Client Satisfaction With Sexually Transmitted Infection (STI) Services and Its Determinants: A Cross-Sectional Study

DISCUSSION

The illustrative findings indicate that client satisfaction with STI services may be relatively high overall while substantial differences remain between individual service domains. In particular, privacy, confidentiality, provider communication and respectful treatment may receive higher satisfaction ratings, whereas waiting time and physical facilities may represent more important areas for improvement.

This pattern is consistent with previous research. Padhiar and Karia reported high satisfaction among STI-clinic attendees, with particularly favorable ratings for doctor-patient communication, privacy, confidentiality, cleanliness and trust in the treating physician [8]. However, waiting time and waiting-area facilities were comparatively weaker aspects of the service.

The importance of confidentiality is particularly understandable in STI services. Patients may fear social stigma, relationship difficulties, discrimination, or disclosure of sensitive information. Consequently, confidentiality is not simply an administrative requirement but a fundamental component of client-centred sexual healthcare.

The systematic review by Weston et al. identified maintenance of confidentiality, staff attitude, effective information provision and convenience as recurring priorities among STI-clinic clients [6]. These findings support the use of these domains in satisfaction questionnaires and indicate that STI clinics should assess patient experience beyond clinical treatment outcomes.

Provider communication emerged as an important illustrative predictor of satisfaction. Effective communication can reduce anxiety, improve understanding of diagnosis and treatment, encourage appropriate disclosure of sexual history and improve client participation in care. Conversely, poor communication may increase uncertainty and dissatisfaction even when technically appropriate treatment is provided.

Mehta et al. found that provider and clinic characteristics were associated with patient satisfaction in public STD clinics [9]. Lower ratings of clinician technical skills and the clinic environment were associated with poorer overall ratings, while written information was associated with better perceptions of care.

This suggests that satisfaction is multidimensional and cannot be improved by addressing only one aspect of care.

Waiting time was another important potential determinant. Long waiting periods may be particularly problematic for STI clients because some may prefer discreet, rapid services due to concerns about being recognized by acquaintances or being seen waiting in a sexual-health clinic. In addition, long waiting times may create perceptions that the service is poorly organized.

The physical environment may also influence satisfaction. Overcrowded waiting areas, inadequate seating, poor signage, lack of privacy, or insufficient separation between registration and clinical areas may increase anxiety and compromise confidentiality. A mystery-shopper study of sexual-health services identified problems with reception, waiting facilities, confidentiality and clinic accessibility, demonstrating that service experience can involve multiple organizational components rather than the clinical consultation alone [11].

The illustrative association between treatment explanation and satisfaction is also important. Clients need to understand the purpose of their treatment, how medications should be taken, possible adverse effects, the importance of completing therapy, prevention of reinfection, partner management and when follow-up is necessary. Effective communication therefore supports both satisfaction and clinical quality.

WHO’s current STI service-delivery recommendations emphasize people-centred approaches, including decentralization, integration, task sharing and digital health interventions designed to improve access and quality of STI care [1]. The evidence reviewed by WHO also indicates that convenient, nearby facilities are generally associated with positive care experiences, although privacy and confidentiality remain important concerns [10].

The findings have implications for service improvement. First, STI clinics should conduct regular client-experience assessments. Second, staff should receive communication and confidentiality training. Third, clinics should review patient flow to reduce unnecessary waiting. Fourth, physical arrangements should protect privacy during registration, consultation, examination and collection of test results. Fifth, written or electronic educational materials should be provided where appropriate.

An important consideration is that satisfaction should not be interpreted as a direct measure of clinical quality. A client may report being highly satisfied despite receiving inappropriate treatment, while another may be dissatisfied despite receiving technically excellent care because of a long waiting time. Therefore, client satisfaction should be assessed alongside clinical quality indicators, treatment adherence, appropriate guideline use, testing quality and health outcomes.

Implications for Clinical Practice

The findings support several practical interventions.

Strengthening Confidentiality

STI clinics should establish clear confidentiality procedures covering registration, consultation, examination, laboratory testing, electronic records and communication of results.

Improving Provider Communication

Healthcare workers should use respectful, non-judgmental communication and allow clients adequate opportunity to ask questions.

Reducing Waiting Time

Patient-flow analysis, appointment systems, triage and appropriate task sharing may reduce unnecessary delays.

Improving Information Provision

Clients should receive understandable information about diagnosis, treatment, prevention, partner management and follow-up.

Improving the Physical Environment

Waiting areas should provide adequate privacy, seating, cleanliness, ventilation and appropriate separation from general outpatient areas where possible.

Routine Patient-Experience Measurement

Short anonymous satisfaction questionnaires can be administered routinely and reviewed by clinic managers as part of continuous quality improvement.

Strengths and Limitations

The proposed study has several strengths. It assesses multiple dimensions of STI service experience rather than focusing exclusively on overall satisfaction. It also evaluates potentially modifiable determinants, including communication, privacy, waiting time, information provision and clinic environment.

However, several limitations should be acknowledged. First, a cross-sectional design cannot establish causal relationships between service characteristics and satisfaction. Second, satisfaction is subjective and may be influenced by expectations and previous healthcare experiences. Third, clients may provide socially desirable responses if questionnaires are administered within the clinic. Fourth, patients who refuse participation may differ systematically from participants. Fifth, a single-centre study may have limited generalizability.

To reduce these limitations, future studies should use anonymous questionnaires, validated patient-experience measures, multicentre sampling and mixed-method approaches incorporating qualitative interviews.