Abstract
Background:
Patient-centred care (PCC) is a form of care that focuses on the disease and the disease process and on the patients’ experience of the illness, shared decision-making, and the psychosocial context to improve care outcomes. PCC is greatly beneficial for patients as it improves population health outcomes and individual health outcomes. The lack of information surrounding chiropractic patients’ perspectives and attitudes concerning PCC makes it difficult for chiropractic education and practitioners to ensure that their care is patient-centred and whether patients prefer patient-centred care above doctor-centred care.
Aim:
The study's primary aim was to determine the patients’ attitudes toward patient-centred care receiving chiropractic care at the University of Johannesburg Chiropractic Day Clinic using the Patient-Practitioner Orientation Scale (PPOS). The secondary aim was to measure the internal consistency using Cronbach's alpha to ensure the reliability of the PPOS in this context.
Research Methodology:
This study was a cross-sectional, quantitative anonymous research study using the PPOS, completed by patients in the University of Johannesburg Chiropractic Day Clinic following treatment. Follow-up questions have been added to the PPOS to assess whether the patient experienced their chiropractic treatment as patient-centred or doctor-centred. All the respondents participated voluntarily in the research and were invited to complete the questionnaire after receiving follow-up treatment. Patients completed the online 18-item PPOS on an iPad using Google Forms in a private consultation room, which took about 15 minutes.
Results and Discussion:
One hundred eighty-three (n=183) follow-up chiropractic patients participated in this research (31.4% response rate). Results associated with the attitudes of agreement and/or disagreement expressed by the patients were represented in bar graphs under each particular question from the PPOS. This allows for an in-depth understanding of the patient’s attitude regarding patient-centred care.
The results concluded a statistically significant difference between the attitudes toward patient-centred care between males and females (p=0.021). Age (p=0.400) and ethnicity (p=0.574) indicated no statistically significant differences between the mean scores of the two groups. Overall, the scores of the PPOS indicated that the female group showed a more positive tendency towards PCC when compared
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to males. Certain trends were noticed in the individual question of the PPOS based on age and ethnicity, even though there was no significant difference between the mean scores of the two demographic groups. These questions are mentioned and discussed in Chapters 4 and 5.
The internal consistency for both the Sharing and Caring subcategories was low, with a Cronbach’s alpha value of 0.566 and 0.369. Consequently, the PPOS indicated unsatisfactory reliability when used on our sample. Exploratory factor analysis suggested that the instrument does not achieve the Sharing and Caring factors in the sample size of this study, and the reliability is low for those factors.
Conclusion and Recommendations:
Patients receiving treatment at the University of Johannesburg Chiropractic Day Clinic showed a positive tendency towards PCC overall. The results found a stronger preference for PCC in the Caring subcategory and a small inclination towards doctor-centred care in the Sharing subcategory. There were indications that the female group showed a higher preference for PCC than males. In contrast, age and ethnic background did not significantly affect the patients’ attitudes. The additional questions added to the original PPOS showed that the patients experienced their chiropractic treatment to be very much patient orientated.
The PPOS showed poor reliability in the context of our study, indicating that the original PPOS may not be the most suitable measuring tool to use. Further development and changes to the PPOS are necessary to investigate the attitudes of PCC in similar contexts.
Keywords
Patient-practitioner Orientation Scale, patient-centred care, chiropractic.