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Why service users do not complain or have ‘voice’: a mixed-methods study from Nepal’s rural primary health care system

Overview of attention for article published in BMC Health Services Research, January 2017
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About this Attention Score

  • Good Attention Score compared to outputs of the same age (69th percentile)

Mentioned by

6 tweeters
3 Facebook pages


18 Dimensions

Readers on

91 Mendeley
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Why service users do not complain or have ‘voice’: a mixed-methods study from Nepal’s rural primary health care system
Published in
BMC Health Services Research, January 2017
DOI 10.1186/s12913-017-2034-5
Pubmed ID

Gagan Gurung, Sarah Derrett, Robin Gauld, Philip C. Hill


Despite abundant literature on the different aspects of health care complaint management systems in high-income countries, little is known about this area in less developed health care systems and most research to date has been conducted in hospital settings. This article seeks to address this gap by reporting on research into complaint systems in primary health care (PHC) settings in Nepal. Using a mixed-methods design, qualitative interviews were conducted with key informants (n = 39) and six community focus groups (n = 56), in the Dang District of Nepal. In addition, interviewer-administered structured questionnaire interviews were held with 400 service users, health facility operation and management committee (HFMC) members and service providers from 22 of the 39 public health facilities. Qualitative data were transcribed, organized and then analyzed using the framework method in QSR NVivo 10, while quantitative data were analyzed using IBM SPSS 22. Despite service users having grievances with the health system, they did not complain frequently: 9% (n = 20) reported ever making complaints about the PHC services. Complaints made were about medicines, health facility opening hours, health facility physical environment, and service providers, and were categorized into environment/equipment, accessibility/availability, level of empathy in the care process and care/safety. Generally, complaints were made verbally to health providers or to HFMC members or female community health volunteers. Use of formal channels such as suggestion boxes or written complaints was almost non-existent. Reasons reported for not complaining included: a lack of complaint channels; lack of knowledge of service entitlements; power asymmetry between service providers and service users; lack of opportunity to choose alternative providers, lack of an established culture of complaining, and a perceived lack of responsiveness to complaints. Very few service users made complaints to PHC services in Nepal. Several contextual factors related to the community and the health system were identified as the reasons for not complaining. We recommend continuing efforts to establish proper complaints mechanisms with an increased emphasis on the existing community health system networks. Furthermore, awareness among service users about service entitlements and complaint mechanisms should be increased.

Twitter Demographics

The data shown below were collected from the profiles of 6 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 91 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Congo, The Democratic Republic of the 1 1%
Unknown 90 99%

Demographic breakdown

Readers by professional status Count As %
Researcher 17 19%
Student > Master 16 18%
Student > Ph. D. Student 10 11%
Student > Doctoral Student 5 5%
Student > Bachelor 5 5%
Other 17 19%
Unknown 21 23%
Readers by discipline Count As %
Nursing and Health Professions 18 20%
Social Sciences 16 18%
Medicine and Dentistry 12 13%
Psychology 6 7%
Computer Science 4 4%
Other 11 12%
Unknown 24 26%

Attention Score in Context

This research output has an Altmetric Attention Score of 5. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 29 January 2018.
All research outputs
of 15,919,321 outputs
Outputs from BMC Health Services Research
of 5,491 outputs
Outputs of similar age
of 359,002 outputs
Outputs of similar age from BMC Health Services Research
of 3 outputs
Altmetric has tracked 15,919,321 research outputs across all sources so far. This one has received more attention than most of these and is in the 72nd percentile.
So far Altmetric has tracked 5,491 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 6.8. This one has gotten more attention than average, scoring higher than 61% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 359,002 tracked outputs that were published within six weeks on either side of this one in any source. This one has gotten more attention than average, scoring higher than 69% of its contemporaries.
We're also able to compare this research output to 3 others from the same source and published within six weeks on either side of this one. This one has scored higher than all of them