Thesis defence & last presentation of my MPH journey. Alhamdulillah, it was published on "Public Health in Practice". https://www.sciencedirect.com/science/article/pii/S2666535220300367

1. Thesis
Assessment of level of patient satisfaction on medical services
at Government Unani & Ayurvedic Medical College Hospital

2. Presented By:
Dr. Sumaiya Akter Snigdha
ID- 1612846080
Department of Public Health
North South University
Supervised By: Guided By:
Dr. Mohammad Delwer Hossain Hawlader
Ph.D., MPH, MBBS
Associate Professor,
Department of Public Health
• Ms. Segufta Dilshad
EMPH,MDS,BBA
Lecturer
Department of Public Health
• Dr. Shaikh Abdus Salam
MPH, MBBS
Core Faculty
Department of Public Health

3. Operational Definitions
• Patient satisfaction- Patient satisfaction is defined as a degree of congruency
between patient expectations of ideal care and their perceptions of real care
received.
• Expectation- Expectation is a strong belief that something will happen or be
the case in the future.
• Perception- The way in which something is regarded, understood, or
interpreted.
• Experience – It is an event or occurrence which leaves an idea, feeling, or
opinion about something or someone.

4. Operational Definitions
• Doctor- A person with a medical degree whose job is to treat people who are
ill or hurt.
• Traditional medicine- Traditional medicine comprises medical aspects of
traditional knowledge that developed over generations within various societies.
The terms complementary/alternative medicine are used interchangeably with
traditional medicine.
• Unani Medicine- Unani is an Arabic spelling of Ionian, means Greek and
Unani medicine is the traditional system of medicine originated from the
ancient Greek medicine.
• Ayurvedic Medicine- Ayur means life and veda means knowledge/science;
Ayurveda means “Science of life”. It is a system of medicine with historical
roots in the Indian subcontinent.

5. Operational Definitions
• General satisfaction- General satisfaction refers only the main features or
elements; not exact or detailed level of satisfaction. It focuses simply on are
patients satisfied on medical services or not?
• Technical quality- It can have two meanings a. The characteristics of a
product or service that bear on its ability to satisfy stated or implied needs; b. A
product or service free of deficiencies.
• Interpersonal manner- It refers the way of behaving towards others.
• Accessibility- The quality of being easy to approach, reach, enter, speak with,
or use.
• Convenience- The state of being able to proceed with something without
difficulty.

6. Introduction
• Health is the root of all happiness.
• Sound health is a basic physiological need and fundamental right for any
human being.
• The Bangladeshi traditional medicine is an unique conglomerate of different
ethnomedical influences.
• Over the last 2500 years, there have been very strong traditional systems of
medicine such as Chinese, Ayurvedic, and the Unani, born and practiced.

7. Introduction
• Due to the geographic location and sociocultural characteristics of the country,
it involves traditionally rooted elements influenced by local indigenous people
and close-by Ayurveda and Unani medicine.
• Patient satisfaction is defined as a degree of congruency between patient
expectations of ideal care and their perceptions of real care received.
• Periodic monitoring is necessary for identifying the lacunas in the health care
delivery system, to correct the existing work deficiency timely and thereby
improving the quality of services.

8. Justification
• Patient satisfaction has been an area of special interest for researchers involved
in health system research for almost half a century. Countless number of
studies on this important topic has been published since then.
• There are multiple reasons to study the concept of patient satisfaction. It is
considered as an important outcome of the quality of healthcare.
• Patient’s feedback on quality of health care services is very important for health
care organizations because it helps the health care organizations for improving
their service policies, enhancing decision making, meeting patient’s
expectations, framing strategies for better management, monitoring
performance of service providers etc.

9. Justification
• The rising strength of consumerism and quality consciousness in the society
with a shift from doctor-to-patient relationship to modern provider-client
attitude has highlighted the importance of recording patient views on
healthcare delivery.
• Its importance increases further as contemporary consumers are more aware
due to advancements in information technology. Their expectations from
health organizations have increased and priorities changed.
• Getting views of the patients on the care services is a much realistic tool to
evaluate and improve the health care services.

10. Justification
• So, it is important to assess the level
of patient satisfaction on medical
services at Government Unani &
Ayurvedic Medical College Hospital
which could be helpful to influence
the outlook of the policy makers of
our country.

11. At a glance:
• Total rooms -8
• Unani OPD- 3
-Room no. 109,
208, 209
• Ayurvedic OPD- 4
-Room no. 110,
111, 210, 211
• Emergency -1,
-Room no. 108

12. Research Question
What is the level of patient satisfaction on medical services at
Government Unani & Ayurvedic Medical College Hospital?

13. Literature Review
• Patient satisfaction has variable definitions in the literature; according
to some authors, this parameter represents the attitude of patients
towards different aspects of health care.
• The study of Mummalaneni and Gopalakrishna, examines socio
demographic factors such as age, gender, occupation, employment
status, education and income and reveals that income is the only socio-
demographic factor found to have an influence on patient satisfaction.

14. Literature Review
• According to the literature, doctor-patient relationship is the most
significant parameter affecting patient satisfaction. Good doctor–
patient relationship was important for the patient satisfaction. Respect
& politeness, communication skills and technical competence were
strong predictors of patient satisfaction.
• Length of waiting time and administrative procedures were common
predictors for poor patient satisfaction with health care services.

15. Literature Review
• In 2012 Arshad et al. reported that the major dissatisfaction in an out-
patients department was the long waiting time and overcrowded
registration.
• The different attributes of satisfaction from environment are:
comfortable environment, cleanliness, facilities & services, building
and convenient location of the hospital. According to some studies,
the patients were satisfied with the cleanliness of the hospital and
waiting area conditions and the patients had good experience from
availability of doctors in wards and good convenience from duration
of service hours.

16. Literature Review
• Marshall GN, Hays RD. RAND Corporation, developed a Short-Form
Patient Satisfaction Questionnaire (PSQ-18) is derived from the 80-
item Patient Satisfaction Questionnaire (PSQ), which examines
satisfaction with medical care includes 7 subscales: general
satisfaction, technical quality, interpersonal manner, communication,
financial aspects of care, time spent with doctor, and accessibility &
convenience of care.

17. Research
Methodology

18. General Objective
To assess the level of
patient satisfaction on
medical services at
GUAMCH
Specific Objectives
To describe the socio-demographic and
economic characteristics associated with patient
satisfaction among the study population on
medical services at Government Unani &
Ayurvedic Medical College Hospital.
To describe the interpersonal manner,
communication and time spent of service
provider among the study population on
medical services at Government Unani &
Ayurvedic Medical College Hospital.
To assess the satisfaction on technical quality,
financial aspects, accessibility and convenience
of medical services among the study population
at Government Unani & Ayurvedic Medical
College Hospital.

19. List of Variables
Independent Variable Dependent variable
A. Socio-demographic and economic characteristics:
1. Age.
2. Gender.
3. Educational status.
4. Occupation.
5. Marital status.
6. Place of residence.
Patient Satisfaction
(Storngly satisfied, satisfied, uncertain, dissatisfied,
strongly dissatisfied)
B. Technical quality
 Lab test
 Clinical examination
 Availability of medicines
 Free medicine facility
C. Interpersonal manner & Communication.
 Respect
 Explanation of conditions
 Emotional support

20. Independent Variable Dependent variable
D. Financial aspects.
 Cost
 Extra payment
Patient Satisfaction
(Storngly satisfied, satisfied, uncertain, dissatisfied,
strongly dissatisfied)
E. Time spent with doctors.
 Plenty of time
F. Accessibility & convenience.
 Availability of doctors
 Timeliness
 Appropriateness

21. Conceptual Framework
Independent Variable Dependent Variable

23. Data
Collection
tools
Face to face
interviewing
method
Two-part
questionnaires
Bangla
Total score
range 18-90
Five-point
Likert scale
Second part
based on
PSQ-18
First part:
Socio-
demographic
characteristics
PSQ-18
 Developed by Marshall GN, Hays
RD. RAND Corporation
 Derived from the 80-item Patient
Satisfaction Questionnaire(PSQ)
 Total 18 items
 7 subscales

24. Data Management & Analysis Plan
• Scoring of PSQ-18
• After data collection, all interviewed questionnaires will be checked
for its completeness and internal consistency and then double entered
on SPSS 20 version. Data analysis will be performed using T-test, Chi-
square, ANOVA and Pearson’s correlation coefficient on SPSS 20
Version. The data will be presented in percentages, tables, graphs and
charts.

25. • Only investigators has the access on data and hard copies will be preserved for next
three years.
• Double entry on SPSS.
Quality Control & Quality Assuarance
• Ethical Approval will be obtained from Research Committee of NSU and
GUAMCH.
• Informed written consent of the study subject will be obtained.
• The information will dealt with highest confidentiality and used only for this study.
Privacy of the respondents will be strictly maintained.
• It will be ensured to the respondent that this study is not harmful for him/her.
Ethical Considerations

27. Variable Mean(SD) N(%)
Age 2.05(1.06) 18-25 years of age group 64(38.8%)
26-35 years of age group 49(29.7%)
36-45 years of age group 34(20.6%)
46-55 years of age group 15(9.1%)
56 or Above years of age group 3(1.8%)
Gender 1.64(0.48) Male 60(36.4%)
Female 105(63.6%)
Education level 2.14(0.89) No education 10(6.1%)
Upto class 5 26(15.8%)
Class 6-SSC/Equiv. 60(36.4%)
HSC/Equiv. &/or Higher 69(41.8%)
Occupation 1.64(1.19) Unemployed 11(6.7%)
Job 98(59.4%)
Business 23(13.9%)
Student 6(3.6%)
Housewife 27(16.4%)
Marital status 1.4(0.72) Married 89(53.9%)
Unmarried 53(32.1%)
Others(divorced/widowed) 23(13.9%)
Place of residence 0.87(0.34) Dhaka 144(87.3%)
Outside Dhaka 21(12.7%)
Table 1: Socio-demographic characteristics of respondents, (n=165)

28. Chief Complaints Frequency(N) Percentage(%)
Gastro-intestinal
disorders
41 24.8%
Hair and skin
disorders
36 21.8%
Menstrual disorders 32 19.4%
Musculo-skeletal
disorders
23 13.9%
Headache 10 6.1%
Metabolic and
endocrine disorders
8 4.8%
Others 15 9.1%
Table-2: Chief complaints of respondents, (n=165)
Figure 1: Frequency and percentages of Chief complaints of
respondents.

29. Subscales Minimum -Maximum Scores Mean(±SD)
General Satisfaction
Item 3: The medical care I have been receiving is just about perfect.
Item 17: I am dissatisfied with some things about the medical care I receive.
2-10 7.76((±2.15)
Technical Quality
Item 2: I think my doctor’s office has everything needed to provide complete medical care.
Item 4: Sometimes doctors make me wonder if their diagnosis is correct.
Item 6: When I go for medical care, they are careful to check everything when treating and examining me.
Item 14: When I go for medical care, they are careful to check everything when treating and examining me.
4-20 15.38((±3.8)
Interpersonal Manner
Item 10: Doctors act too business like and impersonal towards me.
Item 11: My doctors treat me in a very friendly and courteous manner.
2-10 7.64((±1.98)
Communication
Item 1: Doctors are good about explaining the reason for medical tests.
Item 13: Doctors sometimes ignore what I tell them.
2-10 7.67((±2.04)
Financial Aspects
Item 5: I feel confident that I can get the medical care I need without being set back financially.
Item 7: I have to pay for more of my medical care than I can afford.
2-10 7.30((±1.85)
Time Spent with Doctor
Item 12: Those who provide my medical care sometimes hurry too much when they treat me.
Item 15: Doctors usually spend plenty of time with me.
2-10 7.62(±2.05)
Accessibility & Convenience
Item 8: I have easy access the specialists I need.
Item 9: Where I get medical care, people have to wait too long for emergency medical treatment.
Item 16: I find it hard to get an appointment for medical care right away.
Item 18: I am able to get medical care whenever I need it.
4-20 15.73(±3.9)
Total Patient Satisfaction Score 18-90 69.1(±16.9)
Table-4: Mean and standerd deviation of subscale score and total satisfaction score

30. Figure: Distribution of total patient satisfaction questionnaire/PSQ-18 scores
Here, bar chart represents the
distribution of total scores of 18-items
patient satisfaction questionnaires was
answered by 165 respondents. Total
score range 18-90. Minimum score is 18
and maximum 90. Highest 20.61%
respondents scored 73, that indicates
satisfaction whereas satisfaction level
start from score 72 and range 72-89.99.
Here, Score between 54-71.99 indicates
uncertain and score between 36-53.99
indicates dissatisfaction, score between
18-35.99 indicates strongly dis-
satisfaction on medical services.

31. Level of patient satisfaction
Strongly
dissatisfied,
N(%)
Dissatisfied
N(%)
Uncertain,
N(%)
Satisfied
N(%)
Strongly
Satisfied,
N(%)
Patient Satisfaction 5(3%) 23(13.9%) 2(1.2%) 124
(75.15%)
11(6.67%)
Subscales
General satisfaction 8(4.8%) 20(12.1%) 7(4.2%) 94(57%) 36(21.8%)
Technical quality 5(3%) 23(13.9%) 2(1.2%) 115
(69.7%)
20(21.8%)
Interpersonal
manner
5(3%) 23(13.9%) 2(1.2%) 98(59.3%) 31(18.8%)
Communication 7(4.2%) 21(12.7%) 8(4.8%) 102
(61.8%)
27(16.4%)
Financial aspects 5(3%) 29(17.6%) 15(9.1%) 103
(62.5%)
13(7.9%)
Time spent with
doctors
5(3%) 23(13.9%) 14(8.4%) 97(58.8%) 26(15.8%)
Accessibility &
Convenience
5(3%) 21(12.7%) 3(1.8%) 114(69%) 21(12.7%)
Table-5: Level of patient satisfaction on medical services,(n=165)
Figure: Total Patient satisfaction on five point likert scale

32. Table-6: Association between sociodemographic characteristics and patient satisfaction on medical services, (n=165)
Sociodemographic characteristics Level of Patient Satisfaction p-value
Strongly
dissatisfied, N(%)
Dissatisfied, N(%) Uncertain, N(%) Satisfied, N(%) Strongly
Satisfied, N(%)
Age
(years group)
18-25 1 (0.6%) 7 (4.2%) 2 (1.2%) 47 (28.5%) 7 (4.2%) 0.582
26-35 2 (1.2%) 10 (6.1%) 0(0) 33 (20%) 4 (2.4%)
36-45 2 (1.2%) 4 (2.4%) 0(0) 28 (17%) 0(0)
46-55 0(0) 2 (1.2%) 0(0) 13 (7.9%) 0(0)
56 or above 0 0 0 3(1.8%) 0
Gender Male 2 (1.2%) 8 (4.8%) 2 (1.2%) 48 (29.1%) 0 0.038
Female 3 (1.8%) 15 (9.1%) 0 76 (46.1%) 11 (6.7%)
Education level No education 0 5 (3%) 0 5 (3%) 0 0.010
Upto class 5 0 7 (4.2%) 0 19 (11.5%) 0
Class 6-ssc/equiv. 3 (1.8%) 5 (3%) 0 49 (29.7%) 3 (1.8%)
HSC/Equiv &/
higher
2 (1.2%) 6 (3.6%) 2 (1.2%) 51 (30.9%) 8 (4.8%)
Occupation Job 2 (1.2%) 14 (8.5%) 0 76 (46.1%) 6 (3.6%) 0.000
Business 0 3 (1.8%) 0 20 (12.1%) 0
Student 0 0 2 (1.2%) 4 (2.4%) 0
Housewife 0 4 (2.4%) 0 18 (10.9%) 5 (3%)
Unemployed 3 (1.8%) 2 (1.2%) 0 6 (3.6%) 0
Marital status Unmarried 0 4 (2.4%) 2 (1.2%) 47 (28.5%) 0 0.002
Married 3 (1.8%) 15 (9.1%) 0 65 (39.4%) 6 (3.6%)
Others (divorced /
widow)
2 (1.2%) 4 (2.4%) 0 12 (7.3%) 5 (3%)
Place of residence Dhaka 5 (3%) 18 (10.9%) 2 (1.2%) 111 (67.3%) 8 (4.8%) 0.252
Outside Dhaka 0 5 (3%) 0 13 (7.9%) 3 (1.8%)

33. Interpretation:
A Chi-square test of independence was calculated to see the association between
sociodemographic characteristics and patient satisfaction on medical services,
(n=165).
A significant association was found between patient satisfaction and education
level, χ²(12) =26.205, p =0.01. Respondents of “HSC/equiv. &/higher” group
of education level had higher (30.9%) patient satisfaction than other groups of
education level.
A significant association was found between patient satisfaction and occupation,
χ²(16) =87.2, p=0.000. 98 (59.4%) respondents were job holder and 76 (46.1%)
were satisfied on medical services than others.

34. Table-7: Factors associated with patient satisfaction on medical services by multiple linear regression, (n=165)
Coefficientsa
Model Unstandardized
Coefficients
Standardized
Coefficients
t Sig. 95.0% Confidence
Interval for B
R
squared
value
B Std.
Error
Beta Lower
Bound
Upper
Bound
(Constant) 54.709 7.137 7.665 .000 40.612 68.806
R = 0.312
Adjusted
R²=0.097
Age .069 1.333 .004 .051 .959 -2.565 2.702
Gender -.260 2.830 -.007 -.092 .927 -5.849 5.329
Education level 4.929 1.529 .261 3.224 .002 1.909 7.949
Occupation 2.620 1.183 .185 2.215 .028 .284 4.956
Marital status -.776 1.871 -.033 -.415 .679 -4.471 2.920
Places of residence 1.063 3.968 .021 .268 .789 -6.775 8.900
a. Dependent Variable: Total_score

35. Interpretation:
A multiple linear model was performed to predict level of patient satisfaction based
on sociodemographic characteristics of respondents. A significant regression
equation was found (F(6, 158) = 2.841, p=0.012), with an R² of 0.097. Respondents
predicted
Level of patient satisfaction = 54.709+0.069(Age)-
0.26(Gender)+4.929(Education level) +2.62(Occupation)-0.776(Marital
status)+1.063(Places of residence)
The p value less than 0.05 indicates significant association. Education level and
occupation were significantly associated with patient satisfaction, p= 0.002 and p
=0.028 respectively. We can interpret that, respondents level of patient satisfaction
increase by 4.292 for each unit change of education level and respondents who were
job holder satisfied more than others.

36. Discussion
• According to the results of this study, 75.15% respondents were satisfied on medical
services at Government Unani & Ayurvedic Medical College Hospital whereas 13.9%
were dissatisfied, 6.67% were strongly satisfied, 3% were strongly dissatisfied and 1.2%
were uncertain. The level of patient satisfaction in the current study was much higher than
in many studies such as Hashem Dabaghian F, Khadem I, Ghods R.[66] 66.5%, Asraf et
al.[67] (61% patient satisfaction).
• Seven subscales of PSQ-18 questionnares show different values. 36 (21.8%) respondents
were strongly satisfied on medical services measured by two questions of “General
Satisfaction” subscale. The main areas of patient dissatisfaction were “Financial
Aspects” 29 (17.6%) (e.g lack of free medicine supply, high cost of traditional
medicine, extra expenditure of pathology lab or radiology tests etc), “Interpersonal
manner” 23 (13.9%) (e.g. clear explanation of patients condition), “Communication” 21
(12.7%) (e.g. lack of attention), “Time spent with doctors” 23 (13.9%) (e.g. busy with
another work, in a hurry).

37. Discussion
• Chi-squre test of independence was performed to see the association between
sociodemographic characteristics and patient satisfaction on medical services.
Sociodemographic factor “Age” was categorized into five groups where 18-25
years of age group shows highest patient satisfaction 47 (28.5%) and there is no
significant association found between age and patient satisfaction, (p =0.582).
Kurubaran Ganasegeran, Wilson Perianayagam[68] found (p =0.001), significant
association between age and patient satisfaction.
• The result reflects that, among 165 respondents, female participants were more
105 (63.6%) than males 60 (36.4%). Female oriented health services such as
Gynae & Obstetics, Pediatrics were easily available and accessible. The p value
was found 0.038, <0.05, indicates significant association between patient
satisfaction and gender. Kurubaran Ganasegeran, Wilson Perianayagam [68], Male
patients perceived a signifcantly higher service satisfaction (60.0± 6.9) compared
to females (58.0 ± 5.7) (p =0.005).

38. Discussion
• The study shows that respondents of “HSC/equiv. &/higher” group of
education level had higher patient satisfaction than other groups of
education level. Kurubaran Ganasegeran, Wilson Perianayagam [68],
Patients with high school education exhibited higher service satisfaction
(60.4 ± 8.1) than tertiary graduates (58.4 ± 5.1) (p =0.004). The chi square
test of independence indicates significant association between patient
satisfaction and education level of respondents.
• 98 (59.4%) respondents were job holder and 76 (46.1%) were satisfied on
medical services, there is significant association between patient satisfaction
and occupation, p =0.000 . 65 (39.4%) respondents were satisfied on health
services and were married. p =0.002, indicates a significant association
between patient satisfaction and marital status.

39. Discussion
• Due to easy accessibility and convenience, respondents who live in Dhaka 144 (87.3%)
visit more to seek health services and there is no significant association between patient
satisfaction and place of residence of respondents, p=0.252.
• A multiple linear model was performed to predict level of patient satisfaction based on
sociodemographic characteristics of respondents. A significant regression equation was
found (F(6, 158) = 2.841, p=0.012), with an R² of 0.097. Respondents predicted
Level of patient satisfaction = 54.709+0.069(Age)-0.26(Gender)+4.929(Education level)
+2.62(Occupation)-0.776(Marital status)+1.063(Places of residence)
• The p value less than 0.05 indicates significant association. Education level and
occupation were significantly associated with patient satisfaction, p= 0.002 and p =0.028
respectively.
• We can interpret that, respondents level of patient satisfaction increase by 4.292 for each
unit change of education level and respondents who were job holder satisfied more than
others.

40. Conclusion
• The study reflects that, majority 75.15% of respondents were satisfied
on medical services but major dissatisfaction indicates that respondents
were depriving from some basic services or needs such as lack of free
medicine supply, high cost of traditional medicine, extra expenditure of
pathology lab or radiology tests, staffs busy with another work etc.
Gender, education level, occupation were important correlates of patient
satisfaction. The results shows the present conditions of medical
services at Government Unani & Ayurvedic Medical College Hospital
which could be used to influence the outlook of the policy makers of
our country

41. Limitation & Recommendation
Limitations:
• Study has few limitations.
• Study was done on the outpatient population only.
• The results cannot be generalized to inpatient populations.
• The study describes only medical expectations where non-medical
expectations (such as reception, waiting area, cleanliness etc.) has
huge influence on overall patient satisfaction.

42. Limitation & Recommendation
• Recommendations:
• Major dissatisfaction lies on “financial aspects”, pathology lab and radiology
department should be run and maintain properly.
• Adquate medicine supply should be established so that treatment cost could be
reduced.
• To improve technical quality and communication skill, training program should be
organized.
• The sample size calculated for this study could not be achieved and may affect the
results of the study.
• A larger and representative sample is recommended in future studies to avoid
possible selection bias.
• Regular surveys using different methods are recommended annually to find out
lacunas on medical services and take measures immediately.

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