Patient experiences and health system responsiveness among older adults in South Africa

Figures & data

Table 1. Inpatient care in the past 3 years and outpatient care and care at home in the past 12 months (%)

	Inpatient care			Outpatient care and care at home
Reason for visit	Last overnight stay (n=356)	2nd overnight stay (n=86)	3rd overnight stay (n=49)	Last visit (n=1,919)	2nd visit (n=1,471)	3rd visit (n=1,228)
Communicable	13.1	9.2	4.3	2.8	2.0	1.9
Maternal	1.7	0	0	0.4	0.6	0.6
Nutrition	1.0	0	0	0.9	0.1	0.2
Acute condition	2.9	0.7	0	9.6	4.9	3.0
Injury	1.3	0	0	1.4	1.0	0.4
Surgery	13.1	4.3	2.6	0.7	0.5	0.6
Sleep problems	0	0	0	0.2	0.1	0.1
Occupation/work related	3.9	18.0	35.8	1.3	1.4	1.8
Pain in joints/arthritis	1.8	3.4	0	13.1	15.7	16.9
Diabetes	4.8	3.5	1.5	10.3	10.3	11.6
Problems with heart	5.3	11.2	5.1	3.5	2.6	2.5
Problems with mouth	0	0	0	0.9	0.2	0.4
Problems with breathing	2.5	5.4	1.9	2.9	2.7	2.8
High blood pressure	7.4	3.0	7.2	38.8	44.0	46.6
Stroke	7.4	0.9	0	0.8	1.1	1.0
Generalized pain	0	0	0	2.6	2.4	0.8
Depression or anxiety	0.1	1.7	3.3	0.7	0.8	0.9
Cancer	1.9	5.9	5.4	0.5	0.7	0.8
Other	14.3	14.2	21.4	8.5	6.7	4.4
Do not know	10.6	18.6	11.5	8.5	2.3	2.9

Table 2. Healthcare characteristics and mean responsiveness (%)

	Total No.	Total	Public	Private	Eastern Cape	Free State	Gauteng	KwaZulu-Natal	Limpopo	Mpumalanga	North–West	Northern Cape	Western Cape
Inpatient care#			69.5	30.5
Traveling time (1 hour or more)	258	32.9	40.0	16.8	25	56	38	19	25	23	66	63	26
Payment
-Free	254	52.0	75.5	3.4	58	67	33	46	55	18	55	75	79
-Insurance	255	26.9	4.8	75.9	15	22	53	31	18	47	8	6	8
-Out of pocket	255	16.4	16.8	17.0	16	1	7	12	27	34	37	19	14
Responsiveness
Prompt attention	220	68.6	65.0	77.1	61	68	62	77	76	71	78	70	69
Dignity/respect	222	73.5	70.8	79.5	70	68	70	79	75	79	80	68	73
Communication	221	69.5	67.6	73.7	65	66	63	77	73	73	80	67	70
Autonomy	219	65.4	63.6	68.9	65	61	63	74	68	68	52	65	67
Confidentiality	222	74.2	70.6	82.3	68	66	77	78	67	82	84	66	71
Access	222	71.4	68.7	77.6	65	63	72	80	77	77	76	66	68
Quality	221	75.4	77.0	71.4	66	74	70	84	81	83	91	75	72
Total responsiveness		71.4	69.4	75.8	66	67	68	78	74	76	81	68	70
Outpatient care#			73.2	26.8
Traveling time (1 hour or more)	1,896	19.9	19.6	22.0	25	34	17	16	34	25	21	19	8
Payment
-Free	1,890	62.7	82.1	9.6	68	52	62	54	69	58	64	87	73
-Insurance	1,893	8.4	0.3	31.6	3	9	17	3	6	9	8	3	16
-Out of pocket	1,893	26.3	15.6	58.2	25	39	13	41	25	30	29	9	11
Responsiveness
Prompt attention	1,836	58.2	53.6	70.2	56	49	60	62	61	59	47	62	59
Dignity	1,837	70.8	67.2	80.8	63	64	70	72	75	78	72	64	73
Communication	1,830	70.5	66.9	80.4	62	66	67	72	73	78	72	63	74
Autonomy	1,828	66.4	62.7	76.6	62	65	66	67	64	72	68	60	70
Confidentiality	1,834	71.3	67.8	81.0	66	65	70	70	75	79	71	62	78
Access	1,837	69.1	65.1	80.2	65	65	65	69	70	76	70	62	75
Quality	1,837	75.1	72.1	83.9	66	67	79	74	79	79	79	67	79
Total responsiveness		68.8	65.1	79.0	63	63	68	70	71	75	69	63	73

#Cronbach alpha for the 7-item outpatients responsiveness scale was 0.92 and for the 7-item inpatient responsiveness scale 0.90 for this South African sample.

Table 3. Rankings of importance of responsiveness domain by selected sociodemographics and type of health service*

	Overall	Public	Private	Male	Female	Urban	Rural	Low wealth	High wealth	Eastern Cape	Free State	Gauteng	KwaZulu-Natal	Limpopo	Mpumalanga	North-West	Northern Cape	Western Cape
Inpatient care
Quality	1	1	6	3	1	3	1	1	1	3	1	4	1	1	1	1	1	2
Confidentiality	2	3	1	2	2	1	2	2	3	2	5	1	4	5	2	2	5	3
Dignity/respect	3	2	2	1	3	2	3	3	2	1	2	3	3	4	3	3	3	1
Access	4	4	3	6	4	4	4	5	5	4	6	2	2	2	4	6	6	6
Communication	5	5	5	5	5	5	5	4	4	5	4	6	5	6	5	4	4	4
Prompt attention	6	6	4	4	6	6	6	6	6	7	3	7	6	3	6	5	2	5
Autonomy	7	7	7	7	7	7	7	7	7	6	7	5	7	7	7	7	7	7
Outpatient care
Quality	1	1	1	1	1	1	1	1	1	2	1	1	1	1	2	2	1	1
Confidentiality	2	2	2	3	2	2	4	3	2	1	3	2	4	3	1	4	5	2
Dignity	3	3	3	2	3	3	2	2	3	4	6	3	2	2	4	3	2	5
Communication	4	4	4	4	4	4	3	4	5	5	2	4	3	4	3	2	3	4
Access	5	5	5	5	5	5	5	5	4	3	4	6	5	5	5	5	4	3
Autonomy	6	6	6	6	6	6	6	6	6	6	5	5	6	6	6	6	7	6
Prompt attention	7	7	7	7	7	7	7	7	7	7	7	7	7	7	7	7	6	7

*Where 1=highest ranking (highest importance) and 8=lowest ranking.

Table 4. Multivariate logistic regression of sociodemographic and health variables on total healthcare responsiveness [Dependent Variable: Ambulatory or inpatient responsiveness]

	Outpatients		Inpatients
	Mean total responsiveness		Mean total responsiveness
Sociodemographics	AOR (CI 95%)	P	AOR (CI 95%)	P
Sex
Male	1.00	0.913	1.00	0.028
Female	1.02 (0.66–1.60)		0.36 (0.14–0.89)
Age
50–59	1.00	0.739	1.00	0.378
60–69	1.06 (0.74–1.53)	0.373	0.56 (0.15–2.07)	0.280
70–79	1.22 (0.78–1.92)	0.736	2.11 (0.53–8.42)	0.038
80 or more	0.90 (0.48–1.69)		5.83 (1.11–30.63)
Education
None	1.00	0.308	1.00	0.150
Less than primary	1.36 (0.75–2.49)	0.021	3.59 (0.62–20.85)	0.341
Primary	1.64 (1.08–2.48)	0.175	2.61 (0.35–19.69)	0.582
Secondary or more	1.52 (0.82–2.80)		1.63 (0.27–9.80)
Wealth
Low	1.00	0.540	1.00	0.508
Medium	1.14 (0.75–1.73)	0.695	1.70 (0.34–8.56)	0.157
High	1.12 (0.62–2.05)		2.23 (0.72–6.86)
Population group
Black African	1.00	0.005	1.00	0.357
White	3.96 (1.54–10.19)	0.105	2.23 (0.72–6.89)	0.228
Colored	1.70 (0.89–3.24)	0.418	1.87 (0.67–5.23)	0.038
Indian or Asian	1.56 (0.52–4.66)		8.97 (1.14–70.35)
Geolocality
Urban	1.00	0.424	1.00	0.038
Rural	0.85 (0.57–1.27)		0.28 (0.10–0.80)
Religious activity
Low	1.00	0.363	1.00	0.932
High	1.22 (0.79–1.97)		1.04 (0.42–2.55)
Health variables
Private health facility	1.00		1.00
Public health facility	0.34 (0.17–0.69)	0.004	0.62 (0.04–9.14)	0.721
Free healthcare	1.00		1.00
Health insurance	3.39 (1.24–9.27)	0.018	0.35 (0.02–5.07)	0.427
Out of pocket	1.79 (0.86–3.72)	0.116	0.32 (0.09–1.19)	0.087
Time to facility
<1 hour	1.00	0.237	1.00	0.052
≥1 hour	0.68 (0.35–1.30)		2.32 (0.99–5.40)
Subjective health status
Very/good	1.00	0.001	1.00
Moderate	0.53 (0.38–0.75)	0.018	1.14 (0.24–5.36)	0.868
Bad/very bad	0.56 (0.35–0.90)		1.04 (0.16–6.81)	0.966
Activity limitation
None	1.00	0.808	1.00	0.258
Mild	0.94 (0.57–1.54)	0.462	2.24 (0.54–9.36)	0.922
Moderate	1.18 (0.76–1.83)	0.956	0.93 (0.21–4.12)	0.787
Severe/extreme	1.02 (0.44–2.36)		1.34 (0.15–11.78)

Table

For your last overnight visit to a hospital or long-term care facility, how would you rate the following:		Very good	Good	Moderate	Bad	Very bad
Q5018	... the amount of time you waited before being attended to?	1	2	3	4	5
Q5019	...your experience of being treated respectfully?	1	2	3	4	5
Q5020	…how clearly healthcare providers explained things to you?	1	2	3	4	5
Q5021	…your experience of being involved in making decisions for your treatment?	1	2	3	4	5
Q5022	...the way the health services ensured that you could talk privately to providers?	1	2	3	4	5
Q5023	...the ease with which you could see a healthcare provider you were happy with?	1	2	3	4	5
Q5024	...the cleanliness in the health facility?	1	2	3	4	5

Table

For your last visit to a healthcare provider, how would you rate the following:		Very good	Good	Moderate	Bad	Very bad
Q5039	... the amount of time you waited before being attended to?	1	2	3	4	5
Q5040	...your experience of being treated respectfully?	1	2	3	4	5
Q5041	…how clearly healthcare providers explained things to you?	1	2	3	4	5
Q5042	…your experience of being involved in making decisions for your treatment?	1	2	3	4	5
Q5043	...the way the health services ensured that you could talk privately to providers?	1	2	3	4	5
Q5044	...the ease with which you could see a healthcare provider you were happy with?	1	2	3	4	5
Q5045	...the cleanliness in the health facility?	1	2	3	4	5