Becker Davida, Klassen Ann C, Koenig Michael A, LaVeist Thomas A, Sonenstein Freya L, Tsui Amy O
Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA.
Perspect Sex Reprod Health. 2009 Sep;41(3):158-65. doi: 10.1363/4115809.
Despite calls to make family planning services more responsive to the values, needs and preferences of clients, few studies have asked clients about their experiences or values, and most have used surveys framed by researchers', rather than clients', perspectives.
Forty in-depth interviews exploring lifetime experiences with and values regarding services were conducted with 18-36-year-old women who visited family planning clinics in the San Francisco Bay Area in 2007. Women were categorized as black, white, English- or Spanish-speaking Latina, or of mixed ethnicity to allow examination of differences by racial, ethnic and language group. Interviews were audiotaped, transcribed and coded thematically; matrices were then used to compare the themes that emerged across the subgroups.
Eight themes emerged as important to women's views of services: service accessibility, information provision, attention to client comfort, providers' personalization of care, service organization, providers' empathy, technical quality of care and providers' respect for women's autonomy. Women reported that it was important to feel comfortable during visits, to feel that their decision-making autonomy was respected, to have providers show empathy and be nonjudgmental, and to see the same provider across visits. The only notable difference among racial, ethnic and language groups was that Spanish-speaking Latinas wanted to receive language-appropriate care and contraceptive information.
Future surveys of family planning service quality should include measures of the factors that women value in such care, and efforts to improve providers' communication and counseling skills should emphasize the personalization of services and respect for clients' autonomy.
尽管一直有人呼吁让计划生育服务更能响应客户的价值观、需求和偏好，但很少有研究询问过客户的经历或价值观，而且大多数研究采用的是从研究人员而非客户的角度构建的调查。
2007年，对在旧金山湾区计划生育诊所就诊的18至36岁女性进行了40次深度访谈，探讨她们对服务的终生经历和价值观。女性被分为黑人、白人、讲英语或西班牙语的拉丁裔或混血族裔，以便按种族、族裔和语言群体考察差异。访谈进行了录音、转录并进行主题编码；然后使用矩阵来比较各亚组中出现的主题。
八个主题对女性的服务观很重要：服务可及性、信息提供、关注客户舒适度、提供者的个性化护理、服务组织、提供者的同理心、护理技术质量以及提供者对女性自主权的尊重。女性表示，就诊时感到舒适、觉得自己的决策自主权得到尊重、提供者表现出同理心且不评判、每次就诊都能见到同一位提供者很重要。种族、族裔和语言群体之间唯一显著的差异是，讲西班牙语的拉丁裔希望获得符合其语言习惯的护理和避孕信息。
未来对计划生育服务质量的调查应包括衡量女性在此类护理中看重的因素的指标，并且提高提供者沟通和咨询技能的努力应强调服务的个性化以及对客户自主权的尊重。
