Is motivation enough? Responsiveness, patient-centredness, medicalization and cost in family practice and conventional care settings in Thailand

Pongsupap, Yongyuth; Lerberghe, Wim Van

doi:10.1186/1478-4491-4-19

Cited by 13 publications

(7 citation statements)

References 3 publications

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“…Another study from Brazil described the psychometric steps in developing an instrument to assess the responsiveness of nurses [ 30 ]. Another study was from Thailand; and it employed simulated patient method to analyze degree of responsiveness of physicians; but did neither clarify the concept of responsiveness nor investigate the reliability and validity of the tool used [ 29 ].…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a structured observation scale to measure responsiveness of physicians in rural Bangladesh

Joarder

Mahmud

Sarker

et al. 2017

BMC Health Serv Res

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BackgroundResponsiveness of physicians is the social actions that physicians do to meet the legitimate expectations of service seekers. Since there is no such scale, this study aimed at developing one for measuring responsiveness of physicians in rural Bangladesh, by structured observation method.MethodsData were collected from Khulna division of Bangladesh, through structured observation of 393 patient-consultations with physicians. The structured observation tool consisted of 64 items, with four Likert type response categories, each anchored with a defined scenario. Inter-rater reliability was assessed by same three raters observing 30 consultations. Data were analyzed by exploratory factor analysis (EFA), followed by assessment of internal consistency by ordinal alpha coefficient, inter-rater reliability by intra-class correlation coefficient (ICC), concurrent validity by correlating responsiveness score with waiting time, and known group validity by comparing public and private sector physicians.ResultsAfter removing items with more than 50% missing values, 45 items were considered for EFA. Parallel analysis suggested a 5-factor model. Nine items were removed from the list owing to < 0.50 communality, <0.32 loading in un-rotated matrix, and <0.30 on any factor in rotated matrix. Since 34 items (i.e., the number of remaining items after removing nine items by EFA) were loaded neatly under five factors, explained 61.38% of common variance, and demonstrated high internal consistency with coefficient of 0.91, this was adopted as the Responsiveness of Physicians Scale (ROP-Scale). The five factors were named as 1) Friendliness, 2) Respecting, 3) Informing and guiding, 4) Gaining trust, and 5) Financial sensitivity. Inter-rater reliability was high, with an ICC of 0.64 for individual rater’s reliability and 0.84 for average reliability scores. Positive correlation with waiting time (0.51), and higher score of private sector by 0.18 point denote concurrent, and known group validity, respectively.ConclusionsThe ROP-Scale consists of 34 items grouped under five factors. One can apply this with confidence in comparable settings, as this scale demonstrated high internal consistency and inter-rater reliability. More research is needed to test this scale in other settings and with other types of providers.Electronic supplementary materialThe online version of this article (10.1186/s12913-017-2722-1) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Development and validation of a structured observation scale to measure responsiveness of physicians in rural Bangladesh

Joarder

Mahmud

Sarker

et al. 2017

BMC Health Serv Res

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“…Another study was done in Brazil on nursing staff, which described the psychometric steps in developing an instrument to assess nursing care responsiveness but lacked conceptual clarification on how the scale items had been derived [ 36 ]. Finally, a study of physicians from Thailand employed simulated patient method to analyze the degree of responsiveness (along with patient-centeredness, therapeutic decision, and cost) in terms of opening hours, waiting time, consultation time, requests for follow-up visits, and politeness of physician [ 35 ]. This study did not explore qualitatively what responsiveness meant to service seekers or providers or what its constituent elements were.…”

Section: Introductionmentioning

confidence: 99%

What constitutes responsiveness of physicians: A qualitative study in rural Bangladesh

et al. 2017

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Responsiveness entails the social actions by health providers to meet the legitimate expectations of patients. It plays a critical role in ensuring continuity and effectiveness of care within people centered health systems. Given the lack of contextualized research on responsiveness, we qualitatively explored the perceptions of outpatient users and providers regarding what constitute responsiveness in rural Bangladesh. An exploratory study was undertaken in Chuadanga, a southwestern Bangladeshi District, involving in-depth interviews of physicians (n = 17) and users (n = 7), focus group discussions with users (n = 4), and observations of patient provider interactions (three weeks). Analysis was guided by a conceptual framework of responsiveness, which includes friendliness, respecting, informing and guiding, gaining trust and optimizing benefits. In terms of friendliness, patients expected physicians to greet them before starting consultations; even though physicians considered this unusual. Patients also expected physicians to hold social talks during consultations, which was uncommon. With regards to respect patients expected physicians to refrain from disrespecting them in various ways; but also by showing respect explicitly. Patients also had expectations related to informing and guiding: they desired explanation on at least the diagnosis, seriousness of illness, treatment and preventive steps. In gaining trust, patients expected that physicians would refrain from illegal or unethical activities related to patients, e.g., demanding money against free services, bringing patients in own private clinics by brokers (dalals), colluding with diagnostic centers, accepting gifts from pharmaceutical representatives. In terms of optimizing benefits: patients expected that physicians should be financially sensitive and consider individual need of patients. There were multiple dimensions of responsiveness- for some, stakeholders had a consensus; context was an important factor to understand them. This being an exploratory study, further research is recommended to validate the nuances of the findings. It can be a guideline for responsiveness practices, and a tipping point for future research.

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“…Meeting these needs go beyond the goods and services alone but also include environmental conditions that are conducive [2,4]. There seem to be higher use of private health facilities attributed mostly to issues of easy access, shorter waiting time, longer or flexible opening hours, better availability of staff and drugs, better attitude and more confidentiality in socially stigmatized diseases [13]. However, in private hospitals, the quality of services, the responsiveness and discipline of the provider has been questionable [3,[14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Preferred Choice of Health Facilities for Healthcare among Adult Residents in Ilorin Metropolis, Kwara State, Nigeria

Abodunrin¹,

Bamidele²,

Olugbenga-Bello³

et al. 2011

Int J Health Res

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an online international journal allowing free unlimited access to abstract and full-text of published articles. The journal is devoted to the promotion of health sciences and related disciplines (including medicine, pharmacy, nursing, biotechnology, cell and molecular biology, and related engineering fields). It seeks particularly (but not exclusively) to encourage multidisciplinary research and collaboration among scientists, the industry and the healthcare professionals. It will also provide an international forum for the communication and evaluation of data, methods and findings in health sciences and related disciplines. The journal welcomes original research papers, reviews and case reports on current topics of special interest and relevance. All manuscripts will be subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication) will be published without delay. The maximum length of manuscripts should normally be 10,000 words (20 single-spaced typewritten pages) for review, 6,000 words for research articles, 3,000 for technical notes, case reports, commentaries and short communications. Submission of Manuscript:The International Journal of Health Research uses a journal management software to allow authors track the changes to their submission. All manuscripts must be in MS Word and in English and should be submitted online at http://www.ijhr.org. Authors who do not want to submit online or cannot submit online should send their manuscript by e-mail attachment (in single file) to the editorial office below. Submission of a manuscript is an indication that the content has not been published or under consideration for publication elsewhere. Authors may submit the names of expert reviewers or those they do not want to review their papers. The choice of health facilities for healthcare by an individual is largely determined by several factors. This study aims to determine predictors of preferred choice of health facility for care. Methods: In a descriptive cross-sectional study, pre-tested semi-structure questionnaire was administered to 366 adults selected through a multi-stage sampling technique in Ilorin metropolis. Data collected were analysed using Epi Info software version 3.4.1 and level of significance set at p < 0.05. Results: The preferred health facility for medical care was private hospitals (35.2%) followed by pharmaceutical store (27.9%) and 17.0% for general/teaching hospitals and only 12.3% for primary health care (PHC). Quick service and availability of drugs were the major reasons for their preference which were said to be better in private hospitals. Sex, marital status, educational status, occupation and city area where the respondents dwell are all associated with the preferred choice of health facility for care. Conclusion: This study has shown that the private sector is preferred to the public ones with regards to receiving healthcare and that within the public sector, the higher levels of health facilities are preferred to the pr...

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Is motivation enough? Responsiveness, patient-centredness, medicalization and cost in family practice and conventional care settings in Thailand

Cited by 13 publications

References 3 publications

Development and validation of a structured observation scale to measure responsiveness of physicians in rural Bangladesh

Development and validation of a structured observation scale to measure responsiveness of physicians in rural Bangladesh

What constitutes responsiveness of physicians: A qualitative study in rural Bangladesh

Preferred Choice of Health Facilities for Healthcare among Adult Residents in Ilorin Metropolis, Kwara State, Nigeria

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