BACKGROUND/RATIONALE:
Recent studies have examined ways to measure patients’ expectations of providers and clinic visits. Few studies have linked expectations to reports of satisfaction.

OBJECTIVE(S):
Our objectives were to examine the impact of race, sex, and literacy on expressed patient expectations and the relationship of expectations to satisfaction.

METHODS:
As part of a larger study, patients in primary care clinic waiting areas at the Philadelphia VAMC and the University of Pennsylvania Health System were invited to participate. Participants provided sociodemographic information and were administered the REALM (a health literacy assessment), a series of 13 questions to assess expectations, and a patient satisfaction survey. Patients indicated whether it was absolutely necessary, somewhat necessary, somewhat unnecessary, or absolutely unnecessary for their primary care provider to perform certain activities during their clinic visit. The list of expectations included items about communication, procedures, and prescriptions. Chi-square analyses were used to compare expectations for race, literacy, clinic site and sex subgroups. Total numbers of expectations were correlated with satisfaction subscale scores.

FINDINGS/RESULTS:
866 patients participated. The sample was 73% African American and 27% Caucasian; 62% came from a VAMC clinic; 64% were men; and 40% had a literacy level less than or equal to 8th grade. Over 70% of the sample believed 10 of the 13 behaviors were absolutely necessary. For 10 out of 13 behaviors, expectations were higher for African Americans (Ps < .01); for 7 out of 13 behaviors, expectations were higher for those with lower literacy (Ps < .02). The average number of expectations expressed was 7.5 (SD 3.6). Gender and clinic site were not related to expectations. Total number of expectations was not related to overall satisfaction (p=.72), nor was it generally related to satisfaction subscale scores for the total group or for race and literacy based subgroups.

IMPACT:
Future assessment of patients’ expectations should recognize that there may be sociodemographic differences in expectations that are not associated with differences in measured satisfaction.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Shea JA, Beers BB, McDonald VJ, Quistberg DA, Ravenell KL, Asch DA. Assessing health literacy in African American and Caucasian adults: disparities in rapid estimate of adult literacy in medicine (REALM) scores. Family medicine. 2004 Sep 1; 36(8):575-81. [view]
2. Weiner J, Aguirre A, Ravenell K, Kovath K, McDevit L, Murphy J, Asch DA, Shea JA. Designing an illustrated patient satisfaction instrument for low-literacy populations. The American journal of managed care. 2004 Nov 1; 10(11 Pt 2):853-60. [view]
3. Guerra CE, McDonald VJ, Ravenell KL, Asch DA, Shea JA. Effect of race on patient expectations regarding their primary care physicians. Family Practice. 2008 Feb 1; 25(1):49-55. [view]

Conference Presentations

1. Shea JA, Ravenell KL, Henry CN, Fosnocht KM, Murphy JJ, McDonald VJ, Aguirre AC, Asch DA. Comparison of an illustrated patient satisfaction instrument to the NPDFC Ambulatory Care Survey. Paper presented at: VA HSR&D National Meeting; 2002 Feb 13; Washington, DC. [view]
2. Ravenell KL, Asch DA, Henry CAN, Fosnocht KM, Murphy JJ, Shea JA. Health literacy and patient satisfaction. Paper presented at: VA HSR&D National Meeting; 2002 Feb 13; Washington, DC. [view]
3. Shea JA, Ravenell KL, Asch DA, Fosnocht KM, Murphy JJ, McDonald VJ, Aguirre AC. Illustrating the NPDFC Ambulatory Care Survey for low literate patients. Paper presented at: VA HSR&D National Meeting; 2003 Feb 12; Washington, DC. [view]

DRA: Health Systems
DRE: Technology Development and Assessment
Keywords: Ethnic/cultural, Minority, Quality assessment, Research measure, Satisfaction (patient)
MeSH Terms: Ambulatory Care, United States Department of Veterans Affairs, Educational Status