Parents’ satisfaction with physiotherapy services for neuropediatric outpatients in government and private hospitals in the United Arab Emirates: a cross-sectional study

Introduction

Many industries worldwide, including healthcare, have increasingly prioritized performance, quality, and user satisfaction while simultaneously attempting to reduce costs. Healthcare providers deliver vital services to vulnerable and critically ill patients, along with essential preventative and health promotion services. Several healthcare organizations worldwide have launched quality improvement initiatives to improve patient satisfaction and prevent negative experiences, but it is becoming increasingly important to implement effective strategies to provide quality care that is also cost-efficient.^1,2

Satisfaction is known as a belief and attitude regarding certain or specific services provision of an institution.^3,4 Patient satisfaction is considered the most important indicator for health service quality assessment.⁵ Parental and patient satisfaction become a well-established outcome indicator for assessing the quality of healthcare system.^4,6 Parental satisfaction is determined by how effectively parents ‘expectations of ideal care are balanced with how they actually feel about real available care.^7,8 According to the numerous studies, poor communication and lack of information are the most serious parent/patient complaint.^9,10 Even when therapists try to explain the patient condition, their terminology is often misunderstood. So, Listening to parents is very important in process of communication.¹¹

Among the most widely used patient satisfaction tool is the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Many organizations use the HCAHPS as a key performance indicator.¹² However this tool is general and nature and is of limited use for specific and specialized services like the physiotherapy service.¹³ Consistent with global trends, the United Arab Emirates (UAE) has prioritized the development of a world-class healthcare system to serve its population. To achieve this, the UAE government introduced new quality criteria and mandated that all healthcare institutions receive accreditation from national and international agencies.¹⁴

Furthermore, healthcare organizations in the UAE consistently undergo evaluation against comprehensive quality outcomes to assess their efficiency and determine funding and reimbursement. For example, the Department of Health in Abu Dhabi uses a healthcare quality index called “Muashir” to measure the performance of healthcare organizations against pre-set key performance indicators. Distinguished facilities receive a rating from one to five domains, which is made public and used to allocate funding to these institutions.¹⁵ This system means that the operation of these healthcare organizations depends on their achievement of quality outcomes, which results in competition among organizations to perform better and attract more funding. This approach is not implemented universally across the UAE, as healthcare services are managed federally through the Ministry of Health and Prevention (MOHAP) or locally by local health authorities. However, many local health authorities have recognized the successful implementation of Muashir and are considering rolling out this approach across their healthcare institutions.

To support physiotherapists to make a maximum contribution to developing healthcare services for their patient population in the UAE, elements of their practice that contribute to patient satisfaction need to be identified. Identifying these elements can form the basis for planning and implementing relevant measures to improve available services. At the clinical level, physiotherapy patients who are satisfied with their treatment tend to interact well with their therapist, remain loyal to them, and seek further treatment when necessary.¹⁶

When initiating treatment, physiotherapists meet with their patients (and patients’ parents/caregivers in pediatric cases) for a consultation to develop an appropriate treatment plan.¹⁷ The fulfilment of this plan should lead to patient satisfaction; however, many systemic, process, and outcome factors could affect the execution of the treatment plan and thereby affect patient satisfaction. This means it is essential to clarify aspects that impact patient satisfaction in these services. Therefore, the present study explored patient satisfaction in the context of rehabilitation healthcare (physiotherapy) services in the UAE, as the principal investigator is a clinician working in pediatric rehabilitation services. This study was conducted to determine parents’/caregivers’ level of satisfaction with the physiotherapy services provided to their children in the physiotherapy departments of private and government hospitals in the UAE.

Methods

Results

Before proceeding with data analysis, the reliability of the study questionnaire was assessed to ensure valid and reliable results. The reliability of the scale used in this study was assessed and returned a Cronbach’s alpha value of 0.7, which is considered acceptable reliability value.

Discussion

Parents' and caregivers' satisfaction with their child’s rehabilitation intervention is necessary for the sustainability of services. Conducting patient satisfaction surveys can help enhance clinical practice, and can also provide relevant data for the marketability of healthcare services and quality of care delivered.^19,21 Patients are considered users of healthcare services, meaning patient satisfaction is an important tool to evaluate the quality of services provided. In this study, the overall level of satisfaction with neuropediatric rehabilitation services was high, but a lower level of satisfaction was observed when specific aspects of care were assessed. This suggested that it is not possible to assess the level of patient satisfaction by simply asking patients if they were happy with the services that they received.

We found no significant differences in parents’/caregivers’ satisfaction by the child’s sex and physiotherapy duration. However, this finding may be because our sample size was insufficient to allow these comparisons. Similarly, a previous study revealed patient satisfaction was not affected by their age, educational status or occupation.²² In contrast, other studies showed that age, sex, ethnicity, education, and occupation were the main predicators of overall patient satisfaction. For example, a study from Nigeria reported that the communication and access/availability/convenience domains were strongly associated with sex; however, there was no sex-based difference in satisfaction with the time spent with doctor, technical quality, interpersonal financial, and general satisfaction domains.²³

However, we found that age was the best predictor of satisfaction in the majority of satisfaction dimensions, whereas the Nigerian study reported patients’ age was not a determinant of their satisfaction with services they received.²³

In the present study, the satisfaction of parents\caregivers differed across various areas examined in the questionnaire. The mean total satisfaction score (63.8%, 159.49/250) showed that the majority of participants had a good level of satisfaction with the physiotherapy treatment that their children received at the government and private hospitals run by Emirates Health Services. A previous study reported the mean overall score for patient satisfaction with physiotherapy care was 68.2%, which was consistent with our results.²⁴ However, other studies reported lower levels of satisfaction for various reasons. A study from Nepal found that patients’ general satisfaction was relatively low (39%), although this was attributed to the unavailability of certain desired facilities.²⁵ Participants in our study were satisfied with the time the therapist spent with their child (80.6%) in each session. This finding was expected because therapists in the participating services typically spend 45–60 min in one treatment session with their patients. Our participants indicated that their satisfaction was increased when the therapist spent a long time with their child and explained the treatment plan.

In contrast to our results, a study from Dubai reported that 40% of parents/caregivers were dissatisfied with the time that their children spent with the therapist. Those authors suggested that this dissatisfaction could be explained by the therapists’ heavy workloads or the patients’ condition not requiring a long time for treatment.²⁶

Another study conducted in Katsina State, Nigeria, found patients reported low satisfaction with the time spent with the doctor because there was a large number of surgeries completed and patients felt they did not receive proper interaction.²³

Previous studies focused on psychological issues related to pediatric practice revealed that parents/caregivers were interested in knowing more about their children’s psychological problems and good communication was a powerful predictor of satisfaction. Good communication during medical visits was reported to significantly influence parents’/caregivers’ satisfaction, functional status, and patient compliance.²⁷ This was consistent with our finding that most (81.4%) participants were satisfied with the therapist because there was good communication between the therapist and parents/caregivers. This was consistent with the results of other studies that found the highest level of satisfaction was reported for the communication domain.²⁸ One study suggested that communication had the highest mean satisfaction score because patients appreciated their therapists’ listening ability.²⁴

The interpersonal and access/availability/convenience domains had the lowest scores in our study (57.6% and 57.7%, respectively). This was consistent with a previous study that also showed these two domains had the lowest mean satisfaction scores.²³ Financial aspects also had a low satisfaction score in our study (59.6%) Some of our participants were not satisfied with the financial domain because they felt that they were not protected from financial hardship. Others noted they were required to pay for services from their own pocket, which could expose them to future financial issues.

We faced some challenges that might have affected this study, particularly parents’/caregivers’ reluctance to complete the questionnaire and the small sample size because of the COVID-19 pandemic (Coronavirus disease of 2019). In addition, the questionnaire was not translated into Arabic, which makes it difficult to generalize the findings and might have contributed to the small sample size. However, a reasonable number of parents/caregivers completed the survey, and our findings may help in identifying reasons for dissatisfaction with neuropediatric rehabilitation services, as well as which domains require improvement and what improvement they may need.

Conclusions

In conclusion, this study sheds light on the crucial aspect of parents' satisfaction with physiotherapy treatment for neuropediatric outpatients in the UAE. The findings underscore the overall positive satisfaction reported by parents and caregivers regarding various aspects of physiotherapy services, particularly in communication, interpersonal factors, and doctor-patient time. However, it is evident that there are areas in need of improvement, notably access/availability/convenience, technical quality, and economic elements. These findings emphasize the importance of continuous assessment and enhancement of healthcare services to meet the evolving needs of patients and their families. Addressing the identified areas of concern is paramount to enhancing patient experiences and ultimately improving clinical outcomes. Therefore, it is imperative for service providers and managers to prioritize these domains in their efforts to optimize the quality of care provided to neuropediatric outpatients and ensure the delivery of patient-centered healthcare in the UAE.