The use of the quality model of Parasuraman, Zeithaml and Berry in health services

This is an article about the theoretical model for assessing quality in health services proposed by Parasuraman, Zheitaml and Berry, in order to measure the degree of satisfaction of users. This model is based on the analysis of expectations and perceptions of users of health services, by means of five dimensions: tangibility, reliability, responsiveness, assurance and empathy. From the difference between what is expected by the user and the service offered, gaps or shortcomings are derived that may be the main obstacle for users to perceive the provision of such services with quality. It was observed that the use of the psychometric scale called Service Quality (SERVQUAL) in some studies about satisfaction, obtained very favorable results in the institutions in which it was employed. The analysis revealed the need to improve the existing models of evaluation, as well as the importance of measuring user satisfaction in health institutions.

Postharvest UV-B treatments increased fructose content of tomato (Solanum lycopersicon L. cv. Tayfun F1) harvested at different ripening stages

Abstract In the postharvest stage, taste and flavor are the key components of the marketability of tomato. Therefore, greater emphasis is now being placed on improving traits such as sugar content. In this study postharvest ultraviolet-B (UV-B) treatments on sugar, total soluble solids, and color of tomatoes harvested at different stages were investigated. Tomatoes harvested at turning, pink, and red stages were treated with two different doses of UV-B irradiation: UVB4 and UVB8. Color L* and hue angle values of tomatoes treated with UV-B were found to be high, which means the red color of tomatoes was improved. UVB4 treatments increased the color a* and saturation index values of tomatoes at pink and red harvest stage, although it did not affect at the turning stage. Additionally, UV-B irradiation treatments had no effect on sucrose content of the tomatoes. Fructose, glucose, and TSS content of tomatoes treated with UVB8 at red harvest stage were found to be high. Hence, the results obtained from this study are of great importance in terms of providing an increase in the amount of sugar without the need for breeding, and also consumer satisfaction.

Access to information: assessment of the use of automated interaction technologies in call centers

With the purpose of at lowering costs and reendering the demanded information available to users with no access to the internet, service companies have adopted automated interaction technologies in their call centers, which may or may not meet the expectations of users. Based on different areas of knowledge (man-machine interaction, consumer behavior and use of IT) 13 propositions are raised and a research is carried out in three parts: focus group, field study with users and interviews with experts. Eleven automated service characteristics which support the explanation for user satisfaction are listed, a preferences model is proposed and evidence in favor or against each of the 13 propositions is brought in. With balance scorecard concepts, a managerial assessment model is proposed for the use of automated call center technology. In future works, the propositions may become verifiable hypotheses through conclusive empirical research.

Professional and community satisfaction with the Brazilian family health strategy

OBJECTIVE: To analyze the strengths and limitations of the Family Health Strategy from the perspective of health care professionals and the community. METHODS: Between June-August 2009, in the city of Vespasiano, Minas Gerais State, Southeastern Brazil, a questionnaire was used to evaluate the Family Health Strategy (ESF) with 77 healthcare professionals and 293 caregivers of children under five. Health care professional training, community access to health care, communication with patients and delivery of health education and pediatric care were the main points of interest in the evaluation. Logistic regression analysis was used to obtain odds ratios and 95% confidence intervals as well as to assess the statistical significance of the variables studied. RESULTS: The majority of health care professionals reported their program training was insufficient in quantity, content and method of delivery. Caregivers and professionals identified similar weaknesses (services not accessible to the community, lack of healthcare professionals, poor training for professionals) and strengths (community health worker-patient communications, provision of educational information, and pediatric care). Recommendations for improvement included: more doctors and specialists, more and better training, and scheduling improvements. Caregiver satisfaction with the ESF was found to be related to perceived benefits such as community health agent household visits (OR 5.8, 95%CI 2.8;12.1), good professional-patient relationships (OR 4.8, 95%CI 2.5;9.3), and family-focused health (OR 4.1, 95%CI 1.6;10.2); and perceived problems such as lack of personnel (OR 0.3, 95%CI 0.2;0.6), difficulty with access (OR 0.2, 95%CI 0.1;0.4), and poor quality of care (OR 0.3, 95%CI 0.1;0.6). Overall, 62% of caregivers reported being generally satisfied with the ESF services. CONCLUSIONS: Identifying the limitations and strengths of the Family Health Strategy from the healthcare professional and caregiver perspective may serve to advance primary community healthcare in Brazil.

Tuberculosis Control Program and patient satisfaction, Rio de Janeiro, Brazil

OBJECTIVE To evaluate factors associated with users’ satisfaction in the Tuberculosis Control Program. METHODS A cross-sectional study of 295 patients aged ≥ 18 years, with two or more outpatient visits in the Tuberculosis Control Program, in five cities in the metropolitan region of Rio de Janeiro, RJ, Southeastern Brazil, in 2010. Considering an estimated population of 4,345 patients, the sampling plan included 15 health care units participating in the program, divided into two strata: units in Rio de Janeiro City, selected with probability proportional to the monthly average number of outpatient visits, and units in the other four cities. In the units, four temporal clusters of five patients each were selected with equal probability, totaling 300 patients. A questionnaire investigating the users’ clinical and sociodemographic variables and aspects of care and service in the program relevant to user satisfaction was applied to the patients. Descriptive statistics about users and their satisfaction with the program were obtained, and the effects of factors associated with satisfaction were estimated. RESULTS Patients were predominantly males (57.7%), with a mean age of 40.9 and with low level of schooling. The mean treatment time was 4.1 months, mostly self-administered (70.4%). Additionally, 25.8% had previously been treated for tuberculosis. There was a high level of satisfaction, especially regarding medication provision, and respect to patients by the health professionals. Patients who were younger (≤ 30), those on self-administered treatment, and with graduate level, showed less satisfaction. Suggestions to improve the services include having more doctors (70.0%), and offering exams in the same place of attendance (55.1%). CONCLUSIONS Patient satisfaction with the Tuberculosis Control Program was generally high, although lower among younger patients, those with university education and those on self-administered treatment. The study indicates the need for changes to structural and organizational aspects of care, and provides practical support for its improvement.

INFLUENCE OF INFORMATION ABOUT THE BENEFITS OF CONSUMING FRUIT ON CONSUMER PREFERENCES IN TEMUCO, REGION OF THE ARAUCANÍA

ABSTRACT With the aim of identifying strategies to increase fruit consumption in Temuco, consumer segments were classified according to the importance and preference of theattributes type of fruit, package/ brand, benefit associated with fruit consumption and price. A survey was applied to 400 people in Temuco,Chile, distributed using a simple allocation: 200 working adults and 200university students. The questionnaire included the SWFL (Satisfaction with Food-related Life) scale, respondents’ fruit consumption habits and their characteristics. Using conjoint and cluster analyses, three segments were distinguished: Group 1 (22.0%) gave greatest importance to the package/brand and preferred themessage “prevents diseases” and “without information”; Group 2 (47.5%) gave greatest importance to the package/brand and preferred the message “prevents diseases”; Group 3 (30.5%) assigned greatest importance to the price and preferred the message “contains antioxidants”. The segments differed in their level of satisfaction with food-related life, self-declared lifestyle, age and presence of university students. The results provide input to promote fruit consumption in working adults and university students.

Analysis of Brazilian consumer preference of filled chocolate

Chocolate is the most popular product made from cocoa. It is mainly consumed with fillings, such as fondant, hydrogenated fat or fruits. This work aimed at assessing the sensory acceptability of chocolate filled with strawberry, orange or passion fruit pulps, mixed in fondant, in a hydrogenated fat base and as truffles. Ninety four consumers participated in the test using a 10 cm hedonic scale to rate the overall liking of the samples. Two-way analysis of variance and the Internal Preference Mapping technique were used to analyze the data. Results showed a good overall liking for almost all samples, especially for strawberry and passion fruit truffles, which obtained 8.4 and 8.8 global means, respectively (p < 0.05), in liking ratings, followed by the hydrogenated fat and fondant fillings. The Internal Preference Map presented two dimensions explaining 72.5% of the variation found. Regarding the flavors, strawberry - traditional in chocolate and confectionary in Brazil - and passion fruit obtained better acceptance, unlike the orange fillings, which showed significantly lower ratings (p < 0.05). The orange fondant filling obtained a global mean of 6.5.

Sensory evaluation of black instant coffee beverage with some volatile compounds present in aromatic oil from roasted coffee

The oil obtained from Brazilian roasted coffee by supercritical CO2 extraction shows considerable aromatic properties, mainly composed by five aromatic compounds, 2-methylpyrazine; 2-furfurylalcohol, 2,5-dimethylpyrazine; γ-butyrolactone and 2-furfurylacetate. Sensory analyses were used to verify the influence of a mixture of these important classes of aromatic coffee compounds (pyrazines, furans and lactones) and of the roasted coffee aromatic oil on the coffee aroma and flavour of black instant freeze and spray-dried coffee beverages. In the acceptance evaluation of the aroma, the samples prepared with freeze-dried instant coffee without the mixture of volatile compounds (sample 4) were not significantly different from the freeze-dried instant coffee in which the aromatic coffee oil was added (sample 5) and from the sample prepared with freeze-dried coffee in which the mixture of the five volatile was added (sample 3), coincidentally from the same drying process. Therefore, sample (3) did not differ from samples prepared with spray dried instant coffee without (sample 1) and to which (sample 2) the mixture of volatile was added. Therefore, with respect to this attribute, the addition of this mixture did not interfere in this drink acceptance. Taking into consideration the flavor, samples prepared with freeze-dried instant coffee in which the aromatic coffee oil was added (5) and the samples with (3) and without (4) the mixture of the five volatile was added did not differ significantly, however sample (4) did not differ from samples (1) and (2). Regarding this attribute, the addition of the aromatic oil of roasted coffee or a mixture of volatile in samples of freeze-dried instant coffee had a better acceptance than those dried by spray dryer (1) and (2). Thus, the enrichment of drinks with the aromatic oil of roasted coffee, or even with the mixture of the five components did not influence the consumer acceptance with respect to the aroma, but exerts influence with respect to flavour.

Soy and Brazil nut beverage: processing, composition, sensory, and color evaluation

Despite its high nutritional value, soymilk consumption in Western countries is limited mainly due to undesirable flavors developed during the traditional elaboration process. Brazil nut (Bertholletia excelsa) has pleasant flavor and recognized nutritional value. Thus, the aim of this work was to elaborate a soy and Brazil nut beverage exploring the use of two national products of high nutritional quality. The process for manufacturing a soy and Brazil nut beverage consisted of elaboration, formulation, and homogenization of soymilk and Brazil nut milk. The addition of five levels (10, 20, 30, 40, and 50%) of Brazil nut milk to soy beverages was investigated. Although no significant differences in consumer average preference (p > 0.05) were observed among the beverages, analyzing both the consumer preference frequency distribution of the products and the Internal Preference Mapping (IPM), it was possible to conclude that the beverage with 30% of Brazil nut milk reached the most adequate performance demonstrating the sensory benefits Brazil nuts brought to the product. Regarding proximate composition, it did not present a better performance in terms of nutritional value, except for the oil content. The soy and Brazil nut beverage presented visual stability and no phase separation despite the non-stability shown by Brazil nut beverage itself. When Brazil nut milk was added to soy beverage, the final product became whiter than soy beverage, which is appealing to consumers who normally search for a clearer soymilk. The soy and Brazil nut beverage processing can be considered an alternative to increase the use of Brazil nuts in the Brazilian diet.

Sensory evaluation of rice fortified with iron

The objective of this study was to examine sensory differences between conventional rice and iron-fortified Ultra Rice rice (UR) and determine consumer acceptance. Differences between both types of rice were analyzed using the Duo-Trio Test on 37 non-trained judges. The Acceptance Test evaluated general rice appearance, color, aroma and taste by 43 non-trained judges, using a 7-point hedonic scale with extremes ranging from "really disliked" and "really liked." There were no significant differences between the analyzed samples of conventional rice and UR rice using Duo-Trio Test. Mean values from the Acceptance Test for the evaluated attributes (general appearance, color, aroma e taste) were 5.6 and 5.9, corresponding to "liked" and "really liked" according to the hedonic scale, respectively. The iron did not alter the sensory characteristics of the final product, and the iron-fortified rice was well accepted.

Sensory evaluation and nutritional value of cakes prepared with whole flaxseed flour

The objective of this study was to evaluate the nutritional value, the oxidative stabilitiy, and consumer acceptance of cakes containing four different concentrations of flaxseed flour (5, 15, 30 and 45%) as partial replacement for wheat flour. The oxidative stability of polyunsaturated fatty acids was evaluated through the lipid peroxidation test (TBARS) in the flour and cakes. Linolenic acid was determined by gas chromatography as well as contents of protein, lipid, ash, and dietary fiber. Consumer acceptance was assessed using a structured hedonic scale of nine points. The oxidative stability of lipid flaxseeds was not affected by the heat treatment during flour processing and cake baking. Cakes made with 5, 15, and 30% of flaxseed flour, the most accepted by consumers, had dietary fiber levels ranging from 3.5 to 6.2 g and linolenic acid ranging from 445 to 2,500 mg.100 g-1 of the product. The cakes received claims of good and excellent source of dietary fiber and linolenic acid, respectively, both are bioactive compounds. The use of up to 30% of flaxseed flour in the preparation of cakes is a useful strategy to optimize the consumption of food rich in functional ingredients.

Computational fluid dynamics evaluation of liquid food thermal process in a brick shaped package

Food processes must ensure safety and high-quality products for a growing demand consumer creating the need for better knowledge of its unit operations. The Computational Fluid Dynamics (CFD) has been widely used for better understanding the food thermal processes, and it is one of the safest and most frequently used methods for food preservation. However, there is no single study in the literature describing thermal process of liquid foods in a brick shaped package. The present study evaluated such process and the influence of its orientation on the process lethality. It demonstrated the potential of using CFD to evaluate thermal processes of liquid foods and the importance of rheological characterization and convection in thermal processing of liquid foods. It also showed that packaging orientation does not result in different sterilization values during thermal process of the evaluated fluids in the brick shaped package.

Consumer attitudes toward information displayed at food buffets in commercial restaurants

This study aimed to evaluate the attitude of consumers towards information about dishes in a commercial restaurant. This research was conducted from January to April 2009 in a restaurant in the city of Santa Maria (RS), Brazil. Food information including the name of the dish, ingredients, health benefits and warnings, and calorie value was displayed. After providing this nutritional information, a questionnaire was applied to 300 consumers at the restaurant to observe their attitudes towards the food information. It was found that 10.57% of the respondents reported allergy or intolerance to some kinds of food and that 10.98% of the respondents reported having diseases that require moderate consumption and/or total restriction on the consumption of those foods. However, 84.96% of the respondents did not restrict consumption of any food, even though those foods may have posed a risk to their health, and 58.54% of the respondents consumed some food due to the potential benefits to their health. With regard to the respondents' level of satisfaction concerning the food information provided, 72.76% considered the information provided as very good. The respondents had a tendency to change their behavior towards consumption after having access to information about the dishes displayed.

Phisicochemical, sensory, and microbiological evaluation and development of symbiotic fermented drink

The goal of this study was to develop a symbiotic lacteous drink, evaluate its physicochemical and sensory characteristics, and verify the viability of Lactobacillus acidophilus in the drink. The milk serum-based drink consisted of 50% milk serum containing 10% saccharose, 25% powdered milk, 15% yacon pulp, and cultures of Lactobacillus acidophilus-La 5E and Bifidobacterium bifidum BB12. It was stored for up to 21 days under refrigeration. The milk serum-based drink was analyzed for protein, ether extract, total dietary fiber, total frutans, carbohydrate content, color, pH, acidity, and contamination by coliforms, and Salmonella sp. Coliforms and Salmonella sp were not detected, and L. acidophilus and B. bifidum provided satisfactory probiotic counts up to 21 days of storage under refrigeration. Lactobacillus acidophilus resistance to gastric acids and bile salts was detected only up to seven days of storage when evaluated in vitro. Sensory analysis and purchase viability were evaluated by consumers at 0, 7, 14, and 21 days of storage. Based on the analytical results and consumer evaluation, the drink was acceptable up to seven days of storage.

Acceptance of nanotechnology applications and satisfaction with food-related life in southern Chile

Given the increasing use of nanotechnology in food production and packaging, its acceptance was evaluated in Temuco, Chile, and different consumer segments were identified. Different brands of sunflower oil were used at different prices as a case study. A structured questionnaire was applied to 400 supermarket shoppers. It was determined that brand was more important than nanotechnology application in packaging and food, and more important than price. The consumers preferred an average priced oil with a manufacturer's brand with nanoparticles to reduce cholesterol, and packaging with nanoparticles to increase the shelf life of the product and to prevent the growth of microorganisms. Three consumer segments were distinguished by the cluster analysis. The largest segment (44%) preferred the oil without nanotechnology. The second (35.2%) preferred the oil with nanotechnology in the food and the packaging, and the greatest preference was for packaging with nanoparticles extension in the shelf life of the product. The third segment (20.8%) had similar behavior, but it showed greater preference for the oil with nanoparticles that reduced cholesterol and for the packaging that prevented the growth of bacteria and viruses. The segments differed in terms of their satisfaction with food-related life and lifestyle. It was found that over 50% of the participants preferred oil with nanotechnology applications.