846 entries were received: 232 from male patients and 603 from female patients. 11 patients did not respond. The age ranges with the largest number of participants are the groups of 30 to 39 and 40 to 49 years (20% each). See Figure 1
According to the county, 54% of the sample participants are from Tulare County, 23% from Hollister, 14% from Ventura, and 9% from Monterey. 71% of those served are considered Latino, 11% Caucasian, 1% African American, and the remainder from other demographic groups.
Most people receiving care at the clinics are homemakers (25%), farmworkers (18%), and service workers (12%).
Most of the people that received medical care have a maximum degree of studies of high school: 35.1%; 15.6% have studies up to middle school, and 14.2% have completed elementary school.
Most of the patients (70%), who participated were seen by a family doctor. 92% of the patients claimed to have been treated in their clinic before. 43% commented that the doctor spoke to them in Spanish during the consultation and 42% required a translator.
Factorial analysis
The factor analysis showed two factors that met the criteria and are presented in Table 1.
Table 1
Factors load and consistency
Item
|
Question
|
Factor load
|
Consistency (Cronbach’s α)
|
Doctor's attitude
|
0.8218
|
8
|
1. What did you think of the doctor's explanation of your condition?
|
0.4131
|
0.7936
|
11
|
2. How did you feel the doctot treated you?
|
0.6821
|
0.7565
|
12
|
3. How would you rate the care you received from the doctor at the clinic?
|
0.7120
|
0.7723
|
17
|
4. Would you like to be treated by the same physician who treated you?
|
0.5829
|
0.7796
|
Physician empathy perception
|
0.7563
|
4
|
5. Did the physician listen to your explanation of your condition?
|
0.6080
|
0.8000
|
5
|
6. Do you feel that the physician understood your symptoms or complaints that prompted the consultation?
|
0.6668
|
0.6689
|
7
|
7. Did the doctor answer all your questions?
|
0.6177
|
0.6437
|
9
|
8. Did the physician show interest in resolving your condition?
|
0.5704
|
0.7030
|
Table 2 contains the proportion of participation by item and factor mean with 95 % IC.
Table 2
Factorial means by sociodemographic factors of the sample.
Characteristic
|
Proportion
%
|
Factor 1. Doctor's attitude
|
Factor 2. Physician empathy
Mean [IC 95 %]
|
Overall
|
100
|
0.00 [- 0.05 – 0.05]
|
0.05 [- 0.01 – 0.12]
|
Sex
|
|
|
|
Man
|
27.0
|
0.07 [0.01 – 0.14]
|
- 0.02 [- 0.13 – 0.08]
|
Woman
|
70.3
|
- 0.03 [- 0.10 – 0.04]
|
0.01 [- 0.05 – 0.07]
|
No response
|
0.1
|
|
|
Age Group
|
|
|
|
0 – 20
|
12.6
|
0.06 [- 0.01 – 0.14]
|
0.18 [0.07 – 0.28] *
|
20 – 29
|
16.3
|
0.09 [0.01 – 0.17] *
|
0.01 [- 0.13 – 0.15]
|
30 – 39
|
20.4
|
0.02 [- 0.10 – 0.16]
|
- 0.01 [- 0.13 – 0.11]
|
40 – 49
|
20.3
|
0.01 [- 0.09 – 0.13]
|
- 0.03 [- 0.16 – 0.08]
|
50 – 59
|
15.1
|
- 0.16 [- 0.38 – 0.06]
|
0.01 [- 0.11 – 0.14]
|
60 – 69
|
9.1
|
0.04 [- 0.05 – 0.15]
|
0.16 [0.06 – 0.26] *
|
70 and over
|
6.0
|
- 0.10 [- 0.34 – 0.14]
|
- 0.49 [- 0.87 – - 0.11] *
|
County
|
|
|
|
1
|
8.7
|
0.13 [0.03 – 0.23] *
|
0.04 [- 0.24 – 0.14]
|
2
|
13.2
|
0.04 [- 0.09 – 0.17]
|
0.21 [- 0.14 – 0.28]
|
3
|
23.1
|
- 0.20 [- 0.37 – 0.03]
|
0.00 [- 0.11 – 0.11]
|
4
|
51.8
|
0.05 [- 0.01 – 0.12]
|
- 0.05 [- 0.14 – 0.02]
|
Physician’s specialist
|
|
|
|
Family physician
|
70.0
|
- 0.02 [- 0.10 – 0.05]
|
- 0.07 [- 0.10 – 0.05]
|
Internist
|
2.18
|
- 0.37 [- 0.94 – 0.19]
|
0.13 [- 0.21 – 0.48]
|
Gynecologist
|
5.51
|
0.20 [- 0.14 – 0.27] *
|
- 0.04 [- 0.34 – 0.25]
|
Pediatrician
|
14.8
|
0.08 [- 0.03 – 0.20]
|
0.12 [0.03 – 0.22] *
|
Other
|
7.4
|
0.13 [- 0.04 – 0.22]
|
0.22 [0.11 – 0.32]
|
Population group
|
|
|
|
Latin
|
71.6
|
- 0.01 [- 0.07 – 0.05]
|
0.01 [- 0.04 – 0.07]
|
Caucasian
|
11.0
|
- 0.04 [- 0.24 – 0.16]
|
- 0.11 [- 0.32 – 0.08]
|
Afro-Americans
|
1.6
|
- 0.13 [- 0.72 – 0.45]
|
0.05 [- 0.30 – 0.41]
|
Other
|
12.6
|
0.10 [- 0.01 – 0.21]
|
- 0.01 [- 0.19 – 0.16]
|
No answer / did not respond
|
3.0
|
- 0.10 [- 0.43 – 0.22]
|
0.23 [- 0.01 – 0.47]
|
Maximum degree of studies
|
|
|
|
None
|
6.5
|
- 0.12 [- 0.41 – 0.16]
|
0.02 [- 0.14 – 0.18]
|
Elementary school (unfinished)
|
13.4
|
- 0.12 [- 0.31 – 0.06]
|
- 0.07 [- 0.22 – 0.07]
|
Elementary school
|
14.2
|
- 0.06 [- 0.25 – 0.12]
|
- 0.05 [- 0.21 – 0.10]
|
Middle school
|
15.6
|
0.11 [0.04 – 0.18] *
|
0.06 [- 0.06 – 0.17]
|
High school
|
35.1
|
- 0.01 [- 0.10 – 0.08]
|
- 0.02 [- 0.13 – 0.07]
|
University
|
10.6
|
0.14 [0.07 – 0.20] *
|
0.12 [- 0.02 – 0.26]
|
No answer / did not respond
|
4.3
|
0.15 [0.05 – 0.24] *
|
0.18 [0.02 – 0.33] *
|
Occupation
|
|
|
|
Housewife
|
23.7
|
0.03 [- 0.07 – 0.14]
|
- 0.05 [- 0.16 – 0.05]
|
Self-employed worker
|
3.4
|
0.20 [0.15 – 0.26]
|
- 0.10 [- 0.42 – 0.20]
|
Student
|
7.8
|
0.10 [0.01 – 0.18]
|
0.07 [- 0.09 – 0.24]
|
Professional
|
10.2
|
0.04 [- 0.07 – 0.15]
|
- 0.03 [- 0.23 – 0.16]
|
Unemployed
|
9.4
|
0.04 [- 0.09 – 0.18]
|
0.21 [0.08 – 0.33]
|
Pensioner or retiree
|
6.2
|
- 0.32 [- 0.71 – 0.05]
|
- 0.09 [- 0.35 – 0.17]
|
Agricultural worker /
Domestic worker
|
21.6
|
-0.10 [- 0.25 – 0.04]
|
0.02 [- 0.09 – 0.14]
|
Service / industrial worker
|
17.2
|
0.06 [- 0.04 – 0.17]
|
- 0.03 [- 0.18 – 0.11]
|
Civil status
|
|
|
|
Single
|
36.7
|
0.05 [- 0.01 – 0.11]
|
0.03 [- 0.05 – 0.12]
|
Married / Free union
|
50.5
|
- 0.02 [- 0.11 – 0.06]
|
- 0.02 [- 0.09 – 0.05]
|
Divorced / Separated
|
6.7
|
0.05 [- 0.09 – 0.19]
|
0.12 [- 0.02 – 0.27]
|
Widower / Widow
|
3.3
|
- 0.26 [- 0.61 – 0.20]
|
- 0.42 [- 0.91 – 0.06]
|
No answer / did not respond
|
2.6
|
- 0.19 [- 0.81 – 0.41]
|
0.17 [- 0.15 – 0.51]
|
Who is the patient living with?
|
|
|
|
Alone
|
6.8
|
- 0.02 [- 0.21 – 0.16]
|
0.12 [- 0.03 – 0.26]
|
With couple
|
14.5
|
- 0.07 [- 0.23 – 0.08]
|
- 0.03 [- 0.18 – 0.12]
|
With sons
|
13.2
|
- 0.08 [- 0.28 – 0.12]
|
0.02 [- 0.13 – 0.17]
|
With couple and sons
|
35.7
|
- 0.01 [- 0.10 – 0.10]
|
- 0.01 [- 0.09 – 0.08]
|
With other relatives
|
20.4
|
0.09 [- 0.04 – 0.15]
|
- 0.07 [- 0.21 – 0.08]
|
With friends
|
6.7
|
0.03 [- 0.11 – 0.17]
|
0.13 [- 0.00 – 0.26]
|
With strangers
|
0.3
|
0.27 [0.08 – 0.46] *
|
- 0.35 [- 0.81 – 0.11]
|
No answer / did not respond
|
1.9
|
0.21 [0.05 – 0.37] *
|
0.15 [- 0.15 – 0.47]
|
Previously attended on clinic?
|
|
|
|
Yes
|
92.5
|
0.00 [- 0.06 – 0.05]
|
0.00 [- 0.05 – 0.05]
|
No
|
4.2
|
0.06 [- 0.20 – 0.32]
|
- 0.03 [- 0.25 – 0.19]
|
No answer
|
3.2
|
0.05 [- 0.31 – 0.42]
|
-0.01 [- 0.40 – 0.38]
|
Preferred Language
|
|
|
|
Spanish
|
66.2
|
- 0.02 [- 0.10 – 0.05]
|
-0.11 [- 0.18 – - 0.03] *
|
English
|
33.7
|
0.04 [- 0.01 – 0.11]
|
0.21 [0.15 – 0.27] *
|
Physicians spoke in Spanish?
|
|
|
|
Yes
|
43.7
|
0.04 [- 0.03 – 0.12]
|
0.00 [-0.09 – 0.08]
|
No
|
51.2
|
- 0.04 [- 0.12 – 0.04]
|
0.01 [- 0.06 – 0.08]
|
No answer
|
5.0
|
0.02 [- 0.20 – 0.24]
|
0.11 [- 0.52 – 0.28]
|
Patient needed a translator during consultation?
|
|
|
|
Yes
|
42.7
|
- 0.04 [- 0.14 – 0.04]
|
0.02 [- 0.05 – 0.10]
|
No
|
57.3
|
0.02 [- 0.05 – 0.09]
|
- 0.01 [- 0.09 – 0.06]
|
Doctor’s attitude
Of the participants, 83% had a positive value on this factor considering them as satisfied and 1.94 % scored above 0.5 in this factor, considering them as clearly satisfied. On the other hand, 10.6 % were partially unsatisfied and 7.38 % were fully unsatisfied (using a cut point in - 0.5). County “3” had the lowest overall satisfaction even when they have 73.7 % patients satisfied. People between 20 and 29 years showed a better satisfaction than other groups. See Figure 2.
It was found that the language of attention generates a difference in the perception of this satisfaction component. Those patients who prefer English and do not require a translator have better satisfaction than the rest, compared to those who prefer Spanish and use a translator having the worst satisfaction in this component. (p < 0.05)
The demographic group to which they belong is also associated with changes in satisfaction, with the Latino group having less satisfaction than the Caucasian and African American groups. Those who did not specify a demographic group also have a better perception.
Occupation also generates differences in this factor, self-employed workers and students have a good perception of clinical care. The group with the worst perception is pensioners/retired and agricultural workers. (p < 0.05).
There were no significant differences in this factor by education (p = 0.16), marital status (p = 0.25), with whom the patients live (p = 0.11) specialist type (p = 0.12).
Physician empathy perception
73% of the participants were partially satisfied with the doctor's empathy and 3.7% totally satisfied. Of the 23.3% of patients who said they were dissatisfied, 16.5% said they were totally dissatisfied. According to the county of care, no difference was found between them in terms of physician empathy. Patients in the age groups 0-19 years and 60-69 years showed better satisfaction in this component, and patients who were 70 years and older had a lower level of satisfaction. See figure 3.
It was found that the language of attention generates a difference in the perception of satisfaction. Those patients who prefer English, regardless of the use of the translator, have better satisfaction than those who speak Spanish. Spanish speakers who do not have translator support have lower satisfaction than those who do have translator support. (p < 0.01)
The demographic group is not associated with this component. (p = 0.35) According to the occupation, there is a difference in satisfaction with the doctor-patient relationship. The group of unemployed and students have a better satisfaction than the rest. The group of self-employed workers and pensioners are the ones with the worst satisfaction of the group
There were no significant differences in the opinion of this component by schooling (p = 0.41). There were no significant differences in the opinion of this component regarding the specialty of the physician (p = 0.22). The factors were partially correlated (slope = 0.2138) as shown in Figure 4. Most values are concentrated in the upper right quadrant, with 65 % percent of the population.