Mac Octagon Journals Advanced Research Journal of Medicine and Medical Sciences. Vol 1(2) pp. 39-55 March, 2017. http://macoctagonjournals.org/arjmms/index.php Copyright © 2017 Mac Octagon Journals
Full Length Research Paper
Clients’ Satisfaction With Physical Environment In HIV Treatment Centers In Anambra State, Nigeria Azuike EC1*, Nwachukwu CC2, Njelita IA2, Aniemena RC3, Udedibia IN3, Adinma ED3, Azuike ED5. 1. Foundation for Health and Development in Nigeria. 2. Department of Community Medicine, Chukwuemeka Odumegwu Ojukwu University and Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Anambra State, Nigeria. 3. Department of Community Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria. 4. Department of Nursing Sciences, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria.
Accepted 20th, March, 2017. Background:The physical environment in health facilities is commonly neglected as a factor that can affect satisfaction with health services because one is more likely to focus on the interaction with health workers and quality of the treatment given. However some studies have demonstrated that the satisfaction with physical environment can affect the overall satisfaction with services at health facilities. Aim: To determine and compare clients’ satisfaction with the physical environment in the urban and rural HIV treatment centres in Anambra State, Nigeria. Results: Majority 932 (84.7%) of the respondents were satisfied with the physical environment at the HIV treatment centres. However a higher proportion of the urban respondents were very satisfied 526 (95.6%), compared with the rural respondents 406 (73.8%). (p = 0.000). The urban respondents were 14 times more likely to be satisfied with physical environment compared with the rural respondents [OR: 14.260 (95% CI: 8.07525.182)]. Conclusion: Majority of the clients were satisfied with the physical environment of the treatment centres however, the urban respondents were more satisfied with the physical environment in their HIV treatment centres than the rural respondents. We recommended renovation and refurbishing of the rural HIV treatment centers.
Keywords: Satisfaction, physical environment, HIV treatment centers.
Corresponding Author:
[email protected]
Emmanuel
Azuike
ARJMMS.
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INTRODUCTION
of the hospital, followed by the comfort of the
Satisfaction with the physical environment in
waiting room and the conditions of the public
which care is delivered has been studied by
toilet.
several authors. The physical environment in
America (USA) reported a high level of patients'
health facilities is commonly neglected as a
satisfaction with cleanliness of the clinic giving
factor that can affect satisfaction with health
an average score of 4.0 out of 5 on a Likert's
services because one is more likely to focus on
scale. Many other studies have reported similar
the interaction with health workers and quality of
findings of high satisfaction with the physical
the treatment given. Sources of satisfaction with
environment of clinics.
the
general
tertiary hospital in Kano, Nigeria reported high
pleasantness of the atmosphere, comfort of
level of patients’ satisfaction with the physical
seating, attractiveness of waiting rooms, clarity
environment of the hospital.
of signs and directions, good lighting, quiet,
clients at a HIV treatment centre in a tertiary
clean, neat, and orderly facilities and equipment.
hospital in Sokoto, Nigeria, were satisfied with
A study done in Eastern Cape, South Africa on
the physical environment.
patients' satisfaction with primary healthcare
satisfaction with physical environment was
services reported high levels of satisfaction with
reported in another tertiary hospital in Bida,
environment
of
care
include
43
29
A study done in Texas, United States of
44
45-46
30
A study done in a
47
Similarly the
Such high level of
50
the physical environment. Seventy two percent
Nigeria.
of the respondents indicated that the clinic
These positive findings are in contrast with the
building was in good condition, 76.1% indicated
findings of a study done in Ethiopia which
that the clinic and its surroundings were clean,
reported that the level of satisfaction of the
73.9% indicated that there were toilets for
patients with the general cleanliness of the
patients in the clinic, 67.5% indicated that the
facility was the least among the different
toilets were in good condition, 65.5% indicated
dimensions of satisfaction investigated.
that the toilets were clean, 71.7% indicated that
similar finding was reported in Uganda where
there were benches for patients to sit while
the second most complained about dimension of
37
satisfaction in the hospitals studied was the
Another study done in Malaysia reported that the
physical structure (buildings). Similarly in Benin
patients were most satisfied with the cleanliness
City, Nigeria, the patients reported high level of
waiting to be seen by the health workers.
51
A
52
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Emmanuel
Azuike
ARJMMS.
dissatisfaction with the physical environment. These
poor
Areas
(LGAs):
Holy
Rosary
Hospital and Maternity Onitsha and Anambra
environment in these Nigerian health facilities in
State University Teaching Hospital Awka. The
contrast to earlier cited Nigerian health facilities
two other centres are located in rural Local
were mainly because of the poor sanitation in
Government Areas: St Joseph's Hospital and
the centres. These may be as a result of the lack
Maternity
of commitment on the part of the management
Community Medicine and Primary Healthcare,
of
Nnamdi Azikiwe University Teaching Hospital,
centres
to
with
Government
physical
such
satisfaction
53
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sanitation.
However
dissatisfaction with physical environment was also
reported
in
Kuwait.
54
Similarly
the
dissatisfaction with physical environment was reported in HIV clinics in South Africa.
55
Adazi-Nnukwu,
and
Centre
for
Ukpo. Study Design: This was a descriptive crosssectional comparative study. Study Population: This comprised of clients
This study aimed at determining and comparing
accessing HIV care services at the four HIV
clients’
treatment centres.
satisfaction
environment
in
the
with urban
the and
physical rural
HIV
treatment centres in Anambra State, Nigeria.
Inclusion Criteria: Clients who have accessed services at the centres on at least three occasions. Clients that were minimum of 18
METHODOLOGY
years old.Clients who gave informed consent.
Study Area: This study was conducted in 4 HIV
Exclusion Criteria: Clients who met all the inclusion criteria but are too sick to respond to questionnaire.
treatment centres in Anambra state of Nigeria. Two of the centres are located in urban Local
Sample Size Determination:
z = standard deviate (1.96)
Using the formula for calculating minimum
p = proportion of patients who perceived the
sample size for comparison of two groups. 2
65
quality
of
care
in
a
General
Outpatient
n = 2z pq 2 d Where:
Department in a tertiary health facility to be
n = minimum sample size
q = 1 - p = 1-0.79 = 0.21
good
41
= 0.79
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Emmanuel
Azuike
ARJMMS.
| 42
d = level of precision = 0.05 ns = n 1-f
calculation: 2
n = 2 X (1.96) X 0.79 X 0.21 2 0.05
Where:
n = 2 X 3.84 X 0.79 X 0.21 0.0025
ns = adjusted minimum sample size n = calculated minimum sample size
n =
1.27 0.0025
f = non-response rate ns =
n = 508 n =
508 1 – 0.02 508 0.98
Adjusting for non-response rate. Adapting a response rate of 98% as reported in
n = 518 To increase the power of the study this was rounded up to 1100
a study on patients' satisfaction with services in a tertiary health facility in Edo state, Nigeria.
9
Therefore a total of 1,100 respondents were
The non-response rate was 2%.
sampled. Hence 550 respondents were sampled
Therefore applying the formula for adjustment
in the urban centres and 550 respondents were
for non-response rate
65
sampled in the rural centres.
Sampling Technique: Two stage sampling
and
technique was used.
University
Stage 1: The HIV treatment centres in Anambra
selected as the rural centres.
State were stratified into urban and rural, based
Stage
on their location. This comprised of 8 urban and
technique was used to select clients using the
6 rural treatment centres. Then, simple random
clinic attendance registers of the HIV treatment
sampling technique was used to select two
centres.Based on preliminary investigations, it
centres from the urban centres and two centres
was discovered that the average monthly
from the rural centres. Holy Rosary Hospital and
attendance of clients who have attained a
Maternity Onitsha and Anambra State University
minimum of 3 visits at the clinics was 500 clients
Teaching Hospital Awka were selected as the
per centre per month.Data collection was over a
urban centres, while St Joseph's Hospital Adazi
period of two months. Hence the number 1,000
Primary
2
Nnukwu and Centre for Community Medicine
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Healthcare,
Teaching
:
Nnamdi
Hospital
Systematic
Azikiwe
Ukpo,
random
were
sampling
Emmanuel
Azuike
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ARJMMS.
was used as the sampling frame. The sample
workers. The reason was to avoid bias. The
size was 275 per centre.
research assistants were university students
Hence the sampling interval "k" was calculated
(eight in number). They were trained for two
thus:
days on the administration and filling of the
K = Sampling frame Sample size
questionnaire.
They
participated
in
the
pretesting in order to consolidate on the training. K =
1,000 275
K = 3.6
The questionnaires were administered by the 4
research assistants to the respondents in the medical records office when they went for next
Hence sampling interval = 4. appointment booking after they had finished On every clinic day, simple random sampling by consultation
with
the
questionnaire
took
about
doctors.
Each
balloting was used to select the first client to be 10
minutes
to
administered the questionnaire from the list of administer. Data collection took place over a clients in the clinic attendance register. After space of two months. Collected data was selecting the first client, every "4th"client was cleaned by checking for any data collection or selected. If any client did not meet the inclusion coding errors. Collected data was entered into criteria, the next client was selected. This International
Business
Machines-Statistical
process was continued until the calculated package for the Social Sciences (IBM-SPSS) minimum sample size was achieved. Version 20.0. In order to ensure quality control, Study
instrument:
A
pre-tested,
semicollected data was entered by two independent
structured,
interviewer
administered individuals into two different computers; also
questionnaire was used to interview the clients. data was saved in external hard drives separate This questionnaire was originally designed by from the computers. the United States Department of Health and Pretesting: Pretesting of all the instruments of Human
Services,
for
patient
satisfaction data collection was conducted at St Charles
66
surveys, this questionnaire was adapted. Some Borromeo Hospital Onitsha, HIV
treatment
modifications were made to this questionnaire. centre. One hundred and fifty clients were Data collection: Eight research assistants were involved in the pretesting. The purpose of the recruited to collect data. They were non health
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Emmanuel
pretesting
Azuike
was
to
ARJMMS.
determine
how
the
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logistic regression analysis. A p-value of
