What does quality mean to the patient? An exploration of the expectations of patients for primary health care in Nigeria


  • Daprim Ogaji University of Port Harcourt, Port Harcourt
  • Eme Asuquo Department of Preventive and Social Medicine, University of Port Harcourt, Choba, PMB 5323, Port Harcourt, Nigeria.
  • Best Ordinioha Centre for Primary Care, Institute of Population Health, Manchester Academic, Manchester, United Kingdom


expectations, views, primary health care, users, quality, Nigeria


Aim: To explore the expectation of primary health care (PHC) patients to assist the development of a patient evaluation scale designed to promote patient-focused quality assessment and improvement in PHC

Background: A significant proportion of patients seek health care from PHC facilities in Nigeria. Re-organising services to meet their expectations can lead to improved utilization and health benefits. This study is the preliminary phase of an iterative process for the development of a measure for patients’ evaluation of primary health care in Nigeria.

Methods: Semi-structured qualitative interviews conducted with 47 patients drawn from 4 PHC centres in Rivers State and the Federal Capital Territory in Nigeria. The constant comparative method used to analyse verbatim transcripts led to the generation of a framework of codes, concepts, and categories that defined the expectations of patients for PHC in Nigeria.

Findings: Analyses resulted in 44 coded themes for user’ description of the quality of PHC. The themes were reorganised around five thematic areas cutting across the triad of structure, process and outcome dimensions of quality.

Conclusion: It is essential that service users’ views be taken into account when selecting items to measure PHC outcomes and performance. The study provided insights into users’ views and expectations from PHC centres in Nigeria. Identified codes can be useful in an inductive process of generating questionnaire items intended to measure patients’ experiences of PHC in Nigeria.

Author Biography

Daprim Ogaji, University of Port Harcourt, Port Harcourt

Senior Lecturer and Consultant in Public Health, College of Health Sciences and Teaching Hospital, University of Port Harcourt


Van Lerberghe W. The world health report 2008: primary health care: now more than ever: World Health Organization; 2008.

Ross CK, Steward CA, Sinacore JM. The importance of patient preferences in the measurement of health care satisfaction. Medical Care. 1993;31(12):1138-49.

LaVela SL, Schectman G, Gering J, Locatelli SM, Gawron A, Weaver FM. Understanding health care communication preferences of veteran primary care users. Patient Education and Counseling. 2012;88(3):420-6.

Little P, Everitt H, Williamson I, Warner G, Moore M, Gould C, et al. Preferences of patients for patient centred approach to consultation in primary care: observational study. BMJ. 2001;322(7284):468.

Kenten C, Bowling A, Lambert N, Howe A, Rowe G. A study of patient expectations in a Norfolk general practice. Health Expectations. 2010;13(3):273-84.

Weisman CS, Rich DE, Rogers J, Crawford KG, Grayson CE, Henderson JT. Gender and patient satisfaction with primary care: tuning in to women in quality measurement. Journal of Women's Health & Gender-based Medicine. 2000;9(6):657-65.

Aldana JM, Piechulek H, Al-Sabir A. Client satisfaction and quality of health care in rural Bangladesh. Bulletin of the World Health Organization. 2001;79(6):512-7.

Campbell SM, Roland MO, Buetow SA. Defining quality of care. Social Science & Medicine.51(11):1611-25.

Turris SA. Unpacking the concept of patient satisfaction: a feminist analysis. Journal of Advanced Nursing. 2005;50(3):293-8.

World Health Organization. Quality of care: a process for making strategic choices in health systems. 2006.

Blumenthal D. Part I: Quality of Care: What is It? The New England Journal of Medicine. 1996;335(12):891-4.

Labarere J, Francois P, Auquier P, Robert C, Fourny M. Development of a French inpatient satisfaction questionnaire. International Journal for Quality in Health Care. 2001;13(2):99-108.

Cleary PD, Edgman-Levitan S. Health care quality: incorporating consumer perspectives. JAMA. 1997;278(19):1608-12.

World Health Organization. The world health report 2000: health systems: improving performance: World Health Organization; 2000.

Ellis R, Whittington D. Quality assurance in health care : a handbook Roger Ellis and Dorothy Whittington. London: Edward Arnold; 1993. 278 p.

Nathorst-Boos J, Munck IM, Eckerlund I, Ekfeldt-Sandberg C. An evaluation of the QSP and the QPP: two methods for measuring patient satisfaction. International Journal for Quality in Health Care.13(3):257-64.

Streiner DL, Norman GR. Health measurement scales: a practical guide to their development and use: Oxford University Press; 2008.

Wensing M, Elwyn G. Research on patients' views in the evaluation and improvement of quality of care. Quality & Safety in Health Care.11(2):153-7.

Pascoe GC. Patient satisfaction in primary health care: a literature review and analysis. Evaluation and Program Planning. 1983;6(3):185-210.

Campbell SM, Roland MO, Buetow SA. Defining quality of care. Social Science & Medicine. 2000;51(11):1611-25.

Federal Republic of Nigeria. Inventory of health facilities in Nigeria. In: Federal Ministry of Health, editor. Abuja 2012.

Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Quarterly. 2005;83(3):457-502.

World Health Organization. World Health Statistics 2012, Part II Highlighted Topics. 2013.

Pampana E, El Ghoroury A, Dy F, van Thiel P, Metselaar D, Mara L, et al. Some important health statistics available in various countries. Bulletin of the World Health Organization. 2013;11:201-28.

Bowling A. Research methods in health: Open University Press Maidenhead; 2009.

Grimes GC, Reis MD, Budati G, Gupta M, Forjuoh SN. Patient preferences and physician practices for laboratory test results notification. The Journal of the American Board of Family Medicine. 2009;22(6):670-6.

Ogaji D, Etokidem A. Setting agenda for quality improvement in a public hospital in Nigeria using the consumers’ judgement. IOSR Journal of Business and Management. 2012;1(4):1-6.

MCur AK. Perception of clients regarding family planning service delivery in a clinic of the Greater Johannesburg Metropolitan Council 2010.

Federal Republic of Nigeria. The Revised National Health Policy. Federal Ministry of Health. Abuja 2005.

Federal Republic of Nigeria. The National Strategic Health Development Plan (NSHDP) 2010 - 2015. Federal Ministry of Health. Abuja, Nigeria 2010.

Hinkin TR. A brief tutorial on the development of measures for use in survey questionnaires. Organizational Research Methods. 1998;1(1):104-21.

Green J, Thorogood N. Qualitative methods for health research: SAGE; 2013.

Mack N, Woodsong C, MacQueen KM, Guest G, Namey E. Qualitative research methods: a data collectors field guide. 2005.

Green J, Browne J. Principles of social research: McGraw-Hill International; 2005.

Stemler S. An overview of content analysis. Practical Assessment, Research & Evaluation. 2001;7(17):137-46.

Huberman M, Miles MB. The qualitative researcher's companion: SAGE; 2002.

Federal Republic of Nigeria. National guidelines for the development of primary health care system in Nigeria. National Primary Health Care Development Agency. fourth edition. Abuja: NPHCDA; 2012.

Haddad S, Fournier P, Machouf N, Yatara F. What does quality mean to lay people? Community perceptions of primary health care sevices in Guinea. Social Science & Medicine. 1998;47(3):381-94.

Mashego TAB, Peltzer K. Community perception of quality of (primary) health care services in a rural area of Limpopo Province, South Africa: a qualitative study. Curationis. 2005;28(2):13-21.




How to Cite

Ogaji, D., Asuquo, E., & Ordinioha, B. (2017). What does quality mean to the patient? An exploration of the expectations of patients for primary health care in Nigeria. The Nigerian Health Journal, 16(4), 230. Retrieved from https://tnhjph.com/index.php/tnhj/article/view/257

Most read articles by the same author(s)

1 2 > >> 

Similar Articles

1 2 3 4 5 6 7 8 9 10 > >> 

You may also start an advanced similarity search for this article.