Patient satisfaction and associated factors among outpatients at a district hospital in Zanzibar: a facility-based cross-sectional study

Outpatient departments (OPDs) represent the primary interface between patients and healthcare systems in low-resource settings, where service quality critically shapes patient satisfaction. However, evidence from Zanzibar remains limited. To assess patient satisfaction and identify factors associated with satisfaction among outpatients at Jitimai District Hospital, Zanzibar. A facility-based cross-sectional study was conducted among 309 adult outpatients recruited through a non-probability approach combining purposive selection of the study hospital and convenience sampling of outpatients during the data-collection period. Data were collected using a structured, adapted questionnaire based on the Patient Satisfaction Questionnaire (PSQ-18), comprising 28 items across nine domains (physical environment, courtesy/interpersonal manner, communication, accessibility, time with doctor, convenience, technical quality, expenses, and general satisfaction). The internal consistency of the overall 28-item scale was acceptable-to-borderline (Cronbach’s α = 0.685); reliability varied by domain (α = 0.42–0.82 for domains with three or more items), and we report this variation rather than a single summary figure, since several domains did not reach conventional reliability thresholds. Given an outcome prevalence above 10% (dissatisfaction 58.9%), we used modified Poisson regression with robust variance to identify factors independently associated with satisfaction, reporting adjusted prevalence ratios (aPR) with 95% confidence intervals (CI) rather than odds ratios, since odds ratios overstate the corresponding prevalence ratios for a common outcome. A logistic-regression specification of the same model did not converge (quasi-complete separation); we report this explicitly rather than presenting unstable odds-ratio estimates as though they were reliable. Analyses for this revision were conducted in Python 3.12 (pandas, NumPy, SciPy, and statsmodels). Overall, 182 of 309 respondents (58.9%, 95% CI 53.3–64.3%) reported dissatisfaction. Administrative aspects performed relatively better (83.2% satisfaction with registration staff), whereas communication and patient-centred care items showed very low satisfaction. Poor cleanliness (92.9% dissatisfaction) and long waiting times were also prominent. In the modified Poisson model, lower satisfaction was associated with perceived affordability, accessibility, and perceived socioeconomic barriers; the adjusted prevalence ratios for perceived socioeconomic influence and for female sex were very large in magnitude (aPR > 20), which exceeds what a prevalence ratio can plausibly represent and most likely reflects instability in the underlying data rather than a true effect of this size — we report these values for completeness but do not interpret them as precise, generalisable effect sizes. Patient satisfaction at this facility was low, and several modifiable service-delivery domains — communication, interpersonal care, cleanliness, and waiting time — stood out as priorities for facility-level quality improvement. Because of the non-probability sampling design, we present the multivariable associations as hypothesis-generating for this facility rather than as confirmed, generalisable predictors of patient satisfaction. Interventions targeting patient-centered communication, provider attitudes, and financial and access barriers are essential to improve outpatient service quality.