Measuring Service Quality and Assessing Its Relationship to Contraceptive Discontinuation: A Prospective Cohort Study in Pakistan and Uganda
| Autor: | Amanda M. Kalamar, Agha Xaher Gul, Lynn Atuyambe, Sarah E.K. Bradley, Dominic Montagu, Ben Bellows, Waqas Hameed, Nirali M. Chakraborty, Karen T. Chang, Karen A. Grépin |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty Adolescent Exit interview media_common.quotation_subject Audit Young Adult 03 medical and health sciences 0302 clinical medicine medicine Humans Pakistan Uganda Quality (business) 030212 general & internal medicine Contraception Behavior Proportional Hazards Models Quality Indicators Health Care Quality of Health Care Reproductive health media_common Service quality 030219 obstetrics & reproductive medicine business.industry Proportional hazards model General Medicine Middle Aged Discontinuation Contraception Family Planning Services Family medicine Female Original Article business Cohort study |
| Zdroj: | Global Health: Science and Practice |
| ISSN: | 2169-575X |
| DOI: | 10.9745/ghsp-d-20-00105 |
| Popis: | The quality of services provided is likely to affect contraceptive continuation. However, findings are strongly influenced by the quality measurement tools used, emphasizing the need for standardization. Key Finding Despite extensive coverage across structural and process domains, social franchises found that facility-level family planning quality metrics were nonstandard and lacked consistent associations with contraceptive discontinuation. Key Implications Researchers should seek to harmonize andsimplify family planning quality measurement tools to enable routine facility-level monitoring in lower-resource clinics and community settings.Policy makers should consider the value of comparable and generalizable metrics for benchmarking performance of family planning programming and contributions to population well-being.Program managers should consider assessing facility-level quality of care by monitoring data that are simple to both collect and analyze and that are shown to be associated with reproductive health outcomes, including voluntary contraceptive continuation rates. Background: The quality of contraceptive counseling that women receive from their provider can influence their future contraceptive continuation. We examined (1) whether the quality of contraceptive service provision could be measured in a consistent way by using existing tools from 2 large-scale social franchises, and (2) whether facility quality measures based on these tools were consistently associated with contraceptive discontinuation. Methods: We linked existing, routinely collected facility audit data from social franchise clinics in Pakistan and Uganda with client data. Clients were women aged 15–49 who initiated a modern, reversible contraceptive method from a sampled clinic. Consented participants completed an exit interview and were contacted 3, 6, and 12 months later. We collapsed indicators into quality domains using theory-based categorization, created summative quality domain scores, and used Cox proportional hazards models to estimate the relationship between these quality domains and discontinuation while in need of contraception. Results: The 12-month all-modern method discontinuation rate was 12.5% among the 813 enrolled women in Pakistan and 5.1% among the 1,185 women in Uganda. We did not observe similar associations between facility-level quality measures and discontinuation across these 2 settings. In Pakistan, an increase in the structural privacy domain was associated with a 60% lower risk of discontinuation, adjusting for age and baseline method (P |
| Databáze: | OpenAIRE |
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