Abstract
Responsiveness entails the social actions by health providers to meet the legitimate expectations of patients. It plays a critical role in ensuring continuity and effectiveness of care within people centered health systems. Given the lack of contextualized research on responsiveness, we qualitatively explored the perceptions of outpatient users and providers regarding what constitute responsiveness in rural Bangladesh. An exploratory study was undertaken in Chuadanga, a southwestern Bangladeshi District, involving in-depth interviews of physicians (n = 17) and users (n = 7), focus group discussions with users (n = 4), and observations of patient provider interactions (three weeks). Analysis was guided by a conceptual framework of responsiveness, which includes friendliness, respecting, informing and guiding, gaining trust and optimizing benefits. In terms of friendliness, patients expected physicians to greet them before starting consultations; even though physicians considered this unusual. Patients also expected physicians to hold social talks during consultations, which was uncommon. With regards to respect patients expected physicians to refrain from disrespecting them in various ways; but also by showing respect explicitly. Patients also had expectations related to informing and guiding: they desired explanation on at least the diagnosis, seriousness of illness, treatment and preventive steps. In gaining trust, patients expected that physicians would refrain from illegal or unethical activities related to patients, e.g., demanding money against free services, bringing patients in own private clinics by brokers (dalals), colluding with diagnostic centers, accepting gifts from pharmaceutical representatives. In terms of optimizing benefits: patients expected that physicians should be financially sensitive and consider individual need of patients. There were multiple dimensions of responsiveness- for some, stakeholders had a consensus; context was an important factor to understand them. This being an exploratory study, further research is recommended to validate the nuances of the findings. It can be a guideline for responsiveness practices, and a tipping point for future research.
Highlights
The concept of responsiveness is derived from the fields of medical ethics, human rights, and human development [1]
Given the lack of contextualized research on responsiveness, we qualitatively explored the perceptions of outpatient users and providers regarding what constitute responsiveness in rural Bangladesh
It was first used in the context of human resources for health (HRH) by the Joint Learning Initiative on Human Resources for Health, without substantial elaboration [2]
Summary
The concept of responsiveness is derived from the fields of medical ethics, human rights, and human development [1]. It was first used in the context of human resources for health (HRH) by the Joint Learning Initiative on Human Resources for Health, without substantial elaboration [2]. Responsiveness of health workers is important as a right in of its own, while being instrumental to supporting care seeking by patients. Studies show that poor responsiveness may dissuade patients from early care seeking, diminish their interest in adopting preventive health information [5,6,7], and decrease their trust in health service providers [8]. Literature indicates that discourteous behavior from physicians often inhibits care-seeking by the elderly, patients suffering from non-communicable diseases [9], expectant and new mothers [10], and the lesbian-gay-bisexual-transgender (LGBT) community [11,12,13], leading to compromised wellbeing
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