A Research Paper to Determine the Quality and Level of Satisfaction that Children Enjoy/Suffer when they Visit Children Health Care Centres

Abstract

This paper examines the quality and level of satisfaction that children face whenever they visit children healthcare services. This is due to the notable absence of children or any representative, either in person of in form of ideas or feelings in meetings where these policies are made. This paper will try to determine whether there is any significance in difference between involving the children and their views during the policy making process or sidelining them.

From the research that used secondary data, it was determined that children also have an important role to play in the formulation and implementation of laws regarding their healthcare and other issues. This is an indication that children should not only get involved in all the issues that affect them, and not directly. This way, they would be able to enjoy the services with proper knowledge that they are protected by the law. Itperceived to have a better impact than when the participants were not involved in the policy making.At the end of the study, several recommendations were given so as to improve the quality of services that children get from the health facilities.

Introduction

The importance and role of children in the society can never be overlooked. This is because they provide a reassurance of the gene continuity and social sustainability. The most important thing that the leaders as well as those who control the society today areobliged to is to ensure that the future generations are well protected and are not endangered at all. That is why there are many campaigns today advocating for sustainable resource use inorder to ensure those future generations will have enough resources to live on. Among the most important responsibilities on those living today is to have healthy children who will represent these future generations. If the children are weak, or are left to die due to whatever factors, the strength of the future society would be equally hurt.

Among the things that ensure health to the society is the medicine field where the various national governments, their agencies, investors as well as non-governmental organisations have set up health facilities which will ensure that there is adequate provision of health services to the people. The recent advancement of the medicine field with integration with the fast revolving information technology field has also come in handy to ensure that there are reduced deaths. However, the equally increasing resistance and recurrence of diseases is challenging the medical revolution. Ithas, therefore, left hospitals and other health facilities busier with every passing day.

Children are more exposed to pathogens than adults. This is due to their tender and soft bodies that are easily bruised to allow for entry of pathogens into their bodies. They are, therefore, more vulnerable to diseases than adults. Itmeans that they frequent to hospitals more than adults.

The quality of services that children get from the health facilities should remain high so that their confidence in hospitals remains high. The society should ensure that the health facilities are friendly to the children so that they can get the best services without fear. Itcalls for the revision and research on children healthcare policies that are in place to increase the chances of the young members of the society to get the best services from their nearest health facilities. This way, thy can get easily cured and get assured of elongated survival that will ensure their formation of the future society. This paper will be looking into the current status of the children healthcare and its loopholes that could be filled to ensure better health services are provided to the children.

Literature Review

Children healthcare in developed countries has been a forefront agenda. It ensures that children get the health services they deserve. Howlader, Routh, Hossain, Saha & Khuda (2000) notes that while children mortality is increasing in the developing countries andan opposite trend is experienced in the developed world. This is despite the effects of global warming such as re-emergence of diseases that were thought to become extinct in the developed nations such as malaria. Children with disabilities as well as those from disadvantaged backgrounds are the worst hit by the worsening phenomenon.

Children healthcare policy is an important tool to deal with the healthcare programmes. Poor policies would lead to a gap between the implementation and the recipients. This gap could result in aloss of lives. During the implementation of any policy, Chaudhuri (2003) advises that the stakeholders in the implementation of the policies should be involved. Failure to do this would result intoa partial or total ineffectiveness of the policy. This way, there is need to ensure that the policy makers as well as implementers are fully involved during the policy formulation process (Cavet& Sloper 2004a).

The stakeholders in children healthcare programmes are mainly the governments and their agencies. They play the biggest part ahead of the Non-Governmental Organisations (NGOs). This is because they put up most of the healthcare facilities as well as running them. They also provide a serene business environment where investors can put up similar projects.

However, good the policies could be, (Paxson & Schady 2004) notes the omission of the most active people for its implementation: the children. Children are left outside and are only left to listen and receive orders from their parents, guardians, teachers or the professional health workers. When all stakeholders are involved, there is a high chance that the implementation and formulation of the policy would be friendly to all. Itcould in the long run reduce the deaths among the children. He, however, excludes the deaths at birth which might have resulted from maternal care and not child care. People tend to work betteron things that they are conversant with things they are pushed to do. However, her decision should never take precedence since they are young and their look at things can be immature and unworkable. However, the voice of the children is an important force that needs to be heard before the policies that affect them are passed into laws.

Objectives

The main objective is to determine the level of quality of child healthcare among the children in the world.

Other objectives included:

  • To determine the level of satisfaction of the children during their visits to healthcare centres.
  • To determine the reliability of the methods used to determine the quality of the healthcare in paediatric facilities.
  • To determine the quality of healthcare available in hospitals across the ages between zero and eighteen years.

Methodology

During the research, secondary methods were used. Earlier surveys regarding the issue were consulted and the findings recorded in this study. In the first study, a survey to determine the children’s perception to the healthcare programmes in the UK had been carried out. The survey was aimed at determining the need for children participation in healthcare policies as well as their recommendations they would give regarding the issue. Questionnaires were used in 22 different countries (countries that are members of Council of Europe), but most of the questionnaires were distributed in Austria (almost 50%). The participating children filled in the questionnaires independently without help from the children representatives or their parents or guardians.

In this study, the questions were either closed, had multiple choices or had tick boxed answers. Itwas because the alternative open ended questions are tedious and time consuming to analyse (Creswell 1998). Further, more resources that were not available to the researchers would be needed to translate the meaning of the data.

Children aged between 9 and 18 years were used since they could independently and boldly answer the questionnaires without the indulgence of their parents or guardians. These children were picked from different backgrounds, rural, urban and the disadvantaged. Itwas meant to ensure a fair distribution among the population. A total of 2257 children were involved in the study.

The questionnaires asked for many aspects but for the purpose of our current study, only a few aspects will be relevant. The relevant aspects will be age, gender, happiness, frequency of visiting healthcare centres, waiting time and conditions for the service, important people who should be present during the service, the period of stay at the hospital and the quality of the feedback from the healthcare officers.

The second study that was consulted for data extraction was carried out with a main objective of determining the level of quality of children healthcare. The research was then supposed to provide recommendations that would help to improve the quality of children healthcare. In this regard the design used was different from the one used in the first study.

The study was collaborative andthe information was obtained from different sources. Those involved included the staff from the Agency for Healthcare Quality and Research, experts in pediatrics, the Child and Adolescent Health Measurement Initiative,  the Computerized Needs-oriented Quality Measurement Evaluation System, and review of the available medical literature. These were to be used as instruments to determine the quality of children healthcare. Measures taken from clinical performance were then selected from the predetermined instruments and were to be applied to the children aged between ages zero to eighteen years. The individual measures were then categorized for report writing. The issues that the instruments looked into were the quality in effectiveness, patient safety, patient-centeredness, timeliness of the services. Other domains that focused on the patient included staying healthy, to live with the illness, getting better, and end-of-life care. Balance of the laid down measures was determined. That is, the comparison or contrast between the assessment of care between the care provided to all children and the care provided to the children who require special attention due to their requirement for special needs. The comprehensiveness of the measures taken is then assessed according to the age and other development features of the children. An analysis for these measures to determine the equitability in the care was then carried out.

After all data from the two studies were collected, they were observed and analysed in line with the objectives of the current study. Results and then their discussions were then made and conclusions were later drawn.

Results

The results obtained were as follows. From the first study the 40.1% of the respondents were aged between thirteen and fifteen years, 33.1% between sixteen and eighteen while 19.1% aged between ten and twelve years. Only 7.6% was aged below ten (Fig 1)

The gender was 52.5% of the respondents being males and 47% being females. The happiness of the children at the moment of the study was evaluated on a scale of one to ten. Fifteen point six rated themselves at 9, 21.9% at 8, 13.5% at 7, 4.8% at 6 and 6.9 at 5 (Figure 2).

Thirdly, the children’s frequency of visiting a health facility for the past one year was examined. Sixty two point one percent of the respondents had visited a doctor for at least three times in the past one year. They had been visiting different specialists as represented in the Figure 3 below.

The respondents were then for the waiting time they spent waiting for their services. Forty point eight percent of the respondents had a short waiting period, while 28.9% said that they did wait for a medium period of time. Sixteen point seven percent did not wait at all while 13.6% had to wait for a long time. The long time was cited as between one-and-a half to two-and-a half hours. The waiting area was good to 80.1% while 19.1% reported that the waiting area was not good at all.

Asked about the conditions for the service, 54.2% said that they had time alone with the professional, 25% did not while 20.8% were unsure. Eighty point nine received the information they went for while 7% said they did not receive it. Most of those who received the information understood it (81.8%) while 7% did not. Eleven percent said they did not know whether they understood or they did not. Further, 80.6% felt that they were respected by the health professional while 7.1% were on the contrary. Itwas clearly consistent with the fact that around the same proportions had received the information they wanted and others did not. Those who felt respected were given the chance to ask questions for the information they did not understand. Those who did not get some of the information said that the professional used too hard words that they did not understand. Most of the children (84.6%) had direct contact with the professional, while 9.4% did not. Another 6% did not have an idea. Some of the respondents understood what the health professional said (38.3%) while 47.6% understood most of what was said. Only 12.1% understood very little while 2% did not understand anything (Figure 4).

When they were asked of the important people who should be present during the service, 50.5% did not wish to have their parents staying with them overnight in the hospitals. Only 33.5% said they preferred their parents being with them while 16% did not know what they would have liked it to be. During the time they saw the health professional, 60.2% of the children who responded to the questions were accompanied by their parents, while 30.7% of the children said that they were treated alone. Of the 30.7%, 44% wished their parents were there while 37% were happy that their parents were not there. It was notable that the younger children wished to have their parents as contrasted to the elder children. Eighty eight percent of the respondents did not see a teacher while they were at the hospital while 8.9% saw their teachers at the same period.

During the one year that had passed, 57.3% of the respondents stayed in hospital overnight once while 20.8% spent at least a night in hospital for two or three times. Twenty one point nine stayed in hospital overnight for more than three times during the one year that had passed (Figure 5).

The quality of feedback from the healthcare officers varied between the children. Most of the respondents (50.4%) had follow-ups from the health professionals. A third of the respondents, however, had follow-ups and 15.9% did not have an idea.

Asked about the changes they wished that health professionals should embrace, 54.6% said that they needed to be more friendly, 60.3% said the professionals should talk more to children, 67.8% said that the professionals should listen more to children while 80.9% said that children needed comprehensive information about what is going on with them.

In the second study nineteen measure sets were identified, treated separately and 396 measures were employed in determining the quality of children healthcare. The table below shows the major domains that measures have been put in place to determine the quality of healthcare and their percentage levels of quality measures.

Domain

Quality Level (%)

Safety

14.4%

Effectiveness

 59.1%

Patient-centeredness

32.1%

Timeliness

33.3%

 Among the domains that targeted the patients, the table below was drawn.

Domain

Proportion

Staying Healthy

24%

Getting Better

40.2%

Living with Illness

17.4%

End of Life

 0%

Multidimensional

23.5%

Of these measures, 81.1% were meant for the general paediatrics. Most of the measures could be used for children in all ages (more than 79%).Children with special care needs could also get a significantly higher proportion of 18.9%. It was, however, noted that there were few measures that were designed for the different ages or stages of development. Six of the measure sets that were used in the study had been earlier on used in the previous equity studies and there are reports in 5 different languages including English.

Discussion

Most of the respondents were aged between 13 and 18 years of age. Further, the gender of the recipients was almost equal, thus giving the research a less biased result. The number of boys might be higher, but this is still a more realistic gender composition in the world including Europe.

The levels of happiness by the respondents may have been as a result of their backgrounds. Some may not have been comfortable being grouped together with people from other areas such as the rural and humble children beingkept together with the city children. Itwould result ina feeling of inadequacy and out of place. It was a phenomenon that could have impacted the manner in which those affected answer the questions in the questionnaire. This question was supposed to break the tension that may have developed from the children from different backgrounds and physical abilities.

It was also notable that children frequent to hospitals. Itshows the importance of having very friendly facilities that would ensure that patients, especially children, do not get afraid of hospitals and other health providing facilities due to harassment. The hospital should be friendly and welcoming to children in order to reduce their fear and anxiety whenever they visit the facility. Over sixty percent of the respondents had visited a healthcare centre for at least thrice during the one year that preceded the time of the study.

The delivery of the health information to the children may be too shallow. This is because over 10 percent of the children did not understand the things that the professional said about them. There is, therefore, need that the children be accompanied by a guardian or a parent or even a more mature person in order to end to be sure that there is an effective communication regarding the ailment that might have taken the respondent to a health facility. Therefore, the presence of a senior person should go to as high as 97% to ensure that everything that the respondent needs to do is done as per the instructions.

Children may be among the most regulars to health facilities. The study also shows that they had been admitted to health facilities where thy spent a night in the hospital. Itclearly shows the importance of having proper guidelines and satisfaction to the children in order to give them a friendly environment which they would never get afraid of if told to spend time there. Child healthcare is, therefore, an important facet in the health sector due to the dangers they are exposed to whenever they are playing and having their fun.

The use of secondary sources of data during research is very efficient in terms of convenience and energy use. This is because the data is usually verified and analysed thus easy to use and draw conclusions. It reduces the cost of carrying out a research since the cost of collecting data is greatly reduced. Furthermore, time spent on data collection is generally scraped off since available data is used rather than field data collection.

Despite the success of the study, the research had several shortcomings due to the methods used for data collection. The main issue was that secondary data collected was not specifically meant for this research and would not provide completely relevant results. The results from the respondents in the original research may have been oriented towards their set objectives which were relevant to the study. The data collected was used for other purposes and it would have been better for it to be used for the purposes it was collected. Using it in this research may give erroneous results since there may have been answers that were given the way they did due to the influence of preceding questions. The design was also inaccurate since fragments of data were taken from two different studies in different regions. They are only brought together by their relevance to the current study. If independent data for the current study was taken, maybe, different results would have been obtained.

Another weakness of the data collection method used was the difference in the sources. While the first had been carried out in 22 countries in Europe, the second study was carried out in Massachusetts in a single facility. The difference in the sources might be very diverse that it provides varying perceptions and deductions. Therefore, the results might be different and might not give a highly reliable outcome that could be used to draw conclusions. However, it can give a nutshell of the state of affairs in the children healthcare sector in the world.

Conclusions

The level of childcare in hospitals in the world is significantly high. There are measures that many of the governments and their agencies are using to ensure that there is enough time and facilities to work for the children. In most countries, there are paediatric wings in most of the hospitals that are as a result of the need to keep children away from the rest of the adults during treatment and diagnosis. However, there are a few issues that the different governments need to address since there are areas that are not adequately covered by the existing infrastructure. The issue of the poor and underprivileged people in the society is among these. They face alot of difficulties during the access of health facilities. For instance, there are consistent data that show that there is a small percentage of people that stayed for long before seeing the medical professional, a nearly equal percentage were not happy with life and were probably having personal issues. The main objective is to determine the level of quality of child healthcare among the children in the world. A small percentage also did not understand what the doctor said and it means that they were either distracted or the doctors were not very polite with them. Further, an almost similar percentage had the feeling that they had not been respected by the professionals who attended them. It clearly shows that there could be a gap in service provision and the underprivileged could be having difficult times and could be suffering as compared to their more advantaged counterparts.

Most of the children are satisfied with the quality of services they received from the health centres and such service providing centres. However, not every one of them is satisfied and there is a small percentage that undergoes bad times whenever they visit such health services provision centres.

The methods used to determine the success or failure of the quality of the healthcare in health facilities is poor. There is a large loop hole which aggregates children of all ages. This is not the best way to do it since children at different ages get attention due to many factors. A seventeen year old may not get as much preference as a two-week old. Therefore, putting them in the same bracket might prove wrong during the process of making policies regarding health facilities. In this case, more details and classifying the children with their ages should be done properly.

There is no notable advantage to the respondents in terms of their service reception along their gender or age. All ages between 9 and 18 years appeared to have a near similar treatment from the professionals they meet in hospitals and other health centres.

Recommendations

The various governments and authorities should ensure that there are measures to provide every person with equal services. This is because some of the people could be suffering due to their personal attributes such as being disabled, being financially poor, their pedigree and so on. More research should be done to determine how many of the percentage of the disadvantaged in the society suffered during their service receiving in the health facilities.

Children involvement in the issues that pertains their healthcare is a positive step towards improving their abilities. They should, therefore, be involved in all levels of decision making. However, their wishes should not be held solely but experts should determine the best ways to handle the situations.

Different age categories need their own assessment methods. Therefore, more funds should be provided in order to ensure that children research is done at different levels according to the age. It is not fair to have a few month baby decisions being made alongside those of a seventeen year old.

The authorities should come up with systems to ensure that the fastest services are provided to all children at all levels.

More research should be done to differentiate the difference in treatment between the children who visit public hospitals and those who visit high-class hospitals.

The research on children healthcare should be intensified to reduce the children mortality rate. The quality should be highly improved in order to ensure that there are enough data for health professionals to use whenever in need, especially during policy making.

There should be an individual research done by different governments and NGOs to ensure that primary data regarding the issue of children healthcare is obtained from as many regions as possible. This is because there use of the design that was used where the research was solely done from secondary data may not for the best basis to make policies regarding the same.

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