title: Client satisfaction determinants in four Kenyan slums.
abstract: OBJECTIVE
  In Kenya, gaps exist in health service provision to slum residents, especially service availability and access to quality care. There is also little information on the health status of people living in slums other than in Nairobi. The purpose of this paper is to generate evidence for use in designing interventions to improve health services in four mid-sized slums in Embu, Nyeri and Thika, Kenya.
  
  
  METHODS
  A cross-sectional survey of clients receiving services in health facilities was conducted in the targeted slums. Data were collected through face-to-face interviews. Factor scores were generated using the Rasch model; simple and multivariate logistic regression analyses were done using the R statistical software.
  
  
  RESULTS
  Overall, 81 per cent of the 203 participants reported being satisfied with health services. Most clients (89 per cent) reported that health facility staff greeted them warmly; 82 per cent said their consultation was private. The facility type, waiting time and client experience with service providers determined their satisfaction (p<0.05).
  
  
  CONCLUSIONS
  Healthcare managers can improve client satisfaction levels by understanding the client flow in their facilities and addressing causes of client dissatisfaction, such as long waiting times, while at the same time promoting facilitating factors.
  
  
  CONCLUSIONS
  The authors use latent variable modelling to compute client satisfaction scores, which were dichotomised into two categories and fitted into a logistic regression model to identify factors that influence client satisfaction. Health facility clients in the four slums are satisfied with services and have confidence the providers will serve them in a friendly and professional manner that promotes respect and quality care. The paper recommend healthcare managers in similar settings carry out client flow analysis and institute remedial measures to address long waiting times. Qualitative studies are recommended to determine the reasons behind the high satisfaction levels reported in this study.
authors.affiliation: Monitoring, Evaluation and Research, JHPIEGO, an affiliate of Johns Hopkins University, Nairobi, Kenya.
authors.forename: Jonesmus Mutua
authors.initials: JM
authors.lastname: Wambua
authors.forename: Regina
authors.initials: R
authors.lastname: Mbayaki
authors.forename: Paul Musya
authors.initials: PM
authors.lastname: Munyao
authors.forename: Mark Mugo
authors.initials: MM
authors.lastname: Kabue
authors.forename: Rose
authors.initials: R
authors.lastname: Mulindi
authors.forename: Patrick Mose
authors.initials: PM
authors.lastname: Change
authors.forename: Rudia
authors.initials: R
authors.lastname: Ikamati
authors.forename: Ruth
authors.initials: R
authors.lastname: Jahonga
authors.forename: Rachel
authors.initials: R
authors.lastname: Ambalu
authors.forename: Wamae
authors.initials: W
authors.lastname: Maranga
authors.forename: Mildred
authors.initials: M
authors.lastname: Mudany
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D007630:Kenya; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010549:Personal Satisfaction; D011204:Poverty Areas; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D014505:Urban Population
keywords: Client satisfaction; Health services; Quality care; Rasch model; Service availability; Slum