Meuwissen Liesbeth E, Gorter Anna C, Knottnerus J A
ICAS Managua, Nicaragua.
Int J Qual Health Care. 2006 Feb;18(1):35-42. doi: 10.1093/intqhc/mzi073. Epub 2006 Jan 18.
To determine whether female adolescents from low-income areas in Managua were satisfied with the sexual and reproductive health (SRH) care provided through a competitive voucher programme and to analyse the determinants of their satisfaction.
A community-based quasi-experimental intervention study from 2000 to 2002.
Low-income areas of Managua.
Distribution of 28,711 vouchers giving adolescents free-access to SRH care in 19 clinics; training and support for health care providers.
A random sample of 3009 girls from 12 to 20 years completed self-administered questionnaires: 700 respondents had used this care in the last 15 months, 221 with voucher (users-with-voucher) and 479 without voucher (users-without-voucher).
User satisfaction; Satisfaction with clinic reception; Clarity of doctors' explanations.
User satisfaction was significantly higher in users-with-voucher compared with users-without-voucher [Adjusted odds-ratio (AOR) = 2.2; 95% confidence interval (95% CI) = 1.2-4.0]. Voucher use was associated with more frequent satisfaction with clinic reception, especially among sexually active girls not yet pregnant or mother (AOR = 6.9; 95% CI = 1.5-31.8). The clarity of doctors' explanations was not perceived differently (AOR = 1.4; 95% CI = 0.9-2.2). User satisfaction was highly correlated to satisfaction with clinic reception and clarity of doctors' explanations (P < 0.001). Longer consultation times, shorter waiting times, older age, and having a female doctor positively influenced user satisfaction.
Voucher use by teenage girls was associated with a better perceived SRH care. This is an important result, given the crucial role user satisfaction plays in adoption and continued use of health care and contraceptives. Though more research is needed, confidential and guaranteed access appear key factors to voucher success.
确定马那瓜低收入地区的女性青少年对通过竞争性代金券计划提供的性与生殖健康（SRH）护理是否满意，并分析其满意度的决定因素。
2000年至2002年基于社区的准实验干预研究。
马那瓜的低收入地区。
发放28711张代金券，让青少年可在19家诊所免费获得SRH护理；对医疗服务提供者进行培训和支持。
从12至20岁的女孩中随机抽取3009名完成自填问卷：700名受访者在过去15个月内使用过这种护理，其中221名使用了代金券（有券使用者），479名未使用代金券（无券使用者）。
用户满意度；对诊所接待的满意度；医生解释的清晰度。
与无券使用者相比，有券使用者的用户满意度显著更高[调整后的优势比（AOR）=2.2；95%置信区间（95%CI）=1.2 - 4.0]。使用代金券与对诊所接待更频繁的满意度相关，尤其是在尚未怀孕或成为母亲的性活跃女孩中（AOR = 6.9；95%CI = 1.5 - 31.8）。对医生解释清晰度的感受没有差异（AOR = 1.4；95%CI = 0.9 - 2.2）。用户满意度与对诊所接待的满意度和医生解释的清晰度高度相关（P < 0.001）。更长的咨询时间、更短的等待时间、年龄较大以及有女医生对用户满意度有积极影响。
少女使用代金券与对SRH护理的更好感受相关。鉴于用户满意度在采用和持续使用医疗保健及避孕药具方面发挥的关键作用，这是一个重要结果。尽管需要更多研究，但保密和有保障的获取似乎是代金券成功的关键因素。
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