CONCEPT PAPER

I. TITLE

SATISFACTION OF CARE AND ADHERENCE TO TREATMENT AMONG

PATIENTS OF SELECTED HOSPITALS IN CEBU CITY: BASIS FOR
QUALITY HEALTH DEVELOPMENT PROGRAM

II. RATIONALE
To determine the satisfaction of care received by patients in the hospital and their adherence
to treatment. . The following are specific aims of the study;
a.) To determine the relationship between patient satisfaction and adherence to treatment.
b.) To quantify patients’ satisfaction during their stay in hospital focusing on domains that are
important to them: physical comfort, emotional support, respect for patients, preferences,
involvement of family and friends, coordination of care, continuity and
transition/discharge, and overall impression.
c.) To attain knowledge on patients’ adherence to prescribed treatment regimen.
d.) To contribute to the improvement of healthcare services in the hospital.

III. THEORIES

 Social Cognitive Theory - describes the influence of individual experiences, the actions
of others, and environmental factors on individual health behaviors. SCT provides
opportunities for social support through instilling expectations, self-efficacy, and using
observational learning and other reinforcements to achieve behavior change
 Pragmatic model - the model was pragmatic in that it linked together available empirical
evidence about patient satisfaction. Satisfaction then can influence patients' future
behaviour such as compliance with advice or whether they change doctors.

 Information-Behavior-Skill Model - The first construct is information. The prevention

information is directly related to preventative behavior. According to this model, the more
information the person has, the greater the likelihood of his or her indulging in preventative
behavior. The second construct of the IMB model is motivation. Motivation is comprised
of two types: (a) personal motivation to practice preventative behaviors, such as attitudes
toward practicing specific preventative actions and (b) social motivation to engage in
preventative behavior, such as having perceptions of social support. The third construct of
the IMB model is behavioral skills. This is comprised of an individual's objective ability
and self-efficacy in performing the behavior. Self-efficacy is the confidence that a person
has in his or her ability to perform a given behavior at the present moment.

 Health Belief Model - is a psychological health behavior change model developed to

explain and predict health-related behaviors, particularly in regard to the uptake of health
services. The health belief model suggests that people's beliefs about health problems,
perceived benefits of action and barriers to action, and self-efficacy explain engagement

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(or lack of engagement) in health-promoting behavior.[2][3] A stimulus, or cue to action,

must also be present in order to trigger the health-promoting behavior.

 Problem Solving Theory - the thinking of an individual begins with the awareness of the
problematic situation. In this case, the problematic situation has a potential to grow into
a problem that deserves a solution. A person, who finds him/herself in a problematic
situation and is aware of its existence, does not have to “see” the problem until the
ability of the problem awareness is developed. The individual, who is aware of the
problem, is able to specify the difficulty or the source of the conflict which causes the
problematic situation, is capable to deal with the problem. Contrary to that, the individual
who is not able to be aware of the problem, is albeit experiencing the feeling superimposed
by curiosity, however, does not realise what causes the difficulty, which obstacle that
causes the conflict has to be removed, and, therefore, he is not able to remove it.
adult learning theory - , Knowlesadded the 5th assumption.

Self-Concept
As a person matures his/her self concept moves from one of being a dependent
personality toward one of being a self-directed human being.
Adult Learner Experience
As a person matures he/she accumulates a growing reservoir of experience that
becomes an increasing resource for learning.
Readiness to Learn
As a person matures his/her readiness to learn becomes oriented increasingly to the
developmental tasks of his/her social roles.
Orientation to Learning
As a person matures his/her time perspective changes from one of postponed
application of knowledge to immediacy of application. As a result his/her
orientation toward learning shifts from one of subject- centeredness to one of
problem centeredness.
Motivation to Learn
As a person matures the motivation to learn is internal (Knowles 1984:12).

Knowles’ 4 Principles Of Andragogy

In 1984, Knowles suggested 4 principles that are applied to adult learning:

1. Adults need to be involved in the planning and evaluation of their instruction.

2. Experience (including mistakes) provides the basis for the learning activities.
3. Adults are most interested in learning subjects that have immediate relevance and
impact to their job or personal life.
4. Adult learning is problem-centered rather than content-oriented. (Kearsley, 2010)

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 The Transtheoretical Model (Prochaska & DiClemente, 1983; Prochaska, DiClemente, &
Norcross, 1992) - is an integrative, biopsychosocial model to conceptualize the process of
intentional behavior change. It seeks to include and integrate key constructs from other
theories into a comprehensive theory of change that can be applied to a variety of behaviors,
populations, and settings—hence, the name Transtheoretical.

 Self-regulation/Common Sense Model - The key construct within the CSM is the idea of
illness representations or ‘lay’ beliefs about illness. These representations integrate with
existing schemata (the normative guidelines that people hold), enabling them to make sense
of their symptoms and guide any coping actions.
 Self-care Deficit Nursing theory by Dorothea Orem is a theory which included a discussion
of perception in her conceptual framework. She places perception in the category of
selected basic capabilities which are foundational to self-care agency. She sees perception
as having both a passive component of receiving incoming sensory knowledge and an
active reflective component (Lawton, 1991).
 Dawn Dowding’s (2016) “Decision Theory” as stated the theoretical model among the
patients of the hospital with dementia though it is related to their live experiences in the
process of their treatments. On the other-hand it was seconded by the works of Lee, Low
and Ng (2013) as stated that- “Findings of the study highlighted the need for expanding
the current concept of patient values in medical decision making. Clinicians should address
more than just values related to treatment options. Patient values should include patients’
priorities, life philosophy and their background. Current decision support tools, such as
patient decision aids, should consider these new dimensions when clarifying patient
values.”
 Cognitive Theory - is an approach to psychology that attempts to explain human behavior
by understanding your thought processes. Pure cognitive theory largely rejects
behaviorism, another approach to psychology, on the basis that it reduces complex human
behavior to simple cause and effect.
 Self-regulation theory (SRT) is a system of conscious personal management that involves
the process of guiding one's own thoughts, behaviors, and feelings to reach goals. Self-
regulation consists of several stages, and individuals must function as contributors to their
own motivation, behavior, and development within a network of reciprocally interacting
influences.
 Behavior Modification Theory - is a set of therapies / techniques based on operant
conditioning (Skinner, 1938, 1953). The main principle comprises changing environmental
events that are related to a person's behavior. For example, the reinforcement of desired
behaviors and ignoring or punishing undesired ones.
 Theory of Planned Behavior/Reasoned Action - Theory of Reasoned Action suggests that
a person's behavior is determined by his/her intention to perform the behavior and that this
intention is, in turn, a function of his/her attitude toward the behavior and his/her subjective
norm. The best predictor of behavior is intention. Intention is the cognitive representation
of a person's readiness to perform a given behavior, and it is considered to be the immediate
antecedent of behavior.

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IV. STATEMENT OF THE PROBLEM

General Objective:
The study seeks to determine the relationship between patient satisfaction in terms of
service in the hospital and adherence to treatment by gathering data from respondents within the
hospitals in Cebu City.
Specifically, it seeks to answer the following questions;
1. What is the profile of respondents in terms of
1.1 age
1.2 gender
1.3 education
1.4 civil status
1.5 length of stay in hospital
2. How satisfied are patients to the services given to them by the healthcare providers?
3. How often do patients follow the treatment regimen instructed by the healthcare staff?
4. Is there a relationship between patient satisfaction and adherence to treatment?

V. Review of Related Literature and Supporting Studies

1. A literature review to explore the link between treatment satisfaction and adherence,
compliance, and persistence by Carla Dias Barbosa1 et al. (2012)

Purpose: To explore the published evidence on the link between treatment satisfaction and
patients’ compliance, adherence, and/or persistence. Methods: Articles published from January
2005 to November 2010 assessing compliance, adherence, or persistence and treatment satisfaction
were identified through literature searches in Medline, Embase, and PsycInfo. Abstracts were
reviewed by two independent researchers who selected articles for inclusion. The main attributes
of each study examining the link between satisfaction and adherence, compliance, or persistence
were summarized. Results: The database searches yielded 1278 references. Of the 281 abstracts
that met the inclusion criteria, 20 articles were retained. In the articles, adherence and compliance
were often used interchangeably and various methods were used to measure these concepts. All
showed a positive association between treatment satisfaction and adherence, compliance, or
persistence. Sixteen studies demonstrated a statistically significant link between satisfaction and
compliance or persistence. Of these, ten demonstrated a significant link between satisfaction and
compliance, two showed a significant link between satisfaction and persistence, and eight
demonstrated a link between either a related aspect or a component of satisfaction (eg, treatment
convenience) or adherence (eg, intention to persist). An equal number of studies aimed at
explaining compliance or persistence according to treatment satisfaction (n = 8) and treatment
satisfaction explained by compliance or persistence (n = 8). Four studies only reported correlation
coefficients, with no hypothesis about the direction of the link. The methods used to evaluate the
link were varied: two studies reported the link using descriptive statistics, such as percentages, and

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18 used statistical tests, such as Spearman’s correlation or logistic regressions. Conclusion: This
review identified few studies that evaluate the statistical association between satisfaction and
adherence, compliance, or persistence. The available data suggested that greater treatment
satisfaction was associated with better compliance and improved persistence, and with lower
regimen complexity or treatment burden. Keywords: treatment satisfaction, adherence,
compliance, persistence

2. Examining the Link between Patient Satisfaction and Adherence to HIV Care: A Structural

Equation Model by Bich N. Dang et al. (2012)

Abstract

Introduction:
Analogous to the business model of customer satisfaction and retention, patient satisfaction could
serve as an innovative, patient-centered focus for increasing retention in HIV care and adherence
to HAART, and ultimately HIV suppression.
Objective:
To test, through structural equation modeling (SEM), a model of HIV suppression in which patient
satisfaction influences HIV suppression indirectly through retention in HIV care and adherence to
HAART.
Methods:
We conducted a cross-sectional study of adults receiving HIV care at two clinics in Texas. Patient
satisfaction was based on two validated items, one adapted from the Consumer Assessment of
Healthcare Providers and Systems survey (‘‘Would you recommend this clinic to other patients
with HIV?) and one adapted from the Delighted-Terrible Scale, (‘‘Overall, how do you feel about
the care you got at this clinic in the last 12 months?’’). A validated, single-item question measured
adherence to HAART over the past 4 weeks. Retention in HIV care was based on visit constancy
in the year prior to the survey. HIV suppression was defined as plasma HIV RNA ,48 copies/mL
at the time of the survey. We used SEM to test hypothesized relationships.
Results:
The analyses included 489 patients (94% of eligible patients). The patient satisfaction score had a
mean of 8.5 (median 9.2) on a 0- to 10- point scale. A total of 46% reported ‘‘excellent’’ adherence,
76% had adequate retention, and 70% had HIV suppression. In SEM analyses, patient satisfaction
with care influences retention in HIV care and adherence to HAART, which in turn serve as key
determinants of HIV suppression (all p,.0001).
Conclusions:
Patient satisfaction may have direct effects on retention in HIV care and adherence to HAART.
Interventions to improve the care experience, without necessarily targeting objective clinical
performance measures, could serve as an innovative method for optimizing HIV outcomes.

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3. Assessing oral medication adherence among patients with type 2 diabetes mellitus treated
with polytherapy in a developed Asian community: a cross sectional stud by Cia Sin Lee
(2017)

Abstract
Objectives The disease burden of type 2 diabetes mellitus (T2DM) is rising due to suboptimal
glycaemic control leading to vascular complications. Medication adherence (MA) directly
influences glycaemic control and clinical consequences. This study aimed to assess the MA of
patients with T2DM and identify associated factors.
Design Analysis of data from a cross-sectional survey and electronic medical records.
Setting Primary care outpatient clinic in Singapore.
Participants Adult patients with T2DM.
Main outcome measures MA to each prescribed oral hypoglycaemic agent (OHA) was measured
using the five-question Medication Adherence Report Scale (MARS-5). Low MA is defined as a
MARS-R score of <25. Demographic data, clinical characteristics and investigation results were
collected to identify factors that are associated with low MA.
Results The study population comprised 382 patients with a slight female predominance (53.4%)
and a mean±SD age of 62.0±10.4 years. 57.1% of the patients had low MA to at least one OHA.
Univariate analysis showed that patients who were younger, of Chinese ethnicity, married or
widowed, selfadministering their medications or taking fewer (four or less) daily medications
tended to have low MA to OHA. Logistic regression revealed that younger age (OR 0.97; 95% CI
0.95 to0.99), Chinese ethnicity (OR 2.80; 95% CI 1.53 to5.15) and poorer glycaemic control
(HbA1c level) (OR 1.27; 95%  CI 1.06 to1.51) were associated with low MA to OHA.
Conclusions Younger patients with T2DM and of Chinese ethnicity were susceptible to low MA
to OHA, which was associated with poorer glycaemic control. Polytherapy was not associated with
low MA.

4. Patient satisfaction on tuberculosis treatment service and adherence to treatment in public

health facilities of Sidama zone, Sourth Ethiopia by Zekarlyas Sahile Nezenega et al. (2013)

Abstract
Background: patient compliance is a key factor in treatment success. Satisfied patients are more
likely to utilize health services, comply with medical treatment, and continue with the healthcare
providers. Yet, the national tuberculosis control program failed to address some of these aspects
in order to achieve the national targets. Hence, this study attempted to investigate patient
satisfaction and adherence to tuberculosis treatment in Sidama zone of south Ethiopia.

Methods: a facility based cross sectional study was cinducted using quantitative method of data
collection from March to April 2011. A sample of 531 respondents on anti TB treatment from 11
health centers and 1 hospital were included in the study. The sample size to each facility was
allocated using probability proportional to size allocation, and study participants for the interview
were selected by systemic random sampling. A Pre tested, interviewer administered questionnaire
was used to collect the data. Collected data was edited, coded and entered to Epi data version 3.1
and exported to SPSS version 16. Confirmatory factor analysis was done to identify factors that
explain most of the variance observed in most of the manifested variables. Bivariate and
Multivariate analysis were computed to analyze the data.

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Result: the study revealed 90% of the study participants were satisfied with TB treatment service.
However, 26% of respondents had poor adherence to their TB treatment. Patient perceived on
professional care, time spent with healthcare provider, accessibility, technical competency,
convenience (cleanliness) and consultation and relational empathy were independent predictors of
overall patient satisfaction (P<0.05). In addition to this, perceived waiting time was significantly
associated with patient satisfaction (Beta = 0.262). In multivariate analysis occupational status,
area of residence, perceived time spent with healthcare provider, perceived accessibility, perceived
waiting time, perceived professional care and over all patient satisfaction were significantly
associated with adherence to TB treatment (P <0.05). Moreover, patient waiting time at reception
room (Adjusted OR = 1.022, 95% Cl 1.009, 1.0035) and Patient treatment phase (Adjusted OR =
0.295, 95% Cl 0.172, 0.507) were independent predictor of adherence to TB treatment.

Conclusion: The finding of this study showed that patients’ perceptions on health care provider
interaction had a significant influence on patient satisfaction and adherence to TB treatment.
Moreover absence of drugs and long waiting time had a negative outcome on patient adherence.
Therefore, the problem needs an urgent attention from programme managers and health care
providers to intervene the challenges.

5. Patient adherence to medical treatment: a Review of reviews by Sandra van Dulmen et al.
(2007)

Abstract:
Background: Patients’ non-adherence to medical treatment remains a persistent proble. Many
interventions to improve patient adherence are unsuccessful and sound theoretical foundations are
lacking. Innovations in theory and practice are badly needed. A new and promising way could be
to review the existing reviews of adherence to interventions and identify the underlying theories
for effective interventions. That is the aim of our study.

Methods: the study is a review of 38 systematic reviews of the effectiveness of adherence

interventions published between 1990 and 2005. Electronic literature searches were conducted in
Medline, Psychinfo, Embase and the Cochrane Library. Explicit inclusion and exclusion criteria
were applied. The scope of the study is patient adherence to medical treatment in the cure and care
sector.

Results: Significant differences in the effectiveness of adherence interventions were found in 23

of the 38 systematic reviews. Effective interventions were found in each of four theoretical
approaches to adherence interventions: technical, behavioral, educational, and multi-faceted or
complex interventions. Technical solutions, such as a simplification of the regimen, were often
found to be effective, although that does not count for every therapeutic regimen.

Overall, our results show that, firstly, there are effective adherence interventions without an
explicit theoretical explanation of the operating mechanisms, for example technical solutions.

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Secondly, there are effective adherence interventions, which clearly stem from the behavioral
theories, for example incentives and reminders. Thirdly, there are other theoretical models that
seem plausible for explaining non-adherence, but not very effective in improving adherence
behavior. Fourthly, effective components within promising theories could not be identified
because of the complexity of many adherence interventions and the lack of studies that explicitly
compare theoretical components.

Conclusion: there is a scarcity of comparative studies explicitly contrasting theoretical models or

their components. The relative weight of these theories and the effective components in the
interventions designed to improve adherence, need to be assessed in future studies.

6. Patients’ experiences of care quality and satisfaction during hospital stay: a qualitative study
by Vigdis Abrahamsen Grøndahl (2012)

Abstract Rationale, aim and objectives:

Patients experiencing high care quality and satisfied patients are more likely to follow
treatments. Patient satisfaction is an important contributor to physical and mental health-related
quality of life. Research emphasises the need to further study satisfaction from the patients’
perspective. The aim was to describe patients’ experiences of care quality and the relation to their
satisfaction during hospital stay. Methods: A qualitative descriptive design was used. Interviews
were conducted with 22 patients discharged from hospital. Data was analysed by conventional
content analysis. Results: Four categories and seven subcategories describing patients’ experiences
of care quality and the relation to their satisfaction emerged. Desire to regain health comprised
waiting for treatment, being cured, having hopes of being cured and described the treatment and
health outcome of hospitalisation. Need to be met in a professional way as a unique person
comprised receiving personalized knowledge, receiving healthcare by competent healthcare
personnel and described the way patients need to be met by healthcare personnel. Need to be
involved comprised taking responsibility for own health, leaving responsibility for own health and
concerned the patients’ way of handling hospitalisation. Need to have balance between privacy
and companionship concerned the relationship to fellow patients. Conclusions: Health condition
is of great importance to patients’ experiences of quality of care and their satisfaction in relation
to hospital stay. The healthcare personnel need to be aware that seriously ill patients may never be
completely satisfied. Furthermore, healthcare personnel must do their utmost to provide the
patients with person-centered care. Hospital managers must consider the design of wards with
respect to such matters as multiple-bed versus single-bed rooms and heads of nursing must
carefully plan each patient’s accommodation.

7. Patient adherence to medical treatment: a meta review by Emmy Sluijs (2006)

8. Improving Medication Adherence: The Role of the Health Care Delivery System and Health
Care Providers by Jingdong Chao (2007)

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VI. INSTRUMENT

FACE DATA SHEET

English Version

Dear respondents,

I would like to invite you to participate in our research study entitled

“SATISFACTION OF SERVICE AND ADHERENCE TO TREATMENT AMONG
PATIENTS OF SELECTED HOSPITALS IN CEBU CITY: BASIS FOR QUALITY
HEALTH DEVELOPMENT PROGRAM” by filling up the survey form.

1. Name or alias (optional):__________________________________________________

2. Age: _____ 18-20 _____ 21-25 _____ 26-30 _____ 31-35 _____ 36-40 _____
41-45 _____ 46-50 ______ above 50 ______ above 60 _____ above 70
3. Gender: _____ (Male) _____ (Female)
4. Education: _____ (Secondary) ______ (Baccalaureate) ______ (Post-Graduate)
______ (Vocational/Tesda Courses)
5. Social Status: _____ (Single) ______ (Married) _______ (Separated)
6. __________________________ Inpatient _________________________ Outpatient
7. Length of days in Hospital : ______________________________________________

Thank you.

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A. Directions: Check the box corresponding with the statements. For each statement please
indicate how much you agree or disagree.

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VII. REFERENCES

Adefolalu , A. (2017): “Cognitive-Behavioural Theories And Adherence: Application And

Relevance In Antiretroviral Therapy”. Southern African Journal Of HIV Medicine.
Retrieved from https://sajhivmed.org.za/index.php/hivmed/article/view/762/1141
Alerta, Maria (2007): “Attitude Towards Diabetes Mellitus And Adherence To Diabetic
Regimen Among Selected Diabetic Clients And Patients In Metro Cebu; Basis For A
Health Care Guide”. A Master’s Thesis. Cebu Doctors’ University
Altubar, Annjoreca (2010): “Patients’ Health Beliefs And Their Adherence To Hypertensive
Therapeutic Regimen In Philippine National Police Hopital 7 Out-Patient Department:
Basis For Proposed Health Teaching Program”. A Master’s Thesis. Cebu Doctors’
University
Baker, R. (1997): “Pragmatic Model Of Patient Satisfaction In General Practice: Progress
Towards A Theory”. Qual Health Care. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1055494/

Barbosa, Carla Dias et al. (2012): “A Literature Review To Explore The Link Between Treatment
Satisfaction And Adherence, Compliance, And Persistence”. PMC US National Library
of Medicine National Institute of Health. Patient Prefer Adherence. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3262489/
Chao, Jingdong (2007): “Improving Medication Adherence: The Role Of The Health Care
Delivery System And Health Care Providers”. J Manag Care Pharm. Retrieved from
http://www.amcp.org/data/jmcp/JMCPMaga_N-D%2007_807-809.pdf

Conn, Vicki et al. (2016): “Meta-Analyses Of Theory Use In Medication Adherence

Intervention Research”. Am J Health Behav. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4879970/
Cortes, Karla (2010): “Attitude Towards Tuberculosis And Their Adherence To Treatment
Regimen Of Selected Patients In Mandaue City: Basis For A Health Care Guide”. A
Master’s Thesis. Cebu Doctors’ University

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Dang, B. et al. (2013) : “Examining The Link Between Patient Satisfaction And Adherence To
Hiv Care: A Structural Equation Model”. Plos One. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3559888/

Dulmen, Sandra Van (2006): “Patient Adherence To Medical Treatment: A Review Of

Reviews”. BMC Health Services Research. Retrieved from
https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-7-55

Easthall, C. and Barnett, N. (2017): “Using Theory To Explore The Determinants Of

Medication Adherence; Moving Away From A One-Size-Fits-All Approach”. PMC US
National Library of Medicine National Institute of Health. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5622362/
Ganasegeran, Kurubaran (2015): “Patient Satisfaction in Malaysia's Busiest Outpatient Medical
Care”. Scientific World Journal. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4306375/
Grondahl, Vigdis Abraham Et Al. (2013): “Patients’ Experiences Of Care Quality And
Satisfaction During Hospital Stay: A Qualitative Study”. European Journal For Person
Centered Healthcare. Vol 1, No 1 (2013). Retreived from
http://ubplj.org/index.php/ejpch/article/view/650
Holmes, Emily et al. (2014): “Predicting Adherence to Medications Using Health Psychology
Theories: A Systematic Review of 20 Years of Empirical Research”. Value In Health
Journal Vol. 17, Issue 8. Retrieved from https://doi.org/10.1016/j.jval.2014.08.2671Get
rights and content

Khan, T. and Fharni, M. (2016):“Patient Satisfaction And Medication Adherence Assessment

Amongst Patients At The Diabetes Medication Therapy Adherence Clinic”. Diabetes
and Metabolic Syndrome Clinical Research and Reviews. Retrieved from
https://www.researchgate.net/publication/298331390_Patient_Satisfaction_and_Medicati
on_Adherence_Assessment_Amongst_Patients_at_the_Diabetes_Medication_Therapy_A
dherence_Clinic

Molloy, G.J and O’Carrol, R.E (2017): “Medication Adherence Across The Lifespan: Theory,
Methods, Interventions And Six Grand Challenges”. Journal Psychology & Health .
Volume 32, 2017 - Issue 10: Medication adherence across the lifespan. Retrieved from
https://www.tandfonline.com/doi/full/10.1080/08870446.2017.1316850

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Nezenega, Zekariyas (2012):”Patient Satisfaction On Tuberculosis Treatment Service And

Adherence To Treatment In Public Health Facilities Of Sidama Zone, South Ethiopia”.
BMC Health Services Research.
https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-13-110

Patton, D. (2016): “Theory-Based Interventions To Improve Medication Adherence In Older

Adults Prescribed Polypharmacy: A Systematic Review”. Drugs Aging. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5290062/
Sluijs, Emmy et al. (2006): “Patient Adherence To Medical Treatment: A Meta Review”.
NIVEL . Retrieved from https://www.nivel.nl/sites/default/files/bestanden/Patient-
adherence-to-medical-treatment-a-meta-review.pdf?

Tadena, Kelly (2011): “ Self-Acceptance And Adherence To Treatment Among Diagnosed

Psoriatic Patients In Metro Cebu: Proposed Psoriatic Self-Care Program”. A Master’s
Thesis. Cebu Doctors’ University
Thayaparan, A. and Mahdi, Eamon (2013):”The Patient Satisfaction Questionnaire Short Form
(PSQ-18) as an adaptable, reliable, and validated tool for use in various settings”. Med
Educ Online. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3722414/
Thompson, AG. And Sunol, R. (1995): “Expectations as Determinants of Patient Satisfaction :
Concepts , Theory and Evidence”. Int J Qual Health Care. Retrieved from
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.1014.88&rep=rep1&type=pdf
Worthington, C. (2005): “Patient Satisfaction With Health Care: Recent Theoretical
Developments And Implications For Evaluation Practice”. Canadian Evaluation Society.
Retrieved from https://evaluationcanada.ca/system/files/cjpe-entries/20-3-041.pdf

CDU LIBRARY
Tadena, Kelly (2011): “ Self-Acceptance And Adherence To Treatment Among Diagnosed
Psoriatic Patients In Metro Cebu: Proposed Psoriatic Self-Care Program”. A Master’s Thesis.
Cebu Doctors’ University
Cortes, Karla (2010): “Attitude Towards Tuberculosis And Their Adherence To Treatment
Regimen Of Selected Patients In Mandaue City: Basis For A Health Care Guide”. A Master’s
Thesis. Cebu Doctors’ University

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Alerta, Maria (2007): “Attitude Towards Diabetes Mellitus And Adherence To Diabetic
Regimen Among Selected Diabetic Clients And Patients In Metro Cebu; Basis For A Health
Care Guide”. A Master’s Thesis. Cebu Doctors’ University
Altubar, Annjoreca (2010): “Patients’ Health Beliefs And Their Adherence To Hypertensive
Therapeutic Regimen In Philippine National Police Hopital 7 Out-Patient Department: Basis
For Proposed Health Teaching Program”. A Master’s Thesis. Cebu Doctors’ University

ALSSO LOOK FOR THESIS RTD TO HOSPITAL STAFF, SERVICE, CARING NA

MABUTANG SA SITUATIONER

The Patient Satisfaction Questionnaire Short Form (PSQ-18) as an adaptable, reliable, and validated tool
for use in various settings

The patient satisfaction questionnaire (PSQ-18)

Patient Satisfaction in Malaysia’s Busiest Outpatient Medical Care

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