Patient satisfaction and perceived quality of care: Evidence from a cross-sectional national exit survey of HIV and non-HIV service users in Zambia

Objective: To examine the associations between perceived quality of care and patient satisfaction among HIV and non-HIV patients in Zambia. Setting: Patient exit survey conducted at 104 primary, secondary and tertiary health clinics across 16 Zambian districts. Participants: 2789 exiting patients. Primary independent variables: Five dimensions of perceived quality of care (health personnel practice and conduct, adequacy of resources and services, healthcare delivery, accessibility of care, and cost of care). Secondary independent variables: Respondent, visit-related, and facility characteristics. Primary outcome measure: Patient satisfaction measured on a 1-10 scale. Methods: Indices of perceived quality of care were modelled using principal component analysis. Statistical associations between perceived quality of care and patient satisfaction were examined using random-effect ordered logistic regression models, adjusting for demographic, socioeconomic, visit and facility characteristics. Results: Average satisfaction was 6.9 on a 10-point scale for non-HIV services and 7.3 for HIV services. Favourable perceptions of health personnel conduct were associated with higher odds of overall satisfaction for non-HIV (OR=3.53, 95% CI 2.34 to 5.33) and HIV (OR=11.00, 95% CI 3.97 to 30.51) visits. Better perceptions of resources and services were also associated with higher odds of satisfaction for both non-HIV (OR=1.66, 95% CI 1.08 to 2.55) and HIV (OR=4.68, 95% CI 1.81 to 12.10) visits. Two additional dimensions of perceived quality of care-healthcare delivery and accessibility of care-were positively associated with higher satisfaction for non-HIV patients. The odds of overall satisfaction were lower in rural facilities for non-HIV patients (OR 0.69; 95% CI 0.48 to 0.99) and HIV patients (OR=0.26, 95% CI 0.16 to 0.41). For non-HIV patients, the odds of satisfaction were greater in hospitals compared with health centres/ posts (OR 1.78; 95% CI 1.27 to 2.48) and lower at publicly-managed facilities (OR=0.41, 95% CI=0.27 to 0.64). Conclusions: Perceived quality of care is an important driver of patient satisfaction with health service delivery in Zambia.