This is a qualitative study in the form of phenomenology. Qualitative studies are conducted to understand human behaviors (7). Qualitative findings provide objective and subjective data from interviewees. Donagha (1984) believed that gathering subjective information is a difficult task, which can be performed by interviewing (8). In qualitative studies, theory evolution from specific to general is possible and these investigations often provide explanations based on present realities for different events (9). Phenomenological approach uses dialogues and interviews to form ideas from experiences of individuals. Individuals’ experiences about a specific subject lead to a deep understanding of concepts from participants’ perspectives. Additionally, in this method, people’s ideas as the background of real experience are revealed (10, 11).
In this research, the population under study was those clients referring to urban health centers affiliated to Shaheed Beheshti University of Medical Sciences and Health Services. 233 subjects were selected by purposive sampling method from 21 urban health centers (affiliated to Shemiranat, North, and East centers) of the university. The subjects were selected by considering the aims of the study, geographic distribution of the centers, socioeconomic status of the residents, and the variety of services provided.
Semi-structured face-to-face interviews were used to collect data. Questions were divided into two parts. In the first part, demographic information (age, sex, education, occupation, number of children, number and reason of visits…) was collected and in the second part, specific questions regarding the aims of the study were asked. Before interviewing, the researchers visited the subjects to explain the aims and process of the study and to appoint a date for the interview. Interviews were tape-recorded with the permission of subjects and, in case of their disapproval, they were either questioned orally to write their replies or excluded from the study.
To analyze the collected data, Collaizi method was used as follows:
The recorded interviews were then analyzed at the appropriate time as soon as possible by frequent listening to the contents for complete understanding. The whole content were then transcribed verbatim and loaded in the computer. Considering different methods for data analysis in qualitative studies, the researchers used Word Perfect software to encode the collected data. Accordingly, all significant statements resulted from interview analysis were typed in a special form and categorized into cluster of themes. Certain and appropriate letters were then designated for the clusters and the resulted outcomes were discussed.
Demographic findings include age, sex, educational level, occupation, number of children, frequency and reason of visits in the subjects (Tables 1, 2: at bottom of page).
In analyzing qualitative findings related to the aims of the study, relevant factors such as 1- physical condition of the centers (waiting salon; appearance of building, rooms, …); 2- personnel communication (responsibility and responsiveness of staff from entrance of clients to the centers until their departure); and 3- the quality of health services (vaccination, family planning, maternity and child health, health education) and treatment services (medical procedures, dentistry, pharmacy, injection and dressing) were assessed.
In the first, second, and third part of the analysis, urban health centers affiliated to Shemiranat, North, and East centers were evaluated respectively. General opinions of clients referring to health centers affiliated to urban health center of Shemiranat were: 1- improving the quantity and quality of dentistry services; 2- increasing the speed of service delivery and decreasing waiting time in some centers; 3- increasing the types of drugs needed for clients in pharmacies of the centers; 4- increasing working hours and making the activity of some centers around the clock; 5- having medical laboratory and some specialties such a gynecology in the centers.
Similarly, the views of clients referring to health centers affiliated to urban health center of North included: 1- improving the quantity and quality of dentistry services; 2- increasing the speed of service delivery and decreasing waiting time in some centers; 3- increasing the types of drugs needed for clients in pharmacies of the centers; 4- adding some specialties (e.g. gynecology and pediatrics) and making the working hours of some centers around the clock; 5- improving communication skills of personnel with clients; 6- improving physical condition of some centers; 7- delivering better laboratory services in all centers.
The opinions of clients referring to health centers affiliated to urban health center of East were: 1- decreasing wastage of time due to service delivery delay; 2- increasing the number of personnel in some centers to speed up service delivery; 3- improving physical environment in some centers; 4- improving advertising activities to introduce health services of the centers to society; 5- improving communication skills of personnel with clients; 6- improving the quantity and quality of dentistry, pharmacy, and midwifery services; 7- supervising personnel activities by supervisors more than before.
Findings showed that the majority (%24.03) of clients were between 30 – 35. In Shabravy’s study (1992) about clients’ satisfaction with the health services in 140 health centers in Riyadh city, the majority (%30.2) of clients were between 30 – 40 and female (%94.42) with high school diploma (%29.18) (12). In another study, it was also shown that most clients (%84.6) were female with high school diploma (%34.4) (13). These findings are similar to those of our study.
Results also showed that the majority (%80.68) of subjects were housewives, which is similar to findings of the other study in which %45.3 were housewives (12). Most subjects (%25.32) in the study had only one child. This may be attributed to the effects of family planning programs in health centers or mass media. %31.33 of the clients had no medical insurance while, in a similar study, only %19.6 had no insurance (13). This may be due to low income of most clients in our study. The majority (%56.82) of subjects used the services of the centers from 1 to 3 years, which is somehow similar to findings of the mentioned study in which most clients (%87.7) had a history of previous visits (13). However, the duration of visits has not been identified in any corresponding study.
The results also showed that most clients (%23.43) came to the centers due to vaccination of their children while, in the corresponding study, the majority (%32.80) came to visit a physician (13). Concerning clients’ satisfaction with physical environment, findings, generally, indicated that most of them were collectively satisfied while having some critiques about it since they spent relatively short time in the centers and this factor was not so important for them, but they wanted a better appearance for these places.
With respect to clients’ satisfaction with personnel communication during their presence in the centers, most of them were satisfied and only complained about some insulting behaviors in this regard. They ignore these insulting and rude behaviors because of low-cost and free services delivered and the availability of centers. In the previously-mentioned study and without stating the behaviors in detail, supporting findings showed that %77.8, %80.6, %61.1, %83.3, %86.1, and %75 of clients were satisfied with the behaviors of admission; pharmacy; injection and dressing; vaccination; maternity and child health as well as family planning; and dentistry personnel respectively (13). In a study about communication in health, Johnson (1999) noted that research in this field has been in low priority and studies have only focused on problems. Since there are differences between healthcare workers and clients in social class, experience and knowledge, communication models should be devised for each society (14).
Concerning the delivery of different health services, the relative majority of subjects were generally satisfied while having some suggestions and critiques about it. With respect to the contents of interviews and analysis of the statements, it seems that one of the important reasons for clients’ satisfaction is the lack of knowledge regarding the rights of patients as health consumers and the other one despite enough explanation concerning confidentiality and anonymity and isolation of interview location may be a sense of uncertainty and insecurity to express the true feelings.