Listening to older voices: Results of a cross-sectional survey of older patient-reported experiences of facility-based healthcare in Nouna, Burkina Faso
Authors: Goldberg Ellen M , Bountogo Mamadou , Harling Guy , Barnighausen Till , Davies Justine I , Hirschhorn Lisa R 
Published: December 2021

AbstractBackgroundEnsuring responsive healthcare which meets patient expectations and generates trust is important to increase rates of access and retention. This need is important for aging populations where non-communicable diseases (NCDs) are a growing cause of morbidity and mortality.MethodsWe performed a cross-sectional household survey including socio-demographic, morbidities, and health system utilization, responsiveness, and quality outcomes in individuals over age 40 in northwestern Burkina Faso. We describe results and use exploratory factor analysis to derive a contextually appropriate grouping of health system responsiveness (HSR) variables. We used linear or logistic regression to explore associations between socio-demographics, morbidities, and the grouped-variable, then between these variables and health system quality outcomes.ResultsOf 2,639 eligible respondents, 26.8% had least one NCD, 56.3% were frail or pre-frail and 23.9% had a recent visit, including only 1/3 of those with an NCD. Highest ratings of care experience (excellent/very good) included ease of following instructions (86.1%) and trust in provider skills (81.1%). The HSR grouping with the greatest factor loading included involvement in decision-making, clarity in communication, trust in the provider, and confidence in provider skills, termed as Shared Understanding and Decision Making (SUDM). In multivariable analysis, higher quality of life (OR 1.02,95%CI 1.01-1.04), frailty (OR 1.47,95%CI 1.00-2.16), and SUDM (OR 1.06,95%CI 1.05-1.09) were associated with greater health system trust and confidence. SUDM was associated with overall positive assessment of the healthcare system (OR 1.02,95%CI 1.01-1.03) and met healthcare needs (OR 1.09,95%CI 1.08-1.11). Younger age and highest wealth quintile were also associated with higher met needs.ConclusionsRecent healthcare access was low for people with existing NCDs, and SUDM was the most consistent factor associated with higher health system quality outcomes. Results highlight the need to increase continuity of care for aging populations with NCDs and explore strengthening SUDM to achieve this goal.What is already known?Health system responsiveness and health system quality outcomes including meeting health needs and trust in the system are important to ensure patient centered care and increase access and retention.The process and outcomes of care experience of older adults in Burkina Faso and factors associated with ratings has not been widely studied, information needed to inform efforts to improve engagement in care particularly for individuals with non-communicable chronic diseases (NCDs)Shared decision making is emerging as an important component of care to improve engagement in care for people with chronic diseases with studies largely from high income countriesWhat are the new findings?We describe the patterns and gaps in care seeking of people age 40 or older in Burkina Faso, particularly those with non-communicable chronic diseases.Highest ratings of care experience included ease of following instructions and trust in provider skills, with lowest ratings in clarity of communication and involvement in decision making.We identified a grouped variable was identified using exploratory factors analysis, shared understanding and decision making (SUDM), which was associated with overall positive assessment of the healthcare system and met healthcare needs.What do the new findings imply?Work is needed to increase longitudinal engagement in care for older adults, particularly those with NCDs,SUDM may offer an area for strengthening patient-centeredness of care to achieve these goals, but further research is needed to understand the relationships between SUDM and care outcomes, and the impact of strengthening in Burkina Faso.