Health Services Insights最新文献

{"title":"Operationalising Inclusion for Participatory Design: Worked Examples for TRIPOD+AI & PROBAST+AI.","authors":"Riley Martens, Linda Bakunda, Teresa Mushayandebvu, Zack Marshall","doi":"10.1177/11786329261477136","DOIUrl":"https://doi.org/10.1177/11786329261477136","url":null,"abstract":"<p><p>Artificial intelligence (AI) and machine learning (ML) are rapidly transforming the healthcare landscape, enhancing diagnostic accuracy, personalising treatments, and improving operational efficiency. However, alongside these advancements comes a critical concern: the potential for AI models to perpetuate, or even exacerbate, health inequities. This paper examines the complex potential of AI in health, and how it can both improve and undermine equity. The key to addressing these challenges lies not only in developing advanced algorithms but in fostering responsible and inclusive development. We argue that to operationalise inclusion in AI systems, research co-design should be prioritised in order to integrate the perspectives of diverse knowledge users, including patients, clinicians, and community partners, shown through worked examples in TRIPOD+AI and PROBAST+AI. This approach encourages future work to rethink the role of knowledge users in the development of AI for healthcare.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"19 ","pages":"11786329261477136"},"PeriodicalIF":2.1,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13490788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preliminary Field-Note Observations on Referral Uptake Among Community-Dwelling Older Adults: A Qualitative Pilot Study in Tarrant County, Texas.","authors":"Amanda Sease, Gina Alexander, Kimberly Posey, Francesca Gentea, Ewaoluwa Olabisi, Brooke Drenowatz, Kevin Knight","doi":"10.1177/11786329261480925","DOIUrl":"https://doi.org/10.1177/11786329261480925","url":null,"abstract":"<p><p>Older adults with complex health and social needs are frequently referred to community-based services, yet follow-through remains low. Motivational barriers and misalignment with personal values may undermine engagement. This qualitative descriptive pilot study explored barriers to referral uptake and the role of relational engagement within the Age-Friendly Integrative Mobile Services (AIMS) model, using thematic analysis of field notes from a pilot implementation. Seven adults aged ≥65 in Tarrant County, Texas received in-home assessments and referrals across five domains. Quantitative measures included Mini-Cog, TUG, PHQ-9, and the Older People's Quality of Life scale. Field notes were thematically analyzed. Participants had substantial needs-43% screened positive for cognitive impairment, 67% had mobility limitations, and all reported depressive symptoms-yet uptake was limited. Barriers included mistrust, emotional fatigue, and preference for independence. Despite this, participants deeply valued the interpersonal experience, emphasizing the importance of being visited, heard, and treated with respect. Findings support integrating a Values Support Specialist to build trust and align care with personal values.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"19 ","pages":"11786329261480925"},"PeriodicalIF":2.1,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13487107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do Compressed Work Schedules Compromise Care Quality? A Five-Year Case Control Study in the Norwegian Long-Term Care Sector.","authors":"Vilde Hoff Bernstrøm, Mari Ingelsrud, Anne-Marthe Rustad Indregard, Karoline Seglem","doi":"10.1177/11786329261471203","DOIUrl":"https://doi.org/10.1177/11786329261471203","url":null,"abstract":"<p><strong>Background: </strong>In a compressed work schedule, employees work extended shifts (≥10 hours) in exchange for fewer workdays. This shift schedule has been argued to both improve and compromise the quality of care. However, existing research remains limited and inconclusive.</p><p><strong>Objective: </strong>To assess whether extended shifts within compressed work schedules impact the risk of adverse outcomes among care recipients.</p><p><strong>Design: </strong>Quasi-experimental case control study.</p><p><strong>Method: </strong>We combined a nationwide organizational survey from 1,072 long-term care institution in Norway with registry data on service users from 2018-2022. At baseline, all participating organizations operated either a two-shift rotation (day/evening) with fixed night workers or a three-shift rotation (day/evening/night). The intervention group comprised organizations (n=320) that introduced a compressed schedule during the study period; the control group retained their existing shift rotations. Using difference in difference with multiple treatment times we analysed changes in proportion of service users within each organization experiencing at least one adverse outcome per month. Adverse outcomes were identified via diagnostic codes from the Norwegian Registry for Primary Health Care, including infections, chronic ulcers, accidents, and depression.</p><p><strong>Results: </strong>Overall, we found no difference in the risk of adverse outcomes (b -0.46, 95% CI -0.97 to 0.05). Stratified analyses indicated a significant reduction in adverse outcomes in nursing homes (b -0.79, 95% CI -1.48 to -0.10). However, we found no significant change in residential care (b 0.20, 95% CI -1.11 to 0.70) or home care (b -0.42, 95% CI -1.20 to 0.36).</p><p><strong>Conclusion: </strong>The findings neither discourage the use of compressed work schedules due to adverse outcomes nor indicate broad improvements. However, the results suggest potential context-specific benefits that warrant further investigation.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"19 ","pages":"11786329261471203"},"PeriodicalIF":2.1,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13487131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Women's Intention to Maintain Enrollment in Community-Based Health Insurance: A Multilevel Analysis in the Sidama Region, Southern Ethiopia, 2024.","authors":"Kare Chawicha Debessa","doi":"10.1177/11786329261479413","DOIUrl":"https://doi.org/10.1177/11786329261479413","url":null,"abstract":"<p><strong>Background: </strong>Community-based health insurance (CBHI) is essential for improving access to affordable healthcare and protecting vulnerable populations from catastrophic health expenditures in developing countries such as Ethiopia. Ensuring continued membership in CBHI is critical to maintaining these benefits and sustaining the financial viability of the scheme. Therefore, this study examined factors associated with women's intention to continue membership in CBHI in Sidama National Regional State, Ethiopia, in 2024.</p><p><strong>Methods: </strong>A community-based cross-sectional study was conducted among 640 women enrolled in CBHI. A pretested structured questionnaire was utilized to conduct face-to-face interviews using the Open Data Kit (ODK) mobile devices. Multilevel logistic regression analysis was employed to assess both individual and community-level factors of women's intention to maintain membership. The 95% confidence intervals (CIs) and p-values less than 0.05 were used to determine the association between the dependent and independent variables.</p><p><strong>Results: </strong>The analysis showed that women living in high-literacy communities had 3.27 times higher odds of intention to continue CBHI membership compared to those in low-literacy areas (AOR = 3.27, 95% CI: 1.02-10.51). Likewise, women perceiving CBHI as improving the quality of care were 4.22 times more likely to intend to continue membership (AOR = 4.22, 95% CI: 2.45-7.28). Additionally, perception of the premium as fair (AOR = 2.20, 95% CI: 1.10-4.43) and transparency in CBHI decisions (AOR = 1.87, 95% CI: 1.06-3.28) were positively associated with the odds of intention to remain in CBHI membership. Furthermore, each additional health facility visit was associated with increased odds of intention by 28% (AOR = 1.28, 95% CI: 1.03-1.59), and higher healthcare satisfaction was also associated with increased intention to continue CBHI membership (AOR = 1.17, 95% CI: 1.02-1.34).</p><p><strong>Conclusion: </strong>Both community-level literacy and individual-level factors, particularly perceptions of quality of care, fairness of premiums, transparency, frequency of health facility visits, and satisfaction, were associated with women's odds of intending to remain in CBHI membership. Policy efforts that strengthen service quality, promote transparent governance, and enhance community literacy may support sustained CBHI membership and contribute to more resilient health financing systems in Sidama, Ethiopia.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"19 ","pages":"11786329261479413"},"PeriodicalIF":2.1,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13487108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adapting to an Ageing Health Workforce: Alternative Versus the Standard Ageing of Physicians and Nurses in Czechia.","authors":"Filip Čábela, Tereza Patáková, Luděk Šídlo","doi":"10.1177/11786329261477828","DOIUrl":"https://doi.org/10.1177/11786329261477828","url":null,"abstract":"<p><strong>Background: </strong>This article examines the demographic ageing of physicians and nurses in Czechia between 2012 and 2022, a critical issue amid widespread healthcare professional shortages across Europe. The study applies standard and alternative indicators of demographic ageing to working life tables to identify trends and intensity in the ageing structure of the Czech healthcare workforce.</p><p><strong>Methods: </strong>Aimed at analysing the intensity of the ageing and attrition of healthcare professionals in the system, single-decrement working life tables were constructed employing individual anonymised data obtained from the largest Czech health insurance company, which has concluded contracts with practically all the country's healthcare providers. Standard and alternative indicators of demographic ageing were subsequently applied to the working life tables in an adapted form (e.g. the constant prospective age, ageing index, etc.).</p><p><strong>Results: </strong>In addition to the most important finding that the healthcare workforce in Czechia is ageing, the results highlight that nearly one-third of female physicians in outpatient care (OC) had only 10 years of working life remaining in the period 2020-2022. A similar situation was observed concerning nurses across all three monitored intervals within the studied period. Overall, the healthcare system has failed to respond to the ageing of large older cohorts either by extending their professional careers or, more importantly, through generational renewal.</p><p><strong>Conclusions: </strong>Alternative aging indicators reveal that the demographic aging of the Czech health workforce is highly heterogeneous, with nurses posing a more critical threat than physicians due to their lower participation in the workforce after reaching retirement age. Standard workforce planning methods fail to capture these shifting retirement thresholds and dynamics between inpatient and outpatient care. To prevent personnel shortfalls, healthcare policymakers must transition from generic recruitment strategies to creating age-friendly working environments that prolong the professional careers of aging healthcare staff.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"19 ","pages":"11786329261477828"},"PeriodicalIF":2.1,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148758435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceived Health Risk of Climate Change and Public Support for Sustainable Health Policies in South Korea.","authors":"D W Hosmer, Seung-Sik Hwang","doi":"10.1177/11786329261477832","DOIUrl":"10.1177/11786329261477832","url":null,"abstract":"<p><strong>Background: </strong>Climate change poses significant health threats globally, while healthcare systems contribute substantially to greenhouse gas emissions. Understanding public support for sustainable healthcare policies is crucial for policy implementation. This study examined the association between climate change health risk perception and support for sustainable healthcare policies in South Korea after accounting for general climate change concern and relevant covariates.</p><p><strong>Methods: </strong>A national cross-sectional online survey was conducted among 1,500 Korean adults aged ≥19 years from August 29 to September 7, 2022. Participants were recruited from an online research panel using stratified proportionate quota sampling based on the national distributions of gender, age, and region. Binary logistic regression models were used to examine associations between perceived health risk from climate change and support for six sustainable healthcare policies, with adjustment for climate change concern and relevant demographic, socioeconomic, health-related, and household covariates.</p><p><strong>Results: </strong>A majority of the public supported all six sustainable healthcare policies. After adjusting for covariates, higher perceived health risk from climate change was significantly associated with support across all policy domains. The strongest association was observed for Eco-friendly Dietary Options (adjusted odds ratio [aOR] = 1.67, 95% confidence interval [CI] = 1.42-1.96), whereas the weakest association was observed for Telemedicine Services (aOR = 1.26, 95% CI = 1.09-1.47).</p><p><strong>Conclusions: </strong>Perceived health risk from climate change was independently associated with public support for sustainable healthcare policies in South Korea. These findings suggest that framing healthcare decarbonization initiatives in terms of health protection and co-benefits may offer an additional communication approach alongside environmental framing.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"19 ","pages":"11786329261477832"},"PeriodicalIF":2.1,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13462497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148722054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Satisfaction With Sexual and Reproductive Health Services and Associated Factors Among Women Visiting Public Health Facilities of Kembata Zone, Ethiopia.","authors":"Desta Erkalo Abame, Mihiret Mengistu, Dawit Sullamo","doi":"10.1177/11786329261477495","DOIUrl":"10.1177/11786329261477495","url":null,"abstract":"<p><strong>Background: </strong>Client satisfaction is a key measure of healthcare quality with direct implications for service utilization and health outcomes. Despite its importance, evidence on women's satisfaction with sexual and reproductive health (SRH) services and their determinants remains limited in Ethiopia. This study aimed to assess the level of satisfaction with SRH services and associated factors among women attending public health facilities in Kembata Zone, Central Ethiopia.</p><p><strong>Methods: </strong>A facility-based cross-sectional study was conducted among 569 women attending public health facilities in Kembata Zone, recruited using simple random sampling. Data were collected through exit interviews, entered into EpiData 3.1, and analyzed using SPSS 23. Bivariable and multivariable logistic regression analyses were performed to identify factors associated with women's satisfaction. Statistical significance was declared at p < 0.05, and the strength of association was measured using AOR with 95% CI.</p><p><strong>Results: </strong>The overall women's satisfaction with SRH services was 79.2% (95% CI: 72.1-84.5). Women with college-level education or above (AOR = 2.51, 95% CI: 1.10, 5.74), clinical staff showed respect (AOR = 1.62, 95% CI: 1.02, 2.53), and waiting time 30-60 minutes AOR = 0.38, 95% CI: 0.17, 0.86) were significantly associated factors.</p><p><strong>Conclusion: </strong>Women's satisfaction with SRH services was below the national target. Educational status, respectful care by clinical staff, and waiting time were the key determinants of satisfaction. Interventions should focus on training healthcare providers in respectful, person-centered care, reducing waiting times through efficient service organization, and targeting women with lower educational attainment to improve overall SRH service satisfaction.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"19 ","pages":"11786329261477495"},"PeriodicalIF":2.1,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13462633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148722537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the Clinic: How Stroke Survivors Navigate Secondary Prevention Through Situated Agency.","authors":"Charlotte Lee, Hilary Hwu, Shoilee Khan, Lucy Frankel, Raza Noor, Amy Y X Yu, Seema Marwaha, Gustavo Saposnik, Moira K Kapral, Manav V Vyas","doi":"10.1177/11786329261477856","DOIUrl":"10.1177/11786329261477856","url":null,"abstract":"<p><strong>Background: </strong>Secondary stroke prevention is critical to reduce recurrent strokes; however, stroke survivors' real-world engagement with secondary preventive care remains poorly characterized.</p><p><strong>Methods: </strong>We conducted a qualitative study to understand the barriers and facilitators faced by stroke survivors in the Greater Toronto Area, Canada. Adult stroke survivors with low or moderate disability, who had a first-ever stroke in the year prior, were recruited from five stroke prevention clinics. Semi-structured interviews were conducted in three different languages. Recordings were transcribed, and the transcripts were coded and analyzed using interpretive descriptive methodology. We compared experiences by immigration status during coding; overlapping patterns led us to present integrated themes and note where intensity differed.</p><p><strong>Results: </strong>Twenty-five stroke survivors (40% women, mean age 70.3 years) were interviewed. We demonstrate how actions typically framed as patient behaviour were shaped by, and in turn shaped, broader structural and relational conditions, which we interpret through the lens of situated agency. We identified seven core themes: (1) Self-reliance as a default mode of recovery; (2) Gaps in understanding of stroke risk and prevention; (3) Barriers to engaging in preventive health behaviours; (4) Intersectional vulnerability in system navigation; (5) Family and social networks: source of strength or silent gaps; (6) Structural assumptions about self-management; (7) Desire for dignity and agency.</p><p><strong>Discussion: </strong>Stroke survivors' engagement with stroke preventive care is shaped by external circumstances and the ways they act within and respond to their contexts. Using a situated agency framework to design interventions could improve engagement and reduce stroke recurrence.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"19 ","pages":"11786329261477856"},"PeriodicalIF":2.1,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13462630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148720318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental Health Status Among Healthcare Professionals in a Master of Public Health Program at a Higher Education Institution in Bangladesh: A Cross-Sectional Study.","authors":"Bilkis Banu, Nasrin Akter, Nusrat Hossain Sheba, Md Allama Faysal, Nigar Sultana, Md Jiaur Rahman","doi":"10.1177/11786329261477830","DOIUrl":"10.1177/11786329261477830","url":null,"abstract":"<p><strong>Background: </strong>Healthcare professionals pursuing higher education experience psychological distress due to combined professional and academic pressures. However, evidence regarding their mental health status in Bangladesh is limited. This study aimed to assess depression, anxiety, and stress among healthcare professionals enrolled in a Master of Public Health program in Bangladesh.</p><p><strong>Methods: </strong>This cross-sectional study involved 280 healthcare professionals engaged as public health students at a private university in Dhaka, Bangladesh. Demographic, clinical, organizational and mental health related data was collected using an online self-administered questionnaire. Mental health status was assessed by DASS-21 Scale. Regression analyses were performed to examine relationships between outcome and exposure variables.</p><p><strong>Results: </strong>The results showed that 26.4% of respondents were depressed, 35.4% were anxious, and 16.4% were stressed. Depression was significantly higher among single individuals (AOR, 4.06; 95% CI 1.69-9.69; P=0.01), younger respondents (AOR, 2.48; 95% CI 1.23-5.04; P=0.01), those with smaller families (AOR, 2.91; 95% CI 1.51-5.59; P=0.01), and those with comorbidities (AOR, 2.49; 95% CI 1.34-4.62; P=0.01). Anxiety was more prevalent in females (AOR, 3.12; 95% CI 1.29-7.52; P=0.01), singles (AOR, 2.64; 95% CI 1.10-6.35; P=0.03), and had ≤1 child (AOR, 1.90; 95% CI 1.06-3.41; P=0.03) and those comorbidities (AOR, 2.49; 95% CI 1.34-4.62; P=0.01). Stress was higher in younger individuals (AOR, 2.89; 95% CI 1.27-6.63; P = 0.01), those with smaller families (AOR, 2.23; 95% CI 1.09-4.59; P=0.03), and those with comorbidities (AOR, 2.46; 95% CI 1.26-4.79; P=0.01).</p><p><strong>Conclusion: </strong>A substantial prevalence of depression, anxiety, and stress was observed among healthcare professionals. Depression was associated with single, younger age, smaller families, and comorbidities. Anxiety was linked to female, single, having ≤1 child, and comorbidities, while stress related to younger age, smaller families, and comorbid conditions. The findings highlight the need for mental health screening, counseling, and awareness programs for healthcare professionals and public health students.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"19 ","pages":"11786329261477830"},"PeriodicalIF":2.1,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient and Attendant Satisfaction With Services at Medical College Hospital in Bangladesh: A Cross-Sectional Survey.","authors":"Amit Bhowmick, Sumaiya Tohfa Afindi, Suchandana Rani","doi":"10.1177/11786329261477455","DOIUrl":"10.1177/11786329261477455","url":null,"abstract":"<p><strong>Background: </strong>Patient satisfaction is a key indicator of healthcare quality, particularly in resource-constrained public health systems. Despite growing evidence on healthcare service quality in Bangladesh, comprehensive assessments incorporating both patients and attendants remain limited. This study evaluated satisfaction with healthcare services at Sylhet MAG Osmani Medical College Hospital using the SERVQUAL framework.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted among 400 respondents, including 167 patients and 233 attendants, selected through multi-stage cluster sampling. Data were collected using a structured questionnaire measuring five SERVQUAL dimensions: tangibility, reliability, responsiveness, assurance, and empathy. Descriptive statistics, independent-samples t-tests, chi-square tests, and binary logistic regression were employed for data analysis.</p><p><strong>Results: </strong>Reliability and assurance received the highest ratings, particularly accurate diagnosis (mean = 3.96), reliable test results (mean = 3.99), and confidence in specialist doctors (mean = 4.07). In contrast, tangibility recorded the lowest ratings, with 74.6% dissatisfied with bed availability and 70.3% dissatisfied with seating arrangements. Empathy scores revealed concerns regarding equitable care, especially for poor patients (mean = 2.22). Independent-samples t-tests showed no significant differences between patients' and attendants' perceptions across SERVQUAL dimensions or overall satisfaction. Logistic regression identified assurance (OR = 6.86), empathy (OR = 4.64), tangibility (OR = 2.47), and responsiveness (OR = 2.08) as significant predictors of overall satisfaction, whereas reliability was not significant. Age, education, profession, and frequency of hospital visits were associated with satisfaction, while gender and income were not.</p><p><strong>Conclusions: </strong>Interpersonal aspects of care, particularly assurance and empathy, are the strongest determinants of satisfaction in a public medical college hospital in Bangladesh. Although respondents expressed confidence in healthcare providers, substantial deficiencies in infrastructure and perceived inequities in care for vulnerable populations remain. Addressing these gaps is essential for improving patient-centered service delivery and healthcare quality in public hospitals.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"19 ","pages":"11786329261477455"},"PeriodicalIF":2.1,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}