identify the key factors that influence patients’ overall satisfaction with healthcare. It was clear from this study that there is still a gap in improving and managing patients’ satisfaction and expectation. All stakeholders must get involved to ensure timely and satisfactory healthcare delivery to all patients. Training on customer service for healthcare workers is important.

Acknowledgements

The authors wish to acknowledge all the research assistants who assisted them with the data collection. They are grateful for their assistance.

Competing interests

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

Authors contributions

S.T.O. conceived the idea, conducted the literature search, analysed the findings and took the lead in writing the manuscript. C.F. contributed to the analysis of the findings. C.O. and E.D. contributed to the writing of the manuscript.

Funding information

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Data availability statement

Data sharing is not applicable to this article as no new data were created or analysed in this study.

Disclaimer

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.

Footnotes

How to cite this article: Odonkor ST, Frimpong C, Duncan E, Odonkor C. Trends in patients’ overall satisfaction with healthcare delivery in Accra, Ghana. Afr J Prm Health Care Fam Med. 2019;11(1), a1884. https://doi.org/10.4102/phcfm.v11i1.1884

References

  • 1.Mulisa T, Tessema F, Merga H. Patients’ satisfaction towards radiological service and associated factors in Hawassa University Teaching and referral hospital, Southern Ethiopia. BMC Health Serv Res. 2017. Dec;17(1):441 10.1186/s12913-017-2384-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Van Der Wouden CH, Carere DA, Maitland-Van Der Zee AH, Ruffin MT, Roberts JS, Green RC. Consumer perceptions of interactions with primary care providers after direct-to-consumer personal genomic testing. Ann Intern Med. 2016. Apr 19;164(8):513–522. 10.7326/M15-0995 [DOI] [PubMed] [Google Scholar]
  • 3.Bird VJ, Giacco D, Nicaise P, et al. . In-patient treatment in functional and sectorised care: Patient satisfaction and length of stay. Br J Psychiatry. 2018. Feb;212(2):81–87. [DOI] [PubMed] [Google Scholar]
  • 4.DeSilva N, Abeyasekera S, Mendis K, Ramanayake J. Patient satisfaction with consultations in ambulatory care settings in Sri Lanka. Med Today. 2006;Oct;4(4):125. [Google Scholar]
  • 5.Ippolito M, Chary A, Daniel M, Barnoya J, Monroe A, Eakin M. Expectations of health care quality among rural Maya villagers in Sololá Department, Guatemala: A qualitative analysis. Int J Equity Health. 2017. Dec;16(1):51 10.1186/s12939-017-0547-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Feo R, Rasmussen P, Wiechula R, Conroy T, Kitson A. Developing effective and caring nurse-patient relationships. Nurs Stand (2014+). 2017. Mar 8;31(28):54. [DOI] [PubMed] [Google Scholar]
  • 7.Wiechula R, Conroy T, Kitson AL, Marshall RJ, Whitaker N, Rasmussen P. Umbrella review of the evidence: What factors influence the caring relationship between a nurse and patient? J Adv Nurs. 2016. Apr;72(4):723–734. 10.1111/jan.12862 [DOI] [PubMed] [Google Scholar]
  • 8.Salihu A, Metin H. The impact of services, assurance and efficiency in customer satisfaction on electronic banking services offered by banking sector. J Internet Bank Commer. 2017. Oct 16;22(3):1–2. [Google Scholar]
  • 9.Singh A, Prasher A. Measuring healthcare service quality from patients’ perspective: Using Fuzzy AHP application. Total Qual Manag Bus. 2019. Feb 17;30(3–4): 284–300. 10.1080/14783363.2017.1302794 [DOI] [Google Scholar]
  • 10.Fortenberry JL Jr, McGoldrick PJ. Internal marketing: A pathway for healthcare facilities to improve the patient experience. Int J Healthc Manag. 2016. Jan 2;9(1):28–33. 10.1179/2047971915Y.0000000014 [DOI] [Google Scholar]
  • 11.Cohen JB, Myckatyn TM, Brandt K. The importance of patient satisfaction: A blessing, a curse, or simply irrelevant? Plastic Reconstr Surg. 2017. Jan 1;139(1):257–261. 10.1097/PRS.0000000000002848 [DOI] [PubMed] [Google Scholar]
  • 12.Vaidyanathan S, Susmitha TS, Rajkumar M, Ganesh A, Balaji SK, Kandaswamy D. Patient satisfaction with dental services at a rural health care center: A questionnaire survey. J Int Oral Health. 2015. Oct 1;7(10):62. [Google Scholar]
  • 13.World Health Organization The world health report 2000: Health systems: Improving performance. Geneva: World Health Organization; 2000. [Google Scholar]
  • 14.Mack JW, Jacobson J, Frank D, et al. . Evaluation of patient and family outpatient complaints as a strategy to prioritize efforts to improve cancer care delivery. Jt Comm J Qual Patient Saf. 2017. Oct 1;43(10):498–507. 10.1016/j.jcjq.2017.04.008 [DOI] [PubMed] [Google Scholar]
  • 15.Al-Abri R, Al-Balushi A. Patient satisfaction survey as a tool towards quality improvement. Oman Med J. 2014. Jan;29(1):3 10.5001/omj.2014.02 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Ghana Statistical Service Ghana core welfare indicators questionnaire (CWIQ) survey 1997/98. Accra, Ghana: GSS; 1997. [Google Scholar]
  • 17.Ghana Statistical Service Ghana core welfare indicators questionnaire (CWIQ) survey. Accra, Ghana: GSS; 2003. [Google Scholar]
  • 18.Chahal H, Mehta S. Modeling patient satisfaction construct in the Indian health care context. Int J Pharm Healthc Mark. 2013. Mar 29;7(1):75–92. 10.1108/17506121311315445 [DOI] [Google Scholar]
  • 19.Garcia-Perez MA, Nunez-Anton V. Cellwise residual analysis in two-way contingency tables. Educ Psychol Meas. 2003. Oct;63(5):825–839. 10.1177/0013164403251280 [DOI] [Google Scholar]
  • 20.Beasley TM, Schumacker RE. Multiple regression approach to analyzing contingency tables: Post hoc and planned comparison procedures. J Exp Educ. 1995. Oct 1;64(1):79–93. 10.1080/00220973.1995.9943797 [DOI] [Google Scholar]
  • 21.Al-Eisa IS, Al-Mutar MS, Radwan MM, Al-Terkit AM, Al-Eisa I. Patients’ satisfaction with primary health care services at capital health region, Kuwait. Middle East J Family Med. 2005;3(3):10–16. [Google Scholar]
  • 22.Michie S, Yardley L, West R, Patrick K, Greaves F. Developing and evaluating digital interventions to promote behavior change in health and health care: Recommendations resulting from an international workshop. J Med Internet Res. 2017. Jun;19(6). 10.2196/jmir.7126 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Dickinson H, O’Flynn J. Evaluating outcomes in health and social care 2e. Bristol: Policy Press; 2016. May 25. [Google Scholar]
  • 24.Corcoran M, Byrne M. Evaluating a primary care psychology service in Ireland: A survey of stakeholders and psychologists. Health Soc Care Community. 2017. May;25(3):1080–1089. 10.1111/hsc.12410 [DOI] [PubMed] [Google Scholar]
  • 25.Peprah AA, Atarah BA. Assessing patient’s satisfaction using servqual model: A case of Sunyani Regional Hospital, Ghana. Int J Bus Soc Res. 2014. Feb 28;4(2):133–143. [Google Scholar]
  • 26.Wisniewski M, Wisniewski H. Measuring service quality in a hospital colposcopy clinic. Int J Health Care Qual Assur. 2005. May 1;18(3):217–228. 10.1108/09526860510594776 [DOI] [PubMed] [Google Scholar]
  • 27.Olomi GA, Mboya IB, Manongi RN. Patients’ level of satisfaction with the health care services received at outpatient departments in Kilimanjaro region, Tanzania. J Patient Care. 2016. Dec;27(1):1–6. [Google Scholar]
  • 28.Khamis K, Njau B. Patients’ level of satisfaction on quality of health care at Mwananyamala hospital in Dar es Salaam, Tanzania. BMC Health Serv Res. 2014. Dec;14(1):400 10.1186/1472-6963-14-400 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.Fenny AP, Enemark U, Asante FA, Hansen KS. Patient satisfaction with primary health care: A comparison between the insured and non-insured under the National Health Insurance Policy in Ghana. Glob J Health Sci. 2014. Jul;6(4):9 10.5539/gjhs.v6n4p9 [DOI] [PMC free article] [PubMed] [Google Scholar]

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Data Availability Statement

Data sharing is not applicable to this article as no new data were created or analysed in this study.

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