Predictors of patient-reported quality of care in low- and middle-income countries: a four-country survey of person-centered care

Abstract

Background Person-centeredness is a foundation of high-quality health systems but is poorly measured in low and middle-income countries. We piloted an online survey of four low and middle-income countries (LMICs) to identify the prevalence and correlates of excellent patient-reported quality of care. Methods We administered a cross-sectional online survey using Random Domain Intercept Technology to collect a sample of random internet users across India, Kenya, Mexico, and Nigeria in November 2016. The primary outcome was patient-reported quality of care. Covariates included age, gender, level of education, urban/rural residence, person for whom care was sought, type of provider seen, public or private sector status of the health facility, and type of facility. The exposure was an index of health system responsiveness based on a framework from the World Health Organization. We used descriptive statistics to determine the prevalence of excellent patient-reported quality of care and multivariable Poisson regression to calculate adjusted prevalence ratios (aPR) for predictors of excellent patient-reported quality. Results 14,008 people completed the survey (22.6% completion rate). Survey respondents tended to be young, male, well-educated, and urban-dwelling, reflective of the demographic of the internet-using population. 4,191 (29.9%) respondents sought care in the prior six months. Of those, 21.8% rated their quality of care as excellent. The highest proportion of respondents gave the top rating for wait time (44.6%) while the lowest proportion gave the top rating for facility cleanliness (21.7%). In an adjusted analysis, people who experienced the highest level of health system responsiveness were significantly more likely to report excellent quality of care compared to those who did not (aPR 8.61, 95% CI: 7.50, 9.89). In the adjusted model, urban-dwelling individuals were less likely to report excellent quality compared to rural-dwelling individuals (aPR 0.88, 95% CI: 0.78, 0.99). People who saw community health workers (aPR 1.37, 95% CI: 1.12, 1.67) and specialists (aPR 1.30, 95% CI: 1.12, 1.50) were more likely to report excellent quality than those who saw primary care providers. High perceived respect from the provider or staff was most highly associated with excellent ratings of quality while ratings of wait time corresponded the least. Conclusion Patient-reported quality of care is low in four LMICs, even amongst a well-educated, young population of internet users. Better health system responsiveness may be associated with better ratings of care quality. Improving person-centered care will be an important component of building high-quality health systems in these LMICs.

Health Care Responsiveness by Conventional, Traditional and Complementary Medicine Providers in a National Sample of Middle-Aged and Older Adults in India in 2017–2018

“…This result may be explained by the lower cost of consulting primarily public conventional health care, which are more likely to be utilized by poorer than richer segments of society. 7 Some previous research 3 , 4 , 15 showed an association between younger age, rural residence, female sex, not having health insurance, and difficulties with traveling time and poor health care responsiveness, but we did not find significant differences in our study.…”

“…In comparison, in a four-country study, including India, seen by a pharmacist or drug seller (compared to community health workers and specialists) were more likely to report poor health care quality. 15 Possible explanations for the found differences may be related the better quality of AYUSH and/or THP mainly private services or high expectations among these service users. 8 In addition, large conventional facilities can be compromised with a longer waiting time than smaller AYUSH and THP facilities, and the latter will probably need to build a client base by increasing the quality of nonclinical care provided.…”

“… 4 In a study among middle-aged and older adults in South Africa, poor subjective health status and receipt of health insurance were associated with outpatient health care responsiveness. 3 In a four-country online survey, being from India (compared to Kenya, Mexico and Nigeria), younger age, rural residence and seen by a pharmacist or drug seller (compared to community health workers and specialists) were more likely to report poor health care quality, 15 and in a study among outpatients in Germany having chronic conditions and functional disability were associated with poor health care responsiveness indicators. 6 This study aimed to determine the prevalence and correlates of health care responsiveness by conventional, traditional and complementary medicine providers in middle-aged and older community-dwelling adults from the India Longitudinal Ageing Study in India (LASI) Wave 1 in 2017–2018.…”

Clients satisfaction at primary healthcare facilities and its association with implementation of client service charter in Tanzania

“…Third, investing in strengthening implementation of client service charter will help to improve the PHC facilities responsiveness to client’s needs and expectations and hence, improving person-centred care. A study conducted in four low- and middle- income countries (LMICs) has shown that improvements in person-centred care are essential for a high quality health system [ 58 ].…”

Masks, money, and mandates: A national survey on efforts to increase COVID-19 vaccination intentions in the United States

“…Unlike panel surveys, no incentives are provided and no personally identifiable information is exchanged. RIWI technology has been described as nonprobability, online intercept sampling [ 9 ], and has been previously employed to assess various topics such as health care quality [ 10 – 12 ], mental illness stigma [ 13 – 15 ], and anti-vaccine sentiment [ 16 ].…”