|Year : 2013 | Volume
| Issue : 3 | Page : 177-180
Perception and experiences of a tribal community on health-care provider-patient communication
M Shyami Tarao1, H Sanayaima Devi2, K Shantibala2, Sangzuala2, Usha Devi Thounaojam2
1 Department of Community Medicine, JNIMS, Imphal, Manipur, India
2 Department of Community Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
|Date of Web Publication||19-Feb-2014|
H Sanayaima Devi
Department of Community Medicine, Regional Institute of Medical Sciences, Imphal - 795 004, Manipur
Source of Support: None, Conflict of Interest: None
Objective: The objective of this study was to assess the perception and experiences of a tribal community on health-care provider-patient communication and to find out the association between patients' place of seeking health-care and their socio-demographic characteristics. To see any differences between the government and private health-care providers in explaining treatment options and helping in their decision making. Materials and Methods: A cross-sectional study was conducted between September 2008 and February 2010 at Komlathabi area of Chandel District, Manipur. All the eligible subjects were interviewed by using a structured questionnaire. An informed verbal consent was obtained from the participants before collecting the data. Results: Out of 1947 population above 18 years, 1800 completed the interview. A total of 1679 respondents had an illness in their families in the past 1 year. Older people above 60 years, illiterate and unemployed persons went to government health center more than home/private clinic (P = 0.001) when they got sick. More than half of the respondents (58.8%) were not explained of the treatment option with benefits and risks involved. Nearly, 76.3% of the respondents perceived that they should be involved in making a decision for the treatment and nearly 64% of them felt that health-care provider should not see patients at home or private clinics. The majority of government health-care providers (70.3%) did not explain about the treatment option to their clients and also did not take patients' opinion while arriving at treatment option (66.5%), which was found to be statistically significant. Conclusion: Private health-care providers explained more to their patients about the treatment options with the benefits and risks involved, and took patient's opinion while arriving at treatment option than the government health-care providers. Therefore, it is necessary to develop a good communication skill among all the physicians, more so among public sectors.
Keywords: Experience, Communication, Cross-sectional, Health-care provider, Perception
|How to cite this article:|
Tarao M S, Devi H S, Shantibala K, Sangzuala, Thounaojam UD. Perception and experiences of a tribal community on health-care provider-patient communication. J Med Soc 2013;27:177-80
|How to cite this URL:|
Tarao M S, Devi H S, Shantibala K, Sangzuala, Thounaojam UD. Perception and experiences of a tribal community on health-care provider-patient communication. J Med Soc [serial online] 2013 [cited 2020 Oct 20];27:177-80. Available from: https://www.jmedsoc.org/text.asp?2013/27/3/177/127387
| Introduction|| |
Communication can be regarded as a two-way process of exchanging ideas, feelings, and information. The patient comes unbidden to a doctor and enters voluntarily into a contract in which he agrees to follow the doctor's advice. By virtue of his technical superiority, knowledge and skill, the doctor exercises an authoritative role, and issues orders to his patient. 
Communication is a core skill for physicians, yet many patients have difficulty understanding what physicians tell them. Poor health literacy and lack of understanding of written and oral health communication may lead to difficulties in navigating the health-care system. Such patients report worsening health status about their medical condition. 
An effective medical interview elicits information about the patient's health situation. Patient's participation meets their needs and preferences. When a doctor and patient share understanding, compliance is likely to be high and health outcomes improve. 
Physician-patient communication has shown that effective communication and active patient participation in making decisions about treatments can influence a patient's satisfaction, quality of life and treatment outcome. Insufficient communication may compromise a patient's ability to participate in making decisions about treatment. 
The tussle between health-care provider and patients could owe to lack of proper communication. Hence, it is very much essential to understand the patient's perception regarding health-care communication. Hence, this study is contemplated to assess the perception and experience of a tribal community on health-care provider-patient communication.
| Materials and Methods|| |
This cross-sectional study was conducted in the Komlathabi/Kapaam area of Chandel District, Manipur from September 2008 to February 2009. It is about 52 km from Imphal, which has 490 households. Any person residing in the village for the last 12 months and who had an illness during the last 1 year was included in the study.
For those who were 18 years and above, verbal informed consent was taken and a face to face interview was conducted by using a structured interview schedule, which contained socio-demographic characteristics, place of their treatment, questions pertaining to their perceptions, and experiences of the health-care providers' communication. When that person was not available or when he/she was not able to respond, then any adult from that family who had accompanied the sick person to the health-care provider was interviewed.
For those who were below 18 years old, the interview was taken from the adult accompany the sick child using the same interview schedule. In the absence of illness in a family, only the general questions of the interview schedule was asked to any of the available adult in the family. Those individuals who could not be contacted after two successive visits and who refused to give consent were excluded from the study.
Statistical Package for the Social Sciences (SPSS) version 16 was used for the data entry after making a master chart. Descriptive statistic like percentages was employed to describe the perception and experiences of the community on health-care provider-patient communication. Chi-square was used for the analysis and a P value of lesser than 0.05 was considered as statistically significant.
Ethical approval was obtained from the Institutional Ethics Committee, Regional Institute of Medical Sciences, Imphal before the beginning of the study.
| Results|| |
Altogether there were 1947 persons who were above 18 years in the study area, out of which 105 persons were excluded as they could not be contacted and 42 of them were refused to participate. Hence, we could get information from 1800 respondents. A total of 1679 respondents had an illness in their families in the past 1 year. Around 53% of the respondents were female. More than half (54%) were in the age group of 31-60 years. The majority were literate with more than half above class X standards. Most of the respondents were unemployed with only 21.6% employed.
[Table 1] shows the perception and experiences of the respondents on health-care providers' communication. More than ninety percent of the respondents perceived that the health-care providers greeted them when they came for consultation, gave time to express, and to clarify their queries. Maximum of the respondents (87%) were satisfied with the conversation and 1615 (96.2%) were given a demonstration on how to take medicines which they were able to understand. Only 27.3% of the persons who had an illness in the last 1 year knew about their illness from the health-care providers. More than half of the respondents (58.8%) were not explained about the treatment options available with the benefits and risk involved and only a few of them (32.7%) were taken their opinion while giving treatment.
|Table 1: Perception and experiences of the respondents on HCP communication (N = 1679*)|
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Majority of the respondents 1374 (76.3%) felt that it was necessary for them or their family members to be a party in making a decision for treatment. Around 63% (1129) of them did not like their information to be revealed to others without their consent. 73.1% did not like to change health-care provider frequently and 64% of them felt that health-care provider should not see patients at home or private clinics.
[Table 2] reveals that older people above 60 years old, illiterate, and unemployed went to the government health center more than the home/private clinics, which were found to be statistically significant. However, gender has no association with their place of treatment. [Table 3] shows that the majority of the participants were not explained about the treatment options with the benefits and risks involved by the government health-care provider as compared to the private health-care provider, which was found to be statistically significant (70.3% vs. 29.7%). Although arriving at treatment option, private health-care provider took participant's opinion more than the government health-care provider did, which was also found to be significant.
|Table 2: Association between respondent characteristics and place of treatment|
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|Table 3: Respondent's experience in taking treatment decision by the type of health-care provider|
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| Discussion|| |
Doctor-patient communication is considered an important marker of health-care quality, understanding the patients' perspective, giving information, and decision making.
In our study, the female respondents were found to be more than the male participants; this could be because of availability at home since many of them are housewives. Moreover, most of the mothers accompanied their children for treatment more than the male. This was also observed in other studies. ,, Majority of the respondents (65%) visited government health center and this was because of the primary health sub-center in the study area where a medical officer was posted. Another reason may be because the government health center is cheaper than the private health center.
Most of the health-care providers greeted the respondents when they came for consultation, gave time to express and to clarify their queries. The clinicians should be careful not to be judgmental when patient come for consultation as this might rapidly close down communication.  Around 96% of them were shown how to take medicine by the health-care provider. This could lead to adherence to medication. It was found that patient's beliefs and preferences about the medicines prescribed may affect medication adherence.  More than half of the respondents were not explained of the treatment options, benefit, and risks as well. Not explaining of the treatment option was negatively associated with the patient outcomes. 
In the present finding, 73% did not like to change their health-care provider frequently. Providing better health-care and especially maintaining constant patient-physician communication improves the patient satisfaction.  It was observed that half of the rural population had seen the same physician for more than 5 years.  Longer continuity of care was associated with greater patient satisfaction and confidence. Majority of them thought that it is not good for the health-care provider to see the patient at home/private clinic as they neglected patients in the hospital. One-third of them opined it was good as they could not attend OPD in the hospital and they could also consult at any convenient time. More than half of them responded that health care provider did services to humanity and 24.3% felt the health-care providers of these days are after money. Consultations of these days were more task-oriented and businesslike than 16 years earlier. 
This study revealed that older people who are above 60 years, illiterate, and unemployed went to the government health center more than the home/private clinics (P = 0.001). A similar result was reported by Lakatos.
More than half of the participants were explained about the benefits and risks involved including treatment option by the government health-care provider more than the private health-care provider. These were a statistically significant. The reason could be the mutual co-operation between the respondents and government health-care provider in the present area. It was very important for physicians to reduce the magnification of symptoms by explaining the disease, offering available treatment option and possibly engaging the patient family or close friends. 
| Conclusion|| |
The present study concluded that older, illiterate, and unemployed people went to the government health center more than the home/private health center. However, private health-care providers explained more to their patients about the treatment options with the benefits and risks involved than the government health-care providers. They also took respondents' opinion more while arriving at treatment option. To achieve this holistic goal, all the physicians both in public and private sectors should acquire the understanding and skill of communication through well-organized seminars and workshops.
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[Table 1], [Table 2], [Table 3]