Quality of Care – Client Perspectives

Christabel Kambala

Experiential dimension of care

Objectives• Reconstruct process of care • Assess the clients’ perception of

quality of care

Methods

• Cross-sectional facility-based survey among clients- baseline

• Structured questionnaire with close-ended questions on:

• Socio-demographic characteristics• Process of care-services received• Perceived quality of care

• Convenience sampling: Women interviewed as they leave ANC, delivery, and PNC (exit interviews)

Perceived quality of Care measurement

• Made of statements assessing quality of care components about how the women perceived the quality of care on that day.

• The statements were read to the women and were to agree or disagree and rate their perceived quality of care, using a 10 point scale (10 as complete agreement and 1 as complete disagreement).

• The higher the score the more highly quality was rated.

Dimensions of perceptions (Latent variables)

Overall Perceived quality of Care

Interpersonal Relationships

Environment and conditions

of the room

Health services in

general

She/he listened to meShe/he behaved in a

gentle manner

I was set up comfortably.

The room was clean & hygienic

The HW were well coordinated

The quality of care was higher than I

expected

Interviewer side

Interviewee side

Sample sizeANC DELIVERY PNC

BALAKA 77 36 61

DEDZA 102 65 75

MCHINJI 74 59 47

NTCHEU 135 44 49

TOTAL 388 204 232

Results: Characteristics of women (%)

Variable ANC n=388

Delivery n=204

PNC n=232

Age<2020-29>30

235324

205822

215722

Marital statusnon-marriedMarried

298

793

694

EducationNonePrimarySecondary & above

383923

424414

453718

LiteracyIlliterateLiterate

3466

3466

3961

Results: Characteristics of women (%)

Variable ANC n=388

Delivery n= 204

PNC n=232

Gravid 1 2-3 >3

313534

313737

323830

Number of children 1 child 2-3 children >3 children

352045

43660

36433

History of miscarriage : no miscarriage miscarriage

8614

8911

7921

History of still birth no still birth still birth

964

973

946

Premature birth no premature birth premature birth

946

946

9010

Results: Experiences (%)Variable ANC, N=388 Delivery, N=204 PNC, N=232

Wait time above 1 hour 23 3 22

Not done

Self introduction by HW 60 60 56

Explanation of exam procedures

27 40 24

Explanation of medication 22 30 37

Consent seeking 28 41 27

Encouraged to ask questions 37 61 47

Encouraged to have guardian 46 50 55

Confidentiality 6 4 8

Bp measurement 38 - 58

Bp measurement before del - 37 -

Bp measurement after del - 57 -

Baby weighed - - 23

Results: Perceived quality of ANC care

• Interpersonal relationships: 10 items – mean rating =9

• Environment and conditions of the ANC examination room- 7 items- mean rating=9

• ANC health services in general-10 items- mean rating=9

• Overall: mean=9

Factors significantly associated with perceived quality of ANC care. N=388

Variable Chi-square P-value

Self introduction by HW (+) 6.071 0.0137

Explanation of exam procedures (+) 5.569 0.0183

Explanation of medication (+) 8.414 0.0037

Consent (+) 12.527 0.0004

Encouragement to ask questions (+) 11.872 0.0006

Confidentiality (+) 8.577 0.0034

Bp Measurement (+) 5.952 0.0147

Next Steps

• Analysis PNC and delivery data • Bivariate • Regression model on determinants of

perception

Thank you!