Karim Rizwanul M, Abdullah Mamun S, Rahman Anisur M, Alam Ashraful M
Department of community Medicine, Abdul Malek Ukil Medical College (AMUMC), Begumgonj, Noakhali, 3820, Bangladesh.
Filaria Control Program, CDC, Directorate General of Health Services (DGHS), Mohakhali, Dhaka, 1212, Bangladesh.
BMC Health Serv Res. 2016 Jun 24;16:204. doi: 10.1186/s12913-016-1461-z.
Bangladesh is one among the few countries of the world that provides free medical services at the community level through various public health facilities. It is now evident that, clients' perceived quality of services and their expectations of service standards affect health service utilization to a great extent. The aim of the study was to develop and validate the measures for perception and satisfaction of primary health care quality in Bangladesh context and to identify their aspects on the utilization status of the Community Clinic services.
This mixed method cross sectional survey was conducted from January to June 2012, in the catchment area of 12 community clinics. Since most of the outcome indicators focus mainly on women and children, women having children less than 2 years of age were randomly assigned and interviewed for the study purpose. Data were collected through FGD, Key informants interview and a pretested semi- structured questionnaire.
About 95 % of the respondents were Muslims and 5 % were Hindus. The average age of the respondents was 23.38 (SD 4.15) and almost all of them are home makers. The average monthly expenditure of their family was 95US $ (SD 32US$). At the beginning of the study, two psychometric research instruments; 24 items perceived quality of primary care services PQPCS scale (chronbach's α = .89) and 22 items community clinic service satisfaction CCSS scale (chronbach's α = .97), were constructed and validated. This study showed less educated, poor, landless mothers utilized the community clinic services more than their educated and wealthier counterpart. Women who lived in their own residence used the community clinic services more frequently than those who lived in a rental house. Perceptions concerning skill and competence of the health care provider and satisfaction indicating interpersonal communication and attitude of the care provider were important predictors for community clinic service utilization. Perception related to the quality of management, administration, physical environment of the service point and satisfaction addressing health promotion and women health issues played significant role on community clinic's services utilization.
Besides parental education and income, client's perception and satisfaction played significant role in community clinic service utilization. Provider's perception of service quality should be studied. The study findings will enable policy-makers to improve quality of primary health care services, realizing providers' and patients' ideas of community clinic service quality.
孟加拉国是世界上少数几个通过各种公共卫生设施在社区层面提供免费医疗服务的国家之一。现在很明显，客户对服务质量的感知及其对服务标准的期望在很大程度上影响着医疗服务的利用。本研究的目的是开发并验证孟加拉国背景下初级卫生保健质量感知与满意度的测量方法，并确定其对社区诊所服务利用状况的影响因素。
2012年1月至6月，在12家社区诊所的服务区域进行了这项混合方法横断面调查。由于大多数结果指标主要关注妇女和儿童，因此随机抽取了有2岁以下子女的妇女进行研究访谈。通过焦点小组讨论、关键 informant 访谈和预测试的半结构化问卷收集数据。
约95%的受访者为穆斯林，5%为印度教徒。受访者的平均年龄为23.38岁（标准差4.15），几乎所有人都是家庭主妇。其家庭平均月支出为95美元（标准差32美元）。在研究开始时，构建并验证了两种心理测量研究工具；24项初级保健服务质量感知量表（克朗巴赫α系数=0.89）和22项社区诊所服务满意度量表（克朗巴赫α系数=0.97）。本研究表明，受教育程度较低、贫困、无土地的母亲比受教育程度较高和较富裕的母亲更多地利用社区诊所服务。居住在自己住所的妇女比居住在出租房的妇女更频繁地使用社区诊所服务。对医疗服务提供者技能和能力的感知以及表明服务提供者人际沟通和态度的满意度是社区诊所服务利用的重要预测因素。与管理质量、服务点行政、物理环境相关的感知以及涉及健康促进和妇女健康问题的满意度对社区诊所服务利用起着重要作用。
除了父母的教育程度和收入外，客户的感知和满意度在社区诊所服务利用中起着重要作用。应研究服务提供者对服务质量的感知。研究结果将使政策制定者能够提高初级卫生保健服务质量，实现服务提供者和患者对社区诊所服务质量的看法。
