Development and testing of a 25-item patient satisfaction scale for black South African diabetic outpatients.

Although there is general agreement that patient satisfaction is an integral component of service quality, there is a paucity of South African research on reliable and valid satisfaction measures and the effects of health status on satisfaction. A 25-item patient satisfaction scale was developed and tested for evaluating the quality of health care for black diabetic outpatients. It was hypothesised that: (1) the underlying dimensions of patient satisfaction were interpersonal and organisational; and (2) patients in poor health would be less satisfied with the quality of their care than patients in good health. The questionnaire was administered to 263 black outpatients from Pretoria Academic Hospital and Kalafong Hospital. Factor analysis was conducted on the patient satisfaction scale and three factors, accounting for 71% of the variance, were extracted. The major items on Factor I were helpfulness, communication, support and consideration, representing the interpersonal dimension. Factors II and III were mainly concerned with service logistics and technical expertise, with the emphasis on waiting time, follow-up and thoroughness of examination. The three factors had excellent reliability coefficients, ranging between 0.82 (technical), 0.85 (logistics) and 0.98 (interpersonal). Multiple analyses of co-variance showed that patients in poor general health were significantly less satisfied with the logistical (p = 0.004) and technical (p = 0.007) quality of their care than patients in good health; patients in poor mental health were significantly less satisfied with the interpersonal quality of their care (p = 0.05) than patients in good mental health. These findings provided support for both hypotheses and suggested that patients in poor health attend to different aspects of their care than patients in good health. Of more importance to clinical practice, the results endorsed the need for a multidisciplinary health team comprising nurse/social worker (Factor I: support, communication), health service managers (Factor II: service logistics) and physician (Factor III: technical expertise) to enhance treatment outcome for diabetic patients. It is recommended that: (1) further research is conducted on this patient satisfaction scale with diverse populations in different settings to complement and validate the scale for generalised use in South Africa; (2) the scale is used to collect information on patient satisfaction before and after implementing an intervention to improve the quality of health care, and (3) measurement of health status is an essential adjunct to assessment of patient satisfaction.

Environmental health challenges in South Africa: policy lessons from case studies.

In South Africa, the challenges of economic growth, job creation and effective service delivery are regarded as key to the long-term development of the country. The provision of basic environmental health services is acknowledged as an important factor impacting on the quality of living environments and the health of communities. This paper outlines the environmental health challenges faced by local authorities in the context of national policy, the wider local government development framework and the backlog in the provision of basic services. Using South African examples, the paper concludes with a synopsis of the gaps in policy and delivery drawing on the policy framework of the World Health Organisation, Health for All in the 21st Century. Many of the insights highlighted are likely to parallel the experiences in other developing countries.

Evaluation of the 3-drug combination, Rifater, versus 4-drug therapy in the ambulatory treatment of tuberculosis in Cape Town.

The subjective impression among clinicians that the use of Rifater was causing delayed sputum conversion and increased drug resistance was tested in a prospective study. Adults in the Cape Town municipal area with a first episode of pulmonary tuberculosis were treated either with Rifater or a regimen consisting of isoniazid, rifampicin, pyrazinamide and ethambutol. All patients who took the treatment as prescribed (67 Rifater, 39 the 4-drug regimen) converted to a negative sputum culture by the time 90 doses had been taken. The rates of inadequate compliance and of side-effects were similar in the two groups. Drug sensitivity testing of bacteria cultured from pre-treatment sputum specimens revealed an overall primary resistance rate of 4.84% in the population studied, sufficiently low to preclude any necessity for routine pre-treatment drug sensitivity testing.

An evaluation of an education programme on HIV infection using puppetry and street theatre.

'Puppets Against AIDS' is a novel educational medium being used to try to reduce the spread of HIV infection in South Africa. It involves the use of street theatre employing two-metre-high puppets who act out a story of how one person, who is infected with HIV, passes it onto a series of other people until he eventually dies. The puppet show was evaluated in two phases. The first involved a content analysis of a video recording of the show by a multidisciplinary group, according to a set of criteria for appropriate education on HIV infection. This show was found to be professional and comprehensive in terms of the educational messages provided. Some suggestions were made for improvements. The second phase was a before and after study of the impact on the audience at a series of live shows. The show made a significant contribution to knowledge and intended behaviour in the short term. Overall it was felt that the show does make a valuable contribution, but could be made more effective if incorporated into existing community-based education programmes on HIV infection.

PIP: A program of street theater has been developed in South Africa to disseminate educational messages at the community level on the prevention of HIV infection. Puppets Against AIDS employs 2-meter tall puppets to recount the story of how an HIV-positive person infects others until his eventual death. Aimed at the general community, these entertaining and educational shows include music, and are put on without advance publicity. Sex and death often being sensitive taboo issues, puppets were chosen as safe, non-threatening communicators for culturally diverse populations. The presentation was deemed professional and comprehensive. Suggestions were made for improvement. 2nd-stage evaluation questioned appropriateness and effectiveness at the community level, and consisted of a before and after audience impact study based upon a series of 21 live performances in 9 locales. Improvements and positive changes were measured for respondents' self-perceived knowledge about AIDS, expressed concern about AIDS, perceptions of who can get AIDS, perceptions of who will not get AIDS, knowledge of the healthy carrier state, knowledge of modes of transmission, perceived fatality of AIDS, and knowledge of protective behavior. Moreover, 97% of respondents stated that they had enjoyed the show. Overall, the paper urges further evaluation of the show, and incorporation of it into a multi-sectoral, ongoing campaign to effect maximum impact.