DSpace Community: Department of Preventive and Social Medicine

PATIENTS' SATISFACTION WITH THE QUALITY OF SERVICES IN THE GENERAL OUTPATIENTS' DEPARTMENT OF THE UNIVERSITY COLLEGE HOSPITAL, IBADAN

2019-06-28T09:54:47Z

Title: PATIENTS' SATISFACTION WITH THE QUALITY OF SERVICES IN THE GENERAL OUTPATIENTS' DEPARTMENT OF THE UNIVERSITY COLLEGE HOSPITAL, IBADAN Authors: AJAYI, I. O. Abstract: At present there is a trend for all social services to become more client or consumer oriented. This is now pronounced in health care delivery in the western world. The underlying demand for higher standards of health care and the limitation of the resources available make it desirable to measure the satisfaction patients experience from health services at all levels of care. Care assessed to be of high quality according to clinical, economic or other providers' defined criteria is far from ideal if as a result of that care the patients is unhappy or dissatisfied. There is therefore a sound rationale for making the organisation and delivery of health care responsive to consumers' expectations. For these reasons, properly conducted patient satisfaction surveys are encouraged. Patient satisfaction is now recognised as a legitimate measure of health care quality. To determine the level of satisfaction of the users of the General Outpatients' Clinic, University College Hospital, Ibadan with the organisation of the clinic, consultation processes and personal attitude and performance, a descriptive study using both qualitative and quantitative methods was carried out. This was conducted between January and April 1998. Four hundred and seven patients were selected using a systematic sampling technique. Their level of satisfaction with the various aspects of the services was recorded using a 5-point Likert Scale. Focus Group Discussion sessions were held with 10 groups of patients representing various age groups and both sexes. The parametres for assessing patient satisfaction include the accessibility of care, perceived professional competence, organisation of the clinic, consultation process, ammenities provided and personnel-patient relationship. The mean age of the patients was 47(±17) years and them:f ration was 1:1.6. One hundred and seventy-eight (43.7%) of the patients never attended school while 92 (22.6%) and 83 (20.4%) of them attended primary and secondary school respectively. Training constituted the occupation of majority (49.1%) of the patients. The clinic was found to be easily accessible by 303 (74.4%) of the patients and majority 327 (80.5%) required N20.00 (Naira) or less to get to the hospital. Three hundred and ninety five (97.1%) of them, assessed the organisation of the clinic to be satisfactory. The mean waiting time before consultations was found to be 169 (±81) minutes. Two hundred and thirteen patients (52.3%) particularly students, teachers and the unemployed felt that this was too long. A mean waiting time of 67 (±39) minutes was deemed reasonable. The consultation process was opined to be very good by 160 (39.4%), good by 238 (58.5%) and fair by 9 (2.2%) of the patients. Two hundred and eighty patients (68.8%) found the follow-up consultation length to be a bit short and this had significant influence on the assessment of the items constituting the consultation process. A higher percentage of those seen for more than 5 minutes rated the consultation to be very good compared to those seen for less than 5 minutes. The depth of consultation was found to be deeper when the consultation length was more than 5 minutes and doctors that spend more than 5 minutes were significantly found to be warm and friendly p=0.04. Overall, the medical care received by the patients was found to be satisfactory by 378 (92.0%) of them. However, 86 (21.1%) and 321 (7.9%) of the patients perceived the patient-doctor-communication and the health promotion and disease prevention activities to be deficient respectively. The attitude of the nurses was perceived to be good by 378(92.0%) of the respondents. Some communication and attitudinal problems were identified, particularly among the records clerks. Only 39(9.6%) respondents identified barriers to further use of the facility and these include the long waiting time indicated by 21(53.9%); lack of water and fans by 5(12.8%). dirty toilets by 3(7.7%) and the paucity of doctors by 3(7.7%). The result of the Focus Group Discussion sessions corroborated most of the findings of the survey. The patients expressed satisfaction with the quality of service rendered and the cordial relations with most members of staff. They found some of the record clerks to be somewhat hostile. The dissatisfaction with the hall was better expressed at the FGD sessions. Other sources dissatisfaction were as found in the survey. The patients also expressed support for the introduction of an appointment system. The use of the qualitative and quantitative method enriched this study and made it possible to get more in-depth information. There was an overwhelmingly positive response to most of the questions. This type of result is similar to those found in the American and British literature on patients satisfaction and shows that very few patients express dissatisfaction with or are critical of their health care. lt highlighted a high level of patient satisfaction with most of the services provided in the General Outpatients' clinic, University College Hospital, Ibadan. The study also provided valuable information to assist in improving the quality of care at the clinic specifically, the long waiting, attitude of the records clerks, deficient patient-doctor communication skill and the dearth of basic amenities need to be addressed. It is recommended that training workshops and seminars be organised to improve the personel-patient relationship and the doctor-patient communication process. Consultations should start earlier than they do now and a time specific appointment system should be introduced. Basic amenities such as water, functioning toilets, fans and adequate seats in the waiting hall should be provided. It is also recommended that other studies be conducted to determine the patients' level of satisfaction in different settings at all levels of care. Description: A Dissertation submitted to the Department of Preventive and Social Medicine of the College of Medicine, University of Ibadan, Nigeria in part fulfillment of the requirements for the Master Degree of Public Health (Community Medicine) (M.P.H) of the University of Ibadan, Nigeria.

CONSUMERS' BEHAVIOUR TOWARDS EXPANDED PROGRAMME OF IMMUNIZATION

2019-03-25T14:24:16Z

Title: CONSUMERS' BEHAVIOUR TOWARDS EXPANDED PROGRAMME OF IMMUNIZATION Authors: OSAGHAE, P. I. Abstract: The purpose of this study is to examine the factors that impede the utilisation of the services of the expanded programme of immunization, and make recommendations in the light of the findings as to the strategies for implementing an educational programme for the E.P.I. (expanded programme of immunization). In order to investigate these factors, a number of hypothesis provided an anchor for analysis. Also two models were used to help put these gamuts of ideas and studies into a meaningful and proper perspective. These are the health ballot models of Irvin Rosenstock 1966 and his colleague Becker (1974); and Green's Health educational model (1976). Mothers (consumer) who had children since the inception of the expanded programme of immunization services in May 1976 in Ayedade community (made up of Ikire, Apomu and Ikoyi) of Oyo State were interviewed. By the use of questionnaires containing both structured and open ended questions, information was gathered on consumers' knowledge, attitude and practices towards the programme. Information was also gathered by the researcher through observation at the the health centre and oral interview of the Health personnel as well as the Chief Health Officer for the Oyo State. In the administration of the questionnaire, the multistage sampling technique was employed and the final sampling units were mothers who had children since the inception of the programme in May 1976. The data gathered and analysed by means of chi-square percentage, biserial correlation coefficient, and analysis of variance (F-value) point to a situation that behavioural problems exist among the consumers that affect their appropriate utilization of the free child immunization services. These behavioural problems have three major antecedents which are predisposing factors (poor knowledge of the programme, negative attitude, and perception); enabling factors (non-availability of enough immunization centres and vaccines, unsuitability of inmmunization days to some consumers, social inaccessibility of immunization to some consumers because of the attitude of the health worker) and reinforcing factor (non-belief in the efficacy of the immunization vaccines and the poor attitude of some health personnel to duty). In this study, there are three categories of respondents; consumers who took their children for complete immunization (34%); consumers with incomplete immunization for their children (defaulters) (10%) and potential consumers who did not take their children for immunization (56%). In the light of the findings, educational strategies such as more effective communication with consumers to influence their knowledge, attitude, belief, and norms; community organisation activities designed to influence the voluntary adjustment of resources to make health services more accessible were recommended. Other recommendations included staff activities such as continuing education, designed to influence the attitude and behaviour of providers towards clients. Description: A Dissertation in the Department of Preventive and Social Medicine, submitted to the Faculty of Medicine in partial fulfillment of the requirements for the degree of Master of Public Health (Health Education) of the University of Ibadan, Nigeria.

EFFECTS OF EDUCATIONAL INTERVENTION ON KNOWLEDGE, ATTITUDE AND PRACTICE OF REPRODUCTIVE HEALTH AMONG SELECTED SECONDARY SCHOOL STUDENTS IN OYO STATE, NIGERIA.

2019-04-29T12:59:57Z

Title: EFFECTS OF EDUCATIONAL INTERVENTION ON KNOWLEDGE, ATTITUDE AND PRACTICE OF REPRODUCTIVE HEALTH AMONG SELECTED SECONDARY SCHOOL STUDENTS IN OYO STATE, NIGERIA. Authors: AJUWON, A. J. Abstract: In Nigeria, risky sexual behaviours are widespread among adolescents, placing many in this population at high risk of unwanted pregnancies, sexually transmitted infections and associated complications. Schools provide an opportunity for adolescents to learn new knowledge and acquire relevant skills that will enable them prevent the undesirable consequences of unprotected sex. This can be done by formal teaching of existing curriculum and extra-curricular approach such as peer education. Studies have documented the value of peer education, but none have compared its effects with that of instructions provided by teachers. The goal of this study was to compare the effects of three interventions, peer education, classroom instructions and a combination of both on the knowledge, attitudes and practices of reproductive health among secondary school students in rural Oyo State. The study was quasi-experimental in design and consisted of three experimental and one-control schools. Four schools in Eruwa, Lanlate, Igbo-Ora and lgangan in the lbarapa district were randomly allocated among the study groups. At Akolu High School in Eruwa (El), students received teacher instruction. Students of Oke Aako High School Igangan (E2) were exposed to peer education. Igbo-ora Grammar School (E3) students were provided with both instruction and peer education, while those from Bioku High School in Lanlate served as the control group (C). A baseline questionnaire was administered to a systematic sample of 240 male and female students in each school. The results were used to design the contents of the interventions, which covered one academic year (January 19997 through March 1998). A follow-up survey used the same sampling procedures as baseline. We constructed a 34-point reproductive health knowledge score. There was significant difference in knowledge among the schools at baseline. During the follow-up survey however, all three intervention schools showed significant gains over baseline, while the control school students' mean score increased slightly. The amount of improvement among the intervention schools was greatest among E3 (+5.0 points), followed by E2 (+3.4), E1 (+1.4) and C (0.3). The intervention schools showed a significant shift in attitude towards use of contraceptives. The mean increases were 0.6, 0.5. and 0.9 points in E1, E2 and E3 respectively. Scores that measured the students'self-confidence in adopting safe sex practices increased significantly in E1 (from 10.8 to 11.8) and E3 (from 10.4 to 12.6). Reported condom use was significantly higher in E2 (from 16.7% to 62.8%) (p<0.05) and E3 (from 22.8% to 53%) (p<0.05) students compared to E1 (28.6% to 47.4%) (p>0.05) and control (from 25% to 45.8%) (p>0.05). On a ranking of performance, students from the school with the mixed intervention were top with 12 points, followed by those with peer education with 10 points, instructions with 5 points and the control with 2 points. In conclusion, the present study shows that a mixed intervention approach has the greatest potential for influencing the reproductive health practices of in-school adolescents. Description: A thesis in the Department of Health Promotion and Education, submitted to the Faculty of Clinical Sciences and Dentistry, College of Medicine, in partial fulfillment of the requirements of the Degree of Doctor of Philosophy, University of Ibadan, Nigeria.

PERCEIVED STRESS FACTORS AND COPING MECHANISMS AMONG MOTHERS OF CHILDREN WITH SICKLE CELL DISEASE IN IBADAN-IBARAPA HEALTH ZONE, OYO STATE

2019-04-30T11:51:49Z

Title: PERCEIVED STRESS FACTORS AND COPING MECHANISMS AMONG MOTHERS OF CHILDREN WITH SICKLE CELL DISEASE IN IBADAN-IBARAPA HEALTH ZONE, OYO STATE Authors: OLALEYE, L. B. Abstract: Managing a chronically ill child, such as one with sickle cell disease (SCD), poses much hardship and stress on family members, especially mothers who are the primary caretakers of the of affected children. The psychological and physical distress suffered by these mothers may directly influence their own health status, their child care role and subsequently the prognosis of the child. The present study was therefore conceived as an attempt to identify the factors that might produce stress among mother' of children with SCD, to document the level of stress experienced by these mothers, to determine the social and demographic variables that may be associated with stress and to elicit the coping styles use to handle stress. The researcher hypothesized that certain demographic factors, including educational level, type of marriage and total number of children with SCD in the family might be associated with measured stress levels. The target population consisted of mothers of children with SCD who attended a sickle cell clinic in a state, federal, private or mission hospital within the Ibadan-lbarapa Health Zone of Oyo State, between June and July 1993. Six such clinics were identified. Each facility was visited on the appropriate outpatient clinic day during the study period, and all mothers in the target group who attended were interviewed. A total sample, of 200 was thereby produced for this cross-sectional study. A survey instrument was developed based on focus group discussion (FGD) sessions wherein mothers of children with SCD identified possible sources of stress. Mothers ranked these, and a list of 30 relevant stressors was produced. A Likert-type scale was developed and pretested among mothers attending a SCD clinic in Ilorin. Information on coping mechanisms covered the following six broad categories of stressors: hospital, financial, family, child, psychological and disease factors. Additional questions gathered demographic data on mothers and their knowledge about the disease. A mean stress score of 59 points from a potential range of 30-90 was obtained. Mothers below 35 years old displayed significantly less stress (58 points average) than older women (61). Those in a monogamous marriage had a significantly lower mean score (57) than women in polygamous homes (61) or single women (63). Mean stress was found to decrease with mothers' level of education from 62 points among the uneducated to 48 among those with post-secondary education. Having more than one child with SCD in the family yielded a higher stress score (67) than haying only one affected child (57). Coping style varied according to the category of stressor. For example, Mothers confront the financial stressors by searching for money. Most accept treatment as a given, although one-third do try to avoid it. The findings emphasize the need to introduce health education and counseling on stress coping mechanisms for affected mothers as well as community health education to prevent this stress-inducing disease within families. Counseling is needed especially for families that have one child with SCD and that are considering having more children. Older, less educated and single mothers are groups that should be targeted for social support interventions such as participation In SCD clubs. Description: A Dissertation submitted in partial fulfillment of the requirements for the degree of Master of Public Health (Health Education) in the Department of Preventive and Social Medicine, Faculty of Clinical Sciences and Dentistry, College of Medicine, University of Ibadan, Ibadan, Nigeria