| ObjectiveThis study aims to understand the reasons and related factors of people living with HIV/AIDS(PLWHA)in rural area of Jiangxi Province who accepted follow-up services from the township hospitals,and to analyze satisfaction of those who are receiving follow-up services from the township hospitals.To provide evidences for promoting follow-up services for PLWHA from township hospitals.MethodsDuring the period of January-June 2018,PLWHA from Xinjian,Yushan,and Guixi counties(including those who had went out before the investigation but were willing to come back to take the survey),who were diagnosed before December 31st,2017 and over 18 years at the time of the survey,were investigated.When conducting a questionnaire survey on the spot,the investigator needed to decide which questions should be answered according to the HIV diagnosed time of the respondents and the institution that currently provided HIV follow-up services for the respondentsThose who were diagnosed and reported before January 1st,2016 needed to answer the’follow-up shifting’related questions.Data of demographic information,infected route,frequency of receiving follow-up services,stage of the disease,and etc.were collected through a self-designed questionnaire.Univariate and multivariate logistic regression analyses were conducted to determine the factors that relating to acceptibility(refiuse=0,accept=1)of the follow-up services from the primary health care institutions.The factors of age,monthly income,occupation,marital status,education level,follow-up awareness,infection route,etc.were included in the multivariate logistic regression modelAnd others were receiving follow-up services from the township hospitals needed to answer the satisfaction related questions,Data of demographic information,the cumulative follow-up duration(months),frequency and method receiving follow-up services,and etc.were collected through a self-designed questionnaire.The translated and revised version PSQ-18(Patient Satisfaction Questionnaire)was adopted for satisfaction evaluation.The evaluation was conducted from six dimensions of overall satisfaction,technical service quality,service timeliness,service accessibility,and follow-up personnel’s interpersonal communication ability and communication level.Univariate and multivariate logistic regression analyses were conducted to determine the factors that relating to satisfaction(dissatisfaction=0,satisfaction=1)of the follow-up services from the primary health care institutions.The factors of age,monthly income,infection route,cumulative follow-up time from the township hospitals,etc.were included in the multivariate logistic regression model.Results1.Baseline information:466 cases should be investigated in this survey,and 424 cases were actually investigated.424 questionnaires were collected and the effective ratio was 100.00%.119 cases,196 cases,and 109 cases were investigated in Xinjian County,Yushan County,and Guixi City respectively.The age distribution was 20-85 years old,the average age was 53.86±15.87 years old,and the median was 54.50 years old.Of all the respondents,the male accounted for 70.52%(299 cases),the illiterate and the primary school education accounted for 57.55%(244 cases),the married accounted for 47.88%(203 cases),farmers accounted for 69.34%(294 cases),the monthly income≥1000 yuan accounted for 50.71%(215 cases),the Jiangxi Province census register was 98.35%(417 cases).Besides,87.97%(373 cases)of them had received HIV follow-up services from local CDCs and,61.1%(259 cases)were currently receiving follow-up services from the township hospitals2.’Follow-up shifting’investigation:Totally,373 PLWHA were investigated and the’follow-up shifting’ratio was 55.76%(208 cases).The average age was 53.06±16.15 years old.Males accounted for 70.00%(261 cases).The illiteracy and primary education level accounted for 54.69%(204 cases).Those respondents who thought it was necessary to receive follow-up services accounted for 80.43%(300 cases).Those respondents who had known the’follow-up shifting’policy accounted for 63.27%(236 cases).Those respondents whose family advised them to receive the services accounted for 41.82%(156 cases).Those respondents who worried about information disclosure accounted for 66.22%(247 cases).Those respondents who worried about discrimination accounted for 54.96%(205 cases).Those respondents who trusted the staffs accounted for 61.13%(228 cases).The multivariate regression analysis showed that those respondents who were advised by their family to receive’follow-up shifting’services were likely to do so than those who were not or did not have family(OR=16.01,95%Cl:2.25-49.,73),that those who did not worry about discrimination(OR=12.97,95%Cl:4.75-35.42)and those who trusted the local health care workers(OR=5.07,95%Cl:2.19-11.76)had higher’follow-up shifting’ratio.3.Satisfaction score investigation:259 respondents were investigated.The average age was 57.25±15.14 years old.Males accounted for 68.73%(178 cases).Six dimensions’satisfaction scores were as follows:General satisfaction was 3.93±0.51,time spent with doctor was 4.01=10.45,accessibility and convenience of the follow up service was 3.96±0.38,technical quality of the service was 3.78±0.52,interpersonal manner of the local health care provider was 4.01±0.44,and communication level of the local provider was 4.01±0.49.Hierarchical analysis of satisfaction scores showed,the non-farmer group scored significantly higher than the farmer group in four dimensions of general satisfaction,interpersonal manner,technical quality of the follow-up service,and communication level of the local provider(P<0.05).In addition,the longer respondents received follow-up services in primary institutions,the higher the scores were in three dimensions of time spent with doctors,accessibility and convenience,and communication level of’follow-up shifting’services(P<0.05).ConclusionThe’follow-up shifting’in the survey area has achieved very good results(55.76%)Family not to recommend,worries about discrimination,and distrust of local health care providers were the main resistances to patients receiving the’follow-up shifting’service.Therefore,in order to enhance the trust of local health care providers of people living with HIV/AIDS,it is reconmmended that the primary-level health workers should participate in the first epidemiological survey of PLWHA,and to establish a monitoring and evaluation mechanism.Besides,it is recommended to strengthen supervision and training focusing on follow-up technics and privacy protection,and to improve tansitions before and after’follow-up shifting’ services and awareness of privacy protection of local follow-up providers,And then,the quantity and quality of ’follow-up shifting’ will be improvedSatisfaction with follow-up services conducted by primary institutions in the survey area of Jiangxi province is relatively high.However,occupation,follow-up mode,and accumulated time of receiving’follow-up shifting’services were significantly associated with satisfaction.More training focusing on follow-up communication skills should be organized to improve satisfaction of the ’follow-up shifting’ service. |
