Patient satisfaction with antiretroviral services at primary health-care facilities in the Free State, South Africa--a two-year study using four waves of cross-sectional data.
BACKGROUND
The study's first objective was to determine the levels of patient satisfaction with services at antiretroviral treatment (ART) assessment sites. Differences in patient satisfaction with several aspects of service over time and among health districts were measured. The second objective was to examine the association between human resource shortages and levels of patient satisfaction with services.


METHODS
Four cross-sectional waves of data were collected from a random sample of 975 patients enrolled in the Free State's public-sector ART programme. One-way analysis of variance (ANOVA) with the Bonferroni adjustment for multiple comparisons was used to assess the differences in patient satisfaction among the Province's five districts and among the four waves of data. Correlation coefficient analysis using Pearson's r was used to assess the association between ART nurse vacancy rates and patient satisfaction with the services provided by nurses over time.


RESULTS
With respect to both general services and the services provided by nurses, our results indicate high overall satisfaction among Free State patients receiving public-sector ART. However, our data present a less positive picture of patient satisfaction with waiting times. Patients in Fezile Dabi District were generally slightly dissatisfied with the waiting times at their assessment sites. In fact, waiting times at assessment sites were the most important predictor of discontent among ART patients. Significant geographical (P < 0.001) and temporal differences (P < 0.005) were observed in these three aspects of patient satisfaction. Patients were most satisfied in Thabo Mofutsanyana District and least satisfied in Motheo District. Patients in Fezile Dabi District were generally slightly dissatisfied with the waiting times at their assessment sites. Finally, our analysis revealed a strong negative association (r = -0.438, P < 0.001) between nurse vacancy rates and mean satisfaction levels with services performed by nurses at baseline. Patients attending facilities with high professional nurse vacancy rates reported significantly less satisfaction with nurses' services than did those attending facilities with fewer vacant nursing posts.


CONCLUSIONS
Collectively, our findings show high levels of patient satisfaction with ART-related services, but also confirm claims by other studies, which have identified human resource shortages as the most important obstacle to a successful South African AIDS strategy.
Department of Sociology and Research Centre for Longitudinal and Life Course Studies, University of Antwerp, Sint-Jacob Street 2, 2000 Antwerp, Belgium. edwin.wouters@ua.ac.be
Edwin
E
Wouters
Christo
C
Heunis
Dingie
D
van Rensburg
Herman
H
Meulemans
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy; D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D002391:Catchment Area, Health; D003151:Community Health Centers / Q000458:organization & administration / Q000592:standards*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D015397:Program Evaluation; D011635:Public Health Administration / Q000592:standards*; D011637:Public Health Nursing / Q000592:standards; D036301:Qualitative Research; D019984:Quality Indicators, Health Care; D017062:Small-Area Analysis; D013019:South Africa; D011795:Surveys and Questionnaires; D014850:Waiting Lists; D000078329:Workforce; D055815:Young Adult
D044966:Anti-Retroviral Agents