Patient Satisfaction with TB Care Services in Southern Afghanistan [TBN 070]

1. Who

The study included 413 adult tuberculosis (TB) patients (≥18 years) receiving follow-up TB treatment in Southern Afghanistan.

Eligibility criteria:

• Confirmed TB diagnosis (regardless of case type)
• Receiving TB treatment at one of the selected facilities during the study period
• Age ≥18 years

Excluded:

• Very severe illness (3 patients; 0.7%)
• Refused participation (6 patients; 1.4%)

Participant characteristics:

• Mean age: 39.4 ± 16.9 years
• Age >35 years: 49.6%
• Male: 58.6%
• Married: 71.4%
• Rural residents: 60.0%
• No formal education: 51.8%
• Employed: 28.8%
• Pulmonary TB: 66.8%
• New TB cases: 82.6%
• Current smokers: 19.6%
• Received counselling during treatment: 78.9%

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2. What

The study assessed the level of patient dissatisfaction with TB care services and identified associated sociodemographic, clinical, and health-system factors.

Primary Outcome

Patient satisfaction with TB care services measured using the Patient Satisfaction Questionnaire (PSQ-18) across 7 domains:

1. General satisfaction
2. Technical quality
3. Interpersonal manner
4. Communication
5. Financial aspects
6. Time spent with doctor
7. Accessibility and convenience

Patients scoring below the sample mean were classified as dissatisfied.

Key Findings

44.5% of participants were dissatisfied with TB care services
(95% CI: 39.6%–49.4%)

Highest satisfaction domains

• Interpersonal relationship: mean 4.02 (80.4%)
• Technical quality: mean 3.82 (76.4%)
• Communication: mean 3.81 (76.2%)

Lowest satisfaction domains

• Financial aspects: mean 2.94 (58.8%)
• Time spent with doctor: mean 3.39 (67.8%)

Factors independently associated with dissatisfaction

• Rural residence: AOR 1.72 (95% CI: 1.07–2.77)
• Monthly income 5000–10,000 Afghanis: AOR 1.73 (95% CI: 1.07–2.79)
• Out-of-pocket expenses: AOR 1.68 (95% CI: 1.06–2.67)
• Continuation phase of treatment: AOR 1.83 (95% CI: 1.12–2.98)
• No counselling during treatment: AOR 7.25 (95% CI: 3.86–13.61)
• Current smoking: AOR 2.05 (95% CI: 1.16–3.60)

Authors’ Conclusion

Nearly half of TB patients were dissatisfied, indicating major gaps in patient-centered TB care. Lack of counselling was the strongest predictor of dissatisfaction.

Practical / Policy Implications

The authors recommend:

• Strengthening counselling quality across all treatment phases
• Expanding decentralized/community-based TB care
• Reducing financial barriers
• Engaging family members in counselling and treatment support

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3. When

The study was conducted between October and December 2025.

No longitudinal follow-up period was reported because this was a cross-sectional study.

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4. Where

The study was conducted in Southern Afghanistan, specifically in six high-volume TB treatment centers:

• Kandahar Provincial TB Center
• Mirwais Regional Hospital
• Spin Boldak District Hospital
• Provincial TB Centers in:
  • Helmand
  • Uruzgan
  • Zabul

These were outpatient TB care facilities selected based on high patient volume.

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5. Why

The study was conducted because patient satisfaction is a critical indicator of healthcare quality and treatment adherence, especially in TB care.

In fragile health systems like Afghanistan, limited evidence exists regarding patient dissatisfaction and its determinants among TB patients. Identifying these factors helps policymakers and TB program managers improve service quality, equity, and effectiveness.

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6. How

Study Design

Facility-based cross-sectional study

Level of Evidence

Observational study (cross-sectional)
→ lower level for causal inference; useful for prevalence estimation and identifying associations

Sampling

• Sample size formula for single proportion
• Assumed dissatisfaction prevalence: 50%
• Final calculated sample size: 422
• Final analyzed sample: 413

Sampling method

• Proportional allocation across facilities
• Sampling frame from TB registers
• Simple random sampling

Data Collection

• Structured face-to-face interviews
• Conducted by 12 trained nurses
• Interview duration: 15–20 minutes
• Private interview rooms used
• Informed consent obtained

Measurement Tool

PSQ-18

• 18-item validated questionnaire
• Pashtu version via forward-backward translation
• Pilot tested among 30 TB patients
• Excellent internal consistency:
  Cronbach’s α = 0.91

Analysis

• Domain mean scores calculated
• Dichotomization into satisfied vs dissatisfied using mean cut-off
• Multivariable logistic regression used to identify associated factors

Limitations

Likely limitations include:

• Cross-sectional design prevents causal inference
• Facility-based sampling may reduce generalizbility
• Self-reported satisfaction may introduce response bias
• Purposive selection of facilities may limit representativeness

Source: Stanikzai MH, Bariz H, Anwary Z, Baray AH, Shirzad J, Dadras O. Assessment of Patient Satisfaction with TB Care Services in Southern Afghanistan. Patient Prefer Adherence. 2026;20:602353. https://benangmerah.net/record/84/assessment-of-patient