Patient satisfaction with obstetric ultrasonography.

Because of ongoing health sector reform in Nigeria, which emphasizes health care delivery based on a service compact between the government and the governed, there is a need to assess patients' levels of satisfaction with diagnostic tests such as ultrasound examinations. This study investigated patient satisfaction ratings with obstetric ultrasound based on variables that medical ultrasound practitioners can influence, including explanations provided (ie, patient-staff interaction or ultrasound feedback), time from arrival to departure, perceptions of the center itself and patients' comfort while on the scanning couch. We believe that findings from this study could affect sonographers' attitudes and the educational policies and curriculum for their profession.

Literature Review

Several studies have investigated patient satisfaction with obstetric ultrasound examinations. Some of these studies (1-3) investigated variables such as marital status, spousal support, problems with previous pregnancies, previous infertility, anxiety about tests, emotional attachment to the fetus, student involvement in the procedures, gestational age, why the patient came to the hospital and having enough time with health care professionals, among others. Similarly, studies of patient satisfaction with breast screening by mammography have gone beyond investigating pain during the mammogram to consider situational factors such as the perception of privacy at the imaging center, the explanations provided4 and the process from arrival at the center to departure. (5)

Research has shown that couples who have experienced infertility problems have a higher level of anxiety about prenatal diagnostic tests, (6) and their degree of satisfaction with the tests is lower as a consequence] It also has been shown that patient satisfaction with prenatal diagnosis is influenced by factors such as age, marital status, racial background and whether the spouse or other family member was present during the procedure. (1,7,8) Another finding has shown that demonstrating the fetus with ultrasound is related to increased feelings of attachment to the fetus on the mother's part. (2) These feelings likely have significance for the woman's satisfaction with the examination. Finally, Reid made the connection between information factors and patient satisfaction. (7) She stated that 4 types of information should be explained to the patient to lessen anxiety associated with prenatal tests: the purpose of the test, the actual procedure, the risks involved and the implications of the test.

Materials and Methods

A self-completion questionnaire was designed and 25 copies were sent to each of 4 ultrasound centers in Ebonyi State, Nigeria. Questionnaires were used for data collection due to the geographic spread and the resources available.

Questionnaire Design

The questionnaire was designed to elicit both quantitative and qualitative data to gather factual and attitudinal information. It contained 10 questions (both openended and closed-ended), divided into 3 sections. These sections related to:

* Demographic data.

* Rating of factors affecting patient satisfaction.

* Patients' preference for male vs female sonographers.

The length of time from arrival to departure was assessed with a 5-point Likert scale, with 1 indicating very short and 5 indicating extremely long. Patients' perception of the hospital was measured using a 3-point rating scale, with low class scored 1, middle class 2 and high class 3. Scales of 1 to 10 were used to assess patients' perception of privacy, explanations provided (ie, interaction between the sonographer and patient) and the patient's comfort on the scanning couch. A high score indicates a high level of satisfaction with privacy, explanations and comfort. Four questions were used to collect demographic data, including age, occupation, educational qualification and tribe.

Sampling and Data Collection

A convenient and purposive sample of patients who came to the centers for obstetric ultrasound during a 2-month period was approached to participate in the study until all 25 questionnaires allotted to each center were distributed to patients. All of the sonographers who carried out the ultrasound procedures were men with at least 4 years of postbaccalaureate experience who were registered with the Radiographers Registration Board of Nigeria. Ethical clearance and patient consent were obtained.

Patients who underwent transvaginal sonography were excluded from the study. Only patients who had transabdominal ultrasound were included. Patients observed to have multiple pregnancies were excluded from the study because of possible changes in their mood related to learning the results of the scan. It was believed that such changes in mood could affect their satisfaction with the procedure. Unmarried women also were excluded from the study. Only literate women who could fill out the questionnaires correctly were recruited. A period of 2 months was allowed before any data analysis took place.

Pilot Study

The questionnaire was piloted on women who had undergone obstetric ultrasound previously. Ten questionnaires were sent out in the pilot study and 7 (70%) were returned. Minor adjustments were made to the wording of the pilot questionnaire based on comments received.

Data Analysis

Patients were divided into 2 subgroups: those with previous experience of obstetric ultrasound procedures (group 1) and those with no previous experience of obstetric ultrasound procedures (group 2). Statistical analyses were done using SPSS 11.0 software. Descriptive statistics were generated for the measured variables in the 2 groups. Inferential statistics were conducted using 1-way analysis of variance and Pearson correlation analysis (parametric tests). Content analysis of freewill comments made by 5 patients was done and incorporated into the study. Tests were 2 tailed, with a value of P < .05 considered to be statistically significant.

Results

Response Rate

A total of 92 questionnaires (92%) were returned within 2 months. Responses were received from all cohorts. An additional 6 questionnaires were received after 2 months, but these were not included in the data analysis.

Demographic Data

All of the patients were members of the Ibo tribe. Seventy-eight (84.78%) of the patients had lower academic qualifications (ie, secondary school certificate and teachers grade II certificate), and 14 (15.22%) had higher educational qualifications (ie, degree certificates and national certificate in education). Sixty-two patients (67.39%) were involved in business, and 30 (32.61%) of them were students or civil servants. Their ages ranged from 17 to 39 years.

Rating of Factors Affecting Patient Satisfaction

Table 1 shows patient response rates in cohorts. Only Jeomedics Ultrasound Centre did not return all the questionnaires delivered to the center. There were 100% return rates for the other facilities.

Table 2 shows descriptive statistics of patient satisfaction indices in both patients with previous experience of obstetric ultrasound scanning and those who had never had an obstetric ultrasound procedure. The average patient satisfaction ratings were above 50%, which indicates a good satisfaction rating. Mean scores for time from arrival to departure were the lowest scores (less than 50% satisfactory). The scores of 2.6 for the previous experience group and 2.57 for the group with no previous experience translate to 52% long/48% short and 50.8% long/49.2% short, respectively. Thus, on average, patients were satisfied with obstetric ultrasonography.

Table 3 is a crosstabulation showing patients' preferences for the sonographer's sex. The greatest percentage of patients in both groups indicated no special preference, followed by preference for female practitioners and lastly male practitioners.

Table 4 shows Pearson correlation coefficients between patients' age and satisfaction rating indices with their P values for patients with and without previous ultrasound experience. The correlations were insignificant between all the indices except for explanation among patients with previous experience of obstetric ultrasound.

Table 5 is a crosstabulation showing 1-way analysis of variance (ANOVA) in the satisfaction indices between groups 1 and 2. The F-value of 1.69 and the least P value of .197 in the comfort index shows the highest level of variation, although statistically significant, in the comfort rating between the 2 groups. Greater relationship exists in the class perception index (F-value = 0.00; P value = 1).

Although no provision was made in the questionnaire for comments, some patients noted that good information channels, clean toilets, provision of hand-washing basins and waiting room amenities such as televisions and newspapers would increase their satisfaction.

Discussion