World Rural Health Conference
Home Print this page Email this page Small font size Default font size Increase font size
Users Online: 6890
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents 
ORIGINAL ARTICLE
Year : 2019  |  Volume : 8  |  Issue : 10  |  Page : 3282-3286  

Public's perception and satisfaction on the role and services provided by family physicians in Saudi Arabia: A cross-sectional study


College of Medicine, Jazan University, Jazan, Saudi Arabia

Date of Submission05-Aug-2019
Date of Decision20-Aug-2019
Date of Acceptance19-Sep-2019
Date of Web Publication31-Oct-2019

Correspondence Address:
Dr. Amnah Ali Abdulqader Elagi
College of Medicine, Jazan University, Jazan
Saudi Arabia
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_621_19

Rights and Permissions
  Abstract 


Background: Few studies have addressed the awareness of the family physicians' (FPs) role and its impact on the quality of primary healthcare. This study aims to explore public's perception and satisfaction on the role and services provided by FPs in the Kingdom of Saudi Arabia (KSA). Materials and Methods: An online survey was conducted using a convenience sample of 830 participants age 18 years and above from Jazan region, KSA. Statistical analysis was done using SPSS including descriptive studies and Chi-square or Fisher's exact test. Results: A total of 830 valid responses were analyzed, of which 55.1% were females. The median age of respondents was 32.5 years (range 18–75 years). Most of the respondents (90.2%) did not have a regular FP. A considerable proportion of the participants were aware of the principles (81.2%) and essential role of family medicine (73.3%), health conditions that FPs can treat (59.9%), and conditions they do not treat (n = 622, 74.9%). The majority agreed on the value of involving FPs in their care (76.7%), the priority of FPs in the action of health-seeking (58.9%), and the sufficiency of FPs' expertise (55.5%). However, only 28.3% had a positive experience with FPs. In addition, 59.8% preferred to first seek healthcare from specialists from other specialties. Conclusion: In general, participants in this study had good perception of the role of FPs as important components in the healthcare system. However, there may be some gaps in the physician–patient communication which may contribute to the dissatisfaction reported by most of the present sample.

Keywords: Family medicine, family physicians, perception, satisfaction, Saudi Arabia


How to cite this article:
Elagi AA, Jaber BA, Wassly AH, Ahmed RM, Bosily FA. Public's perception and satisfaction on the role and services provided by family physicians in Saudi Arabia: A cross-sectional study. J Family Med Prim Care 2019;8:3282-6

How to cite this URL:
Elagi AA, Jaber BA, Wassly AH, Ahmed RM, Bosily FA. Public's perception and satisfaction on the role and services provided by family physicians in Saudi Arabia: A cross-sectional study. J Family Med Prim Care [serial online] 2019 [cited 2019 Nov 19];8:3282-6. Available from: http://www.jfmpc.com/text.asp?2019/8/10/3282/270002




  Introduction Top


Being one of the most important specialties in medicine, family medicine is focused on the overall healthcare of all individuals irrespective of their age, sex, and affected organ or system entity.[1],[2] Family physicians (FPs) incorporate knowledge from clinical, biological, and behavioral sciences and stand on important principles, namely, comprehensiveness, continuity of care, coordination, and accessibility.[3] At present, there are 2282 primary healthcare centers (PHCCs) in the Kingdom of Saudi Arabia (KSA), with 60% of them being located in the rural areas. FPs comprise around 10% of all physicians in PHCCs in KSA.[1]

FPs are critical to the healthcare system, whose foremost role is to deliver health services in treatment, prevention, rehabilitation, family planning, and education;[4],[5] therefore, public awareness of the role of FPs is vital for proper healthcare as it plays an important role in health-seeking behavior.[4] Studies have found that patients frequently skip PHCCs and unnecessarily seek healthcare in specialized medical centers and tertiary hospitals; therefore, studies addressing patients' awareness of the role of FPs are needed.

Several studies have evaluated the relationship between patients' awareness and utilization of PHCCs services and have shown a positive association.[6],[7],[8] One study examined factors affecting patients' utilization of PHCCs in KSA and showed that patients' education level and awareness of care quality were important factors in determining the extent of primary healthcare utilization.[9]

Mutual respect, trust, and confidentiality are the crucial aspects of the doctor–patient relationship which plays an important role in improving healthcare outcomes.[10],[11],[12] Several studies have confirmed that patients' awareness of the role of their physicians influences their adherence and health outcomes, particularly when they have chronic and stigmatizing conditions such as diabetes mellitus, hypertension, cancer, and mental health problems.[12],[13],[14],[15],[16]

Generally, acceptance of involvement of FPs has been reported to be high among patients attending to PHCCs. Chronically ill patients, in particular, were found to appreciate the continuity of care and the feeling of safety in the presence of a regular physician.[17],[18],[19]

Acceptance and satisfaction with FPs have also been found to be associated with patients' trust and desire for meaningful communication.[20],[21],[22],[23],[24],[25] Several studies have found some gaps in the perception of FPs' roles and responsibilities among patients and their families.[26],[27] This lack of knowledge may be explained, in part, by patients' level of awareness of their physicians' role and poor communication skills from the treating doctor side.[26]

Few studies have addressed awareness of the FPs' role and its impact on the quality of primary healthcare. This study aims to explore public's perception and satisfaction on the role and services provided by the FPs in KSA. Our findings may shed light on the gaps in perception of the role of FPs among the general Saudi population, which is central to decision-making and policies to ensuring satisfaction with the healthcare system.


  Materials and Methods Top


This is an observational cross-sectional survey using an online questionnaire to explore public's perception and satisfaction on the role and services provided by FPs. The inclusion criteria were being a male or female, age 18 years or above, and residing in Jazan region, KSA for at least 6 months. Those who failed to meet the inclusion criteria were excluded from the study.

The questionnaire consisted of four main parts covering demographic information (part 1); participants' perception of the role of FPs, concerns regarding FPs' involvement in their care, and whether they would choose to have FPs involved in their healthcare (part 2); participants' experiences with their FPs using a series of Likert-scale-based responses (part 3); the overall satisfaction with healthcare provided by FPs in the PHCCs and other health facilities. The questionnaire was adopted and modified from a previous study[18] to meet the goals of this study. Given that Arabic is the mother language in the region, we found it necessary to translate the survey items from English to simple Arabic using back-translation.

A sample of 830 participants took part in our survey during the period from 1 February, 2019, to 1 June, 2019. The sample technique is considered convenience as only complete responses within this predesigned period were accepted.

After explaining the study goals, all participants were asked for their willingness to take part in the survey. The names and contact details were not included in the survey. Access to the online questionnaire was only allowed once to eliminate duplicate responses.

Prior to statistical analysis, data mining was done to check for the completeness of responses and coding errors. The categorical variables were presented as frequencies and percentages. The continuous variables were presented as means and standard deviations. Chi-square or Fisher' exact test was used for comparison between two categorical variables. Differences were considered significant if P > 0.05. Data were analyzed using Statistical Package of Social Sciences (SPSS) Version 20 (SPSS Inc., Chicago, IL, USA).


  Results Top


A total of 830 participants agreed to take part in this study. The median age of respondents was 32.5 years (range 18–75 years); 457 (55.1%) of the sample were females. Most of participants (n = 749, 90.2%) did not have a regular FP. The sociodemographic details are summarized in [Table 1].
Table 1: Sociodemographic characteristics of study participants (n=830)

Click here to view


[Table 2] describes participants' perception of the role and involvement of FPs in their healthcare. Of respondents, 467 (56.3%) were aware of the FPs' role and 559 (67.3%) believed that FPs have an important role in the health system. Overall, most of respondents were aware of the principles (n = 674, 81.2%) and essential role of family medicine (n = 612, 73.3%), health conditions that the FPs can treat (n = 497, 59.9%) and conditions they do not treat (n = 622, 74.9%).
Table 2: Participants' knowledge about the role of FPs (n=830)

Click here to view


[Table 3] describes participants' perceptions and experiences of having an FP involved in their healthcare. Regarding perceptions, 637 (76.7%) agreed on the value of having FPs involved in their care, the priority of the FPs in the action of health-seeking (n = 489, 58.9%), and the sufficiency of the FPs' expertise (n = 461, 55.5%). However, a significant proportion of participants (n = 496, 59.8) reported that they usually prefer to first see a specialist or consultant from specialties other than family medicine.
Table 3: Participants' perceptions and experiences of having an FP involved in their healthcare (n=830)

Click here to view


Regarding participants' experiences and satisfaction with FP, 431 (51.9%) agreed that FPs are professional, attentive to their health concerns (419, 50.5%) and take a complete medical history (499, 60.1%) and physical examination (351, 42.3%). Also, 517 (62.3%) thought they could discuss all health issues with an FP.

Although 317 (38.2%) of participants were generally satisfied with having an FP involved in their care, only 235 (28.3%) had a positive experience with FPs. Nearly a quarter (n = 204, 24.6%) of participants complained of long visits and long waiting time (n = 195, 23.5%) in family medicine clinics. Overall, these results suggest that participants in our study have good perceptions of having FPs though a considerable proportion were less satisfied due, in part, to the factors attributed to the provided care.

[Table 4] shows that having a regular FP was significantly associated with advanced age (>0.000). The difference was not significant with regard to sex (P = 0.09).
Table 4: Sex and age of participants who had and did not have a regular FP (n=830)

Click here to view



  Discussion Top


The main objective of this study was to explore public's perception and satisfaction on the role and services provided by the FPs in Jazan region, KSA. Although 43.7% thought they were not, the analysis showed that most respondents were aware of the role of FPs. Overall, most of our respondents reported positive attitudes toward the significance of FPs in the healthcare system and agreed on the basic role of family medicine and the FPs' scope of practice. These findings are in agreement with what has been shown in previous studies from Ireland,[28] Denmark,[29] and Nairobi.[30] The findings are also consistent with the notion that patients usually tend to initially seek care from a specialist from other specialties.[30]

Most respondents perceived the role of FPs as important. This is evident in that almost 67.3% of the respondents appreciated the role of FPs as the primary care providers. However, there are gaps related to trusting FPs' medical expertise. Mohamoud et al. found that patients in the PHCCs had low confidence in the FPs' ability to manage tuberculosis, human immunodeficiency virus, diabetes, depression, and anxiety. They suggested that these gaps could be addressed by clearly defining the expected care from FPs and modifying patients' expectations and health-seeking behaviors through appropriate communication strategies.[30]

Only 28.3% agreed on the statement “Having an FP involved in my care was a positive experience,” indicating low levels of satisfaction with FPs among the public in this region. This finding is contrary to what has been reported by other studies,[18] which found higher levels of satisfaction with the involvement of FPs in healthcare. Therefore, there is a need to bridge the communication gaps in the physician–patient relationship as a trusting relationship plays a vital role in determining patients' satisfaction with the healthcare system.[20],[21],[22],[23],[24],[25],[31]

We found no significant sex difference in having a regular FP (P = 0.09), but a significant difference was found among different age groups, with older respondents being significantly more likely to have a regular FP (P < 0.000). This confirms the findings of previous studies that found care provided by FPs to be more valued by older patients and those who were chronically ill.[17],[18],[19]

In recent years, the unclear identity and future of family medicine as a discipline is concerning to practitioners, researchers, academicians, and policy makers.[32],[33] This study is the first to explore the public's perception and satisfaction on the role of FPs in Saudi Arabia. It may serve as a paradigm for local research attempting to understand the importance of public perception on family medicine as a medical specialty and its relation to the utilization of primary healthcare provided by family practitioners.

Some limitations of this study are noteworthy. We used a convenience sample based on an electronic survey; therefore, sampling bias is inevitable. Although the questionnaire was adopted from a previous study, it has not yet been validated for use among Arabic-speaking population.


  Conclusion Top


In general, participants in this study had good perception of the role of FPs as important components in the healthcare system. However, there may be some gaps in the physician–patient communication which may contribute to the dissatisfaction reported by most of the present sample. We suggest that these gaps could be addressed by clearly defining the role of FPs and the expected care obtained from family medicine, as well as by designing a healthcare system that encourage primary care utilization and ensuring that care is provided by competent FPs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Al-Khaldi YM, Al-Ghamdi EA, Al-Mogbil TI, Al-Khashan HI. Family medicine practice in Saudi Arabia: The current situation and proposed strategic directions plan. J Family Community Med 202024:156-63.  Back to cited text no. 1
    
2.
Huda SA, Samani ZAA, Qidwai W. Perception about family physicians: Results of a survey of patients visiting specialist clinics for treatment. J Pak Med Assoc 2004;54:589-92.  Back to cited text no. 2
    
3.
Rakel RE. Essential Family Medicine Fundamentals and Case Studies. 3rd ed. Philadelphia, USA: Saunder Publisher; 2006. p. 19-27.  Back to cited text no. 3
    
4.
Liu X, Tan A, Towne Jr SD, Hou Z, Mao Z. Awareness of the role of general practitioners in primary care among outpatient populations: Evidence from a cross-sectional survey of tertiary hospitals in China. BMJ Open 2018;8:e020605.  Back to cited text no. 4
    
5.
Freeman AC, Sweeney K. Why general practitioners do not implement evidence: Qualitative study. BMJ 2001;323:1100-2.  Back to cited text no. 5
    
6.
Burnham G, Hoe C, Hung YW, Ferati A, Dyer A, Hifi TA, et al. Perceptions and utilization of primary health care services in Iraq: Findings from a national household survey. BMC Int Health Hum Rights 2011;11:15.  Back to cited text no. 6
    
7.
Onyeneho NG, Amazigo U V., Njepuome NA, Nwaorgu OC, Okeibunor JC. Perception and utilization of public health services in Southeast Nigeria: Implication for health care in communities with different degrees of urbanization. Int J Equity Health 2016;15:1-11.  Back to cited text no. 7
    
8.
Kim KY, Lim K, Park EW, Choi EY, Cheong YS. Patients' perceived quality of family physicians' primary care with or without “Family Medicine” in the clinic name. Korean J Fam Med 2016;37:303-7.  Back to cited text no. 8
    
9.
Al-Omar BA, Saeed KS. Factors influencing patients' utilization of primary health care providers in saudi arabia. J Family Community Med 1998;5:23-30.  Back to cited text no. 9
    
10.
Matusitz J, Spear J. Effective doctor-patient communication: An updated examination. Soc Work Public Health 2014;29:252-66.  Back to cited text no. 10
    
11.
Kyle S, Shaw D. Doctor-patient communication, patient knowledge and health literacy: How difficult can it all be? Bull R Coll Surg Engl 2014;96:e9-13.  Back to cited text no. 11
    
12.
Michael Petrilli C, Mack M, Janowitz Petrilli J, Hickner A, Saint S, Chopra V. Understanding the role of physician attire on patient perceptions: A systematic review of the literature-Targeting attire to improve likelihood of rapport (TAILOR) investigators. BMJ Open 2015;5:e006578.  Back to cited text no. 12
    
13.
O'Malley AS, Forrest CB, Mandelblatt J. Adherence of low-income women to cancer screening recommendations. J Gen Intern Med 2002;17:144-54.  Back to cited text no. 13
    
14.
Dias-Barbosa C, Balp, Kulich K, Germain N, Rofail D. A literature review to explore the link between treatment satisfaction and adherence, compliance, and persistence. Patient Prefer Adherence 2012;6:39-48.  Back to cited text no. 14
    
15.
Daube H, Billich A, Mann K, Schramm HJ. Cleavage of phosphorylase kinase and calcium-free calmodulin by HIV-1 protease. Biochem Biophys Res Commun 1991;178:892-8.  Back to cited text no. 15
    
16.
Rehman SU, Nietert PJ, Cope DW, Kilpatrick AO. What to wear today? Effect of doctor's attire on the trust and confidence of patients. Am J Med 2005;118:1279-86.  Back to cited text no. 16
    
17.
Bonds DE, Foley KL, Dugan E, Hall MA, Extrom P. An exploration of patients' trust in physicians in training. J Health Care Poor Underserved 2004;15:294-306.  Back to cited text no. 17
    
18.
Malcolm CE, Wong KK, Elwood-Martin R. Patients' perceptions and experiences of family medicine residents in the office. Can Fam Physician 2008;54:570-1, 571.e1-6.  Back to cited text no. 18
    
19.
Jones R. Patients' attitudes to chaperones. J R Coll Gen Pract 1985;35:192-3.  Back to cited text no. 19
    
20.
Hall MA, Zheng B, Dugan E, Camacho F, Kidd KE, Mishra A, et al. Measuring patients' trust in their primary care providers. Med Care Res Rev 2002;59:293-318.  Back to cited text no. 20
    
21.
Baker R. Characteristics of practices, general practitioners and patients related to levels of patients' satisfaction with consultations. Br J Gen Pract 1996;46:601-5.  Back to cited text no. 21
    
22.
Reichgott MJ, Schwartz JS. Acceptance by private patients of resident involvement in their outpatient care. J Med Educ 1983;58:703-9.  Back to cited text no. 22
    
23.
von Bültzingslöwen I, Eliasson G, Sarvimäki A, Mattsson B, Hjortdahl P. Patients' views on interpersonal continuity in primary care: A sense of security based on four core foundations. Fam Pract 2006;23:210-9.  Back to cited text no. 23
    
24.
Baker R, Mainous AG, Gray DP, Love MM. Exploration of the relationship between continuity, trust in regular doctors and patient satisfaction with consultations with family doctors. Scand J Prim Health Care 2003;21:27-32.  Back to cited text no. 24
    
25.
Al-briek A, Al-barrak A, Al-johi K, Al-anazi M. Factors that influence patients in choosing their treating physicians in the private sector in Saudi Arabia. Am J Public Heal Res 2018;6:173-81.  Back to cited text no. 25
    
26.
Santen SA, Rotter TS, Hemphill RR. Patients do not know the level of training of their doctors because doctors do not tell them. J Gen Intern Med 2008;23:607-10.  Back to cited text no. 26
    
27.
Santen SA, Hemphill RR, Prough EE, Perlowski AA. Do patients understand their physician's level of training? a survey of emergency department patients. Acad Med 2004;79:139-43.  Back to cited text no. 27
    
28.
Murphy A. Opening Pandora's box: Patients' attitudes towards trainees. Dublin general practice vocational training scheme third year group 1991-1992. Fam Pract 1995;12:318-23.  Back to cited text no. 28
    
29.
Fuglsang H, Olesgaard P, Pedersen NF, Olesen F. Patients' attitudes towards and satisfaction with interns in general practice. Practicing interns and patient satisfaction. Ugeskr Laeger 1996;158:5768-72.  Back to cited text no. 29
    
30.
Mohamoud G, Mash B, Merali M, Orwa J, Mahoney M. Perceptions regarding the scope of practice of family doctors amongst patients in primary care settings in Nairobi. African J Prim Heal Care Fam Med 2018;10:e1-7.  Back to cited text no. 30
    
31.
Marshall MN. How well do general practitioners and hospital consultants work together? A qualitative study of cooperation and conflict within the medical profession. Br J Gen Pract 1998;48:1379-82.  Back to cited text no. 31
    
32.
Stein HF. Family Medicine's Identity: Being Generalists in a Specialist Culture? Ann Fam Med 2006;4:455-9.  Back to cited text no. 32
    
33.
Raghavendran S, Inbaraj LR. Do family physicians suffer an identity crisis? A perspective of family physicians in Bangalore city. J Fam Med Prim Care 2018;7:1274-8.  Back to cited text no. 33
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

Top
   
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
   Abstract
  Introduction
   Materials and Me...
  Results
  Discussion
  Conclusion
   References
   Article Tables

 Article Access Statistics
    Viewed82    
    Printed3    
    Emailed0    
    PDF Downloaded26    
    Comments [Add]    

Recommend this journal