https://doi.org/10.15218/ejnm.2025.06 Erbil j. nurs. midwifery, Vol. 8, No. (1), May 2025 Original Article Patient’s Satisfaction with Coronary Artery Disease Concerning Medical Care Services at Teaching Hospitals in Erbil City ABSTRACT Background and Objectives: Coronary artery disease is now broadly recognized as a ma- jor global health issue. Patient’s satisfaction with medical care services is an important health outcome. The study was to assess the satisfaction level of patients with coronary artery disease concerning medical care services and to find out the difference between patients’ satisfaction and the socio-demographic characteristics of the patients. Methods: A descriptive cross-sectional study design was conducted from February 2022 to May 2022. To find out the satisfaction level of patients with coronary artery disease concerning medical care services. Researchers used a non-probability purposive sampling technique among 205 patients diagnosed with coronary artery disease. Data were ana- lyzed using Statistical Package for the Social Sciences version 25. Results: The result shows that half of the sample (50.7%) was among the age group 61 years and older. More than half of them (51.2%) were females. About (58%) of the partici- pants were illiterate. The majority (79%) of the samples were married. However, (46.8%) of the study samples were housewives and living in an urban area (47.8%). The highest percentage of the samples (64.9%) had satisfied with medical care. There was a significant difference among patients’ medical care satisfaction: age, gender, marital status, and oc- cupational status. Conclusion: A substantial proportion of patients were satisfied with medical care, and there was a significant difference between patients' medical care satisfaction and age, gender, marital status, and occupational status. Keywords: Patient’s Satisfaction; Coronary Artery Disease; Medical Care Services; Erbil City. Srusht Dhahier Ismael; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Kurdistan Region, Iraq. (Correspondence: srusht.ismael@hmu.edu.krd) Yousif Mohammad Younis; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Kurdistan Region, Iraq. 49 Received: 26/08/2022 Accepted: 30/09/2022 Published: 30/05/2025 Copyright ©2025The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. mailto:(Correspondence:%20dara.albanna@hmu.edu.krd) mailto:Srusht.ismael@hmu.edu.krd?subject=Srusht.ismael@hmu.edu.krd%20%20%20%20 mailto:jawdat.baker@hmu.edu.krd?subject=jawdat.baker@hmu.edu.krd%20%20%20 https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.06 Erbil j. nurs. midwifery, Vol. 8, No. (1), May 2025 Original Article The lining of arterial blood vessels devel- ops an abnormal buildup of lipid, or fatty substances and fibrous tissue, known as coronary artery disease (CAD). These sub- stances cause the arterial lumen to narrow and block, which lowers blood flow to the myocardium [1] it has remained the world's leading killer and the source of public health issues, as well as one of the most prevalent causes of morbidity and mortality in many communities [2].According to health data from the American Heart Association (AHA), coro- nary artery disease remained the leading cause of mortality in more than 190 coun- tries, with 17.3 million deaths per year. By 2030, the number is estimated to rise up to 23.6 million(3). In United States of America, CAD is the most common type of heart disease, killing 365,914 people in 2017. About 18.2 million adults age 20 and older have CAD (about 6.7%) and 2 in 10 deaths from CAD happen in adults less than 65 years old(4).The prevalence of CAD has been found to range from 5.4 per- cent to 13.4 percent in the Middle East [5,6]. According to a study conducted in Tehran, the prevalence of CAD among the Tehranian population was 15.81% (8.62% for men and 7.19% for women respective- ly) [7].Patient satisfaction is an essential component in evaluating the quality of healthcare services because it shows how well the staff is achieving the patients' goals. It has a significant impact on pa- tients' expectations [8]. It was initially ex- pressed by Risser in 1975 as the grade of agreement between patients' expectations of the optimal level of treatment and their perceptions of the care they receive [9].Medical care is an essential hospital service or technical quality. It refers to "what" treatment the patient receives from the physician and is established on the precision of medical diagnosis, treatment, and adherence to professional principles. Patients may not believe they are getting high-quality care when a hospital falls short in this area [10]. Successfulphysician-patientcommunication has been indicated to improve health outcomes by raising patient satisfaction, enhancing patient comprehension of health issues and available treatments, promoting better adherence to treatment regimens, and offering patients support and assurance [11]. Effective collaboration of health care professionals in care of patients with heart disease will usually result in good quality care for the patient [12]. The record from Erbil General Directorate of Health showed that in Erbil Government, there were about 8853 patients diagnosed with CAD during 2019- 2020. Because heart disease develops gradually and not easily detected, and morbidity and mortality with the disease increase day by day. Therefore, this study was aimed at assessing the socio demographic characteristics, evaluating satisfaction level of patients with CAD related to medical care from the patient’s point of view as a determinant of whether there is improvement in patient’s satisfaction of care or not, and determining the difference between some of the sociodemographic characteristics of the sample and over all medical care satisfaction levels. A descriptive cross-sectional study was conducted from February 2022 to May 2022 among 205 CAD patients at Rizgary and Hawler Teaching Hospitals in Erbil City. The sample size was determined by Z2 p q/ d2, z = confidence interval 95% (1.96), p= prevalence= (0.1581), q = (1-p) = (0.8419), d = sampling error (0.05) [13]. The samplesof the study were adult patients 50 Copyright ©2025 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. INTRODUCTION METHODS https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.06 Erbil j. nurs. midwifery, Vol. 8, No. (1), May 2025 Original Article were analyzed using Statistical Package for Social Science (SPSS) version 25 for calcu- lating descriptive statistical data analysis (frequency and percentage) and inferential statistical data analysis (independent sam- ple t-test and ANOVA test). Table 1 showed the distribution of socio- demographic characteristics of 205 study samples with CAD. Half (50.7%) of the sam- ple were in the age group 61 years and more, followed by 47- 60 years (36.1%), 33 - 46 years (11.2%), while the lowest per- centage (2%) were in the age group 19 - 32 years . More than half of them (51.2%) were females, and higher than the per- centage of males (48.8%). In addition, the table showed that the highest percentage (58%) of the participants were illiterate, followed those who could read and write (12.2%), primary school (11.2%), institute (7.8%), secondary school (6.8%), and col- lege (3.9%) respectively. It was also re- vealed that the majority of the samples were married and accounted for (79%).Regarding occupational status, housewives were the highest percentage among all occupational statuses (46.8%), followed by employed (34.6%), unem- ployed (10.2%), and retired (8.3%) respec- tively. Meanwhile, most of them were liv- ing in an urban area (47.8%). Table 2 revealed the frequency and per- centage of items about medical care satis- faction. Item (The doctor treats you friend- ly and in a courteous manner) ranked first with a rate of 98.8%, and item (The doctor did not ignore what you told him/or her) ranked second with 93.7%. Furthermore, item (The doctor spends plenty of time with you) ranked third with 91.2%. diagnosed with coronary artery disease. Non-probability, purposive sampling tech- niques were used to collect the relevant study data. The inclusion criteria include adult patients who had coronary artery disease and (were older than18 years old) as well as both genders. The exclusion cri- teria included patients who had psychiatric or mental problems and patients with communication problem. The researcher obtained an approval letter from the ethics committee at Hawler Medical University/ College of Nursing (Code No.111, date 7/10/2021). The official approval was tak- en from general directorate of health, Rizgary and Hawler Teaching Hospitals in Erbil city. Oral informed consent was ob- tained from patients after a detailed expla- nation about the aim of the study before starting the interview. Each patient's form was coded with a specific number. The re- searcher prepared a questionnaire for col- lecting data based on the review literature and exploring questionnaires used in simi- lar studies. The face-to-face interview technique was used to collect data about socio-demographics and patients satisfac- tion with medical care services. The ques- tionnaire was checked by a panel of ex- perts of different specialties related to the fields of the present study. Based on their comments, the questionnaire was correct- ed and changed for suitable data collec- tion .The reliability of the study done by using a pilot study on a purposive sample of 15 CAD patients in January 2022.The researcher spent with each patient approx- imately 20-30 minutes to respond to ques- tionnaire. The researcher assessed the so- ciodemographics characteristics, including age, gender, educational level, marital sta- tus, occupational status and residential area. Patient satisfaction regarding medical care services consists of 12 questions and includes three answers or options (1=Disagree, 2= Neutral, 3= Agree). Data 51 Copyright ©2025The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. RESULTS https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.06 Erbil j. nurs. midwifery, Vol. 8, No. (1), May 2025 Original Article 52 Copyright ©2025 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 1: Socio-demographic characteristic of the study sample (n=205) Socio-Demographic Characteristics F (%) Age 19-32 4 (2) 33-46 23(11.2) 47-60 74 (36.1) 61 and more 104 (50.7) Gender Male 100 (48.8) Female 105 (51.2) Educational level Illiterate 119 (58) Reading and writing 25 (12.2) Primary school 23 (11.2) Secondary school 14 (6.8) Institute graduate 16 (7.8) College graduate 8 (3.9) Marital status Single 10 (4.9) Married 162 (79) Widowed 33 (16.1) Occupational statues Employed 71 (34.6) Unemployed 21(10.2) Housewife 96 (46.8) Retired 17 (8.3) Residential area Urban 98 (47.8) Sub-urban 93 (45.4) Rural 14 (6.8) Table 2: Patient’s satisfaction related to medical care services (n=205) items Disagree F (%) Neutral F (%) Agree F (%) The doctor spends plenty of time with you. 3 (1.5) 15 (7.3) 187 (91.2) The doctor treats you friendly and in a courteous manner. 3(1.50) 0 (0) 202 (98.5) The doctor always gives you instructions. I02 (49.8) 33 (16.1) 70 (34.1) It has easy to access the medical specialist when you need it. 36 (17.6) 35 (17.1) 134 (65.5) The doctor understands your health need. 5 (2.4) 24 (11.7) 175 (85.5) The doctor gave you information about your health condition. 80 (39) 21 (10.2) 104 (50.7) The doctor gave you information about the present treatment. 66 (32.2) 29 (14.1) 110 (53.7) The doctor sometimes hurries too much when they treat you. 176 (85.9) 13 (6.3) 16 (7.8) The doctor explains to you the reason for doing tests. 74 (36.1) 31 (15.1) 100 (48.8) The doctor gives you information about the test results. 59 (28.8) 30 (14.6) 116 (59.6) The doctor did not ignores what you tell him/or her. 6 (2.9) 7 (3.4) 192 (93.7) Sometimes you have doubt about the ability of the doctor who treats you. 175 (85.4) 13 (6.3) 17 (8.3) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.06 Erbil j. nurs. midwifery, Vol. 8, No. (1), May 2025 Original Article 53 (64.9%) of the samples had agreed with medical care, followed by neutral (34.1%) and disagree (1%) respectively. A significant difference was reported for age group (p=0.006), gender (p=0.004), marital status (p=0.039) and occupational status (p=0.004) ≤ 0.05.While there was no significant correlation with education- al level and residential area at p 0.05. Table 3 showed the overall levels of patient satisfaction with CAD regarding medical care services. The highest percentage Table 4 showed the difference between socio demographics characteristics the study sample with medical care satisfac- tion. There was a significant difference be- tween the mean of age group, gender, marital status, occupational status and quality of medical care. Copyright ©2025 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 3: Overall levels of satisfaction with medical services among patients with CAD (n=205) Table 4: Difference between socio-demographics characteristics of study sample and medical care satisfaction (n=205) Overall level of satisfaction F (%) Disagree 2 (1) Neutral 70 (34.1) Agree 133 (64.9) Socio-demographic characteristic F Mean± SD P-value Age 19-32 4 30.250±0.957 F=4.23 P-value= 0.006(S) 33-46 23 29.739±2.750 47-60 74 29.257±2.659 61 and more 104 27.971±3.263 Gender Male 100 29.300±3.215 t=2.903 Female 105 28.086±2.767 Educational level Illiterate 119 28.437±2.845 F=1.663 P-value= 0.145(NS) Read and write 25 28.560±3.927 Primary school 23 28.261±2.734 Secondarey school 14 30.000±3.038 Institute graduate 16 30.250±2.295 College graduate 8 28.375±4.307 Marital status Single 10 29.700±3.128 t=3.301 P-value= 0.039(S) Married 162 28.851±3.046 Widowed 33 27.515±2.807 Occupational statues Employed 71 29.718±2.948 F=4.497 P-value= 0.004(S) Unemployed 21 28.381±3.138 Housewife 96 28.072±2.753 Retired 17 28.117±3.950 Residencal area Urban 98 29.091±2.970 F=1.765 P-value= 0.174(NS) Sub-urban 93 28.322±3.029 Rural 14 28.142±3.526 F= one way Anova test, t= independent sample t-test https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.06 Erbil j. nurs. midwifery, Vol. 8, No. (1), May 2025 Original Article not ignore what they told him/or her” (93.7%) and (Time spend with the doctor) (91.2%). Likewise, research carried out in Nepal in 2021 had a similar result [22]. On the subject of overall satisfaction with medical care services, most of the samples were satisfied with the care pro- vided by doctors. This agrees with a cross- sectional study finding that was performed in South Saudi Arabia in 2022 among 423 patients, which displayed that the overall satisfaction level related to doctor services was 81% [23]. However, in contrast to the study carried out in Iraq/Baquba, they found that the patients with CAD were not satisfied with the care provided by doctors [24]. The present study illustrated a signifi- cant difference among overall satisfaction , age, gender, marital status and occupa- tional status. It was supported by a study conducted in Turkey in 2013, which demonstrated significant differences among patients’ gender, marital status, and occupational status as well as overall medical care services[25]. Additionally, it was in line with a research in Australia which revealed that age and gender were significant with overall satisfaction[26]. conversely, it disagreed with a study per- formed in Iraq in 2014 that clarified no sig- nificant differences between patients' soci- odemographic characteristics and overall medical care services[24]. 54 DISCUSSION The result of this study illustrated that the majority of samples were within the age group (61 years and more); this is compa- rable to the studies conducted in India and Tanzania that showed most of the samples were older than 60 years [14,15]. This finding indicates that in com- parison to young people, aging has a sig- nificant impact on the development of heart disease. The current study result found that more than half of the study samples were female. That may be due to hormonal changes that occur in females after the age of 45 years, and in addition, females are often overloaded, especially after having several children, which im- pact on the body's whole function. Corre- spond to the studies done in Kuwait and Nepal that revealed the majority of sam- ples were females [16,17]. Regarding edu- cational level more than half of the pre- sent study samples were illiterate. A simi- lar result was found in the research per- formed in Maysan/Iraq, among 100 pa- tients in 2015, representing that most of the study samples were illiterate [18]. The present study found that the majority of samples were married. This result is supported by a study conducted in India in 2015 that found that most of study the samples, 68% were married [19]. Most of the samples were housewives. The result is supported by finding from a cross- sectional study in Iran in 2015;which clari- fied that the majority of study samples were housewives [20]. About residential area, the majority of present study sam- ples were from urban areas. This is con- sistent with a study done in Iraqi Kurdi- stan, which concluded that most of the study sample were from urban areas[21]. The result showed the majority of sam- ples satisfied with the items “The doctor treats them friendly and courteous- ly” (98.5), followed by “The doctor did Copyright ©2025The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.06 Erbil j. nurs. midwifery, Vol. 8, No. (1), May 2025 Original Article correlates of coronary heart disease: first population-based study in Lebanon. 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Patient satisfaction and its socio-demographic correlates in a tertiary public hospital in Nepal: a cross-sectional study. 56 Copyright ©2025 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/