Clients Satisfaction About Interpersonal Communication Sessions Conducted at Primary Health Care Centers by Health Education Providers

Medical interpersonal communication is a core clinical skill and an essential component as they are convincing the patient to follow medical advice. Client prefer health providers to be warm and sympathetic, listen to what they say and ask question which are precise and easily understood. All clients attending either single or in group a session of health education held at PHC centers during the study period were included in this descriptive study. It was found that the clients of age group (35-45) years were more satisfied in communications skills of the health providers reporting a mean score of 25.6±4.8 (P = 0.02). Female more satisfied about health provider communication skills, competency and health provider information This difference was found to be significant Pvalue (0.01, 0.02, 0.01) respectively. Illiterate clients were more satisfied with the health provider communication skills, competency and information since they gave them high score (26.4 ±4.5, 7.9±1.3, 10.7 ±1.8) compared to the scores given by clients with higher education (24±5, 7.3±1.6, 9.7±1.9). This difference was found to be significant (P = 0.01).Older female clients who have no job and with low education level were more satisfied with interpersonal communication of health education providers at PHC level.

of the effectiveness of physician-patient communication. However, unlike patient satisfaction study results do not indicate a clear association between doctor-patient interaction and subsequent patient compliance (Ley 1989).

Aim of the study
To assess the client satisfaction toward the health provider achievement in health education. And to determine to what extent this satisfaction affected by some sociodemographic characteristics such as age, gender, level of education and job.
2. Patients and methods 2.1. Study group: All clients attending either single or in group a session of health education held at PHC centers during the study period, and they were willing to participate in the study were included. Thus 325 clients were involved.

Method
A Structured questioner was formulated by the researcher and completed through direct interview with every client. The questionnaire was in Arabic and consist of two parts: Part I covered the sociodemographic characteristics (gender, age, educational level and occupation of the client).
Part II consist of six domains which reflect client satisfaction regarding the effectiveness of interpersonal communication of the health provider during health education session.

Statistical analysis
The collected data were introduced into micro soft office excel 2010 and were analyzed using SPSS version (21). Descriptive analysis such as frequencies and percentages had been used to describe different variables, while (mean ± SD) was calculated for the allocated scores of different domains of interpersonal communication. To compare mean scores of different variables t-test was used. Pearson linear correlation had been assessed to detect the correlation between different domains of interpersonal communication. p value ≤ 0.05 considered as the level of significance in this study.

Ethical issues
An approval of the scientific and ethical committee at Al-Kindy College of Medicine had been taken initially, then an official request for facilitation of the omission of conducting the study was delivered from Al-Kindy College of Medicine and administered to all PHC centers that included in the study. A nonverbal consent had been taken from all the participants in the study groups.

Results:
Table-1 showed that total clients included in this study were (325), 85.5% were female and 14.5% were male. Half of the client's 161(49.5%) were of young age group, the frequency decreases with increasing in age. The clients were closely distributed on different education levels. Only 28.6% of the clients have job whether governmental or nongovernmental while the remaining 71.4% were without job.  Table-2 showed the client response toward the achievement of the health providers in: Communication skill they reported high agreement response to six themes out of the ten themes and equivocal to four themes out of ten; Client satisfaction with health provider competency was agree for all the three themes (53.5%, 51.1%, 46.2%); Client satisfaction with health provider information was agree for two themes and equivocal for other two themes. Most of clients 69.2% gave equivocal response to the time spent by health provider in the communication session. While 71.4, 76% of the clients were agreed and satisfied with the place and the tools prepared for the health education sessions respectively.  Table 3 was constructed to examine the association between age of clients and satisfaction toward the main domains of the health provider communication skills, competency and information. It was found that the clients of age group (35-45) years were more satisfied in communications skills of the health providers reporting a mean score of 25.6±4.8 (P = 0.02), while client of older age groups ≥ 45 were more satisfied in competency and information of the health providers giving mean score of 6.7±1.5, 10.4±1.7 but no significant differences in between the three age groups (P = 0.4) (P = 0.1) respectively. Again, no significant differences had been found in other domain of interpersonal communication, related to time, place and tool.  Female appeared more satisfied about health provider communication skills, competency and health provider information since they reported higher mean scores (24.9±5, 7.4±1.5, 10±1.9) than the mean score reported by male (22.7±6.2, 6.8±1.9, 9.3±1.9). This difference was found to be significant (P-value 0.01, 0.02, 0.01) respectively. There were no significant differences in their responses to time, place and tool of the health education sessions (Table-4).  Table 5 revealed that illiterate clients were more satisfied with the health provider communication skills, competency and information since they gave them high score (26.4 ±4.5, 7.9±1.3, 10.7 ±1.8) compared to the scores given by clients with higher education (24±5, 7.3±1.6, 9.7±1.9). This difference was found to be significant (P = 0.01). Also, there were significant differences between education level in their perception of health workers achievement for all domains except for the place. a significant association had been found between the clients who have job and those without job in regard to their satisfaction with the health provider communication skill, competency and information as those without job were more satisfied giving mean scores of (25±5.1, 7.4±1.6, 10.1±1.9) which were higher than those who have job mean scores (23.6±5.4, 7.1±1.7, 9.5±1.9) P-value (0.03, 0.1, 0.01) respectively. Beside that a significant difference had been found in between them in their perception to the time allocated for the sessions (P= 0.01) but not other two domains place and tools. The illiterate client and those jobless which represent most of the housewives in our study were more satisfied with interpersonal communication than educated women, this might be due to the high expectation by those who are more educated, compared to the low expectation and more confidence in medical care system in low educated clients, this is supported by meta -analysis study done by Hall and Dornan which revealed greater satisfaction is associated with less education (Hall & Dornan 1990). On the other hand, a study conducted by Ishikawa et al. (2009) found that education has been shown to be significant predictor of outcome of communication, since literacy of client express worse outcome in the process of care; empowerment and consideration of patient's desire and ability to adhere to treatment plan.

Conclusions
Most of the clients were satisfied with the effectiveness of interpersonal communication of the health education provider in relation to communication skills, competency and information. Older female clients who have no job and with low education level were more satisfied with interpersonal communication of health education providers at PHC level. Place and tools of health education unit in PHC were adequately prepared to upgrade the environment required to reach the expectation of the client. The time consumed during health education session was not enough from the client point of view.

Recommendations
Training courses and workshops in interpersonal communication are mandatory for all health workers. There is a need to increase the number of health providers included in health education unit in primary health care center.