Patients' Perceptions of Person-Centred Care in Audiology: A South African Cross-Sectional Survey

Blasl, Danielle

Patients' Perceptions of Person-Centred Care in Audiology: A South African Cross-Sectional Survey

Master Thesis

2022

Abstract

Background: Person-centred care (PCC) has gained momentum over recent years as essential in the practice of health care. This is largely due to research documenting the benefits of PCC to both patients and practitioners. PCC ensures that patients receive care that respects and accounts for their needs and preferences as individuals. However, until now studies have focused mainly on PCC from the audiologists' point of view; with few exploring the perceptions of PCC (P-PCC) held by patients, particularly within a South African context. One reason for this may be due to the variability around the definition of PCC among professionals. Subsequently, no universal tool to measure P-PCC and its underlying concepts exists, much less one that is suitable for a South African context. Developing and implementing a tool to measure South African audiology patients' perspectives of PCC (PP-PCC), will not only address this paucity in literature, but further inspire PCC strategies which could lead to improvement in clinical practice and quality of care. Aims: 1) To create a tool to assess PP-PCC in a South African audiology context; 2) Determine PP-PCC across 5 dimensions (i.e., communication, shared decision-making, audiologist-patient relationship, provision of individualized care, and holistic care); and 3) Determine associations between PP-PCC and patient characteristics (i.e. age; sex; level of education; socioeconomic status; number of previous consultations; frequency of consultations; public vs. private; nature of consultation; presence of hearing loss; use of amplification; in-patients vs. out-patients). Method: The Patient-and-Audiology-Reported Inventory (PARI) was adapted from the previously validated Patient-and-Dietician-Reported Inventory (PADRI) to an audiological context. To remain inclusive to the South African population, the PARI was translated into Afrikaans and IsiXhosa. A quantitative validation study was conducted using suggested translation and cross-cultural adaptation guidelines proposed by Gjersing, Caplehorn, and Clausen (2010). A group of six validators which consisted of audiology lecturers, researchers, clinicians, and audiology patients validated the PARI and its translated versions using the content validity index (CVI). Once validated a quantitative, descriptive, cross-sectional survey design was carried out using the PARI and a short self-developed demographic questionnaire. The PARI was distributed via electronic, telephonic, face-to-face and paper-based mediums. The initial target sample size was 150 participants, with an inclusion criterion of South African adults, who were able to communicate in English, IsiXhosa or Afrikaans and had attended at least one audiology consultation in South Africa within three months of participation in the study. Participants were purposely sampled, and recruited via advertisements on social media and in patient waiting rooms. Due to hindrances to data collection from the COVID-19 pandemic, the time-frame in which a participant had to have consulted an audiologist was revised to one year. After a year of data collection, a total sample size of 111 participants was obtained. Results: Data analysis employed a mixed methods (i.e. descriptive and inferential) approach to analyse the data, using Stata version 17. The final PARI consisted of 28-items, with CVI analysis indicating appropriate validity at both an item and scale level. Using the responses of 111 participants, the PARI was found to display excellent internal consistency (α = 0.95). Significant differences in scores were initially associated with patients' healthcare sector; in-patient versus out-patient status; age; education level; employment status; frequency of audiological consultations; nature of consultations; hearing loss status; and use of amplification. However, associations between scores and all patient characteristics were no longer statistically significant when scores were adjusted for the influence of healthcare sector (i.e. public vs. private) on PP-PCC. Patients from the private health sector displayed significantly more positive P-PCC than those from the public health sector. Nonetheless, scores from the PARI suggested that South African audiology patients generally held positive P-PCC and its five underlying dimensions. Conclusions: The newly developed PARI has shown to be a valid and reliable tool to measure the P-PCC among South African audiology patients. South African patients generally held a positive PPCC and its underlying dimensions however, disparities were observed among PARI scores between audiology patients from public and private healthcare sectors. This exhibits the stark differences in participant characteristics between the two sectors. This study has provided a foundation for addressing the paucity in PCC literature in South African hearing healthcare. Therefore, future research should focus on using the PARI as a self-reflection tool among practitioners, and an outcome measurement tool for PCC intervention strategies. Moreover, closer investigation between healthcare sectors is needed, especially in developing countries like South Africa.

Keywords

Audiology

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