Theories of Patient Satisfaction

Theories of Patient Satisfaction Patients satisfaction Formulation of Patient satisfaction Pascoe (1983) defined patient satisfaction as â€Å"†¦the health care recipient’s  reaction to salient aspects of the context, process, and result of their service  experiences†¦ (pp. 189)†. It consists of a â€Å"†¦cognitively based evaluation or  grading of directly-received services including structure, process, and outcome  of services†¦ and an affectively based response to the structure, process, and  outcome of services†¦(pp. 189)†. In terms of the formulation of patient  satisfaction, Pascoe described the Discrepancy Theory and Fulfillment Theory. The two theories were originated from job satisfaction research, the Fulfillment  Theory assumed the magnitude of the outcomes received under particular  circumstance determine satisfaction and neglected any psychological evaluation  of the outcomes. Discrepancy Theory has taken psychological evaluation of  outcomes into consideration in satisfaction formulation and claimed that  dissatisfaction results if the actual outcomes were deviated from the subject’s  initial expectation. It was understood that the Discrepancy approaches that view  patients prior expectations as determinants of satisfaction have be frequently  applied in many patient satisfaction researches, but what determines patient  expectations at the first place? Fox and Storms (1981) present two sets of intervening variables in satisfaction  formulation, including Orientations Towards Care and Conditions of Care,  mediated by patients’ social and cultural characteristics. Orientations Towards  Care refer to patients’ difference in their wants and expectation in a medical  encounter, as people would have different beliefs in the causes of illness and in  the socially-patterned responses to illness. Conditions of Care refer to the  different Theoretical approaches to care, Situation of care and Outcomes of care  delivered by the care providers. Patient satisfaction results if the Orientations  Towards Care was congruent with the Conditions of Care. If the individual’s  Orientations Towards Care, including the perception and interpretation of care,  can be affected by their broader social and cultural contexts, peoples with shared  characteristics may presented a socially-patterned responses in their s atisfaction  formulation accordingly. Suchman Edward Allen proposed that â€Å"†¦ certain  socio-cultural background factors will predispose the individual toward  accepting or rejecting the approach of professional medicine and, hence,  increase or decrease the possibility of conflict between patient and  physician†¦(pp.558) [19]†which basically correlated patient’s socio-demographic  factors with satisfaction. Patient satisfaction and Social identity theory Linder-Pelz (1982) assumed a value-expectancy model in satisfaction  formulation and defined â€Å"patient satisfaction as a positive attitude†¦ a positive  evaluations of distinct dimension of health care, such as a single clinical visit,  the whole treatment process, particular health care setting or plan or the health  care system in general (pp.578)†. Attitude was defined by Fishbein and Azjen  (1975) as the â€Å"general evaluation or feeling of favorableness toward the object  in question†. Built on the view of the Social identity theory that â€Å"attitudes are  moderated by environmental, individual, physical, psychological or sociological  variables (pp. 72)†, Jessie L. Tucker (2000) claimed that patient satisfaction shall  be â€Å"moderated by socio-demographic attributes such as environmental,  individual, physical, psychological and sociological characteristics (pp. 72)†. In  her later study, Jessie L .Tucker (2002) provided empirical support to patient  satisfaction and social identity theory. Patient satisfaction theory considered  patient satisfaction as an attitude, and her results confirmed that patient’s  evaluation of access, communication, outcomes and quality were significant  predictors of satisfaction. Social identity theory argued that attitudes were altered  and affected by demographic, situational, environmental, and psychological  factors, and her research findings indicated that patient’s specific characteristics  significantly explain their satisfaction. Haslam et al. (1993) study of in-group favoritism and social identity models of  stereotype formation suggested that â€Å"manifestations of favoritism are sensitive to  comparative and normative features of social context (pp. 97)†. The result  revealed that a person’s judgments will be impinged by his/her boarder  macro-social context and background knowledge, and the stereotype formulation  were not automatics but instead accustomed by the social context where meaning  and attitudes towards different aspects were constructed. Social identity theory was outlined by Sociologists Henri Tajfel and John Turner  (1979) and was defined as â€Å"the individual’s knowledge that he/she belongs to  certain social groups together with some emotional and value significance to  him/her of the group membership (pp.2) [17]†. The theory believed that  individual’s process a repertoire of self identities with individuating  characteristic at the personal extreme and social categorical characteristics at the  social extreme. Depending on the social context, the personal identity may  prominent and individuals would perceive themselves as members of a social  group and adopt shared attitudes towards a particular aspect, and possibly  satisfaction towards care, or vice versa. To construct a social identity, the theory  proposed that individuals will â€Å"firstly categorize and define themselves as  members of a social category or assign themselves a social identity; second, they  form or learn the stereotypic norms of they category; and third, they assign these  norms to themselves and thus their behavior becomes more normative as their  category membership (pp.15) [42]†. The categories under which individuals  assign themselves at the first place will depends on a person’s social contexts  such as life experience, backgrounds, culture and situation etc. Social identity theory was closely related to the â€Å"Self-categorization theory†,  which was defined by Hogg and McGarty as the theoretical concept of Social  Identify itself and â€Å"concerns the ways collection of individuals comes to define  and feel themselves to be a social group and how does shared group membership  influence their behavior†. Lorenzi-Cioldi and Doise claimed that  Self-categorization theory led to accentuation of between-group differences and  within-group similarities by the fact that â€Å"different levels of categorization are  simultaneously used by group members to encode information pertaining to their  own group and to the other group (pp. 74) [20]†, and the role constraints of  members of inter-group give rise to a consistent mode of responding. Based on  the theoretical framework, it was assumed that patients with shared  socio-demographic characteristics would categorize information they perceived  (inc luding experiences from a medical encounter) for subsequent satisfaction  rating in a particular level and therefore presented a more or less homogenous  rating with the care received.