Sampling Method Research Articles

Healthcare-Seeking Behaviour of Elderly Indigenous Malayali Tribal Women in South India

Indigenous people inhabit forests and hilly regions and hereditarily follow certain healthcare beliefs and practices. This study explicitly focuses on the healthcare-seeking behaviour of elderly Malayali tribal women (MTW), with special emphasis on their knowledge, practices and use of indigenous plants, as well as their awareness of healthcare systems. The study aims to explore all aspects related to the health of elderly tribal women. For the purpose of this study, elderly MTW are defined as individuals above 60 years of age. The quota sampling method is employed, along with other characteristics. This phenomenological study utilizes methods including group discussions, interviews, field observations and informal meetings. The experiences of the participants were collected through in-depth interviews, analysed thematically to identify common patterns and interpreted to understand their healthcare-seeking behaviours within their cultural context. The study found that 60% of women above 70 years of age used medicinal plants. Formal literacy was not found to be a determining factor in the usage of medicinal and traditional knowledge. Illiterate elderly women possess more knowledge about traditional herbal medicines than their literate counterparts.

Flash Floods, Livelihoods and Food Security: Evidence from the Affected Smallholder Farming Households in Northeast Bangladesh

The 2017 flash flood events in Northeast districts created differential impacts on poor people; therefore, the adaptation strategies adopted by the poor were insufficient to survive. The weakness in these strategies often resulted in vulnerability to them. The present paper attempts to argue that the impacts created by those barriers are heterogeneous in nature, which did not receive considerable attention in ongoing research on this issue. This research has been conducted in two villages in the Habiganj district. Purposive sampling methods were used aiming to investigate how poor households adapt to flash flood disasters. A mixed method was applied to capture the scenario, which included a household questionnaire survey, focus group discussions, key informant interviews, and informal discussions. Findings suggest that flood disasters affect farming households differently. As the findings reveal that the agriculture-based livelihoods are affected by the flash flood drastically that created household food insecurity in many smallholder farming households. The findings present some specific policy suggestions for policymakers and development workers to shape policies that may benefit all actors more inclusively. Social Science Review, Vol. 41(1), June 2024, Page 57-72.

Analysis of Mathematics Education Students' ICT Behavior at IAIN Syekh Nurjati Cirebon Post-Pandemic

This study analyzes student behavior in using ICT when using LMS at IAIN Syekh Nurjati Cirebon. This study used quantitative methods with a survey research design. The type of survey used is a cross-sectional survey design. Samples were taken from Mathematics Education students in semesters I, III, V and VII, as many as 258 from 627 active students in 2021/2022 using the stratified random sampling method. The instrument was developed following the aspects and indicators in the TAM model, containing (1) perceived ease of use, (2) perceived usefulness, (3) attitude towards using, (4) behavioral intention to use, and (5) actual usage. The instrument will be tested for validity using CVR and reliability using the Guttman Split-Half Coefficient correlation. Data on student behavior using ICT were analyzed using Widoyoko categorization. The study results showed that the instrument was confirmed to be valid and reliable, with students' behavior in using ICT categorized as "good." The findings suggest that students are generally well-prepared to engage with ICT tools for online learning, reflecting their adaptability and positive attitudes toward technology adoption. However, to maximize the potential benefits of ICT in education, the study highlights the need for institutions to implement targeted strategies. These include providing more comprehensive ICT training programs, upgrading and maintaining digital infrastructure, and creating policies encouraging consistent and meaningful use of ICT in learning activities.

The Influence of the Background and Characteristics of the Chief Executive Officer on Company Performance

This study aims to analyze the influence of CEO background and characteristics on company performance. Purposive sampling is the method of sampling that is employed, using information gathered from 83 financial firms that were listed between 2020 and 2022 on the Indonesia Stock Exchange. According to data analysis using multiple regression, the background characteristics of the CEO including gender, tenure, education, and experience significantly improve the performance of the business. As for CEO characteristics, duality, citizenship, stock ownership, and turnover also significantly improve business performance. These results demonstrate that according to agency theory, CEO characteristics, and background are crucial in reducing agency conflicts and enhancing company performance. CEOs with sufficient educational background, experience, and tenure are typically more successful in reaching judgments that are in line with the objectives of shareholders. Characteristics such as duality, citizenship, and stock ownership by the CEO provide greater motivation to enhance company value, while strategic turnover can bring the necessary innovation and change.

Characteristics of functional constipation and analysis of intestinal microbiota in children aged 0–4 in Zunyi region

BackgroundFunctional constipation (FC) significantly impacts children’s health. This study investigates the prevalence and microbiota characteristics of FC in children aged 0–4 years in Zunyi area.MethodsFrom October to December 2023, 2039 children aged 0–4 years in Zunyi were selected using stratified sampling and cross-sectional survey methods. A questionnaire based on Rome IV diagnostic criteria was used. Twenty-nine children with FC were randomly selected as the functional constipation group (FCG), and 26 healthy children, matched for age, sex, and area, were selected as the control group (CG).ResultsA total of 2051 questionnaires were collected, with 2039 valid responses. Among them, 151 children had FC, resulting in a prevalence rate of 7.4%. The prevalence rates in boys and girls were 6.6% and 8.5%, respectively, with no significant gender difference (P > 0.05). Alpha diversity analysis revealed higher richness and diversity of intestinal flora in the FCG compared to the CG. At the phylum level, Actinobacteria, Firmicutes, Proteobacteria, and Bacteroidetes were dominant in both groups. The FCG showed a higher relative abundance of Firmicutes, Actinobacteria, and Proteobacteria compared to the CG (P < 0.05).ConclusionsThe prevalence of FC in children aged 0–4 years in Zunyi is 7.4%. Disease characteristics vary with age and living environment but are unrelated to gender. The gut microbiota of children with FC shows significant alterations, with higher diversity and specific phyla abundance.

Parental burnout and parent-child relationship: the role of harsh parenting in couples.

Parental burnout is a prominent topic in current family research, with proven detrimental effects on the well-being of both parents and children. However, the specific mechanism by which parenting burnout impacts the parent-child relationship within families remains unclear. Furthermore, there is limited research exploring whether parenting burnout has a direct impact on the parent-child relationship. This study aims to address this gap by constructing an actor-partner interdependent mediation model of parental harsh parenting in order to explore the influence of parents' own and their spouse's parenting burnout on their respective parent-child relationships, as well as the mediating effect of their own harsh parenting and that of their spouse. A convenient sampling method was used to select 405 parents from two middle schools in Yichun, Heilongjiang Province as participants for this investigation. The Chinese version of the Parenting Burnout Inventory, Harsh Parenting Scale, and Parent-child Relationship Scale were utilized for data collection over half year period. The findings revealed that (1) parenting burnout significantly negatively predicts both one's own and one's spouse's parent-child relationships; (2) parenting burnout affects one's own parent-child relationship through their own harsh parenting; (3) parenting burnout influences one's spouse's parent-child relationship through their spouse's harsh parenting. This study sheds light on the influence and mechanisms underlying parental burnout on the parent-child relationship, offering valuable insights for preventing parental burnout and enhancing family dynamics.

Factors Affecting the Severity of Domestic Violence against Pregnant Women: A Cross-Sectional Study in Northeastern Iran

Background and Objectives: Violence against pregnant women is a clear violation of women's rights associated with many consequences and complications both for the mother and fetus. In this study, we aimed to determine factors affecting the severity of domestic violence against pregnant women. Methods: This cross-sectional descriptive-analytical study was carried out between July 2020 and September 2021. The participants were 234 women with low-risk pregnancies (28-40 weeks) who were transferred to the maternity ward of Bentolhoda Hospital in Bojnurd City. Mothers were selected by the convenience sampling method. A two-part questionnaire was used in this study, which included demographic and midwifery information questionnaires and a domestic violence questionnaire created by Tabrizi in 2013. Subsequently, the data were analyzed using logistic regression. Results: The prevalence rate of violence against pregnant women (experiencing at least one type of domestic violence from the husband) was 64.6%. Among those who had experienced violence, 36.1% of the participants experienced low to very mild violence during pregnancy and 63.9% experienced moderate violence. However, severe violence was not experienced by any of the research units. Also, there was a significant relationship between babies' gender and the severity of violence (P=0.03). Pregnant women with male fetus (OR = 3.14, CI95%:1.093–9.069) were 3.14 times more exposed to violence with moderate severity. Conclusion: In this study, most women suffered domestic violence with moderate severity. Among pregnant women with male fetuses, the severity of violence was even higher. Thus, it is necessary to pay a proper attention to the design and implementation of educational and support programs for these women to prevent domestic violence and reduce its adverse impacts.

Effect of Stress Management Training Based on Multimedia Software on the Stress Response of Nurses in Children's Wards of Iran University of Medical Sciences

Background and Objectives: The use of modern and technology-based educational methods can play a significant role in enhancing nurses' capabilities in stress management and improving their responses to stressful situations. Therefore, this study aims to determine the impact of stress management on the stress responses of nurses working in pediatric departments of educational hospitals affiliated Iran University of Medical Sciences through a multimedia software intervention. Methods: In this quasi-experimental study, a random sampling method was employed to select 102 nurses (51 individuals in the intervention group and 51 in the control group) working in general hospital departments. The inclusion criteria for evaluating the effectiveness of stress management training on the stress responses of nurses included having at least a bachelor’s degree, a minimum of 6 months of work experience in pediatric wards, no reported psychological disorders, and no use of psychiatric medications based on self-reports. Additionally, participants were required to have access to a computer capable of running DVDs and familiarity with its operation, with no prior experience or readiness to participate in a stress management workshop within the last 6 months. Conversely, the exclusion criteria were participant dissatisfaction, change of department, and hospital relocation. This assessment is shared in improving the skills and response to the stress of nurses in pediatric department of medical centers. To measure the stress responses, the Inventory Response Stress questionnaire was utilized, which was completed by both groups prior to the intervention. Subsequently, the educational content regarding stress management was provided to the intervention group for duration of 8 weeks. At the end of the eighth week, both groups completed the stress response questionnaire again. Data analysis was performed using SPSS version 22 software, with statistical tests including Fisher's exact test, Mann-Whitney U test, Kruskal-Wallis H test, and Analysis of Variance (ANOVA). Results: No significant difference was observed in the mean of stress response in the intervention (29.69 ± 23.66) and control (33.20 ± 27.95) groups before the intervention (p = 0.661). The average stress response score in the intervention group (19.65 ± 16.74) was significantly lower than the control group (32.67 ± 28.17) after the intervention (p &lt; 0.001). Conclusion: These data demonstrated the positive effect of the stress management program on nurses' stress response who participated in this study.

Role of Divalent Ions in Membrane Models of Polymyxin-Sensitive and Resistant Gram-Negative Bacteria.

Polymyxins, critical last-resort antibiotics, impact the distribution of membrane-bound divalent cations in the outer membrane of Gram-negative bacteria. We employed atomistic molecular dynamics simulations to model the effect of displacing these ions. Two polymyxin-sensitive and two polymyxin-resistant models of the outer membrane of Salmonella enterica were investigated. First, we found that the removal of all calcium ions induces global stress on the model membranes, leading to substantial membrane restructuring. Next, we used enhanced sampling methods to explore the effects of localized stress by displacing membrane-bound ions. Our findings indicate that creating defects in the membrane-bound ion network facilitates polymyxin permeation. Additionally, our study of polymyxin-resistant mutations revealed that divalent ions in resistant model membranes are less likely to be displaced, potentially contributing to the increased resistance associated with these mutations. Lastly, we compared results from all-atom molecular dynamics simulations with coarse-grained simulations, demonstrating that the choice of force field significantly influences the behavior of membrane-bound ions under stress.

Presence of EGF ligand restricts the binding ability of EgB4 nanobody to EGFR extracellular domain

EgB4 is a nanobody that could facilitate the development of drug–nanobody conjugates or drug delivery in cancer treatment due to its specific binding ability to the EGFR transmembrane protein. More significantly, EgB4 does not hamper the EGFR function and associates with EGFR in both the presence and absence of an EGF ligand. However, the difference in EgB4–EGFR interaction with and without EGF ligand is not clear. To explore this aspect, we carried out computations including classical molecular dynamics simulations, steered molecular dynamics simulations and the umbrella sampling method. The three main objectives of the study are: (i) how EgB4 interacts with EGFR, (ii) the role of an EGF molecule, and (iii) how to mutate EgB4 to efficiently construct a stronger nanobody. Our computed results showed that, in addition to the residues asp98 and asp110 that were previously reported, two other residues, arg105 and asp108, are also highly interactive with the EGFR extracellular domain. Notably, the absolute binding free energy of the EgB4–EGFR complex decreases from − 17.1 to -13.3 kcal/mol in going from an absence to a presence of EGF. With the EGF presence, the interacting space between both EgB4 and EGFR entities is also reduced. When EGF stabilizes the dimerization of EGFR, there is less opportunity for EgB4 to bind. This crucial aspect has not been reported before.

Investigating the Status of Non-Communicable Diseases and Dietary Patterns of Patients with Lipid Disorders in Alvand City

Background and Objectives: Evidence shows that blood lipid disorders in people are influenced by their unhealthy diet. This study was conducted with the aim of investigating the dietary pattern of people with lipid disorders and the status of non-communicable diseases in the studied population. Methods: A cross-sectional study was conducted on 300 patients with lipid disorders. The participants were selected among people with lipids who referred to comprehensive health service centers in Alvand city by multistage sampling method. The data were collected using a semi-quantitative food frequency questionnaire (FFQ). The findings were analyzed by SPSS software. Results: Three dietary patterns including healthy, unhealthy and average were identified in the research participants. Most people (66.3%) followed a moderate dietary pattern. Also, 85% of people were overweight or obese. The results of the logistic regression analysis showed that an unhealthy eating pattern increases the likelihood of developing diseases by 2.267 times compared to a healthy eating pattern. It also showed that with increasing age, the probability of contracting the disease increases by 1.093. Also, there was a significant relationship between food pattern and education level (P&lt;0.05). In this study, there was no significant relationship between age, marital status of people and their food pattern (P&gt;0.05). Conclusion: The results showed that people who follow an unhealthy food pattern have more non-communicable diseases. Therefore, it seems that modifying the food pattern through nutrition education is appropriate and can be effective in preventing other non-communicable diseases in the future.

Breath Analysis via Surface Enhanced Raman Spectroscopy.

Breath analysis is increasingly recognized as a powerful noninvasive diagnostic technique, and a plethora of exhaled volatile biomarkers have been associated with various diseases. However, traditional analytical methodologies are not amenable to high-throughput diagnostic applications at the point of need. An optical spectroscopic technique, surface-enhanced Raman spectroscopy (SERS), mostly used in the research setting for liquid sample analysis, has recently been applied to breath-based diagnostics. This promising noninvasive diagnostic tool has been demonstrated for the identification of various diseases, including lung cancer, gastric cancer, and diabetes. The versatility of SERS has enabled the use of different diagnostic strategies and allowed for fast and accurate detection of small analytes in exhaled breath. In this review, we provide an overview of recent advances in SERS-based breath analysis, focusing on sensors for the detection of gases and volatile organic compounds (VOCs) in exhaled breath, and highlight generic strategies for sample preconcentration and methods for spectral analysis. We aim to provide an overview of the state of the art and inspiration for further SERS investigation of expiration.

Enhancing International Postgraduate Students’ Research and Supervision Capabilities in Tanzanian Higher Education Institutions

Research and supervision are viewed as vital aspects of successful learning in postgraduate programs. This cultivates the effectiveness of the whole process of learning for international postgraduates in their host countries. In this process, learning environment is designated to facilitate the international postgraduate students’ knowledge based on useful learning resources offered by the respective institutions. Currently, most of the common complaints from the international postgraduate students in Tanzanian Higher Education Institutions centered around infrequent and erratic communications between them, their lecturers, and supervisors who were mentioned to be very busy with other administrative and teaching responsibilities. Some were said to have many students and tend to be away from their universities too often. This study was conducted in Tanzania, involving eight international postgraduate students (4 females and 4 males). Convenient and snowball sampling methods were employed to recruit the participants of the study. Qualitative design was employed whereby telephonic in-depth interview and reflective writing were utilized to generate data which were thematically analysed. By using the Sen’s capability theoretical framework, this study endeavored to unveil conversion factors that hinder enhancement of international postgraduates’ research and supervision capabilities. The study thrusts the importance of enhancing research and supervision capabilities to postgraduate students and proposes the best practices of supervisory inputs.

The Effect of Online Registration System on Outpatient Satisfaction

This study aims to analyze the effect of online registration system on outpatient satisfaction . The background of this study focuses on the need for improving fast, efficient, and technology-based health services to meet patient expectations. The online registration system is expected to reduce queues, speed up the administrative process, and improve patient comfort. This study uses a quantitative method with a cross-sectional approach. The sampling technique was carried out using the simple random sampling method , with the criteria of patients using the online registration system in December 2024, namely 115 patients. Data were collected through a questionnaire that measured aspects of patient satisfaction, such as ease of access, speed of service, data accuracy and system convenience. Data analysis was carried out using a simple linear regression test to identify the effect between the online registration system and patient satisfaction levels. The results of the study showed a positive and significant effect between the online registration system and patient satisfaction. This system simplifies the registration process and increases positive perceptions of the quality of hospital services. Therefore, it is recommended to improve the quality of information technology and training for officers to ensure the sustainability of excellent services and further development of system features is needed to improve accessibility and reliability of services.

Identification of global main cable line shape parameters of suspension bridges based on local 3D point cloud

Main cable line shape measurement and parameter identification are a critical task in the construction monitoring and service maintenance of suspension bridges. 3D LiDAR scanning can simultaneously obtain the coordinates of multiple points on the target, offering high accuracy and efficiency. As a result, it is expected to be used in applications requiring rapid, large-scale measurements, such as main cable line shape measurement for suspension bridges. However, due to the large span and tall main towers of suspension bridges, the LiDAR field of view often encounters obstructions, making it difficult to obtain high-quality point clouds for the entire bridge. The collected point clouds are typically unevenly distributed and of poor quality. Therefore, LiDAR is used to monitor the local cable line shape. This paper proposes an innovative non-uniform sampling method that adjusts the sampling density based on the main cable’s rate of change. Additionally, the Random Sample Consensus (RANSAC) algorithm, the ordinary least squares, and center-of-mass calibration are applied to identify and optimize the geometric parameters of the cross-section point cloud of the main cable. Given the strong design prior information available during suspension bridge construction, Bayesian theory is applied to predict and adjust the global line shape of the main cable. The study shows that using LiDAR for cable point cloud measurement enables rapid acquisition of high-precision point cloud data, significantly enhancing data collection efficiency. The method proposed in this paper offers advantages such as highly automated, low risk, low cost, and sustainability, making it suitable for green monitoring throughout the entire main cable construction process.

Feeding ecology and diurnal activity patterns of the new populations of geladas (Theropithecus gelada) in the escarpments of eastern Tigray, northern Ethiopia

Studying the behavioral ecology of primates is essential to realize their conservation and management strategies. Geladas (Theropithecus gelada) are endemic primates of the Ethiopian highlands and the last remaining member of the genus Theropithecus. We present here the first-ever study on the behavioral ecology, of the newly discovered geladas in the eastern part of Tigray, Northern Ethiopia. We collected data from February to September 2020, which included both dry and wet seasons, and focused on activity patterns and feeding ecology of geladas. A band of 48 individuals was selected as a study group. Data was collected through the instantaneous scan sampling method from the focal band of geladas. Feeding accounted for 49.5% of the activity patterns, followed by moving (22.3%), resting (16%), social (10.4%), and other non-social activities (1.9%). Geladas in the present study consumed 25 plant species that belong to 12 families, more than 50% (14) being graminoids. Food items included graminoid parts (66.1%), forb parts (27.5%), tree/shrub leaves (2.4%), fruit/seeds (2.6%), flowers (0.9%), and the rest being unidentified (0.5%). Geladas are fed in large quantities on graminoid leaves, although they shifted to underground (corms, rhizomes, and roots) food items when leaves were desiccated, particularly during the dry season. The data on the diurnal activity patterns and feeding ecology of the gelada helps in developing conservation strategies and understanding habitat selection and its level of dietary specialization. The current study area is known as a new distribution of geladas in the Tigray region. Thus, this study provides data that would be crucial information for conservation practitioners at local and national levels to ensure the survival of the new and isolated population of Tigray geladas that are patchily distributed to a few escarpments of eastern Tigray, Ethiopia.

The Influence of Service Quality Dimensions, Insurance System, and Sincerity on BPJS Patient Satisfaction, Trust, and Loyalty in Indonesian Hospitals

This study was conducted to determine the effect of service quality, insurance system, and sincerity of medical personnel on the level of satisfaction, trust, and loyalty of outpatients at XYZ Private Hospital. This study involved 450 outpatient BPJS patients. Data collection was carried out by distributing questionnaires containing 45 questions with a Likert Scale of 1-5 based on the judgmental sampling method. Data were analyzed using the SEM PLS method. The results showed that empathy, insurance system, and sincerity had a significant positive effect on patient satisfaction. Reliability had a significant negative effect on patient satisfaction. Assurance and responsiveness did not affect patient satisfaction. In addition, patient satisfaction and trust had a positive and significant effect on patient loyalty. Patient satisfaction had a positive and significant effect on patient trust in XYZ Private Hospital, while tangible assets had a negative and significant effect on loyalty. Assurance, responsiveness and reliability are further evaluated to ensure that resources are not over-utilized on aspects that are considered less important by respondents. Future studies can take a larger population including other Private Hospitals as well as Government Hospitals and record the diagnosis of diseases experienced by participating patients.

The factors influencing self-management in patients with depression: a qualitative research from China

BackgroundAs depressed patients often fail to seek help and obtain treatment on time for reasons such as stigma and lack of treatment resources, research on self-management for depressed patients is crucial. This study aimed to explore the factors influencing self-management in depression patients from the perspectives of both patients and psychiatric nurses.MethodsSix depression patients and twelve psychiatric nurses were chosen for semi-structured interviews through a purposive sampling method from a tertiary Grade A psychiatric hospital in Shandong Province, China. The group of depressed patients included in the study had a male to female sex ratio of 1:1 with a mean age of 46years. The psychiatric nurse group had a male to female ratio of 1:2 with a mean age of 42.42 years. We used descriptive qualitative research techniques. Nvivo 12.0 software was used for the data management and analysis using thematic analysis.ResultsThe factors influencing the self-management of depression patients were summarized into three themes and eight sub-themes: disease impact (symptoms, stigma), the degree of symptom control (medication adherence, depression’s cognitive status, its treatment and rehabilitation as well as additional factors), and support (self-efficacy, external support).ConclusionsThis study found that multiple factors influence the self-management of depression patients, including disease impact, the degree of symptom control, and support. In addition to helping patients integrate social resources and seek social support, medical staff should also pay attention to changes in the patient’s condition and disease control. Moreover, they should help patients increase their self-efficacy and enhance their self-management abilities through health education and other means.Clinical trial numberNot applicable.

Half logistic exponentiated inverse Rayleigh distribution: Properties and application to life time data.

This paper presents a novel extension of the exponentiated inverse Rayleigh distribution called the half-logistic exponentiated inverse Rayleigh distribution. This extension improves the flexibility of the distribution for modeling lifetime data for both monotonic and non-monotonic hazard rates. The statistical properties of the half-logistic exponentiated inverse Rayleigh distribution, such as the quantiles, moments, reliability, and hazard function, are examined. In particular, we provide several techniques to estimate the half-logistic exponentiated inverse Rayleigh distribution parameters: weighted least squares, Cramér-Von Mises, maximum likelihood, maximum product spacings and ordinary least squares methods. Moreover, numerical simulations were performed to evaluate these estimation methods for both small and large samples through Monte Carlo simulations, and the finding reveals that the maximum likelihood estimation was the best among all estimation methods since it comprises small mean square error compared to other estimation methods. We employ real-world lifetime data to demonstrate the performance of the newly generated distribution compared to other distributions through practical application. The results show that the half-logistic exponentiated inverse Rayleigh distribution performs better than alternative versions of the Rayleigh distributions.

Exploring the voice of patients: Mapping their experience following care in an integrated health area

Measuring patient-reported experience measures (PREMs) is essential for the continuous improvement of quality. This study aims to assess the quality perceived by patients in the key care processes of an integrated health area measuring PREM elements, with the goal of identifying opportunities for improvement. The research was conducted in the first half of 2023 within a Spanish integrated health area, analysing five key healthcare processes: Primary Care, Emergency Services, Hospitalisation, Consultations, and Surgery. To assess perceived quality, PREM elements such as accessibility, information, and professionalism were measured using the Net Promoter Score (NPS). The Lot Quality Assurance Sampling (LQAS) method was employed to identify specific areas for improvement by detecting rejected lots and optimising sample sizes. Although the perceived quality was generally high, with good or excellent NPS scores, significant variability was observed between processes. A total of 104 rejected lots (21%) were identified across the processes evaluated. The highest number of rejections occurred in and Emergency Services (67%), with notable issues in accessibility and information. The study underscores the need for targeted interventions in accessibility and information to enhance the patient experience, particularly in Primary Care and Emergency Services. The measurement of PREM elements using NPS, in conjunction with the LQAS method, proves to be an effective tool for identifying and prioritising areas for improvement, especially when applied on a regular basis.