Patients’ views on health promotion and disease prevention services provided by healthcare workers in a South African tertiary hospital

The Health Promotion Provision assessment (HPPA) is a good tool for assessing the view of patients regarding the quality of health care services received from various groups of HCWs. We used it to assess the HP and DP services provided by the different HCW groups in three phases of patient care: pre-admission phase, admission phase, and post admission phase. Patients’ assessment of HCWs’ HP and DP performance were influenced by their experiences from the HCWs. Consistent with existing studies, our data show that patients received HP and DP services from HCWs mostly during the PAP and ADP [33‐37], while the least of such services were received in the POP [38]. As observed in other studies [39‐41], our study revealed that medical doctors had the greatest positive HP and DP influence on patients at both the PAP and ADP, while nurses influence was greatest at the POP .

In the PAP, our results showed that majority (greater than 50%) of patients seen by the various cadres of HCWs were adequately attended to across the statistically significant HP and DP services delivered. This finding may be related to the chosen study institution, in this case, a tertiary hospital. A tertiary hospital is a specialist centre [42] where patients with special needs beyond the care of the primary and secondary level hospitals are referred to. When patients with specific needs are seen by the appropriate specialists, chances are that they will receive the best care possible including HP and DP services. Although the rehabilitation health workers recorded a 100% response rate from patients regarding their role in educating patients on the importance of treatment compliance, this variable at PAP was not found to be statistically significant. Further in the PAP, greater number of patients were attended to by the medical doctors and nurses, and reasons for this may be due to the tailored needs of patients and a higher numerical staffing for these cadres of HCWs [29] compared to rehabilitation health workers in the hospital.

Again, in the PAP, patients’ satisfaction with HP services were 0.45 and 0.68 times lower by their interactions with nurses when compared to their interactions with medical doctors. Our findings corroborate with the results of Kalroozi, Dadgari, and Zareiyan [43] who reported 17.2% dissatisfaction of patients from nurses and only 8% dissatisfaction from medical doctors. The study of Karoozi et al. showed that high patients’ satisfaction with doctors was however demonstrated in the highly specialized wards of open-heart surgery. The current study, however, did not explore patients’ satisfaction at the specialized wards, and this warrants further exploration. Similarly, the study of Stump et al. 2019 [44] which showed that 90% of primary care physicians recommended HP and DP activities to their patients further supports our finding. Though our study’s finding shows that patients in the PAP were 1.12 times more likely to receive information concerning preventable diseases from the rehabilitation service staff compared to receiving it from medical doctors, this finding was not statistically significant, and search of the literature did not reveal a previous study to which this finding could be correlated. This finding can be explained in the light of the doctor – patient relationship which can be considered to be one of the most ethically significant dimensions of good medical care. It is during the interactions that constitute this relationship that information is shared, that choices get determined, that reassurances are provided, that decisions are made and, ultimately, that care is given, hence, the positive influence of medical doctors [45].

During the ADP, we found that patients’ empowerment to both manage and have good control over their health were 0.43 and 0.46 times less from their interactions with nurses when compared to their interactions with medical doctors. Although the contributions of all HCWs are strongly acknowledged and appreciated, during hospital admissions, patients believe that medical doctors have the final say regarding the quality of care they receive towards wellbeing. Further in the ADP, it was noted that patients ability to change their health behaviour for better was 1.79 times better from their interaction with nurses compared to medical doctors, this finding was however not statistically significant.

Results from the POP showed that nurses were more likely to influence better health behavioral change among patients compared to patients who were not attended to by any HCW. Further findings from the POP reveal that the influence from medical doctors, social workers, rehabilitation health workers, and dieticians was less likely to influence patients. This may be related to the minimal participation of these groups of HCWs in patients’ care once patients have been discharged. This minimal participation of certain groups of HCWs may be connected to the several challenges confronting the health department of the study area such as constrained human resources and infrastructure [46, 47]. At the POP, nurses were the only HCW group that positively influenced a HP/DP variable. This findings corroborate the study of Guzmán, Ferreira, and de Andrade (2020) which highlighted the important role nurses played through care networks in ensuring continuity of nursing services for discharged patients [48].

Although no study comparing HP and DP impact at the different phases was identified, most HP and DP services carried out at the primary healthcare centers are outpatient services (pre-admission phases). The WHO vision for primary healthcare in the 21st century recognizes HP and DP as a vital primary care responsibility in the delivery of comprehensive healthcare services [49]. Whilst some studies [50, 51] have attempted to explore the HP and DP services at primary healthcare, this study is distinctive in linking the HCWs HP and DP services at a tertiary level hospital with the accruing HP empowerment.

We also noted that two HP dimensions; ‘patients’ empowerment to manage their health’ and ‘patients’ empowerment to have good control over their health’ were the most recurrent variables. The former occurring twice in PAP and ADP, while the later dimension occurred twice in ADP and POP. The occurrence of both dimensions in the PAP and ADP may be related to most hospital outpatients and inpatients having risk factors [34] that are amenable to changes following their interactions with HCWs.