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THE ROLE OF DEMOGRAPHY IN MODERATION THE INFLUENCE OF NONVERBAL COMMUNICATION TO PATIENT’S SATISFACTION

Effective nonverbal communication affects patient satisfaction and also affects the optimal level of patient’s healthiness. This is primarily caused by asymmetry information between doctor and patient since in most cases patients heavily rely on nonverbal communication as a tool to get information they need. Patient’s sensitivity to the nonverbal communication is generally varied in according to their demography characteristics. This research is aimed at analyzing the effect of non-verbal communication to the patient satisfaction with respect to different demographic perspectives. The research was carried out in the inpatient of selected hospitals in the Makassar city of Indonesia involving 420 respondents taken using proportional stratified random sampling technique. The research design is quantitative research using a cross sectional study design with questionnaires as the instrument to collect the data. The result of the study showed that the sixth variables of nonverbal communication (artifact, haptic, kinesics, chronemics, proxemics, and vocalic) significantly influence patient’s satisfaction. However, the result of the partial test showed different effects of each nonverbal communication variable to the patients based on the age categorize, gender, ward, ethnics, education level, and occupation.

patient would then be loyal and return to the same physician when needing health services in the future [5].
In order to comprehend on how to satisfy the patients, it is required to identify their wish, need, and hope by identifying the characteristics of each patient. Patients who are satisfied with hospital or physician health service will be loyal and return if they need health care service [6]. This is primarily due to the sensitivity of patient to non-verbal communication which is varied depending on the characteristics of patient. Therefore, it is important to further analyze the influence of non-verbal communication of physician to the patient with respect to different perspectives of patient's demography.

Communication
Communication is one of quality indicators of health services in hospitals that could alter the patient satisfaction. Communication is an effort to create a mutual understanding and trust through idea exchanges with words, symbols or messages that will lead to mutual relationship between individuals. Effective communication occurs when a message is delivered and understood as what sender's intention and then followed up an action by the receiver without any obstacles.
In health services, physicians and patients play an important role as a source of information either as a sender or a receiver. Effective communication in the context of physician and patient relationship is a professional attitude of a physician to build safe, secured, and trust feelings of the patients. These attitudes have already been exposed since at the beginning of consultation, during consultation process, and at the end of consultation. The ability of physician to dig and exchange the information both verbally and nonverbally with patients, patient's families, societies, colleagues, and other different characteristic of professions is core competency that should be possessed by a physician [7].
Patient behavior in accepting diagnosis is determined by a physician including curing treatment, self-treatment as well as pay attention and obey the physician's advices that will be determined by the presence of communication effectiveness. Such communication will also influence the existing therapy whether it will be continued or terminated partially. Physician's feedbacks obtained from the result of communication is a patient's reaction or response during diagnosing patient's behavior in repeated visits, and patient's preferences in implementing the curing.
Different characteristic of patient will give different reactions such that a physician needs to pay attention on the background of patients with respect to a demographic factor in developing communication.

Verbal and Nonverbal Communication
The most common form of communication used by physicians in delivering their messages is verbal communication. This is simply because the characteristics of verbal communication that is more accurate and punctuate. In verbal communication, words are used to express ideas or feelings to stimulate emotional responses or to describe object, observation, and memory. The advantage of verbal communication in face to face interaction is the possibility to obtaina direct response from each individual.

1.
Object Communication (Artifact) Dressing is the most common object communication although it is often considered as one form of stereotypes; but generally people are valued based on their dresses. About 65% of patients expect the physicians wear a white coat during consultation.

Touch (Haptic)
The indicator of this variable is shake hand, grasping hand, kissing, touching back, stroking, hitting and others. The form of this communication is to deliver messages about goal or feeling of the sender. The feelings or emotions of the sender either positive or negative can emerge due to touching. In fact touching can give incredible effect in medication. Touching has a strong effect in delivering message as long as delivered in good and responsible manners. If the touching is conducted in an inconvenience way it will cause trust loss, anxiety, and hostility.

Chronemics
Chronemics is about using time in nonverbal communication. Time is used in precise duration for a particular activity and also punctuality in doing communication.

1) Body Movements (Kinesics)
Eye contact, facial expression, sign language, and attitude are types of body movements that used to substitute words to explain something, express feeling, and handle a conversation or to release a tense.

2) Proxemics
Proxemics is a distance between people when they are communicating or having a conversation, including the place or position that you are in.

3) Vocalic
Vocalic is nonverbal communication such as intonation, accent, swiftness in speaking, and others used during a conversation.

4) Environment
Environment is also used to send a certain command or instruction including distance, temperature, light, and color

Conceptual Framework
The  Physician's nonverbal communication was considered as an independent variable and while patient's satisfaction was considered as a dependent variable in accordance of demographic characteristics of patient which was further categorized as age, gender, wards, ethnics, education level, and occupation.    Satisfaction of adult patients is significantly influenced by haptic and proxemics but mostly influenced by haptic as illustrated in table 5. For the elderly and the oldest patients, their satisfaction are significantly influenced by haptic, proxemics, and vocalic but mostly influenced by haptic variable as indicated in table 6.      While in the third class as illustrated in table 12, haptic and vocalic variables significantly influence patient's satisfaction in which the dominant variable is vocalic. In summary, patient's satisfaction in the VIP and first classes showsa pretty similar situation as well as those at second and third classes.         Generally haptic variable significantly influenced patient's satisfaction in all categorizations.

ANALYSIS AND DISCUSSION
Physician's touch excluding patient examination can be treated by holding patient's hand, touching the shoulder or patient's head. Touch will result in comfortable feelings to the patients and also can reduce the illness [10]. The conceptual structure of physical touch is caring.
Previous findings revealed that touch in caring centered on five aspects of goals for touch: promoting physical comfort; promoting emotional comfort; promoting mind-body comfort; performing social role and sharing spiritually [11]. Gender can affect someone when they communicate or accept a command or instruction. Basically male and female has a different way to communicate [12]. Patient's gender or doctor, both affect to the medical communication.