Factors influencing elderly patient perceptions and experiences of clinical service quality in a private and a public radiology facility in the eThekwini District

Abstract

Background: Over the years, South Africa’s ageing population has grown, resulting in vulnerable elderly individuals who require frequent use of healthcare. It is therefore important to ensure that these citizens receive the correct level of health services as they generally need more attention, effort and compassion in ensuring a pleasant healthcare experience. In line with the above, radiology healthcare specifically can be a more intensive process to the elderly individual. Hence it is important to know the elderly patient's clinical service requirements in order to improve their experiences when visiting radiology facilities. With a lack of literature on elderly patient satisfaction with clinical service quality in private and public radiology facilities specific to the Ethekwini district, the current study used the SERVQUAL model's five dimensions (tangibles, reliability, responsiveness, assurance and empathy) as the theoretical framework to quantify the service delivery of private and public radiology facilities, thereby attaining elderly patients’ perceptions and experiences. Aim: This research study aimed to determine the factors influencing elderly patient perceptions and their experiences of clinical service quality in a private and a public radiology facility in the Ethekwini district in order to identify, improve and enhance clinical care for elderly individuals. Methodology: A quantitative research methodology with a descriptive research design and a positivist paradigm was used in this study. A convenience sampling technique of all the elderly patients was used to collect data that was analyzed using the latest version (26) of SPSS (the Statistical Package for the Social Sciences). The tests used were the t-test, one sample t-test, paired sample t-test, independent sample t-test, the Analysis of Variance Model (ANOVA), Cronbach’s alpha and the Mann Whitney U test. Results: An independent sample t-test was performed across demographics and payment types, revealing that the gap for all items under tangibles for expectations and experiences was far greater for outpatients than for inpatient respondents, and those paying cash perceive the gap between their experiences and expectations to be significantly larger than those who use medical aid in private. Paired t-tests and Cronbach's alpha were used to assess each individual question's expectations and experiences across all domains and to determine internal consistency. A paired t-test was then performed on the entire domain, revealing a significant difference in the elderly's expectations and experiences with private and public radiology facilities, as well as their degree of clinical service quality. A one-sample t-test was used to analyze composite variables to determine significant differences in each overall domain, which revealed that the "mean" values were higher for the gap in expectations of elderly people, implying that while the elderly population agrees to some extent with the help/services they receive, their expectations are still higher than their experiences. A Mann-Whitney U test was used to compare each item within each domain across facilities. The mean rank values for these items with significant p-values were greater in private facilities than in public facilities, indicating that private facilities have a better level of agreement. To compare expectations and experiences across domains, the Mann-Whitney test was used for each item, comparing mean rankings rather than mean scores. All but two dimensions vary considerably amongst facilities: EXPECT_TAN (.058) and EXPECT_ASS (.146). The private Radiology facility had a greater agreement than the public Radiology facility. For each domain, the Mann Whitney test was used to compare the mean ranks of private and public facilities. According to the p-value, four significant results were found: GAP_TAN (.044), GAP_REL (.010), GAP_ASS (.013) and GAP_EMP (.006) demonstrated a considerable discrepancy between the public and private facilities. In all categories, individuals who use public facilities perceive a substantially larger difference between what they get and what they anticipate obtaining than those who use private facilities. Conclusion: The conclusion based on the first objective was that while there may be various factors impacting elderly patients’ perceptions of clinical care quality, not all of them can be addressed as some are influenced by personal socio-economic conditions. The second objective result was that while the six domains of healthcare quantification may be applicable to current healthcare systems to some extent, there are still areas for development.