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Patients’ Satisfaction, Diabe= tic Control and Associated Factors

at a Tertiary Health Facility= in Rivers State, Nigeria

 

* Affio= ng John1, Geraldine Ndukwu2, Paul Dienye3.

 =

1Department of Fa= mily Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.

2Department of Fa= mily Medicine, College of Health Sciences, University of Port Harcourt, Port Harcourt, Nigeria. 3Department of Family Medicine, Rivers State University Teaching Hospital, Port Harcourt, Nigeria.

=  

 

<= /p>

 

Background<= /b>: Non-communicable diseases (NCDs) are the leading cause of death globally and diabetes mellitus (DM) is the fourth ma= in contributor. The incidence of its complications could be reduced with high-quality care and good glycaemic control. Treatment satisfaction is an important aspect of quality of care, especiall= y in treating chronic diseases like DM. This study sought to determine the satisfaction of diabetics with their care and to identify the relationship between patients’ satisfaction and diabetic control alongside other associa= ted factors.

Methodology: The study was a descriptive cross-sectional, hospital-based study. Respondents were admitted into the s= tudy based on inclusion criteria and selected using a systematic random sampling technique. Blood samples for fasting plasma glucose and total cholesterol w= ere collected. Diabetic Treatment Satisfaction Questionnaire and the Patient Satisfaction Questionnaire were used to assess treatment satisfaction. The = SPSS version 21.0 was used for data analysis and linear regression was used to determine the factors influencing satisfaction. The level of significance w= as set at 0.05.

Results= : The mean total Diabetes Treatm= ent Satisfaction score was 33.8 ± 8.2 and the mean total Short-Form Patient Satisfaction score was found to be 16.8 ± 3.6. There was a statistically significant difference between the mean satisfaction scores with treatment = of diabetes mellitus and age groups (p < 0.001).  There was also a statistically signific= ant association between DM treatment satisfaction with the use of oral antidiab= etic agents (p =3D 0.043) and the presence of complications (P < 0.001).

Conclusion<= /b>: There was a significant correlation between patient satisfaction scores and other factors like accessibility and convenience, time spent with doctors, and so on. In conclusion, the study identified the use of oral anti-diabetic agents, and the presence of compli= cations, among others as factors affecting patient satisfaction. This study, therefo= re, suggests improving the practice of patient-centered medicine by increasing patient satisfaction through addressing these factors.

Keywords: Diabetes, Patient Satisfaction, Quality of Care, Glycemic Control

=  

­­­­­­­­­­­­­*Correspondence:  <= /span>= Dr Geraldine Ndukwu Department of Family Medicine, College of Health Sciences, University of Port Harcourt, Port Harcourt, Nigeria. Email: geraldine.ndukwu@uniport.edu.ng

 

This is an open access journal, and articles are distributed und= er the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creati= ons are licensed under the identical terms.

 

How to cite this article= := John A, Ndukwu G, Dienye P. Patients’ Satisfaction, Diabetic Control and Associated Factors at a Tertia= ry Health Facility in Rivers State, Nigeria. Niger Med J 2023;64(4):508-523. Accepted: September 6, 2023. Published: September 21, 2023.

 


Introduction

Non-communicable diseases (NCDs) have been established as clear threats to both human health and national development.1 NCDs cla= im 63% of all deaths and are currently the world’s main killer.1 Diabetes mellitus (DM) is one of the major non-communicable diseases with dramatically increasing prevalence in both developed and developing countri= es.2 DM is a serious condition at a clinical and public health level. Its increa= sing prevalence calls for improved care to forestall associated complications. T= he International Federation of Diabetes estimates that if the current trend of= DM incidence continues, by 2030 over 500 million people will be diabetic.= 3 In developing countries, those frequently affected by this disease are aged between 35 and 64 which makes the burden in terms of Disability-Adjusted Li= fe years and years living with disability heavier in poorer countries.1 <= o:p>

 

Diabetes mellitus is an emerging problem of public health significance in Sub-Saharan Africa especially Nige= ria with type 2 diabetes mellitus being the most common.4 It is beco= ming more prevalent owing to the increasing rates of obesity, physical inactivit= y, and urbanization.4 In 2010 in Sub-Saharan Africa, 12.1 million people were estimated to be living with diabetes and was projected to incre= ase to 23.1 million by 2030.5 In Nigeria, the incidence and prevalen= ce of diabetes have continued to increase despite the investment of a great de= al of research and resources.6 According to WHO, there are 1.71 mil= lion people living with diabetes in Nigeria and this is projected to reach 4.84 million by the year 2030 alongside an increase in the disease burden.7= ,8 Diabetes mellitus and its complications impose substantial economic costs on patients,  their families, health systems, and national economies because of the direct costs of treatment and loss of work and wages.9

The clinical course of Diabetes mellitus especially glycaemic control is largely influenced by patient self-management10 and the success of self-management is dependent on the psychosocial characteristics of the individual including the satisfaction with the quality of diabetic care received.2 Satisfied patients are more likely to develop deeper = and longer-lasting relationships with their medical care providers leading to improved compliance, continuity of care, and ultimately better outcomes.11 Patients’ satisfaction can be said to be patients’ values, judgment, and subsequent reaction to what they perceive in the health environment just before, during, and after the course of their clinical visit. Improving the= quality of care for patients with chronic conditions like diabetes has become an important focus of the healthcare system.12 This is because desp= ite advances in diabetes care and diabetes care facilities, desired outcomes and patient satisfaction with the care received and outcomes experienced are not optimal.6 The global control of glycaemia in diabetics remains an uphill task and achieving target blood glucose levels require good adherenc= e to prescribed medication and specific health-related beha= viours. These could be attained where there is good patient satisfaction as treatme= nt satisfaction has been associated with adherence to treatment, glycaemic control, and treatment preference.13

 

There is a paucity of research i= n Nigeria on the relationship between patients’ satisfaction and glycaemic control in diabetics. Most studies have focused on patient satisfaction with healthcare services. This study thus aimed to explore the relationship betw= een patients’ satisfaction and diabetic control, as well as to identify associa= ted factors such as duration of diabetes, types of treatment, types of complications, and associated co-morbidities among diabetic patients in a tertiary care facility in Rivers State, to improve the outcome of diabetic = care in the state and the country at large.

 

Materials and Methods

The study was carried out at the diabetic clinic of the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt. The UPTH is a tertiary healthcare institution and comprises various specialties. The diabetic clinic is held in the Medical Outpatient = Department and is run once a week. It attends to an average of 50 Diabetic patients on follow-up a week giving a total of 200 patients a month most of which are referred from the Family Medicine clinic and Accident and Emergency departments. This was a cross-sectional descriptive hospital-based study carried out among consenting diabetics aged between 15-70 years. Newly diagnosed diabetics, diabetic patients who had not been managed for up to o= ne month at the facility as well as those who were severely ill and could not stand the stress of the research, were however excluded from the study.

In the absence of any prevalence figure on patient satisfaction among diabetics, the prevalence of 50% satisfaction was used to determine a sample size of 400 for the study using Cochrane’s formula. Respondents were selected by systematic random sampling. From the records in the diabetic clinic, an average of 50 diabetic patients= on more than one-month follow-up are seen weekly giving a total of 50 x 16 (wh= ere 16 is the number of weeks the study is expected to last) =3D800. Therefore,= the total number of patients was 800 patients. The sample interval was derived = by dividing the sampling frame by the estimated sample size i.e.  =3D2. The first sample was selected usin= g a simple random technique in which the first two diabetic patients on follow-= up present in the clinic at the commencement of the study each week handpicked numbers from 1 and 2. The person who picked number “1” was taken as the fir= st and approximately 25 persons were seen each week.

 

Data collection was conducted us= ing a pretested interviewer-administ= ered structured questionnaire (The Diabetic Treatment Satisfaction Questionnaire= and the Patient Satisfaction Questionnaire)14 and was done by the principal researcher and trained assistants. It contains eight items scored= on a six-point scale. Six items measured treatment satisfaction (dealing with satisfaction with the current treatment, the convenience of the treatment, flexibility, satisfaction with own understanding of their diabetes, how lik= ely to recommend their present treatment, and how satisfied to continue their present treatment). These were summed to produce a total treatment satisfac= tion score. Questions 2 and 3 concerning the level of blood sugar were treated separately from the satisfaction items and each other. On these two items, = low scores represented good perceived blood glucose control. DTSQ scores ranged from, 6=3D very satisfied to 0 =3D very dissatisfied.

 

The= PSQ–18 yields separate scores for each of the seven different subscales. General s= atisfaction (items 3 and 7), technical quality (items 2,4, 6, and 14), interpersonal ma= nner (10 and 11), communications (1 and 13) financial aspects (5 and 7), time sp= ent with the doctor (12 and 15) as well as accessibility and convenience (8, 9,= 16 and 18). Some items of PSQ-18 were worded so that agreement reflected satisfaction with medical care whereas other items were worded so that agreement reflected dissatisfaction with medical care. After item scoring, items within the same subscale were averaged together to create the seven subscale scores. Items left blank by respondents were ignored when calculat= ing scale scores.

 

The independent variables measur= ed were sex, age, marital status, occupation, level of education, and glycaemic control, while the dependent variable was t= he patients’ satisfaction. Other data collected included the respondents’ weig= ht and height which were used to estimate their body mass index (BMI) and categorized as underweight: BMI< 18.5kg/m2; norm= al weight: BMI of 18.5-24.9kg/m2, overweight: BMI of 25-29.9kg/m2; and obesity: BMI of >30kg/m2. Their blood pressure was also measured and their fasting blood sugar was assessed. A fasting blood glucose level of le= ss than or equal to 5.5mmol/L was taken as good glycaemic= control. Urinalysis as well as blood cholesterol levels of each participant were also assessed. Hypercholesterolemia was diagnosed by total blood cholesterol > 240mg/dl according to the 2001 National Cholesterol Educat= ion Program (NCEP) Guidelines.15 All samples were sent to the Chemic= al Pathology laboratory of UPTH for laboratory analysis.

 

Data analysis was carried out us= ing Statistical Package for Social Sciences (SPSS) version 21. Quantitative variables were summarized using mean and standard deviation, while categori= cal variables were summarized using frequencies and percentages. The Chi-squared test was used to test the association between two categorical variables. The satisfaction scores were compared between and among the different categorie= s of the socio-demographic characteristics using the student’s t-test and analys= is of variance (ANOVA) respectively. Spearman’s rank correlation coefficient w= as used to determine the degree of association between the pairs of PSQ satisfaction subscales. Linear regression was used to determine the factors influencing satisfaction and the level of significance was set at 0.05. Eth= ical approval was obtained from the UPTH Ethics Committee. Departmental approval from the Head of Internal medicine was also sought and obtained. Informed c= onsent was sought and obtained from each study participant recruited in accordance with the ethical principles for the guidance of physicians in medical resea= rch. Confidentiality, beneficence, non-maleficence, and the right to withdraw without loss of benefits of the study participants were also ensured during= the study.

 

Results

Four hundred subjects were involved in the study. The age range of participants was between 21 and 69 years and the largest proportion of them were aged between 60 and 69 years with a mean ag= e of 55.3 ± 12.8 years. The majority of the study participants were also females (62.0%), were Christians (96.5%), and were married (74.75%). 45.3% of the respondents had received tertiary education, and 41.5% were skilled workers. These are shown in Table 1.

Table 1: Demographic Characteristics of Respondents=

Variable

Frequency (n=3D400)

Percentage

Age (year)

 

 

20 – 29

13

 3.3

30 – 39

33

 8.2

40 – 49

78

19.5

50 – 59

112

28.0

60-69

164

41.0

Mean age

55.3± 12.8

 

Sex

 

 

Male

152

38.0

Female

248

62.0

Religion

 

 

Christianity

386

96.5

Islam

12

3.0

Traditional

2

0.50

Marital status

 

 

Single

25

6.3

Married

299

74.8

Separated/Divorced

17

4.2

Widowed

59

14.7

Education

 

 

No formal

32

8.0

Primary

107

26.8

Junior Secondary

14

3.5

Senior Secondary

66

16.5

Tertiary

181

45.2

Occupation

 

 

Skilled

166

41.5

Unskilled

130

32.5

Unemployed

42

10.5

Retired

62

15.5 

Clinical characteristics of participants

Regarding their clinical characteristics, 41% had been diabetic for less than 5 years, 29.5% and 29.= 5% had been diabetic for 5 – 10 years and > 10 years respectively as shown = in Figure 1.<= ![endif]>

Figure 1: Duration since diagnosis of diabetes among respondents

The majority of the respondents, 81.0% had received oral hypoglycaemic agents, w= hile 39.0% and 30% had received diet/exercise and insulin respectively for manag= ing the disease as shown in Figure 2.

 

<= ![endif]>

 

Figure 2: Proportion of type of treatment received by respondents

Among the participants, 51.5% of them experienced complications as a result of the disease. Among this numbe= r, 53.4% had retinopathies, 41.3% experienced neuropathies, 25.7% had foot ulc= ers, 6.8% had nephropathies and 6.8% experienced other complications. This is sh= own in Figure 3.

 

<= ![endif]>

 

Figure 3: Types of complications of diabetic mellitus among participants

 

Findings on Physical Examination

Regarding the blood pressure of = the participants, the majority of them 66.5% had normal blood pressure, and 32.= 0% were hypertensive. The mean systolic blood pressure was 133 ± 20 mmHg and t= he mean diastolic blood pressure was 82 ± 12 mmHg. Also, only 26.8% of the participants had normal BMI, while 35.8% and 36.5% of the study participants were overweight and obese respectively. The mean BMI was found to be 28.4 ±= 5.8 kg/m2. Additionally, 46.3% of the participants were found to have glycosuria and 20.3% of them had proteinuria. Concerning their level of glycemic control, it was found that 19.8% of them had fasting blood sugar of <5.5 mmol/L and the mean fasting blood sugar was 8.9 ± 5.5 mmol/L. (Table 2).

 

Table 2: Blood Pressure Measurement

Variables

Frequency (n =3D 400)

Percentage (%)

Blood pressure

 

 

Normal

266

66.5

Hypotension<= /p>

6

1.5

Hypertension=

128

32.0

Mean SBP

133 ± 20mmHg

 

Mean DBP

82 ± 12mmHg

 

Body Mass Index (BMI)

 

 

< 18.5

4

1.0

18.5 – 24.9<= /p>

107

26.8

25.0 – 29.9<= /p>

143

35.8

≥ 30

146

36.5

Mean BMI

28.4 ± 5.8

 

Glycosuria

 

 

Absent

215

53.75

Present

185

46.25

Proteinuria

 

 

Absent

319

79.75

 

Present

81

20.25

FBS (mmol/l)

 

 

< 5.5 (controlled)

79

19.75

≥ 5.5 (not controlled)

321

80.25

Mean FBS

8.9 ± 5.5

 

 

Regarding the lipid profile of t= he study participants, it was found that the majority of them (67.5%) had total cholesterol that was ≤ 6 mmol/L and the mean t= otal cholesterol was 5.7 ± 1.7 mmol/L. Only 20.0% of them had triglyceride of ≤ 1.7 mmol/L with a mean triglyceride of 2.5 ± 1.0 mmol/L, and up to 57.0% of them had high-density lipoprotein (HDL) levels of ≥ 1.2mmol/L with a mean HDL of 1.3 ± 0.6 mmol/L. (Table 3).

 

Table 3:  Lipid Profile of Study Participa= nts

Variable

F= requency (n =3D 400)

P= ercentage

TC (mmol/l)<= /p>

<= o:p> 

<= o:p> 

≤ 6

270

67.5

> 6

130

32.5

Mean TC

5.7 ± 1.7

<= o:p> 

TG (mmol/l)<= /p>

<= o:p> 

<= o:p> 

≤ 1.7<= /p>

80

20.0

> 1.7

320

80.0

Mean TG

2.5 ±1.0

<= o:p> 

HDL (mmol/l)=

<= o:p> 

<= o:p> 

< 1.2

172

43.0

≥ 1.2<= /p>

228

57.0

Mean HDL

1.3 ± 0.6

<= o:p> 

 

Patients’ Satisfaction Score

As shown in Table 4, the mean to= tal Diabetes Treatment Satisfaction Questionnaire score was 33.8 ± 8.2 after cumulating the different mean scores of the various domains of the study instrument which assessed patient satisfaction.

&nb= sp;

Table 4:  Diabetes Treatment Satisfaction Questionnaire scores

Item

Mean ± SD

M= edian

How satis= fied are you with your current treatment?

4.8 ± 1.4

5

How often have you felt that your blood sugar has been unacceptably high recently?<= /span>

3.1 ± 2.0

3

How often have you felt that your blood sugar has been unacceptably low recently?

4.2 ± 1.8

5

How convenient have you been finding your treatment to be recently?

4.3 ± 1.5

5

How flexi= ble have you been finding your treatment to be recently?

4.2 ± 1.4

4

How satis= fied are you with your understanding of your diabetes?

4.2 ± 1.6

5

Would recommend this form of treatment to someone else with a kind of diabetes?=

4.4 ± 1.6

5

How satis= fied would you be to continue with your present form of treatment?

4.6 ± 1.5

5

Total score

33.8 ± 8.2

35

 

The mean total Short Form Patien= t Satisfaction Questionnaire (PSQ) score was found to be 16.8 ± 3.6 after cumulating the m= ean scores for the different domains of the PSQ. These are shown in Tables 5a a= nd 5b.

 

Table 5a: Short-Form Patient Satisfaction Questionna= ire Scores

Item

S= core (n =3D 400)

M= ean ± SD

M= edian

1. Doctors are good at explaining the reason for medical tests

2= .0 ± 1.1

2=

2. I thin= k my doctor’s office has needed to provide complete medical care

2= .5 ± 1.2

2=

3. The medical care I have been receiving is just about perfect

2= .2 ± 0.9

2=

4. Someti= mes doctors make me wonder if their diagnosis is correct

2= .5 ± 1.1

2=

5. I feel confident that I can get the medical care I need without being set back financially

2= .8 ± 1.2

3=

6. When I= go for medical care, they are careful to check everything when treating and examining me

2= .1 ± 0.9

2=

7. I have= to pay for more of my medical care than I can afford

3= .2 ± 1.3

3=

8. I have easy access to the medical specialists I need

2= .4 ± 0.9

<= span lang=3DEN-US style=3D'font-size:12.0pt;font-family:"Times New Roman",seri= f; mso-ascii-theme-font:major-bidi;mso-fareast-font-family:Calibri;mso-hansi= -theme-font: major-bidi;mso-bidi-theme-font:major-bidi'>2

9. Where I get medical care people have to wait too long for emergency treatment

3= .1 ± 1.1

3=

10. Docto= rs act too business-like and impersonal towards me

2= .4 ± 1.1

2=

11. My doctors treat me in a very friendly courteous manner

2= .0 ± 0.9

2=

12. Those= who provide my medical care sometimes hurry too much when they treat me<= /o:p>

2= .5 ± 1.0

2=

13. Docto= rs sometimes ignore what I tell them

2= .2 ± 0.9

2=

14. I have some doubts about the ability of the doctors who treat me

2= .2 ± 1.0

2=

15. Docto= rs usually spend plenty of time with me

2= .4 ± 1.0

2=

16. I fin= d it hard to get an appointment for medical care right away<= /p>

2= .4 ± 1.0

2=

17. I am dissatisfied with some things about the medical care I receive=

2= .5 ± 1.0

2=

18. I am = able to get medical care whenever I need it

2= .1 ± 0.9

2=

 

Table 5b: Short-form patient satisfaction questionnaire subscales sc= ores

Scale

I= tems averaged

S= core (n =3D 400)

M= ean ± SD

M= edian

General satisfaction

3 & 17

2= .4 ± 0.8

2= .0

Technical Quality

2= , 4, 6 & 14

2= .3 ± 0.6

2= .3

Interpers= onal Manner

10 & 11

2= .2 ± 0.8

2= .0

Communica= tion

1 & 13

2= .1 ± 0.8

2= .0

Financial Aspect

5 & 7

3= .0 ± 1.1

3= .0

Time Spent with Doctor

12 & 15

2= .4 ± 0.8

2= .0

Accessibi= lity and Convenience

8= , 9, 11 & 18

2= .4 ± 0.6

2= .5

Total score<= /i>

<= o:p> 

1= 6.8 ± 3.6

1= 6.5

 

4.4       Association between Socio-Demographic factors and Treatment satisfaction

There was a statistically significant difference between satisfaction with the treatment of diabetes mellitus and the age groups of the respondents (p < 0.001). The mean sco= re for satisfaction with treatment of diabetes mellitus was highest in the age group 30–39 years (37.0 ± 4.6), followed by the age group 50–59 years (35.8= ± 7.7). The mean was lowest in the age group 20–29 years (23.2 ± 8.9), follow= ed by the age group 40-49 years and 60-69 years (33.1 ± 8.3). No other socio-demographic factor was found to be associated with treatment satisfac= tion among the respondents (Table 6).

 

Table 6: Associations between socio-demogra= phic factors and treatment satisfaction

V= ariable

M= ean ± SD

9= 5% CI of mean

S= tatistics

p= -value

L= ower

U= pper

A= ge (Year)

<= o:p> 

<= o:p> 

<= o:p> 

<= o:p> 

<= o:p> 

2= 0 – 29

2= 3.2 ± 8.9

1= 7.9

2= 8.5

F= =3D 9.556

&= lt; 0.001*

3= 0 – 39

3= 7.0 ± 4.6

3= 5.4

3= 8.7

<= o:p> 

<= o:p> 

4= 0 – 49

3= 3.1 ± 8.3

3= 1.2

3= 4.9

<= o:p> 

<= o:p> 

5= 0 – 59

3= 5.8 ± 7.7

3= 4.3

3= 7.2

<= o:p> 

<= o:p> 

&= #8805; 60

3= 3.1 ± 8.3

3= 1.8

3= 4.3

<= o:p> 

<= o:p> 

S= ex

<= o:p> 

<= o:p> 

<= o:p> 

<= o:p> 

<= o:p> 

M= ale

3= 3.3 ± 8.8

3= 1.9

3= 4.7

t= =3D 1.031

0= .303

F= emale

3= 4.2 ± 7.9

3= 3.2

3= 5.1

<= o:p> 

<= o:p> 

S= tate of Origin

<= o:p> 

<= o:p> 

<= o:p> 

<= o:p> 

<= o:p> 

R= ivers

3= 3.9 ± 8.2

3= 3.0

3= 4.7

t= =3D 0.317

0= .751

N= on-Rivers

3= 3.5 ± 8.5

3= 1.2

3= 5.8

<= o:p> 

<= o:p> 

R= eligion

<= o:p> 

<= o:p> 

<= o:p> 

<= o:p> 

<= o:p> 

Christianity

3= 3.9 ± 8.2

3= 3.1

3= 4.7

t= =3D 0.777

0= .437

Others

3= 2.1 ± 10.4

2= 6.1

3= 8.1

<= o:p> 

<= o:p> 

Marital Status

<= o:p> 

<= o:p> 

<= o:p> 

<= o:p> 

<= o:p> 

Single

3= 1.0 ± 9.5

2= 7.1

3= 5.0

F= =3D 1.104

0= .347

Married

3= 4.3 ± 8.2

3= 3.2

3= 5.0

<= o:p> 

<= o:p> 

Separated/Divorced

3= 4.2 ± 5.8

3= 1.2

3= 7.2

<= o:p> 

<= o:p> 

Widowed

3= 3.5 ± 8.4

3= 1.3

3= 5.7

<= o:p> 

<= o:p> 

E= ducation

<= o:p> 

<= o:p> 

<= o:p> 

<= o:p> 

<= o:p> 

No formal

3= 7.2 ± 5.9

3= 5.1

3= 9.3

F= =3D 1.624

0= .167

Primary

3= 3.6 ± 8.4

3= 1.9

3= 5.2

<= o:p> 

<= o:p> 

Junior Secondary

3= 3.2 ± 7.5

2= 8.9

3= 7.6

<= o:p> 

<= o:p> 

Senior Secondary

3= 4.2 ± 7.0

3= 2.5

3= 5.9

<= o:p> 

<= o:p> 

Tertiary

3= 3.3 ± 8.9

3= 2.0

3= 4.6

<= o:p> 

<= o:p> 

O= ccupation

<= o:p> 

<= o:p> 

<= o:p> 

<= o:p> 

<= o:p> 

Skilled

3= 3.6 ± 8.4

3= 2.3

3= 4.9

F= =3D 0.348

0= .791

Unskilled

3= 4.0 ± 8.6

3= 2.5

3= 5.5

<= o:p> 

<= o:p> 

Unemployed

3= 4.8 ± 6.8

3= 2.7

3= 6.9

<= o:p> 

<= o:p> 

Retired

3= 3.4 ± 7.9

3= 1.4

3= 5.4

<= o:p> 

<= o:p> 

SES

<= o:p> 

<= o:p> 

<= o:p> 

<= o:p> 

<= o:p> 

Class 1

3= 1.8 ± 8.4

2= 8.3

3= 5.3

F= =3D 0.794

0= .530

Class 2

3= 3.2 ± 7.9

3= 1.2

3= 5.1

<= o:p> 

<= o:p> 

Class 3

3= 5.5 ± 7.4

3= 2.9

3= 8.2

<= o:p> 

<= o:p> 

C= lass 4

3= 3.8 ± 8.9

3= 1.7

3= 5.9

<= o:p> 

<= o:p> 

C= lass 5

3= 3.9 ± 8.3

3= 1.7

3= 6.2

<= o:p> 

<= o:p> 

 

 

 

 

 

 

 

 

 

 

* Statistically significant; F =3D F statistic for Analysis of Variance (ANOV= A); t =3D Student’s t statistic

4.5 Treatment satisfaction and other associ= ated factors

There were statistically signifi= cant associations between scores for treatment satisfaction with the use of an o= ral hypoglycaemic agent (p =3D 0.043) and the presence of complications (P < 0.001). Participants using an oral hypoglycaemic agent had a higher mean satisfaction score (34.2 ± 8.1) than those who were= not using an oral hypoglycaemic agent (32.1 ± 8.6).= Those with no complications of diabetes mellitus had a higher mean satisfaction s= core (35.3 ± 8.0) than those with complications of diabetes mellitus (32.4 ± 8.2= ). (Table 7)

 

Table 7:  Diabetes Treatment Satisfaction and Other Associated Factors

Variable

When diagnosed (year)

Mean ± SD

95% CI of mean

Statistics

p-value

Lower

Upper

< 5

33.6 ± 7.8

32.4

34.8

F =3D 0.339<= /p>

0.713

5 – 10

34.3 ± 8.4

32.8

35.9

 

 

> 10

33.6 ± 8.7

32.0

35.1

 

 

Type of Treatment <= /span>

 

 

 

 

 

Diet and exercise

 

 

 

 

 

Yes

34.3 ± 7.5

33.1

35.5

t =3D 0.925<= /p>

0.356

No

33.5 ± 8.7

32.4

34.6

 

 

Oral Anti-Diabetic Agents

 

 

 

 

 

Yes

34.2 ± 8.1

33.3

35.1

t =3D 2.015<= /p>

0.045*

No

32.1 ± 8.6

30.2

34.1

 

 

Insulin

 

 

 

 

 

Yes

32.9 ± 7.6

31.5

34.2

t =3D 1.535<= /p>

0.126

No

34.2 ± 8.5

33.2

35.3

 

 

Have complication(s)

 

 

 

 

 

Yes

32.4 ± 8.2

31.3

33.5

t =3D 3.573<= /p>

< 0.001*<= /p>

No

35.3 ± 8.0

34.2

36.5

 

 

SBP (mmHg)

 

 

 

 

 

< 120

35.0 ± 7.7

33.5

36.6

F =3D 1.706<= /p>

0.183

120 – 139

33.9 ± 8.9

32.4

35.3

 

 

≥ 140<= /p>

33.1 ± 7.8

31.8

34.3

 

 

       

 

 

 

 

 

< 80

33.6 ± 8.5

32.0

35.2

F =3D 0.680<= /p>

0.507

80 – 89

34.5 ± 8.3

33.1

35.9

 

 

≥ 90

33.4 ± 8.0

32.1

34.7

 

 

Glycosuria

 

 

 

 

 

Absent

34.5 ± 7.8

33.5

35.6

t =3D 1.889<= /p>

0.060

Present

33.0 ± 8.6

31.7

34.2

 

 

Proteinuria =

 

 

 

 

 

Absent

33.6 ± 8.2

32.7

34.6

t =3D 0.848<= /p>

0.397

Present

34.5 ± 8.5

32.6

36.4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

* Statistically significant; F =3D F statis= tic for Analysis of Variance (ANOVA); t =3D Student’s t statistic

 

After multivariate analysis, it = was observed that the satisfaction with DM treatment increased by 2.35 with the= use of oral hypoglycaemic agent and it decreased by= 2.91 with the presence of complications of DM. (Table 8).

 

 

Table 8: Simple Linear Regressio= n of Diabetes Treatment Satisfaction on The Associated Factors

Variable      

B

SE

p-value

r2 (%)

Age (year)

0.03

0.320

0.372

0.2

Use of oral hypoglycaemic agent

2.35

1.029

0.045*

1.0

Presence of complications of D= M

-2.91

0.811

< 0.001*<= /p>

3.1

Presence of glycosuria

-1.56

0.823

0.060

0.9

*Statistically significant; b =3D regression coefficient; SE =3D standard error; r2 =3D coefficien= t of determination

 

4.6       <= /span>Correlation between the subscales and the overall score of PSQ Satisfaction =

Accessibili= ty and Convenience correlated most with overall satisfaction (r =3D 0.74), fol= lowed by Interpersonal Manner (r =3D 0.68), Time spent with the doctor (r =3D 0.6= 5), and Technical Quality (r =3D 0.62), while Financial Aspect correlated least wit= h the overall satisfaction (r =3D 0.50), followed by General Satisfaction (r =3D = 0.60) and Communication (r =3D 0.61). See Table 9.

 

Table 9: Spearman’s Rank Correlation (ρ= ;) between the subscales and the overall score of PSQ Satisfaction =

PSQ Subscale=

Spearman’s Rank correlation (r= )

p-value

General Satisfaction

0.60

< 0.001*<= /p>

Technical Quality <= /span>

0.62

< 0.001*<= /p>

Interpersonal Manner

0.68

< 0.001*<= /p>

Communication

0.61

< 0.001*<= /p>

Financial Aspect

0.50

< 0.001*<= /p>

Time Spent with Doctor

0.65

< 0.001*<= /p>

Accessibility and Convenience =

0.74

< 0.001*<= /p>

*Statistically significant<= /o:p>

 

4.7       <= /span>Patients’ Satisfaction and Glycaemic Control

There was no statistically significant association between fasting blood sugar and treatment satisfact= ion (p =3D 0.607). However, the mean score for satisfaction with DM treatment w= as higher among participants with fasting blood sugar ≤ 5.5mmol/L (34.3 ± 8.5) than those with fasting blood sugar > 5.5mmol/L (33.7 ± 8.2). (Table 10). Also, the Table shows that there was no statistically significant association between fasting blood sugar and patient satisfaction as measured with short form patient satisfaction questionnaire though the mean score for satisfaction was higher among participants with fasting blood glucose Ͱ= 4; 5.5mmol/L (17.0 ± 0.3) than those with fasting blood sugar >5.5mmol/L (1= 6 ± 3.6).

 

Table 10: Treatment Satisfaction and Fasting Blood Sugar

Variable

Mean ± SD

Mean diff.

95% CI of diff.

Statistics

p-value

Lower

Upper

FBS (mmol/l)

 

 

 

 

 

 

<= 5.5 (controlled)

34.3 ± 8.5

0.5

-1.5

2.6

t =3D 0.515

0.607

X= 05; 5.5 (not controlled)

33.7 ± 8.2

FBS (mmol/l)

 

<= o:p> 

<= o:p> 

<= o:p> 

<= o:p> 

<= o:p> 

<= 5.5 (controlled)

17.0 ± 3.3

0.2

<= o:p> 

-0.7

<= o:p> 

1.1

<= o:p> 

t= =3D 0.509

0= .611

X= 05; 5.5 (not controlled)

16.8 ± 3.6

<= o:p> 

<= o:p> 

<= o:p> 

<= o:p> 

<= o:p> 

 

 =

 =

 =

 =

 =

 =

 =

The preponderance of diabetics in the age group 60-69 years (41.0%= ) in this study could be attributed to the fact that the proportion of people diagnosed with diabetes generally increases with age 16 because = of worsening insulin resistance with age, increased inactivity as well as longevity of diabetics due to improved care.4 This finding has b= een corroborated by various Nigerian studies6,17,18 and international studies.19,20 However, Gezawa et al<= sup>21 in Maiduguri found the highest prevalence among the middle age group though= age greater than 35 years was an independent risk factor for diabetics in that study. This could be due to the fact that their study was a population-based study. This study demonstrated a statistically significant difference betwe= en treatment satisfaction and the different age groups (p<0.001). However, after regression, this association no longer existed (p=3D0.372). This is in keeping with the findings by Kuteyi et al2= 2in Ile-Ife, Adeniyi et al23 in Lagos, and Al Shahrani et al12<= /sup> in Oman, who found no significant relationship between age and patient satisfaction with diabetic care. This finding is however in contrast to sev= eral other studies24-29 which posited that satisfaction is associated with age and increases with increasing age and that younger patients have higher expectations that may be difficult to meet. This difference may be d= ue to the differences in study tools used in assessing patient satisfaction and population characteristics.

 

Regarding the treatment modality, patients who were taking tablets had higher mean treatment satisfaction sco= res (34.2 ± 8.1; p =3D 0.045), with a significant difference from those who did= not. Multivariate analysis confirmed a positive correlation between use of oral anti-diabetic drugs (OAD) and treatment satisfaction (p=3D0.023). This impl= ied that taking a pill was more comfortable for diabetic patients rather than injecting insulin. It could be due to the reason that patients might think insulin treatment meant that their health status had deteriorated. This was corroborated by Bener et al2 but was in cont= rast to the findings by Biderman et al30 where patients on diet alone were the most satisfied with their treatment modality. Patients taking only oral anti-diabetic drugs have also been reported to be more satisfied than those taking insulin and OAD30.

 

This study also reported that satisfaction scores were lower in patients with complications (32.4 ± 8.2; p<0.001). Multivariate analysis confirmed a negative correlation between treatment satisfaction and the presence of complications. It may be suggest= ed that those with complications were less likely to be satisfied because they felt that the presence of complications meant inadequate provision of care. In addition, it is pertinent to note that most diabetics with complications we= re on insulin hence the low satisfaction scores in both groups of respondents. This finding is similar to the findings of other authors.2,30,31

 

Furthermore, this study found accessibility and convenience as significant predictors of satisfaction whi= ch also correlated most with overall satisfaction on the PSQ-18 scale (r=3D0.7= 4). Easy access and short waiting times have also been found to be strong determinants of patient satisfaction in different studies.32,33 = This however contrasted with the findings of Amole et al34 where wait= ing time had the least impact on satisfaction probably because of the method of analysis (analytical hierarchy process) and the fact that it was a multicentre study. The interpersonal manner of the do= ctors was found to be a significant predictor of satisfaction in the short-form PSQ-18 satisfaction score as it was highly correlated with overall satisfac= tion (r=3D0.68). Doctors’ empathy has consistently been found as an important fa= ctor in the determination of patients’ satisfaction. It agreed with reports by A= mole et al34 where it was found that the empathy dimension of 16.46% = had the greatest impact on service delivery and Nasir et al35 who fo= und that patients who evaluated the behaviour of the staff members as poor were least likely to be satisfied.<= /p>

 

The time spent with the doctor w= as also found in this study to be a significant contributor to the satisfaction score as it had a high correlation with overall satisfaction (r =3D0.65).  Time spent with the doctor appears to c= ompensate the patient for all the inconveniences of the system and the patient feels = that more time spent with the doctor meant better care. This was in keeping with some studies.36,37 In this study, technical quality was another significant predictor of satisfaction (r =3D0.62). Perceptions of provider technical competence have also been reported to influence patient satisfact= ion.38,39 Communication between doctor and patient was a significant predictor = of patient satisfaction because information to the patient is considered an important aspect of patients’ expectation of personalized care which is in agreement with the findings of several studies34,35-41 where communication was the most important factor associated with patient satisfaction. Ironically, the financial aspect was found in this study to c= orrelate least with overall satisfaction scores (r=3D0.50). This may be because of t= he prevalent out-of-pocket financing of health care in our environment, hence, most clients coming to the facility are prepared to personally fund the healthcare services they receive which could be higher than what they expec= ted to pay. This was similar to the finding by Zaiei et al39 but was in contrast with the= Nabbuye-Sekandi et al’38 study conducted in Uganda. 

 

In this study, there was no statistically significant association between glycaemi= c control as measured by fasting blood glucose and treatment satisfaction (r = =3D 0.607). Also, there was no statistically significant association between glycaemic control as measured by fasting blood glucos= e and patient satisfaction as measured by the short-form satisfaction questionnai= re (r =3D 0.611). This finding corroborates the findings of Al Shahrani et al<= sup>12 who found no association between glycaemic cont= rol and patient satisfaction. It was, however, in contrast with the reports from other studies.2,42,43 This may be due to the difference in the criteria used to assess glycaemic control in the contrasting studies.

 

The present study did not also s= how any significant association between the duration of diabetes and treatment satisfaction (r=3D0.713). Patients with chronic illnesses were expected to = know more about their illness and thought to require more attention.44 However, this study did not demonstrate any effect on satisfaction rates by= the duration of diabetes. This finding may be explained by the fact that many patients in our environment are not well informed about their illnesses, so their knowledge of the illnesses does not necessarily increase as the durat= ion of their illnesses increases, hence may not affect their desire for attenti= on and consequent treatment satisfaction. This finding was in keeping with rep= orts by Udonwa et al44 in Calabar where t= here was no significant association between satisfaction and duration of illness. This similarity could be explained by the fact that both studies were carri= ed out in the same South-South geopolitical zone of Nigeria. However, it contrasted with the finding by Othman et al25 in the United Arab Emirates where there was a significant association between the duration of disease and treatment satisfaction with higher satisfaction among those wit= h a higher duration of diabetes.

 

In conclusion, this study identi= fied that the use of oral anti-diabetic agents, the presence of complications, a= nd some doctor-related and practice-related characteristics like accessibility and convenience, interpersonal manner, time spent with doctor, technical qualit= y, and communication were factors associated with patient satisfaction. It, however, did not show a significant association between patient satisfaction and glycaemic control. It should however be not= ed that seeing the hospital-based nature of this study, it may not have been f= ully representative of the community considering that most dissatisfied clients = may no longer be attending the clinic for follow-up.   

 

In order to improve patient satisfaction with care for diabetics, the following measures were recommend= ed. Viz:

  • Patien= ts, who are treated with insulin and have diabetes complications, should be targeted as a unique group among diabetic patients and given more attention by counseling so as to improve their satisfaction and qualit= y of life.
  • Patient waiting time should be also evaluated and ideally reduced or used as an opportunity for patient education and consequently improve patient satisfaction.
  • Consultation techniques with an emphas= is on patient-centeredness should be taught in medical training instituti= ons to improve patient satisfaction with clinical consultation. 

 <= /o:p>

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=  

 

 

 

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