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Chapter I
INTRODUCTION
1.1 Background
Researchers have discovered that a doctor's capacity to understand, listen, and empathize may have a profound impact on a patient's biological as well as functional health outcomes, and also their experience receiving treatment and their level of happiness. In addition to improving adherence to therapy and self-management, effective healthcare information sharing may enable patients and their families to take an active role in their care (Bouaouina et al., 2022). Patient-provider dialogue, however, is crucial not only during hospital stays. Patients should maintain contact with their care team even after they have been discharged from the hospital or clinic. A patient's prognosis may be affected by more than just the fact that they have to learn a great deal about their health in order to make informed decisions about things like new drugs, follow-up treatment, and (perhaps) physical therapy (Bouaouina et al., 2022).
So, if there is not proper communication from the medical practitioners, there will not be enough trust or satisfaction on behalf of the care provider towards the patient causing less trust and satisfaction causing substandard results in the recovery progress. Communication with patients is one of the most important aspects of being a doctor. Even diagnosing and treating patients is dependent on conversation with them to determine what they require. Any specialty of the medical field will require some patient interaction which should be done in way to improvise trust between the two bodies, whether its emergency department, pediatrics, surgery, or during or after a pandemic like COVID-19 most recently (Borah & Hwang, 2022; LI et al., 2022). Nobody wants to be treated inconsiderately while they are in pain. So, the simplest thing a doctor or medical staff can do is alleviate the load as much as they can. This is why it is important to have a genuine and clear communication. Trust between patients and healthcare professionals is strengthened as a consequence of open lines of communication. Healthcare administrators may gain confidence and identify ways to improve care for their patients via timely, personalized communications (Peuchant et al., 2022). Studies have been done around different variables of interest with patient satisfaction as mediator and in this study, we are going to use patient engagement/experience as moderator to see how doctor’s communication helps in development of building trust and satisfaction and in the long run revisiting intention of the patient with the mediating role of patient satisfaction
(Bekka-Hadji et al., 2022). This study is going to explore patients of an outpatient department (OPD) in a private hospital of Islamabad to evaluate how an effective mode of communication with the doctor can help retain a patients trust and his/her satisfaction towards the very medical facility or health practitioner. This will show how essential is the importance of strategic communication towards the patients and its pros and cons. Whether there is any need of ethical training of the healthcare professionals or not (Varkey, 2021). This is going to explore this area of the medical field. The term "patient satisfaction" refers to an individual's impression and experience with a healthcare facility before, during, and after treatment. The healthcare system's single end user is the patient, thus meeting their needs is paramount. The success of a healthcare facility as a whole relies on the level of care received by its patients. Finding strategies to make hospitals in poor nations more customer focused is a key difficulty they may encounter. The healthcare sector is one of the fastest-growing businesses, and its expansion may be attributed to a number of causes (Tremblay, Turcotte, et al., 2022). Many factors have contributed to this development, including environmental shifts, competitive pressures, alternative healthcare processes, new responsibilities and laws imposed by governments to enhance healthcare facilities, patient access to information, cost structures, and so on. Many hospitals and other medical facilities have understood that patient pleasure is crucial to their long-term survival. Therefore, it is generally agreed that patient happiness is the ideal result for any healthcare facility (Azil et al., 2022). Different research (Jenkinson et al., 2002; Sitzia & Wood, 1997) reveal that people care more about businesses that offer high standards of care and make an effort to fulfil their customers in a better manner, suggesting that patient satisfaction is an essential lucrative competitive strategy. According to Prakash (2010)'s study, hospitals with a higher reputation for patient satisfaction are more likely to attract new patients and remain profitable in the long run. Similarly, modern patients have a greater understanding of and appreciation for healthcare than their predecessors. As a result of their research and deliberation, they were able to choose a hospital that best meet their requirements. Patients' heightened sensitivity to the quality of healthcare facilities and services is, in large part, attributable to the ease with which they may get relevant information. Panchapakesan et al. (2015) argue that a patient's experience at a hospital is more important than whether or not the patient is correct. If doctors and nurses don't realize how important it is for their patients to be satisfied, it might spell disaster for their facilities. When deciding which hospital to go to, people place a high value on the opinions of
their fellow patients. Satisfaction among patients may be explained by looking at factors including demographics, socioeconomic level, and overall health. Delivering healthcare services from a hospital, such as the experience of the doctor and the healthcare delivery setting, also affects patient satisfaction. Drossman et al. (2021) argues that a partner-like connection between the healthcare professional and the patient is necessary for continuity of care to be effective. Patients' happiness, however, may be abruptly interrupted by recent developments in the healthcare industry, such as shifts in insurance coverage. Also, different patients and different reasons for going to different hospitals would have different levels of satisfaction with their healthcare providers. For instance, patients with life-threatening conditions may not be able to wait even one day to visit their concerned physician. Studies have shown that patients are more likely to trust a hospital or healthcare professional if they have a consistent experience with them (Batbaatar et al., 2017). Patients' unique qualities and the healthcare aspects offered by a certain hospital all have a role in the relationship between continuity and satisfaction, as stated by Shabeer et al. (2021). There are several elements linked to satisfied patients. Things like how long you have to wait to be seen, how clean the facility is, how kind the staff is, and how confident you feel in their abilities are all factors. In addition, there is a wealth of aspects that contribute to patients' overall happiness with healthcare facilities (Lorenzen et al., 2022). The clinic's atmosphere, the ease of registering, the length of time spent in consultation, and the availability of personnel are all potential factors. The outpatient service (OPD) is the public face of any medical facility. Thus, the patient's response in the outpatient department is indicative of the patient's overall satisfaction with the healthcare facility (Nikalayevich et al., 2022). Existing evidence also suggests that factors influencing patients' satisfaction differ between public and private hospitals. Patient satisfaction may be influenced by a variety of variables, and these may vary across the developed, developing, and least developed nations. It's because the government invests in and supports healthcare facilities (Patel & Patel, 2017).
Islamabad, Pakistan's private healthcare sector, in particular, has expanded rapidly in recent years. Outpatient care is an important part of the healthcare system, and private hospitals play a significant role in its delivery (Monge et al., 2022). Non-emergency medical treatment, consultations, and follow-up visits are often handled in outpatient departments (OPDs). It is crucial for healthcare practitioners and policymakers to get insight into why patients return to OPDs for further treatment. Deo et al. (2012) explained that high rate of patient readmissions
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is indicative of satisfied patients and efficient healthcare systems. The quality of treatment, the outcomes for patients, and the efficiency with which resources are used may all be improved by analyzing what causes patients to return (Hamdi et al., 2022). There have been a number of research looking at what influences patients to return to different healthcare facilities, such as public and private hospitals (Gorce et al., 2022). However, there is a dearth of studies examining patients' propensity to return to private hospitals in the Islamabad area. This research seeks to fill this information vacuum by analyzing what leads patients to return to the outpatient departments of private hospitals in Islamabad (Bajaria & Abdul, 2020; Heuschen et al., 2022).
Multiple variables may influence a patient's decision to return to an outpatient clinic. Age, gender, income, and education level are only few of the demographic factors that have been shown to affect patients' propensity to seek medical treatment and frequency of subsequent visits (Tirinzoni et al., 2022). Patient satisfaction and subsequent choices to return are strongly influenced by service quality, which includes factors such as wait times, appointment systems, accessibility, and the availability of diagnostic facilities (Jaldurgam, Ahmad, Touati, Al Ashraf, Shakoor, et al., 2022). The level of patient satisfaction is a major determinant of whether or not a patient would return to a certain healthcare provider. Patient return rates may also be affected by physicians' and nurses' expertise, as well as by patients' and doctors' ability to communicate with one another and with patients (Bajaria & Abdul, 2020).
1.2
Problem Statement
Strategic and professional communication from a healthcare provider helps them to gain the patients confidence, asses their medical history (if any), the problem they are here for, to establish a correct diagnosis plan and ultimately a successful treatment plan. These are all possible when a patient is genuinely ready to cooperate with the doctor and that is possible only if the patient trusts the medical practitioner (Wu et al., 2022) which is possible through strategic and satisfactory communication from the doctor towards the patient. This would help gain the patients trust in terms of patient satisfaction (C. Lee, 2019) which would result in the revisit of the patient towards the same medical center because of the positive satisfactory past.(McLaughlin, 2009).
Communication is a major and fundamental base for any profession and same is its importance and effectiveness in the field of healthcare (Kumah, 2019). Also, in the vast field of healthcare, it is important from every aspect (Gupta , Jai, & Yadav, 2021) not only for the mediacal professionals but also for other supporting medical staff (Kibret et al., 2022) that the
patient is going to have interaction with during their hospital visit, complete diagnostic and treatment period. This is what this study is being based upon and that is how an effective communication from a healthcare practitioner helps a healthcare seeker establish trust and satisfaction towards them with the moderating role of patient engagement/ experience towards inspecting the the intentions of patient revisit.
1.3
Research Gaps
The physician-patient interaction begins the moment the patient enters the doctors’ room. The physician is then the charge of looking after that patient. All have their own methods of connecting with others, and there are various approaches to patients. Some specialties even have their own method of communicating with patients (Mohamed, Mohamed, & Mohd, 2020). In a country like Pakistan, where literacy rate is much lower as compared to other countries of the world, studies have shown that respective communication and full attention to the patients can beyond and doubt cause betterment in doctor patient relationship (Jamil et al., 2022) leading to a better quality of life and if not implemented, misinterpretation and miscommunication can lead to many errors like in diagnosis and treatment along with certain malpractices. Some studies also suggests that some physicians consider their communication skills way beyond being exceptional as compared to the opinions of the patients (Hussain et al., 2022) which identifies different ethical training needs for the medical practitioners for improving the barrier of communication between the physicians and patients. In this current study, factors regarding that communication leads to include patient revisit intentions and patient satisfaction (Abass et al., 2021), with the moderating role the moderator patient engagement is used. It is used here in this current study that to observe that how an effective level of doctor-patient relationship is helpful to obtain the patient’s trust and satisfaction in way that he/she becomes engage/involve in his/her treatment by putting their complete trust in the medical practitioner as now a days with the evolving trends and times, people are becoming more and more aware of everything as there is access to everything over the internet and they want to know more. And if there is any case of a disease or illness, people want to be involved in every step toward their treatment and recovery and that can be achieved if they have trust in their physician who is treating them and are fully satisfied that their doctor is fully dedicated to them which they can judge by the first impression of how the medical physician is communicating with them and either he is contributing to build a degree of satisfaction or not.
So, to study that moderating role of patient engagement together their relationship with communication and patient’s revisit intention as well as mediating role of patient satisfaction. A substantial amount of studies have been found already that have been done for evaluating the levels of communication (Liping & Jiang, 2021) and patient satisfaction (Daniel et al, 2021) in the medical field especially after the catastrophic happening of the pandemic COVID-19 (Pogorzelska & Chlabicz, 2022) but still there have to be a lot of studies that can be done in the same subject with the almost same variables of interests in Pakistan as it is still developing in different ways so studies and researches in this field of topic can be very practical and beneficial not only for the patients but also especially for the healthcare professionals so they can all asses their abilities to handle their patients communications stills and if anyone needs training accordingly they can be catered. As a result, the current study is being carried out with the objective of bringing additional value to the already existing research on patient doctor communication examining its effects and results in relation to patient satisfaction and role of patient revisit intentions and hence, a lot of scholars have investigated the association between communication and patient satisfaction with almost same and some other variables like monthly income, job status, etc. Nevertheless, none of those research encompassed patient engagement/experience as a moderating variable, especially when it came to terms of as one of the effects of the variables in the study. As a result, in order to fill the deficiencies mentioned in the existing scholarship, the present study is intended to learn more about the influences of patient doctor communication degree in relation to the mediating effect of patient satisfaction towards the patients revisit intention and including the moderating effect of patient engagement/experience 1.4
Objective of the Study
Following are the objectives of this research study
To find out the impact of the doctor’s communication on satisfaction among patients.
To find out the influence of satisfaction of patients on revisit intention.
To find out the role of mindfulness in the relationship between deviance behavior and project success.
1.5
Research Question
Following are the specific research questions:
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1.
How does the doctors’ communication level with the patients induce trust and satisfaction among patients?
2.
How can the professional behavior and communication of doctors towards patients can influence patient engagement? 3.
What is role of communication in the relationship between doctors and patients and how it can influence the patients’ decision to revisit the same doctor?
1.6
Research Significance
Communication is basically the art of conveying or sharing one’s ideas or thoughts effectively. Several experts agree that communication skills include: Conveying messages without misinterpretation or misleading others. Effectively communicating with a range of people from all walks of life. Even during the pandemic COVID-19, several countries adopted strategic communication to battle against the deadly virus.
In regard to the medical field, communication plays a major role in exchange of to the point and suitable details and the progress of positive therapeutic relationships (Gupta et al., 2021). Renata Schiavo, in the year 2013, defined health communication (Schiavo, 2013) as, "A multifaceted as well as multifaceted field of research, theory, and practice concerned with reaching different demographics and categories that share health-related information, ideas, and approaches in order to influence, engage, empower, and support people, communities, health care workers, patients, policymakers, organizations, special interest groups, and the public so they will support, introduce, adopt, or sustain a health or social behavior, practice, or policy"
To safeguard their patients, save expenses, and improve daily operational efficiency, healthcare providers need to communicate effectively. Patients gain from easier access to their medical records, which lowers the risk of medical mistakes (Blackburn et al., 2019). 1.7
Definition of Study Variables
1.7.1
Communication
In order to promote effective diagnosis, a doctor's interpersonal and communication abilities must include the capacity to properly advise patients, provide treatment instructions, and build enduring connections with them. These are the fundamental clinical abilities required for the efficient provision of medical treatment, with the ultimate goals of getting the greatest results and elevating patient happiness
(
Ha & Longnecker, 2010).
1.7.2
Patient satisfaction
The level of patient satisfaction reflects how happy the patient is with the medical attention they have received. One of the most crucial components in a healthcare facility's performance is the level of pleasure its patients have with their treatment
(
Manzoor et all 2019).
1.7.3
Revisit intention
A customer's propensity to return to a business after a previous experience with that company, in this case a hospital, to make a purchase of some kind is known as their "revisit intention" or "revisit intention."
(Jones and Taylor, 2007).
1.7.4
Patient engagement
Engaged patients are those who voluntarily and consciously choose to work with their healthcare providers and institutions to improve their health and healthcare outcomes and experiences (Higgins, Larson, & Schnall 2017).
CHAPTER II
LITERATURE REVIEW
The theory of planned behavior (TPB) is a branch of psychology that seeks to establish a causal relationship between cognition and action. Attitude, subjective norms, and the perception of behavioral control are the three primary influences on an individual's behavioral intentions, as proposed by the theory. The primary tenet of the planned behavior theory is that a person's behavioral intention is the best predictor of their future social conduct.
This is the overarching theory that suits my research study. As communication of the doctor towards patient exerts a form of the behavior that builds a level of trust and satisfaction in the patient and a patients' satisfaction with a health-care interaction is mostly determined by the duration and quality of care, as well as how compassionate and communicative the medical professionals are. It benefits from a positive doctor-patient interaction.
Communication With Doctor and Patients Revisit Intention
Patients' attitudes on revisiting to their doctor are influenced by how well they were able to communicate with their doctors. Doctor-patient relationships benefit from open lines of communication that foster mutual understanding and active participation. As a result, the doctor-patient connection is strengthened and patients are more likely to return for follow-up care.
Abidova et al. (2020a) explained that it is crucial that doctor and nurses provide information to their patients in a way that is easy to understand and doesn't waste their time. Helping people understand difficult medical ideas, doctors who avoid jargon are invaluable. Doctors may encourage their patients to ask questions, voice concerns, and take an active role in their healthcare decisions by using active listening and other communication tactics. Informed patients are more likely to complete their recommended treatments and make healthy lifestyle choices, both of which contribute to better health outcomes (Park et al., 2021). Putri and Syah (2022) concluded that emotional support and empathy are promoted via empathic communication, which in turn increases patients' happiness and likelihood of revisiting to their healthcare providers. Mbwogge et al. (2020) concluded that Doctors that show compassion for their patients by validating their feelings and recognising their worries promote open communication. This compassionate method encourages a more all-encompassing method of treatment by making patients feel important and cared for regardless of their health status. Patients are more inclined to follow their doctor' advice if they believe their doctors care about them. As a consequence, people are more likely to stay with the same doctor over time, which improves health management and preventative measures (Reagen et al., 2021).
Patients' impressions of their doctor' attention and professionalism are greatly influenced by non-verbal signals such as body language and eye contact. Hermann et al. (2019) explain that making and keeping eye contact with patients conveys interest in them and shows that you care. When doctor and patients use these nonverbal clues, it helps them connect on a deeper level and fosters trust. On the other hand, patients may feel discarded or overlooked by doctor who give the impression of being uninterested or hurried. Patients who see their doctor as uncaring are more likely to go elsewhere for treatment or be hesitant to return for future needs (Sibiya, 2018).
Additionally, the usage of telemedicine and other contemporary communication technologies, such as encrypted messaging platforms, have completely altered the dynamics of doctor-patient interaction. These online forums enable patients to ask their doctor questions remotely and get answers outside of regular business hours, providing a convenient and accessible service (Karlsson et al., 2012). Vinson and Underman (2020) explored that communicating with patients in a timely and effective manner via various channels improves their care by easing their worries and answering their questions. Those who have had a good experience with these innovations are more inclined to consider seeing their doctor again, as they appreciate the time and effort saved by using them (Kelvered et al., 2012).
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Patients are more likely to return to their doctor when they have open lines of contact with them. When patients are given information in a way that is easy to grasp, they are better able to take an active role in their own healthcare. Increased patient satisfaction and the development of lasting relationships are the results of empathic communication that establishes trust, provides emotional support, and makes the other person feel appreciated. Patients' impressions of their doctor' availability and attention are heavily influenced by both verbal and nonverbal indicators and by advances in communication technology. Doctors may improve the doctor-
patient connection, get patients more involved in their treatment, and enhance the chance of patients revisit for follow-up visits by prioritising effective communication tactics (Swartz, 2020).
There are a lot of factors that can help not only build but also provide the quality of services that can help retain a patient towards a specific doctor or hospital. For many patients, going back to the hospital can be a result of various reasons. Some of these include experiencing side effects from their previous treatment, having a new health issue, or needing to undergo follow-
up care. There are many factors that affect these decision making from patients (Singh, Dey, & Sahay, 2019). A strategic and professional communication from the doctors end can earn many patients as they would feel more welcome and heard and so will be more confident to revisit the same health care provider in case (Kim et al., 2021).
H1: Communication with doctor positively effects patient revisit intention.
Communication with the doctor and Patient satisfaction
Establishing a solid rapport between doctor and patient is fundamental to the medical process. To practice medicine effectively, doctors must master not just the science of medicine but also the skill of humanizing the doctor-patient relationship. Studies in literature and the sciences highlight the need of open lines of communication between patients and doctors. Jill Allenbaugh et al. (2019) explored that patient's trust in the doctor is usually more vital to the healing process than the medication that is prescribed. When it comes to the patient's health and physical condition, no one is as knowledgeable as the patient when discussing it with the doctor. Jiang (2019) explained that with an adequate communication skill, the doctor would be able to learn about the patient's emotional and physiological state. This allowed him to choose the most effective course of therapy. Effective therapeutic physician-patient interpersonal relationships are built on the foundation of good communication skills between doctors and their patients. It's the essence and craft of medicine, thus the name (Wei et al., 2020).
Takeshita et al. (2020) concluded that primary medical treatment process is the doctor-
patient connection. It is widely agreed that a doctor's ability to establish a rapport with his or her patient is crucial to the success of therapy, making it one of the most critical skills for a doctor to acquire. Scientific and literary studies have shown that open lines of communication between doctors and their patients may have a significant impact on the health of both parties. Patients usually put more faith in their doctors than in the doctor and/or prescribed medications, which might slow down the therapeutic process (Manzoor et al., 2019). No one other than the patient knows as much about his or her health and physical condition at the time of referral to the doctor. A doctor's ability to interact with his or her patients is crucial for gathering information about their health and wellbeing. Layfield et al. (2020) investigated that the doctor may decide on the best course of action for each individual patient. Presently, the level of contentment expressed by patients is considered the primary indicator of the quality of therapeutic and health services provided (Yang et al., 2019). The study by Uzir et al. (2021) explored that medicine might be seen of as a synthesis of life science and humanism, or as the union of experience and art. Instead of acquiring only academic books and resources, medical education texts emphasise developing communication and interpersonal skills. It is generally accepted that the health care industry relies heavily on satisfied patients. Orrange et al. (2021) investigated that the doctors' ability to effectively communicate with their patients is likely a major contributor to their patients' happiness. Professionals in the medical field are highly regarded for their ability to communicate effectively. Umoke et al. (2020) explained that the doctor's ability to convey information to patients is often used as a yardstick of evaluation. One of the most crucial considerations for medical education systems is teaching students how to effectively communicate. Sharing information, making decisions, and formulating therapy plans between a physician and patient is a collaborative effort that requires the subjective ability of listening. Karaca and Durna (2019) explored that ineffective communication between doctors and their patients can lead to a number of undesirable outcomes, including patient dissatisfaction, incorrect diagnoses, higher healthcare costs, the administration of unnecessary medications, and the waste of valuable time and resources. The quality of medical care provided as a result of such a trend inevitably declines (Baashar et al., 2020). As a result of issues such as a shortage of time for patient visits, an unbalanced caseload, and a high rate of visiting fee for patients, medical professionals in some societies fail to give adequate weight to the importance of good communication in the treatment process, which can lead to patient dissatisfaction and a loss of trust in doctors
(Wittenberg et al., 2021). Donelan et al. (2019) concluded that doctors' ability to communicate effectively with their patients, whether via attentive listening, cordial demeanor, or other means, has been linked to increased patient satisfaction and lower healthcare costs (Ng & Luk, 2019).
Furthermore, several researches (Asnawi et al., 2019; De Leon et al., 2020; Teo et al., 2019) have highlighted that the lack of communicational skills among doctors is the most crucial element which leads to the neglect of patients' sentiments, highlighting the significance of the interactive contact between the doctor and patient. This hinders doctors' capacity to provide effective two-way communication with their patients. The ability of doctors to effectively communicate is the single most important element in reducing the frequency of medication mix-ups. Patients are more likely to be dissatisfied when they are visited in groups and/or when they are not given enough attention during visits (Aburayya et al., 2020).
An important part of providing effective treatment is building trust with patients, which may be facilitated by listening to their concerns with patience. Patients have said that doctor' cordial dialogue is one of the most essential sources of emotional and spiritual support throughout treatment. Ganguli et al. (2020) concluded that the doctor may learn more about the patient's condition and increase the likelihood that the patient will adhere to the treatment plan if he or she is able to communicate well with the patient. Last but not least, it has the potential to expand the physician's influence in illness prevention and health improvement. The inability of many medical professionals to successfully engage with their patients highlights the need for interaction and communication skills training to be included into medical education at all levels.
Whatever reason a patient visits a hospital/doctor, there are many things that he/she is counting on and one of them is their communication with the doctor. The way a doctor presents himself/herself and conducts everything politely like the greeting, history taking and medical exam, they all have their own significance which can either have psychological relief on the patient or the reverse which is can make the patient more anxious about him/her or the situation. These effects have been studied to identify the most influential factors that influence the perceptions and communication of doctors (Street, Gordon & Haidet 2007). A good and expert way of conveying is important in medical management of patients. Direct, understandable, truthful and straightforward communication between the doctor/health provider and the patient aids in correct and precise diagnosis and treatment plan(Vega-Hurtado, 2020).
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(Park, Kim, Choi, & Lee, 2021) importance of communication in health is well acknowledged. Planned and tactical communication enlighten, educates, influences and guides. Building up the communication skills of medical staff and providing clear guidelines on when and how to inform patients are necessary(Katsaliaki 2022). The better and more up to the mark the level of communication between the medical practitioners is, the more adequate will be the degree of satisfaction of the patient.
H2: Communication with doctor positively effects patient satisfaction. 2.3
Patient Satisfaction and Patient Revisit Intention
There are few areas of healthcare delivery as important as patient satisfaction and the likelihood that a patient would revisit for further treatment. Nguyen et al. (2021) explained that patients' future intentions to revisit to a healthcare institution are influenced by their satisfaction with their healthcare experience, which is enhanced when they get high-quality treatment and have pleasant relationships with healthcare personnel. In recent years, this issue has received a lot of attention as healthcare facilities work to improve patient outcomes by emphasizing patient-centered care (Selin Woo & Mankyu Choi, 2021).
Dimensions of care quality, communication, empathy, accessibility, and timeliness all have a role in whether or not a patient is satisfied with their experience. Yu et al. (2021) explored that patients have the right to get treatment that is both timely and effective, as well as to have their concerns acknowledged and addressed, and to be treated with respect and dignity. Liu et al. (2021) concluded that patient understanding of their diagnosis, treatment choices, and care instructions relies on open lines of communication between themselves and their healthcare professionals. It entails paying close attention to the patient, giving them accurate and detailed information, and answering any questions they may have. The degree to which patients perceive that their healthcare professionals are invested in their health and well-
being is a major factor in how satisfied they are with that treatment (Rita et al., 2019).
Furthermore, several researches (Siripipatthanakul & Chana, 2021; Suhail & Srinivasulu, 2021) explained that patient satisfaction can only be achieved via individualized treatment that takes into account each patient's specific requirements and preferences. Positive patient experiences are more likely to result from healthcare practitioners that take the time to learn about each patient's unique situation and develop individualized treatment plans. As part of this individualized strategy, we may take into account the patient's cultural, social, and psychological background. Healthcare practitioners may improve patient empowerment and
happiness by treating patients as partners in their own treatment and including them in the decision-making process (Cakici et al., 2019).
The ease with which patients may get healthcare is also a major consideration. Patients like healthcare services that are convenient in terms of location, cost, and availability of appointments. Mohd Isa et al. (2019) explained that reduced wait times and well-organized appointment scheduling show appreciation for patients' time and boost their happiness. In addition, continuity and quality of treatment, which in turn affect patient satisfaction, are greatly aided by the efficient coordination of care across various healthcare venues, such as primary care clinics, hospitals, and specialist consultations (Xu et al., 2020).
Aljumah et al. (2020) explored that patient satisfaction correlates strongly with patients' propensity to revisit to a doctor. Patients are more likely to revisit to the same healthcare provider if they were pleased with their treatment this time around. A patient's confidence in the healthcare system, its personnel, and its services increases when they have a positive experience. Cham et al. (2022) investigated that patients who have faith in their doctors are more likely to complete prescribed therapies, have regular checkups, and seek emergency care when necessary. Healthcare organizations may improve patient outcomes by encouraging revisit visits to help maintain patient health and build lasting connections (Ge et al., 2021).
In addition, circumstances other from the actual healthcare encounter have an impact on the patient's likelihood of revisiting. Patients' impressions of healthcare facilities and their propensity to revisit are significantly influenced by their reputation and the recommendations of friends, family, and online communities. A healthcare provider's development and performance may be boosted by positive feedback and word-of-mouth from delighted patients. That's why it's so important to keep a good name in the neighborhood and address the needs of your patients first (He & Luo, 2020). Healthcare providers have launched a number of initiatives aimed at increasing patient satisfaction and the likelihood that patients would revisit to get future treatment. D. Lee (2019) explained that quality enhancement techniques like patient satisfaction surveys and feedback channels are examples. By gathering feedback from patients, healthcare providers may learn more about their patients' experiences and work to improve certain areas. Patients are encouraged to provide their input on how treatment might be improved via the use of feedback methods such as suggestion boxes and online forums. This information may be used by healthcare organizations to make improvements and fill service shortages (Park, 2019).
Manzoor et al. (2019) investigated that healthcare providers may also assess and enhance the patient experience overall with the use of ongoing quality improvement programs. Healthcare practitioners may enhance patient satisfaction via data analysis, trend identification, and the adoption of evidence-based practices. Patient-centered care models, technological advancements, and staff training programs aimed at bettering interpersonal interactions are all examples of possible activities in this category (Ilardo & Speciale, 2020).
The quality of care provided has a significant effect on the patient's experience and the quality of treatment received by the patient. Maatouk-Bürmann et al. (2016) concluded that doctors may improve patient satisfaction by delivering high-quality care, good communication, individualized treatment plans, and easy access to services. Patients who have a great experience are more likely to revisit to that same healthcare provider in the future, which is good for everyone's health. Healthcare organizations must deliver patient-centered treatment and enhance the entire healthcare experience by understanding the variables that impact patient satisfaction and patient revisit intention and adopting strategies to address them (Petrescu et al., 2022).
Definitely if the patient is thoroughly satisfied with the healthcare provider he will tend have this in mind and would opt again for the same medical facility and the doctor/physician next time he/she have any medical query or in case of any follow ups in the future. Past studies have been done with other different mediating roles (Isa, Lim, & Chin, 2019) and these studies have a scope that have been used further with other variables (Mallat et al., 2020) and the more the patient is satisfied, the more he/she will have an adequate trust in the very medical practitioner and the more the patient would have the intention to revisit. This way patient would develop a level of trust about the doctor and would recommend others also (Nabi et al., 2022) . H3:
Patient satisfaction has a positive effect on patient revisit intention.
2.4 Communication With Doctor, Patient Satisfaction and Patient Revisit Intention
The happiness of patients and their propensity to revisit to the same doctor is dependent on open lines of communication between the two parties. It's the bedrock of a positive healthcare experience and the key to a healthy doctor-patient relationship. In this paragraph,
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we'll go back to the topic of intent and discuss how communication relates to patient satisfaction.
Al-Refaie (2013) explained that trust and confidence between doctor and patients can only be built by open and compassionate dialogue. Patients appreciate their doctor more when they take the time to listen to them, acknowledge their concerns, and thoroughly explain their diagnoses and treatment plans. Because of the doctor's openness and empathy, the patient feels more comfortable following his or her advice. Because they are given a voice in their care, patients are more likely to report being happy with the services they get (Tam, 2007). Lee and Kim (2017) explained that patient satisfaction may be increased by using better communication to manage expectations. Doctors who are open with their patients about the advantages, disadvantages, and consequences of their recommended treatments are more likely to have satisfied patients. Naik Jandavath and Byram (2016) investigated that patients are less likely to experience negative emotions if they prepare for a range of possible outcomes. Patients may take an active role in their care and make educated choices when they have a thorough awareness of their diagnosis, treatment options, and expected results. Patients are happier and doctor are more invested in their care when they work together in making decisions (Vasiliki Amarantou et al., 2019).
Some researches (Gu et al., 2018; Swain & Kar, 2018; Selin Woo & Mankyu Choi, 2021) explained that fewer misconceptions and greater patient compliance with treatment programs are also outcomes of effective communication. Patients are more likely to comply with their doctors' orders when they are given instructions in plain English rather than medicalese. Kitapci et al. (2014) explained that patients are more likely to take medications as prescribed, make healthy behavioral changes, and keep follow-up visits if they understand the reasoning for their care. This boosts patient satisfaction and repeat visits to the same clinician, which in turn improves patient outcomes and decreases treatment failure (Kim et al., 2017). D. Lee (2019) explored that the doctor-patient connection is strengthened and care continuity is improved when there is good communication between the two parties. When doctor make an effort to keep in touch with their patients, it makes them feel like they're a part of a team. Liu et al. (2021) explained that follow-up visits, phone conversations, and electronic messaging systems let doctor keep tabs on their patients' progress, hear out their worries, and provide timely advice. This kind of open communication shows that the doctor really cares about their patients and boosts their confidence and pleasure. As a result, patients are more likely to
remember their doctors and revisit to them for future medical treatment (Siripipatthanakul & Vui, 2021). Last but not least, good communication aids in providing treatment that is focused on the individual patient. Patients get individualized care that is in line with their needs and values when their doctors include them in decision-making, consider their input, and adapt treatment plans appropriately. Doctors display a patient-centered approach, which improves patient satisfaction, by listening to patients' concerns and encouraging them to participate in their own treatment. Patients are more likely to report being pleased with their doctor and to plan to revisit to the same healthcare provider in the future when they feel heard, respected, and included in their healthcare journey (Wandebori & Pidada, 2017). Good doctor-patient communication is crucial for maintaining patient satisfaction and influencing patients' propensity to revisit for further treatment. Trust is established, expectations are moderated, adherence to treatment regimens is improved, continuity of care is promoted, and patient-centred care is fostered when there is open and compassionate communication between the healthcare provider and patient. Doctors may improve their patients' satisfaction, patients' sense of agency, and their desire to seek their expertise in the future by stressing good communication (Siripipatthanakul & Chana, 2021)
There are a lot of elements responsible towards satisfaction of a patient whenever he/she comes to a medical center (Chandra & Mohammadnezhad, 2021) that is why due to certain advancements there has been a demand towards medical education to promote a more hands-
on and realistic approach towards patient care, history taking, diagnosis and treatment plan(Steiner-Hofbauer et al., 2017). Many studies been don on casual relation between service quality, patient satisfaction and other variables (Selin Woo & Mankyu Choi, 2021).
H4: Patient satisfaction mediates the positive effect of communication with doctor with patient revisit intention.
2.5 Patient Satisfaction, Patient Engagement and Patient Revisit Intention
Care quality and health outcomes are strongly related to patient satisfaction, patient engagement and the likelihood of a revisit intention for further treatment. These three factors work together and have a major impact on patients' satisfaction and propensity for repeat visits. Mancuso et al. (2021) elaborated that how effectively doctor meet or surpass patients'
expectations is quantified by their patients' level of satisfaction. It includes things like how well people are communicated with, how much they are heard and understood, how easy it is to go about the facility, and how accessible everything is. Patients are more likely to be satisfied with their treatment and express their satisfaction with the doctor when they get high-quality care and have pleasant experiences (AlOmari, 2022). The term "patient engagement" describes when patients take an active role in their treatment. Mason (2022) explained that communication between patients and doctors is fostered by patient education, patient involvement in treatment decisions, and doctor-patient communication. Patients who are involved in their care are more likely to complete their prescribed treatments, take initiative towards their health, and make educated choices. Because of their increased confidence and sense of worth, patients report higher levels of satisfaction (Haque et al., 2020).
Sanyang et al. (2019) investigated that the possibility that a patient will revisit to the same doctor in the future is measured by the term "revisit intention." Patient involvement and contentment have a role. Patients are more likely to trust and remain loyal to their doctor if they are an active participant in their treatment. If they have a positive impression of the doctor, they are more likely to revisit for follow-up care or to seek treatment for new health issues (West & Coia, 2019). Ye et al. (2022) elaborated that there is a strong relationship between patient satisfaction, patient engagement, and patients' revisit intentions. Patient satisfaction is affected not only by the actual medical result but also by how the patient felt about the treatment they got and how involved their doctor were in their recovery. Patient satisfaction rises when they believe their opinions matter and they have a opportunity to communicate with their doctor during their treatment. (Wu, 2018).
Mohd Isa et al. (2019) explained that patient engagement also mediates the link between satisfaction and revisit intention. Patient satisfaction and stated willingness to revisit are both increased when patients are actively involved in their care. Patients who take an active role in their care are more likely to have realistic expectations about their diagnoses, treatments, and results (Sediawan et al., 2023). Peng et al. (2023) concluded that there is no secret that doctor value patient’s feedback on satisfaction, engagement, and willingness to revisit. Improved communication, collaborative decision-making procedures, and patient-centered care are just a few of the programs and tactics they fund to improve the patient experience. Better health outcomes, less healthcare inequities, and longer connections with patients are the end goals of this focus (Abrar et al., 2020).
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Healthcare delivery relies heavily on metrics like patient satisfaction, engagement, and willingness to revisit. There is a recursive link between the two variables whereby patient pleasure affects engagement which then affects revisit intentions. Doctors have a responsibility to their patients to provide excellent treatment that is focused on them, with the goals of increasing patient engagement and satisfaction. They are able to gain their patients' confidence, loyalty, and a feeling of cooperation while simultaneously enhancing patient results. Better health outcomes and longer life for the healthcare system are the end results (Mohd Isa et al., 2019).
A satisfied patient can get involved in the treatment which he is contempt with and which can get the patient to revisit the same medical facility in future if he needs(L. Harrington et al., 2020). A high degree of patient satisfaction can involve and engage the patient in his/her own healthcare treatment and diagnosis plans in such a way that he/she can get engaged and involved in a positive way throughout the process to his/her advantage accordingly. This can in a way ensure that the patient would have revisit intentions to the same very practitioners in the future. H5: Patient engagement moderates the relation between patient satisfactions and communication in a way that increase in patient engagement strengthen the said positive effect.
2.6. Research Model
IV Med DV
Mod
CHAPTER III
METHODOLOGY
Communicatio
n with doctor
Patient Satisfaction
Patient re-visit intention
Patient encouragement/ experience
3.1 Overview
This chapter outlines the quantitative methodology employed to investigate Factors effecting patient revisit to OPD in private sector hospitals of Islamabad with mediating role of patient satisfaction and moderating role of patient engagement. The research objectives will be addressed through a structured survey conducted among patients from private sector hospitals in Islamabad. The chapter provides an overview of the research design, sampling techniques, data collection procedures, and data analysis methods used in the study.
3.2
Research Design
Research is by far the most popular method used to learn something new or to refresh one's memory on an old subject. Business, sociology, psychology, science, technology, and even economics might all learn something from marketing. According to Aziz et al. (2016), there are three different types of study designs: qualitative, quantitative, and mixed. This study used a quantitative methodology. A positivist deductive method was applied in this investigation. Quantitative research techniques emphasize the use of mathematical and statistical analysis of primary sources from the real world for data collection and analysis (Zhou et al., 2022). This is why Bloomfield and Fisher (2019) advocated for a possible split between quantitative and qualitative research methods. Quantitative studies need to take into account issues of credibility, objectivity, validity, and generalizability in their design. A researcher should also be aware of the context in which their concept will be used. What distinguishes quantitative research from a qualitative one, and how do I know which to conduct? Information that cannot be converted to statistics, such as words and tales, is used in qualitative investigations. Qualitative research sheds light on how a person perceives their social circumstances. In contrast to the quantitative data represented by numbers, the qualitative data represented by text, video, and audio recordings are all instances of the latter. Journals and in-
depth interviews may be used to compile and examine this kind of material, which can then be studied using grounding theory or theme analysis. Naturalistic and interpretive in nature, qualitative research still often draws on techniques from other schools of thought. Qualitative researchers investigate items in their natural settings to learn how people use them and what meanings they may have for them. When some psychologists saw the results of behaviorists' empirical study and were unsatisfied, they began to focus on qualitative
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information instead. Psychological scholars have concluded that conventional scientific approaches are inadequate because they overlook crucial aspects of the human condition. The phenomenological approach values first-hand accounts of human experience. The objective of qualitative research is to gain insight into a social phenomena by speaking with those who have direct experience with it. We can now see people and groups in their natural environments. Qualitative research is conducted to learn the "how" and "why" of a phenomenon or behavior in a specific context. The facts provide the groundwork for the development of hypotheses and theoretical frameworks.
In quantitative studies, results are often presented in the form of numbers and graphs. It's the benchmark by which all other theories and propositions are judged. From this data, generalizations might be made. Quantitative research techniques include things like controlled experiments, statistically documented observations, and predetermined answer surveys. There are several methods for collecting both quantitative and qualitative information. You may report data statistically (using rating scales or counting frequencies, for example) or orally (using open-ended questions or describing what you observe) in surveys, observations, and case studies. Natural scientific methods are used in quantitative studies, yielding quantifiable data and undeniable evidence. The goal of this technique is to establish a link between two parameters from a mathematical, computational, and statistical perspective. Empirical research is one that relies on hard numbers to draw conclusions. When sorting and ranking the data, the researcher might choose from a variety of measuring systems. Charts and tables may be useful tools for analyzing the raw data collected in quantitative investigations.
3.3
Population Size
3.3.1 Type of study
This study is descriptive in nature and investigate how a good and ethical behavior from the doctor towards patient can influence patient satisfaction and trust in the doctor that can lead him to revisit.s
3.3.2 Study setting
This will be a field study because respondents i.e. patients from OPD (outpatient department) of private sector hospitals in Islamabad will be targeted.
3.3.3 Time horizon
The data for this research will be collected throughout the study period.
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3.3.4 Research interference
There is no or limited research interference, and this investigation is conducted in the field. A self-report questionnaire will be used to collect data on all factors. Furthermore, because it is less expensive, it offers the advantage of reducing the possibility of responder bias. This strategy makes it easier for respondents to answer to questionnaires and allows them to take their time for reasonable and well-thought-out responses.
3.3.5 Unit of analysis
The unit of analysis for this research thesis will be patients from private sector hospitals in Islamabad.
3.4.
Population and Sample
3.4.1 Population
The population of the current study comprises a combination of all types of patients that visit daily at an OPD in private hospitals in Islamabad, Pakistan
. An adequate set of respondents from the OPD will be selected. The research will approach the OPD of private tertiary care hospital in Islamabad for data collection.
3.4.2 Sampling and sampling techniques
The study is based on convenient sampling due to time limitations. The data will be collected from the patients of the Railway Hospital in Islamabad, the rationale for which is that data collection from this population was easy and convenient. 300 will be requested to fill the questionnaire.
3.5.
Scale/Measures
All the study variables will be measured on a 5-point Likert scale ranging from Strongly Disagreed=1 to strongly agree=5. 3.5.1 Communication The 7 items measure developed by Kondasani, R. K. R., & Panda, R. K. (2015) will be used to measure the level of communication. 3.5.2 Patient satisfaction
The 5 items measure developed by Kim (2008) will be used to evaluate the level of patient satisfaction. The obtained items for relationship conflict include. 3.5.3 Revisit intention
The 3 items measure developed by Swain, S., & Kar (2018
) will be used to evaluate the level of satisfied patients’ revisits. The obtained items for process conflict include.
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3.5.4 Patient engagement The 4 items measure developed by Jenkinson, Coulter & Bruster (2002) will be used to evaluate the nature of patient engagement/encouragement.
3.5.5 Measurement model
A confirmatory factor analysis is a type of factor analysis used to evaluate if measures of a construct are compatible with a researcher's knowledge of the nature of that construct. The confirmatory factor analysis (CFA) was done on the Smart-PLS to assess the scales' validity. The factor loadings of all items, according to the results, are at or above the minimum criterion of 0.7 except C4 and C5.
Figure 1: CFA (Confirmatory Factor Analysis) Level 1
So, these items were removed from further analysis due to low factor loadings (figure) after the removal of the items with the low score.
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Figure 2: CFA (Confirmatory Factor Analysis) after dropped low values.
3.5.
Data Analysis Procedure
Data will be analyzed using SPSS and following procedures/tests will be carried out:
The primary component of a research project is data analysis. Using the right data collection and analysis methodologies, researchers may draw a firm conclusion regarding their study endeavor. The next stage after data has been gathered for a research project is analysis of the data. To do this, a variety of techniques are used. The information obtained from the research participants is first processed and organized into the required order. It is crucial to complete this step-in order to prepare the collected data for further investigation. A variety of test procedure done for data analysis. The minimum and maximum score, mean and standard deviation was done through descriptive statistics. Outlier analysis was done to analyze the underlying structure of a set of observed variables and identify underlying latent factors that explain the patterns of correlations among these variables. Missing values was replaced by mean values. To find the frequency, frequency distribution was done. To find the F-statistics and p-values ANOVA was done using SPSS. Reliability, Regression analysis and correlation analysis was also calculated using SPSS.
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4.1
Overview
The research approach used in this study was discussed in the previous chapter, and now we will discuss the results of our statistical analysis of the survey data. Quantitative analysis, such as demographic findings, one-way analysis of variance (ANOVA), descriptive statistics, and results from correlation and regression analyses, are presented here. The process starts off with a statistical dissection of the dataset's collection of demographic characteristics.
4.2
Demographics
The table 1 shows the demographic of the population. There was total 265 responses included in the study. All respondents were the patients of the hospital to visit the OPD (outpatient department) from Islamabad. As looking on the age profile 41.9 percent (n=111) respondents belong to the age group 30-40 years, 40 percent (n=102) respondents belong to age group 20-30 years, and 17 percent (n=45) respondents were from the age group 40-50 years. All the respondents including male and females’ patients in which 54.7 (n= 120) percent were male and 45.3 percent (n= 145) were females. Most of the education of the overall patients responded to the questionnaire included 41.9 percent (n= 111) have done bachelors, 38.5 percent (n=102) have completed masters, while 14 percent (n=37) have completed their intermediate. The marital status of the participants was 54.3 percent (n= 144) married and 45.7 percent (n= 121) were unmarried.
Table 1: Demographics of The Population
Demographics Category Frequency Percentage% Age Profile 10-20 3 1.1 20-30 106 40 30-40 111 41.9 40-50 17 45 Gender Male 120 45.3 Female 145 54.7 CHAPTER IV RESULTS
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Education Matriculation 13 4.9 Intermediate 37 14 Bachelor 111 41.9 Master 102 38.5 Ph.D 2 0.8 Marital Status Married 144 54.3 Unmarried 121 45.7 4.2.
Descriptive Statistics
The given information provides insights into the mean and standard deviations for various variables. Firstly, the average age of the participants is found to be 2.7434, indicating the central tendency of age within the sample. The standard deviation of 0.75516 suggests that the ages are somewhat spread out around the mean, reflecting the variability or dispersion in the age distribution. Moving on to the gender variable, the mean of 1.5472 does not have a direct interpretation as it represents a categorical variable. Gender is represented by two values (e.g., 1 for male and 2 for female), but the specific meaning of these values is not provided in the given information.
In terms of education, the mean of 3.1547 indicates the average level of educational attainment among the participants. The standard deviation of 0.84535 reveals the degree of dispersion in education levels, highlighting the variability in the sample's educational backgrounds. Regarding marital status, the mean value of 1.4491 does not have a direct interpretation since it represents a categorical variable. Similar to gender, the specific meaning of the values (e.g., 1 for married and 2 for unmarried) is not explicitly mentioned. The standard deviation of 0.49834 demonstrates the dispersion or variability in marital status among the participants.
Table 2: Descriptive Analysis of The Population
N Minimum Maximum Mean Std. Deviation Age 265 1.00 4.00 2.7434 .75516
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Gender 265 1.00 2.00 1.5472 .49871 Education 265 1.00 5.00 3.1547 .84535 Marital status 265 1.00 2.00 1.4491 .49834 Valid N (Listwise) 265 4.3.
One-Way Anova The table presents the results of statistical analyses examining the relationship between various variables and patient satisfaction as well as patient re-visit intention. The F statistics and p-values are reported for each variable. Regarding age, the F statistic of 3.021 and p-value of 0.084 suggest a weak association with patient satisfaction. This indicates that age may have a minor influence on patient satisfaction, but it does not reach a significant level of statistical significance. Similarly, age shows no significant impact on patient re-visit intention, as evidenced by an F statistic of 1.354 and a p-value of 0.246.
The variable of gender exhibits a non-significant relationship with both patient satisfaction and patient re-visit intention. With an F statistic of 1.707 and a p-value of 0.149 for patient satisfaction, and an F statistic of 0.857 and a p-value of 0.490 for patient re-visit intention, the results suggest that gender does not play a significant role in influencing either outcome. Education, on the other hand, shows a somewhat stronger association with patient satisfaction. The F statistic of 2.403 and the p-value of 0.068 indicate a relatively moderate relationship. Although it falls short of achieving statistical significance, it suggests that education level may have a slightly more substantial impact on patient satisfaction compared to age or gender. Similarly, education level does not significantly affect patient re-visit intention, as evidenced by an F statistic of 1.614 and a p-value of 0.187.
Lastly, marital status demonstrates no significant relationship with either patient satisfaction or patient re-visit intention. Both F statistics are extremely low, with values of 0.001 and 0.076, and their associated p-values are very high (0.980 and 0.782). Therefore, marital status does not appear to be a determining factor in either patient satisfaction or patient re-visit intention. In conclusion, based on the statistical analyses conducted, age, gender, education, and marital status do not have a conclusive impact on patient satisfaction or patient re-visit intention. The associations observed are weak, non-significant, or show no substantial relationship.
Table 3: One Way ANOVA Analysis
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Patient Satisfaction Patient re-visit intention Variables F statistics p-value F statistics p-value Age 3.021 0.084 1.354 0.246 Gender 1.707 0.149 0.857 0.490 Education 2.403 0.068 1.614 0.187 Marital Status 0.001 0.980 0.076 0.782 4.3.
PLS-SEM In this study, the latest version 4 of smartPLS has been used to test the CFA (confirmatory factor analysis). Confirmatory factor analysis (CFA) is a statistical technique used to confirm the structure of a set of perceived variables. CFA allows the investigator to assess the hypothesis of the relationship between perceived variables and their fundamental constructs exists.
4.4.
Reliability Analysis
Reliability of each of the scale was calculated using Cronbach’s alpha. All the values in the reliability table are mentioned using the reliability analysis and the values greater than or equal <0.7 indicates good reliability of the variables. These values indicate there is good reliability of the variables used in this study.
Table 4: Reliability Analysis
Variable Name Mean Cronbach's Alpha C 3.3 0.7 PS 2.24 0.93 RI 3.9 0.74 PE 4 0.819
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4.4
Correlation Analysis
The table presents the correlation coefficients between four variables: Patient Satisfaction, Communication, Patient Revisit Intention, and Patient Engagement. The correlation coefficients measure the strength and direction of the linear relationship between pairs of variables. The results reveal significant positive correlations between Patient Satisfaction and Communication (r = 0.542, p < 0.01), indicating that better communication is associated with higher levels of patient satisfaction. Additionally, Patient Satisfaction demonstrates a significant positive correlation with Patient Revisit Intention (r = 0.180, p < 0.01), suggesting that satisfied patients are more likely to intend to revisit healthcare facilities. Furthermore, Patient Satisfaction exhibits a significant positive correlation with Patient Engagement (r = 0.178, p < 0.01), indicating that engaged patients tend to report higher satisfaction levels.
The variable of Communication also shows significant positive correlations with Patient Revisit Intention (r = 0.510, p < 0.01) and Patient Engagement (r = 0.392, p < 0.01). This suggests that effective communication between healthcare providers and patients is associated with a higher likelihood of patients intending to revisit and increased patient engagement. Moreover, Patient Revisit Intention demonstrates significant positive correlations with both Patient Satisfaction (r = 0.180, p < 0.01) and Communication (r = 0.510, p < 0.01). These findings imply that patients who express a greater intention to revisit healthcare facilities tend to report higher satisfaction levels and perceive better communication.
Lastly, Patient Engagement exhibits significant positive correlations with Patient Satisfaction (r = 0.178, p < 0.01), Communication (r = 0.392, p < 0.01), and Patient Revisit Intention (r = 0.728, p < 0.01). This indicates that patients who are more engaged in their healthcare experience tend to report higher levels of satisfaction, perceive better communication, and have a stronger intention to revisit healthcare facilities. In conclusion, the findings highlight the interconnectedness of Patient Satisfaction, Communication, Patient Revisit Intention, and Patient Engagement. Positive correlations between these variables suggest that improvements in communication, patient satisfaction, and patient engagement can contribute to increased likelihood of patient revisit and overall satisfaction with healthcare experiences. These insights underscore the importance of effective communication and patient-
centered care in fostering positive patient outcomes and perceptions of care.
Table 5: Correlation Analysis
1 2 3 4 1 Patient Satisfaction 1 2 Communication 0.542** 1 3 Patient Revisit Intention 0.180** 0.510** 1
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4 Patient Engagement 0.178** 0.392** 0.728** 1 Note: **. Correlation is significant at the 0.01 level (2-tailed). *. Correlation is significant at the 0.05 level (2-tailed). 4.5
Regression (Mediation Analysis)
Finding the variables that have an effect on an interest issue can be done with accuracy using regression analysis. One can confidently establish which elements are most important, which ones can be ignored, and how these factors interact when you do a regression. Table 7 displays the findings of regression analysis using the Hayes procedure, model number 14. The findings for Hypothesis 1— which states that communication with doctor positively effects patient revisit intention. —explained that there is a positive association between communication and patient revisit intention (=.0.813, p-value =.000), as shown in Table 6. Therefore, Hypothesis 1 is validated, and the direct link between communication and the patient revisit intention is established. According to hypothesis 2, communication with doctor positively effects patient satisfaction. As can be seen in Table 7, the findings revealed a significant positive link between communication and patient satisfaction, with control variables having bearing on involvement. As a result, Hypothesis 2 is confirmed, and it is demonstrated that an association between communication and patient satisfaction are directly related. Regarding Hypothesis 3, analysis that patient satisfaction has a positive effect on patient revisit intention showed that the two were substantially unrelated ( =-0.165, p-value =0.0297). As a result, hypothesis three is not supported and unaccepted. Then regarding the Hypothesis 4, patient satisfaction mediates the positive effect of communication with doctor with patient revisit intention, the analysis shows a positive and accepted relation between variables communication and revisit intention under the mediating role of patient satisfaction which suggest that the hypothesis is accepted. The last one, Hypothesis 5, patient engagement moderates the relation between patient satisfactions and communication in a way that increase in patient engagement strengthen the said positive effect, patient engagement is utilized as a moderator and is anticipated to have a positive impact on the strength of the association between communication and patient satisfaction. The results of Hayes' process moderation are described in Table 6. The findings showed that the interaction between patient satisfaction and communication have no noteworthy effect on revisit intention ( =0.932, p-value =0.000;). Therefore, Hypothesis 5 cannot be proven.
Table 6: Mediation Analysis
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B SE t-value p-value Communication > Patient Revisit Intention 0.813 0.084 9.62 0.000 Communication > Patient Satisfaction 0.712 0.68 10.45 0.000 Patient Satisfaction > Patient Revisit Intentions -0.165 0.075 -2.18 0.0297 Communication > Patient Satisfaction > Patient Revisit Intentions 0.932 0.099 9.33 0.000 Bootstrap results for indirect effect Indirect effect LL 95% CI UL95%CI 0.883 -0.2186 -0.279 4.6 Moderation Analysis The table presents the results of a moderation analysis examining the relationship between Communication (C), Patient Engagement (PE), and Patient Satisfaction. The variables B, R2, and ΔR2 are reported for each step of the analysis. In Step 1, Communication (C) is found to have a significant positive relationship with Patient Satisfaction, indicated by a coefficient (B) of 0.424. This suggests that better communication is associated with higher levels of patient satisfaction. The R2 value of 0.628 indicates that Communication explains 62.8% of the variance in Patient Satisfaction. In Step 2, an interaction term, Interact PExC, is introduced to examine the moderation effect of Patient Engagement (PE) on the relationship between Communication (C) and Patient Satisfaction. The coefficient for the interaction term (B) is -0.014. However, it is important to note that the interaction term is not statistically significant. This implies that Patient Engagement does not moderate the relationship between Communication and Patient Satisfaction.
The ΔR2 value represents the change in the proportion of variance explained in Patient Satisfaction between Step 1 and Step 2. In this case, the ΔR2 value is 0.585, indicating that the inclusion of the interaction term does not substantially improve the model's ability to explain Patient Satisfaction beyond what is already explained by Communication alone. In conclusion, the results suggest that Communication has a significant positive effect on Patient Satisfaction, highlighting the importance of effective communication in healthcare settings. However, the
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analysis did not find evidence to support the moderation effect of Patient Engagement on the relationship between Communication and Patient Satisfaction. Therefore, based on these findings, Patient Engagement does not appear to moderate the impact of Communication on Patient Satisfaction.
Table 7: Regression Analysis
B R2 ΔR2
Step 1 Communication (C) 0.424 Patient Engagement (PE) 0.628 0.590 0.587 Step 2 Interact PE x C -.014 0.590 0.585 4.6. Summary of Accepted and Rejected Hypothesis
The purpose of this study was to basically test the relationship between doctor’s communication and patients revisit intention, patient satisfaction and patient engagement. And this research study shows five hypothesis from the research model and the outcomes of these hypothesis based on the analysis are given in the table below:
H
Hypothesis
Status H1
Communication with doctor positively effects patient revisit intention.
Supported
H2
Communication with doctor positively effects patient satisfaction.
Supported
H3
Patient satisfaction has a positive effect on patient revisit intention.
Not Supported
H4
Patient satisfaction mediates the positive effect of communication with doctor with patient revisit intention.
Supported
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H5
Patient engagement moderated the relation between patient satisfactions and communication in a way that increase in patient engagement strengthen the said positive effect
Not Supported
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A complete and detailed analysis of the results of the data collected through questionnaires has been completed in Chapter 4. As briefed earlier in the hypothetical model concerning this research has allure support on four proposed theories. This study aims to investigate the impact of doctor’s communication with patient’s revisit intention and the impact of doctor’s communication on patient’s revisit intention in the mediating effect of patient satisfaction weakens or strengthen the said relationship, followed by examining the moderating impact of patient engagement on the relationship between communication and patient satisfaction can lead to patient revisit intention or not. Moreover, it is also speculated that patient satisfaction mediates the connection between communication and patient revisit intention. And lasty in closing, the moderating role of patient engagement on relationship between variables- communication and mediator patient satisfaction together is observed. Based on regression analysis, the hypothesis test shown in Table 10 discusses the relationships between the variables.
5.1.
Communication and revisit intention
The result of regression analysis (β=.0.813, p-value =.000) of the relation between communication and revisit intention, showed that there exists a significant positive effect of communication and patients revisit intention. It proves right as some other studies as well (Park et al., 2021). The finding that doctor’s communication had a positive effect on the patient’s revisit intention reveals that a good and proper communication gate between a doctor and patient can have a positive influence on patient in terms of good services, genuine patient medical history leading to an acceptable diagnosis and treatment plan causing the patient to revisit the same doctor for the purpose of ease and facilitation. Patients are more likely to desire to stick with the same doctor for future treatment or consultations if they feel they can communicate well with the doctor the first time around. The doctor-patient relationship benefits from good communication because it promotes trust and confidence on both sides (Jaldurgam, Ahmad, Touati, Al Ashraf, Bhadra, et al., 2022). Patients are more inclined to trust their doctor's suggestions and judgment when they believe they have been heard, understood, and appreciated by their physician. Patients benefit from thorough explanations of their medical condition, available treatment choices, and any required modifications to their lifestyle. Patients are more likely to cooperate with treatments and follow the doctor's advice when they have a firm grasp of their health state (Janssen et al., 2022).
CHAPTER 5: DISCUSSION
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The doctor's ability to empathize and provide emotional support is also an important part of effective communication. Patients' experiences and levels of satisfaction tend to improve when they perceive that their doctors care about them as people as well as patients. Anxiety and dread regarding a patient's health state may be reduced via honest and open conversation (Tremblay, Touati, et al., 2022). If you and your doctor have a good rapport, you may end up having a more favorable experience. Continuity of care is more likely to occur when patients have a good rapport with their doctors and feel comfortable talking to them. As clinicians get more acquainted with their patients' medical histories and requirements, continuity of care is linked to improved health outcomes (R. Touati et al., 2022).
Patient satisfaction and involvement in healthcare decision-making are both improved when clinicians adopt a patient-centered communication style that puts the patient's preferences, values, and requirements front and center. Patients who are pleased with their care are more inclined to refer their physicians to others, which may boost their standing and bring in new patients (Saeidian et al., 2022). When patients and physicians are able to work together effectively, everyone benefits. Patients have better experiences, are more satisfied with their treatment, and are more likely to return to the same doctor in the future. Improvements in health outcomes and a more trusting doctor-patient connection are two additional benefits (Mrabah et al., 2022). 5.2.
Communication with Doctor Positively Effects Patient Satisfaction
Regression examination of the association between communication and patient satisfaction (β =0.712, p-value =.0000) revealed a positive and favorable relationship between the two. These results show that if there is proper communication between a doctor and a patient then it will most definitely lead to an adequate level of satisfaction in patient towards the doctor and the hospital facility. These results are accordant with that of a previous study (Lotfi et al., 2019) where the same effects of communication between nurses and patients are studied and the study shows that due to lack of communication the patients were dissatisfied. Another study V. O’Rorke et al. (2022) shows the positive results of communication between doctors and patients develops patient satisfaction.
The quality and efficacy of the communication between healthcare professionals and their patients has been hypothesized to have a direct impact on the degree of satisfaction reported by patients. Clear and compassionate explanations of medical issues, treatment choices, and possible results are all part of what is meant by "effective communication" in this setting (S. Touati et al., 2022). Patients are more likely to feel valued, respected, and educated
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about their healthcare journey when clinicians listen actively, carefully answer patients' concerns and questions, and include them in collaborative decision-making (Calfee et al., 2022). Therefore, it stands to reason that patients who see their physicians as communicative and accessible would be more satisfied with their healthcare experience as a whole, which in turn may improve their treatment adherence and overall health results (Alassaad et al., 2022). By testing this theory, medical practitioners may learn more about why good doctor-patient communication is so crucial to patients' health and how to use that knowledge to boost both patient happiness and the quality of their treatment.
5.3.
Mediator Effect of Patient Satisfaction
Regression analysis of the link between patient satisfaction and revisit intention (=-0.165, p-
value =.0008) found negative relationship between the two according to the results of the questionnaire. Even though some studies suggests that a fine level of patient satisfaction that can lead to patient revisit intention (Eka Putri & Rahmat Syah, 2022; Siripipatthanakul 2021) but according to the sample size of this study, the result came out to be negative between the mediating effect of patient satisfaction and direct variable revisit intention. The hypothesis "Patient satisfaction has a positive effect on patient revisit intention" proposes that patients are more likely to return to the same healthcare provider or facility if they are satisfied with the care, they received the first time around (H. Touati et al., 2022).
Patient retention is the probability that a patient will return to the same hospital, clinic, or healthcare provider for future medical treatment based on their past experience with that facility or service. According to this concept, a healthcare facility's ability to keep its patients happy is a major factor in predicting which patients would return for future treatment (A. Touati et al., 2022). If a patient believes that their healthcare practitioner is effective, knowledgeable, and sympathetic to their requirements, they are more likely to return to that physician (Samraoui et al., 2022). Patient satisfaction may be increased by clear and understandable communication between healthcare practitioners and patients. The physicians, nurses, and administrators a patient interacts with may have a major influence on their experience with the healthcare system as a whole (C. D. Touati et al., 2022). Patients are more likely to be pleased if they have to spend less time between appointments and in the waiting area. A patient's outlook may be improved by a clean, comfortable environment. This hypothesis just posits a connection; it does not prove causality (Ouattara et al., 2022). That is to say, although the data supports the hypothesis that pleasure
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with the previous visit has some bearing on the likelihood of a subsequent visit, it does not show that this is the case. The decision to return to a previous healthcare provider may also be influenced by a number of other circumstances (Hidouri et al., 2022).
H4: Patient satisfaction mediates the positive effect of communication with doctor with patient revisit intention.
Regression analysis's findings ( =.0.883; LLCI =-0.2186 and ULCI =-0.279) show that patient’s satisfaction has a mediating effect on patients' revisit intentions when it comes to the relationship between communication and that patient revisit intention. This result is harmony with the findings of a past study (Woo & Choi, 2021). This shows that if there is powerful level of communication between the doctor and patient I will most definitely result in the patient being more satisfied towards his diagnosis and treatment plan and would certainly plan to revisit the same hospital or doctor with whom he/she is satisfied for future follow up visitations. The hypothesis "Patient satisfaction has a positive effect on patient revisit intention" suggests that patients are more likely to return to the same healthcare provider or facility if they are pleased with the treatment, they got the first time around (Yverneau et al., 2022).
Patient retention measures how likely a patient is to use the same healthcare practitioner, hospital, or clinic again after a previous positive experience. According to this theory, the likelihood that a patient would return to a certain healthcare provider depends heavily on the quality of care they received the first time around (Touati & Elngar, 2022).
Patients are more likely to stick with the same doctor over time if they have faith in the doctor's competence, expertise, and compassion. Clear and intelligible communication between healthcare providers and patients may improve patient satisfaction. The doctors, nurses, and administrators with whom a patient encounters may have a significant impact on how they feel about the healthcare system as a whole. If patients have to wait less time in the waiting room and between appointments, they will be more satisfied (Mairi et al., 2022).
The patient's viewpoint may improve in a spotless, relaxing setting. The hypothesis just postulates a link; it does not establish causation. That is to say, the evidence suggests, but does not prove, that satisfaction with a past visit affects the chance of a later one. Other factors may also play a role in the choice to go back to an old healthcare provider.
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5.4
Moderation of Patient engagement
Regression examination of the moderating role of patient engagement on the association between communication and patient satisfaction yielded a negative result. Even though if proper communication occurs between the doctor and the patient it will engage the patient at being satisfied from the services of the doctor but according to the outcomes of the analysis of this study, the said effect is negative and not achieved but now it is rising as a topic and variable of interest in researches as engaged patient is much more concerned for his diagnosis and treatment plans.(Timmermans, 2020).
This hypothesis suggests that there is a relationship between three main variables: "communication with doctor," "patient satisfaction," and "patient revisit intention." This refers to the quality and effectiveness of the communication that takes place between a patient and their doctor during a medical encounter. Effective communication involves clear explanations, active listening, empathy, and addressing the patient's concerns and questions (Batbaatar et al., 2017).
This represents the overall satisfaction level of the patient with the healthcare experience they received. It takes into account various factors, such as the doctor's communication style, medical treatment received, waiting times, and the general atmosphere of the healthcare facility (Kruse et al., 2017).
This refers to the likelihood that a patient will return to the same doctor or healthcare facility for future medical needs or appointments. It indicates the patient's intention to continue seeking care from the same healthcare provider (Kahlenberg et al., 2018).
The hypothesis states that "patient satisfaction mediates the positive effect of communication with the doctor on patient revisit intention." In simpler terms, this means that effective communication between a doctor and a patient has a positive impact on the patient's intention to revisit the same doctor or healthcare facility. However, this positive effect is not direct but rather is partially influenced by the level of patient satisfaction.
To put it in a step-by-step manner, the hypothesis proposes the following causal relationship:
Effective communication with the doctor leads to increased patient satisfaction.
Increased patient satisfaction, in turn, positively influences the patient's intention to revisit the same doctor or healthcare facility in the future.
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In summary, the hypothesis suggests that improving the communication between doctors and patients can enhance patient satisfaction, which, in turn, can increase the likelihood of patients returning for future medical care. This highlights the importance of effective doctor-patient communication in enhancing patient satisfaction and promoting patient loyalty to the healthcare provider.
5.4 Theoretical Implications
This study has been done on the grounds of importance of communication between a physician and a patient which is the basic and most important step towards building a healthy and fundamental treatment plan for the patient to get positive results in terms of treatment and well-being. The more the communication gap is lesser between the patient and the doctor, the more there is a level of patient satisfaction. Patient satisfaction is what a lot of doctors or hospitals strive to achieve. Patient satisfaction is used here in this current study as a mediator between communication and patient revisit intention.
The theoretical implications deal to how your discoveries relate to other theories or ideas in your field. There have been a lot of studies done on communication to conclude its results on patient satisfaction (Burgener, 2020) and patient safety as it is the basic and utmost important step towards correct and genuine diagnosis and treatment plan that the patient have to follow. That’s what this study has investigated in terms of the relationship between communications of the doctor with patient as it can with satisfy the patient (Abidova et al., 2020b) and when the patient will be satisfied with his/her diagnostic plans and treatment plan, he/she would eventually want to revisit for follow up or any other medical advice in the future(Guspianto et al., 2022). The results of this study are negative in the aspect of patient revisit intentions as compared to the other studies that have been done on the same topic (Kim, Sim, & Kim, 2021). A lot of studies have used patient satisfaction as mediator in various ways, like a study narrated that patient satisfaction is also related to lesser waiting periods (Lee et al., 2020) during their inpatient stay and another one investigates the mediation effect of parient satisfaction towards patient loyalty (Siripipatthanakul & Vui, 2021). So, according to some of theses studies where patient satisfaction is used for mediating effect, there have been positive findings towards a (Vasiliki Amarantou et al., 2019) patient behavioral intentions to revisit, our this current study also investigates the mediationg role of patient satisfaction between communication and patient revisit intentions exploring the samples from an outpatient
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department to see if the patients are willing to come back after their first visit or not and the results are negative according to the findings.
Altogether, the outcomes of this study suggests that there is a profound positive effect of communication on patient sarisfaction as observed by other studies aswell (Jill Allenbaugh et al., 2019) but this study states that the observations are negative and there is no consistancy with the results of this study. Only in proving that the outcomes of patient satisfaction as a result of good communication can lead to patients intention to revisit as well(Damayanti & Kusumawardani, 2020). The moderating effect of patient engagement is being studied between doctors communication and patient satisfaction which has yielded a negative result as comapred to the positive outcomes of some of the studies (Danielle et all, 2020) which states that shared decision making can help engage patients in making decisions regarding therir treatment and it will help involve them more so contributing to a positive outcome of patient engagement. 5.5.
Practical Implications
For organizations like healthcare establishments, specialists and professionals like dentists, nurses, doctors, dental hygienists, lab assistants, etc. this study offers some valuable and practical implications. In accordance with the results of this study, a good communication level between a patient and doctor have positive outcomes in terms of giving rise to patient satisfaction and revisit intention which is unquestionably one of the most important factor in terms of maintaining a first-class hospital reputation in terms that of patient safety as giving importance to the patient and communicating well with him/her about his/condition gives more insight about their condition with respect to a good treatment plan and a road to progressive recovery. This way, the doctors, nurses, dentists, etc. can learn more about how they can engage the patients to be more involved by communicating with them on every level of treatment and in this way patient engagement by communication can give rise to satisfaction in the patients in the sense that that are well taken care of which would then result in revisit intention of the patients towards the same facility or the doctor they are satisfied with and have trust in. In simple words, the more there is communication with the patients the more the patients will be satisfied towards their recovery plan as in they can freely discuss anything and any query with their doctor or nurse which will help ensure rapid recovery progress. This practice can be well implicated in the healthcare organizations may it be private or public, charitable or trust funded, the eventual aim is to achieve more patients revisits which in other
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words can be termed as to achieve patients’ loyalty. Plus, it will also help attain professionalism among the healthcare workers at all levels. In order to comprehend the patient's values and concerns, doctors and other health professionals must make an effort to speak the patient's language. The physicians’ should be fully attentive towards the patient and ask as many questions related to the condition or query patient is presenting with because history in medicine is of utmost importance which will enable a trust relationship between the doctor and patient and if the patient have a full trust, he/she will be more comfortable in conveying their queries more openly and if the doctor or nurse is going to respond more empathetically and attentively, this will yield more satisfaction from the patient and will engage the patient in such a way that he/she feels more welcome and secure around the very people. Thus, the patient will be more willing to revisit in case of any follow ups. According to a fact that has been mentioned numerous times in this research, communication channels between the doctor and patient and its advantages appears to be a successful method for increasing patients engagement and, as a result, their intention to revisit the same healthcare establishment or the same healthcare practitioner. The provision of patient with correct, appropriate, and pertinent information regarding the processes and methods involved in their treatment process may therefore be extremely valuable and pertinent in light of this. Such understanding and information will help to increase their trust and confidence in the physician as well as in nurses and lab attendants and technicians who are going to help the patient during the diagnostic and treatment process. How the physicians’ manage the patient will depend on the holistic appraisal of their patients.
The health authorities should routinely check and regulate the healthcare organizations in light of implementation of any ethical work trainings necessities. A full check and balance is required that can be done via researches and routinely inspections of the health institutes to rule out the negative effects patients have due to unprofessionalism and unethicality. So in short, it implements that this study offers some insightful information for policy makers and higher medical authorities in addition to the professionals like physicians, nurses, etc. As this study has been done on OPD (outpatient department) patients, it is helpful in giving the insight of the hospital where the samples have been taken that where the work is being necessary to be done (training needs) and where it is flourishing. Suitable measures should be taken to ensure that the healthcare professionals understand the meaning of professionalism implying they know how to properly communicate with the patient and this can be achieved by doing necessary researches accordingly.
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5.6. Limitations and Directions for Future Research
Just like with any other research, it is crucial to accept the limits of the current study before generalizing its conclusions. These restrictions might prove useful in directing researchers toward promising areas for future study. Because certain variables in my study did not adequately explain the complicated mechanism, it was constrained in its ability to further knowledge of wider relationships.
It was an empirical study that solely depended on information being gathered in a condensed period of time. Self-reporting bias may cause respondents to provide erroneous information. Foremost, the subjets of this current study are restricted to a hospital in the city of Islamabad and even though they are one of the major cities of the country, but still samples and subjects from other cities of Pakistan or even other hospitals of the twin cities or other provinces can aid in the development of a deeper knowledge of this study relationships. Furthermore, surveying and investigating this study model from different health settings of the country like, urban and rural areas can serve as yet another fascinating topic that is available for exploration because of the differences in population, level of services and facilities, etc. even there might be some differences regarding the communication level between both the areas between patients and the physicians as people living in urban societies are more well aware of their conditions as compared to the ones residing in rural areas. And additionally, a lot of patients from whom the data was being collected were reluctant to fill in the sample questionnaire forms some because of some kind of bad experience like long waiting hours or some were in a hurry to take rest after getting the treatment because if some patients and participants are not willing to pitch in details about their bad hospital visit experience which cannot be documented and so a lot of findings can get missing and lost. The study's sample size is very small due to scheduling restrictions. It is recommended that subsequent researchers and future studies employ a bigger sample size to improve the generalizability of their research's findings. Additionally, because the data for this study was gathered through distributing online survey questionnaires, there is a possibility of some respondent bias; therefore, future researchers may employ alternative data collection techniques to ensure that their conclusions are more trustworthy and accurate. Another limitation is that the current study only looked at patient satisfaction as a mediating factor that connects the level of communication between physicians and patients revisit intention but future researchers can include patient safety and care quality to obtain more objective results or can use patient satisfaction as predecessor or antecedent of the communication. Finally, this
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study has used only one moderator which is patient engagement on association between communication and patient satisfaction and this did not prove to be manifest. Future researchers can observe this association with a larger sample size. Other than patient engagement, the role of factors and variables acting as moderators is also worth investigating. 5.7.
Conclusion
People nowadays are increasingly nervous and concerned about how they are going to get treated and how their treatment is going to affect their health, treatment and recovery period and as a result, they try to have a healthy communication with their doctors/physicians according to their conditions so that can help minimize the risk of progressing their existing condition to chronic diseases and ailments. In this regard, having a righteous level of communication to help achieve care and a level of satisfaction for and safeguard one's well-
being while also if the patient have sufficient trust and satisfaction towards the physician, he/she can have revisit intention as well. As a result, the current study proposes a comprehensive research model that considers factors such doctor communication, revisit intention with mediating roe of patient satisfaction while moderating role of patient engagement, that how a trustworthy level of communication of the patient with their physician can engage the patient with the goal of developing intentions of revisit towards the same healthcare establishment or the physician to consumers' intentions to increase good reputation as well as to gain more patients and experience towards the respective field so that the healthcare workers can serve their subjects exemplary. The importance of such research has been neglected in developing countries like Pakistan when compared to developed countries, where communication between the doctor and patient is given fundamental importance and substantial research has been conducted to investigate it in order to promote greater health and welfare among individuals and populations. Based on data from a sample of 266 respondents from the current study, the findings of this study revealed that communication has a significant impact on patient revisit intention and also it have a positive effect towards patient satisfaction, patient satisfaction has a significant negative impact on patient revisit intention. Patient satisfaction mediates the relationship between physician communication and patient revisit intention in a positive direction except that as for the effect of moderation, patient engagement was not identified to have any kind of moderating role between communication and patient satisfaction. According to these findings, it can be determined that the more a doctor is concerned about his or her communication level with the patient, the more likely he or she is to associate with the benefits of patients wellbeing
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earning his trust and satisfaction with his or her innate values of being healthy, thereby increasing his or her contentment in the physician himself or herself and their intent to revisit depending on the level of the confidence they have gained in that particular health establishment or healthcare practitioner. As a result, future research studies can benefit greatly from the advantageous understanding obtained from this study's empirical findings, which also offer some useful implications intended to promote such behaviors through the use of ethical and moral communications of healthcare workers towards their patients that are useful and constructive not only at the individual level but also for the society altogether.
5.8
TIME FRAME
The proposed study will be carried according to the following schedule:
S.No
Activity
Duration
1 Introduction 2 weeks 2 Literature review 4 weeks 3 Data Collection 6 weeks 4 Data entry and Analysis 2 weeks 5 1
st
draft 1 week 6 Final Draft 1 week
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