Factors Influencing Patient Satisfaction With Antiretroviral Services at a Primary health care facility (Thesis Proposal Sample)

Thesis Proposal
FACTORS INFLUENCING PATIENT SATISFACTION WITH ANTIRETROVIRAL SERVICES AT A PRIMARY HEALTH-CARE FACILITY
Submitted By: Emma Arias
Department of Human Services
This Thesis Proposal Is Submitted In Partial Fulfillment of the Requirement for The Degree Of Master Of Science In Human Services
Boricua College
Spring 2013
Advisor:
TABLE OF CONTENTS
Title page 1 Table of contents 2
Abbreviation and Acronyms 4
Abstract 5
CHAPTER ONE: INTRODUCTION
1.1 Background 6
1.2 Statement of the Problem and Justification 8
1.3 Research Questions 8
1.4 Study Hypothesis 9
1.5 Objective 9
1.5.1 Broad Objective 9
1.5.2 Specific Objectives 9
1.6 Conceptual Framework 10
CHAPTER TWO: LITERATURE REVIEW
2.1 Overview 11
2.2 Anti-retroviral Therapy Services 11
2.3 Goals of antiretroviral therapy 13
2.4 Role of Supportive services 13
2.4.1 Laboratory services 14
2.4.2 Role of Counseling 14
2.4.3 Chemoprophylaxis 15
2.5 Factors that influence patients satisfaction with Antiretroviral Therapy services 16
2.5.1 Accessibility 16
2.5.2 Lengthy waiting time and follow up schedule 17
2.5.3 Patient –Provider relationship 17
2.5.4 Lack of confidentiality 18
2.5.5 Integration of services 18
2.5.6 Provider- patient ratio 19
2.5.7 Medical supplies 19
2.5.8 Availability of quality lab services and counseling 20
2.5.9 Health Insurance 20
2.6 Definition of Terms 21
CHAPTER 3: METHODOLOGY
3.1 Research Design 22
3.2 Variables 22
3.3 Study area 22
3.4 Target Population 23
3.5 Inclusion and exclusion criteria 23
3.6 Sampling technique and sample size 23
3.7 Research instrument and data collection techniques 24
3.8 Data analysis 24
3.9 Ethical consideration 24
References: 25

ABBREVIATIONS AND ACRONYMS
AIDS Acquired Immunodeficiency Syndrome
Anti-HBV Anti Hepatitis B Virus
ART Anti-retroviral Therapy
ARV Antiretroviral drugs
DAART Directly Administered Antiretroviral Therapy
DNA deoxyribonucleic acid
FGD Focused group discussion
HIV Human Immunodeficiency Virus
IPT Isoniazid Preventive Therapy
NRTIs Nucleoside and nucleotide reverse transcriptase inhibitors
NNRTIs Non-Nucleoside Reverse Transcriptase Inhibitors
PLWHA People Living With HIV and AIDS
PIs Protease Inhibitors
RNA Ribonucleic acid
T.B Tuberculosis
UNAIDS United Nations Agency for International Development
WHO World Health Organization
Abstract
BACKGROUND: The advent of Anti-retroviral therapy has lessened this burden but despite this, less research has been done on the quality of ART services in health facilities. Knowledge on ART use has many gaps primarily in the perceptions that ART users have concerning the quality of services rendered and set-backs that exist in the delivery of these services. Moreover, gaps exist on how ART services affect perceptions of ART users. It is necessary to fill these gaps so that ART programs will achieve their objectives. Identifying obstacles that exist in rendering ARV services will enable healthcare providers come up with noteworthy countermeasures. It is, thus, necessary to conduct a study influencing patient satisfaction with Antiretroviral Services at a primary health-care facility.
OBJECTIVE: the core purpose of this study is to evaluate the quality of ART services in primary health facilities around the country. The selected study area will serve as the representative sample of the entire nation. It gives a special focus on client satisfaction, perceived quality of life and adherence.
METHOD: Both quantitative and qualitative research methods will be applied to assess clients’ satisfactions, perceived quality of life and adherence. Various factors will be used to gauge the quality of ARV services and satisfaction levels among clients. The factors to be used will be: drug supply, laboratory equipment, guideline availability, trained personnel and adequate patient-provider time. A structured questionnaire will be the main method of data collection. A sample size of 384 will be used, and this value will be arrived at with the help of a statistical equation. The interviewed sample group will give responses which will be assessed in order to assess factors affecting patient satisfaction with ARV services rendered in a primary health facility.
CHAPTER I
INTRODUCTION
1.1 Background to the study
Since its recognition in the 1981, HIV/AIDS has remained to be one of the most devastating epidemics in the world. There are consorted efforts worldwide to address the epidemic including increased access to effective treatment and prevention programs (UNAIDS/WHO, 2011). However, much is still to be done to decrease AIDS prevalence mainly in developing countries. Statistics from the Joint United Nations Program on HIV/AIDS (UNAIDS/WHO, 2011), showed the number of people living with HIV globally has risen from 29.5 million in 2002 to 34 million in 2010. It was also reported that 2.7 million people became newly infected, and 1.8 million people died of AIDS worldwide in the same year. HIV/AIDS is still a leading cause of morbidity and mortality, especially so in developing countries in Africa. In the same year, the number of people under ART in low and middle income countries was estimated to be 6.65 million up from 300,000 in 2002 representing 47% coverage. (UNAIDS/WHO, 2011).
Most countries in Africa continue to bear the burden of the epidemic. In 2010, 68% of all people who are HIV-positive lived in Sub-Saharan Africa, and 76% AIDS related deaths were reported from this region. However, the estimated 1.2 million people dying from AIDS-related illnesses in 2010 were 29% fewer than in 2005 (UNAIDS/WHO, 2011). Approximately 1.9 million people were newly infected with HIV in the same year, bringing to 22.9 million the total number of people living with the virus in Sub-Saharan Africa (UNAIDS/WHO, 2011). These new cases represented 70% of all the people who acquired HIV infection globally.
The impact of HIV worldwide will be felt in decades to come. Effective preventive and treatment measures in the recent past have led to a reduction in HIV and AIDS related mortality and morbidity (UNAIDS/WHO, 2006). However, the number of HIV victims continues to grow, as does the number of deaths due to AIDS. Approximately 39.5 million people worldwide were living with HIV in 2006 (UNAIDS/WHO 2006). In 2007, new data showed global HIV prevalence and the number of new infection had fallen, in part as a result of the impact of HIV programmes (WHO, 2007). In 2007, 33.2 million people were estimated to be living with HIV, 2.5 million people became newly infected, and 2.1 million people died of AIDS worldwide. In low and middle income countries, 3 million people were receiving ARV treatment by end of 2007 (UNAIDS/WHO, 2007, 2008).
Patient satisfaction refers to patients' “Personal evaluation of providers’ ability of health care services’’. It reflects providers' ability to deliver care that meets patients’ expectations and needs (Sitzia et al, 1997). When evaluating healthcare programs, satisfaction with care is considered to be a health outcome, a quality of care indicator, and a predictor of patient behavior. (Mahon, 1996) Wu et al recommended that a patient's satisfaction, along with measures of health status and essential care processes, be used as a quality of care indicator for adults with HIV/AIDS. It is widely accepted that satisfied patients are more likely to comply with their treatment unlike those that are not satisfied, which is in turn associated with better clinical outcomes (Sitzia et al, 1997, Kane et al, 1997). It is, hence, necessary to identify factors that influence patient satisfaction to ensure more success as many nations scale up ART programs.
Problem Statement and Justification
Many countries have rolled out natio...