Patients’ Perspectives of the Health Worker-patient Relationship in Cape Coast Metropolis, Ghana

Objective: The importance of good interactions between health workers and patients cannot be over-emphasised. It calms troubled patients and allows them access to all pertinent information to ensure good health. However, some patients are harshly treated, compelling them to withhold sensitive and relevant information whiles others are given very little education on preventive health practices, hampering their preventive health practice. This study aimed to assess the health worker-patient relationship from the patients’ perspective and its effect on preventive health practices in the Cape Coast Metropolis, Ghana. Results: About 70% of patients were satisfied with how they are related to in hospital as 93.8% were allowed to express themselves freely without interruption by the doctor, though 22.7% believed they were not examined by the doctor. 53.1% of the participants were given explanations of their ailments, with 64.4% receiving information on how to prevent complications and recurrences. 70.7% left the consultation with a sense of control over personal health events. Below 50% were educated on intervention procedures, treatment regimens and side effects of their drugs. Generally, patients showed satisfaction with their interactions with health workers.


Introduction
The importance of health, as a need for all and not a want [1], requires good relations between health workers and patients, as it is necessary for the success of the medical consultation, which is used as a measure of efficiency [1]. Good health refers to physical, mental and social well-being [2] at all times, highlighting the need for a holistic approach to healthcare delivery, with due consideration for the psychosocial disposition of the individual. Poor interpersonal relations lead to problems with compliance and inhibit patient education, affecting preventive health practices [3][4][5]. A cordial relationship 3 between health workers and patients is thus imperative for an adequate exchange of information [6].
That notwithstanding, Andersen (2004), in a study on Ghanaian hospitals, reported that patients are sometimes abused verbally and even physically when they "disobey" health workers' instructions [7]. This may sometimes result in patients withholding information that may be vital to accurate diagnosis and management, potentially increasing morbidity.
This shows that it is not satisfying enough to concern oneself solely with the availability and supply of healthcare services to the population, but also the manner in which these services are offered [1,3,4] to allow health workers adequately educate patients as agents of behaviour change [8]. The Ghanaian medical consultation is however paternalistic [9], and minimally involves patients [10].
Though patients are encouraged to take initiative and seek advice [12], Longo et al.
(2010) showed that information seeking is conceptual; patients seek information on what they think is important at that particular point in time [13].
Other studies showed a direct relation between understanding and health seeking behaviour [5,14]. Patients briefed on hospital proceedings, including examination findings, tend to develop trust in the physician [5]. Thus, it is important to assess the patienthealth worker relationship for enhanced interraction.

S t u d y a r e a
The study was conducted in the Cape Coast Metropolis, Ghana. There are a number of government and private health facilities in the Metropolis. At the district level, there are 5 health sub-districts; Ewim, Adisadel, Efutu, Cape Coast RCH Central and University. The University Hospital supplements health services at this level. At the metropolitan level, 4 Cape Coast is served by the Cape Coast Metropolitan Hospital and the Central Regional Hospital, which serves as a Regional referral hospital. The study was specifically conducted at the Adisadel Health Centre, University Hospital and the Cape Coast Metropolitan Hospital.
S t u d y d e s i g n The researcher used a descriptive case study design and quantitative methods to evaluate the interaction between health workers and patients by measuring specific parameters. After coding and entry, the data, frequencies, percentages, pie charts, bar and line graphs, were generated with the help of SPSS and Microsoft Excel to help understand and establish the data. Cross tabulation and correlation were also employed to help understand and establish the relationship between specified variables.

O b s e r v a t i o n s
Interaction with patients was courteous in all departments on most of the days. Courtesy, as used above, refers to a means of communicating in which the receiver feels treated 6 with respect. Personnel began the interaction with a greeting and spoke in low tones.
There were, however, isolated incidents where there were misunderstandings between both parties.

Patients were not interrupted as they spoke, and doctors used open questions to
understand what the patients were coming in with. A few patients, notably those with acute conditions like gastroenteritis and malaria, were counselled on practices to prevent recurrence of these conditions. Interaction between laboratory staff and patients was usually indifferent, with patients being instructed on what to do without any greeting. After sitting down, the next instruction was to ask the patient to stretch his/her hand, without offering any explanation for the procedure going to be carried out. When patients were in pain, however, the staff apologised for the pain and consoled the patients.
Q u e s t i o n n a i r e s A total of 384 questionnaires were administered to people across all age groups, with a 100% response rate. The results are presented below.

Discussion I n t e r a c t i o n w i t h h e a l t h w o r k e r s
Respondents were generally satisfied with the nature of their interaction with all health workers. Interaction with health workers is a major source of patient satisfaction with health services and a measure of health workers' efficiency [1]. Some respondents however said when they attended hospital in the afternoons, health workers were more irritable than when they went in the mornings.

The medical consultation
Respondents were encouraged to narrate their problems to the doctor freely and whatever questions they asked were answered. This contradicts Norman et al.'s (2011) conclusion on the medical interview process being paternalistic in Ghana [9]. These patients will therefore understand whatever condition they have, helping them maintain good health in the future. Patients expressed satisfaction with the consultation, which can be attributed it to their ability to talk freely about their health concerns.
Patients' experiences of the hospital visit were enhanced when doctors "touched" them to examine and told them their findings, corroborating findings from studies in Nigeria [5].
Such patients are likely to feel more thoroughly attended to than those who were not examined as expected. Indeed, a few respondents complained that they were not During the observational periods, it was found that though most of the patients were examined by the doctors, they were not informed of their diagnoses, given explanations for the condition they presented with, nor educated on the treatment regimen.
Contrary to this observation, data from the study showed that many of the participants were given explanations for their conditions. This may be because of the high educational level among respondents, as shown in Table 1. In spite of this, majority were not given any information on the treatment being given, or treatment options (if any). The lack of information on treatment may lead to people defaulting or overdosing their medications [3,5,11].
Respondents understood their diagnoses because the doctor had explained it to them and corrected misconceptions they had. This, as stated by Longo et al. (2010), is a very important part of the medical consultation [13].
Some respondents received explanations for their conditions and, therefore, understood the condition but did not know the name of the ailment. Though 71.8% and 75.3% of those with long term and acute diagnoses, respectively, received an explanation on how to prevent complications, a correlation coefficient of 0.027 was however found between being told the name of the diagnosis and receiving information on preventive health, suggesting a mild positive relationship. This is contrasted with correlation coefficient of 0.577 between explanation of a diagnosis and information on how to prevent complications, proving a strong direct relationship between the two. Thus, explanations for presenting conditions are more likely to lead to patients learning to practice preventive health by gaining control over modifiable risk factors than just telling them their diagnoses. This may be because, as patients ask questions, understanding of their ailments is deepened [5,13].

Limitation
These is the possibility of changed behaviour on the side of the hospital staff during the observation as they were told they are being observed. Other behaviours might have also been under look or missed especially when the has to move to a different unit.

Declaration
Ethics approval and consent to participate: Ethical approval was obtained from the research department of the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana. All the directors at the various hospitals where the data was collected received written notice and has further approved the study.
Participants consent to participate was also sought. After explaining the purpose of the study to them and assure them of confidentiality, a consent form was given to each participant to be completed as a confirmation of their consent to participate. Those who do not sign to the consent form were not involved.

Consent for publication: Not Applicable
Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. This dataset is with the corresponding author and can be provided when requested.