SATISFACTION TOWARDS HEALTH CARE SERVICES

AMONG TUBERCULOSIS PATIENT ATTENDING

REGIONAL TB CENTRE, POKHARA

A Research Report Submitted in the Partial Fulfillment of

Requirement for Post Basic Bachelor of Nursing in
Purbanchal University
March, 2021

ANITA SHARMA
Post Basic Bachelor of Nursing
P.U. REG. No: 139-6-2-07278-2017
Charak Academy Pvt. Ltd., Pokhara , Nepal
 APPROVAL SHEET
The research report entitled “Satisfaction towards health care services among
tuberculosis patients attending in Regional TB center, Pokhara ” is a bonafide
work and is being submitted for approval to Charak Academy Pvt. Ltd, Pokhara -
11 kamalpokhari, as requirement of the Post Basic Bachelor Degree in Nursing
Program, Purbanchal University.

Student Researcher ………………………..

Anita Sharma

Approved by
Research Advisor …………………………
Lecturer Sunita Mahato
MN in Medical Surgical Nursing
Charak Academy

Principal .……………………….
Mrs. Sirjana Pandit Pahari
MN in Pediatric Nursing
Charak Academy Pvt. Ltd.
Kamal Pokhari-11, Pokhara

Date:……………………

II
 ABSTRACT

Title: ‘Satisfaction towards health care services among tuberculosis patients attending
in Regional TB center, Pokhara ’.
Background: DOTS therapy has been recognized as best cost effective approach to
tuberculosis treatment. Evaluating patients’ satisfaction is an important method of
measuring the quality of health services. Satisfied patient are more likely to utilize
health services and comply with medical treatment thus patients satisfaction is key
determinant in treatment success. Thus this data is small attempt to assess patients’
satisfaction level with DOTS services.
Objectives: The objective of the study was to assess the satisfaction towards health
care services among tuberculosis patient, to identify the level of satisfaction towards
health care services among tuberculosis patients, to assess the association between
level of satisfaction towards health care services among tuberculosis patient and
selected variables.
Method: A descriptive, cross sectional study was conducted among 60 patient of
regional TB center Pokhara . Structured questionnaire technique was done for data
collection. Descriptive statistics such as frequencies and percentage was used for data
analysis with the use of SPSS version 25.
Results: In this study, of all 60 patients, 33(55%) patient were unsatisfied and 27
(45%)patient Most of the patients were satisfied.
Conclusion: In the study overall satisfaction with DOTS services is good. But there is
still dissatisfaction with frequent visit to DOTS centre and total duration of DOTS
therapy.
Key word: Satisfaction, Tuberculosis, DOTS

III
 ACKNOWLEDGEMENT
It is great pleasure for me to express researcher appreciation to those who helped
researcher to carry out this descriptive study for the partial fulfillment of the Bachelor
in nursing program. It would had been never possible to complete the study without
the help of those brilliant brains, helping hands and all those inspirations that have
contributed so much in bringing this study to a successful end.

Researcher would like to express overwhelming gratitude to researcher college

Charak Academy for providing the opportunity to carry out this research study.
Researcher would like to express the deepest appreciation to the nursing chief Ms.
Srijana Pandit Pahari lecturer Co-coordinator of BN 3rd year Ms. Aakriti Kafle and
all department of Charak Academy .for the valuable suggestions, encouragement and
support throughout my study.

Researcher special gratitude goes to research advisor Ms. Sunita mahato for her
encouragement and valuable suggestion throughout the research study. Without her
guidance and persistent help this study would not have been possible. By whom
researcher always inspired to do this great achievement.
Researcher would like to express thanks to the Regional tuberculosis center Pokhara
for giving the permission to carry out the research study.

Researcher feels particularly grateful to the lecturer sir Mr. keshav lamichane for
sharing expertise and valuable guidance for analysis collected data. Similarly
researcher cannot forget to give thanks to all faculty teacher of Charak Academy for
their valuable suggestion. Researcher is also thankful to friends for their support and
encouragement during the research study. Researcher is also grateful to Charak
Academy and regional tuberculosis center, Health division for granting me the
permission and platform to collect data.

Researcher special thanks go to respondents. Without them research study would not
be possible. Researcher would like to wish for their good health and wellbeing.
Researcher would like to extend my gratitude to the library team of Charak Academy
for their help to collect relevant literature and references.

IV
Finally, Researcher takes this opportunity to acknowledge the help of all who directly
and indirectly helped me in making my study successful.

Anita Sharma
PBBN 3rd Year

V
 TABLE OF CONTENT
CONTENTS PAGE
TITLE PAGE I

APPROVAL SHEET II

ABSTRACT III

ACKNOWLEDGEMENT IV

TABLE OF CONTENT VI

LIST OF TABLES AND FIGURE IX

CHAPTER 1: INTRODUCTION
1.1 Background of the study 1
1.2 Need of the study 2
1.3 Objective of the study 3
1.3.1 General objective 3
1.3.2 Specific objective 3
1.4 Significance of the study 4
1.5 Research question 4
1.6 Conceptual framework 4
1.7 Study variables 5
1.7.1 Independent variables 5
1.7.2 Dependent variable 5
1.8 Operational definition 5
1.9 Delimitation of the study 6
CHAPTER II: REVIEW OF LITERATURE
2.1 Introduction 7
2.2 Review of literature 7
2.3 Summary of literature 10
CHAPTER III: METHODOLOGY
3.1 Research design 11
3.2 Research setting and population 11
3.2.1 Ethical consideration 11
3.3 Sampling 11
3.3.1 Sampling technique 11

VI
 3.3.2 Sample size 12
3.3.3 Exclusion criteria 12
3.3.4 Inclusion criteria 12
3.4 Research instrument 12
3.5 Validity and Reliability 12
3.6 Data collection procedure 12
3.7 Data analysis procedure 13
CHAPTER IV: FINDING OF THE STUDY 14

CHAPTER V: DISCUSSION, CONCLUSION,

LIMITATION, RECOMMENDATIONS
5.1 Discussion 22
5.2 Conclusion 23
5.3 Implication for nursing research 23
5.4 Limitations of the study 23
5.5 Recommendation for the study 23
REFERENCES 24

APPENDICES
APPENDIX A: Consent form i

APPENDIX B: Consent form (Nepali) ii

APPENDIX C: Tool of data collection iii

APPENDIX D: Tool of data collection (Nepali) vii

APPENDIX E: Work Plan xi

APPENDIX F: Budget Expenditure xii

APPENDIX G: Official letter xiii

VII
 LIST OF TABLE AND FIGURE
TABLES PAGE NO.

1 Socio- demographic characteristics of the respondents 15

2 Clinical characteristics of the respondents 17
3 Item wise analysis of respondent’s satisfaction towards health 18
care services
4 Level of satisfaction towards health care services 19
5 Association of respondent’s level of satisfaction with Socio- 20
demographic variables

FIGURE PAGE NO.

1 Conceptual Framework 4

VIII
 CHAPTER I
INTRODUCTION

1.1 Background of the Study

Tuberculosis (TB) is an airborne bacterial infection caused by the organism

Mycobacterium tuberculosis that primarily affects the lungs, although other organs
and tissues may be involve. Tuberculosis is spread from person to person through the
air. When a person with TB in their lungs or throat coughs, laughs, sneezes, or even
talks; the germs that cause TB may spread through the air. If another person breathes
in these germs there is a chance that they will become infected with tuberculosis. (1)

Globally, an estimated 10.0 million (range, 9.0–11.1 million) people fell ill with TB in
2018, a number that has been relatively stable in recent years. There were an
estimated 1.2 million (range, 1.1–1.3 million) TB deaths among HIV-negative people
in 2018 (a 27% reduction from 1.7 million in 2000), and an additional 251000 deaths
(range, 223 000–281 000)3 among HIV positive people (a 60% reduction from
620000 in 2000). Geographically, most TB cases in 2018 were in the WHO regions
of South-East Asia (44%), Africa (24%) and the Western Pacific (18%), with smaller
percentages in the Eastern Mediterranean (8%), the Americas (3%) and Europe (3%).
Eight countries accounted for two thirds of the global total: India (27%), China (9%),
Indonesia (8%), the Philippines (6%), Pakistan (6%), Nigeria (4%), Bangladesh (4%)
and South Africa (3%). These and 22 other countries in WHO’s list of 30 high TB
burden countries accounted for 87% of the world’s cases. (2)

Despite the fact that the causative organism was discovered more than 100 years ago
and highly effective drug, vaccines and reliable diagnostic procedures are available
making tuberculosis a preventable and curable diseases, tuberculosis remains a
worldwide public health problem. (3)

DOTS (Directly Observed Treatment, Short-course) or (watching the patient take

his/her medication to ensure medications are taken in the right combination and for

1
the correct duration) is the most effective strategy available for controlling the TB
epidemic today. DOTS has five key components: Government commitment to
sustained TB control activities, Case detection by sputum smear microscopy among
symptomatic patients self-reporting to health services, Standardized treatment
regimen of six to eight months for at least all confirmed sputum smear positive cases,
with directly observed treatment (DOT) for at least the initial two months, A regular,
uninterrupted supply of all essential anti-TB drugs, A standardized recording and
reporting system that allows assessment of treatment results for each patient and of
the TB control programme overall. (4)

DOTS is limited to satisfy patients with TB and lacks a consistent system that
determines the satisfaction level of patients with TB. Therefore, DOTS strategy needs
to have a system to captures patients' satisfaction level to respond on areas that need
progress to improve DOTS service quality. (5)

Patient satisfaction is an important outcome of health systems. It can be defined as

the perceived fulfillment of patients’ needs and desires through the delivery of
healthcare. (6) It is how individuals perceive health care services, which is affected
by the quality of care delivered by the providers. It is often based on the patient’s
expectations of care and the self-assessment of their experiences. Patients’ satisfaction
may play a major role in their behaviors; if patients are dissatisfied with the care
provider or with the clinical setting, he or she may be less likely to be adherent to
medications, keep appointments, identify contacts, and so forth. Research has shown
that patients’ satisfaction with services can be increased with effective patient-
provider communication and development of a trusting relationship between the two
parties. (7)

A cross sectional study on satisfaction levels among patients availing DOTS services
in Bundelkhand Region (UP), India from 1st January 2009 to 31st March 2009 .
78.6% patients were fully satisfied with the services provided at the centers. Lack of
financial burden was the most common reason for satisfaction (95.4%), followed by
improvement in symptoms (75%). Most common problems faced by the patients was
difficult in coming on alternate days (30.0%) followed by loss of wages and transport
charges (26.8%). (8)

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1.2 Need for the study

Tuberculosis (TB) is one of the top 10 causes of death worldwide. 10 million people
fell ill with TB. 5.7 million men, 3.2 million women and 1.1 million children, and 1.5
million died from the disease. In 2018, there were 205000 child deaths due to TB
(including among children with HIV). An estimated 58 million lives were saved
through TB diagnosis and treatment between 2000 to 2018. (9)

A cross-sectional study on patient satisfaction with tuberculosis services of directly

observed therapy programs in Gezira State of Sudan, 56.2% of TB patients were
satisfied with the provided services. Patients having high income, attended private
hospitals and general/chest hospitals and patients treated by a junior staff were more
satisfied with the provided TB services than those with low income, who attended
health centers and the Tuberculosis Basic Management Units (TBMUs) and patients
treated by a senior physician. (7)

A cross sectional study conducted on evaluation of satisfaction level of TB patient

enrolled for directly observed treatment short course was carried out at 15 DMC cum
DOTS Centers of Rewa district, Madhya Pradesh, India among 337 patients
concluded that 241 (71.5%) were fully satisfied and remaining 96 (28.5%) were
satisfied Somewhat with the health services. Majority of the patients expressed
satisfaction with timing of DOTS Centres (93.17%) including waiting time for
medical care (86.05%) as well as behavior of staff (90.20%). While most of the
patients were dissatisfied due to frequent visits to DOTS centers (37.1%) and total
duration of DOTS therapy (29.1%). (10)

Client satisfaction survey on Tuberculosis services in Lalitpur & Kaski districts,

Nepal shows only 44% of patients were highly satisfied with TB treatment. The level
of satisfaction was significantly associated with the behavior of health workers, mode
of information provision and counseling to the clients and family members and other
functional aspects of health services. (11) So, this study will be conducted to assess
the patient's satisfaction towards health care service at a Regional TB center Pokhara .

3
1.3 Objective of the study

1.3.1 General Objective

To assess the satisfaction towards health care services among tuberculosis

patients.

1.3.2 Specific Objectives

 To identify the level of satisfaction towards health care services among

tuberculosis patients.
 To assess the association between level of satisfaction toward health
care services among tuberculosis patients and selected variables.

1.4 Significance of the Study

The findings of the study was provide the baseline data for the further study. The
findings of the study was helpful to program managers to develop and implement
appropriate and effective strategies program.

1.5 Research Question

What is the satisfaction towards health care services among tuberculosis patients?

4
1.6 Conceptual Framework
A conceptual framework is an analytical tool with several variations and contents. It is
used to make conceptual distinctions and organize ideas. This provides some insight
about this research. In this framework there is the relationship between the dependent
variable and independent variables. Fig 1 shows that socio demographic variables
such as age, sex, education, marital status, occupation, distance between residence and
DOTS clinic , HIV test and HIV status and clinical characterstics such as type of
tuberculosis, phase of treatment and treatment category are the independents variables
which affect the satisfaction towards health care service among tuberculosis patients.

Figure 1:Conceptual Framework regarding the study of Satisfaction towards

Health Care Service among Tuberculosis patients

5
1.7 Study Variables
1.7.1 Independent Variables
Socio demographic factors
Age
Sex
Education
Occupation
Marital status
Residence
Distance between residence and DOTS clinic

Clinical Characteristics
Type of tuberculosis
Phase of treatment
Treatment category
1.7.2 Dependent variable
Satisfaction towards health care services among tuberculosis patients.

1.8 Operational Definitions

Satisfaction: It refers to the information obtained from respondents that they feel
towards service provided in regional TB center Pokhara . Patient satisfaction will be
categorized into two categories ie satisfied and dissatisfied.
Patients: Refers to the persons, who are receiving treatment from Regional TB
centre Pokhara except multidrug resistance (MDR) TB.
Health: Health is " as state of complete physical, mental and social well being and
not merely an absence of disease or infirmity".
Tuberculosis: Tuberculosis (TB) is an airborne bacterial infection caused by the
organism Mycobacterium tuberculosis that primarily affects the lungs, although other
organs and tissues may be involve.

Age: It refers to the patients who are above15 years and receiving treatment from
regional TB center Pokhara .

6
service: It refers to all treatment and facilities provided by the Regional TB center
Pokhara .

1.9 Delimitation of the study

This study was delimited to:

 Data collection duration was limited to 2 weeks.

 The study was not generalized because this study was exclusively academic.

7
 CHAPTER II
LITERATURE REVIEW
2.1 Introduction

The chapter represents the review literature taken from different source such as
journal, research paper, books, publications and internet search. The reviewed
literature regarding satisfaction towards health care service among tuberculosis
patients is organized in terms of introduction, international and national scenario and
finding from different studies.

2.2 Review of Literature

A cross sectional study on Public health facilities of Sidama zone south Ethiopia has
been 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 interviews were selected by systematic random
sampling. 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 health care
provider, accessibility, technical competency, convenience (cleanliness) and
consultation and relational empathy were independent predictors of overall patient
satisfaction. (12)

Patient satisfaction with HIV and TB treatment in public programme in rural

KwaZulu-Natal evidence from patient-exit interviews with 300 TB patients who
were randomly selected using a two-stage cluster random sampling .Almost all
patients 97% TB reported to be globally satisfied with the healthcare services received
on the day of the interview. However, patient satisfaction with specific concrete
aspects of the health services was substantially lower 40% of TB patients agreed that
some staff did not treat patients with sufficient respect 40% of TB patients agreed
that health worker queues were too long . The level of satisfaction did not vary
significantly with patients’ socio-demographic characteristics. (6)

8
A cross sectional study on evaluation of satisfaction level of TB patient enrolled for
directly observed treatment short course was carried out at 15 DMC cum DOTS
Centers of Rewa district, Madhya Pradesh, India from 1st July 2007 to 30th June
2008. These centers were selected by simple random sampling. In the study, of all 337
patients, 241 (71.5%) were fully satisfied and remaining 96 (28.5%) were satisfied
somewhat with the health services. Majority of the patients expressed satisfaction
with timing of DOTS centres (93.17%) including waiting time for medical care
(86.05%) as well as behavior of staff (90.20%). While most of the patients were
dissatisfied due to frequent visits to DOTS centers (37.1%) and total duration of
DOTS therapy (29.1%). (10)

A cross-sectional study on patient satisfaction with tuberculosis services of directly

observed therapy programs in the Gazira state of Sudan. The data was collected by
simple random sampling from 292 patients using a pre tested questionnaire after
obtaining an informed consent. The level of satisfaction with the provided TB
services was 56.2%. Patients with no income were more satisfied (82.7%) with TB
services than those with debts (67.1%) and savings (42.7%). Patients who attended
private facilities were more satisfied with TB services (85.3%) than those who
attended public health facilities. Patients were more satisfied with TB services
provided by the medical assistants. (7)

A study on evaluation on patients satisfaction with tuberculosis services in southern

Nigeria was conducted with total 378 patients accessing TB care were studied using
a validated Patient Satisfaction questionnaire on various aspects of TB services.
Highest satisfaction was reported for adherence counseling and access to care. Patient
characteristics were associated with overall satisfaction , registration, adherence
counseling, access to care, amenities, and staff attitude, while health system factors
were associated with staff attitude, amenities, and health education. Predictors of
satisfaction with TB services included gender, educational status, if tested for HIV,
distance, payment for TB services,and level and type of health-care facility. (13)

A cross sectional study on satisfaction levels among patients availing DOTS services
in Bundelkhand Region (UP), India from 1 st January 2009 to 31 st March 2009.
78.6% patients were fully satisfied with the services provided at the centers. Lack of
financial burden was the most common reason for satisfaction (95.4%), followed by

9
improvement in symptoms (75%). Most common problems faced by the patients was
difficult in coming on alternate days (30.0%) followed by loss of wages and transport
charges (26.8%). (8)

A cross sectional study done on Patient satisfaction with TB care clinical

consultations in Kampala from September 2012 and February 2013 Of the 260
registered TB patients, 178(68.5%) completed the questionnaire. Overall, 162 (91.0%)
were satisfied with the clinical consultation. Factors that contributed to high patient
satisfaction, were: time spent with clinician (85.4%), explanation of what was done
(87.6%), technical skills (91.6%), personal manner of the clinician seen (91.6%).
Factors for low satisfaction were; waiting time before getting an appointment
(61.8%), convenience of location of consultation office (53.4%), getting through to
the office by phone (21.3%) and length of time waiting at the office (61.2%). (14)

A study of patient satisfaction towards RNTCP in Meerut district, Uttar Pradesh,

India. Four hundred patients were interviewed directly either at home or at DOTS
centres regarding behavior and availability of DOTS provider, delay in starting the
treatment, charging money by the health staff and waiting time at DOTS centre.
About 68 % patients were found highly satisfied, 16.7 % just satisfied and 15.5 %
were found unsatisfied. (15)

A study of satisfaction level of Tuberculosis patients regarding their access to TB

Care and prevention services, Delivered Through a Public–Private Mix Model in
Pakistan. This study included 53% (n = 301) males and 47% (n = 271) females, with
mean age of 38 years (SD, _18). Almost half of the participants were illiterate (51%, n
= 289), and 64% (n = 365) were non-earning members of the family. In practice, most
of the participants visit private providers (71%, n = 407), including private
hospitals/clinics (44%) and traditional practitioners (27%; n = 153); 55% of
participants visited their current doctor because of the clinic’s proximity to their
residence. Of the articipants, 82% (n = 469) were satisfied with TB care services and
85% (n = 488) said that they would recommend this clinic to others. (16)

A study Is directly observed tuberculosis treatment strategy patient-centered? A

mixed method study in Addis Ababa, Ethiopia. Forty percent of patients with TB had
not received patient-centered TB care (PC-TB care) with DOTS. Male gender (AOR

10
= 0.45, 95% CI 0.3, 0.7), good communication (AOR = 3.2, 95%CI 1.6, 6.1), and
health care providers as a treatment supporter (AOR = 3.4, 95% CI 2.1, 5.48) had
significant associations with PC-TB care. All persons lost to follow-up and TB
experts perceived that DOTS is merely patient-centered. The identified categories
were patient preferences, treatment supporter choice, integration of DOTS with
nutritional support, mental health, and transport services, provider's commitment and
communication skills. (5)

A cross sectional study done on Patient satisfaction, feasibility and reliability of

satisfaction questionnaire among patients with pulmonary tuberculosis in urban
Uganda. 133 participants, 35% (46/133) were starting, 33% (44/133) had completed
two months, and 32% (43/133) had completed eight months of TB therapy. The male
to female and public to private hospital ratios in the study population were 1:1. The
PS-13 and the SIMS tools were highly acceptable and easily administered. Both
scales and the subscales demonstrated acceptable internal consistency with
Cronbach’s alpha above 0.70. Patients that were enrolled at the public hospital had
relatively lower PS-13 satisfaction scores (0.48 (95% confidence interval (CI), 0.42 -
0.52)), (0.86 (95% CI, 0.81 - 0.90)) for technical quality of care and responsiveness to
patient preferences, respectively compared to patients that were enrolled at the private
hospital. For potential problems SIMS subscale, male patients that were recruited at
the public hospital had relatively lower satisfaction scores (0.58 (95% CI, 0.40 -
0.86)) compared to female patients after adjusting for other factors. Similarly, patients
that had completed eight months of TB treatment had relatively higher satisfaction
scores (1.23 (95% CI, 1.06 - 1.44)) for action and usage SIMS subscale, and higher
satisfaction scores (1.09 (95% CI, 1.03 - 1.16)) for management of patient preference
(PS-13 satisfaction subscale) compared to patients that were starting treatment,
respectively. (17)

2.3 Summary of Literature

After review of related literature, it was found that limited studies have been
conducted on satisfaction towards health care services among tuberculosis patients.
The finding of the study revealed that there is still some factor that affect in
satisfaction such as duration of treatments and frequent visit to DOTS clinic, in some

11
area there is problems to reach DOTS clinic. So this study helps to find out factors
that mostly affects in level of satisfaction.

12
 CHAPTER III

RESEARCH METHODOLOGY

Research methodology is a way to systematically solve the research approach,

research design, sample setting sampling technique, sample selection criteria,
procedure, tools used, validity and reliability of the tools.

3.1 Research Design

Descriptive cross-sectional analytical research design was carried to find out the
satisfaction toward health care services among tuberculosis patients.

3.2 Research Setting and Population

The study was carried out in western regional TB center Pokhara .

The study population was patients above 15 years diagnosed with tuberculosis and
receiving health care services from regional TB center Pokhara ,

3.2.1 Ethical Consideration

Administrative approval was obtained from Charak Academy . Ethical approval was
obtained from Charak Academy . Permission was taken from regional TB center
Pokhara . Written informed consent from the respondents was obtained. Anonymity
was ensure by requesting not to write their name on the questionnaire.confidentiality
was be maintained by not disclosing the information of the respondents with other
purpose. Respondent s dignity was maintained by giving right to reject or discontinue
from the study at any time. Privacy of the respondents was maintained by
interviewing in a separate room.

3.3 Sampling

All the tuberculosis patient who comes to western regional TB center Pokhara from
date 2077/10/5 to 2077/10/12 was taken as a sample for the study.

13
3.3.1 Sampling Technique

Sampling technique was non probability convenience sampling.

3.3.2 Sample Size

The Sample Size was 60 .

3.3.3 Inclusion criteria

All the patient above 15 years, diagnosed with tuberculosis, receiving health care
service from western regional center Pokhara for at least one month before data
collection and willing to participate in the study was included.

3.3.4 Exclusion Criteria

Exclusion for this study was be patient who was absence during the data collection
and Multidrug resistance (MDR) tuberculosis patients was not included in the study.

3.4 Research Instrument

Semi-structured interview schedule was use for data collection it is divided into three
parts.
The research instrument was consist of three parts.
Part I- Questions related to socio-demographic information.
Part II- Questions related to clinical characteristics.
Part III- Questions related to satisfaction towards health care services among
tuberculosis patient.

3.5 Validity and Reliability

Validity of instrument was established by developing instrument on the basis of

literature review, advice from research advisor and subject expert. First of all question
was making in English and secondly it was translate in Nepali and retranslate in
English. Necessary modification was done on the basis of their suggestion.

The reliability of instrument was examined of internal consistency after pre-testing in

10% of estimated population in similar setting. Those who were included in pre-
testing were excluded in main study.

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3.6 Data Collection Procedure

The permission for data collection was taken from the administration of Regional TB
Pokhara center . Approval was obtained from concerned authority. The researcher
herself was collect the data by using semi-structured interview schedule through face
to face interview method from 10 am to 4 pm. Data was collected within 2 weeks
estimating per day 7 to 8 cases. Data was collected around 25-30 minutes per
respondent. Simple language was used while asking question to the respondents.

3.7 Data Analysis Procedure

The data was collected through the semi-structured interview schedule that was
checked for accuracy, competences and then organized. All the data was entered in
excel and analyzed and interpreted by stastistical package for social science ( SPSS)
version 25 by using descriptive statistics methods in term of frequency, mean and
percentage and inferential statistics (chi square).


15
 CHAPTER IV

FINDING OF THE STUDY

The chapter deals with the analysis and interpretation of the data obtained from 60
respondents regarding the satisfaction towards health care services among
tuberculosis patient. After data collection all the obtained data was analyzed
according to the objective of the study. Descriptive statistics namely frequency,
percentage, mean and standard deviation were used to describe the socio-demographic
characteristics of the participants. The inferential statistics namely chi-square test was
used.

Findings are presented in various tables. The socio-demographic characteristics of the

respondents are presented in table 1, table 2 contain clinical characteristics, table 3
contain analysis of respondents satisfaction of health care services, table 4 contain
level of satisfaction towards health care services and table 5 contain association of
respondents level of satisfaction with selected variables .

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 TABLE 1
Socio-demographic Characteristics of the Respondents
N=60
Variables Frequency Percent
Age Group
0-25 15 25.0
26-39 10 16.7
40-54 19 31.7
>=55 16 26.7
Sex
Male 34 56.7
Female 26 43.3
Educational status
Literate 53 88.3
Illiterate 7 11.7
If literate, level of education (n=53)
General literate 10 18.9
Basic education 8 15.1
Secondary level 11 20.8
Higher secondary level 14 26.4
Bachelor and above 10 18.9
Occupational status
Laborer(daily wage) 12 20.0
Service holder 12 20.0
business man 14 23.3
Farmer 9 15.0
Other 13 21.7
Religious status
Hinduism 50 83.3
Christianity 7 11.7
Buddhism 2 3.3
Islam 1 1.7

Marital status

17
 Single 10 16.7
Married 44 73.3
Divorced 2 3.3
Widows/widower 4 6.7
Distance between DOTS clinic and the house
0-1.5 10 16.7
1.6- 2.4 25 41.7
2.5-3.4 22 36.7
>=3.5 3 5.0

Table 1: Represents the Socio-demographic status of respondents, majority of them

19 (31.7%) patient were indicate 40-54 age group, 16 (26.7%) patient have more than
55 years, 34 (56.7%) were male and 26(43.3%) were female. In educational status
mostly patient 53(88.3%) were literate and 7 (11.7%) patient were illiterate. Among
literate patient 14 (26.4%) patient have higher secondary level and 11(20.8%) patient
have secondary level. In occupational status 14(23.3%) patient were business, 12
(20%) patient were laborer and 12 (20%) patient were service holder. In religious
status mostly 50 (83.3%) patient were Hinduism, 7 (11.7%) were Christianity ,
2(3.3%) were Buddhism, and 1 (1.7%) was Islam. In marital status mostly patient 44
(73.3%) were married and 10 (16.7%) were single and 4(6.7%) were widower and
2(3.3%) were divorced. In distance between DOTs clinic and house, 25(41.7%) were
from 1.6 to 2.4 km far and 22 (36.7%) patient were from 2.5 – 3.4 km far. 10
(16.7%) patient were from less than 1.5 km and 3(5%) patient were from more than
3.5 km.

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 TABLE 2
Clinical Characteristics of the Respondents
N=60
Variables Frequency Percent
Type of tuberculosis suffering from
Pulmonary tuberculosis 52 86.7
Extra pulmonary tuberculosis 8 13.3
Phase of treatment
Initial 15 25.0
Continuous 45 75.0
Category of the tuberculosis treatment
Category I (new smear positive) 18 30.0
Category II (Smear positive who have relapse) 2 3.3
Category III (new smear negative) 40 66.7

Table 2: It shows 52( 86.7% )people have pulmonary tuberculosis where 45( 75%)
people were on continuous phase of treatment and majority 40(66.7%) people were
on Cat III treatment, 18 (30%) people were on Cat I treatment, 15 (25%) people were
on initial phase of treatment and 8(13.3%) people have suffering from extra
pulmonary tuberculosis.

19
 TABLE 3
Item Wise Analysis of Respondent's Satisfaction towards Health
Care Services
N=60
Satisfied Dissatisfied
Items
No. % No. %
Location of DOTS centre 39 65 21 35
Timing of DOTS centre 38 63,3 22 36.7
Waiting time for medical care 55 91.7 5 8.3
Behavior of staff at DOTS centre 57 95 3 5
Pretreatment counseling by health staff 56 93.3 4 6.7
Satisfied with total duration of treatment 35 58.3 25 41.7
Improvement in condition after initiation of DOTS 53 88.3 7 11.7
Frequent visit to DOTS centre 33 55 27 45
Thinking that DOTS will cure 56 93.3 4 6.7

Table 3: It represents the majority of patient 57( 95%) people were satisfied with the
behavior of staff at DOTS center.. Whereas 56( 93.3% ) people were satisfied with
thinking that DOTS will cure and also pretreatment counseling by health staff,
55( 91.7%) people were waiting time for medical care,53(88.3%) people were
improvement in condition after initiation of DOTS. The table shows that
dissatisfaction is mainly due to frequent visit to DOTS center people were 27(45%)
where as 25(41.7%) people were total duration of treatment, 22(36.7%) people were
timing of DOTS centre, 21(35%) people were location of DOTS centre and 7(11.7%)
people were dissatisfied with improvement in condition after initiation of DOTS.

20
 TABLE 4
Level of Satisfaction towards Health Care Services
N=60

Level of Satisfaction Frequency Percent

Dissatisfied 33 55

Satisfied 27 45

Table 4: Reveals that the majority of respondents were dissatisfied (55%) and
rest of the respondents (45%) were satisfied.

21
 TABLE 5
Association of Respondent's Level of Satisfaction with Socio-
demographic Variables
N=60

Variables Not satisfied Satisfied χ2 P

Value Value
Age Group
< 15-45 23 13
2.873 0.76
>= 45 10 14
Sex
Male 13 13
0.463 0.337
Female 20 14
Educational status
Literate 29 24
0.15 0.614
Illiterate 4 3
If literate, level of
education (n=53)
General literate 5 5
Basic education 4 4
Secondary level 4 7
4.270 0.371
Higher secondary
8 6
level
Bachelor or above 8 2

Occupational status
Labour (daily
7 5
wager)
Service holder 6 6
4.390 0.356
Businessman 5 9
Farmer 7 2
Others 8 5
Religious status
Hindu 27 23 2.026 0.567
Christian 5 2

22
 Buddhist 1 1
Islam/ Sikh 0 1
Marital status
Single 6 4
Married 25 19
Divorced 1 1 1.635 0.652
Widow or
1 3
Widower

Table 5: shows the association between socio-demographic variables and satisfaction

of respondents. There was no statistically significant relationship between level of
satisfaction towards health care services among respondents attending to regional
hospital Pokhara like age, sex educations, occupation marital status, distance between
residence and DOTS clinic..

23
 CHAPTER V
DISCUSSION, CONCLUSION, LIMITATION,
RECOMMENDATIONS

This chapter deals with discussion, conclusion, limitation, implications and

recommendations based on the findings of the study. The discussion presents all the
findings of the study in comparison to those studies from the reviewed literature.
Conclusion includes the inferences drawn from the finding of the study.
Recommendation gives direction to future and suggestion for replication and
extension of the present study.

5.1 Discussion

The study was conducted to find patient satisfaction regarding health Care services
in Regional TB center Pokhara . The overall objective of this study is to find out the
satisfaction of patient towards health care services so that the reasons that lead to
dissatisfaction can be improved in coming days. The descriptive cross sectional study
was done by using non probability sampling technique

In this study of all 60 respondents 45% were satisfied where 55% were dissatisfied.
Similar findings conducted by Rai, Sing, Kushwah and Dubey(2016)observed that
28.5% were fully satisfied, 71.5% were somewhat satisfied. But contrast to this
finding Nezenega, Gacho, and Tafere, (2013) reported high satisfaction rate 90%in
their study in South Ethiopia.

This study shows that 95% people were satisfied with behaviour of staff at DOTS
center.93.3% people thinking that DOTS will cure. location of DOTS centre. In this
study, 63.3% respondents experienced satisfaction with timing of DOTS centers. The
finding is supported with the finding of the study done by Rai, Sing, Kushwah and
Dubey (2016) observed 93.17% patient satisfied with timing of DOTS centres.

Likewise, in this study 91.7% people were also satisfied with waiting time of DOTS
centers whereas Mohamed, Ounsa, Mansour, Alzahrani, Abdalla, Medani, Sami,
(2014) also shows greater satisfaction on waiting time of DOTS centers (90%). In
this study, 95 % patient were satisfied with behavior of staff at DOTS centers.

24
similarly Haque(2014) observed 90% satisfied with behavior of staff. 93.3% people
were satisfied with pretreatment counseling whereas Rai, Sing, Kushwah and
Dubey(2016) observed 86.9% satisfaction.

In this study, only 58.3%% patients were satisfied with total duration of treatment.
Similarly with Davidson, etal observed that only 74% people were satisfied with total
duration of treatment. In this study majority of patient 88.3% patient have good
improvement after initiation of DOTS treatment whereas Rai, Sing, Kushwah, and
Dubey D(2016)observed 94.36% have improvement after DOTS treatment. In this
study 33 patient (55%) were satisfied with frequent visit to DOTS centre. The finding
is supported with the finding of the study done by Rai, Sing, Kushwah and Dubey
(2016) reported (62.9%) patients were satisfied with frequent visit to DOTS center.

Majority of patient 93.3% believed that DOTS will cure them. Similarly Haque
(2014) observed that 93% people agreed with they will cure after DOTS treatment.

In the study I found that dissatisfaction is mainly due to frequent visit to DOTS
centers and total duration of treatments.

5.2 Conclusion
Overall satisfaction with TB services is good. However there is some dissatisfaction
particularly with regard to frequent visit to DOTS centers and total duration of DOTS
program. So there is an urgent need to address these issues by concerned authority to
improve quality service by proper counseling program.

5.3 Implication for nursing research

The study will be valuable for the further research. The finding of the study would
help to expand the scientific body of professional knowledge up on which further
research can be conducted.

5.4 Limitations of the study

The total number of 60 samples was taken in study in regional TB center
Pokhara .The duration for data collection was within 2 weeks. So, it cannot be
generalized to other setting.

25
5.5 Recommendations for the study
From the findings of the study, the following recommendations are made for the
further research:

Similar study can be conducted on other setting. The small scale study was carried out
with a minimum number of respondents therefore it is recommended for further study
in large study.

26
 References
x

1. American Lung Association. [Online].; 2020. Available from: www.lung.org.

2. Global Tuberculosis Report. Annual report. Geneva: World Health Organization;

2019. Report No.: ISBN 978-92-4-156571-4.

3. Park K. Park's textbook of preventive and social medicine. 19th ed. Banarsidas,
India: Bhanot ; 2007.

4. World Health Organization. A Guide to Understanding the WHO-recommended

TB Control Strategy Known as DOTS. What is DOTs. 1999.

5. Getahun B, Nkosi ZZ. Satisfaction of patients with directly observed treatment

strategy in Addis Ababa, Ethiopia. ResearchGate. 2017.

6. Chimbindi N, Bärnighausen T, Newe ML. Patient satisfaction with HIV and TB

treatment in a public programme in rural KwaZulu-Natal. BMC Healt hService
Research. 2014.

7. Mohamed EY, Ounsa M, Almansour MA, Alzahrani M, Abdalla S, Medani K, et

al. Patients’ Satisfaction With Tuberculosis Services of Directly Observed
Therapy Programs in the Gezira State of Sudan. ResearchGate. 2014 June; 9(4).

8. Srivastav S, Mahajan H. Satisfaction levels among patients availing DOTS

services in Bundelkhand Region (UP), India. Annals of Tropical Medicine and
Public Health. 2014; 7(2).

9. World Health Organization. [Online].; 2020 [cited 2020 March 24. Available
from: https://www.who.int/news-room/fact-sheets/detail/tuberculosis.

10. Rai N, Singh SP, Kushwah SS, Dubey D. A cross sectional study on evaluation of
satisfaction level of TB patients enrolled for directly observed treatment, short
course chemotherapy in a district of Central India. International Journal of
Community Medicine and Public Health. 2016 November; 4(1).

1
11. herd. [Online].; 2011 [cited 2020 may 14. Available from: www.herd.org.np.

12. Nezenega ZS, Gacho YH, Tafere TE. Patient satisfaction on tuberculosis
treatment service and adherence to treatment in public health facilities of Sidama
zone, South Ethiopia. BMC Health services Research. 2013; 13(110).

13. Onyeonoro UU, Chukwu JN, Nwafor CC, Meka AO, Omotowo BI, Madichie
NO, et al. Evaluation of Patient Satisfaction with Tuberculosis Services in
Southern Nigeria. Libertas Academica. 2015 July.

14. Ssengooba W, Kirenga B, Muwonge C, Kyaligonza S, Kasozi S, Mugabe F, et al.

Patient satisfaction with TB care clinical consultations in Kampala: a cross
sectional study. Afri Health Sci. 2016; 16(4).

15. Srivastava K, Gupta A, Saxena R, Sharma RP, Midha T. Patient’s satisfaction

regarding directly observed treatment short course. International Journal of
Community Medicine and Public Health. 2017 May; 4(5).

16. Ali SM, Anjum N, Farah , Rashid A, Tahir A, Ishaq M, et al. Satisfaction Level
of Tuberculosis Patients Regarding Their Access to TB Care and Prevention
Services, Delivered Through a Public–Private Mix Model in Pakistan. Healthcare.
2019 september.

17. Babikako HM, Neuhauser D, Katamba A, Mupere E. Patient satisfaction,

feasibility and reliability of satisfaction questionnaire among patients with
pulmonary tuberculosis in urban Uganda: a cross-sectional study. Health research
policy and system. 2011; 9(6).

2
 APPENDIX A
Charak Academy
Affiliated to Purbanchal university
Pokhara -11, Kamalpokhari
Informed consent for data collection

Namaskar, I am Anita Sharma currently enrolled as a student of post basic Bachelor

of Nursing in Charak Academy pvt ltd. Pokhara . The research is going to be
conducted on topic “Satisfaction towards Health Care Services among Tuberculosis
Patients in regional TB center Pokhara .”. Although the study will not benefit you
directly, it will help you to make policy for patient’s satisfaction.

In the research you are requested to respond on questions, it will take 15-20 minutes. I
would like to assure you that information will be kept confidential, used for research
purpose only and your identity will not be disclosed. You have full right to withdraw
at any time if you wish. I hopes you will participate in this study by providing your
valuable response to the questions.

Name of the Researcher: Name of Respondent:

Signature: Signature:
Date: Date:

i
 APPENDIX B
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;lx M ;lx M
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ii
iii
 APPENDIX C
RESEARCH INSTRUMENTS
(Strecture Questionnaire)
Direction: During interview part I is related to socio demographic information, part II
is related to clinical characteristics and part III is related to satisfaction towards health
care services among tuberculosis patient. A researcher tick in the option for the
appropriate answer provided to the close ended question according to respondent
viewpoint and completes the answer with space provided to the open ended question
according to respondent viewpoint.

Part I
Socio Demographic Information

1. Age ………………….
2. Sex
a. Male ( ) Female ( )
3. educational status
a. Literate ( )
b. Illiterate ( )

4. If literate, your educational level

a. General literate
b. Basic education
c. Secondary level
d. Higher secondary level
e. Bachelor and above

5. occupation
a. Laborer (Daily wage)
b. Service Holder
c. Businessmen
d. Farmer
e. Others (Please specify)………………..

iv
6. religion
a. Hinduism
b. Christianity
c. Buddhism
d. Islam
e. Others (Please specify)………………….

7. marital status
a. Single
b. Married
c. Divorced
d. Widow/ Widower

8. Address:
a. Rural
b. Urban
9. Distance between DOTS clinic and your house (in kilometers)
…………………………………………………………………

v
 Part II
Questions related to clinical characterstics

1. Which type of tuberculosis you suffer from?

a.Pulmonary tuberculosis
b. Extra pulmonary tuberculosis

2. Which is the phase of your tuberculosis?

a.Initial
b. Continuous

3. Which is the category of your treatment?

a. Category I(new smear positive)
b. Category II(smear positive who have relapsed)
c. Category III(new smear negative)
d. Category IV(Chronic, still sputum positive after re- treatment)

vi
 Part III:
Questions related to patients satisfaction regarding different parameter
Those patient who answered satisfied for each of the satisfaction related question
were taken as fully satisfied while those who were satisfied with the least one
parameter were categorized as somewhat satisfied while totally unsatisfied patients
were those patient who were not satisfied with all parameter of assessment.

S.N. Questions Satisfied Not Satisfied

1. Location of DOTS centre
2. Timing of DOTS centre
3. Waiting time for medical care
4. Behavior of staff at DOTS centre
5. Pre-treatment counseling by health staff
6. Satisfied with total duration of treatment
7. Improvement in condition after initiation of
DOTS
8. Do you think that DOTS will care you
9. Frequent visit to DOTS

vii
 APPENDIX D
Research instrument (Nepali)

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viii
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xi
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xii
 APPENDIX E
WORK PLAN

Year 2077

Month Jestha Mangsir Magh Falgun Chaitra

S. N Week 1st 2nd 3rd 4th 5th 6th 7th 8th

Activities

1. Literature
review

2. Topic selection

3 Proposal
writing &
Presentation

4 Development
of research
Instrument

5 Data collection

6 Data Analysis

7 Report writing

8 Report
Presentation

9 Final Report
Submission

xiii
 APPENDIX F

BUDGET EXPENDITURE

S.N Items Amounts

1. Printings 5000/-

2 Photocopies 2500/-

3 Internet Services 2000/-

4 Stationaries 1000/-

5 Black book Printing 2000/-

6 Other ( Phone calls, Travelling 1000/-

expenses)

Total 13,500

APPENDIX G
Administrative Letter

xiv
xv