International Journal of Current Medical And Applied Sciences, vol.4. Issue 1, September: 2014. PP: 18-24.

Measuring Patient Satisfaction: A Cross Sectional

Study to Improve Quality of Care at a Rural Health
Training Centre, Bareilly (Up).
S.B. Gupta* & J.P. Singh**
*Professor & Head, **Assistant professor, Department of community Medicine, SRMS
Institute of Medical Sciences, Bareilly (UP), India
E-mail: jpaliwal0001@gmail.com

Subject: Community Medicine

Research Article
-----------------------------------------------------------------------------------------------------Abstract:
Background: Patient satisfaction is a key
determinant of quality of care. It is also a
parameter for assessing the quality of patient care
services. Objective: To measure the satisfaction
level of patients attending the OPD at Rural Health
Training Centre (RHTC) attached to Department
of Community Medicine, SRMS Institute of Medical
Sciences, Bareilly [UP] India.
Materials and methods: It was a cross sectional
study carried out among patients who attended
the OPD at RHTC from January 2014 to April 2014.
Study subjects were selected by a systematic
random sampling method and interviewed using a
pre-tested & semi-structured interview schedule.
Data entry and analysis were done using the Epiinfo statistical software.
Results:
A total of 354 OPD patients were
included in the study. Majority of them were
satisfied with the facilities available as well as
with the behavior of doctors and other health
staff. Statistically significant relation was seen
between behavior of doctors and class III & IV
staffs with satisfaction level, gender & cleanliness,
gender & behavior of class III/IV employees and
also education & behavior of doctors.
Conclusion: The health care delivered at this
centre can be improved by monitoring the
delivery of quality care on an ongoing basis and
continually making small changes so as to
improve the individual processes.
Keywords: OPD patients, Patient satisfaction,
behavior, cleanliness.
---------------------------------------------------------------

Introduction:
Patient satisfaction is a key determinant
of quality of care and an important component of
pay-for-performance metrics and it is a multidimensional healthcare issue affected by many
factors. It is parameter for assessing the quality of
patient care services [1]. Quality services increase
the confidence of the patient about hospital care.
Patient satisfaction and healthcare service quality
can be increased by using a multi-disciplinary
approach that combines patient inputs as well as
expert judgment [2]. It is difficult to measure the
patient satisfaction level. Both clinical and
nonclinical outcomes of care have influence on
patient satisfaction [3]. Patients carry certain
expectations before their visit and the resultant
satisfaction or dissatisfaction is the outcome of
their actual experience [4,5,6] .
Patients perceptions about healthcare
systems seem to have been largely ignored by
health care managers in developing countries
[7,8]. This is despite the fact that patient
satisfaction surveys are one of the established
yardsticks to measure success of the service
delivery system, functional at hospitals.
Awareness about patient satisfaction is relevant in
the sense that satisfied patients are more likely to
abide by the treatment advised, to continue using
medical services and to promote referrals, thereby
increasing the service volumes.
The SRMS IMS and Hospital was started
by a trust in 1995. As a requirement for education
and training of medical students, the rural health
training center (RHTC) of department of PSM of
this college was started in 2005. The social policy
throughout the world was to built-up health
system based on primary health care, towards the

Copyright @ 2014 Logic Publications, IJCMAAS,E-ISSN:2321-9335,P-ISSN:2321-9327, Page I 18

S.B. Gupta & J.P. Singh

policy objective of health for all by 2000 AD. The
persons concerned with health of people, all over
the world, are striving to expand and improve
their health care services.
The RHTC is concerned not only to reach
the whole population with adequate health care
services but also to secure an acceptable level of
health for all through the application of primary
health care programmes in adopted geographic
area. Health services at RHTC are designed to
meet the health needs of the community through
the use of various general, specialty and
ambulatory services.
Primary health care approach at RHTC
includes services meant provision of integrated
preventive, promotive and curative health
services from womb to tomb to every individual
residing in a defined geographic area.
RHTC is functioning in adopted
geographic area with the aim of providing primary
health care. Addition of specialist health care
services to routine health services of RHTC were
made from time to time to meet the demand and
need of the defined community.
Reasonable period has passed after
implementation of these services in the
community and now it is high time for evaluation
of health services at RHTC to find out whether the
community has benefited by it or not. To fulfill this
need the current study was carried out at RHTC,
Dhaura.

Aims & Objectives

To find out satisfaction level of the patient
To study bio-social characteristics of the patient
To give recommendations regarding improvement
in health center services.

Materials and Methodology:

Setting and study design:
This was a cross sectional study
conducted in a primary care centre situated in the
rural part of northern India, which is attached to
department of community medicine, SRMS
Institute of medical sciences, Bareilly. This is a
centre for undergraduate and postgraduate
medical training and provides outpatient
consultations and counseling services to patients
presenting to the centre from periphery villages.
Patients were mainly seen in the General
Outpatient Department, obstetrics & gynecology
unit on daily and Specialty clinics on weekly basis
(Pediatric, skin & VD unit and geriatric unit). The

majority of patients are indigenous Hindu and

Muslim. A mixed occupational background
individuals as farmers, traders, service class and
students avail the health care facility.
Sample size and data collection:
The study was carried out between
January 2014 and March 2014. On the basis of
previous studies of patient satisfaction and quality
of care and using an appropriate statistical
formula for estimating minimum sample size in
descriptive health studies [n=4pq/d2], a sample
size of 354 was calculated to detect level of
satisfaction among the study participants. The
prevalence (p) used for sample size calculation
was taken as 72% (mean of satisfaction level with
Doctor Services as found in reviewed studies
[9,10,11,12] with 5% absolute error(d). The
sample size was further inflated by 10% to take
care of non-response, incomplete responses and
refusals. Patients between the ages of 18 and 75
years attending the outpatient department (OPD)
were included in the study. Daily OPD attendance
at RHTC was 60-80.
However, patients referred or advised for
admission, emergency with conditions related to
psychiatry or maternity and those with severe
acute or chronic illness were excluded from the
study since these were considered to be
exceptional circumstances.
Thus a total of nearly 354 patients were enrolled
for the study. A systematic random sampling
technique was used to select respondents from
among out patients department. Every 3rd patient
attending the OPD was taken for the study
purpose.
Questionnaire:
A pre- designed pre- tested Outdoor
Patient Feedback Questionnaire Form was
designed and filled up to examine several aspect
of centre care. Questionnaire was comprised of 27
items which measures deferent core dimension of
patient satisfaction like- evaluation of health care
facility, perception of waiting time, cleanliness of
waiting area, and behavior of health care
providers. It also contained questions on socio
demographic characteristics of the respondents.
The questionnaire consisted of five points Likert
scale items, with 1 and 5 indicating the highest
and lowest levels of satisfaction respectively.
Patients indicated their level of satisfaction by
selecting responses ranging from excellent=1,
very good=2, average=3, bad=4 and very bad=5.
Those who chose very bad and bad were

International Journal of Current Medical And Applied Sciences [IJCMAAS] volume 4, Issue 1.

Logic Publications @2014, IJCMAAS, E-ISSN: 2321-9335,P-ISSN:2321-9327.

considered dissatisfied while those who selected

average, very good and excellent were considered
satisfied. The prescribing doctor and the
supporting staff were largely kept unaware of the
survey, except in unavoidable circumstances, to
avoid the bias in their behavior with the patient.
The questionnaire was administered by
trained individuals after obtaining verbal consent
from all subjects and complete confidentiality was
maintained. Prior approval of the ethical board
was obtained before beginning the survey.
Outpatients were interviewed during their exit.
Statistical Analysis:
On the day of the attending the OPD, after
informing the patient about objectives of the
study, the patient was interviewed by the intern
and predesigned outdoor patient feedback from
was filled up. After completion the form was
signed by the intern and the patient. After the end
of three months the data was analyzed by using
simple percentages and chi square test.

The surveyed questionnaires were

collected and coded in a MS Excel database and
analyzed by using the Epi Info statistical package,
version 3.4.1. Descriptive statistics were
performed on the socio-demographic data, and
Pearsons chi-square test was used to examine the
relationship between satisfaction levels of
behavior of doctors and class IIIrd & IVth staffs
with bio social characteristics.
Inclusion criteria: A new or referred patient
attending the OPD of the respective health care
facility.
Exclusion criteria: Patients working in the health
care facility and follow-up patients attending the
OPD of the respective health care facility were
excluded from the study. Those below 18 years of
age were also excluded.
Definition of OPD: In this study, OPD is
defined as the rural centre where patients
received diagnosis and treatment services but
did not stay overnight.

Observation & Results:

Table 1: Satisfaction level of patients regarding behavior of hospital staffs (n=354)
Satisfaction level
Not Satisfied
Satisfied
Total

Behavior of rural health centre staff

Doctors (%)
135(38.1)
219(61.9)
354(100.0)

Class III & Class IV Workers (%)

56(15.8)
298(84.2)
354(100.0)

Patients were more satisfied with

behavior of Class III & Class IV workers (84.2%)

than behavior of doctors (61.9 %). It was found to

be statistically highly significant (P<0.001).

Table 2: Gender wise cleanliness satisfaction among study subjects (n=354)

Satisfaction
level
Not Satisfied
Satisfied
Total

Cleanliness at rural health centre (%)

Male (%)
30 (30.0%)
120(47.2%)
150(42.4%)

Female (%)
70(70.0%)
134(52.8%)
204(57.6%)

Nearly 3/4th (71.7%) of the study subjects

were satisfied with cleanliness at the health centre.
Patients level of satisfaction was found to be better

Total (%)
100 (28.3)
254 (71.7%)
354 (100%)

Chi-square
value
8.74

p-value
0.003

among females (52.8%) than males (47.2%)

regarding cleanliness in patients area and it was
found statistically significant (P<0.05).

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S.B. Gupta & J.P. Singh

Table 3: Reasons for selecting the facility :

S.
N.

Quality Of Services

Source of information about

RHTC OPD

RESPONSES
Number
(n=354)
90
14
40
178
32
78
4
6
0
266
123
97
28
106
326
16
8
4
184
31
6
0
133

percentage

Media(News paper/Radio/TV)
25.4
Hospital staff
3.95
Friends/Relatives
11.3
Old patients
50.3
Others
9.04
2
Mode of transport from
Own vehicle
22.03
home to health centre
Auto rickshaw
1.23
Hospital bus
1.69
Govt. roadways bus
0.00
Others
75.14
3
Type / Kind of health centre
Government
34.7
Private
27.4
Charitable
7.91
Trust
4.5
4
Waiting period b/w arrival
Less than hour
92.1
at OPD and attended by
- 1 hour
4.5
doctor
1 -2 hour
2.3
1.1
More than 2 hour
5
Source of medicine
Free medicine in RHTC
51.9
Paid medicine in RHTC
8.56
Outside from RHTC
1.69
0.00
Free + paid medicine at RHTC
37.6
Free medicine at RHTC + other
medicines from outside
Majority of subjects told that major
326 (92.1%), major source of medicine at RHTC
Source of information about RHTC OPD was
was free medicine 184 (51.9%) and type / Kind of
through old patients (50.3%), mode of transport
centre was a government health centre (34.7%)
from home to health centre was through other
while only few patients (7.91%) knew rightly that
it is a charitable health centre. (Table 3)
vehicles (75.14%), waiting period was less than 30
minute b/w arrival at OPD and attended by doctor
Table 4: Satisfaction of patients regarding quality of services availability at the rural health training
centre
RESPONSES
QUALITY OF SERVICES
Number
Percentage
Availability of drinking water
Yes
342
96.6
No
12
3.4
Satisfaction with cost of treatment
Yes
325
91.8
No
29
8.19
Satisfaction with given treatment
Yes
344
97.2
No
10
2.8
Would you like to visit health centre again
Yes
352
99.4
No
2
0.6
Would you motivate to your friends/relatives to visit this health Yes
330
93.2
centre
No
24
6.8
Are you aware about any beneficial scheme of SRMS IMS
Yes
315
89.0
No
39
11.0
Are you ever heard about Janhit Chikitsa Yojna / Samudayik
Yes
307
86.7
Swasthya Yojna / AHSAS programme of SRMS IMS
No
47
13.3
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Logic Publications @2014, IJCMAAS, E-ISSN: 2321-9335,P-ISSN:2321-9327.

Most of the patients (96.6%) were satisfied

with availability of drinking water in the health
centre. The availability of water purifier (RO
system) and study was carried out during winter &
autumn season, may be the reason for better
availability of water.
Most of the patients were satisfied with
cost (91.8%) & given treatment (97.2%), may be

due to free medicine distribution and better cure

rate at UHTC. Most of the patients were agree with
visit to health centre again (99.4%), motivate to
their friends/relatives to visit this health centre
(93.2%), aware about beneficial schemes of SRMS
IMS (89.0%) and also agree with ever heard about
Janhit Chikitsa Yojna / Samudayik Swasthya Yojna
/ AHSAS programme of SRMS IMS (86.7%).

Table 5: Association of satisfaction levels with bio-social characteristics (n=354)

Satisfaction with doctors
Bio-social characters

Age

Sex

Educat
ion

Socio
econo
mic
status
Type
of
family

Less than 20
yrs
20-40 yrs
40-60 yrs
More than 60
yrs
Male
Female
Post graduate
Graduate
Intermediate
High school
Junior high
school
Primary school
Illiterate
Upper
Upper middle
Middle
Lower middle
Lower
Nuclear family
Joint family
3generation
family

Satisfied
219 (%)

Notsatisfied
135 (%)

29(13.2%)

19(14.1%)

115(52.5%)
35(16.0%)

63(46.7%)
25(18.5%)

40(18.3%)

28(20.7%)

100(45.7%)
119(54.3%)
16(7.3%)
14(6.4%)
24(11.0%)
19(8.7%)

50(37.0%)
85(63.0%)
13(9.6%)
12(8.9%)
30(22.2%)
7(5.2%)

42(19.2%)

Pvalue

Satisfaction with class III & IV

workers
NotPSatisfied
satisfied
value
298 (%)
56 (%)
39(13.1%)

9(16.1%)

150(50.3%)
52(17.4%)

28(50.0%)
8(14.3%)

57(19.1%)

11(19.6%)

135(45.3%)
163(54.7%)
23(7.7%)
24(8.1%)
47(15.8%)
24(8.1%)

15(26.8%)
41(73.2%)
6(10.7%)
2(3.6%)
7(12.5%)
2(3.6%)

17(12.6%)

52(17.4%)

7(12.5%)

52(23.7%)
52(23.7%)
13(5.9%)
34(15.5%)
24(11.0%)
45(20.5%)
103(47.0%)
124(56.6%)
75(34.2%)

18(13.3%)
38(28.1%)
7(5.2%)
16(11.9%)
21(15.6%)
26(19.3%)
65(48.1%)
84(62.2%)
42(31.1%)

61(20.5%)
67(22.5%)
16(5.4%)
40(13.4%)
37(12.4%)
64(21.5%)
141(47.3%)
172(57.7%)
102(34.2%)

9(16.1%)
23(41.1%)
4(7.1%)
10(17.9%)
8(14.3%)
7(12.5%)
27(48.2%)
36(64.3%)
15(26.8%)

20(9.1%)

9(6.7%)

24(8.1%)

5(8.9%)

Table 5 shows that, as age advances,

satisfaction with behavior of the doctors and class III
& IV workers was also increases. More than 50% of
the subjects were belonging to 20-40 years age
groups were satisfied with behavior of the doctors
and class III & IV workers.
Females were more satisfied than males
with the behavior of doctors and class III & IV
workers and it was found statistically significant
association between gender and class III & IV
workers.

0.75

0.11

0.009

0.66

0.51

0.89

0.01

0.08

0.56

0.55

With respect to educational qualification, as

the educational status increases, they tend to be less
satisfied with behavior of the doctors and class III &
IV workers. Here significant association was found
between
education
and
satisfaction
with
doctors.(p<0.05)
According to B.G.Prasads SES scale, lower
class of the patients was more satisfied with
behavior of the doctors and class III & IV workers
than other class of SES. Generally as the SES class
advances, satisfaction level decreases amongst

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S.B. Gupta & J.P. Singh

hospital staff workers and here non-significant
association was found between SES class and
satisfaction with employees of hospital. Nuclear
family patients were more satisfied with behavior of
doctors & class IIIrd & IVth workers than other
types of family.

Discussion:
The health care system is basically service
based and patient experiences, satisfaction is of the
utmost importance. It has direct impact on
improving the quality of care in the health service
[13].The present study highlighted the level of
satisfaction and related determinants among
patients attending O.P.D. of RHTC, which is field
practice area of Department of Community
Medicine, SRMS IMS, Bareilly.
Majority of the patients (61.9%) were
satisfied with doctor's behavior at all the facilities
and they also felt that the doctor has given adequate
time to see the patients. More similar finding was
also reported by Arshad A S et al (66%) [14]. In
another study, Arpita Bhattacharya et al [15]
reported 98.2% patients were satisfied with
behavior of doctors.
In present study, 71.7% patients replied
that they were satisfied with cleanliness of health
centre. In another study done by Sodani et al [16]
found 65% satisfied patients with respect to
cleanliness. The better cleanliness could be due to
sufficient & trained class IV employee in this centre.
About 326 (92.1%) patients had to wait less
than 30 minute before consulting doctors. Ranjeeta
Kumari et al [12] found 22.55% patient waited less
than hours. Whereas in another study conducted
by Prasanna KS et al [17] showed that 20% patient
waited less than 30 minutes. This could be due to
competent and better time management of working
health staffs at this centre.
A large majority of respondents (96.6%)
felt that the drinking water facility available at RHTC
for patients was better, which is more close finding
(92.8%) of Rasheed N et al18. This may be due to
better facilities and RO system purifier available at
RHTC.
Table 1 shows that 42.4% patients were
males and rest 57.6% were females. The maximum
number of respondents (50.3%) belongs to the age
group of 20-40 years and minimum respondents
(13.5%) to less than 20 year age group.
The education level of the respondents was
very poor as most of them were either illiterate
(25.4%) or primary passed (19.8%). A study done
by Sodani et al [16] showed that 39% of

respondents were illiterate or primary passed

(18%), which is more closer to our findings. There is
a significant relationship between the educational
status of the patient and behavior of the doctors. As
the educational status increases, they tend to be less
satisfied with behavior of the doctors.
Similar to other study by Sarkar J et al [19],
low satisfaction at both younger age and older age in
our study may be due to more expectations from
health services at this peripherally situated teaching
referral hospital, and this may be the reason why
experience along with an increase in age could not
influence the expectation of older people also. In
contrast to Sarkar J et al19 study, females were
more satisfied than males with the behavior of
doctors and class III & IV workers in our study.

Conclusion:
Assessing satisfaction of
patients is
simple and cost effective way for evaluation of
health centre Services. The findings of the present
study carried out for assessing satisfaction of
outdoor patients came in rural health training
centre (RHTC) reveal patients were more satisfied
with behavior of doctors and availability of drinking
water at centre. Illiterates were more satisfied with
behavior of the doctors and class III & IV workers.
Most of the patients were satisfied regarding
cleanliness in the OPD area and hospital campus.

Recommendations:
Patient satisfaction assessment should be
conducted regularly every 6 months interval. In the
OPDs, complaint and suggestion box should be kept,
so that patients can freely put their complaints and
suggestions.

References:
1.

2.

3.
4.

5.

6.

Kishore J. Health Care Delivery System In India. J.

Kishores National Health Programs of India
National Policies and Legislations Related to Health.
9th edition. Century Publications. 72-75.
Naidu A et.al. Factors affecting patient satisfaction
and healthcare quality. Int J Health Care Qual
Assur.2009; 22 (4):366-8
Agrawal D et al. Health sector reforms: Relevance in
India. Indian J Community Med 2006; 31:220-2.
Brennan TA. Incidence of adverse events and
negligence in hospitalized patients. Results from the
Harvard medical practice society N Engl J M
1991;324:370
Sitzia J,Wood N. Patient satisfaction ;a review of
issues and concepts. social sciences and medicine
1997;45(12):1829-43
David W Bates. The safety and quality care.
Harrisons principles of Int. Medicine 2008; 17(1) .

International Journal of Current Medical And Applied Sciences [IJCMAAS] volume 4, Issue 1.

Logic Publications @2014, IJCMAAS, E-ISSN: 2321-9335,P-ISSN:2321-9327.

7.

8.

9.

10.

11.

12.

13.

Aldana JM, Piechulk H, Al Sabir A. Client satisfaction

& quality of health care in rural Bangledsh Bulletin
of the World Health Organisation 2001;79(6):51217.
Pawan Kumar Sharma, Sheik Iftikhar Ahmad,
Manisha Bhatia. Health care services in Punjab:
findings of a pt satisfaction survey. Social change.
Sept 2008; 138(3):458-77
Anand D, Kaushal S K, Gupta S C. A study on status of
client satisfaction in patients attending government
health facilities in Agra district, National Journal of
Community health, Vol. 24, No.3: July 2012Sept.2012, 209-214
Kulkarni M V,Dasgupta S, Deoke A R, Nayse J. Study
of satisfaction of patients admitted in a tertiary care
hospital in nagpur, national journal of community
medicine 2011 volume 2 issue 1, 37-39
Galhotra A, Sarpal SS, Gupta S, Goel NK. A crosssectional study on patient satisfaction toward
services received at rural health center, Chandigarh,
North India. Ann Trop Med Public Health 2013;6:
240-4
Ranjeeta Kumari, MZ Idris, Vidya Bhushan, Anish
Khanna, Monika Agarwal, SK Singh/Study on
Patient Satisfaction in the Government Allopathic
Health Facilities of Lucknow District, India.Indian J
Community Med.Jan 2009;34(1):35-42.
Deepa R, Pradhan P. Patient Counseling at Aravind
Eye Hospital. Illumination 2002; 2(3):13-7.

14. Andrabi Syed Arshad , Hamid Shamila , Rohul,

Jabeen, Anjum Fazli; Measuring patient satisfaction:
A cross sectional study to improve quality of care at
a tertiary care hospital: Volume 3 Issue 1 JanuaryJune 2012
15. Arpita bhattacharya, Prema Menon, Vipin
Koushal,KLN Rao. Study of patient satisfaction in a
Tertiary referral hospital. Journal of Academy of
hospital administration 2003; Vol 15, No. 1 (200301-2003-06)
16. Sodani PR, Kumar R, Srivastava J, Sharma L.
Measuring patient satisfaction: A case study to
improve quality of care at public health facilities.
Indian J Community Med 2010;35(1):52-6.
17. Prasanna KS,Bashith MA ,Sucharitha S-Consumer
satisfaction about hospital services :A study from the
outpatient department of a private medical college
hospital at Manglore/ Indian J Community Med April
2009;34(2): 156-59.
18. Rasheed N, Arya S, Acharya A, Khandekar J: Client
satisfaction and perceptions about quality of health
care at primary health centre of Delhi, India; Indian
Journal of Community Health, Vol. 24, No. 3, July
2012- Sept.2012
19. Sarkar J, Chatterjee B. An experience of health
services provided by a peripheral government
teaching hospital in India: Patients' perspective.
Indian J Med Sci 2011;65:321-30.

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