TY - JOUR T1 - ‘The nurse did not even greet me’: how informed versus non-informed patients evaluate health systems responsiveness in South Africa JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2020-004360 VL - 6 IS - 4 SP - e004360 AU - Dumisani MacDonald Hompashe AU - Ulf-G Gerdtham AU - Carmen S Christian AU - Anja Smith AU - Ronelle Burger Y1 - 2021/04/01 UR - http://gh.bmj.com/content/6/4/e004360.abstract N2 - Introduction Universal Health Coverage is not only about access to health services but also about access to high-quality care, since poor experiences may deter patients from accessing care. Evidence shows that quality of care drives health outcomes, yet little is known about non-clinical dimensions of care, and patients’ experience thereof relative to satisfaction with visits. This paper investigates the role of non-clinical dimensions of care in patient satisfaction.Methods Our study describes the interactions of informed and non-informed patients with primary healthcare workers at 39 public healthcare facilities in two metropolitan centres in two South African provinces. Our analysis included 1357 interactions using standardised patients (for informed patients) and patients’ exit interviews (for non-informed patients). The data were combined for three types of visits: contraception, hypertension and tuberculosis. We describe how satisfaction with care was related to patients’ experiences of non-clinical dimensions.Results We show that when real patients (RPs) reported being satisfied (vs dissatisfied) with a visit, it was associated with a 30% increase in the probability that a patient is greeted at the facilities. Likewise, when the RPs reported being satisfied (vs dissatisfied) with the visit, it was correlated with a 15% increase in the prospect that patients are pleased with healthcare workers’ explanations of health conditions.Conclusion Informed patients are better equipped to assess health-systems responsiveness in healthcare provision. Insights into responsiveness could guide broader efforts aimed at targeted education and empowerment of primary healthcare users to strengthen health systems and shape expectations for appropriate care and conduct.Data are available upon request. Individual de-identified data will be available on reasonable request. All variables needed to recreate the results reported in this article will be included, as will the code required to reproduce these results. The data and code can be accessed through email request to the first author. ER -