Measures of family planning service quality associated with contraceptive discontinuation: an analysis of Measurement, LearningEvaluation (MLE) project data from urban Kenya
| Autor: | Karla R. Feeser, Nirali M. Chakraborty, Lisa Calhoun, Ilene S. Speizer |
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| Rok vydání: | 2019 |
| Předmět: |
Ordinal data
medicine.medical_specialty Service delivery framework Medicine (miscellaneous) Biochemistry Genetics and Molecular Biology (miscellaneous) Contraceptive discontinuation 03 medical and health sciences 0302 clinical medicine Health facility Immunology and Microbiology (miscellaneous) medicine 030212 general & internal medicine Family planning Competence (human resources) Information exchange Service quality 030219 obstetrics & reproductive medicine 030503 health policy & services Health Policy Public Health Environmental and Occupational Health Articles Kenya Exploratory factor analysis quality Family medicine measurement 0305 other medical science Psychology Research Article |
| Zdroj: | Gates Open Research |
| ISSN: | 2572-4754 |
| Popis: | Introduction: Several measures to assess family planning service quality (FPQ) exist, yet there is limited evidence on their association with contraceptive discontinuation. Using data from the Measurement, Learning & Evaluation (MLE) Project, this study investigates the association between FPQ and discontinuation-while-in-need in five cities in Kenya. Two measures of FPQ are examined – the Method Information Index (MII) and a comprehensive service delivery point (SDP) assessment rooted in the Bruce Framework for FPQ. Methods: Three models were constructed: two to assess MII reported in household interviews (as an ordinal and binary variable) among 1,033 FP users, and one for facility-level quality domains among 938 FP users who could be linked to a facility type included in the SDP assessment. Cox proportional hazards ratios were estimated where the event of interest was discontinuation-while-in-need. Facility-level FPQ domains were identified using exploratory factor analysis (EFA) using SDP assessment data from 124 facilities. Results: A woman’s likelihood of discontinuation-while-in-need was approximately halved whether she was informed of one aspect of MII (HR: 0.45, p < 0.05), or all three (HR: 0.51, p < 0.01) versus receiving no information, when MII was assessed as an ordinal variable. Six facility-level quality domains were identified in EFA. Higher scores in information exchange, privacy, autonomy & dignity and technical competence were associated with a reduced risk of discontinuation-while-in-need (p < 0.05). Facility-level MII was correlated with overall facility quality (R= 0.3197, p < 0.05). Conclusions: The MII has potential as an actionable metric for FPQ monitoring at the health facility level. Furthermore, family planning facilities and programs should emphasize information provision and client-centered approaches to care alongside technical competence in the provision of FP care. |
| Databáze: | OpenAIRE |
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