Reading Material for the Prevention of Blindness Workshop

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  1. Vaneeste G. Breaking Down Barriers. .hristoffel Blindenmission, 2001.

Patients’ Perspective: An Important Factor in Assessing Patient Satisfaction

R Muralikrishnan MHM MSc
A K Sivakumar MHM

Lions Aravind Institute of Community Ophthalmology
720 Kuruvikaran Salai
Gandhi Nagar
Madurai 625 020
Tamil Nadu

Conventionally, the preparation of a patient satisfaction questionnaire is based on textbooks, one’s own perception and similar forms used at other hospitals. This process often reflects the providers’ perception of factors influencing satisfaction, perpetuating their shortcomings and not adequately dealing with necessary cultural and social variations.


Aravind Eye Care System in India, one of the highest volume eye care centres in the world, developed an innovative way of developing an in-patient satisfaction assessment tool. All the ‘suggestions and complaints’ of inpatients registered in a separate suggestion register during the year 1997 were scrutinised and grouped. To confirm that the groupings indeed reflected the patient’s expectations and concerns, another survey through interviews was conduct¤d on 50 patients and 50 staff (ophthalmologists, nurses, administrative staff) with the objective of finding out the patients’ expectations, concerns and worries.


The 123 different complaints in the initial study and the results of the supplementary study were used to develop 12 different categories to assess patient satisfaction. These are:

  1. Medical care

  2. Nursing care

  3. Behaviour of staff

  4. Clear information

  5. Personal attention

  6. Responsiveness to complaints & care*

  7. Integrity*

  8. Physical facilities

  9. Supportive services

10. Cleanliness & maintenance

11. Waiting time

12. Charges
* Derived from the supplementary study

Action(s) Taken

In order to monitor patient satisfaction objectively, questions were developed in the broad categories, piloted and developed as a standard questionnaire to grade responses on different point scales. Some additional information, such as age, gender and treatment, was also included for better analysis. The questionnaire also used very clear and simple language and was worded to elicit thoughtful responses.
Consequence of Action(s)

This process has helped to develop a standard questionnaire to measure patient satisfaction regularly in our hospital. The expectations are also understood as these change and are incorporated into the questionnaire from time to time. The results are presented to the hospital’s Quality Council and during meetings of heads of departments with a view to taking corrective actions. Individual audits are also undertaken on high patient dissatisfaction areas. The impact is that our patients are more satisfied (our regular survey results confirms this) and we experience an average workload increase of 15% every year. The success of our assessment and improvement of patient satisfaction is because we take into account the patients’ own views and perspectives.

Teaching Resources: Be Prepared!

Sue Stevens


Nurse Consultant
Journal of Community Eye Health
Ophthalmic Resource Coordinator
International Centre for Eye Health
Institute of Ophthalmology
11-43 Bath Street
London EC1V 9EL

The Journal of Community Eye Health, with its theme-orientated approach, attempts to inform readers of current relevant educational materials in each issue. Learning and teaching resources are sought extensively but are they always appropriate and used effectively?
This article completes the series on Teaching Eye Health and will overview:
The criteria for selecting materials, advise on accessing teaching resources and suggest strategies for continuing education.

Selection Criteria

Context and Relevance

Choosing material because someone has recommended it as ‘a really good resource’ does not ensure it will be effective.

It is important to consider:

WHO the users will be

Are they health workers, professionals, Ministry of Health officials, schoolteachers, or patients? Are the materials needed for eye care education for those working at primary, secondary or tertiary level?
WHERE the materials will be used

Will it be in a lecture hall, classroom, community room?

WHAT facilities will be available

Will there be suitable seating arrangements, a projector, flipcharts, computer, videotape player, good lighting, blackout blinds?

HOW the materials will be used

Will the teaching method used be didactic, interactive, group work, project assignments?


Many formats are now available. Photographs, slides, overhead transparencies and videotapes are useful visual aids to complement didactic teaching or written text. The subject may, however, be more conducive to real situation teaching, conveying the experience of the teacher by means of demonstration, practice, and supervision in the clinical area. Posters are very popular for teaching purposes but care must be taken to display them in appropriate places – stairways can prove unsafe and nervous patients will not appreciate clinical or pathology pictures in a waiting area!


Where teaching materials are for use with ophthalmic patients, e.g., patient information leaflets for health education and promotion, it is vital to ensure these are available in accessible formats, e.g., large print. Audiotapes are particularly appropriate for reinforcing verbal information given to ophthalmic patients.

There are many advantages and disadvantages to consider when choosing formats - see Table 1.1


Cost may be an important constraint. In an attempt to be helpful and meet the needs of users, suppliers will sometimes offer surplus, out of date materials, free of charge. Such availability is often sought. This must be a guarded practice – free materials are not always appropriate to the actual requirements. Many commercially produced teaching materials, e.g., posters, booklets and videos, are now available from pharmaceutical and equipment companies. Offered free of charge, they attract users with limited financial resources. The content will often, understandably, reflect the sophisticated materials they produce and may even carry advertisements which may result in inappropriate messages in certain situations. It is for this very reason that the Journal of Community Eye Health avoids indiscriminate advertising.


Teaching materials, if they are to achieve their aims, must be up-to-date, applicable and cover the required scope of the subject. Health practice is ever changing and this is reflected in the rate at which medical textbooks appear in new editions.

Language and Culture

Teaching resources, first and foremost, need to be understood. Availability in the local language makes any learning resource more attractive and valuable and increases its demand. Sadly, most materials are available in English only. Where English is not the user’s first language but is the language used or encouraged in the workplace or educational institution, it is important to ensure that materials are produced in plain English. Applying a ‘Gobbledygook Test’ – see Box 1 – will help decide if the text contains plain English before purchasing in bulk, e.g., books for a whole class.1

Teaching material content should avoid stereotyping of target groups but at the same time needs to be culturally appropriate and reflect local practice, conditions, available health services and the values and concerns of users.

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