Patient satisfaction in primary health
care service .
Maram Banakhar .
Amerah Al-Amri
Hawaa Al- Abdul Aziz
Date : 6/5/2006
Sara Al-Khify
Salma Falatah
Faigah Al-Shibily.
Abstract ..
Primary health care (PHC)can be considered the first
contact between the patient and the health care system .it
includes all the basic health care services provided to every
member of the society. The Research statement is patient
satisfaction of primary health care service.
The aim of this study was to determine patient's level of
satisfaction with the primary health care services in
Jeddah in Al-balad center.The objectives of this study
were:
1- to assess the patients satisfaction level with different
aspects of primary health care services in Jeddah in al
balad center.
2-to determine strategies for improvement as perceived by
the patients .
3-to determine the effect of certain independent variables
on the patients satisfaction level.
The study carried out during the month of April11-42006.The data was collected by questionnaire method. The
study sample consistent of 27 patients were disseminated
randomly in Al- Balad primary health care center and their
age from( 20-60 )year, male and female . The Result (SSPS)
analysis show that the patients were satisfy about the
services of Al –Balad primary care center. Its recommended
that
-2-
Introduction ..
Primary health care (PHC)can be considered the first
contact between the patient and the health care system .it
includes all the basic health care services provided to every
member of the society .thus PHC is essential for attaining
an acceptable level of health for the general public .it also
an integral and critical component of the entire health care
system of any country. Therefore, PHC services should be
accessible and available to the entire population, regardless
of their economic or social class and geographical
location.(Badran A .Al-Omar1999)
The primary health care approach is a relatively new
concept in the kingdom of Saudi Arabia .in 1978 the
kingdom of Saudi Arabia adopted the strategy of (health
for all the year 2000) and in 1984 it began the gradual
implementation of a comprehensive plan of primary health
care.
This step was accompanied by an increase in the number of
health centers all over the kingdom.
(S.A.AL-Shammari1991 )
It is defined by the world health organization as essential
health care made universally accessible to individuals and
families in the community by means acceptable to them
through their full participation and at a cost the
community and the county can afford
(Mansour A.1993and Al-Osimy. M 1993 )
-3-
The elements of PHC , are health education , proper
nutrition and food supply , adequate safe water and basic
sanitation , maternal and child health care , prevention
and control of endemic diseases , treatment of common
diseases , immunization and provision of essential
drugs(WHO,1978)
The modern approach to healthcare seeks to engage the
attention of both patients and the public in developing
healthcare services and equity of access, but this is not easy
to achieve, requiring time, commitment, political support
and cultural change to overcome barriers to change
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retr
ieve&db=pubmed&dopt=Abstract&list_uids=11307115
&itool=iconabstr&query_hl=4&itool=pubmed_docsum
Patient's satisfaction regarding health care has often been
considered as an objective of the health care .It has also
been considered as one of the most important measure for
evaluation outcome in health care. For this reason, nursing
staff play main role in patient's satisfaction regarding to
primary health care center .role of nurses in primary health
care center present as educator, care giver, and counselor,
for this reason all of the nursing staff should be competent
in practical skills, level of education, and interpersonal
relation ship skills. Other factors that may affect patient
satisfaction about primary health care center are medical
services, laboratory services, and pharmacological services.
In our study we focus on nursing services factor.
( Yahia MAQ1997)
-4-
Satisfaction can be defined as the extent of an individual's
experience compared with his or her expectations
Patients' satisfaction is related to the extent to which
general health care needs and condition-specific needs are
met
.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Ret
rieve&db=pubmed&dopt=Abstract&list_uids=11307115
&itool=iconabstr&query_hl=4&itool=pubmed_docsum
Patient dissatisfaction occurs when the patients’
experience of the service falls short of expectations, while
patient satisfaction occurs when the patients’ experience of
the service exceeds their expectation .The importance of the
differentiation is needed because though satisfaction is
essential for keeping high loyalty of the patient,
dissatisfaction is crucial because it may lead to unwanted
patient future behavior. therefore a well designed,
implemented, and used patient satisfaction evaluation
systems expected to help hospital mangers improve both
clinical and managerial activities (badran Al-omar2000)
The purpose of this study was to determine patients' level
of satisfaction with the primary health care services in
Jeddah in
Al -balaad center.
The specific objectives of the study were:
1- To assess the patients satisfaction level with different
aspects of primary health care services in Jeddah in Albalaad center.
2-to determine strategies for improvement as perceived by
the patients.
-5-
3-to determine the effect of certain independent
variables on the patients' satisfaction level
( Al-Mansour A. 1993and Al-Osimy M. 1993).
Methodology ..
The study was carried out in the Al- Balad primary health
care center in Jeddah city. The study carried out during the
month of April11-4- 2006.The data was collected by
questionnaire method. The study sample consistent of 27
patients were disseminated randomly in Al- Balad primary
health care center and their age from( 20-60 )year, male
and female . The Items included in this questionnaire were
socio-demographic data, nursing services data, medical
services data, and general services data such as
(pharmacological services, laboratory services and
appointment services).
(SSPS) software was used for statistical analysis .
-6-
Result ..
Some demographic characteristics of the studied population
and their overall satisfaction with the health services
provided were shown
Variable
Age:
20-30 years
30-40 years
40-60 years
Sex:
male
Female
Martial status:
Married
Single
Widowed
unknown
Occupation:
Student
Employee in government
Employee in private
Unknown
Education level:
Illiterate
Elementary
Intermediate
Secondary
University
Unknown
Total percentage %
Percentage
23.1%
42.3%
43.6%
Percentage
57.7%
42.3%
Percentage
61.5%
19.2%
15.4%
3.8%
Percentage
15.4%
50%
19.2%
15.4%
Percentage
7.7%
11.5%
19.2%
34.6%
23.1%
3.8%
-7-
DOCTNOM * LEVEL Crosstabulation
Count
LEVEL
Doctor
no.
Total
good
bad
yes
8
1
no
14
22
2
3
Total
no
commen
t
9
1
1
17
26
Case Processing Summary
100
11
6
12
90
89
80
82
70
60
50
40
LEVEL
Count
30
20
no comment
10
bad
0
good
yes
no
DOCTNOM
-8-
INVEST * LEVEL Crosstabulation
Count
INVEST.
yes
no
Total
100
LEVEL
good
bad
Total
6
16
22
3
3
no
comment
1
1
14
16
86
84
7
19
26
90
80
70
60
50
40
LEVEL
Count
30
20
no comment
10
bad
0
good
yes
no
INVEST
-9-
DRUGS * LEVEL Crosstabulation
Count
DRUGS
yes
no
Total
100
LEVEL
good
bad
16
6
22
3
3
6
Total
no
comment
1
1
17
9
26
33
94
90
80
70
67
60
50
40
LEVEL
Count
30
20
no comment
10
bad
0
good
yes
no
DRUGS
- 10-
NURSESNO * LEVEL Crosstabulation
Count
NURSES
NO
LEVEL
good
bad
yes
17
3
no
5
22
Total
100
5
Total
3
no
comment
1
21
1
5
26
100
14
90
80
81
70
60
50
40
LEVEL
Count
30
20
no comment
10
bad
0
good
yes
no
NURSESNO
- 11 -
NURSELVL * LEVEL Crosstabulation
Count
LEVEL
good
NURSE
LEVL
yes
14
no
8
22
Total
100
100
90
Total
bad
no
comment
14
3
3
1
1
12
26
8
25
80
70
67
60
50
40
LEVEL
Count
30
20
no comment
10
bad
0
good
yes
no
NURSELVL
- 12 -
NURSSURV * LEVEL Crosstabulation
Count
LEVEL
good
bad
15
7
22
NURES
yes
SURVECES
no
Total
100
Total
2
no
comment
1
18
1
3
1
8
26
6
90
11
80
83
13
88
70
60
50
40
LEVEL
Count
30
20
no comment
10
bad
0
good
yes
no
NURSSURV
- 13 -
EDUCATIO * LEVEL Crosstabulation
Count
Total
LEVEL
good
EDUCATION
litret
elementry
intermediate
secondary
university
1
3
4
9
3
20
Total
100
100
100
20
100
bad
no
comment
1
3
3
1
50
90
80
80
70
60
50
50
40
LEVEL
30
no comment
Count
20
bad
10
0
good
litret
intermediate
elementry
university
secondary
EDUCATIO
- 14 -
1
3
5
9
6
24
OPD * LEVEL Crosstabulation
Count
Total
LEVEl
OPD
telephone
attendance
both
Total
100
good
bad
3
19
3
22
3
100
no
comment
3
22
1
26
1
1
14
100
90
86
80
70
60
50
40
LEVEL
Count
30
20
no comment
10
bad
0
good
telephone
attendance
OPD
- 15 -
both
WTPRFOPD * LEVEL Crosstabulation
Count
good
LEVEL
bad
14
3
WAITING telephone
FOR
OPD
attendanc
e
Total
Total
no
comment
17
8
22
100
3
18
1
9
1
26
11
90
89
80
82
70
60
50
40
LEVEL
Count
30
20
no comment
10
bad
0
good
telephone
attendance
WTPRFOPD
-16-
NRSLSTN * NURSSURV Crosstabulation
Count
NURSE
yes
LISENTING
no
Total
100
NURSE
SURVICE
yes
14
5
19
Total
no
14
8
8
100
13
27
62
90
80
70
60
50
40
38
30
NURSSURV
Count
20
no
10
0
yes
yes
no
NRSLSTN
- 17 -
NURSSURV Crosstabulation
Count
NURSE
EXPLIANATION
yes
NURSSURV
yes
14
no
5
19
8
8
no
Total
100
100
Total
14
13
27
62
90
80
70
60
50
40
38
30
NURSSURV
Count
20
no
10
0
yes
yes
no
NRSEXPL
- 18 -
NURSELVL * NURSSURV Crosstabulation
Count
NURSSURV
yes
yes
11
NURSE
LEVEL
no
Total
8
19
100
Total
no
4
15
4
8
12
27
27
33
90
80
70
73
67
60
50
40
30
NURSSURV
Count
20
no
10
0
yes
yes
no
NURSELVL
- 19 -
NUTSPTRL * NURSSURV Crosstabulation
Count
NURSE PT. yes
RELATION .
no
Total
NURSE
SURVICE
yes
19
no
4
23
19
4
8
4
27
100
17
Total
100
90
80
83
70
60
50
40
30
NURSSURV
Count
20
no
10
0
yes
yes
no
NUTSPTRL
- 20 -
NRSQ * NURSSURV Crosstabulation
Count
NURSE
QUSTIONS
yes
no
Total
100
NURSE
SURVICE
yes
16
3
19
100
Total
no
16
8
8
11
27
73
90
80
70
60
50
40
30
27
Count
20
NURSSURV
10
no
0
yes
yes
no
NRSQ
- 21 -
NURSSURV * HOMEHCR Crosstabulation
Count
NURSE
SURVICE
yes
no
Total
HOME
CARE
yes
18
Total
7
25
7
25
18
20
18
18
16
14
12
10
Count
8
7
6
4
yes
no
NURSSURV
- 22 -
CETRBUSY * LEVEL Crosstabulation
Count
good
CENTER
BUSY
Total
LEVEL
bad
Total
yes
10
1
no
comment
1
no
12
22
2
3
1
100
8
90
8
80
83
12
14
26
14
86
70
60
50
40
LEVEL
Count
30
20
no comment
10
bad
0
good
yes
no
CETRBUSY
- 23 -
Discussion ..
In this study, patients’ sex had no significant effect on
overall satisfaction which conforms with the finding of
many earlier studies (Eiad 1996)
 Patients who respond the physicians number is
enough were 52.9% and their satisfaction were 89% ,
but 58.6% respond no and their satisfaction were
82% .However doctors number in primary health care
center depend on number of services and the
population size serviced by the center
Alblad rejoin very large, also this area very crowded
because, most of the people prefer to live in this area
due to its position in the central rejoin in Jeddah. we
think patient were did not satisfy with number of
doctors was due to large number of patients serviced by
alblad primary health care center.
 Patient how said investigation level was good were
26.9% and their satisfactions were, 86%. Patient
who written investigation level was bad were 73%,
and their satisfactions were 84%.
The cause of unsatisfied patient about level of
investigation may due to two major causes .The first
cause is poor machine technology of laboratory
investigation in the primary health care centers as
general.
- 24 -
The second cause is not all investigation method cane do in
primary health care center.
 Patient who written drug services level was good
were 65.3%, and their satisfaction about this services
was 94%. Patient who written drug services level
was bad were 34.6%, and their satisfaction were 67%
the patient satisfy was good, but the drug services was
bad. May due to patient expectation regarding to drugs
services must be high and available , because alblad
primary health care center take vital place in Jeddah. In
the previous studies reported that problem faced by
patients attending in primary health care centers in Riyadh
city including insufficient drug supply and delayed
laboratory investigations. ( consumers' satisfaction with
primary health care center services in the city of
Jeddah,abdullahH.AL-Doghaither,phD.abdulla
A.Saeed,MD page 451)
Many or most of patients
highlighted to increase availability of investigation and
drug should increase patient satisfaction by improve the
investigations to meet the need of patient and give enough
medication to meet their needs.
 Patients who written nurse number was good were
80.8%, and their satisfaction about nursing services
was 81%. Patients who written nurse's number was
bad were 19.5% and their satisfaction were 100%.
This result represent all patients generally satisfy with
nurse's number and nursing services in Al -Balad primary
health care cente, because government open a lot of nursing
school to meet defect in nursing number in the past. -25-
The Saudi nurses may have a good effect on this result,
because all patients prefer with Saudi nurses. Because no
language barrier between patients and Saudi nurses. Also
Saudi nurse know all patients culture and their needs that
directly affect patient satisfaction regarding their care.
Many primary health care centers physicians (nurses) are
not Arabic –speakers. Thy need a translators to accompany
with them, imposing an extra – financial burden.(a study
of patient satisfaction with primary health care cervices in
Saudi Arabia .M.El Shabrawy All ,ph.D; and M.Ali
Mahmoud.M.D.
There many suggestion like our suggestion in previous
study were raised to improve the services including
provision of specialist care for 50% of patients additional
radiological investigations (41%), additional laboratory
services (35%) and more dentists (33%). About 15-24%
opted for more doctors and nurses, improving emergency
and medical record services and expanding waiting and
parking areas (Eiad 1996)
 53.8 % was the results of patients accept nurse
education level, and their satisfaction with education
level of nurses was 100%.And 46% was the results of
patients didn't accept nurse education level, and their
satisfaction with education level of nurses was 67%.
Generally the patients satisfy with nursing education
level is high. But patients who were didn't accept
nursing education level was also high, due to increase
number of model of education in nursing program
Some nursing program need 3 menthes , 2 years , -26-
3 years, For this reason weak nurses in knowledge may
be present.
 The vital role of nurses in primary health care center
is patient education, for this reason we give this
factor more important than other factors, and we
divide the patient to five groups according to their
level of education.
litret patients who said the patient education level is
good were 4.1%, and their satisfy about this services
were 100%.
Patients in elementary level who said the patient
education level is good were 12.5%, and their satisfaction
about this service were 100%.
Patients in intermediate level who said the patient
education level is good were 20.8%, and their satisfaction
about this service were 80%.
Patients in secondary level who aside the patient
education level is good were 37.5%, and their satisfaction
about this service were 100%
Patients in university level who aside the patient
education level is good were 25%, and their satisfaction
about this service were 50%.
From this result we cane see , when education level
increase , the patient satisfaction on patient education
level become low. Because of patient education increase
the level of patient's acceptation.
-27-
Like Statistic process result patient with university
certification not satisfy (50%) with nursing services
because their expectation bigger than patient their degree
of education below university degree.
 Patients who report preferring to get appointment by
telephone were 11.5% and their satisfaction about
this service was 100%. Patients who report preferring
to get appointment by attendance were 84.6%, and
their satisfy with this services was 86%. Patients
generally satisfy with any way of appointment
method. But complete satisfaction occur to patient
when they take their appointment through telephone
because easier and save time for them.
patients did not accept to make appointment by
telephone may due to this way is new in Saudi primary
health care centers or lack of patients interest to get
appointment with telephone,or because there is no
telephones in their home .
 Patients who report the nurse listens to patient
compliance is enough were 51.87%, and their
satisfaction with this services were 100% .But
patients who report the listens to patients compliance
is not enough were 48.1% ,and their satisfy were 38%
from asking patient we saw less than 50% of patient
dissatisfaction from lisnting skills of nurse for them ,
-28-
so many nurses needed some improvement in their
skill and also education level of nurses not enough they
need more study and practice to know how to
communicate to patient.
So nurses who work in the primary health care centre
should be listen to patient's compliance to decrease patient
anxiety, and to take general assessment from patient to
facilitate physician diagnosis. Also while listening; the
nurse concentrates only on what the patients say and
underlining meaning. (Psychiatric nursing- Boyed)
 Patient who report accepting nurses explanation for
patient needs were 51.9%, and their satisfy with this
services was 100%.But patients who report nurses
explanation for patients not acceptance were 48.1%
and their satisfy with this service was 38%.
(48.1%) of patient approve the nurses not cooperative
with them to explain to them every thing they need to
understand and this consider large percentage and this
affection on patient satisfaction and we think the most
nurses not aware to this point and they need some
courses for help them to improve their skills to reach
information to level of patient in easy way, so nursing
explanation is very important to decrease patients
anxiety.
-29-
 Patients who said nurses' answer the patients
questions were 61.5% and their satisfaction were
100%. Patients who said nurses did not answer
patients question were 42.3%and, their satisfaction
were 27%.Satisfaied patient was more than
unsatisfied. But 42.3% was high for patient report
nurses did not answer patient's questions. We think
this result due to busy in the center or lack of nurse's
knowledge.
 (55.6%) of patient said the nurses level was good
while their satisfaction about this level (73%) on
other hand (44.4%) of patient approve the nurses
level was not good or was not acceptable but they
satisfy (67%) about this level.
most of patient satisfy with nurses level in providing
services but on other hand (44.4%) of patient approve the
nurses level was not acceptable and we think this due to
most of nurses in primary care center under bachelor level
and this give us picture the nurses need to improve their
level of education to improve the level of service provided.
The defect in nurses’ functions, as perceived by patients is
more difficult to solve because currently fewer than 15% of
the nurses working in the Ministry of Health are Saudi
nationals and the nursing profession in Saudi Arabia is
dominated by personnel who do not speak Arabic (Eiad
1996)
-30-
 Patient who said waiting time was long were
65.3%, and their satisfaction were 82%. But
patients who said was no long waiting time were
34.6%, and their satisfaction was 89%. From this
result we can say generally waiting time was long,
and patients dissatisfied may due to center busy.
In other study- patient satisfaction with primary
health care services in Saudi Arabia- found this
result, almost two third( 63.9%) of the
dissatisfaction group complained about the waiting
time in the center. This may reflection of undue
overcrowded, excess non-effective time or
distributed flow of work load (study patient
satisfaction with primary health care services in
Saudi Arabia, Shabrawy,Mhmmode.
 Patients who said center was busy were 46.2%,
and their satisfaction was 83%. Patients were said
center no busy in the center were 53.8%, and their
satisfaction was 86%. Our finding of greater
satisfaction with center not was busy (86%) due
to government give limitation to non Saudi
patients not as before the primary care center was
very crowded by all nationalities of patients,so
center busy is moderate .But the center position in
vital area, so the number of patients served by
albald center should be high. But may due to lack
of patients' confidents in the primary health care
center.
-31-
On other study- patient satisfaction with primary
health care services in Saudi Arabia- find that 16.7%
lost confidence in the primary health care center.
These people prefer to go to hospital directly, to
specialist or to a private practitioner. The cause of
loss of cause confides are multi factors, some of which
are inherent in the personality of the patient, or
genuine deficiencies of the centers.
In previous study we findlarge proportion of patients
identified the ideal health center as one which is not
crowded, has a sufficient stock of drugs, provides free
service, is accessible and has friendly staff who can
communicate in Arabic (Eiad 1996).
 Nurse patient relation ship was approve by patient
(85.2%) was consider good relation ship and just
(14.8%) of patient approve there is no good relation
ship between nurses and patient .
Our finding from research study the most patient
satisfy about relation ship occur between nurse and
patient and this help patient and nurse to seek their
objective and goals from this relationship. major factor
play role in this relation: language of nurse which consider
the major problem in the past to most of patient when deal
with non Saudi patient
-32-
 (72%) of patient wish to include nursing home care to
nursing services.
most of patient want or wish to include home care to
nursing services because this increase satisfaction of
patient due to save time for them and also to decrease the
cost for primary care center.
-33-
Recommendation ..
-34-
-35-
References
Badran A.AL-omar (2000). Patient's expectation,
satisfaction and future behavior in hospitals in Riyadh
city.saudi medical journal 2000,21(7):65665.
.(Badran A .Al-Omar1999)
Eiad A.AL Faris , Etall (1996) patient satisfaction with
accessibility and services offered in Riyadh health centers.
Saudi medical journal 1996:17(1): 11-17.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retr
ieve&db=pubmed&dopt=Abstract&list_uids=11307115
&itool=iconabstr&query_hl=4&itool=pubmed_docsum
(Mansour A.1993and Al-Osimy. M 1993 )
. (S.A.AL-Shammari1991 )
(WHO,1978)
.( Yahia MAQ1997)
-36-