The current study aimed to investigate the relationship between service quality dimensions and demographic characteristics and patient satisfaction. The total mean score of service quality (3.73) was less than that of the study in Nigeria where the overall mean score of service quality across all dimensions was 4.20 (23). This result was almost in accord with another study in Iran in which the overall service quality mean score was 3.89 (5).
As stated by Cohen, R2 values greater than 0.25 represent a significant variance in the model (24). The R2 value in this study was 0.662 meaning that approximately 66.2% of the variance of satisfaction were defined through the service quality dimensions and demographic characteristics as the independent variables. Therefore, the regression model has relatively good predictive power. The results are in line with those of the studies previously conducted in Iran and South Korea (5, 25).
The overall patient satisfaction mean score was 3.61 out of 5 that is relatively high; however, other studies in the Central and Eastern European countries and Uganda reported low consumer satisfaction with the healthcare system (10). Satisfaction levels with healthcare services can be associated with patients’ expectations (2, 10, 14), i.e., patients with lower expectations who are uncritical or lack knowledge may be more satisfied with services than patients with higher expectation (2).
All questions obtained good mean scores; however, the highest mean score (3.8 out of 5) was related to Q1, i.e., “Totally, I am satisfied with the clinic and its services”. Whereas in other similar studies in Iran and Ethiopia the highest mean score was related to Q7, “I will recommend this clinic to my friends and relatives” (5, 26).
Based on the regression results, the admission process was the most significant predictor of patient satisfaction. It means that the behavior of reception staff (courtesy, friendliness, and respect) can increase the overall patient satisfaction. The finding is in accord with those of previous studies where patient satisfaction was positively associated with quick and easy admission (11) and scheduled admission (27). Likewise, the results of a study in Turkey referred to admission process as one of the most critical healthcare shortcomings causing patient dissatisfaction (28).
Physician consultation was the second determinant of patient satisfaction. The result can be attributed to patients who were not aware of medicine and medical procedures; consequently, gave higher scores to this item. Similarly, other studies approved the significant relationship between physician consultation and patient satisfaction meaning that doctor-patient relationships, effective communication, and empathy during the consultations play an important role in patient satisfaction (5, 14, 16).
A significant relationship was observed between service cost and patient satisfaction (coefficient = 0.26), that is, patients are satisfied if they perceive that out-of-pocket payments are reasonable in terms of value and quality. The result matches the findings of previous studies where service costs were found to be one of the important determinants of patient satisfaction (5, 25, 29)
Accessibility and appointment were recognized as two other factors affecting patient satisfaction. These findings are reinforced by those of previous studies in which accessibility was an important and determining factor in patient satisfaction (13, 30). The importance of getting an appointment (faster and easier) has been demonstrated in another study (11).
The regression analysis of patients’ demographic characteristics and their satisfaction indicated that only age, marital status, and residence area had significantly affected patient satisfaction. Although previous studies described the relationships between patients’ demographic characteristics and their satisfaction with services, there are not sufficient sources in literature to narrate the main reasons of the relationships which can be either due to differences in patient values and expectations or the differences in the treatment they receive (31).
Regarding the patients’ age, it was found that the younger patients were more satisfied with services than the older ones. This can be attributed to old patients’ frequent healthcare visits, their focus on details of provided services or facilities which meet their special needs (e.g. wheelchair). This is consistent with the findings of other studies in which the older patients reported lower satisfaction with their hospital services (31, 32)
Moreover, a statistically significant association was found between patients’ residence area and the overall satisfaction score. The respondents in urban areas were more satisfied with the services. Perhaps, patients from rural area, after travelling long distances, had higher expectations of services in the urban clinics. These results are in contrast with those of a study in Nigeria where the patients living outside the site of the clinic were more satisfied than those living within the location (33). However, a study by Atkinson and Haran in Brazil indicated that urban populations were more likely to be satisfied with services (34).
As for marital status, single patients were found to be more dissatisfied with provided services, and a negative coefficient (b= -1.31) was observed between the single and married patients. This is in contrast with the findings of the study by Quintana et al. who conducted a cross-sectional study to assess predictors of patient satisfaction with regard to their socio-demographic variables and found that single or divorced respondents were more satisfied with health services (35).
Finally, a limitation of this study is that the data were collected through a self-report questionnaire in hospitals which may lead to a bias which could have been avoided if the patients were required to answer the questions the day after refereeing to hospitals.