Can socio-economic differences explain low expectation of health services among HIV patients compared to non-HIV counterparts?

Abstract

BackgroundThe health service of China has encountered significant challenges due to inequalities in socio-economic determinants of health. HIV patients are known to suffer from social stigma, and may receive inadequate responsiveness from health providers. Before assessing the responsiveness they receive, it is important to know their expectations. We aimed to compare levels of expectation towards the healthcare service among HIV and non-HIV patients with adjustment for socio-economic factors.MethodsA cross-sectional study was conducted during January and February, 2015 among two consecutive groups of HIV positive and non-HIV patients in two hospitals in Kunming, China. Patients’ expectation towards eight domains of health system responsiveness was measured using 40 vignettes; five per domain. Each vignette was ranked from 1 “very good” to 5 “very bad”, and the responses were summed to obtain a total score for each domain. Differences in total scores were compared between the two groups and adjusted for other factors using multiple linear regression.ResultsThe three domains with the highest scores, reflecting high expectation, were prompt attention, basic amenities and choice. Adjusted for other factors, HIV patients had significantly lower levels of expectation in all domains compared to the non-HIV group. Age was associated with the basic amenities domain, with young adults having higher expectations than other age groups. Minority ethnic groups had lower expectation towards dignity, prompt attention and autonomy domains compared to Han ethnicity. Those who lived in a home with 2–4 family members had higher expectations towards confidentiality than those who lived alone.ConclusionPatients with HIV have significantly lower levels of expectations even after adjusting for socio-economic factors. Assessment of health system responsiveness based on their judgments above may give biased results toward favorable service quality.

<p>Comparison Of Expectations For Health Services Between Inpatients From Mental Health Department And Endocrinology Department In China</p>

“…One study comparing healthcare expectations between patients with and without HIV (human immunodeficiency virus infection) showed that disease-related stigma could influence the level of patient expectation and that statistical differences were found in all eight domains of responsiveness. 27 In China, mental disorders are also associated with stigma, and patients with mental disorders are likely to have negative experiences and discrimination when receiving health services. 49,50 However, statistical differences of expectations between patients from the MHD and ED were only detected in two domains in our study.…”

“…However, stigma of HIV is still serious in China 52 and is identified as an explanation for HIV patients' much lower expectations for health services. 27…”

“…24,26 Now the method of vignette has been used as a measurement to patient expectations in several recent studies. 27,28 Each selected vignette provided one scenario of people's experience with health services and tested one domain of health system responsiveness. WZ, a researcher with a Ph.D. degree in Public Health and 7-years of research experience of Chinese mental health policy and services, translated the eight vignettes into simplified Chinese.…”

Comparison of health system responsiveness between HIV and non-HIV patients at infectious disease clinics in Yunnan, China

“…These two hospitals have the largest number of admissions of HIV and non-HIV-infectious patients in Yunnan. 14 …”

“…Our previous study showed that the expectations of HIV patients among the eight domains were lower than that of non-HIV patients, and the assessment of HSR based on HIV patient’s perceptions may give biased results toward the quality of HIV services. 14 Thus, studies are needed to compare differences in HSR based on patients’ experience of health care service simultaneously.…”