Objectives: The majority (80%) of stroke survivors in Bangladesh have lived with either minor or major physical, emotional, and cognitive disabilities. Due to patients’ poor perceived experience in healthcare services, participation in rehabilitation care has become a significant challenge for them. Consequently, it increases the burden of stroke disability. Therefore, this study aimed to measure the gaps in post-stroke outpatients’ rehabilitation Service Quality (SQ) and factors related to these gaps. Methods: A cross-sectional descriptive study was administered on 311 post-stroke outpatients who were selected by stratified sampling method from 5 divisional centers of a rehabilitation hospital. Data collection tools consisted of the following: a demographic information form and a modified Service Quality (SERVQUAL) questionnaire. Cronbach’s alpha coefficient was applied to analyze the internal consistency. Besides, Pearson’s (r) correlation test was applied to examine the correlation coefficient between the explored items. The obtained data were analyzed by descriptive statistics, Paired Samples t-test, and Eta-statistic (δ) of the Analysis of Variance (ANOVA). Results: Patients’ expectations were rated higher than the perceptions in all dimensions of rehabilitation SQ and indicated a significant gap (t=-29.604, P<0.001). Patients’ occupation (δ=0.189), family status (δ=0.289), pre-stroke daily activities (δ=0.235), and post-stroke disability (δ=0.286) indicated a significant relationship with the gaps in rehabilitation SQ. Discussion: Post-stroke rehabilitation SQ gaps are required to be addressed by considering the factors related to these gaps. Most importantly, the rehabilitation hospital must integrate the continuous quality improvement monitoring systems to enhance SQ as well as patients’ participation in rehabilitation care programs.
Globally, healthcare systems are struggling to make a healthier citizen by dropping infectious and non-infectious diseases. South-east Asian countries have achieved several Millennium Development Goals (MDG) with the efforts of better health system management. For instance, in the year 2015, the healthcare system of Bangladesh has achieved the MDG-Four in reducing the infant mortality rate and growth rate. Even then, the life-threatening diseases still remain as a major challenge to the healthcare systems in Bangladesh. Among those, non-communicable diseases (NCDs) are the major cause of death, and stroke is the second leading NCD in accordance with causes of death and long-term disability in Bangladesh. The majority as 80% of stroke survivors are living with either minor or major physical, emotional, and cognitive disabilities. They could get back to their functional life through comprehensive rehabilitation services. Nevertheless, information on the availability of rehabilitation services is not visible to all citizens of Bangladesh. That’s why more than half of all stroke survivors are dying on their way to the hospital to seek health care facilities. Therefore, the aim of this literature review was to present a clear vision of the healthcare system and the path of care to all citizens of Bangladesh.
Purpose: For enhancing patients’ participation, this study aims to identify the patient-related factors that relate to the expectations and perceptions of post-stroke outpatients’ in the rehabilitation services of Bangladesh. Methods: A questionnaire survey was administered to 342 outpatients from the stroke rehabilitation department. Descriptive statistical analysis was applied to measure patients’ perceptions and expectations. Eta statistic from ANOVA was applied to examine the relationship between patient-related factors and the patients’ expectations and perceptions of the rehabilitation services. Findings: Patients’ expectations rated higher than the perceptions in all the dimensions of rehabilitation services. Factors such as; (i) patients' education (0.222, p=0.005) and post-stroke disability (0.447, p<0.001) indicated a significant relationship with patients' expectations. (ii) Patients' education (0.210, p=0.010), occupation (0.226, p=0.003), family status (0.180, p=0.048) and daily activities before the stroke (0.169, p=0.044), post-stroke disability (0.195, p=0.004) and distance from home to the hospital (0.190, p=0.006) indicated a significant relationship with their perceptions in the rehabilitation services. Conclusion: The findings of this study concluded that the rehabilitation manager needs to work on these factors and recommended developing a continuing education program to minimize these factors of poor perceptions in the rehabilitation services.
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