Person-centered care in Uganda: analysis of responsiveness, patient satisfaction, patient-reported health outcomes, and trust among adults

Abstract

Objectives

Person-centeredness and patient experience are key components of high-quality health systems. The World Health Organization defines seven domains of health system responsiveness, and there is a growing body of research that uses these domains as a proxy for experiential quality.

Methods

We examined overall levels of responsiveness across the domains and across demographic and visit characteristics in Uganda. We also explored the relationship between responsiveness and patient satisfaction, self-rated health outcomes, and trust. This study uses data from a nationally-representative cross-sectional household survey conducted in Uganda in 2019. Respondents who had sought care in the last 6 months were asked questions about responsiveness of care during their most recent visit. We compared demographic and visit characteristics in total and between respondents within the highest and lowest responsiveness and also explored the distribution of the responsiveness index across all responsiveness domains. Finally, we assessed the relationship between responsiveness quintiles and the highest rating of our outcomes using Poisson regression. Our six outcomes fell within three categories: patient satisfaction, patient-reported health outcomes, and trust.

Results

Of the 4823 men and women surveyed, 2924 (60.6%) visited a healthcare facility in the last 6 months, and the total weighted study sample of those who visited a healthcare facility was 2827. Respondents who reported high responsiveness were more likely to be wealthier, urban dwellings, and with higher levels of education, and more likely to have greater access to care, to see the same provider at each visit, and to have gone to a private facility. We found that respondents reporting higher responsiveness were significantly more likely to report the highest rating on all six outcomes.

Conclusions

Our findings suggest that responsiveness is a central component of high-quality health systems and that efforts to improve health outcomes must look beyond technical quality.