Patient satisfaction and its associated factors in selected primary healthcare facilities in Kono District, Sierra Leone: a cross-sectional study

Objective: To assess patient satisfaction (PS) with services and its associated factors across selected primary care facilities in Kono district, Sierra Leone.

Design: Facility-based cross-sectional study.

Setting: Five primary healthcare facilities (Wellbody, Sewafe, Kombayendeh, Gandorhun and Kayima) located in Kono district, Sierra Leone. All five are Community Health Centres (CHCs), with two CHCs benefiting from a comprehensive package of support (5S model) from the non-governmental organisation, Partners In Health (PIH). This support, dubbed as 5S health systems strengthening (HSS) model, will be elaborated in this article. The other three CHCs were not beneficiaries of the 5S model.

Participants: The study population comprised all patients and caregivers who attended outpatient services at the selected health facilities. We included adult outpatients over 18 years old and adult caregivers accompanying their children while waiting in the various outpatient departments. This study considered a sample size of 290 and the data were collected from 3rd March to 31st March 2021.

Outcomes: PS was measured using an 11-item Likert scale questionnaire. The outcome was categorised as good or poor satisfaction level using the median value. Descriptive statistics were applied to assess satisfaction level and multivariable binary logistic regression analysis was applied to identify factors associated with the outcome variable.

Results: Out of the 290 respondents included for analysis, the overall PS level was 63.8% (95% CI 58.1% to 69.0%). Around 69.2% (95% CI 62.1% to 75.4%) of respondents from PIH intervention sites and 53.9% (95% CI 44.1% to 63.4%) from the non-PIH intervention sites had a good satisfaction level. The multivariable binary logistic regression analysis indicated that PIH intervention site status (adjusted OR (AOR)=2.47, 95% CI 1.28 to 4.78), educational status of respondents (AOR=0.53, 95% CI 0.28 to 0.98), distance to health facility (AOR=0.40, 95% CI 0.18 to 0.87) and waiting time to receive care (AOR=0.41, 95% CI 0.22 to 0.76) were the significant factors associated with PS.

Conclusion: The overall PS was relatively high andPIH-supported health facilities show better PS than non-PIH health facilities. In addition, patients’ educational status, distance to health facility and waiting time were negatively associated with PS level. The findings suggest that PIH’s model of health systems strengthening with targeted investment on the 5S model can be scaled up and the Ministry of Health could consider implementing this approach for improving the quality of services provided at the primary healthcare facilities.