Analysis of patient satisfaction with health services at Sei Berombang Labuhanbatu Health Center

 Corresponding author: Ali Napiah. Nasution Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Liscense 4.0. Analysis of patient satisfaction with health services at Sei Berombang Labuhanbatu Health Center Badri Nur, Chrismis Novalinda Ginting and Ali Napiah. Nasution * Master of Public Health Study Program, Faculty of Dentistry and Health Sciences (FKKGIK) Universitas Prima Indonesia, Medan, Indonesia. International Journal of Science and Research Archive, 2025, 21(01), 309-314 Publication history: Received on 29 November 2024; revised on 07 January 2025; accepted on 09 January 2025 Article DOI: https://doi.org/10.30574/wjbphs.2025.21.1.1054 Abstract The quality of health services is an essential factor in creating patient satisfaction and trust in health facilities. Puskesmas, as a critical health service, plays a central role in meeting the community's health needs, especially in remote areas such as Sei Berombang Labuhanbatu. However, the challenges faced by Puskesmas in providing adequate services often lead to variations in patient satisfaction levels. Lack of resources and infrastructure are barriers to improving service quality. This study aims to analyze the effect of health service quality dimensions on patient satisfaction at Puskesmas Sei Berombang in 2024. The method used was a quantitative approach with a cross-sectional analytic design involving 160 respondents from a population of 256 patients selected incidentally. Data were collected through interviews and online questionnaires and then analyzed using the Chi-Square test and multiple logistic regression. The results showed that reliability, assurance, tangibles, responsiveness, and empathy had a significant relationship with patient satisfaction, with p-values of 0.001, 0.008, 0.009, 0.002, and 0.003, respectively. The empathy variable has the most important influence on patient satisfaction, with an odds ratio (OR) of 8.256, indicating that increased empathy in service increases the chance of patient satisfaction by more than eight times. These findings highlight the importance of improving the quality of health services, especially empathy, to achieve optimal patient satisfaction. Therefore, service quality improvement strategies are recommended to focus on all five quality dimensions to effectively improve patient satisfaction in community health centers. Keywords: Patient satisfaction; Service quality; Health center; Empathy 1. Introduction Patient satisfaction is a key indicator of the quality of health services, reflecting the extent to which services meet expectations. Factors such as effectiveness, affordability, and empathy affect satisfaction. Dissatisfaction indicates the need for improvement (Mundung et al., 2019). Measuring patient satisfaction helps health facilities identify areas of improvement and ensure services meet expected standards (Rianasari, 2019). Patient satisfaction is calculated by comparing expectations with the experience received. A high level of satisfaction indicates service as expected, while low satisfaction suggests the need for improvement (Sujarwo & Subekti, 2019). Patient loyalty to the health center is formed from satisfaction with the quality of service—such as interaction, speed, facilities, and support. This satisfaction creates a positive experience that encourages patients to return and recommend puskesmas services (Marzuq & Andriani, 2022). Conversely, if the service does not meet expectations, the patient may look for alternatives, lowering the loyalty level (Rerung et al., 2021). Patient dissatisfaction is negatively impacted by spreading bad experiences, affecting reputation, and lowering public trust, which can decrease patient numbers and financial losses (Imran et al., 2021). Handle patient complaints and make essential improvements to maintain reputation and quality of service. Increasing patient satisfaction is key to loyalty, strengthening relationships, and building a good reputation in the health center (Maharani et al., 2023); (Engkus, 2019). Based on the Regulation of the Ministry of Health of the Republic of World Journal of Biology Pharmacy and Health Sciences, 2025, 21(01), 309-314 310 Indonesia in 2016, the minimum standard of patient satisfaction must be above 95%. Services with satisfaction below this number do not meet the standard (Ali et al., 2021). The quality of service is assessed based on the suitability of patient expectations and the services received, using the SERVQUAL concept with five dimensions (physical evidence, reliability, responsiveness, guarantee, and empathy). Improvements must be made if the satisfaction index is below the standard (Hasanah et al., 2020). Quality services at health centers are essential to increase patient satisfaction and loyalty, encouraging them to remain loyal and recommend services (Andi Rizky Amaliah, 2021). High quality indicates service effectiveness, and dissatisfaction suggests a problem that needs to be fixed ( & Sitio, 2020). Previous research has shown a significant influence of service quality on patient satisfaction, such as influential physical evidence at the Langsa Lama Health Center (Meutia 2019) and a significance value of 0.000 (Meutia & Andiny, 2019). Mundung (2019) also reported the significant effect of physical evidence on patient satisfaction in hospitals, with a significance value of 0.000 and a t-count of 3.791 (Mundung et al. 2019). Based on the above background, the researcher is interested in researching and analyzing the influence of the quality of health services on patient satisfaction at the Sei Berombang Labuhanbatu Health Center in 2024. 2. Research methods This study uses a quantitative approach and statistical analysis based on the philosophy of positivism. Data is collected through instruments to test hypotheses. The study's design is an analysis with a cross-sectional approach that compares two variables simultaneously. The research location is the Sei Berombang Labuhanbatu Health Center, with the research time from September to completion in 2024. The population consisted of 256 patient visits over the past three months, and the sample was determined with the Slovin formula, resulting in a minimum of 160 people through incidental techniques. Primary data was collected through interviews and questionnaires on Google Forms, while secondary data came from health center records. Data analysis included univariate analysis, bivariate using the Chi-Square test, and multivariate with multiple logistic regression to determine the influence of independent variables on dependents, with the best model determined by p-value (p ≤ 0.05). This research uses ethical principles, namely utility, confidentiality, and justice, and it obtains an honest license with number 047/KEPK/UNPRI/IX/2024. 3. Results and discussion Table 1 Overview of Respondent Characteristics at the Sei Berombang Labuhanbatu Health Center in 2024 Category Sub-Category n Percentage Age < 20 Years 10 6% 21-30 Years 40 25% 31-40 Years 30 19% > 41 years 80 50% Total 160 100% Gender Male 68 43% Woman 92 58% Total 160 100% Education No School 10 6% SD 16 10% SMP 24 15% SMA 30 19% D3 5 3% S1 65 41% Total 160 100% World Journal of Biology Pharmacy and Health Sciences, 2025, 21(01), 309-314 311 Table 1. describes the characteristics of 160 respondents at the Sei Berombang Labuhanbatu Health Center in 2024. The majority of respondents were over 41 years old (80 people, 50%), followed by the 21-30 years old group (40 people, 25%), 31-40 years old (30 people, 19%), and under 20 years old (10 people, 6%). Regarding gender, women dominated, with 92 people (58%), while men dominated 68 people (43%). The education level of the respondents consisted of 65 people (41%) with S1 degrees, 30 people (19%) in high school, 24 people (15%) in junior high school, 16 people (10%) in elementary school, ten people (6%) not attending school, and five people (3%) D3. Most visitors to health centers are educated individuals, which can affect their awareness of health services. Table 2 Chi-Square Test Table of Research Variables Analysis of Patient Satisfaction with Health Services at the Sei Berombang Labuhanbatu Health Center in 2024 Category Sub-Category Service Satisfaction Total df p-value Satisfied Dissatisfied Reliability Good 95 10 105 1 0.001 59% 6% 66% Bad 30 25 55 19% 16% 34% Total 125 35 160 78% 22% 100% Jaminan (Assurance) Good 70 15 85 1 0.008 44% 9% 53% Bad 55 20 75 34% 13% 47% Total 125 35 160 78% 22% 100% Displays (Tangibles) Good 80 20 100 1 0.009 50% 13% 63% Bad 45 15 60 28% 9% 38% Total 125 35 160 78% 22% 100% Data Responsiveness Good 85 15 100 1 0.002 53% 9% 63% Bad 40 20 60 25% 13% 38% Total 125 35 160 78% 22% 100% Empathy (Empathy) Good 90 10 100 1 0.003 56% 6% 63% Bad 35 25 60 22% 16% 38% Total 125 35 160 78% 22% 100% World Journal of Biology Pharmacy and Health Sciences, 2025, 21(01), 309-314 312 Table 2 presents the Chi-Square test results to analyze patient satisfaction at the Sei Berombang Labuhanbatu Health Center in 2024 with 160 respondents. In the reliability variable, of the 105 respondents who received good service, 95 people (59%) were satisfied, while ten people (6%) were dissatisfied. For poor service, 30 out of 55 respondents (19%) were satisfied. A P-value of 0.001 indicates a significant relationship. This finding aligns with the research of Komaling (2023), which also found a significant relationship between service quality and patient satisfaction with a p-value of 0.015 (Komaling, 2023). Puskesmas managers need to improve the quality of services to maintain and increase patient satisfaction, an indicator of the success of health services. Steps that can be taken include regular training for medical personnel, ensuring infrastructure and equipment standards, and gathering patient feedback for improvement. The development of standard operating procedures and improved communication between patients and healthcare workers are also significant. These efforts will maintain patient satisfaction, create loyalty, and enhance the reputation and number of patients served, supporting the achievement of public health goals. For the guarantee variable, of the 85 respondents who felt they received good service, 70 people (44%) were satisfied, while of the 55 respondents who were dissatisfied, 34% were satisfied. The p-value of 0.008 also shows a significant relationship. This finding aligns with Meutia (2019), who reported a p-value of 0.001 for a substantial effect of assurance on patient satisfaction at the Langsa Lama Health Center (Meutia & Andiny, 2019). In health services, assurance includes health workers' reliability, skills, and knowledge. When patients feel that the service is reliable and the staff is competent, they are more satisfied, creating a sense of security and trust. These findings emphasize the importance of the guarantee aspect in increasing patient satisfaction. Health centers must provide high-quality services, conduct ongoing training for medical personnel, and improve communication between staff and patients to meet their expectations. Puskesmas should also identify areas to improve service assurance, such as officers' communication skills and standard operating procedures, and provide clear information about services. Focusing on enhancing insurance will positively impact patient satisfaction and the reputation of the Health Center. In the tangibles, out of 100 respondents who rated it well, 80 people (50%) were satisfied, while out of 60 respondents who rated it poorly, 45 people (28%) were satisfied. A p-value of 0.009 indicates a significant relationship. These findings underscore the importance of physical aspects in health services, including cleanliness and comfort. Ilmianti's research (2022) also supports this finding, stating a significant influence of physical appearance on patient satisfaction at the Kolakaasi Health Center with a p-value of 0.004 (Ilmianti et al., 2022). Therefore, Puskesmas needs to improve display elements, such as the physical condition of the waiting room, the cleanliness of facilities, and the accessibility of information. A comfortable and professional environment will make patients feel valued. Providing adequate facilities like comfy seating and sanitation will contribute to a positive patient experience. Focusing on the display element increases satisfaction and the perception of service quality, encouraging patients to return to using Puskesmas services. For the responsiveness variable, 85 out of 100 respondents (53%) were satisfied, while out of 60 respondents who were dissatisfied, 40 people (25%) were satisfied. A P-value of 0.002 indicates a significant relationship. Al Rajab's research (2023) also supports this finding, stating a substantial relationship between responsiveness and patient satisfaction with a p-value of 0.046 (Al Rajab & Andilah, 2023). These findings emphasize the importance of the speed and precision of healthcare workers' responses to patient needs, which can increase satisfaction. Therefore, increasing responsiveness is highly recommended to improve patient satisfaction at the Health Center. Finally, on the empathy variable, out of 100 respondents who rated it well, 90 people (56%) were satisfied, while out of 60 respondents who rated it inadequate, 35 (22%) were satisfied. A p-value of 0.003 indicates a significant relationship. Safitri's (2022) research supports this finding, with a p-value of 0.043, which shows a meaningful relationship between empathy and patient satisfaction in Puskesmas (Safitri et al., 2022). These results confirm the importance of empathy in health services. When healthcare workers show care and concern, this can reduce anxiety and improve patient comfort. The empathy variable had the highest odds ratio (OR), which was 8,256 (Table 3), meaning that patients who felt empathy were more than eight times more likely to feel satisfied than those who did not. Empathy is not only crucial in direct interactions but also in a holistic approach to healthcare. Understanding patients' physical and emotional condition allows healthcare workers to be more responsive. Empathic service also encourages patient involvement in treatment, speeding up recovery. Empathy is a key factor in patient satisfaction at the Sei Berombang Labuhanbatu Health Center, so health institutions must invest in empathy skills training for healthcare workers. By prioritizing empathy, health centers can improve the patient experience and strengthen the relationship between healthcare workers and patients, contributing to better health service quality. World Journal of Biology Pharmacy and Health Sciences, 2025, 21(01), 309-314 313 Overall, all the variables tested showed a significant relationship with patient satisfaction levels, underlining the importance of these factors in health services in health centers and deserving of further testing with multivariate analysis. Table 3 Table of Logistic Regression Test Entry Method Analysis of Patient Satisfaction Level with Health Services at the Sei Berombang Labuhanbatu Health Center in 2024 Variable B S.E. Forest df Mr OR EXP(B) Lower Upper Physical Evidence (Tangibles) -0.195 1.023 3.014 1 0.801 0.829 0.829 0.155 4.488 Reliability 1.001 0.715 13.062 1 0.037 2.787 2.787 0.964 7.702 Responsiveness 1.111 0.713 0.960 1 0.027 3.065 3.065 1.002 9.192 Jaminan (Assurance) 1.016 1.023 3.014 1 0.055 2.743 2.743 0.903 8.454 Empathy (Empathy) 2.022 0.715 13.062 1 0.002 8.256 8.256 1.438 39.29 Based on Table 3, the most significant odds ratio (OR) variable is the empathy variable, with an OR of 8,256. This shows that the increase in service empathy is associated with an increase in the chance of patient satisfaction by more than eight times, making it a very influential factor in patient satisfaction at the Sei Berombang Labuhanbatu Health Center. 4. Conclusion This study found a significant relationship between health service variables and patient satisfaction at the Sei Berombang Labuhanbatu Health Center in 2024. The reliability variables (p-value 0.001) and guarantee (p-value 0.008) showed that reliable services and a sense of security contributed to patient satisfaction. Physical appearance (tangibles) is also essential, with a p-value of 0.009, while responsiveness has a p-value of 0.002, emphasizing the importance of the speed of response of health workers. The empathy variable, with a p-value of 0.003 and the highest odds ratio of 8.256, showed that increased empathy was closely related to patient satisfaction. The main conclusion is that empathy is the most influential factor, and its improvement is expected to improve patient satisfaction significantly. Compliance with ethical standards Acknowledgments The author would like to thank all parties who have helped and supported this research. Disclosure of conflict of interest No conflict of interest to be disclosed. References [1] Al Rajab, M., & Andilah, S. (2023). 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