Assessing Health Care Perception and Needs of the Older Adults in Bangladesh: Application of the Kano Model to Assess Gaps

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The country's growing older adult is challenging Bangladesh's existing health system, and it must be reformed to ensure geriatric care. The main objective of this study is to measure the existing gap in perceived and expected healthcare needs among older adults and propose a measure to eliminate the gap. Methods Using a cross-sectional research design, we collected data from 500 respondents in Narsingdi and Narayanganj districts. The gap between the older adults' perceived and expected healthcare needs was assessed using a structured questionnaire with 28 items (using the Kano Model) that could be answered positively and negatively. Descriptive statistics, T-tests, and multiple linear regression analyses were carried out. Results The findings showed where Bangladesh's healthcare sector, particularly older adult care services, comes close to matching their expectations and areas where it falls far short. The Kano model showed that 12 of 28 geriatric health service qualities were classified as Must-Be quality and eight as attractive or delighters. Type of residence (β=-0.264, p < 0.001), quality of life (β = 0.227, p < 0.001), marital status (β=-0.104, p = 0.047), and educational status (β=-0.124, p = 0.015) was significantly associated with of older population health care needs and expectation. Conclusion This study gives healthcare practitioners a detailed understanding of their service quality from the perspective of patient satisfaction in Bangladesh. Reforming and modifying the country's existing healthcare structure services for older adults while keeping these attributes in mind will likely result in a safe and healthy environment for them. Reformed Eliminate Expectation Delighters Satisfaction Older Adults Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background Aging is a natural phenomenon that offers an unprecedented challenge for the entire segment of society. Although the accurate definition of older adults varies by country, a person aged 65 and over is considered an older adult internationally [ 1 ]. However, people aged sixty and over in Bangladesh are considered older adults. Bangladesh's senior population is growing faster than the rest of the world, which is anticipated to continue in the coming years. In 1990, 4.98% of the population was aged 60 or over, which increased to 6.1% in 2001 and 8.3% in 2020 and is estimated to be 20% in 2050 [ 2 , 3 ]. With this trend of population aging, whether aging has arisen as a demographic issue is already being debated. It is even now time to identify the critical concerns that must be handled. The country must be prepared to tackle the challenges of aging by putting public policies in place [ 4 ]. Several policies and plans, for example, the National Policy on Older Persons 2013, National Health Policy 2011, National Social Welfare Policy 2005, National Education Policy 2010, and National Population Policy 2012, have been taken in Bangladesh to implement the Madrid International Plan of Action on Ageing (MIPAA), ensure health, dignity, poverty-free, active older adults, and sustainable development goals (SDGs). However, implementation has not yet been secured [ 2 , 5 , 6 ]. Hence, none of the National policies or plans addressed whether older people are satisfied with existing healthcare services and health services that need improvement in the eyes of older people [ 7 ]. Therefore, it is necessary to assess the quality of health care services offered to older people and redesign it according to their needs. Previous researchers used the Kano Model, developed by Noriaki Kano in 1984, in various service situations, including banks, laundries, supermarkets, restaurants, and tourism [ 8 , 9 ]. These studies used a questionnaire survey and the Kano Model to analyze hospital service quality, employing majority decisions to classify attributes and gather patients' impressions of whether attributes are fulfilled as benchmarks for hospital service quality improvement. A growing body of knowledge shows gaps exist between the perception and expectation of older adults' healthcare needs [ 10 ]. The study in Vietnam about public health quality assessment revealed gaps between expectations and perceptions and identified that patients expected staff's empathy and tangibles infrastructure the least. A study in primary healthcare facilities showed that the gap between expectation and perception was because of differences in patients' perceptions rather than expectations, where the most significant gap was detected in empathy [ 11 ]. However, the gap between the expectations and their fulfillment in health care services showed a low correlation with satisfaction [ 9 ]. Perceived quality was significantly lower than expected despite being accompanied by positive satisfaction and repurchase intentions in one Nigerian hospital [ 12 ]. Further, Occupational stress, frailty, and sleeping quality showed significant negative correlations with perceived health status among older adults [ 13 ]. Although it is a significant public health issue, there is a lack of understanding in assessing the healthcare needs and expectations gap among older adults in low and middle-income countries, such as Bangladesh. This study explores the current disparity between perceived and expected healthcare needs among older adults in Bangladesh's Dhaka Division and the socioeconomic differential of such a gap, which will help take proper measures to eliminate the gap. Methods Data Collection This study used the quantitative research strategy to assess health care perception and needs using a cross-sectional design in two districts, Narsingdi and Narayanganj, of the Dhaka division, Bangladesh ( Fig. 1 ) . Face-to-face interviews were conducted using a structured questionnaire to gather information about the healthcare needs and expectations of older adults (aged 60 and above) using the 'Kobo Toolbox' ( https://www.kobotoolbox.org ) from 14 Nov 2021 to 14 Dec 2021. This research used a prevalence (p) of 68.9% of patients who expressed satisfaction with the provider's usual behavior in primary healthcare settings in Bangladesh [ 14 ]. With a p of 0.689, Z of 1.96 for a 95% confidence interval (CI), a margin of error (e) of 0.05, a design effect (Deff) of 1.75 for sampling variation, and a non-response rate (NR) of 5%, the calculated sample size was 605. The final sample size was 500, with a response rate of 82.6%. Around 59% of the data was collected from rural areas, and the rest from urban regions. [Fig. 1 will be inserted here] Variables and their Measurements Outcome Variable: The Kano Model This research article adopts the 'Kano Model' as its theoretical framework because this is the most relevant one; however, the GAPS model can be used for the same purpose. Most of the studies in the healthcare industry adopt the Kano model instead of the GAPS model because GAP analysis focuses on the current performance of a business as opposed to what the market wants from the business. While it is better with the Kano model for understanding, presenting the result, and measuring the expectations and perception gap and what the market wants from the business, participants wish to from the health industry for this study. Noriaki Kano, a Japanese researcher and consultant, produced a paper in 1984 outlining concepts and methods for determining customers' happiness with product characteristics [ 15 ]. This model assumes that contentment does not always occur when all required attributes are present and that customers may feel dissatisfied or have no feelings at all. The Kano Model, which was first used in the manufacturing business to classify quality into five aspects, is as follows: One-Dimensional or Performance Attributes : Some product features function the same way we may expect satisfaction to work: the more we supply, the happier our consumers become. In the Kano literature, these traits are referred to as Linear, Performance, or One-Dimensional attributes. Attractive Quality Attributes Customers are happy when unexpected traits are there, but they are not disappointed if they are absent. Must-Be Quality Attributes : Customers anticipate other characteristics of a product. If the product lacks these, it will be considered incomplete or inferior. Must-have or Basic Expectations are terms used to describe this sort of feature; here is the thing with these features: we need them, yet having them will not make our consumers happier. They will just not be dissatisfied. Indifferent Quality Attributes Naturally, there are aspects in which we are uninterested—those whose existence (or absence) has no discernible effect on our reaction to the product. Reverse Quality Attributes Their presence causes consumer discontent, and their absence causes customer satisfaction. The horizontal coordinate in the Kano Model reflects the degree to which the quality attribute is satisfactorily met (Fig. 2 ). The higher the degree of deficiency, the closer it gets to the left, where the quality characteristic becomes insufficient; the higher the degree of fulfillment, the closer it gets to the right. The vertical axis represents the level of client satisfaction with the quality qualities. The higher it is, the more happiness is expressed; the lower it is, the more discontent is shown. In this study, Noriaki Kano's original Kano model is applied to examine patients' perceptions and expectations through a survey questionnaire. [Fig. 2 will be inserted here] This section measured elders' replies to two questions—one functional and the other dysfunctional—for each aspect of health service quality. The first question in each pair was designed to capture the respondents' feelings if the health service has that attribute, while the second was intended to catch the respondents' feelings if the health service does not. The participant chooses one of five alternate solutions for each question component. Kano (1984) defined these five options as "extremely satisfied," "satisfied," "not sure," "unhappy," and "very dissatisfied." As a result, utilizing 28 statements, the Kano model examined the needs and gaps between the perception and expectations of older patients (Table 1 ). The Kano model was broken down into two parts, one for positive attributes and the other for negative attributes, then converted the response score into composite mean and sum scores for further analysis. Table 1 Kano Matrix for Evaluating Functional and Dysfunctional Health Service Quality Attributes Service Requirement Dysfunctional Questions (Absence of attributes), feature does not exist Very Satisfied/ I like it Satisfied/ I expect it Neutral/Not sure Dissatisfied/ I can tolerate it Very dissatisfied/ I dislike it Functional Questions (Presence of attributes) Feature Exist Very Satisfied/ I like it Questionable Attractive/ Delighters Attractive/ Delighters Attractive/Delighters One-dimensional/performance Satisfied/ I expect it Reverse Questionable/Indifferent Indifferent Indifferent Must-Be Neutral/Not sure Reverse Indifferent Indifferent Indifferent Must-Be Dissatisfied/ I can tolerate it Reverse Indifferent Indifferent Questionable Must-Be Very dissatisfied/ I dislike it Reverse Reverse Reverse Reverse Questionable [Table 1 will be inserted here] Independent Variables Independent variables of this research paper were selected based on the literature review, as stated earlier. Respondent's age, sex, religion, marital status, educational status, living status, monthly income, disease prevalence, old age and health insurance, disease knowledge, and monthly expenditure on healthcare were selected as independent variables (Table 2 ). Statistical Analysis Descriptive statistics were used, followed by an independent sample t-test to determine the mean differences for positive and negative attributes. In addition, multiple linear regression was utilized to assess the value of selected predictors depending on the fulfillment of assumptions. Multiple linear regression was used to evaluate the ability of eleven control measures to predict levels of the Kano Model (Positive and Negative Attributes) after checking the assumption. Preliminary analyses were conducted to ensure no violation of linear regression's normality, linearity, multicollinearity, and homoscedasticity assumptions. First, boxplots indicated that each variable in the regression was normally distributed and free from univariate outliers. Second, an inspection of the normal probability plot of standardized residuals and the scatterplot of standardized residuals against standardized predicted values indicated that the assumptions of normality, linearity, and homoscedasticity of residuals were met. Third, for both positive and negative attributes, relatively high tolerances and low variance inflation factor (VIF) scores for all predictors (for example, on average tolerance: 0.75, VIF: 1.3, respectively) in the regression model indicated that multicollinearity would not interfere with the outcome of the regression model. Fourth, the AIC (Akaike's Information Criteria) and BIC (Bayesian Information Criteria) values were used for model selection. Results Socio-Demographic Characteristics The socio-demographic characteristics of the respondents are presented in Table 2 . Among the respondents, 41.6% (208) were male and 42.2% (211) were from urban areas. In the urban region, 126 (43.2%) females and 85 (40.9%) males, whereas in the rural area, 166 (56.8%) females and 123 (59.1%) males. According to respondents, 248 (49.6%) belonged to the higher-income group, while 252 (50.4%) belonged to the lower-income group. In the higher-income group, 117 (23.4%) men and 131 (26.2%) women responded, whereas 91 (18.2%) men and 161 (32.2%) women responded in the lower-income group. A significant majority (85.4%) of the aging population was between 60 and 70 (males = 83.7%, females = 86.6%). Most older people (77%) were married, and only 23% were single (unmarried, divorced, widowed, or widower). Almost every male senior person (89.4%) had a mate, with only 10.6% having no companion (unmarried, widower). The average number of people in a household was 6.8. The average family income was 25524 BDT. About two-fifths of the older adults were illiterate (those who have never been to school, 37%). In contrast, approximately 22.3% had only completed primary school. Among the female older adults, 24.8% (those who had never been to school) were illiterate, 14.9% had an incomplete primary education, and 33.9% had a complete primary education. There were 67% of older people who had any clinically diagnosed one or more diseases, while 33% had no diseases. Among 431 respondents, 205 older adults who had heard or had knowledge of the old age allowance program were getting it, while 226 were not. Among 199 older adults, 130 respondents who knew about health insurance coverage had it, while 69 elderlies did not. There were more females (60.2%) than males among old-age allowance recipients (27.3%). In contrast, males (71.3%) had higher health insurance coverage than females (59.2%). Table 2 Distribution (%) of demographic and socioeconomic characteristics of the study population (n = 500) Characteristics Sex Total (%) Male (%) Female (%) Age Group (in years) 60–70 174 (83.7) 253 (86.6) 427 (85.4) 70 and up 34 (16.3) 39 (13.4) 73 (14.6) Residence Urban 85 (40.9) 126 (43.2) 211 (42.2) Rural 123 (59.1) 166 (56.8) 289 (57.8) Religions Islam 196 (94.2) 289 (99.0) 485 (97.0) Others 12 (5.8) 3 (1.0) 15 (3.0) Marital Status Married 186 (89.4) 199 (68.2) 385 (77.0) Widowed 16 (7.7) 89 (30.5) 105 (21.0) Others 6 (2.9) 4 (1.3) 10 (2.0) Family Member Less than 5 61 (29.3) 86 (29.5) 147 (29.4) More than 5 147 (70.7) 206 (70.5) 353 (70.6) Family Income (in Taka) Less than 15000 50 (24.0) 75 (25.7) 125 (25.0) More than 15000 158 (76.0) 217 (74.3) 375 (75.0) Educational Qualification Primary Incomplete 8 (5.4) 25 (14.9) 33 (10.4) Primary Complete 33 (22.3) 57 (33.9) 90 (28.5) Secondary Complete 43 (29.1) 55 (32.7) 98 (31) Higher Secondary 43 (29.1) 22 (13.1) 65 (20.6) University/Hons/Degree 21 (14.2) 9 (5.4) 30 (9.5) Who Lives With Son 189 (90.9) 261 (89.4) 450 (90.0) Spouse 10 (4.8) 17 (5.8) 27 (5.4) Others 9 (4.3) 14 (4.8) 23 (4.6) Disease Suffering Yes 142 (68.3) 194 (66.4) 336 (67.2) No 66 (31.7) 98 (33.6) 164 (32.8) Old Age Allowance Receiver Yes 45 (27.3) 160 (60.2) 205 (47.6) No 120 (72.7) 106 (39.8) 226 (52.4) Health Insurance Coverage Yes 72 (71.3) 58 (59.2) 130 (65.3) No 29 (28.7) 40 (40.8) 69 (34.7) [Table 2 will be inserted here] Health Profiles of the Older Population As shown in Fig. 3 , diabetes affects the majority of older adults (approximately 30%), followed by arthritis (22%), asthma (14%), chronic respiratory disease (13.5%), and hypertension (7.6%). [Fig. 3 will be inserted here] According to Fig. 4 , 72 % of the older adults were aware of their ailments from diseases. In contrast, only 40% of the older adults were aware of the consequences of those diseases. On the other hand, around 28% of the population had no in-depth knowledge of diseases, and 60% had no idea how they affect their lives. They lacked a basic understanding of what was happening to them, and, more importantly, they had no idea how to help prevent or decrease the damage to extend their lives. [Fig. 4 will be inserted here] Older Adult's Expectations and Perception of Their Healthcare Needs in Bangladesh Participants in this study were asked to rate each statement on a Kano scale ranging from 'extremely dissatisfied' to 'extremely satisfied.' On the Kano scale, there were 28 positive and negative statements. Table 3 shows the results of the older adult's reactions to expectations and perceptions and the gap between them. Table 3 Older People's Expectations and Perception of Healthcare Needs Based on the Kano Model Health Service Quality Expectation Perception Expectation Gap Kano Classification 1. Staff reaction time is quick and appropriate for the patient 4.79 1.33 3.46 One Dimensional/ Performance 2. Efficiency of service procedures and appointment system 4.22 2.23 1.99 Must-Be 3. Medical treatment and doctor visiting as scheduled 4.30 2.05 2.25 Must-be 4. Available and adequate visiting for patient family as scheduled 4.13 1.89 2.24 Indifferent 5. Adequate rest time for patient as promised 4.01 1.65 2.36 Attractive/ Delighters 6. Quick medical treatment response 4.35 1.94 2.41 Must-Be 7. Clear and understandable information given 4.21 1.96 2.25 Must-Be 8. Provision of good communication of the service right from the first time 4.01 1.65 2.36 Attractive/ Delighters 9. Availability of immunization services 4.31 1.89 2.42 Must-Be 10. Nurses are never busy to respond 4.06 1.73 2.33 Attractive/ Delighters 11. Employee's politeness and friendliness in serving elders 4.21 1.71 2.50 One Dimensional/ Performance 12. Provision of prostheses and other medical aids 4.06 2.03 2.03 Indifferent 13. Development of gerontology units 4.09 1.71 2.38 Attractive/ Delighters 14. Doctors' ability to accurately diagnose patient disease 4.00 2.00 2.00 Must-Be 15. Good communication among doctors, staff, and patients 4.10 1.68 2.42 Attractive/ Delighters 16. Doctors and nurses are careful about treating and examining patient 4.27 1.72 2.55 Must-Be 17. Dedicated attention employees give patients and their family 4.16 1.85 2.31 Indifferent 18. Specialist being assigned to patient 4.06 1.79 2.27 Attractive/ Delighters 19. No social status discrimination towards patients 4.25 1.86 2.39 Must-Be 20. Physical facilities and medical instruments in place to assist older adults persons 4.33 1.84 2.49 Must-Be 21. Suitable temperature at patient rooms 4.17 1.87 2.30 Indifferent 22. Adequate fresh water supply at the ward 4.32 1.92 2.40 Must-Be 23. Clean and adequate supplies for each ward 4.25 1.86 2.39 Must-Be 24. Clean and well-maintained washroom 4.30 1.81 2.49 Must-Be 25. Neat hospital staff 4.19 1.64 2.55 Attractive/ Delighters 26. Specific needs of patients are met, including various food and beverage 4.23 1.58 2.65 Attractive/ Delighters 27. Frequent Community health nurses and another personnel visit at home 4.17 1.85 2.32 Indifferent 28. Cheaper Cost of Healthcare 4.58 1.50 One Dimensional/ Performance Total 538.88 50.54 488.34 [Table 3 will be inserted here] The findings of the customer expectation, perception, and, more importantly, perception gaps were computed using the five-point Likert scale and the integrated Kano model questionnaire presented in Table 3 . The table demonstrates that the present level of services being delivered for each of the 28 categories for which respondents were asked to indicate their expectations fall short of their expectations, resulting in an expectation gap. In essence, the comments suggested that aside from hospitals' ability to address specific demands of senior patients, such as providing diverse foods and beverages, they believed there was still potential for development in other aspects of older adults' healthcare. Using the Kano model also revealed that, while there were general expectation gaps, their critical or urgency differs according to the respondents, essential information for policy direction given the scarcity of resources that the health sector in developing economies like Bangladesh is always confronted with. Table 4 summarizes the criticality of the items in the following way: Table 4 Summary of Kano Quality Items for Older Adults Attributes Item Number Total Total Attractive/ Delighters 5, 8, 10, 13, 15, 18, 25, 26 8 One Dimensional/ Performance 1, 11, 28 3 Must-Be 2, 3, 6, 7, 9, 14, 16, 19, 20, 22, 23, 24 12 Indifferent 4, 12, 17, 21, 27 5 [Table 4 will be inserted here] The Kano model scale classified 12 of 28 geriatric health service qualities as Must-Be quality (Fig. 5 ). When these traits were met, they were taken for granted or anticipated to be of high quality, but when not, they caused discontent. On the Kano model scale, eight of the aged health care quality attributes had been classified as attractive or delighters, which refer to service criteria that provided satisfaction when completely met but did not create dissatisfaction when not. These were exciting characteristics that people did not usually expect. The summary findings of the 'kano model' can also be seen through the graphical presentation presented below: [Fig. 5 will be inserted here] The data revealed no reverse or questionable quality attributes for aged health services. Further analysis of the data showed that up to three items fit into the aged health categories that were classified as one-dimensional or high-value-added. These were the desired quality traits, resulting in satisfaction when met and discontent when not. Finally, five characteristics showed that older adults were unconcerned about the supply of specific hospital services. These were neither good nor terrible services and did not result in patient or consumer satisfaction. Differentials in Health Care Perception and Expectations Perception of health care needs was significantly varied by school-going and residence type (Table 5 ). Those who did not go to school had a higher mean (51.01; SD = 5.09) than those who did (50.04; SD = 5.47), and rural older adults had a higher mean (51.48; SD = 4.60) than urban older adults (48.92; SD = 5.92). The expectation of healthcare needs was significantly varied by marital status and family income. Table 5 Differentials of Perceived and Expected Healthcare Needs Gender Perceived Healthcare Needs Healthcare Needs Expectation Mean SD P-Value Mean SD P-Value Male 50.38 5.35 0.957 118.48 5.40 0.788 Female 50.41 5.36 118.35 5.00 Marital Status Married 50.19 5.19 0.126 118.60 5.20 0.017 Others 51.11 5.80 114.27 19.37 School Going Yes 50.04 5.47 0.047 118.08 5.20 0.062 No 51.01 5.09 118.97 5.06 Disease Yes 50.53 5.73 0.399 118.68 5.27 0.087 No 50.13 4.47 117.85 4.92 Residence Urban 48.92 5.92 0.000 118.51 5.46 0.060 Rural 51.48 4.60 116.91 13.06 Family Income 15000 50.31 5.63 117.17 11.87 Old Age Allowance Yes 50.06 4.05 0.209 118.22 4.49 0.333 No 50.71 6.55 118.69 5.64 Wealth Index Poor 50.87 4.80 0.097 118.22 4.83 0.197 Others 50.08 5.66 117.16 13.00 [Table 5 will be inserted here] Predictors of Healthcare Needs Perception Multiple linear regression was calculated to predict respondents' responses in the 'Kano Model' positive attributes or perceived health needs based on eleven variables, as per Table 6 . A significant regression equation was found [F(11, 419) = 6.593, p < 0.001, with adjusted R 2 of 0.125]. Results show that the ten predictors collectively can account for 12.5% of the variance in perceived healthcare needs. Table 6 Predictors of Perceived Healthcare Needs & Expectations Model 1 (Kano Positive Attributes) Model 2 (Kano Negative Attributes) Variables Beta (SE) p value Beta (SE) p value Respondents Age -0.132 (0.059) 0.025 0.038 (0.062) .542 Respondents Sex Female Male (RC) 0.055 (0.051) .275 -0.061 (0.053) .252 Have ever been to a school/ institution Yes (RC) -0.088 (0.049) .072 -0.124 (0.051) .015 No Marital Status Married (RC) -0.104 (0.052) .047 0.075 (0.055) .171 Others Residence Type Rural Urban (RC) -0.264 (0.048) .000 0.036 (0.048) .458 Suffering from any disease Yes No (RC) 0.002 (0.048) .963 -0.154 (0.050) .002 Family Monthly Income 15000 Quality of Life 0.227 (0.055) .000 -0.154 (0.059) .009 Life Satisfaction 0.077 (0.047) .102 -0.024 (0.050) .635 Old Age Allowance Yes (RC) -0.103 (0.052) 0.050 -0.063 (0.054) .238 No Wealth Index Poor (RC) 0.107 (0.047) 0.023 -0.044 (0.049) .375 Others Model Summary n 500 500 R 2 .148 .050 Adjusted R 2 .125 .028 F Change 6.593 2.224 df 11, 419 10, 420 Significance of F change < .001 < .016 Note: SE=Standard Error, Beta= Standardized Coefficients Beta, RC=Reference Category . [Table 6 will be inserted here] The older population's age (β=-0.132, p = 0.025) predicts perceived health needs significantly. Unmarried or any older adults other than married had − 0.104 unit lower perceived health needs (β=-0.104, p = 0.047) than older adults who were married. On the other hand, older people living in rural areas also had lower perceived healthcare needs (β=-0.264, p < 0.001) than older adults living in urban areas. The older adults' quality of life significantly predicted their perceived healthcare needs, accounting for a 0.227 unit increase (β = 0.227, p < 0.001) in perceived healthcare needs. Older adults with higher wealth quantile had 0.107 units higher perceived healthcare needs (β = 0.107, p = 0.023) than poor older adults. The older population who did not receive the old age allowance had lower perceived healthcare needs (β=-0.103, p = 0.050) than those who received the old age allowance. Other predictors, such as respondent sex, educational status, disease prevalence, family income, and life satisfaction, were insignificant in predicting older adults' perceived healthcare needs in Bangladesh. Multiple linear regression was also used to predict respondents' responses in the 'Kano Model' negative attributes or expected health needs based on ten variables, as Table 6 shows. A significant regression equation was found (F(10, 420) = 2.224, p = 0.016, with adjusted R 2 of 0.028. Results show that the ten predictors collectively can account for 2.8% of the variance in expected healthcare needs. Older adults who had not been in the educational institution had lower expected healthcare needs (β=-0.124, p = 0.015) than those who did. Disease prevalence among older adults was significant in predicting older adults' expected health care needs, older adults with diseases had lower expected health care needs (β-0.154, p = 0.002) than older adults with no diseases. The quality of life of the older adults (β-0.154, p = 0.009) was negatively affecting expected healthcare needs. Other predictors were not significant in predicting older adults' expected healthcare needs in Bangladesh. The point is to notice that quality of life is significant in predicting both perceived and expected quality. Discussions The primary objective of this study was to determine the older adults' perceptions and expectations regarding healthcare needs and services they believe are required in healthcare services in Bangladesh. Bangladesh's overall population is 169.80 million (enumerated), with an older population (above 60 years) of 9.28%, or 15.3 million [ 16 ]. The government spent 3445.40 crores of Taka in 2022-23, with 5.7 million older adults as recipients. The old-age payment program currently covers approximately 40% of older adults. It is worth noting that older adults receive 500 takas per month, with a 65-year-old male limit and a 62-year-old female limit [ 17 ]. According to our study, 48% of older adults received or registered for the old age allowance program, which is consistent with Bangladesh's current scenario. About 65% of the older adults had health insurance coverage, with males and urban residents dominating. The majority of the older adults were literate, around 60%. The findings showed specific sectors where Bangladesh's healthcare sector, particularly older adult care services, comes close to matching elders' expectations and areas where it falls far short. Perceived needs and expectations for more aged adults' healthcare services were derived from older adults' responses in the interview using the 'Kano Model.' The study revealed needs for various aspects and dimensions of services, such as service provider-related needs, service-related needs, different financial needs for receiving health care, accommodation needs, and expectation gaps. In these cases, the Bangladesh Health Service and other health providers must concentrate on being able to deliver fundamental services like- efficiency of service procedures and appointment system, medical treatment and doctor visiting as scheduled, availability of immunization services, doctors and nurses are careful about treating and examining patient, physical facilities and medical instruments in place to assist older adults persons, adequate fresh water supply at the ward, and clean and well-maintained washroom. Because these services were recognized as a must-have attribute in healthcare facilities by the aged, they were regarded as expected or essential attributes by the older adults, whose presence was taken for granted. In this way, healthcare management can raise its quality in areas that impact patient perceptions of service quality. This case study also demonstrates how an existing worldwide health quality and service quality methodology (Kano Model) developed in various cultural contexts can administer aged healthcare services. This finding aligns with Yiranbon et al.'s 2014 study in Ghana, which used the 'Kano Model,' consisting of 32 items, to investigate the expectation and perception gap regarding healthcare needs. As with this research paper, most of the items were considered critical or must-be by older adults. Other findings in this field in other countries show similar results, as Anh, 2016, revealed gaps between expectations and perceptions, with expectations exceeding those in one national hospital in Vietnam. In primary healthcare facilities, analysis shows that the gap between expectation and perception was because of 9 differences in patients' perceptions rather than expectations. The most significant gap was detected in empathy [ 11 , 18 ]. The study also indicated that perceived healthcare needs differed significantly by literacy status and residence type, with rural older adults having a higher mean score. Their knowledge about geriatric health problems and care is limited among Bangladesh older adults, impacting their health-seeking behavior, as they only seek assistance when their health condition deteriorates [ 19 ]. According to the findings, respondents' age, residence type, and quality of life significantly impacted their perceived healthcare needs. Patients' perceptions of healthcare interactions differ by age. Patients aged 18–64 were less likely to state that their provider "always" listened to them, "always" showed respect for what they had to say, and "always" spent enough time with them when compared to patients aged 65 and up [ 19 ]. Older adults' self-perception of aging is also linked to their desire to seek medical help. A higher risk of health care delay and perceived barriers to care were related to more negative self-perceptions of aging (SPA) [ 19 , 20 ]. The expected healthcare needs were also significantly varied by marital status and family monthly income, with mean scores higher for married and family incomes less than 15 thousand than others. According to findings, literacy, disease prevalence, and quality of life significantly predicted the older adult's expected healthcare needs. Regarding accessibility, income was the most critical factor related to problems of self-perceived access, although insurance coverage, age, doctor's lack of responsiveness to patient concerns, and gender remained independently associated [ 21 ]. Therefore, the patients' representatives can be included in the planning, prioritizing, and fulfilling that vulnerable group's health needs [ 6 , 22 ]. Strengths of the Study The key findings of this study were the older adults' expectations and perception gap about healthcare needs in the Bangladesh context, which can contribute to the formulation of future health policies for the more aging adult population. The research paper's objective was clearly defined, as were the inclusion and exclusion criteria. Multiple databases were searched to validate this research in the context of Bangladesh (PUBMED, Jstore, PMC, and ResearchGate), as there had been few previous studies in this sector. The goal of this research article is to reduce the gap. Furthermore, using the Kano Model, this study introduces a new research dimension to identify healthcare needs and expectations among other population groups (e.g., adolescents and indigenous people's health). Limitations of the Study A cross-sectional research design was adopted in this study. However, causal judgments about links observed in the data are impossible. Another disadvantage of the research was that it was limited to a specific geographical site in Bangladesh (Dhaka). As a result, the study's findings may not reflect the experiences of all older people in the country. Data was collected during the COVID-19 breakdown, and getting respondents for this study was a significant difficulty, particularly for older adults. This study only covers the perception and expectations of older adults considering the demand side, while the supply side could not be assessed. Finally, only data from the general population was gathered. This study did not include older adults who live in a particular setting (such as an old home). Their expectations may differ from those of the general older population. Conclusions In this study, the perceptions and expectations of senior persons regarding health care requirements are presented to present their perceived and expected needs related to health care services. Understanding the older adults' perceived and expected healthcare requirements would aid in developing healthcare interventions for them and the modification or reformulation of various sectors of the healthcare structure in Bangladesh. In this context, this method gives healthcare practitioners a thorough insight into their service quality levels from patient satisfaction. It also aids management in developing unique ideas at both the strategic and tactical levels by identifying the most significant service features that are highly appealing to their patients. The current study focused on the areas that senior people believe should be addressed when building the healthcare service system for the country's older population. Reforming and modifying the country's existing healthcare structure services for the senior population while keeping these characteristics in mind may result in a safe and healthy environment where the older adult is not seen as a burden but as a resource for Bangladesh. People in their later years require an atmosphere encourages them to live well. Older adults can be used to their full potential provided they are given support from their environment. List Of Abbreviations CI Confidence interval Deff Design effect MIPAA Madrid international plan of action on ageing NR Non response SDGs Sustainable development goals SPA Self-perceptions of aging Declarations Ethics approval and consent to participate This manuscript is a part of a research monograph submitted to the Department of Population Sciences, the University of Dhaka, for partial fulfillment of the bachelor (undergraduate) degree. The Academic Committee (AC) of the Department of Population Sciences, University of Dhaka, approved the topic and study protocol under Registration Number 2016-316-605. The AC is responsible for handling all aspects of the research monograph. The present study was carried out following the Declaration of Helsinki. Moreover, the research evaluation committee of the Department of Population Sciences, University of Dhaka, approved the study and provided written permission before the field visit. All the respondents were 60 years and above. Informed consent was taken from all participants. We took the informed consent in writing or verbally (in many cases) because sometimes written consent (signature) is very sensitive in Bangladesh. The study's objectives were clearly stated to each participant (in some cases, the questionnaire was provided), and we asked permission to interview using the following question: 'Do you agree to participate in this study after reading the information about this research?' We interviewed the respondents after getting approval from them. Consent for publication There is no need for consent for publication as all data are de-identifiable. Availability of data and materials This research was conducted as a part of partial fulfillment of the Bachelor of Social Sciences (BSS) honors degree from the Department of Population Sciences, University of Dhaka. The Department of Population Sciences, University of Dhaka, has the right to reserve the data. Therefore, data cannot be provided in a supplementary file or deposited in a public repository. However, the dataset could be obtained from the Department of Population Sciences, University of Dhaka (https://www.dpsdu.edu.bd/index.php/en/) or the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding There was no funding for this study. Authors' contributions It was a part of an undergraduate research monograph in 2021 at the Department of Population Sciences, the University of Dhaka, Bangladesh. Sahadat Hossain completed this monograph under the supervision of Md Zakiul Alam. Acknowledgments We acknowledge the Department of Population Sciences, the University of Dhaka, for approving this research under Registration Number 2016-316-605 as part of the undergraduate research monograph. We also acknowledge all the unknown/known respondents who participated in the study. References WHO, Ageing. 2023. https://www.who.int/health-topics/ageing#tab=tab_1 . Accessed30 May 2023. Ministry of Social Welfare. National Policy on Older Persons2013. Dhaka; 2014. Bangladesh Bureau of Statistics (BBS). Report on Bangladesh Sample Vital Statistics 2018. Dhaka; 2019. Bangladesh. Parisaṃkhyāna Byuro. Statistics and Informatics Division. Elderly population in Bangladesh: current features and future perspectives. Ministry of Health and Family Welfare. National Health Policy 2011. Dhaka; 2012. Hossain DM, Constitutional. Legal and Policy Framework of Human Rights for Older Persons in Bangladesh. In: 3rd Annual Conference (2018), Narrating Human Rights: Issues of Migration, Discrimination, and Protection of Human Rights in Southeast Asia. East Java, Indonesia: University of Jember; 2018. Tareque MI. Requisites to achieve SDG 3 for older adults in Bangladesh: Justification from extant literature on healthy life expectancy and older adults' issues Session: Aging and Health Policy in South Asian Country. Regional Workshop on Integrating Policy and Research on Ageing in ASEAN: Conversations Across the Policy and Research Divide. Singapore: CARE, Duke-NUS Medical School, Singapore;; 2019. Schvaneveldt SJ, Enkawa T, Miyakawa M. Consumer evaluation perspectives of service quality: Evaluation factors and two-way model of quality. Total Qual Manag. 1991;2:149–62. Baron-Epel O, Dushenat M, Friedman N. Evaluation of the consumer model: relationship between patients' expectations, perceptions and satisfaction with care. 2001. Yiranbon E, Lulin Z, Antwi HA, Marfo EO, Amoako KO, Offin DK. Exploring the Expectation and Perception of Healthcare Needs of the Elderly in Ghana: An Empirical Analysis. Int J Acad Res Econ Manage Sci. 2014;3. Papanikolaou V, Zygiaris S. Service quality perceptions in primary health care centres in Greece. Health Expect. 2014;17:197–207. Mahmoud AB, Ekwere T, Fuxman L, Meero AA. Assessing Patients' Perception of Health Care Service Quality Offered by COHSASA-Accredited Hospitals in Nigeria. Sage Open. 2019;9. Ha J, Kim J. Factors influencing perceived health status among elderly workers: Occupational stress, frailty, sleep quality, and motives for food choices. Clin Interv Aging. 2019;14:1493–501. Karim RM, Abdullah MS, Rahman AM, Alam AM. Identifying influence of perceived quality and satisfaction on the utilization status of the community clinic services; Bangladesh context. Bangladesh Med Res Counc Bull. 2015;41:1–12. Kano N, SN TF. Attractive Quality and Must-Be Quality. J Japanese Soc Qual Control. 1984;14:147–56. BANGLADESH BUREAU OF STATISTICS. POPULATION & HOUSING CENSUS 2022 PRELIMINARY REPORT. Dhaka; 2023. Department of Social Services. Old Age Allowance. 2023. http://www.dss.gov.bd/site/page/7314930b-3f4b-4f90-9605-886c36ff423a/Old-Age-Allowance . Accessed 27 Jun 2023. Hossain S, Ferdousi MJ, Siddique MA, Tipu SMMU, Qayyum M, Laskar M. Self-reported health problems, health care seeking behaviour and cost coping mechanism of older people: Implication for primary health care delivery in rural Bangladesh. J Family Med Prim Care. 2019;8:1209. Sun JK, Smith J. Self-perceptions of aging and perceived barriers to care: Reasons for health care delay. Gerontologist. 2017;57:216–26. Khan MN, Mondal MN, Haque N, Islam MS, Shahiduzzaman MD. A Study on Quality of Life of Elderly Population in Bangladesh. Am J Health Res. 2014;2:152. Fitzpatrick AL, Powe NR, Cooper LS, Ives DG, Robbins JA. Barriers to Health Care Access Among the Elderly and Who Perceives Them. Am J Public Health. 2004;94:1788–94. Muazzam Hussain M, Mojammel M, Raihan H. Patients' Satisfaction with Public Health Care Services in Bangladesh: Some Critical Issues. Malaysian J Med Biol Res. 2015;2. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3879910","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":268562936,"identity":"96c2b9fe-51f1-49ec-b771-b4757dd02a99","order_by":0,"name":"Sahadat Hossain","email":"","orcid":"","institution":"South Asian Institute for Social Transformation (SAIST)","correspondingAuthor":false,"prefix":"","firstName":"Sahadat","middleName":"","lastName":"Hossain","suffix":""},{"id":268562937,"identity":"29db43c4-76ba-4be2-9cc5-2796a70c80a2","order_by":1,"name":"Md Zakiul Alam","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3ElEQVRIiWNgGAWjYFACNoYDDAUMDHwMDIwPeMAiPAwShLUYgCgGZgOitTBAtbBJEKVFvv1Y4mEeAwZ5NvbTaRVv2xjk+Rt4D97Ap4WxJ+0ASIthG0/utptz2xgMZxzgS7bAp4WZIb0BpIWxjSF3223eNgbGDQw8Zngdxsb/HKzFvo3/7bZioBZ7glp4JCAOS2yTyN3GDNSSSFCLhMSzhINzDCSS2yTebpacc04iecZhAn6R708z/vCmwsa2nz9344c3ZUBGey/+EINZhsRgJkL9KBgFo2AUjAL8AAB9Nj7ujUNbJQAAAABJRU5ErkJggg==","orcid":"","institution":"University of Dhaka","correspondingAuthor":true,"prefix":"","firstName":"Md","middleName":"Zakiul","lastName":"Alam","suffix":""}],"badges":[],"createdAt":"2024-01-19 21:29:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3879910/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3879910/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":50105966,"identity":"f3a4d820-1f01-477d-8286-ad635b2dce34","added_by":"auto","created_at":"2024-01-24 15:52:09","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":240838,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSample Selection Process of this Study\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3879910/v1/f817e3d70cea1a65c342225f.jpeg"},{"id":50105962,"identity":"bbe14ab7-aca8-4d35-a3b4-4ebc69985ad3","added_by":"auto","created_at":"2024-01-24 15:52:09","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":30010,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe Kano Model\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-3879910/v1/48a128788b1021d7a061ff3c.png"},{"id":50105963,"identity":"96a88461-0482-49c2-9ebd-733aef22a612","added_by":"auto","created_at":"2024-01-24 15:52:09","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":62322,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eChronic Diseases (%) among Elderly\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-3879910/v1/f4d0e96cf29f6cce60a74a4e.png"},{"id":50105965,"identity":"9d55d279-fbdb-4b1c-b9e4-cd0bb2137634","added_by":"auto","created_at":"2024-01-24 15:52:09","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":35348,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDisease Knowledge and Implications (%)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-3879910/v1/fc4ef450bca67b8208e075c8.png"},{"id":50105964,"identity":"6acb2cd6-9631-4e43-bade-04bddc4ba91d","added_by":"auto","created_at":"2024-01-24 15:52:09","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":43504,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSummary of Kano Model (Item Numbers)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-3879910/v1/58a77afcb341b15c4b650353.png"},{"id":55264933,"identity":"30b91d90-4ead-4394-a932-f6191471aadb","added_by":"auto","created_at":"2024-04-25 01:51:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1428283,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3879910/v1/93e07e9a-af62-4b17-a315-d4a3a4b60603.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessing Health Care Perception and Needs of the Older Adults in Bangladesh: Application of the Kano Model to Assess Gaps","fulltext":[{"header":"Background","content":"\u003cp\u003eAging is a natural phenomenon that offers an unprecedented challenge for the entire segment of society. Although the accurate definition of older adults varies by country, a person aged 65 and over is considered an older adult internationally [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, people aged sixty and over in Bangladesh are considered older adults. Bangladesh's senior population is growing faster than the rest of the world, which is anticipated to continue in the coming years. In 1990, 4.98% of the population was aged 60 or over, which increased to 6.1% in 2001 and 8.3% in 2020 and is estimated to be 20% in 2050 [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. With this trend of population aging, whether aging has arisen as a demographic issue is already being debated. It is even now time to identify the critical concerns that must be handled. The country must be prepared to tackle the challenges of aging by putting public policies in place [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSeveral policies and plans, for example, the National Policy on Older Persons 2013, National Health Policy 2011, National Social Welfare Policy 2005, National Education Policy 2010, and National Population Policy 2012, have been taken in Bangladesh to implement the Madrid International Plan of Action on Ageing (MIPAA), ensure health, dignity, poverty-free, active older adults, and sustainable development goals (SDGs). However, implementation has not yet been secured [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Hence, none of the National policies or plans addressed whether older people are satisfied with existing healthcare services and health services that need improvement in the eyes of older people [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Therefore, it is necessary to assess the quality of health care services offered to older people and redesign it according to their needs.\u003c/p\u003e \u003cp\u003ePrevious researchers used the Kano Model, developed by Noriaki Kano in 1984, in various service situations, including banks, laundries, supermarkets, restaurants, and tourism [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. These studies used a questionnaire survey and the Kano Model to analyze hospital service quality, employing majority decisions to classify attributes and gather patients' impressions of whether attributes are fulfilled as benchmarks for hospital service quality improvement. A growing body of knowledge shows gaps exist between the perception and expectation of older adults' healthcare needs [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The study in Vietnam about public health quality assessment revealed gaps between expectations and perceptions and identified that patients expected staff's empathy and tangibles infrastructure the least. A study in primary healthcare facilities showed that the gap between expectation and perception was because of differences in patients' perceptions rather than expectations, where the most significant gap was detected in empathy [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, the gap between the expectations and their fulfillment in health care services showed a low correlation with satisfaction [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Perceived quality was significantly lower than expected despite being accompanied by positive satisfaction and repurchase intentions in one Nigerian hospital [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Further, Occupational stress, frailty, and sleeping quality showed significant negative correlations with perceived health status among older adults [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough it is a significant public health issue, there is a lack of understanding in assessing the healthcare needs and expectations gap among older adults in low and middle-income countries, such as Bangladesh. This study explores the current disparity between perceived and expected healthcare needs among older adults in Bangladesh's Dhaka Division and the socioeconomic differential of such a gap, which will help take proper measures to eliminate the gap.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003eThis study used the quantitative research strategy to assess health care perception and needs using a cross-sectional design in two districts, Narsingdi and Narayanganj, of the Dhaka division, Bangladesh \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. Face-to-face interviews were conducted using a structured questionnaire to gather information about the healthcare needs and expectations of older adults (aged 60 and above) using the 'Kobo Toolbox' (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.kobotoolbox.org\u003c/span\u003e\u003cspan address=\"https://www.kobotoolbox.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) from 14 Nov 2021 to 14 Dec 2021. This research used a prevalence (p) of 68.9% of patients who expressed satisfaction with the provider's usual behavior in primary healthcare settings in Bangladesh [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. With a p of 0.689, Z of 1.96 for a 95% confidence interval (CI), a margin of error (e) of 0.05, a design effect (Deff) of 1.75 for sampling variation, and a non-response rate (NR) of 5%, the calculated sample size was 605. The final sample size was 500, with a response rate of 82.6%. Around 59% of the data was collected from rural areas, and the rest from urban regions.\u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003cp\u003e[Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e will be inserted here]\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section4\"\u003e \u003ch2\u003eVariables and their Measurements\u003c/h2\u003e \u003cp\u003e \u003cb\u003eOutcome Variable: The Kano Model\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis research article adopts the 'Kano Model' as its theoretical framework because this is the most relevant one; however, the GAPS model can be used for the same purpose. Most of the studies in the healthcare industry adopt the Kano model instead of the GAPS model because GAP analysis focuses on the current performance of a business as opposed to what the market wants from the business. While it is better with the Kano model for understanding, presenting the result, and measuring the expectations and perception gap and what the market wants from the business, participants wish to from the health industry for this study. Noriaki Kano, a Japanese researcher and consultant, produced a paper in 1984 outlining concepts and methods for determining customers' happiness with product characteristics [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This model assumes that contentment does not always occur when all required attributes are present and that customers may feel dissatisfied or have no feelings at all. The Kano Model, which was first used in the manufacturing business to classify quality into five aspects, is as follows:\u003c/p\u003e \u003cp\u003e \u003cb\u003eOne-Dimensional or Performance Attributes\u003c/b\u003e: Some product features function the same way we may expect satisfaction to work: the more we supply, the happier our consumers become. In the Kano literature, these traits are referred to as Linear, Performance, or One-Dimensional attributes.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eAttractive Quality Attributes\u003c/strong\u003e \u003cp\u003eCustomers are happy when unexpected traits are there, but they are not disappointed if they are absent.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eMust-Be Quality Attributes\u003c/b\u003e: Customers anticipate other characteristics of a product. If the product lacks these, it will be considered incomplete or inferior. Must-have or Basic Expectations are terms used to describe this sort of feature; here is the thing with these features: we need them, yet having them will not make our consumers happier. They will just not be dissatisfied.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eIndifferent Quality Attributes\u003c/strong\u003e \u003cp\u003eNaturally, there are aspects in which we are uninterested\u0026mdash;those whose existence (or absence) has no discernible effect on our reaction to the product.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eReverse Quality Attributes\u003c/strong\u003e \u003cp\u003eTheir presence causes consumer discontent, and their absence causes customer satisfaction.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThe horizontal coordinate in the Kano Model reflects the degree to which the quality attribute is satisfactorily met (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The higher the degree of deficiency, the closer it gets to the left, where the quality characteristic becomes insufficient; the higher the degree of fulfillment, the closer it gets to the right. The vertical axis represents the level of client satisfaction with the quality qualities. The higher it is, the more happiness is expressed; the lower it is, the more discontent is shown. In this study, Noriaki Kano's original Kano model is applied to examine patients' perceptions and expectations through a survey questionnaire.\u003c/p\u003e \u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003cp\u003e[Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e will be inserted here]\u003c/p\u003e \u003cp\u003eThis section measured elders' replies to two questions\u0026mdash;one functional and the other dysfunctional\u0026mdash;for each aspect of health service quality. The first question in each pair was designed to capture the respondents' feelings if the health service has that attribute, while the second was intended to catch the respondents' feelings if the health service does not. The participant chooses one of five alternate solutions for each question component. Kano (1984) defined these five options as \"extremely satisfied,\" \"satisfied,\" \"not sure,\" \"unhappy,\" and \"very dissatisfied.\" As a result, utilizing 28 statements, the Kano model examined the needs and gaps between the perception and expectations of older patients (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The Kano model was broken down into two parts, one for positive attributes and the other for negative attributes, then converted the response score into composite mean and sum scores for further analysis.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKano Matrix for Evaluating Functional and Dysfunctional Health Service Quality Attributes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eService Requirement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e \u003cp\u003eDysfunctional Questions (Absence of attributes), feature does not exist\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVery Satisfied/ I like it\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSatisfied/ I expect it\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNeutral/Not sure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDissatisfied/ I can tolerate it\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eVery dissatisfied/ I dislike it\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eFunctional\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eQuestions (Presence of attributes)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eFeature Exist\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery Satisfied/ I like it\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuestionable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAttractive/\u003c/p\u003e \u003cp\u003eDelighters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAttractive/\u003c/p\u003e \u003cp\u003eDelighters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAttractive/Delighters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOne-dimensional/performance\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSatisfied/\u003c/p\u003e \u003cp\u003eI expect it\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReverse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQuestionable/Indifferent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIndifferent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIndifferent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMust-Be\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeutral/Not sure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReverse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIndifferent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIndifferent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIndifferent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMust-Be\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDissatisfied/\u003c/p\u003e \u003cp\u003eI can tolerate it\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReverse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIndifferent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIndifferent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eQuestionable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMust-Be\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery dissatisfied/\u003c/p\u003e \u003cp\u003eI dislike it\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReverse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReverse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReverse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReverse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eQuestionable\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003cp\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e will be inserted here]\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eIndependent Variables\u003c/h2\u003e \u003cp\u003eIndependent variables of this research paper were selected based on the literature review, as stated earlier. Respondent's age, sex, religion, marital status, educational status, living status, monthly income, disease prevalence, old age and health insurance, disease knowledge, and monthly expenditure on healthcare were selected as independent variables (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were used, followed by an independent sample t-test to determine the mean differences for positive and negative attributes. In addition, multiple linear regression was utilized to assess the value of selected predictors depending on the fulfillment of assumptions. Multiple linear regression was used to evaluate the ability of eleven control measures to predict levels of the Kano Model (Positive and Negative Attributes) after checking the assumption. Preliminary analyses were conducted to ensure no violation of linear regression's normality, linearity, multicollinearity, and homoscedasticity assumptions. First, boxplots indicated that each variable in the regression was normally distributed and free from univariate outliers. Second, an inspection of the normal probability plot of standardized residuals and the scatterplot of standardized residuals against standardized predicted values indicated that the assumptions of normality, linearity, and homoscedasticity of residuals were met. Third, for both positive and negative attributes, relatively high tolerances and low variance inflation factor (VIF) scores for all predictors (for example, on average tolerance: 0.75, VIF: 1.3, respectively) in the regression model indicated that multicollinearity would not interfere with the outcome of the regression model. Fourth, the AIC (Akaike's Information Criteria) and BIC (Bayesian Information Criteria) values were used for model selection.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSocio-Demographic Characteristics\u003c/h2\u003e \u003cp\u003eThe socio-demographic characteristics of the respondents are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Among the respondents, 41.6% (208) were male and 42.2% (211) were from urban areas. In the urban region, 126 (43.2%) females and 85 (40.9%) males, whereas in the rural area, 166 (56.8%) females and 123 (59.1%) males. According to respondents, 248 (49.6%) belonged to the higher-income group, while 252 (50.4%) belonged to the lower-income group. In the higher-income group, 117 (23.4%) men and 131 (26.2%) women responded, whereas 91 (18.2%) men and 161 (32.2%) women responded in the lower-income group. A significant majority (85.4%) of the aging population was between 60 and 70 (males\u0026thinsp;=\u0026thinsp;83.7%, females\u0026thinsp;=\u0026thinsp;86.6%). Most older people (77%) were married, and only 23% were single (unmarried, divorced, widowed, or widower). Almost every male senior person (89.4%) had a mate, with only 10.6% having no companion (unmarried, widower). The average number of people in a household was 6.8. The average family income was 25524 BDT.\u003c/p\u003e \u003cp\u003eAbout two-fifths of the older adults were illiterate (those who have never been to school, 37%). In contrast, approximately 22.3% had only completed primary school. Among the female older adults, 24.8% (those who had never been to school) were illiterate, 14.9% had an incomplete primary education, and 33.9% had a complete primary education. There were 67% of older people who had any clinically diagnosed one or more diseases, while 33% had no diseases. Among 431 respondents, 205 older adults who had heard or had knowledge of the old age allowance program were getting it, while 226 were not. Among 199 older adults, 130 respondents who knew about health insurance coverage had it, while 69 elderlies did not. There were more females (60.2%) than males among old-age allowance recipients (27.3%). In contrast, males (71.3%) had higher health insurance coverage than females (59.2%).\u003c/p\u003e \u003c/div\u003e \n\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eDistribution (%) of demographic and socioeconomic characteristics of the study population (n\u0026thinsp;=\u0026thinsp;500)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge Group (in years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60\u0026ndash;70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e174 (83.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e253 (86.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e427 (85.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e70 and up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34 (16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39 (13.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73 (14.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85 (40.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e126 (43.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e211 (42.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e123 (59.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e166 (56.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e289 (57.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIslam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e196 (94.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e289 (99.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e485 (97.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (3.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e186 (89.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e199 (68.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e385 (77.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89 (30.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e105 (21.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (2.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily Member\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e61 (29.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86 (29.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e147 (29.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e147 (70.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e206 (70.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e353 (70.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily Income (in Taka)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 15000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50 (24.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75 (25.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e125 (25.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than 15000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e158 (76.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e217 (74.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e375 (75.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational Qualification\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary Incomplete\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (10.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary Complete\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33 (22.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57 (33.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90 (28.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary Complete\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43 (29.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55 (32.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98 (31)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigher Secondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43 (29.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22 (13.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65 (20.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity/Hons/Degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21 (14.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (9.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWho Lives With\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e189 (90.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e261 (89.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e450 (90.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (5.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (4.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDisease Suffering\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e142 (68.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e194 (66.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e336 (67.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66 (31.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e98 (33.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e164 (32.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOld Age Allowance Receiver\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45 (27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e160 (60.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e205 (47.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e120 (72.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e106 (39.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e226 (52.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealth Insurance Coverage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e72 (71.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58 (59.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e130 (65.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29 (28.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40 (40.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69 (34.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003cp\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e will be inserted here]\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003eHealth Profiles of the Older Population\u003c/h2\u003e \u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, diabetes affects the majority of older adults (approximately 30%), followed by arthritis (22%), asthma (14%), chronic respiratory disease (13.5%), and hypertension (7.6%).\u003c/p\u003e\u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003cp\u003e[Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e will be inserted here]\u003c/p\u003e \u003cp\u003eAccording to Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, \u003cb\u003e72\u003c/b\u003e% of the older adults were aware of their ailments from diseases. In contrast, only 40% of the older adults were aware of the consequences of those diseases. On the other hand, around 28% of the population had no in-depth knowledge of diseases, and 60% had no idea how they affect their lives. They lacked a basic understanding of what was happening to them, and, more importantly, they had no idea how to help prevent or decrease the damage to extend their lives.\u003c/p\u003e\u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003cp\u003e[Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e will be inserted here]\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003eOlder Adult's Expectations and Perception of Their Healthcare Needs in Bangladesh\u003c/h2\u003e \u003cp\u003eParticipants in this study were asked to rate each statement on a Kano scale ranging from 'extremely dissatisfied' to 'extremely satisfied.' On the Kano scale, there were 28 positive and negative statements. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the results of the older adult's reactions to expectations and perceptions and the gap between them.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOlder People's Expectations and Perception of Healthcare Needs Based on the Kano Model\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth Service Quality\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExpectation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePerception\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eExpectation Gap\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKano Classification\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Staff reaction time is quick and appropriate for the patient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOne Dimensional/\u003c/p\u003e \u003cp\u003ePerformance\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Efficiency of service procedures and appointment system\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMust-Be\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Medical treatment and doctor visiting as scheduled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMust-be\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Available and adequate visiting for patient family as scheduled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIndifferent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Adequate rest time for patient as promised\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAttractive/ Delighters\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. Quick medical treatment response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMust-Be\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. Clear and understandable information given\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMust-Be\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8. Provision of good communication of the service right from the first time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAttractive/ Delighters\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9. Availability of immunization services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMust-Be\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10. Nurses are never busy to respond\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAttractive/ Delighters\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11. Employee's politeness and friendliness in serving elders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOne Dimensional/\u003c/p\u003e \u003cp\u003ePerformance\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12. Provision of prostheses and other medical aids\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIndifferent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13. Development of gerontology units\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAttractive/ Delighters\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14. Doctors' ability to accurately diagnose patient disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMust-Be\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15. Good communication among doctors, staff, and patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAttractive/ Delighters\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16. Doctors and nurses are careful about treating and examining patient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMust-Be\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17. Dedicated attention employees give patients and their family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIndifferent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18. Specialist being assigned to patient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAttractive/ Delighters\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19. No social status discrimination towards patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMust-Be\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20. Physical facilities and medical instruments in place to assist older adults persons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMust-Be\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21. Suitable temperature at patient rooms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIndifferent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22. Adequate fresh water supply at the ward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMust-Be\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23. Clean and adequate supplies for each ward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMust-Be\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24. Clean and well-maintained washroom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMust-Be\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25. Neat hospital staff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAttractive/ Delighters\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26. Specific needs of patients are met, including various food and beverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAttractive/ Delighters\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e27. Frequent Community health nurses and another personnel visit at home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIndifferent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e28. Cheaper Cost of Healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOne Dimensional/\u003c/p\u003e \u003cp\u003ePerformance\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e538.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e488.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003cp\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e will be inserted here]\u003c/p\u003e \u003cp\u003eThe findings of the customer expectation, perception, and, more importantly, perception gaps were computed using the five-point Likert scale and the integrated Kano model questionnaire presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The table demonstrates that the present level of services being delivered for each of the 28 categories for which respondents were asked to indicate their expectations fall short of their expectations, resulting in an expectation gap. In essence, the comments suggested that aside from hospitals' ability to address specific demands of senior patients, such as providing diverse foods and beverages, they believed there was still potential for development in other aspects of older adults' healthcare. Using the Kano model also revealed that, while there were general expectation gaps, their critical or urgency differs according to the respondents, essential information for policy direction given the scarcity of resources that the health sector in developing economies like Bangladesh is always confronted with. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e summarizes the criticality of the items in the following way:\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eSummary of Kano Quality Items for Older Adults\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttributes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem Number Total\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttractive/ Delighters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5, 8, 10, 13, 15, 18, 25, 26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne Dimensional/ Performance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1, 11, 28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e Must-Be\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2, 3, 6, 7, 9, 14, 16, 19, 20, 22, 23, 24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndifferent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4, 12, 17, 21, 27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003cp\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e will be inserted here]\u003c/p\u003e \u003cp\u003eThe Kano model scale classified 12 of 28 geriatric health service qualities as Must-Be quality (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). When these traits were met, they were taken for granted or anticipated to be of high quality, but when not, they caused discontent. On the Kano model scale, eight of the aged health care quality attributes had been classified as attractive or delighters, which refer to service criteria that provided satisfaction when completely met but did not create dissatisfaction when not. These were exciting characteristics that people did not usually expect. The summary findings of the 'kano model' can also be seen through the graphical presentation presented below:\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003cp\u003e[Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e will be inserted here]\u003c/p\u003e \u003cp\u003eThe data revealed no reverse or questionable quality attributes for aged health services. Further analysis of the data showed that up to three items fit into the aged health categories that were classified as one-dimensional or high-value-added. These were the desired quality traits, resulting in satisfaction when met and discontent when not. Finally, five characteristics showed that older adults were unconcerned about the supply of specific hospital services. These were neither good nor terrible services and did not result in patient or consumer satisfaction.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eDifferentials in Health Care Perception and Expectations\u003c/h2\u003e \u003cp\u003ePerception of health care needs was significantly varied by school-going and residence type (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Those who did not go to school had a higher mean (51.01; SD\u0026thinsp;=\u0026thinsp;5.09) than those who did (50.04; SD\u0026thinsp;=\u0026thinsp;5.47), and rural older adults had a higher mean (51.48; SD\u0026thinsp;=\u0026thinsp;4.60) than urban older adults (48.92; SD\u0026thinsp;=\u0026thinsp;5.92). The expectation of healthcare needs was significantly varied by marital status and family income.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDifferentials of Perceived and Expected Healthcare Needs\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003ePerceived Healthcare Needs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eHealthcare Needs Expectation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.957\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e118.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.788\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e118.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e118.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e114.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e19.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSchool Going\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e118.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e118.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDisease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.399\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e118.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.087\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e117.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e118.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.060\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e116.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e13.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily Income\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;15000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.486\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e118.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;15000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e117.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e11.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOld Age Allowance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e118.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.333\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e118.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWealth Index\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e118.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.197\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e117.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e13.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003cp\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e will be inserted here]\u003c/p\u003e \u003cdiv id=\"Sec22\" class=\"Section3\"\u003e \u003ch2\u003ePredictors of Healthcare Needs Perception\u003c/h2\u003e \u003cp\u003eMultiple linear regression was calculated to predict respondents' responses in the 'Kano Model' positive attributes or perceived health needs based on eleven variables, as per Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e. A significant regression equation was found [F(11, 419)\u0026thinsp;=\u0026thinsp;6.593, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, with adjusted R\u003csup\u003e2\u003c/sup\u003e of 0.125]. Results show that the ten predictors collectively can account for 12.5% of the variance in perceived healthcare needs.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePredictors of Perceived Healthcare Needs \u0026amp; Expectations\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModel 1 (Kano Positive Attributes)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModel 2 (Kano Negative Attributes)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBeta (SE)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBeta (SE)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRespondents Age\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.132 (0.059)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.038 (0.062)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.542\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRespondents Sex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMale (RC)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.055 (0.051)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.275\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.061 (0.053)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.252\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHave ever been to a school/ institution\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eYes (RC)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.088 (0.049)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.124 (0.051)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMarried (RC)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.104 (0.052)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.075 (0.055)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.171\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence Type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eUrban (RC)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.264 (0.048)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.036 (0.048)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.458\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSuffering from any disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNo (RC)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.002 (0.048)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.963\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.154 (0.050)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily Monthly Income\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;15000 (RC)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.043 (0.052)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.407\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;15000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQuality of Life\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.227 (0.055)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.154 (0.059)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLife Satisfaction\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.077 (0.047)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.024 (0.050)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.635\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOld Age Allowance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eYes (RC)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.103 (0.052)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.063 (0.054)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.238\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWealth Index\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePoor (RC)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.107 (0.047)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.044 (0.049)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.375\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eModel Summary\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e500\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e.148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e.050\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdjusted R\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF Change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e6.593\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.224\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e11, 419\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e10, 420\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSignificance of F change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003eNote: SE=Standard Error, Beta= Standardized Coefficients Beta, RC=Reference Category\u003c/sup\u003e.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003cp\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e will be inserted here]\u003c/p\u003e \u003cp\u003eThe older population's age (β=-0.132, p\u0026thinsp;=\u0026thinsp;0.025) predicts perceived health needs significantly. Unmarried or any older adults other than married had \u0026minus;\u0026thinsp;0.104 unit lower perceived health needs (β=-0.104, p\u0026thinsp;=\u0026thinsp;0.047) than older adults who were married. On the other hand, older people living in rural areas also had lower perceived healthcare needs (β=-0.264, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) than older adults living in urban areas. The older adults' quality of life significantly predicted their perceived healthcare needs, accounting for a 0.227 unit increase (β\u0026thinsp;=\u0026thinsp;0.227, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) in perceived healthcare needs. Older adults with higher wealth quantile had 0.107 units higher perceived healthcare needs (β\u0026thinsp;=\u0026thinsp;0.107, p\u0026thinsp;=\u0026thinsp;0.023) than poor older adults. The older population who did not receive the old age allowance had lower perceived healthcare needs (β=-0.103, p\u0026thinsp;=\u0026thinsp;0.050) than those who received the old age allowance. Other predictors, such as respondent sex, educational status, disease prevalence, family income, and life satisfaction, were insignificant in predicting older adults' perceived healthcare needs in Bangladesh.\u003c/p\u003e \u003cp\u003eMultiple linear regression was also used to predict respondents' responses in the 'Kano Model' negative attributes or expected health needs based on ten variables, as Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e shows. A significant regression equation was found (F(10, 420)\u0026thinsp;=\u0026thinsp;2.224, p\u0026thinsp;=\u0026thinsp;0.016, with adjusted R\u003csup\u003e2\u003c/sup\u003e of 0.028. Results show that the ten predictors collectively can account for 2.8% of the variance in expected healthcare needs.\u003c/p\u003e \u003cp\u003eOlder adults who had not been in the educational institution had lower expected healthcare needs (β=-0.124, p\u0026thinsp;=\u0026thinsp;0.015) than those who did. Disease prevalence among older adults was significant in predicting older adults' expected health care needs, older adults with diseases had lower expected health care needs (β-0.154, p\u0026thinsp;=\u0026thinsp;0.002) than older adults with no diseases. The quality of life of the older adults (β-0.154, p\u0026thinsp;=\u0026thinsp;0.009) was negatively affecting expected healthcare needs. Other predictors were not significant in predicting older adults' expected healthcare needs in Bangladesh. The point is to notice that quality of life is significant in predicting both perceived and expected quality.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussions","content":"\u003cp\u003eThe primary objective of this study was to determine the older adults' perceptions and expectations regarding healthcare needs and services they believe are required in healthcare services in Bangladesh. Bangladesh's overall population is 169.80\u0026nbsp;million (enumerated), with an older population (above 60 years) of 9.28%, or 15.3\u0026nbsp;million [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The government spent 3445.40 crores of Taka in 2022-23, with 5.7\u0026nbsp;million older adults as recipients. The old-age payment program currently covers approximately 40% of older adults. It is worth noting that older adults receive 500 takas per month, with a 65-year-old male limit and a 62-year-old female limit [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. According to our study, 48% of older adults received or registered for the old age allowance program, which is consistent with Bangladesh's current scenario. About 65% of the older adults had health insurance coverage, with males and urban residents dominating. The majority of the older adults were literate, around 60%.\u003c/p\u003e \u003cp\u003eThe findings showed specific sectors where Bangladesh's healthcare sector, particularly older adult care services, comes close to matching elders' expectations and areas where it falls far short. Perceived needs and expectations for more aged adults' healthcare services were derived from older adults' responses in the interview using the 'Kano Model.' The study revealed needs for various aspects and dimensions of services, such as service provider-related needs, service-related needs, different financial needs for receiving health care, accommodation needs, and expectation gaps.\u003c/p\u003e \u003cp\u003eIn these cases, the Bangladesh Health Service and other health providers must concentrate on being able to deliver fundamental services like- efficiency of service procedures and appointment system, medical treatment and doctor visiting as scheduled, availability of immunization services, doctors and nurses are careful about treating and examining patient, physical facilities and medical instruments in place to assist older adults persons, adequate fresh water supply at the ward, and clean and well-maintained washroom. Because these services were recognized as a must-have attribute in healthcare facilities by the aged, they were regarded as expected or essential attributes by the older adults, whose presence was taken for granted. In this way, healthcare management can raise its quality in areas that impact patient perceptions of service quality. This case study also demonstrates how an existing worldwide health quality and service quality methodology (Kano Model) developed in various cultural contexts can administer aged healthcare services.\u003c/p\u003e \u003cp\u003eThis finding aligns with Yiranbon et al.'s 2014 study in Ghana, which used the 'Kano Model,' consisting of 32 items, to investigate the expectation and perception gap regarding healthcare needs. As with this research paper, most of the items were considered critical or must-be by older adults. Other findings in this field in other countries show similar results, as Anh, 2016, revealed gaps between expectations and perceptions, with expectations exceeding those in one national hospital in Vietnam. In primary healthcare facilities, analysis shows that the gap between expectation and perception was because of 9 differences in patients' perceptions rather than expectations. The most significant gap was detected in empathy [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study also indicated that perceived healthcare needs differed significantly by literacy status and residence type, with rural older adults having a higher mean score. Their knowledge about geriatric health problems and care is limited among Bangladesh older adults, impacting their health-seeking behavior, as they only seek assistance when their health condition deteriorates [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. According to the findings, respondents' age, residence type, and quality of life significantly impacted their perceived healthcare needs. Patients' perceptions of healthcare interactions differ by age. Patients aged 18\u0026ndash;64 were less likely to state that their provider \"always\" listened to them, \"always\" showed respect for what they had to say, and \"always\" spent enough time with them when compared to patients aged 65 and up [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Older adults' self-perception of aging is also linked to their desire to seek medical help. A higher risk of health care delay and perceived barriers to care were related to more negative self-perceptions of aging (SPA) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe expected healthcare needs were also significantly varied by marital status and family monthly income, with mean scores higher for married and family incomes less than 15 thousand than others. According to findings, literacy, disease prevalence, and quality of life significantly predicted the older adult's expected healthcare needs. Regarding accessibility, income was the most critical factor related to problems of self-perceived access, although insurance coverage, age, doctor's lack of responsiveness to patient concerns, and gender remained independently associated [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Therefore, the patients' representatives can be included in the planning, prioritizing, and fulfilling that vulnerable group's health needs [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003eStrengths of the Study\u003c/h2\u003e \u003cp\u003eThe key findings of this study were the older adults' expectations and perception gap about healthcare needs in the Bangladesh context, which can contribute to the formulation of future health policies for the more aging adult population.\u003c/p\u003e \u003cp\u003eThe research paper's objective was clearly defined, as were the inclusion and exclusion criteria. Multiple databases were searched to validate this research in the context of Bangladesh (PUBMED, Jstore, PMC, and ResearchGate), as there had been few previous studies in this sector. The goal of this research article is to reduce the gap. Furthermore, using the Kano Model, this study introduces a new research dimension to identify healthcare needs and expectations among other population groups (e.g., adolescents and indigenous people's health).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003eLimitations of the Study\u003c/h2\u003e \u003cp\u003eA cross-sectional research design was adopted in this study. However, causal judgments about links observed in the data are impossible. Another disadvantage of the research was that it was limited to a specific geographical site in Bangladesh (Dhaka). As a result, the study's findings may not reflect the experiences of all older people in the country. Data was collected during the COVID-19 breakdown, and getting respondents for this study was a significant difficulty, particularly for older adults. This study only covers the perception and expectations of older adults considering the demand side, while the supply side could not be assessed. Finally, only data from the general population was gathered. This study did not include older adults who live in a particular setting (such as an old home). Their expectations may differ from those of the general older population.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn this study, the perceptions and expectations of senior persons regarding health care requirements are presented to present their perceived and expected needs related to health care services. Understanding the older adults' perceived and expected healthcare requirements would aid in developing healthcare interventions for them and the modification or reformulation of various sectors of the healthcare structure in Bangladesh. In this context, this method gives healthcare practitioners a thorough insight into their service quality levels from patient satisfaction. It also aids management in developing unique ideas at both the strategic and tactical levels by identifying the most significant service features that are highly appealing to their patients.\u003c/p\u003e \u003cp\u003eThe current study focused on the areas that senior people believe should be addressed when building the healthcare service system for the country's older population. Reforming and modifying the country's existing healthcare structure services for the senior population while keeping these characteristics in mind may result in a safe and healthy environment where the older adult is not seen as a burden but as a resource for Bangladesh. People in their later years require an atmosphere encourages them to live well. Older adults can be used to their full potential provided they are given support from their environment.\u003c/p\u003e"},{"header":"List Of Abbreviations","content":"\u003cp\u003eCI Confidence interval\u003c/p\u003e \u003cp\u003eDeff Design effect\u003c/p\u003e \u003cp\u003eMIPAA Madrid international plan of action on ageing\u003c/p\u003e \u003cp\u003eNR Non response\u003c/p\u003e \u003cp\u003eSDGs Sustainable development goals\u003c/p\u003e \u003cp\u003eSPA Self-perceptions of aging\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis\u0026nbsp;manuscript\u0026nbsp;is a part of a research monograph submitted to the Department of Population Sciences, the University of Dhaka, for partial fulfillment of the bachelor (undergraduate) degree. The Academic Committee (AC) of the Department of Population Sciences, University of Dhaka, approved the topic and study protocol\u0026nbsp;under Registration Number 2016-316-605. The AC is responsible for handling all aspects of the research monograph. The present study was carried out following the Declaration of Helsinki. Moreover, the research evaluation committee of the Department of Population Sciences, University of Dhaka, approved the study and provided written permission before the field visit. All the respondents were 60 years and above. Informed consent was taken from all participants. We took the informed consent in writing or verbally (in many cases) because sometimes written consent (signature) is very sensitive in Bangladesh. The study\u0026apos;s objectives were clearly stated to each participant (in some cases, the questionnaire was provided), and we asked permission to interview using the following question: \u0026apos;Do you agree to participate in this study after reading the information about this research?\u0026apos; We interviewed the respondents after getting approval from them.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no need for consent for publication as all data are de-identifiable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was conducted as a part of partial fulfillment of the Bachelor of Social Sciences (BSS) honors degree from the Department of Population Sciences, University of Dhaka. The Department of Population Sciences, University of Dhaka, has the right to reserve the data. Therefore, data cannot be provided in a supplementary file or deposited in a public repository. However, the dataset could be obtained from the Department of Population Sciences, University of Dhaka (https://www.dpsdu.edu.bd/index.php/en/) or the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was no funding for this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt was a part of an undergraduate research monograph in 2021 at the Department of Population Sciences, the University of Dhaka, Bangladesh. Sahadat Hossain completed this monograph under the supervision of Md Zakiul Alam.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge the Department of Population Sciences, the University of Dhaka, for approving this research under Registration Number 2016-316-605 as part of the undergraduate research monograph. We also acknowledge all the unknown/known respondents who participated in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWHO, Ageing. 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/health-topics/ageing#tab=tab_1\u003c/span\u003e\u003cspan address=\"https://www.who.int/health-topics/ageing#tab=tab_1\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 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East Java, Indonesia: University of Jember; 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTareque MI. Requisites to achieve SDG 3 for older adults in Bangladesh: Justification from extant literature on healthy life expectancy and older adults' issues Session: Aging and Health Policy in South Asian Country. Regional Workshop on Integrating Policy and Research on Ageing in ASEAN: Conversations Across the Policy and Research Divide. Singapore: CARE, Duke-NUS Medical School, Singapore;; 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchvaneveldt SJ, Enkawa T, Miyakawa M. Consumer evaluation perspectives of service quality: Evaluation factors and two-way model of quality. Total Qual Manag. 1991;2:149\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaron-Epel O, Dushenat M, Friedman N. Evaluation of the consumer model: relationship between patients' expectations, perceptions and satisfaction with care. 2001.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYiranbon E, Lulin Z, Antwi HA, Marfo EO, Amoako KO, Offin DK. Exploring the Expectation and Perception of Healthcare Needs of the Elderly in Ghana: An Empirical Analysis. Int J Acad Res Econ Manage Sci. 2014;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePapanikolaou V, Zygiaris S. Service quality perceptions in primary health care centres in Greece. Health Expect. 2014;17:197\u0026ndash;207.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMahmoud AB, Ekwere T, Fuxman L, Meero AA. Assessing Patients' Perception of Health Care Service Quality Offered by COHSASA-Accredited Hospitals in Nigeria. Sage Open. 2019;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHa J, Kim J. Factors influencing perceived health status among elderly workers: Occupational stress, frailty, sleep quality, and motives for food choices. Clin Interv Aging. 2019;14:1493\u0026ndash;501.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKarim RM, Abdullah MS, Rahman AM, Alam AM. Identifying influence of perceived quality and satisfaction on the utilization status of the community clinic services; Bangladesh context. Bangladesh Med Res Counc Bull. 2015;41:1\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKano N, SN TF. Attractive Quality and Must-Be Quality. J Japanese Soc Qual Control. 1984;14:147\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBANGLADESH BUREAU OF STATISTICS. POPULATION \u0026amp; HOUSING CENSUS 2022 PRELIMINARY REPORT. Dhaka; 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDepartment of Social Services. Old Age Allowance. 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.dss.gov.bd/site/page/7314930b-3f4b-4f90-9605-886c36ff423a/Old-Age-Allowance\u003c/span\u003e\u003cspan address=\"http://www.dss.gov.bd/site/page/7314930b-3f4b-4f90-9605-886c36ff423a/Old-Age-Allowance\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 27 Jun 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHossain S, Ferdousi MJ, Siddique MA, Tipu SMMU, Qayyum M, Laskar M. Self-reported health problems, health care seeking behaviour and cost coping mechanism of older people: Implication for primary health care delivery in rural Bangladesh. J Family Med Prim Care. 2019;8:1209.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSun JK, Smith J. Self-perceptions of aging and perceived barriers to care: Reasons for health care delay. Gerontologist. 2017;57:216\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhan MN, Mondal MN, Haque N, Islam MS, Shahiduzzaman MD. A Study on Quality of Life of Elderly Population in Bangladesh. Am J Health Res. 2014;2:152.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFitzpatrick AL, Powe NR, Cooper LS, Ives DG, Robbins JA. Barriers to Health Care Access Among the Elderly and Who Perceives Them. Am J Public Health. 2004;94:1788\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMuazzam Hussain M, Mojammel M, Raihan H. Patients' Satisfaction with Public Health Care Services in Bangladesh: Some Critical Issues. Malaysian J Med Biol Res. 2015;2.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Reformed, Eliminate, Expectation, Delighters, Satisfaction, Older Adults","lastPublishedDoi":"10.21203/rs.3.rs-3879910/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3879910/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eBangladesh's old population is growing faster than the rest of the world and is anticipated to continue in the coming years. The country's growing older adult is challenging Bangladesh's existing health system, and it must be reformed to ensure geriatric care. The main objective of this study is to measure the existing gap in perceived and expected healthcare needs among older adults and propose a measure to eliminate the gap.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eUsing a cross-sectional research design, we collected data from 500 respondents in Narsingdi and Narayanganj districts. The gap between the older adults' perceived and expected healthcare needs was assessed using a structured questionnaire with 28 items (using the Kano Model) that could be answered positively and negatively. Descriptive statistics, T-tests, and multiple linear regression analyses were carried out.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe findings showed where Bangladesh's healthcare sector, particularly older adult care services, comes close to matching their expectations and areas where it falls far short. The Kano model showed that 12 of 28 geriatric health service qualities were classified as Must-Be quality and eight as attractive or delighters. Type of residence (β=-0.264, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), quality of life (β\u0026thinsp;=\u0026thinsp;0.227, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), marital status (β=-0.104, p\u0026thinsp;=\u0026thinsp;0.047), and educational status (β=-0.124, p\u0026thinsp;=\u0026thinsp;0.015) was significantly associated with of older population health care needs and expectation.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study gives healthcare practitioners a detailed understanding of their service quality from the perspective of patient satisfaction in Bangladesh. Reforming and modifying the country's existing healthcare structure services for older adults while keeping these attributes in mind will likely result in a safe and healthy environment for them.\u003c/p\u003e","manuscriptTitle":"Assessing Health Care Perception and Needs of the Older Adults in Bangladesh: Application of the Kano Model to Assess Gaps","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-24 15:52:04","doi":"10.21203/rs.3.rs-3879910/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5eafa84d-5e05-4698-9bcb-3056ce44f4ff","owner":[],"postedDate":"January 24th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-22T18:20:43+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-24 15:52:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3879910","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3879910","identity":"rs-3879910","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}