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Abstract
Objective To measure the gap between expectations of patients with cancer for oncology services and their perceptions of the actual service and to identify associated factors at the oncology centre of Tikur Anbessa Specialized Hospital, Ethiopia.
Design An institutional-based cross-sectional study design was conducted using the service quality (SERVQUAL) tool from March to April 2022 on a sample of 256 hospitalised patients with cancer at the oncology centre of Tikur Anbessa Specialized Hospital. A paired Wilcoxon test and Kruskal-Wallis tests were used to determine the statistically significant difference between expectation and perception and to quantify the strength of association between the level of gap in the quality of oncology service and dependent variables, respectively.
Results Out of 256 patients with cancer included in the study, all of them agreed and participated, making the response rate 100%. The overall gap in service quality explained by the mean and SD is −1.42 (±0.41). The overall score for expectation and perception is 4.24 (±0.31) and 2.82 (±0.37), respectively. Being female, age greater than 65, having a college degree and above, being a patient with cervical cancer, patients with stage 4 cancer and patients who waited for more than 12 months for radiotherapy were found to have a statistically significant higher expectation compared with their perceived care in one or more dimensions of the SERVQUAL tool.
Conclusion Patient perceptions of the quality of service they received were lower than their expectations of the quality of service in all service quality aspects at Tikur Anbessa Specialized Hospital’s oncology centre, implying unmet quality expectations from the oncology service users, with tangibility, assurance and empathy being the dimensions with the highest gap recorded, respectively. Therefore, the hospital and other stakeholders should strive to exceed patient expectations and the overall quality of care.
- Patient Satisfaction
- HEALTH SERVICES ADMINISTRATION & MANAGEMENT
- Health & safety
- Quality in health care
Data availability statement
Data are available upon reasonable request.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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- Patient Satisfaction
- HEALTH SERVICES ADMINISTRATION & MANAGEMENT
- Health & safety
- Quality in health care
STRENGTHS AND LIMITATION OF THE STUDY
This study included patients’ expectations and perceptions, making it easier for comparison and understanding whether the provided services are meeting patients’ expectations.
As a limitation, this study included only a single setting, which was the comprehensive referral centre for the whole country at the time of data collection; in return, this may affect the generalisability of the result to other settings.
In addition, this study assessed the functional aspect of quality from the patients’ side only, and the technical aspect was not assessed.
Background
The National Academy of Medicine (formerly the Institute of Medicine) defines quality as ‘the degree to which health services for individuals and populations increase the likelihood of the desired health outcomes and are consistent with current professional knowledge’.1 According to the Ethiopian National Healthcare Quality Strategy (NHQS), quality in the Ethiopian context is defined as ‘comprehensive care that is measurably safe, effective, patient-centered, and uniformly delivered in a timely way that is affordable to the Ethiopian population and appropriately utilizes resources and services efficiently.’2
Cancer is the leading cause of death worldwide, accounting for more than 10 million deaths in 2020. The most common causes of cancer deaths in the same year were lung, colon and liver, respectively. In Africa, cancer cases are on the rise, with more than 1 million new cases registered in 2020 and 700 000 deaths. Despite the absence of a population-based cancer registry for the entire nation except for Addis Ababa, the annual incidence of cancer in Ethiopia is estimated to be 60 960 cases, with a yearly mortality of over 44 000.3–5
According to the WHO, governments and stakeholders across the globe need to champion and spearhead efforts to ensure the quality of oncology services, as it is crucial to achieve Sustainable Development Goal (SDG) 3, Target 3.4, to reduce premature mortality from cancer and other non-communicable diseases by 2030. Moreover, the WHO stresses the need to access cancer care planning and coordination so that each patient with cancer will make an informed decision about his or her treatments and to facilitate collaboration among the multidisciplinary cancer care providers.6
Worldwide, the quality of cancer care is under siege, as the majority of patients with cancer are not accessing or receiving adequate care, mainly because of inadequate national service, weak health systems, high financial costs and disparities in access to cancer care. Moreover, the delay in timely access to care is resulting in premature cancer mortality and late-stage cancer diagnosis.7 8
The quality of oncology services in Africa continues to suffer from the shortage of medical equipment, research resources and epidemiological expertise. Despite the fact that cancer death rates have surpassed those of AIDS, malaria and tuberculosis altogether, there still remains a lack of unwavering commitment to fight against cancer. Out of 56 countries in Africa, only 22 of them were confidently known to have a radiotherapy machine—not more than 277 in the year 2015. And 60% of these were located in two countries: Egypt and South Africa. Overall, only 50% of the population had some access to radiation oncology services.9–11
Poor quality of cancer care in Ethiopia is manifested by most patients with cancer presented with an advanced disease due to inadequate availability of screening and diagnostic facilities and a lack of skilled healthcare providers. Besides, quality is compromised due to long waiting times, as one radiotherapy machine was giving service to more than 110 million Ethiopians until the recent inauguration of another oncology centre in Jimma by Federal Ministry of Health (FMOH) in the year 2022.12 13 According to the Ministry of Health’s 2021–2022 Annual Performance Report, Ethiopia’s health professional density (core health professional categories) in 2021–2022 was 1.23 doctors, health officers, nurses and midwives per 1000 population, much below the SDG level. The SDG index threshold of 4.45 doctors, nurses and midwives per 1000 inhabitants is regarded as the standard for determining healthcare staffing levels.13 Regarding to oncology services, in total, only 28% of facilities provide cancer services. The services vary depending on the type of health facility, with the lowest (12%) in lesser clinics and the greatest 85% in general hospitals. Cancer service availability varied among regions, with the lowest (5%) in Benishangul Gumuz and the greatest (69%) in the Dire Dawa Region. Only 40% of urban facilities and 27% of rural facilities provide cancer diagnosis, treatment or management.13
There is so much discrepancy among different studies in terms of factors associated with the level of the gap in service quality. In some studies, patients age and gender were found to be significant factors affecting the level of the gap in service quality14–16; however, in another studies, those factors did not have any influence on the level of the gap in service quality.17–19 A study conducted in Taiwan to analyse the gaps in healthcare service quality in nurse practitioner practice has found that the source of admission has an association with the level of gap in quality, with admissions from the emergency department recording lower gaps compared with those from outpatient setups.20
Despite the many efforts by the Ethiopian Ministry of Health to put quality in healthcare at the centre of its world through consecutive health sector development programmes, making quality one of the transformation agendas in HSTP 1 (2015–2020) and HSTP 2 (2021–2025), and developing a NHQS (2015–2020) as a roadmap to facilitate service quality across the sector, the quality of service in Ethiopia remains poor.2 21–23 The interventions include the collaboration by the Ethiopian FMOH and the Institute for Healthcare Improvement, which collaborated on a three-pronged approach to accelerate national health system improvement, including the development of a NHQS, the development of quality improvement (QI) capability at all health system levels, and the implementation of scalable district maternal and neonatal health QI collaboratives across four regions, involving healthcare providers and managers.24 However, a review report of the National Health Care Quality Strategy indicted a lack of fundamental health infrastructure and financial resources in the health sector, which impacts proper planning and quality control of health services. Inadequate quality indicators, an emphasis on coverage rather than outcome indicators, inadequate data use culture and dashboard utilisation, and a lack of adequately defined quality measures for monitoring and feedback systems for relevant programme sections have been recognised as challenges for the planned QI strategies.25
Some studies in Ethiopia measured service quality as an indicator of patient satisfaction in cancer and non-cancer settings,26–28 in which patient satisfaction is considered a measure of how content a patient is with the healthcare they received from their healthcare provider.29 However, these studies measured patients’ perceptions only, that is, patients’ assessments of the services they received and the outcomes of their treatment, missing out on their expectations, which can refer to the anticipation or belief about what will occur during receiving a health service or in the healthcare system or the gap analysis between clients’ expectations and perceptions, leading to failure to inadequately or completely capture the idea of patient-centred care.30 31 Therefore, this study aimed to measure the gap between expectations of patients with cancer for oncology services and their perceptions of the actual service and the relationship between their service gap scores and the sociodemographic and clinical characteristics of patients. As a result, the findings of this study can be helpful in providing a clear picture and baseline information to the hospital administration, QI teams and healthcare professionals to establish goals, policies and strategies to close the identified gaps and meet and exceed patients’ expectations.
Methods and materials
Study design
An institutional-based, quantitative cross-sectional study design was conducted.
Study area and period
The study was conducted at Tikur Anbessa Specialized Hospital (TASH), which is found in the nation’s capital, Addis Ababa, from March to April 2022. The oncology centre serves an estimated 60 000 patients per year. The centre has six senior oncologists, 25 oncology residents, 11 oncology nurses, 5 radiologists and 8 pharmacists.26
Service is given in both inpatient and outpatient departments. The inpatient department has a bed capacity of 33 patients, and the outpatient department provides service for more than 850 patients per month in 2 clinics. Moreover, the hospital is the sole cancer referral centre in the country, with access to chemotherapy, radiotherapy and surgical treatment options. The study area was selected purposefully because, as a nation’s main cancer treatment centre, it gives service almost to everyone coming from all corners of Ethiopia and provides comprehensive cancer care.26
Source and study population
The source population for this study was all cancer-confirmed patients at TASH, and the study population was all cancer-confirmed patients who were admitted to TASH at the time of data collection.
The inclusion criteria were all patients with cancer who were admitted for at least 24 hours, and the exclusion criteria was patients with cancer who were less than 18 years old, critically ill according to the Karnofsky Performance Scale<50,32 and unable to respond.
Sample size determination and sampling procedure
A single population mean formula33 was used to calculate the sample size by taking the SD of the population (±0.39) after undertaking a pilot study on 30 patients with cancer at TASH due to a lack of similar studies in Ethiopia, a confidence level of 95%, and the maximum acceptable difference of 5%
n= 
where
n=Minimum sample size of the study subject, z=Standard normal distribution curve /value for the 95% CI (1.96), σ = SD deviation of the population (
, d=Margin of error (0.05)).
Therefore, n= 
= 233
After considering a non-response rate of 10%, the final sample size was 256.
A simple random sampling method was applied to get the required number of samples. Patients who were admitted for at least 24 hours were identified, and their sampling frame was prepared based on their medical record number. The average monthly estimated total number of admissions is approximately 400. Inpatient admission service only happens 3 days per week (Monday, Wednesday and Friday), and an average of 33 patients are admitted each day. As a referral hospital, all 33 beds are in full capacity all the time. The data collection days in 1 month were 12 days, and for the study to get 256 sample sizes, it recruited a sample of 21 patients daily on those admission days. The lottery method was used to recruit those samples from the sampling frame.
Data collection tools and procedures
The study used a tool called service quality (SERVQUAL) and a secondary document review to collect data. SERVQUAL stands for service quality, and it is a multidimensional tool to measure quality based on patient perspective. SERVQUAL has five service quality dimensions: ‘tangibility’, ‘empathy’,‘reliability’, ‘responsiveness’ and ‘assurance’.34
The tool is organised into a 22 item, 5-point Likert scale, where the respondents are asked to select the most appropriate number that corresponds to the extent to which they agree with the statement. The scale in our survey questions ranges from 1 to 5, with ‘1’denoting ‘strongly disagree’ and ‘5’ denoting ‘strongly agree’. The means of collection was an interviewer-administered structured questionnaire. In addition to SERVQUAL, the study included questions regarding the sociodemographic and clinical characteristics of patients (online supplemental file 1).
Supplemental material
Data regarding the service quality dimensions and the sociodemographic characteristics of patients were collected face-to-face by using an interviewer-administered structured questionnaire (online supplemental file 1). The patient’s medical record was reviewed to get information about cancer-related characteristics like type of cancer, stage of cancer and type of treatment.
Data quality assurance and reliability
The questionnaire was first translated from its original English-language version to Amharic by a bilingual person who has a command of both languages. A second bilingual translator who had not seen the original English language version back translated the questionnaire from the Amharic version to English, and then the two English language versions were compared for consistency.
A pretest of the questionnaire was conducted on 5% of the sample size (13 patients with cancer) before the actual data collection period at TASH, and no amendments were made. The reason why the pretest has been conducted at the same centre as the actual study area is because TASH is the sole provider of comprehensive cancer care, including radiotherapy treatment. Internal consistency was checked by using Cronbach’s alpha, and all items scored a value greater than 0.7 (0.82 for expectation and 0.77 for perception). Two data collectors were hired and trained on how to collect the data and the overall objective of the study under the supervision of the principal investigator. Data were checked for completeness and accuracy in the field, cleaned and exported from a Google Form directly to SPSS.
Data processing and analysis
The data was first checked for completeness and consistency in the field and then exported directly from Google Forms to SPSS V.25 for processing and analysis. Descriptive statistics such as frequency, percentage, mean and SD were used to analyse the sociodemographic characteristics of the service users and to determine the overall level of the gap in service quality.
The originally planned analysis was a paired sample t-test, one-way analysis of variance (ANOVA) and a post-hoc test. The paired t-test is employed when measurements from two groups are linked to one another. A one-way ANOVA compares the means of two or more groups for a single-dependent variable. When there are more than two groups in the investigation, a one-way ANOVA is necessary.35 To identify which groups vary, ‘post hoc’ tests are used.36 For these approaches, the dependent variable should be continuous scale and approximately normally distributed.37 Before conducting a paired sample t-test, a one-way ANOVA, and a post-hoc test, the data were checked against the normality assumption by using the Kolmogorov-Smirnov test, and it became statistically significant at p<0.001; hence, the assumption of normality is violated. Therefore, the study used non-parametric tests like the paired Wilcoxon test to determine if there is a statistically significant difference between the means of perception and expectation.38 The Kruskal-Wallis test was used to assess if patients with different sociodemographic and clinical characteristics attributed differing amounts of importance to the service quality dimensions.39 Significance was accepted for p values less than 0.05 for both tests. Friedman’s test was also used to rank the dimensions of the SERVQUAL tool based on the level of gap recorded.
The Wilcoxon signed rank test is a frequently used non-parametric test for paired data (eg, consisting of pretreatment and post-treatment measurements) based on independent units of analysis.38 The Kruskal-Wallis test (Kruskal & Wallis, 1952) is a non-parametric statistical test that compares three or more independently sampled groups on a single non-normally distributed continuous variable.39
Operational and term definitions
Perception: the experience of the patient during the care delivery process.
Expectation: the anticipation of the patient regarding what is to be encountered in the healthcare system.
Level of gap: the difference between the sum of patient perceptions (P) and expectations (E) in each service quality dimension divided by 22 (level of gap = ∑ (P−E)/22).40
Positive gap: if the patient’s perceptions exceeded their expectations.
Negative gap: if the patient’s expectations exceed their perceptions.
Tangibility: the appearance of physical facilities, personnel and equipment.34
Empathy: the ability to provide caring and individualised attention to patients.34
Reliability: the ability to perform the promised service accurately and dependably.34
Responsiveness: the willingness to help customers and provide prompt service.34
Assurance: the knowledge and courtesy of employees and their ability to inspire trust and confidence.34
Patient and public involvement
There was no involvement of patients or the public in the development, design, or implementation of this study.
Result
Sociodemographic and economic characteristics of participants
Out of 256 patients with cancer included in the study, all of them agreed and participated, which made the response rate 100%. The median age of the study participants was 49, and the IQR was 20. The minimum age was 24 and the maximum age was 79. With regard to marital status, the majority of the respondents, 172 (67.2%), are married. Out of all participants, 142 (55.5%) were females and regarding educational status, 80 (31.3%) did not attend any formal education. A large segment of the participants, 182 (71.1%), resided outside Addis Ababa, and half of the participants were insured by community-based health insurance (table 1).
Sociodemographic characteristics of patients who were treated for cancer at Tikur Anbessa Specialized Hospital, Addis Ababa, 2022 (n=256)
Cancer-related characteristics
Regarding cancer-related factors, the majority of patients, 68 (26.6%), were treated for cervical cancer, followed by lung cancer, 56 (21.9%). Of the numerous treatment options for cancer, a large proportion, 95 (37.1%), received chemotherapy alone, and 62 (24.2%) received chemotherapy and radiotherapy in combination. Among 246 patients for whom chemotherapy was ordered, 240 (93.8%) received the treatment in less than 6 months, while of the 105 patients who were eligible for radiotherapy, 74 (30%) waited for more than a year to receive the treatment (table 2).
Cancer-related characteristics of patients who were treated for cancer at Tikur Anbessa Specialized Hospital, Addis Ababa, 2022 (n=256)
The level of gap of service quality
The overall gap in service quality explained by the mean and SD is −1.42 (±0.41). As it is observed in table 3, the overall score for expectation and perception is 4.24 (±0.31) and 2.82 (±0.37), respectively. Based on the paired Wilcoxon test result, there is a significant difference between expectation and perception scores in all service quality dimensions, which leads to the rejection of the hypothesis, which claims there is equality of mean between perception and expectation in the service quality dimensions of tangibility, reliability, responsiveness, assurance and empathy. The highest gap was observed for the tangibility dimension with a gap score of −1.64 (±0.50), while the smallest gap was related to the service quality dimension of reliability with a gap score of −1.20 (±0.61) (table 3).
Paired Wilcoxon test and Friedman’s test results to examine the difference between expectation and perception of service quality and dimension ranks at the Oncology Center of Tikur Anbessa Specialized Hospital, Addis Ababa, 2022 (n=256)
Factors associated with service quality dimensions
Sociodemographic factors
The Kruskal-Wallis test result in table 4 demonstrated the association between demographic factors and service quality dimensions. The female expectations were statistically significantly higher compared with the male expectations in the dimensions of tangibility (p<0.00) and reliability (p<0.00). Patients whose age>65 had statistically significant highest expectations and a more negative gap in the dimensions of assurance (p<0.01) compared with other age groups. Regarding educational status, patients with cancer who had a college degree and above had statistically significant highest expectations in the dimensions of tangibility (p<0.05). Source of medical expense, frequency of visit, and marital status of patients did not show any significant relationship with the service quality dimensions (table 4).
Kruskal-Wallis test result for sociodemographic factors at the oncology centre of Tikur Anbessa Specialized Hospital, 2022 (n=256)
Cancer-related factors
Like the demographic characteristics of patients, the Kruskal-Wallis test result in table 5 also revealed the association between clinically related factors and service quality dimensions. Patients with cervical cancer had statistically significant lowest perception and highest expectations compared with other patients with cancer in the dimension of reliability (p<0.05). Patients with stage 4 cancer had the highest expectation and lowest perception in the dimensions of assurance (p<0.001) and empathy (p<0.01). Patients who waited for more than 12 months for radiotherapy had statistically significant lowest perception and highest expectation compared with others in the dimension of reliability (p<0.04) (Table 5).
Kruskal-Wallis test result for cancer-related factors at the oncology centre of Tikur Anbessa Specialized Hospital, 2022 (n=256)
Discussion
This study demonstrated the level of the gap in service quality at the oncology centre of TASH based on the SERVQUAL model. It also identified key service quality items that contributed to the negative gap and factors associated with service quality dimensions.
According to this study, the level of gap in service quality at the oncology centre of TASH is (−1.42±0.41). This finding of this study showed a negative gap in which the service provided or perceived quality of care has not met the expected quality of service by patients. The findings of this study are in line with a studies conducted in India41 and Iran42 that assessed the service quality of hospital outpatient department services, where the overall total unweighted gap in service quality using the SERVQUAL tool was found to be −1.63 and −1.56, respectively. In addition, the findings of this study are similar to those of a study conducted in the outpatient setup of Eastern Saudi Arabian hospitals, with an overall gap of −1.2±0.8 (40). Furthermore, the findings of this study are also similar to those of studies in South Africa (−0.27±0.2),43 Iran (−1.7±0.56),44 Iran(−0.85),15 Oman (−0.77±0.83),45 China (−0.388),46 in terms of the significant negative difference between patients’ perceptions and expectations. The similarity might be a reflection of the new era of increasing patients’ expectations and the demand for quality care. Patients in the 21st century are becoming more in need, and as a result, they have certain expectations from the healthcare system, but the system is unable to meet their expectations, which eventually leads to a negative gap in service quality.
Despite patients’ expectations exceeding their perceptions in all the studies mentioned above, the difference in magnitude is clearly observed. The level of gap in service quality at TASH is higher than the quality gap in South Africa,43 Iran,15 Oman45 and China.46 This difference could be attributed to the economic status and the level of healthcare spending in these countries, as they spent 8.58, 5.34%, 4.39% and 5.59% of their gross domestic product, respectively, on healthcare in 2020 compared with the 3.48% healthcare spending in Ethiopia that same year, emphasising the importance of increasing spending on healthcare.47 However, the result of this study quite contradicts studies in Nigeria and Ghana,48 49 with a possible reason for the contradiction being methodological, as the later studies were conducted in an outpatient setting and incorporated multiple hospitals.
Out of the five service quality dimensions in this study, the greatest gap was observed in the dimension of tangibility (−1.64±0.50), while the smallest gap was related to the service quality dimension of reliability (−1.26±0.61). The result agrees with the previous systematic review and meta-analysis study in Iran where the service quality dimensions of tangibility and reliability scored the highest and lowest gap scores, respectively.50 This similarity in the tangibility score could be explained by the fact that the appearance of physical facilities, equipment and hospital infrastructure is under siege across the globe, so patients’ expectations were not met in the dimensions of tangibility. As a result, improving the physical status and infrastructure of health facilities can be helpful to reduce the gap and surpass patients’ expectations in the tangibility domain. The similarity in the dimension of reliability may be attributed to the revolution of digital health management systems like iCare, which might help to decrease problems regarding keeping and retrieving patient medical records. The finding of this study, however, is not similar to a study in Nigeria where the highest gap was scored in the dimension of assurance (−1.26±2.99).48 The reason could be a difference in the patient’s sociodemographic status, which in turn might affect which service quality dimensions to prioritise.
The study demonstrates an association between sex and the level of service quality. The female expectations were statistically significantly higher compared with the male expectations in the dimensions of tangibility (p<0.05) and reliability (p<0.00). The result of this study is similar to a study in Iran, where the quality gap was negative among females compared with men in the service quality dimensions of tangibility (p=0.045) and empathy (p=0.002).51 The possible explanation could be that women constitute a vulnerable group in society, and the body and mind are more vulnerable in the face of disease, so as female patients with cancer, they might expect a lot in terms of compassion and quality care. However, the result of the above studies is quite different from a study in Tamil Nadu, India, which showed that patients demographic characteristics, such as sex, did not have any influence on any of the SERVQUAL (p=0.166) dimensions.17 The reason for the difference could be a different study setup, as the study in India was conducted in a private healthcare facility. The data reveal that patients with cancer who have college degree and above had statistically significant highest expectations in the dimensions of tangibility(p=0.05). This finding agrees with an Iranian study that indicated a significant difference between patients' educational status and the level of service quality.51 Patients with a university degree were found to have a negative gap score in the dimensions of tangibility (p=0.002) and reliability (p<0.0001). This similarity could be explained in the sense that the more patients climb the educational ladder, the more they are aware of what to expect from the healthcare industry. The same study in Iran also showed that patients without insurance coverage had a negative gap score (p=0.01) compared with their insured counterparts. This finding directly contradicts the result of this study, which found that the source of medical expenses did not show any significant relationship with the service quality dimensions. The possible explanation could be that even if more than half of patients with cancer at TASH have community-based health insurance, it is not that relevant from the patient’s point of view as a lot of medications and laboratory services are still purchased from private providers.
Patients with cervical cancer had the statistically lowest perception compared with other patients with cancer in the dimension of reliability (p=0.01). The finding agrees with another study in Addis Ababa, which indicates that, as the number of patients treated for gynaecological malignancy increases by one, overall perception of service quality decreases by 2.33.26 The reason for this similarity could be explained in terms of waiting time. Despite the fact that many patients with cervical cancer are eligible for radiotherapy, TASH was not calling for patients with cervical cancer who had been registered back in 2020 at the time of data collection. This implies that waiting time to get radiotherapy treatment is becoming unimaginable, and that could possibly contribute to the low perception score among patients with cervical cancer, so expanding timely radiotherapy services could help in reducing this gap. Patients with stage 4 cancer had the highest expectations in the dimensions of assurance (p=0.00) and empathy (p=0.01). This could be because a stage 4 cancer diagnosis is a terminal stage; these patients might have a lot of expectations in terms of getting more emotional support and assurance from healthcare professionals implying the significance of emotional support and assurance to the overall service quality and the need for consideration of emotional support and assurance for patients with terminal cancer.
Limitation
This study included only a single setting, which was the sole provider of radiotherapy for the whole country; in return, this may affect the generalisability of the result to other settings. In addition, this study assessed the functional aspect of quality from the patients’ side only and the technical aspect was not assessed. Due to the cross-sectional nature of the study design, it is difficult to ascertain the cause-and-effect relationship between the factors and the outcome variable.
Conclusion
Patient perceptions of the quality of service they received were lower than their expectations of the quality of service in all service quality aspects at TASH’s oncology centre, implying unmet quality expectations from the oncology service users. Being female, age greater than 65, having a college degree and above, being a cervical cancer patient, patients with stage 4 cancer, and patients who waited for more than 12 months for radiotherapy were found to have a statistically significant higher expectation compared with their perceived care in one or more dimensions of the SERVQUAL tool. Therefore, the hospital and other stakeholders should strive to exceed patient expectations and improve the overall quality of care. Researchers should also conduct studies in other hospitals by including the technical aspect of the quality of oncology services.
Data availability statement
Data are available upon reasonable request.
Ethics statements
Patient consent for publication
Ethics approval
Ethical clearance was obtained from the ethical review committee of Addis Ababa University, College of Health Science, School of Public Health (Ref. No SPH/1321/14). Participants gave informed consent to participate in the study before taking part.
References
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
Contributors GAW wrote the proposal and participated in data collection. MA, AN, AK, GT, and AYG made revisions to the proposal, and GW wrote the manuscript. All authors participated in the data analysis, review, revision, and approval of the manuscript for publication. GAW is the guarantor and accepts full responsibility for the finished work and/or the conduct of the study, had access to the data, and controlled the decision to publish.
Funding This work was supported by JSI Research & Training.Institute, Inc., via Grant 2017187 from the Doris Duke Charitable Foundation and the Ministry of Health Ethiopia, through the CBMP project.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.