African Journal of Science and Research,2016,(5)4:14-18 ISSN: 2306-5877 Available Online: http://ajsr.rstpublishers.com/ PERCEPTION STUDY ON INFORMATION, EDUCATION AND COMMUNICATION IN A TERTIARY CARE HOSPITAL,CHENNAI. Received:14,May,2016 Bhoomadevi.A 1, Ganesh.M 2, Panchanatham.N 3 1)Sri Ramachanra College of Management, Sri Ramachandra University, Chennai, Tamil Nadu, India. 2) Department of Physiology, ACS Medical College, Chennai, Tamil Nadu, India. 3)Department of Business Administration,Annamalai University,Chidambaram, Tamil Nadu, India. Email: bhooma.ganesh@gmail.com Accepted: 10,July,2016 Abstract Healthcare professionals, when develop and understand communication skills, they build trust easily among the patients; p romote healing which will in turn improve the outcome of healthcare delivery. Successful communication with patients not only improves the patient outcomes, it also has personal satisfaction. Developing these skills may lead to professional respect among peer groups and also result in more patients seeking care from these healthcare professionals. The study is intended to find out the contributing factors like, information provid ed and education given to the patients that influence the communication among the patients and the healthcare professionals in a tertiary set up hospital. The study design is descriptive and questionnaire was devised to assess the perception of patients and healthcare professionals at sele cted tertiary care giving hospitals. The sample of 512 inpatients and 280 health care professionals from both the hospitals were selected. Various statistical tools like ANOVA, multiple correlation were used to assess the perception of patients and healthcare professionals.the study reveals that the perception of healthcare professionals is higher than the patients for the aspect regarding information given to patients for which the difference is statistically significant (p < 0.01). Perception of healthcare professionals for the aspect education given to patients is higher than the patients and is statistically significant (p < 0.01).An information system can be developed for providing information to patients, educating the patients and communicating with patients related to their treatment process in the hospitals. That information system should be integrated so that it can support efficient management decisions, networking and it can be implemented which may be useful for healthcare professionals to compete in the managerial aspects.the perception of healthcare professionals and patients with regard to information, education and communication given to patients and its impact were assessed. Keywords:Perception,Information,Communication,Tertiary Care,Chennai. INTRODUCTION Effective communication between healthcare professionals and patients results in successful healthcare delivery. Here the word success implies that a physician is developing a partnership with patient where he educates the patient fully on his or her medical condition and tries to address the problem which makes the patient actively participate in the decision-making process (Ambrosia, 1999). To improve the communication with patients, several models have been developed to support the healthcare professionals which focus on improvement in the quality of the communication. Hence these methods allow the healthcare professionals to communicate empathetically, with concern, considering their values which improve the patient satisfaction (Schattner 2009; Tongue et al., 2005). Cutcliffe and McKenna (2005) and Long (1999), stated that patients will interact more with nurses during their treatment than with healthcare professional in the multidisciplinary team. Further these authors highlighted that the role of nurses in medical and surgical practice continues to expand. REVIEW OF LITERATURE The literature search was conducted using on-line database searches, manual searches of relevant journals and substantiating the information with the bibliographies of formerly published reviews and original articles. This literature reviews shows different studies about the doctor-patient communication and their behaviors which are related to patient satisfaction: Information provided by the doctor and /or patient (both in terms of general information provision and information on specific topics) Behaviours of doctors and patients on information-seeking; The doctor-patient relationship and their negative or positive expressions and its effect; The communicative style of the doctor. Many studies have investigated how far the doctor s level of information provision, information seeking and communication skills during consultations are related to patient satisfaction. Investigators have looked at whether the amount of information provided by the doctor, in general, and discussion of specific topics, in particular (e.g. etiology, psychosocial information) is associated with differences in patient satisfaction. There have also been investigations into how far patient information provision/seeking in general and during specific parts of the consultation (e.g. during the patient history-taking segment) was associated to patient satisfaction (Williams et al., 1998). Doctors providing information to patients has been found to be positively related to patient satisfaction. In an early study, a modified version of the Bales system (Bales 1968) was used to analyze 285 audiotapes of pediatric consultations (Korsch et al., 1968). Statement of the problem Many studies have investigated how far the doctor s level of information provision, information seeking and communication skills during consultations are related to patient satisfaction. Investigators have looked at whether the amount of information provided by the doctor, in general, and discussion of specific topics, in particular is associated with differences in patient satisfaction. There have also been investigations into how far patient information in general and during specific parts of the consultation (e.g. during the patient history-taking segment) was related to patient satisfaction. Thus this study is intended to find out the perception of patients and the
African Journal of Science and Research, 2016,(5)4:14-18 15 healthcare professionals towards information, education and communication. Objectives: 1. To know the perception of patients towards information, education and communication given to patients 2. To know the perception of healthcare professionals towards information, education and communication given to patients 3. To assess the difference between the perception of healthcare professionals and patients with regard to information, education and communication given to patients Study Area The was conducted in two tertiary healthcare centres (The Government General Hospital and Sri Ramachandra Medical Centre) at Chennai. Approval from Institutional Ethics Committee was obtained from both the hospitals before conducting the study. METHODOLOGY The present research is to assess and compare the perception of patients towards information, education and communication given to patients and healthcare professionals in tertiary healthcare centres in Chennai. Two hospitals were identified with similar infrastructure and functionality. The present study is both a descriptive and an exploratory survey regarding the perception of patients and healthcare professionals at selected tertiary care giving hospitals. The data collection method in the present case involves devising a questionnaire in the necessary dimensions of the study incorporated and subdivided into relevant aspects. The study population includes inpatients and healthcare professionals at a selected tertiary healthcare centers. The sample of 512 inpatients and 280 health care professionals from both the hospitals were selected for the study using simple judgmental sampling technique. The respondents were selected based on their readiness to cooperate on the specific days that the researcher visited the hospital. Inclusion criteria for patients: Patients who are admitted for two days or more are included in the study. Exclusion criteria for patients: Unconscious patients who cannot answer the questions, Patients with congenital cardiac failure excluded in the study and patients under18 years also excluded. The study has nineteen variables which help to identify the perception of respondents on the items like information given to patients, education given to patients and four variables for communication with patients. ANALYSIS AND RESULTS Null Hypothesis 1: There is no difference between the perception of healthcare professionals and patients with regard to information given to patients, communication with patients and Education given to patients Information given to patients (7 variables): The t-test was conducted to assess whether the aspects of information given to patients differs significantly between healthcare professionals and patients. Mean, SD and t-value were computed. The t-value shows that the mean variation of Healthcare professional is high for the aspect information given to patients and the difference is statistically significant and hence the null hypothesis is not accepted (p<0.001). The mean difference shows gap in the perception of HCPs and patients with regard to information given to patients. The patients while taking up an appointment with the hospital regarding illness, they expect to be clearly informed about their appointment and any queries related to it. If there is any registration fee involved the patient also wants to be informed about it. Information regarding the risks and benefits of treatment, results of a diagnostic test/procedure, details regarding the importance of informed consent before a surgery are the other information that are mandatory for the healthcare delivery system to be informed to the patient. Communication with patients (4 variables): The t-value reveals that the mean variation of both HCPs and patients for the aspect communication with patients is uniform and there is no significant difference and hence the null hypothesis is accepted. Therefore the perception of HCPs (Health Care Professionals) and patient is uniform with regard to communication with patients. The art of communication should be practiced at its best in a healthcare delivery system. Most of the issues related to patient s dissatisfaction often stems from the lack of proper communication. Therefore the healthcare professionals should encourage the patients to approach them regarding any medical queries without any hesitation. The communication is expected to be clear and preferably in the language that the patient understands. Similarly patients also should be involved in the decision-making process regarding their treatment and procedures involved in the treatment. Education given to patients (8 variables): The t-value reveals
16 Bhoomadevi et.al that the mean variation with regard to the perception of Healthcare professionals for the aspect education given to patients is high and statistically significant and hence the null hypothesis is not accepted (p<0.001). Therefore there is significant difference in the perception of Healthcare professional and patients with regard to education given to patients. Patients also feel that education should be imparted according to their needs. There is a popular saying that educating a man to fish is always better than feeding him with it. So educating a patient in the entire spectrum of events that takes place during his hospital stay is mandatory in the process of healthcare delivery. Therefore in a healthcare delivery system it is appropriate that the patient should receive proper health education according to their needs and all measures taken up by the hospital to achieve this should reach the patients both at the rural and urban levels effectively. Null Hypothesis 2: There is no difference between the gender, marital status, age group, type of ward, number of days stayed and educational qualification of a patient and Information, Communication and Education given to patients. Table(2) The t-test was conducted to assess whether the perception differs among the patients gender and the aspect of information, communication and education given to patients. The t-value reveals that there is a significant difference between the perception of male and female patients with regard to information given to patients and hence the null hypothesis is not accepted (p<0.001). There is no significant difference in the perception of male and female patients with regard to communication and education given to patients. The male patients perception towards the aspects information, communication and education given to patients is higher than female patients. The t-value reveals that there is no significant difference between the perception of marital status of patients with regard to Information, Education and Communication given to Patients. differs among the age group of patients. It shows that the age group of patients with regard to the aspect Information given to patients is statistically significant, communication with patients and Education given to patients and hence the null hypothesis is not accepted (p<0.001). Based on the Duncan Multiple Range test, the perception of patients who are in the age group between 26 35 years, 46-55 years and above 55 years significantly varies with the other age group patients at 0.05 level of confidence in the aspects of The result of one way ANOVA shows that there is a significant difference in the perception of patients type of ward and the aspects of information (p<0.001), education given to patients (p<0.001) and communication; therefore the null hypothesis is not accepted. Based on the Duncan Multiple Range test, the perception of patients in the general medicine and general surgery ward coincides with each other and differs with the other wards in the aspect of information given to patients. The perception of patients in OBG ward differs from the other ward patients in the aspects of communication and education given to patients. sub scales of information, communication and education significantly differs among the number of day stay of a patient. The ANOVA result reveals that there is a significant difference in the perception of patients between number of days the patient stayed in the hospital and the aspects of information given to patients, Communication with patients and Education given to patients and hence the null hypothesis is not accepted (p<0.001). Based on the Duncan Multiple Range test, the perception of patients who stayed 8 12 days in the hospital differs with other patients with regard to the aspects differs among the educational qualification of patients. It shows that the perception of patients and their educational qualifications with regard to the aspects of Information, Communication and Education given to patients is statistically significant, therefore the null hypothesis is not accepted (p<0.001). Based on the Duncan Multiple Range test, the perception of patients who have no education differs from the other group of patients with regard to the aspects Null Hypothesis 3: There is no difference between the experience and type of ward of a healthcare professional and Information, Communication and Education given to patients. Table(3) sub scales of information, communication and education significantly differs among the years of experience of the healthcare professionals. There is a significant difference in the perception of experiences for healthcare professionals and the aspects of communication and education given to patients and hence the null hypothesis is not accepted (p<0.05). Based on the Duncan Multiple Range test, the perception of health care professionals whose experiences is between 2-5 years differs from other groups in the aspects of communication and education given to patients. differs among the type of ward of healthcare professionals. The perception of health care professionals type of ward and the aspect education given to patients showed significance at 1% level and hence the null hypothesis is not accepted. The aspect information and communication and the type of ward of healthcare professionals
African Journal of Science and Research, 2016,(5)4:14-18 17 showed no significant difference and hence the null hypothesis is accepted. Based on the Duncan Multiple Range test, the perception of health care professionals who are in the general medicine ward and special ward differs significantly with regard to education given to patients. Null Hypothesis 4: There is no relationship between the perception of patients and healthcare professionals with regard to the aspects information given to patient, education given to patients and communication with patients. Table(4) The correlation between patients perceptions for the aspects like information given to patients, education given to patients and communication with patients range from 0.650 for the aspect information given to patient to 0.611 for the aspect Education given to patients and hence the relationship is significant at 0.01 level of confidence. The correlation between health care professionals perception for the aspects like information given to patients, education given to patients and communication with patients range from 0.464 for the aspect information given to patient to 0.538 for the aspect education given to patients and hence the relationship is significant at 0.01 level of confidence. Table(5) The multiple correlation coefficient value for health care professionals perception comes to 0.565 and for patients the value comes to 0.668 which measures the degree of relationship between the actual values and the predicted values of communication with patients. Because the predicted values are obtained as a linear combination of aspects like information and education given to patients and the coefficient value of 0.565 and 0.668 indicates a relationship between Communication with patients and the independent variables. From the above table, the value of R square is 0.319 which means that about 31.9% for healthcare professional and 44.6% for patients of the variation in communication with patients is explained by the estimated Sample Regression Plane (SRP) that uses information given to patients and education given to patients and R square value is significant at 0.01 level of confidence. DISCUSSION The overall perception of healthcare professionals is 2.16 % higher than that of the patients for the aspect information given to patients and the difference is statistically significant and hence the null hypothesis has not been accepted (p<0.01). For the aspect communication with patients the perception of both healthcare professionals and patients is uniform. With regard to the aspect education given to patients, the healthcare professionals perception is higher than the patients and is statistically significant and hence the null hypothesis has not been accepted (p<0.01). Further the study shows that there is a significant difference between the perception of male and female patients with regard to information given to patients and hence the null hypothesis has not been accepted (p<0.01) except communication and education given to patients. Hence the perception of male patients towards the aspects information given to patients is higher than female patients. Similarly the study reveals that there is no significant difference between the perception of marital status of patients and the aspects like information, education and communication given to patients and hence the null hypothesis has been accepted. And there is significant difference in the perception of experiences of healthcare professionals and the aspects of communication and education given to patients and hence the null hypothesis has not been accepted (p<0.05) except information given to patients. The Duncan Multiple Range test shows that the perception of health care professionals whose experiences is between 2-5 years differs from other groups in the aspects of communication and education given to patients. The study also reveals that the perception of health care professionals type of ward and the aspect education given to patients is significant at 1% level and hence the null hypothesis has not been accepted. Based on the Duncan Multiple Range test, the perception of health care professionals who are in the general medicine ward differs significantly with regard to education given to patients. The age group of patients and the aspects like information given to patients, communication with patients and education given to patients is found to be significant at 1 percent level therefore null hypothesis has not been accepted. Based on the Duncan Multiple Range test, the perception of patients who are in the age group between 46-55 years significantly varies with the other age group patients with regard to the aspects of information, communication and education given to patients. There is significant difference in the perception of patients type of ward and the aspects of information (p<0.01), education given to patients (p<0.01) and communication (p<0.05) and hence the null hypothesis has not been accepted. Based on the Duncan Multiple Range test, the perception of patients in the general medicine differs with the other wards in the aspect of information given to patients. The perception of patients in general surgery ward differs with other ward patients in the aspects of communication and education given to patients. There is a significant difference in the perception of patients between number of days the patient stayed in the hospital and the aspects of information given to patients, communication with patients and Education given to patients and hence the null hypothesis has not been accepted (p<0.01). Based on the Duncan Multiple Range test, the perception of patients who stayed between 8 12 days in the hospital differs with other patients with regard to the aspects
18 Bhoomadevi et.al There is a significant difference between the perception of patients and their educational qualifications with regard to the aspects of information, communication and education given to patients and hence the null hypothesis has not been accepted (p<0.01). Based on the Duncan Multiple Range test, the perception of patients who have no education differs from the other group of patients with regard to the aspects information, communication and education given to patients. Further research can be conducted to recognize the importance of patient-physician relationship which would help the health service organizations to encourage such practice through meaningful education programs. Hospital Administrators can also benchmark the best practices in the similar healthcare organization and identify opportunities in their healthcare setup for potential improvement areas and use it in a best way. CONCLUSION This study indicates that mostly the healthcare professionals perceive that they provide information and educate the patients according to their needs whereas the patients sometimes feel that the information and education given was not appropriate to their needs. For the aspect communication with patients the perception of both healthcare professionals and patients is uniform. Overall, this study reveals that the healthcare professionals communicate to the expectations of the patients whilst they have to improve in providing information and educate them according to their needs. When information is given, it frequently consists of information that the healthcare professional thinks is needed rather than information that the patient needs or desires. Further research can be conducted to recognize the importance of patient-physician relationship which would help the health service organizations to encourage such practice through meaningful education programs. Hospital Administrators can also benchmark the best practices in the similar healthcare organization and identify opportunities in their healthcare setup for potential improvement areas and use it in a best way. References 1) Galloway S., Rebeyka, D., Saxe-Braithwaite M., Bubela N. and McKibbon A. (1997). Discharge information needs and symptom distress after abdominal aortic surgery. Canadian Journal of Cardiovascular Nursing, 8, 9-15. 2) Giloth, (1990). Promoting patient involvement: educational, organizational, and environmental strategies. Patient Education and Counseling, 15. 3) Jenkinson, C., Coulter, A., Bruster, S., Richards, N., Chandola, T. (2002). Patients experiences and satisfaction with health care: results of a questionnaire study of specific aspects of care. Qual Saf Health Care, 11, 335 339. 4) The Joint Commission. (2010). Advancing effective communication, cultural competence, and patient and family centered care: A roadmap for hospitals. Oakbrook Terrace, IL: Author. 5) Latter S., Macleod Clark J., Wilson-Barnett J. and Maben J. (1992) Health education in nursing: perceptions of practice in acute settings. Journal of Advanced Nursing, 17, 164-172. 6) Leino-Kilpi H., Iire L., Suominen T., Vuoreniieimo J. and Valimaki M. (1993). Client and information: a literature review. Journal of Clinical Nursing, 2, 331-340. 7) Little Paul, Everitt Hazel,Williamson Ian, Warner Greg,MooreMichael, Gould Clare, FerrierKate, Sheila Payne, (2001). Preferences of patients for patient centred approach to consultation in primary care: observational study. BMJ, 322. 8) Stewart, M., Brown, JB., Donner, A., McWhinney, IR., Oates, J., Weston, WW. And Jordon, A. (2000). The impact of patient-centered care on outcomes. The Journal of Family Practice, 49(9), 796 804. 9) Stiles, W. B., Putnam, S. M., Wolf, M. H., and James, S. A. (1979b). Interaction exchange structure and patient satisfaction with medical interviews. Medical Care, 17(6), 667-681. 10) Wolf, M. H., Putnam, S. M., James, S. A, and Stiles, W. B. (1978). The Medical Interview Satisfaction Scale: Development of a scale to measure patient perceptions of physician behavior. Journal of Behavioral Medicine, 1(4),391-401.