ABSTRACT
BACKGROUND: Since 2016, the government of Bangladesh has been piloting a health protection scheme known as Shasthyo Surokhsha Karmasuchi (SSK), which specifically targets households living below the poverty line. This noncontributory scheme provides enrolled households access to inpatient health care services for 78 disease groups. Understanding patients' experiences with health care utilization from the pilot SSK scheme is important for enhancing the quality of health care service delivery during the national-level scale-up of the scheme. OBJECTIVE: We aimed to evaluate patient satisfaction with the health care services provided under the pilot health protection scheme in Bangladesh. METHODS: A cross-sectional survey was conducted with the users of the SSK scheme from August to November 2019. Patients who had spent a minimum of 2 nights at health care facilities were selected for face-to-face exit interviews. During these interviews, we collected information on patients' socioeconomic characteristics, care-seeking experiences, and level of satisfaction with various aspects of health care service delivery. To measure satisfaction, we employed a 5-point Likert scale (very satisfied, 5; satisfied, 4; neither satisfied nor dissatisfied, 3; dissatisfied, 2; very dissatisfied, 1). Descriptive statistics, statistical inferential tests (t-test and 1-way ANOVA), and linear regression analyses were performed. RESULTS: We found that 55.1% (241/438) of users were either very satisfied or satisfied with the health care services of the SSK scheme. The most satisfactory indicators were related to privacy maintained during diagnostic tests (mean 3.91, SD 0.64), physicians' behaviors (mean 3.86, SD 0.77), services provided at the registration booth (mean 3.86, SD 0.62), confidentiality maintained regarding diseases (mean 3.78, SD 0.72), and nurses' behaviors (mean 3.60, SD 0.83). Poor satisfaction was identified in the interaction of patients with providers about illness-related information (mean 2.14, SD 1.40), availability of drinking water (mean 1.46, SD 0.76), cleanliness of toilets (mean 2.85, SD 1.04), and cleanliness of the waiting room (mean 2.92, SD 1.09). Patient satisfaction significantly decreased by 0.20 points for registration times of 16-30 minutes and by 0.32 points for registration times of >30 minutes compared with registration times of ≤15 minutes. Similarly, patient satisfaction significantly decreased with an increase in the waiting time to obtain services. However, the satisfaction of users significantly increased if they received a complete course of medicines and all prescribed diagnostic services. CONCLUSIONS: More than half of the users were satisfied with the services provided under the SSK scheme. However, there is scope for improving user satisfaction. To improve the satisfaction level, the SSK scheme implementation authorities should pay attention to reducing the registration time and waiting time to obtain services and improving the availability of drugs and prescribed diagnostic services. The authorities should also ensure the supply of drinking water and enhance the cleanliness of the facility.
ABSTRACT
BACKGROUND: The world has been grappling with the COVID-19 pandemic, a dire public health crisis, since December 2019. Preventive and control measures have been adopted to reduce the spread of COVID-19. To date, the public's knowledge, attitudes, and practices regarding COVID-19 across Bangladesh have been poorly understood. Therefore, it is important to assess people's knowledge, attitudes, and practices (KAP) toward the disease and suggest appropriate strategies to combat COVID-19 effectively. OBJECTIVE: This study aimed to assess the KAP of Bangladeshi people toward COVID-19 and to identify their determinants. METHODS: We conducted a country-wide cross-sectional telephonic survey from May 7 to 29, 2020. A purposive sampling method was applied, and adult Bangladeshi citizens who have mobile phones were approached to participate in the survey. Interviews were conducted based on verbal consent. Multiple logistic regression analyses and several tests were performed to identify the factors associated with KAP related to COVID-19. RESULTS: A total of 492 of 576 Bangladeshi adults aged 18 years and above completed the interview, with a response rate of 85.4% (492/576). Of the 492 participants, 321 (65.2%) were male, and 304 (61.8%) lived in a rural area. Mean scores for knowledge, attitudes, and practices were 10.56 (SD 2.86), 1.24 (SD 0.83), and 3.17 (SD 1.5), respectively. Among the 492 respondents, 273 (55.5%) had poor knowledge, and 251 (49%) expressed a negative attitude; 192 out of 359 respondents (53.5%) had poor practices toward COVID-19. Mean scores of knowledge, attitudes, and practices differed significantly across various demographic and socioeconomic groups. Rural residents had lower mean scores of knowledge (mean 9.8, SD 3.1, P<.001) and adherence to appropriate practice measures (mean 4, SD 1.4, P<.001) compared to their urban counterparts. Positive and statistically strong correlations between knowledge and attitudes (r=0.21, P<.001), knowledge and practices (r=0.45, P<.001), and attitudes and practices (r=0.27, P<.001) were observed. Television (53.7%) was identified as the major source of knowledge regarding COVID-19. Almost three-quarters of the respondents (359/492, 73%) went outside the home during the lockdown period. Furthermore, the study found that good knowledge (odds ratio [OR] 3.13, 95% CI 2.03-4.83, and adjusted OR 2.33, 95% CI 1.16-4.68) and a positive attitude (OR 2.43, 95% CI 1.59-3.72, and adjusted OR 3.87, 95% CI 1.95-7.68) are significantly associated with better practice of COVID-19 health measures. CONCLUSIONS: Evidence-informed and context-specific risk communication and community engagement, and a social and behavior change communication strategy against COVID-19 should be developed in Bangladesh based on the findings of this study, targeting different socioeconomic groups.
