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Year : 2021  |  Volume : 10  |  Issue : 3  |  Page : 185-190

Chronic disease patients' satisfaction with primary health-care services provided by the second health cluster in Riyadh, Saudi Arabia

1 Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh; Health Informatic Lead of Community Health, Riyadh Second Health Cluster, Ministry of Health, Dammam, Saudi Arabia
2 Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia; Department of Community Health Nursing, Faculty of Nursing, Ain Shams University, Cairo, Egypt
3 Department of Public Health, College of Health Sciences, Saudi Electronic University, Dammam, Saudi Arabia; Department of Obstetrics and Gynaecology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
4 Department of Public Health, College of Health Sciences, Saudi Electronic University, Abha, Saudi Arabia
5 Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia

Date of Submission16-Sep-2021
Date of Acceptance05-Nov-2021
Date of Web Publication6-Dec-2021

Correspondence Address:
Mohammed AL-Mohaithef
Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjhs.sjhs_213_20

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Background: Having a high quality primary health-care (PHC) system leads to a more efficient health-care system, which lower rates of hospitalization and leads to better health outcomes. One of the main criteria for assessing the quality of PHC services is the assessment of patient satisfaction, so the study aims to assess the chronic disease patients' satisfaction with PHC services provided by centers. Methods: A descriptive cross-sectional study conducted on patients with chronic diseases who follow-up in PHC centers within the Second Health Cluster in Riyadh using a questionnaire to assess their satisfaction level. A total 210 patients with different chronic diseases from the seven PHC centers (30 patients from each PHC center) who agreed to participate were included in the study. Results: In the study, 126 (60%) participants were females and 96 (45.7%) participants were in the age group more than 50 years. The survey showed that patients were satisfied with services offered by physicians, nurses, laboratory, and pharmacy with weighted means (3.81, 3.54, 3.59, and 3.88, respectively), while they were not satisfied with waiting time and services offered by receptionists with weighted means (3.22 and 3.27, respectively). The patient satisfaction showed a significant association with gender and level of education (P = 0.003 and 0.005, respectively). Conclusions: The survey showed that patients with chronic diseases were satisfied with services provided by PHC centers of the Second Health Cluster in Riyadh except receptionists' services, appointments, and waiting time. This survey will guide the policymakers for improving the services provided at the PHC centers.

Keywords:  Chronic disease, chronic disorders, healthcare services, patients' satisfaction, primary healthcare, Saudi Arabia, second health cluster in Riyadh

How to cite this article:
Almezaal EA, Elsayed EA, Javed NB, Chandramohan S, AL-Mohaithef M. Chronic disease patients' satisfaction with primary health-care services provided by the second health cluster in Riyadh, Saudi Arabia. Saudi J Health Sci 2021;10:185-90

How to cite this URL:
Almezaal EA, Elsayed EA, Javed NB, Chandramohan S, AL-Mohaithef M. Chronic disease patients' satisfaction with primary health-care services provided by the second health cluster in Riyadh, Saudi Arabia. Saudi J Health Sci [serial online] 2021 [cited 2022 Jun 28];10:185-90. Available from: https://www.saudijhealthsci.org/text.asp?2021/10/3/185/331775

  Introduction Top

The disease pattern has changed from communicable to chronic diseases in Saudi Arabia. The chronic diseases have become highly prevalent and are posing a challenge to existing health-care services. This change in disease pattern resulted in insufficient primary health-care (PHC) services, which include patient follow-up strategies and health education activities.[1] There is a crucial need for the development of PHC services directed to patients with chronic diseases and people who are at high risk. Chronic disease refers to the long-term health disturbance that can be due to noncommunicable disease and need people to live and cope-up with this disruption.[2] In Saudi Arabia, hypertension, diabetes, obesity, heart diseases, and asthma are reported as the common chronic diseases.[3] Chronic diseases are the leading cause of death worldwide, and their impact on the health of the global population continues to increase, nearly 17 million people die each year from chronic diseases.[4] Chronic diseases are managed and handled by providers at PHC centers initially and then are managed at a higher level before transferring the patient to a tertiary care center.

Patient satisfaction is one of the key performance tools in evaluating the quality and continuity of health-care services in various institutions and settings.[5],[6] Satisfaction is defined as the function of the discrepancy among what is expected and what is really happening.[7] When providing high-quality services, it is essential for health-care providers to offer patient-centered care focusing on the medical and personal needs of the patient.[8],[9] Patient satisfaction plays a pivotal role in establishing a good relationship between the health-care providers and patients; it also determines the compliance rate.[10] Moreover, whenever the patient is satisfied with the services of the doctor, nursing, or follow-up services, it is an indication of the success of service providers and the extent to which they meet their patients' expectations.[11] Patients' satisfaction is usually measured by analyzing various factors that are reported by the patients. The researchers and the policymakers assess patients' satisfaction to implement new programs and policies to enhance the rate of satisfaction.[12]

The World Health Organization declared the PHC centers as the cornerstone to accomplish their goals through its statement Health for all in 1981. The PHC centers have essential public health roles by empowering the community health and taking action to promote health and facing the threats.[13] These PHC centers have a major responsibility in managing patients with chronic diseases.[14] The health law in the Kingdom of Saudi Arabia objectives to provide health care for all people within the country. The Saudi Ministry of Health (MoH) provides an integrated network of health-care services covering all regions of the Kingdom. In order to facilitate access to health services, the MoH launched health clusters in the Kingdom's regions. The health cluster is an integrated network of health-care providers under one administrative structure serving 1 million people and allowing mobility of medical professionals within the health cluster system and Second Health Cluster in Riyadh is one of such health clusters.[15]

The MoH in Saudi Arabia developed a plan to improve health information system (HIS) within all health-care organizations and facilities.[1],[16] The HIS is a valuable tool that monitors the dimensions of service quality at the health-care centers and checks the performance of health-care center by comparing the perceptions of services against the expected standards using the health management information system, which enhances the patient satisfaction rates.[17]

Most of previous review papers focused on the hospital-based medical care services, neglecting PHC services, which represent the first access level of care in the Saudi health-care system. The PHC sector provides essential health-care services for Saudi citizens and expatriates working in the public sector. No reform of the Saudi health-care system can be completed without first considering the PHC services.[1] A comprehensive PHC system leads to a more efficient health-care system, which lower rates of hospitalization. The aim of this study was to assess the chronic disease patients' satisfaction with PHC services provided by centers within the Second Health Cluster in Riyadh Saudi Arabia.

  Methods Top

Study design

The study design was a descriptive cross-sectional study.


The study was conducted at PHC centers within the Second Health Cluster in Riyadh; seven PHC centers were selected (Alsulimaniah, Alsahafa, Almoroj, Alyasmian, Iregah, Alwadi, and Almohamadiah) to be included in the current study.

Study population and sampling

The study used convenience sampling method to recruit the chronic disease patients visiting PHC centers between September 2018 and January 2019. A total of 210 chronic disease patients from the seven PHC centers (30 patients from each PHC center) who agreed to participate in the study were included into the study.

Inclusion criteria

Patients with chronic disease and agreed to participate in study were included in the study.

Exclusion criteria

Patients with disability and special needs were excluded from the study.

Data collection tools

The data collections were gathered using a questionnaire based on the previous literature.[3],[18],[19],[20] The questionnaire consisted of two parts: first part was concerned with demographic data related to patients and the second part was concerned with patients' satisfaction regarding services offered by PHC centers. The patients' satisfaction was assessed in six dimensions, which included services provided by physicians, nurses, receptionists, laboratory, pharmacy, and finally appointments and waiting time. The 5-point Likert response scale was used to rate the answers from 5 = strongly agree to 1 = strongly disagree; negative phrases are encoded inversely. The score for mean interpretation reference was strongly disagree 1–1.79; disagree 1.80–2.59; neutral 2.60–3.39; agree 3.40–4.19; and strongly agree 4.20–5. The cutoff point is equal to 3.39, so satisfied was acknowledged if the weighted mean is more than 3.39. In contrast, unsatisfied was acknowledged if the weighted mean is <3.39.

Validity and reliability

A pilot study was carried out on ten patients to evaluate the validity and reliability of the questionnaire to detect any ambiguity in the questionnaire, clarity of the items, as well as to determine the time consumed for data collection. The patients included in the pilot study were excluded from the study. Necessary modifications were carried out to develop the final form of questionnaire. Cronbach's alpha coefficient was used to measure the reliability of all the sections of the questionnaire, it was 0.745

Data analysis

The data were analyzed using the IBM Statistical Package for the Social Sciences (SPSS) for windows, version 20 (IBM Corp., New York, USA). For descriptive statistical analysis, frequencies and percentages were used for all variables included in the study to describe the demographic data, and the patients' satisfaction was explored by calculating mean and standard deviation. For inferential analysis, the Chi-square test was used to examine the association between demographic variables and patients' satisfaction. The P < 0.05 was considered statistically significant. The internal consistency of the questionnaire was assessed by Cronbach's alpha reliability test.

Ethical considerations

The study got approval from the Institutional Review Board committee of the King Fahad Medical City, Riyadh. Informed consent was obtained from all the participants providing a brief explanation of the study purpose. Participation was voluntary, and participants had the right to refuse to participate in the study. Confidentiality and anonymity of the participants were maintained.

  Results Top

Demographic characteristics of participants

Among the 210 participants included in the study, 96 (45.7%) participants were above 50 years in age and 126 (60%) participants were female. Majority of participants (51.9%) were married, had bachelor degree (57.1%), and were working (80.9%). The demographic details of the participants are shown in [Table 1]. [Figure 1] shows the distribution of chronic diseases suffered by the participants. The top two chronic diseases among the participants were hypertension 61 (29%) and diabetes 54 (25.7%).
Table 1: Demographic characteristics of participants (n=210)

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Figure 1: Distribution of participants according to their chronic diseases

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Participants' satisfaction scores

The result of chronic patients' satisfaction survey is shown in [Table 2]. According to the mean scores, participants were most satisfied by the pharmacy services (3.88 ± 0.91) followed by physicians service (3.81 ± 0.94). According to the mean scores, the participants were most dissatisfied by the appointments and waiting time (3.22 ± 1.16) followed by receptionists services (3.27 ± 1.11). Overall, the patients were satisfied by the services provided by the PHC center, the mean score was 3.61 ± 0.84.
Table 2: Participants' satisfaction regarding primary health-care centers (n=210)

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Association between the demographic characteristics and patients' satisfaction

The association between demographic variables and patients' satisfaction is shown in [Table 3]. In the present study, the gender and educational level showed association with the patients' satisfaction. The male participants showed significantly higher satisfaction than the female participants P = 0.003. The participants' satisfaction increased significantly with increase in education level (P = 0.001).
Table 3: Association between the demographic variables and patients' satisfaction (n=210)

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Participants' satisfaction scores and availability of health information system

Out of seven PHC centers, four PHC centers had the facility of HIS. The participants from the four PHC centers with HIS facility showed higher satisfaction than the three PHC centers where HIS was not available [Table 4]. The highest satisfaction score in the centers with HIS was 4.00 and lowest satisfaction score was 3.55, while for the PHC centers without HIS facility, the satisfaction score ranged from 2.98 to 3.29.
Table 4: Patient satisfaction and availability of health information system in the primary health care

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  Discussion Top

In past decades, significant improvements have been achieved in the Saudi health-care services sector, but Saudi Arabia is still facing critical challenges in its PHC system. One of these challenges is the growing burden of chronic diseases and less effective HIS in the PHC centers.[1] The current study assesses the chronic diseases patients' satisfaction about services provided by PHC centers in the Second Health Cluster in Riyadh. The results of the current study showed that the chronic disease patients were satisfied with services provided by PHC centers within the Second Health Cluster in Riyadh, especially with regard to the physician's instructions, nurses, pharmacy services, and laboratory services. A study conducted by Jalil et al.[19] which investigated the relationship between the patients' satisfaction and five aspects of medical interaction reported that the patients' satisfaction among diabetic patients was significantly correlated with the doctor–patient interaction, in terms of technical expertise, interpersonal aspects, communication, time dimension, and access. In contrast to the findings of the present study, a study carried out by Alhashem et al.[21] which measured the factors that influence the patients' satisfaction at PHC clinics, revealed that the patients expressed their dissatisfaction of the communication between the doctor and the patient.

The patients' satisfaction with PHC service was reviewed by Al Asmri et al.,[1] the study concluded that patients in Saudi Arabia are not satisfied with PHC services; the main reasons for dissatisfaction included the physical environment, waiting times, confidentiality measures, the location of centers, working hours, absence of specialty clinics, language and communication barriers, and the waiting area structures. However, it also reported that recent studies indicate an increased level of patients' satisfaction with primary care services compared to previous studies, while the current study still showed that patients were dissatisfied with appointments and waiting time. This may be due to a large number of patients who visit the PHC face a shortage of health-care professionals, which is also considered as a global challenge and the Saudi health-care system is not an exceptional to this challenge.

The present study findings showed that the PHCs that use the HISs were the centers that demonstrated the higher patient satisfaction rates. This finding indicates the significance of HIS in achieving higher satisfaction rates among patients. The role of HISs was underpinned by many studies,[21],[22],[23] which revealed that HISs are essential for the quality service and the nonstop provision of the medical care as well as for the easiness of procedures and saving of time and efforts. Furthermore, the present study finding is supported by Essel et al.,[20] who concluded that the chronic disease patients are well served when they are provided technology-based instructional and awareness materials that educate them about their disease and treatment. Alghanim[24] conducted a study to identify the information needs and information-seeking behavior of primary care physicians in Saudi Arabia and found that the absence of HIS was a major contributor to the weaknesses of PHC service and infrastructure such initiatives can assist in delivering effective patient centered care.[25] Therefore, implementing HIS to the current PHC facilities is crucial to meet patients' needs and enhance the knowledge base of health-care professionals.[1] The MoH strives to reform the health system including the PHC services through a new reform strategy, which calls for the establishment of HIS in PHC centers to meet the growing need for health services.

Regarding to sociodemographic variables, the current study showed a statistically significant difference between the patients' satisfaction and educational level. The study observed that participants with higher education level were more satisfied by the PHC services than less educated participants. These results were contrary to what was expected, as it is known that the patients with a higher level of education are less satisfied, since they have higher incomes and social status. Thus, their expectations are higher. In the same line, the study conducted by Booth et al. in 2012[26] showed a statistically significant differences between the perception of chronic disease patients and their educational qualification. However, in contrast, a study carried out by Margolis et al.[27] in the United Arab Emirates reported that the participants with primary education were more satisfied with the services provided at the primary health centers followed by the patients with intermediate education. A study done by Alsayali et al.[28] demonstrated that there was no significant difference between the satisfaction levels of highly educated and uneducated patients.

The present study showed a statistically significant difference between the patients' satisfaction and gender. The study found that male participants were more satisfied by the PHC services than female participants. Mohamed et al.[29] found that the gender, marital status, and income have no effect on the level of satisfaction with the services provided by PHC centers; however, the lower are more satisfied than the higher educated.

In the current study, the results showed that there was no a statistically significant difference between the patients' satisfaction and age. However, the study done by Xiong et al.[30] found that older patients have a lower degree of satisfaction than younger patients. A study conducted in the USA found that older and literacy-deficient patients tend to have a higher degree of satisfaction than their younger and functionally literate peers.[14] A study done by Cohen in the UK also found that age is a strong predictor of patient ratings on satisfaction for both hospital and primary care, with older patients having a higher degree of satisfaction.[31]

  Conclusions Top

Health services in Saudi Arabia have improved over the past 10 years; the infrastructure, the number of hospitals and health centers, and medical facilities have all improved. The MoH announced the division of health services in Riyadh into two health clusters, these clusters exist to improve services provided by the health services including PHC centers. The present study gives an insight into identification and exploration of the level of satisfaction among patient with chronic diseases. This study concludes that the patients with chronic diseases were satisfied with services provided by PHC centers of the Second Health Cluster in Riyadh except with receptionists' services, appointments, and waiting time. Surveying patients' experiences with services provided by PHC after being divided into clusters will guide authorities and help policymakers in identifying and recognizing potential areas for service improvement leading to better patient satisfaction.


The study recommends establishment of HISs in all the PHC centers to meet the growing need for health services and to increase the number of health-care professional in PHC centers to meet the demand of large number of chronic patients.


We would like to express our sincere gratitude to the Deanship of Scientific Research, Saudi Electronic University, Riyadh, Kingdom of Saudi Arabia, for their continuous support throughout this research.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Figure 1]

  [Table 1], [Table 2], [Table 3], [Table 4]


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