Bauhoff Sebastian, Rabinovich Lila, Mayer Lauren A
Center for Global Development, Washington, District of Columbia, United States of America.
Center for Economic and Social Research, University of Southern California, Arlington, Virginia, United States of America.
PLoS One. 2017 Oct 24;12(10):e0186745. doi: 10.1371/journal.pone.0186745. eCollection 2017.
Citizen report cards on health care providers have been identified as a potential means to increase citizen engagement, provider accountability and health systems performance. Research in high-income settings indicates that the wording, presentation and display of performance information are critical to achieve these goals. However, there are limited insights on developing effective report card designs for middle- and low-income settings. We conducted cognitive interviews to assess consumers' understanding, interpretation of and preferences for displaying information for a health care report card in rural Tajikistan. We recruited a convenience sample of 40 citizens (20 women and 20 men aged 18-45) from rural areas of two provinces of Tajikistan (Soghd and Khatlon oblasts). The interview protocol was adapted from the model of cognitive interviews used in social science research to improve survey questionnaires. We used multivariate regression to assess understanding and interpretation of the report card; chi2 tests to assess differences in preferences for displaying information; and tests of proportions to assess the preferred comparison group. Respondents understood the main idea of the report card and are not confused by the indicators or display. However, many respondents had difficulties making comparisons, and when asked to identify worst-performing services. Respondents preferred detailed rankings using school grades, comparisons of their local clinic with the regional or national average performance, and the use of color in the report card. We found some heterogeneity across the two provinces. Overall, our findings are promising regarding the citizens' comprehension of health care report cards in rural Tajikistan, while underscoring the challenges of effectively providing health care performance information to communities. Cognitive interviews and iterative testing can support an effective implementation of reporting initiatives.
医疗服务提供者的公民报告卡已被视为一种增加公民参与度、提高提供者问责制和改善卫生系统绩效的潜在手段。高收入环境下的研究表明，绩效信息的措辞、呈现方式和展示形式对于实现这些目标至关重要。然而，对于为中低收入环境设计有效的报告卡，人们了解有限。我们进行了认知访谈，以评估塔吉克斯坦农村地区消费者对医疗报告卡信息展示的理解、解读和偏好。我们从塔吉克斯坦两个省份（索格特州和哈特隆州）的农村地区方便抽样招募了40名公民（20名女性和20名年龄在18至45岁之间的男性）。访谈方案改编自社会科学研究中用于改进调查问卷的认知访谈模型。我们使用多元回归来评估对报告卡的理解和解读；使用卡方检验来评估信息展示偏好的差异；使用比例检验来评估首选的比较组。受访者理解报告卡的主要内容，没有被指标或展示形式弄糊涂。然而，许多受访者在进行比较以及被要求指出表现最差的服务时遇到困难。受访者更喜欢使用学校成绩的详细排名、将当地诊所与地区或全国平均表现进行比较，以及在报告卡中使用颜色。我们发现两个省份之间存在一些差异。总体而言，我们的研究结果对于塔吉克斯坦农村地区公民对医疗报告卡的理解很有前景，同时也凸显了向社区有效提供医疗绩效信息的挑战。认知访谈和迭代测试可以支持报告举措的有效实施。
