Healthcare quality in rural Armenia: Focus group perceptions

Previous studies in Armenia have found low healthcare quality and satisfaction, with significant barriers to healthcare access and high out-of-pocket spending, especially in rural areas. This study is the first to utilize focus groups to better understand patient perceptions of healthcare quality in rural Armenia. Study participants were volunteers, mostly women and teachers, among 15 rural Armenian villages. Using the Lévesque model, we assessed participant responses using the domains of approachability, acceptability, availability and accommodation, affordability, and appropriateness. Our study found that many residents have low trust in physicians and the healthcare system, and associate higher quality of care with increased diagnostic testing and sub-specialty care. The interpersonal component of healthcare was an important factor in determining quality of care; residents voiced that high quality is characterized by providers who communicate clearly, have a compassionate demeanor, value patient preferences, and support patient autonomy. Residents also expressed positivity towards low cost of care. When discussing the quality of providers, residents noted that providers should communicate test results, and generally keep patients informed throughout the treatment process. In discussing barriers to access, residents noted poor roads and inconsistent physician availability. Our findings align with observations from studies in other LMIC settings on the topic of perceptions of healthcare quality while providing a more comprehensive understanding of previously reported low patient satisfaction rates and low quality of care in Armenia. We have provided targeted recommendations to improve rural healthcare in Armenia that include implementation of patient-centered care, required trainings for physicians and nurses, system-level strategies for improved utilization and outcomes, and co-produced health campaigns.