Patients' perceptions of hospital care and quality policy development for health care in developing countries : a case study from Yemen

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Daily routine versus on-demand chest radiograph policy and practice in adult ICU patients- clinicians’ perspective

Abstract Background Chest radiographs are taken daily as a part of routine investigations in Intensive care unit (ICU) patients. They are less effective and unlikely to alter the management of the majority of these patients compared to the radiographs obtained when indicated. According to the American College of Radiology (ACR) Appropriateness criteria, only selective ordering of chest radiographs is recommended, including elderly or high risk patients. The aim of this study was to identify and assess the clinician’s perspective in abandoning the current practice of daily routine chest radiograph and replacing with the on-demand radiograph in Saudi hospitals. Methods This was a cross-sectional study. A valid self-administered questionnaire was distributed to all clinical staff members working in ICUs in the major tertiary hospitals in Saudi Arabia. The study population was primarily the ICU intensivists (physicians), nurses and respiratory therapists (RT). The data collected were statistically processed using SPSS version 20.0; descriptive and inferential analyses were done. Results Out of 730 questionnaires sent, we received only 495 completed questionnaires with a response rate of 67.8%. Majority of them (n = 351) are working at academic hospitals. About half of the respondents (n = 247) are working in an open-format ICUs. Findings showed that the daily routine chest X-ray was performed in almost 96.8% of ICUs patients, which the majority of the clinical staff members (73%) thought that this current daily routine CXR protocol in the ICUs should be replaced with the on-demand CXR policy. Interestingly, the differences in demographic and work-related characteristics had no significant impact on the clinician’s view and supported moving to on-demand CXR policy and practice. Conclusions The daily routine CXR is still a common practice in most of the Saudi hospitals ICUs although enough empirical evidence shows that it can be avoided. We observed that intensivists support the change of the current practice and recommend an on-demand CXR policy likely to be followed in intensive care management

Female dental students’ perceptions of patient safety culture: a cross sectional study at a middle eastern setting

Abstract Background Patient safety is an integral part of all health care specialties, including dentistry. Dental students are exposed to patient safety culture during their clinical training. The aim of this study was to evaluate the perception of female students enrolled in dental degrees and dental hygiene programs towards patient safety culture and to determine its associated factors at a Middle Eastern setting. Methods This is a cross sectional study, based on a self-administered, English language questionnaire distributed by convenience among female dental students enrolled in two major Colleges of dentistry in Riyadh, Saudi Arabia. Participants had fulfilled at least one year of clinical training. Sample characteristics included the specialty and years of clinical training. Student’s perception was measured using the validated Safety Attitude Questionnaire (SAQ) that consists of 36 statements, distributed over six domains. Responses were rated on a five point Likert scale and the average positive response rate (APRR) was calculated. Binary logistic regression models were constructed to determine factors significantly associated with positive perceptions. Results The response rate of both student programs was 221/312(70.8%). Students of dental sciences and dental hygiene programs were 133(60.2%) and 88(39.8%) respectively. Almost 42% of students were in their 1st and 2nd years of clinical training. The APRR of: Team Work Climate domain was 54.4 ± 28.0, Safety Climate domain was 51.4 ± 29.7, Job Satisfaction domain was 64.5 ± 33.8, Stress Recognition domain was 56.2 ± 37.8, Perceived Management Support domain was 50.7 ± 37.7, and Working conditions was 55.3 ± 32.1. Female students in their 3rd and 4th year of clinical were adj.OR = 2.3[1.3–4.0] times more likely to have positive perception regarding the team work climate domain when compared to 1st and 2nd year clinical students, P = 0.005. At each of the six individual domains, the odds of having a positive perception were also significantly higher among dentistry students in comparison to dental hygiene students with a range of adj.OR 2.6–4.6. Conclusions Apparently patient safety is a concern among female dental students enrolled in dental degree and dental hygiene programs. This requires more attention from the staff, dental college's leadership/management, and faculty/students. Perception of dental students towards patient safety culture is expected to improve with the increase of clinical training

Additional file1: of Daily routine versus on-demand chest radiograph policy and practice in adult ICU patients- clinicians’ perspective

Questionnaire used in the study. Part one: Demographic Characteristics. Part two: Questions regarding chest radiography. (PDF 270 kb

Psychometric Evaluation of the Arabic Version of the Person-Centered Climate Questionnaire: Patient Version (PCQ-P)

Background: Adopting a person-centered care approach has transformed different healthcare settings worldwide. However, this concept has gained little attention in many Middle Eastern countries, including Saudi Arabia and other Arab countries. This study aimed to evaluate the psychometric characteristics of the Arabic person-centered climate questionnaire—patient version, measuring to what extent the climate of health care settings is perceived as being person-centered. Method: This is a psychometric analysis study. The original validated version of the English Person-Centered Climate Questionnaire—Patient version (PCQ-P) was translated into Arabic and tested among a sample of hospital patients (n = 300) in Saudi Arabia using translation and back translation procedures. For psychometric evaluation, statistical analyses of validity and reliability were used, including exploratory factor analysis as well as conformity analysis. Results: The Arabic version of the person-centered climate questionnaire—patient version—showed good reliability as the Cronbach’s alpha value of the total of 17 items was 0.84, and the Cronbach’s alpha values of the three sub-scales (safety, everydayness, and hospitality) were 0.83, 0.56, and 0.68, respectively. Internal consistency results were high in terms cof orrelation coefficient for all 17 items. The exploratory factor analysis identified the three factors (safety, everydayness, and hospitality) responsible for 47.174% of the total variance. Conclusion: The Arabic version of the PCQ-P showed satisfactory reliability and validity for measuring patients’ perceptions of person-centeredness in Arab healthcare settings. This Arabic version will be accessible to those interested in generating and using empirical evidence to promote a patient-centered care approach in Arab healthcare settings. The results of this study can be used as a starting point for assessing and developing a person-centered care culture in Saudi hospitals and other Arab countries in the Middle East

Validation and adaptation of the hospital consumer assessment of healthcare providers and systems in Arabic context: Evidence from Saudi Arabia

One of the main purposes of healthcare organizations is to serve patients by providing safe and high-quality patient-centered care. Patients are considered the most appropriate source to assess the quality level of healthcare services. The objectives of this paper were to describe the translation and adaptation process of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for Arabic speaking populations, examine the degree of equivalence between the original English version and the Arabic translated version, and estimate and report the validity and reliability of the translated Arabic HCAHPS version.The translation process had four main steps: (1) qualified bilingual translators translated the HCAHPS from English to Arabic; (2) the Arabic version was translated back to English and reviewed by experts to ensure content accuracy (content equivalence); (3) both Arabic and English versions were verified for accuracy and validity of the translation, checking for the similarities and differences (semantic equivalence); (4) finally, two independent bilinguals reviewed and made the final revision of both the Arabic and English versions separately and agreed on one final version that is similar and equivalent to the original English version in terms of content and meaning.The study findings showed that the overall Cronbach’s α for the Arabic HCAHPS version was 0.90, showing good internal consistency across the 9 separate domains, which ranged from 0.70 to 0.97 Cronbach’s α. The correlation coefficient between each statement for each separate domain revealed a highly positive significant correlation ranging from 0.72 to 0.89.The results of the study show empirical evidence of validity and reliability of HCAHPS in its Arabic version. Moreover, the Arabic version of HCAHPS in our study presented good internal consistency and it is highly recommended to be replicated and applied in the context of other Arab countries. Keywords: HCAHPS psychometrics, Reliability, Validity, Patient experience, Arabic language, Saudi Arabi

Person-centered-care climate in a tertiary hospital: Staff perspective

Introduction: Most health care systems strive to improve the quality, safety and value of healthcare, with an emphasis on moving towards patient-centered care/person-centered care (PCC) approach. The aim of the current study was to assess health care providers’ perspectives on PCC climate in hospital setting and to identify the role of providers in determining the perception of the PCC climate. Methods: A survey, using person-centered climate questionnaire-staff version, was employed in health care providers of a tertiary care hospital. Data included variables age, gender, education level, occupation, and years of experience and three PCC dimensions. PCC overall and subscale scores were reported as mean and standard deviation. Factors associated with PCC climate perception were analyzed using a Poisson model. Results: Out of 1216 respondents; the majority 47% aged between 18 and 34 years; 79% women, 68% were nurses. The overall mean score was 45.96±15.36 (range 0–70). Subscale scores were Safety 20.15±5.0 (range 0–30), Everydayness 12.02±3.52 (range 0–20) and Community 13.79±3.34 (range 0–20). Increasing age was a significant factor associated with PCC scores for the overall, safety, everydayness, and community scales, with a positive association. Lower scores were reported more by women compared with men, for overall (p=0.0005), and everydayness (p=0.006) scales. Higher safety scores were reported by health care providers with a diploma compared to master’s degree (p=0.009), Ph.D. (p=0.007), for technicians compared with nurses (p=0.007), and for day shift compared with day/night shift workers (p=0.025). PCC scores were not significantly different across health care providers’ years of experience. Conclusion: There is a room for PCC climate improvement based on the low scores compared to the literature. The study findings indicated that the main factors associated with HCPs’ perception of PCC were higher age and female gender, and these factors would benefit from further research

Quality of life among home healthcare patients in Saudi Arabia: household-based survey

Abstract Background The need for home healthcare programs is an increasingly becoming important common component of healthcare worldwide, as an alternative to hospitalization, owing to the growing elderly population, chronic and acute diseases that need continuous monitoring and care. The overall aim of this study was to describe and assess the quality of life (QOL) and associated determinants among patients enrolled in the Home Health Care (HHC) program affiliated with the Ministry of National Guard Health Affairs in Riyadh, Saudi Arabia. Methods This cross-sectional study was conducted among patients enrolled at the HHC program. The World Health Organization QOL questionnaire (WHOQOL-BREF) was used to collect data about the different domains of patients’ QOL. Logistic regression models were fitted to determine factors associated with QOL low score. Results The study included 253 patients. Mean age was 67.05 (± 20.0). The overall QOL for HHC patients was significantly affected by both socio-demographic and morbid characteristics. In the final Multivariate logistic regression models, marital status, and having psychological problems, stroke and number illness were independently associated with the overall QOL of HHC patients (p = .022, p = .002, p = .031, .057 respectively). The physical health domain score was significantly associated with education level, having psychological problems and stroke (p = .028, p = .002, p = .007 retrospectively) whereas the psychological domain score was significantly associated with age (p = < 0.001) and three types of chronic diseases: pulmonary (p = .002), psychological problems (p = < 0.001). The social domain score was significantly associated only with the marital status (p = .026). The environmental domain was significantly associated with the education level and having stroke (p = .017 vs .027). Conclusions The overall QOL and its domains are significantly associated with several different factors. Many of these factors can be monitored and enhanced by improving quality of HHC services, thus improving the QOL of patients