Assaf Shireen, Wang Wenjuan, Mallick Lindsay
ICF, The Demographic and Health Surveys (DHS) Program, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA.
Avenir Health, The Demographic and Health Surveys (DHS) Program, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA.
BMC Health Serv Res. 2017 May 12;17(1):346. doi: 10.1186/s12913-017-2287-z.
High quality of care in family planning (FP) services has been found to be associated with increased and continued use of contraceptive methods. The interpersonal skills and technical competence of the provider is one of the main components of quality of care. To study the process component of quality of care, the distribution of the FP counseling topics was examined by client, provider and facility characteristics. To assess the outcomes of quality of care, client satisfaction and their knowledge of their method's protection from STIs were used. This study examined the factors associated with these outcomes with a focus on provider counseling and training.
Data from the 2012-2013 Senegal Service Provision Assessment survey was used for the analysis. The survey included a representative sample of the health facilities in Senegal and collects data by observing the clients' FP visits and conducting exit interviews. The main outcomes of interest were provider's counseling in FP, client's satisfaction with FP services and client's knowledge of their method's protection from STIs. Several covariates were used in the analysis which represent client, provider and facility characteristics.
The level of counseling was inadequate-- very low proportions of providers that performed different types of counseling. Counseling was more likely to be provided to new than returning clients. Approximately 84% of the clients were very satisfied with services but only 58% had correct knowledge of their method's protection from STIs. Clients were significantly less likely to be very satisfied when their providers counseled on side effects and when to return, and counseling provided on method's protection from STIs did not significantly improve knowledge in this area. Clients seen by a provider with FP training had almost twice the odds of having correct knowledge about their method's protection from STIs compared with clients seen by a provider with no recent training.
The percentage of providers offering FP counseling to their clients was relatively low and was ineffective on the client-focused outcomes. Interventions may be required for more effective counseling methods that are client-centered as well as providing more FP training to providers.
研究发现，计划生育（FP）服务的高质量护理与避孕方法的使用增加及持续使用相关。提供者的人际沟通技巧和技术能力是护理质量的主要组成部分之一。为研究护理质量的过程组成部分，通过客户、提供者和机构特征对计划生育咨询主题的分布进行了检查。为评估护理质量的结果，使用了客户满意度及其对所采用方法预防性传播感染（STIs）的了解情况。本研究重点关注提供者咨询和培训，考察了与这些结果相关的因素。
分析使用了2012 - 2013年塞内加尔服务提供评估调查的数据。该调查包括塞内加尔卫生设施的代表性样本，并通过观察客户的计划生育就诊情况和进行出院访谈来收集数据。主要关注的结果是提供者在计划生育方面的咨询、客户对计划生育服务的满意度以及客户对所采用方法预防性传播感染的了解情况。分析中使用了几个协变量，代表客户、提供者和机构特征。
咨询水平不足——进行不同类型咨询的提供者比例非常低。与回访客户相比，新客户更有可能接受咨询。约84%的客户对服务非常满意，但只有58%的客户对所采用方法预防性传播感染有正确的了解。当提供者就副作用和回访时间进行咨询时，客户非常满意的可能性显著降低，并且关于所采用方法预防性传播感染的咨询并没有显著提高这方面的知识。与未接受近期培训的提供者接待的客户相比，接受过计划生育培训的提供者接待的客户对所采用方法预防性传播感染有正确了解的几率几乎高出一倍。
向客户提供计划生育咨询的提供者比例相对较低，并且对以客户为中心的结果无效。可能需要采取干预措施，采用更有效的以客户为中心的咨询方法，并为提供者提供更多的计划生育培训。
