Perceptions Of Health Services Research Articles

A Pilot Study Comparing Two Measures of Perceived Health Services Access Among Military Veterans With Musculoskeletal Injuries and Mental Health Conditions.

ABSTRACTIntroductionService members endure a number of musculoskeletal injuries (MSIs) during service (e.g., ankle sprains and chronic back pain). Musculoskeletal injuries can reduce engagement in physical activity after military service and contribute to a sedentary lifestyle that diminishes physical health and elevates the risk for psychological distress including suicide-related behaviors. Yet, little is known about barriers and facilitators to accessing care in veterans with co-occurring MSI and mental health conditions. The purpose of this study was to pilot two brief measures of barriers and facilitators to rehabilitation and mental health services in military veterans with musculoskeletal and mental health conditions. Self-report tools vary in their response formats in ways that can impact usability, data quality, and completeness. We examine two response styles (i.e., checklist vs. thermometer) for two health services (mental health and rehabilitation) to determine usability, patterns in item endorsement, and veteran preference.Materials and MethodsBarriers and facilitators informed by the Fortney Veterans Healthcare Access model were assessed by veterans (n = 31) on the newly developed 22-item, paper-and-pencil scale with separate ratings for mental health and rehabilitation services. All participants completed scales with both response styles and the order of administration was randomized (i.e., either the checklist first or the thermometer-style response first). Data also included self-reported demographics, musculoskeletal and mental health diagnoses, health-related quality of life, physical activity levels, mental health symptoms, suicide risk, and coronavirus disease of 2019 pandemic-related stress.ResultsVeterans reported no differences in ease of use across response formats; however, 83.9% (n = 26) preferred the checklist style, with only 3.22% (n = 1) preferring the thermometer format. Checklist items also resulted in less missing data (i.e., range 0.00%-6.45%) than the thermometer-style option (i.e., range 6.45%-61.30%). On the checklist, total number of perceived barriers was low for mental health and rehabilitation services (i.e., M = 1.58 and M = 1.61, respectively). Distance to care and problems related to symptoms were the most frequently identified barriers for both services. Facilitators outnumbered barriers for mental and rehabilitation services, and nearness of the clinic/hospital was the top-rated facilitator for both. On the thermometer, the perceived strength of each mental health (M = 39.37) and rehabilitation (M = 39.81) service barrier was moderate (0-100 scale), while the average perceived strength of each mental health (M = 61.66) and rehabilitation service (M = 61.84) facilitator was higher. Associations between barrier and facilitator scores with mental and physical health indicators were small with exceptions. For instance, suicide attempt likelihood was positively correlated with rehabilitation services barriers; mental health burden was positively associated with both barriers and facilitators.ConclusionsResults of this pilot comparing two measurement approaches identified actionable next steps. Brief barriers and facilitators checklists were viable for veteran ratings across type of health. The thermometer-based tool captured the perceived strength of barriers and facilitators but yielded problematic rates of missing data in its current form and was not preferred by veterans.

Determinants of Community Based Health Insurance Implementation: Evidence from South Gondar Zone, Amhara Region (2020)

Recently in Ethiopia, there is an increasing movement to implement community based mostly insurance theme as integral a part of health care finance and significant movements has resulted within the unfold of the theme in several elements of the country. Despite such increasing effort, recent empirical proof shows entering have remained low. The aim of this study is to spot determinants of enrollment in community based mostly insurance implementation in South Gondar Zone, Amhara region A community based mostly cross sectional survey was conducted to gather information from 1,035 family heads employing a multi-stag sampling technique. A binary logistic regression was accustomed to determine the determinants of family decisions for CBHI enrollment. Out of the participants, (68.17%) were CBHI members. Besides, family size (AOR=2.18; CI=1.13-1.45), average health status (AOR=.590; CI=.281-.906), chronic malady (AOR=4.42; CI=1.92-8.22), theme benefit package adequacy (AOR=3.18; CI=1.90- 6.20), perceived health service quality (AOR=4.69; CI=1.78-7.70), CBHI awareness (AOR=4.78; CI=1.75-15.7), community commonality (AOR = 4.87; CI = 2.06–6.93) and wealth (AOR = 4.52; CI = 1.78–7.94) were vital determinant factors for entering within the community based mostly insurance theme. CBHI awareness, family health condition, community commonality, quality of health service of health organizations and wealth were major factors that almost all confirm the family decisions to register within the system. Therefore, in depth and continuous awareness creation programs on the scheme; stratified premium – supported economic status of households; incorporation of social capital factors, notably building community commonality within the theme implementation are important to boost continuous enrollment. As perceived family health status and therefore the existence of chronic malady were also found vital determinants of enrollment, the government may need to seem for choices to create the theme obligatory.

Customer Satisfaction at Galen House, Bulawayo, Zimbabwe, 2019

Introduction: Healthcare industries have seen recent movements towards continuous quality improvement. The healthcare regulators shifted towards a market-driven approach of turning patient satisfaction surveys into a quality improvement tool for overall organizational performance. Data concerning this has remained limited in private sector in Zimbabwe. Thus, this study aims to determine patients and health workers perception about health services offered at Galen house in order to enable the institution to come up with evidence-based interventions to improve the quality of healthcare services. Methods: This was a descriptive cross sectional study. It was a mixed qualitative and quantitative study involving data collected from patients/ guardians and health workers at Galen House from January 2019 to March of the same year. Data was analysed using Microsoft Excel version 2013. Results: There were a total of 270 patients involved into the study. 173 (64%) perceived the waiting before services as good. 213 (79%) perceived the total waiting time as not long. Privacy 215 (80%) and confidentiality 223 (83%) perceived as good by patients. More than 50% of health workers perceived health services offered at Galen House as good. Staff attitude was perceived as good 191 (71%) by patients in contrary to some instance by health workers. Affordability of services was perceived as manageable. Conclusion: The total waiting time was perceived as not long at Galen House. Staff attitude was perceived differently by patients and health workers. Improving those two will contribute to more utilization of services by the community.

P76 The experiences of and preferences for delivery of outpatient rheumatology services in adults diagnosed with axSpA living in the UK: a qualitative study

Abstract Background Rising healthcare demand for people with rheumatic and musculoskeletal diseases in the UK is set to continue. Delivering sustainable outpatient rheumatology services, with a shift towards remote patient monitoring, virtual consultations, shared decision-making and supported self-management, is now a key NHS priority. Involving patients in outpatient rheumatology services transformation is considered a core prerequisite for success; a first step being to understand the perspectives of and preferences for care of patients with rheumatic and musculoskeletal diseases. Current evidence of perceived health service needs in people with inflammatory arthritis centres on rheumatoid arthritis; understanding about perceptions of people with axial spondyloarthritis (axSpA), in particular younger adults, is limited. The aim of this qualitative study was to explore in depth the experiences of, and preferences for, the delivery of NHS outpatient rheumatology services in adults diagnosed with AxSpA. Methods Five semi-structured focus groups were conducted between 2018 and 2019 with younger (age <45 years) and older (age ≥45 years) adults diagnosed with AxSpA living in the UK. Participants were recruited from the National Ankylosing Spondylitis Society (one group) and hospital outpatient rheumatology clinics in two NHS Trusts in England (four groups). Focus groups were audio-recorded, transcribed verbatim, anonymised and uploaded to NVivo 12. Data were analysed thematically and validated by including deviant accounts and single counting. Initial codes were generated, and subsequent themes developed through iterative discussions among the researchers. Results Thirty-three adults with AxSpA (18 men and 15 women) from diverse ethnic backgrounds and with a range of disease-related characteristics participated in the study. Thirteen participants were aged <45 years (M = 33, SD = 5.88) and twenty were aged ≥45 years (M = 59.6, SD = 9.79). Four key themes were developed from the data: (i) early access to specialist rheumatology services staffed by health professionals with up-to-date knowledge and expertise in AxSpA. ii) preferences for need-based flexibly delivered patient-centred consultations with shared decision-making (specifically in younger adults) and continuity of care that is integrated across providers. iii) opportunities to discuss different treatment options with clinicians (younger adults) and information about rapid access at time of flare (younger and older adults). iv) self-management, including the value of peer support and reliable sources of evidence-based information about AxSpA. Conclusion Focus group members described a picture of inconsistent delivery of NHS rheumatology outpatient services in the UK. Preferences for care in adults with AxSpA largely align with proposals to transform NHS outpatient services and revolve around flexible delivery of patient-centred consultations, underpinned by shared decision-making and supported self-management. However, integrating these preferences into new models of care delivery to ensure optimal patient outcomes will require transformative action. These data can inform local and national developments to reconfigure outpatient services for people with AxSpA. Disclosures N. Wilson None. N. Kaiser None. J. Roose None. R. Martinez None. S. Steer None. H. Lempp None.

SAĞLIK HİZMETİ KALİTESİNİN ÖLÇÜMÜNDE SERVQUAL SKORLARININ KULLANILDIĞI TEZLER ÜZERİNE BİR ARAŞTIRMA

The study was aimed at reviewing the postgraduate theses in which Servqual scores were used to measure the quality of perceived health service and comparing the scores obtained based on each quality sub-dimension in terms of health institutions of different ownership. In this qualitative study conducted between July 27 and 31 2020, 30 theses were reviewed. The results of the study demonstrated that, of the theses, 20% were written in 2019, all were at the master's level, 80% were prepared in a social sciences institute, and only 3.3% were in English. While a greater number of theses were written in Gazi (16.7%) and Dokuz Eylül (16.7%) universities in the public sector, 10.0% of the theses were written in Beykent University, a foundation university. Most of the studies were performed in Ankara (23.3 %), Ä°zmir (20.0%) and Istanbul (20%) provinces. Of the participants in those studies, 70% were patients, 46.7% of the studies were conducted in publicly owned health institutions and the average sample size of the theses was 286.3. In the tangibles sub-dimension of the health service quality, the perceived service quality was lower than the expected service quality in 90% of the theses. In the empathy sub-dimension, the perceived service quality was higher than the expected service quality in 16.7% of them. The comparison of the service quality sub-dimensions and the ownership types of the health institutions revealed that in the private hospitals were at the forefront in responsiveness, assurance and empathy sub-dimensions, those in the public hospitals were in the tangibles sub-dimension, and university hospitals were in the reliability sub-dimension. General Servqual scores of the 30 studies were calculated to range from -0.52 to -0.82 in each sub-dimension. Although the values obtained were negative, it was concluded that all sub-dimensions had a “good” quality level in terms of Servqual score ranges.

Does capitation affect patient satisfaction and prevalence of out-of-pocket payments in the insured? A propensity score analysis of Ghana\u2019s demographic and health survey data

BackgroundGhana’s National Health Insurance Scheme (NHIS) piloted capitation payment for primary care services in the Ashanti region from 2012 to 2017. Capitation was piloted as a means of cost containment but also to induce managed competition among health providers to improve the responsiveness of healthcare delivery. This study examined the effects of exposure to capitation on perceived health service quality and prevalence of out-of-pocket payments in NHIS insured clients.MethodsRespondents of the 2014 Ghana Demographic and Health Survey (G-DHS) who reported having a valid NHIS card as their only form of health insurance coverage and made a health facility visit within the 6 months prior to the survey were used to assess the exposure effects of capitation on four outcomes: overall patient satisfaction, perceived friendliness of health staff, perceived adequacy of consultation time, and prevalence of out-of-pocket payments. We applied propensity score matching to balance distributions of covariates and to compare outcomes between exposed NHIS insured clients and their unexposed counterparts.ResultsNHIS insured clients exposed to capitation had 10 percentage points higher probability of encountering out-of-pocket payments than their unexposed counterparts (p = 0.009; 95% CI: 2.5–17.8%). There was no evidence of a difference between the two exposure groups for ratings of the three quality perceptions outcomes examined: overall patient satisfaction, difference 0.63 units (p = 0.46); perceived friendliness of health staff, difference 1.1% (p = 0.50); and perceived adequacy of consultation times, difference 0.1% (p = 0.96).ConclusionIn the Ghanaian context, our results suggest capitation was associated with a greater probability of out-of-pocket payments and no difference in perceived service quality. Future research should examine clinical quality of healthcare and how much out-of-pocket payment occurred under capitation.

Is having private health insurance associated with less support for public healthcare? Evidence from the Norwegian NHS

The purpose of this study was to investigate whether increased uptake of private health insurance (PHI) in a traditionally NHS type system is likely to affect support for the public healthcare system. Using the Norwegian healthcare system as our case, and building on a survey among 7500 citizens, with 2688 respondents, we employed multivariate analysis to uncover whether the preferences for public health services are associated with having PHI, controlling for key predictors such as socio-economic background, self-rated health and perceived health service quality, as well as age and gender. The basis for our analysis was the following two propositions related to the role of public healthcare, which the respondents were asked to score on a 5-point Likert scale (1 = “totally disagree”, 5 = “totally agree”): 1) “the responsibility of providing health services should mainly be public”, and 2) “the activity of private commercial actors should be limited”. The regression analyses showed that the willingness to increase the role of commercial private actors is positively associated with having a PHI. However, we found no relationship between holding a PHI and support for public provision of health services when other factors were controlled for.

Impact of Perceived Health Services Quality on the Beneficiaries’ Satisfaction An Explorative Study of Erbil Hospitals

Impact of Perceived Health Services Quality on the Beneficiaries’ Satisfaction An Explorative Study of Erbil Hospitals

Access to Health Care by Urban Refugees and Surrounding Host Population in Uganda

Uganda hosts an estimated 34,200 urban refugees who are living within the peri-urban areas among nationals in Kampala city. The study assessed factors that affect access to health services by the urban refugees and host communities. A cross-sectional study was conducted between July 2011 and June 2012 employing qualitative and quantitative techniques of data collection. Using structured questionnaires and guides, 944 heads of households interviews who were randomly selected using cluster sampling, 6 key informant interviews and 2 focus group discussions were conducted. SPSS, STATA and manifest-content analysis was used for analysis. The factors found to promote access to health services for refugees and host communities were availability of health facilities, (91.2%, 229/246) for refugees compared to (97.8%, 220/224) for nationals (OR = 2.61; 95%CI 1.36-5.03; p<0.05); and geographical accessibility to health facilities within a 5 km distance, (75.6%, 291/384) for refugees compared to (95.5%, 340/356) for nationals (OR=1.64; 95%1.25-2.16; p=0.000). Access was hindered by affordability of health services, refugees (44.9%, 173/385) compared to nationals (80.9%, 288/356) (OR = 4.68; 95%CI 3.33-6.59; p<0.05) and temporal accessibility of health services, refugees (23.5%, 53/226) compared to nationals (67.4%, 203/301) (OR = 2.61; 95%CI 1.36-5.03; p<0.05). Nationals (55.7%, 234/420) compared to refugees (21.3%, 76/356) (OR=0.41; 95%CI 0.23-0.73; p=0.003) perceived health services provided by the public facilities as good. Access to health care by urban refugees is enhanced by availability of and the proximity to health facilities while it is hindered by cost of health care, long-waiting time and low acceptability of the services. Refugees have a poorer perception towards the quality of health services compared to nationals. There is need to invest in the availability of comprehensive health services, demand creation initiatives, refugee skills trainings and income generating activities, establishment of a refugee buddy-system to facilitate communication and institutionalization of a refugee-based village health system.

Patient-perceived health service needs in inflammatory arthritis: A systematic scoping review.

Care that is patient-centred is more likely to be sustainable and associated with improved health outcomes. This approach to care requires an understanding of patients' health service needs, yet few studies have directly investigated the perceived health service needs of people with inflammatory arthritis. To systematically identify the existing literature relating to patient perceived health service needs for inflammatory arthritis. A systematic review of MEDLINE, EMBASE, CINAHL, and PsycINFO was conducted (1990-2016). Studies examining patients' perceived needs relating to health services for inflammatory arthritis were identified. Descriptive data regarding study design and methodology were extracted and risk of bias assessed. Findings were collated and categorized thematically. In total, 27 of 1405 (16 qualitative, 9 quantitative, and 2 mixed-methods) studies were relevant. The main areas of perceived need related to (1) Communication: consumers wanted clear, empathic communication, and to be involved with decision-making. (2) Characteristics of ongoing care: adequate consultation length with continuity and timely care were valued. (3) Factors influencing care-seeking included individual attitudes, disease severity, finances and family expectations. (4) Allied health and complementary and alternative medicines (CAM) were perceived as useful by many. The reporting of CAM use to doctors was variable, with several factors contributing to under-reporting. This review identified patients' perceived needs for better communication with their health providers, the heterogeneity of influences determining when care is sought and preferences regarding non-pharmacologic therapies. Aligning patients' perceived needs with evidence-based therapy for people with inflammatory arthritis will be important in optimizing patient outcomes.

Systematic scoping review of patients' perceived needs of health services for osteoporosis.

Health service planners, administrators and providers need to understand the patients' perspective of health services related to osteoporosis to optimise health outcomes. The aims of this study were to systematically identify and review the literature regarding patients' perceived health service needs relating to osteoporosis and osteopenia. A systematic scoping review was performed of publications in MEDLINE, EMBASE, CINAHL and PsycINFO (1990-2016). Descriptive data regarding study design and methodology were extracted and risk of bias assessed. Aggregates of patients' perceived needs of osteoporosis health services were categorised. Thirty-three studies (19 quantitative and 14 qualitative) from 1027 were relevant. The following areas of perceived need emerged: (1) patients sought healthcare from doctors to obtain information and initiate management. They were dissatisfied with poor communication, lack of time and poor continuity of care. (2) Patients perceived a role for osteoporosis pharmacotherapy but were concerned about medication administration and adverse effects. (3) Patients believed that exercise and vitamin supplementation were important, but there is a lack of data examining the needs for other non-pharmacological measures such as smoking cessation and alcohol. (4) Patients wanted diagnostic evaluation and ongoing surveillance of their bone health. This review identified patients' needs for better communication with their healthcare providers. It also showed that a number of important cornerstones of therapy for osteoporosis, such as pharmacotherapy and exercise, are identified as important by patients, as well as ongoing surveillance of bone health. Understanding patients' perceived needs and aligning them with responsive and evidence-informed service models are likely to optimise patient outcomes.

Patients' perceived health service needs for osteoarthritis (OA) care: ascoping systematic review.

To identify and synthesise evidence regarding patients' perceived health service needs related to osteoarthritis (OA). A comprehensive systematic scoping review of MEDLINE, PsycINFO, EMBASE and CINAHL (1990-2016) was performed to capture information regarding patient perceived health service needs related to OA. Risk of bias and quality of included articles were assessed. Relevant data were extracted and collated to provide a systematic review of the existing literature. Of the 1384 identified manuscripts, 21 were relevant to areas of patient perceived need, including needs related to medical care, pharmacologic therapy, physiotherapy and exercise therapy and alternative medicine. Key findings included (1) Symptom control drove the need for both conventional and complementary services. (2) An individualized relationship was sought with a practitioner knowledgeable in OA care and who adopted a holistic approach, whether providing conventional or alternative therapies. (3) Medications were required to obtain symptomatic relief, with use tempered by recognition of potential side effects and financial cost. (4) The need for allied health services was recognised, although patient and system issues were barriers to uptake. (5) Patient's attitudes towards joint replacement, orthoses and physical aids were influenced by patient preferences and previous healthcare experiences. Patient perceived needs are similar to those suggested by clinical guideline recommendations. Better aligning patient perceived needs with healthcare requirements may improve OA outcomes and optimise healthcare system utilisation.

Government Public Housing Health Needs Assessment: Focus on Race, Ethnicity, and the Older Adult: Background, Methods, and Demographics

St. Vincent's Catholic Medical Centers of New York initiated a study in 2009 to assess the health needs of residents of New York City (NYC) municipal housing at the Robert Fulton public housing complex in Manhattan. The aim of this project was to provide valid data on perceived health services needs of the residents of a NYC housing project. These data may also be used to support hospital and community collaborative strategic decisions for developing resident-appropriate health and social services and would be valuable for use in formulating policies and programs by other interested nonprofit health and social services organizations and government. We designed a 28-item instrument and pilot tested it with our research team and members of the population under study. The English and Spanish surveys were designed as an in-person surveyor-administered instruments addressing four domains: demographics, access and barriers to health care services, risk behaviors, and perceived health needs. The sampling was an apartment-level stratified random sampling. A 20%, 188 apartment sample was drawn from the population of 944 housing units. Our response rate was 92% (173/188 apartments). Background methods, and demographic results are reported in this article. A second article will report on the needs assessment results.

Health Literacy Skills in Relatives? Speech: A Canadian Case-Study

Objective: Exploring how health literacy skills are expressed by relatives of two first stroke survivors and the influence of such skills on their participation in the rehabilitation process. Methods: This case study consists of a secondary analysis of qualitative material focusing on perceived health services received by relatives post-stroke. Two cases were purposively selected for their contrast in educational attainment. Results: Four core concepts, in accordance with current HL conceptualization, emerged from the analysis. Themes related to understanding and communicating health-related information was prominent. More specifically, comprehension and linguistic skills, and particularly the use of medical terminology, as well as self-confidence appear to be conducive to a better dialogue with health professionals and lead to more satisfactory answers. Conclusion: The relatives’ speech provided indications about health literacy skills and confirmed their importance in developing self-determination. Fostering an open dialogue with relatives represents an opportunity to consider their skills when establishing a partnership and thus contributes to the development of greater health literacy and participation.

Patient Satisfaction: A Valid Indicator for the Quality of Primary Care?

Copyright: © 2012 Schoenfelder T. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Studies have evidenced that satisfaction with the perceived health service quality is an important determinant whether a patient complies with prescribed treatment plans, seeks medical advice, and maintains a continuing relationship with his or her medical practitioner, which can affect the subsequent resulting health outcome [5-7]. For example, improvements in outcomes in relation to satisfaction levels such as blood pressure and blood sugar, less complications in surgical patients, and lower mortality were found by several studies [8-11]. Dissatisfaction appears to lead to malpractice litigations [12] and doctor shopping, which can cause high costs and inefficiencies in health care systems [13].

Why don't some women attend antenatal and postnatal care services?: a qualitative study of community members' perspectives in Garut, Sukabumi and Ciamis districts of West Java Province, Indonesia

BackgroundAntenatal, delivery and postnatal care services are amongst the recommended interventions aimed at preventing maternal and newborn deaths worldwide. West Java is one of the provinces of Java Island in Indonesia with a high proportion of home deliveries, a low attendance of four antenatal services and a low postnatal care uptake. This paper aims to explore community members' perspectives on antenatal and postnatal care services, including reasons for using or not using these services, the services received during antenatal and postnatal care, and cultural practices during antenatal and postnatal periods in Garut, Sukabumi and Ciamis districts of West Java province.MethodsA qualitative study was conducted from March to July 2009 in six villages in three districts of West Java province. Twenty focus group discussions (FGDs) and 165 in-depth interviews were carried out involving a total of 295 respondents. The guidelines for FGDs and in-depth interviews included the topics of community experiences with antenatal and postnatal care services, reasons for not attending the services, and cultural practices during antenatal and postnatal periods.ResultsOur study found that the main reason women attended antenatal and postnatal care services was to ensure the safe health of both mother and infant. Financial difficulty emerged as the major issue among women who did not fulfil the minimum requirements of four antenatal care services or two postnatal care services within the first month after delivery. This was related to the cost of health services, transportation costs, or both. In remote areas, the limited availability of health services was also a problem, especially if the village midwife frequently travelled out of the village. The distances from health facilities, in addition to poor road conditions were major concerns, particularly for those living in remote areas. Lack of community awareness about the importance of these services was also found, as some community members perceived health services to be necessary only if obstetric complications occurred. The services of traditional birth attendants for antenatal, delivery, and postnatal care were widely used, and their roles in maternal and child care were considered vital by some community members.ConclusionsIt is important that public health strategies take into account the availability, affordability and accessibility of health services. Poverty alleviation strategies will help financially deprived communities to use antenatal and postnatal health services. This study also demonstrated the importance of health promotion programs for increasing community awareness about the necessity of antenatal and postnatal services.

A critical review of patient satisfaction

PurposeThis paper aims to review the patient satisfaction literature, specifically meta‐analyses, which critically analyses its theory and use; then to present evidence for perceived service quality as a separate and more advanced construct.Design/methodology/approachPapers that judiciously review the development and application of patient satisfaction were identified; along with studies addressing the conceptual and methodological deficiencies associated with the concept; and the current perceived service quality theory.FindingsPatient satisfaction has been extensively studied and considerable effort has gone into developing survey instruments to measure it. However, most reviews have been critical of its use, since there is rarely any theoretical or conceptual development of the patient satisfaction concept. The construct has little standardisation, low reliability and uncertain validity. It continues to be used interchangeably with, and as a proxy for, perceived service quality, which is a conceptually different and superior construct.Practical implicationsThe persistent use of patient satisfaction to evaluate the client's perception of the quality of a health service is seriously flawed. The key to solving this dilemma may be for the healthcare sector to focus on perceived health service quality by considering the specific concepts and models that can be found in the services marketing literature. This literature offers more advanced consumer theories which are better differentiated and tested than existing healthcare satisfaction models.Originality/valueThe paper points out that there is an urgent need for differentiation and standardisation of satisfaction and service quality definitions and constructs, and argues for research to focus on measuring perceived health service quality.

Perceived social environment and quality of life among people living with HIV/AIDS in northern Thailand

Efforts have been made to improve the social environment of people living with HIV/AIDS (PLWHA) in Thailand but have not been assessed in terms of their quality of life (QOL). In this study, we preliminarily examined the relationship between PLWHA's perception of social environment and QOL. The participants of this study were 200 PLWHA who belonged to the self-help groups in Chiang Mai province, northern Thailand. We collected data in face-to-face interviews using a structured questionnaire. The QOL was measured using a Thai version of the Medical Outcomes Study HIV Health Survey. Those who perceived themselves as well accepted by the community, perceived health services accessible or someone's help available, tended to have better QOL in terms of mental health. Community acceptance was most significantly related to QOL. Stratified analyses revealed similar relationships between perceived social environment and QOL among symptomatic and non-symptomatic participants but the relationships appeared weaker among men than women. In sum, our preliminary findings suggest that supportive social environment, especially community acceptance, is important for mental aspects of PLWHA's QOL irrespective of the disease stages and for women who usually take on multiple roles in the Thai traditional family.