title: Patient satisfaction with doctor-patient interactions: a mixed methods study among diabetes mellitus patients in Pakistan.
abstract: Patient satisfaction with doctor-patient interactions is an indicator of physicians' competence. The satisfaction of diabetes patients is rarely studied in public diabetes clinics of Pakistan. Thus, this study aims to analyse the association between patient satisfaction and five dimensions of medical interaction: technical expertise, interpersonal aspects, communication, consultation time, and access/availability.
  
  
  
  A cross-sectional mixed methods study was conducted during July and August 2015 in the largest public diabetes outpatient clinic in Punjab province. We used the criterion sampling method to identify 1164 patients who: (i) were adult (18 years and above), (ii) had diabetes mellitus, (iii) had made at least three previous visits to the same clinic. The data was collected through face-to-face interviews. The structured part of the questionnaire was based on demographic characteristics and the Patient Satisfaction Questionnaire (PSQ-III). We translated the questionnaire into Urdu and pretested it with 25 patients in a similar context. Data storage and analysis were carried out using SPSS (version 22.0). Bivariate analyses and multinomial logistic regression model were used to generate the quantitative findings. Out of the 1164 eligible patients approached for interviews, 1095 patients completed the structured questionnaire and 186 respondents provided qualitative information in comments section. We conducted a thematic content analysis of qualitative responses in order to explain the quantitative findings.
  
  
  
  Demographic characteristics such as gender, education and occupation were significantly associated with the levels of patient satisfaction. The dimensions of doctor-patient interaction were significantly associated with patient satisfaction: technical expertise (OR = .87; 95% CI = .84-.91), interpersonal aspects (OR = .82; 95% CI = .77-.87), communication (OR = .83; 95% CI = .78-.89), time dimension (OR = .90; 95% CI = .81-.99) and access/availability (OR = .78; 95% CI = .72-.84). Several factors involving doctors' incompetence, such as inappropriate handling of critical cases, inaccurate diagnose, excessive reliance on medical tests, absence of physical examination, non-availability of specialist doctors, and experimentation by trainee doctors were related to patient dissatisfaction.
  
  
  
  The findings of this study highlight a need to develop the interpersonal and clinical skills of doctors in order to improve the quality of doctor-patient interactions in public clinics for diabetes in Pakistan. Prospective researches should explore context-specific factors that form patient satisfaction.
authors.affiliation: Department of Sociology, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan.
authors.forename: Aisha
authors.initials: A
authors.lastname: Jalil
authors.affiliation: Department of Public Health, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan.
authors.forename: Rubeena
authors.initials: R
authors.lastname: Zakar
authors.affiliation: Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan.
authors.forename: Muhammad Zakria
authors.initials: MZ
authors.lastname: Zakar
authors.affiliation: Department of Public Health Medicine, School of Public Health, Bielefeld University, Bielefeld, Germany. f.fischer@uni-bielefeld.de.
authors.forename: Florian
authors.identifier: 0000-0002-4388-1245
authors.initials: F
authors.lastname: Fischer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000592:standards; D003142:Communication; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000628:therapy*; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D036301:Qualitative Research; D058996:Quality Improvement; D012017:Referral and Consultation / Q000592:standards; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Diabetes; Doctor-patient interaction; Pakistan; Patient satisfaction