Atkinson Sarah, Haran Dave
University of Manchester, UK.
Soc Sci Med. 2005 Feb;60(3):501-13. doi: 10.1016/j.socscimed.2004.05.019.
The paper has two aims: to explore possible determinants of user satisfaction based on a broad conception of the health care system involving both individual and district scale variables, and to add to the limited knowledge and empirical study about such determinants in developing countries. The study was carried out in one of Brazil's poorest states, Ceará, in the northeast of the country. Brazil has a policy of an increased role for the population in management together with decentralised management to the local administrative (municipio) scale. For user views on health care to be useful in management, understanding their determinants needs to explore not only individual scale factors but also influences from the local health system and wider society, here termed district scale factors. The study design took different angles on users' satisfaction to build three measures: the particular health event (termed perceived quality); a generalised perception (termed satisfaction); and, satisfaction with the Community Health Worker (termed CHW satisfaction). Potential determinants explored at the individual scale (17 variables) are grouped into: socio-demographic and economic characteristics; health outcome; health care provision; and, awareness of space for local voice in planning. Potential determinants explored at the district scale (50 variables) are grouped into: formal organisation and management (health system inputs, management capacity, outputs and outcomes); informal organisation (population awareness of health system activities, staff characteristics, district management style); and, local political culture (geographic and socio-economic population profile, commitment to the district of local leaders, norms and values of staff regarding practice). Three determinants were key for all three user evaluation measures: getting an appointment, getting better, and the type of district (rural-urban). Our primary conclusion from this study is that there are limitations to the extent that user satisfaction can fulfill the claims made for it. On a more positive note, with these limitations noted, user satisfaction can prove a useful management tool more modestly at a local, context-specific scale.
基于涉及个体和地区层面变量的广泛医疗保健系统概念，探索用户满意度的可能决定因素；并补充发展中国家关于此类决定因素的有限知识和实证研究。该研究在巴西东北部最贫困的州之一塞阿拉进行。巴西实行一项政策，即让民众在管理中发挥更大作用，并将管理权力下放到地方行政（市）层面。为了使关于医疗保健的用户观点在管理中有用，了解其决定因素不仅需要探索个体层面的因素，还需要探索当地卫生系统和更广泛社会的影响，这里称之为地区层面因素。该研究设计从不同角度考察用户满意度，构建了三项指标：特定健康事件（称为感知质量）；一种普遍认知（称为满意度）；以及对社区卫生工作者的满意度（称为社区卫生工作者满意度）。在个体层面探索的潜在决定因素（17个变量）分为：社会人口和经济特征；健康结果；医疗保健服务；以及对规划中地方发声空间的认知。在地区层面探索的潜在决定因素（50个变量）分为：正式组织和管理（卫生系统投入、管理能力、产出和结果）；非正式组织（民众对卫生系统活动的认知、工作人员特征、地区管理风格）；以及当地政治文化（地理和社会经济人口概况、地方领导人对地区的承诺、工作人员关于实践的规范和价值观）。对于所有三项用户评估指标而言，有三个决定因素至关重要：预约就诊、病情好转以及地区类型（农村 - 城市）。我们从这项研究得出的主要结论是，用户满意度能够实现其宣称作用的程度存在局限性。更积极的一面是，在注意到这些局限性的情况下，用户满意度在地方特定背景下可以适度地证明是一种有用的管理工具。
