Assaf Shireen
ICF, The Demographic and Health Surveys (DHS) Program, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA.
Matern Child Health J. 2018 Nov;22(11):1659-1667. doi: 10.1007/s10995-018-2563-5.
Objectives Providing counseling on danger signs of pregnancy complications as part of visits for antenatal care (ANC) can raise expecting women's awareness so that if danger signs occur they can seek assistance in time. The study examines the level of agreement in counseling on danger signs between observation of the provider during the ANC visit and the client's report in the exit interview, and the association of this agreement with the client's level of knowledge on danger signs. Methods The analysis used data from service provision and assessment (SPA) surveys in Haiti, Malawi, and Senegal. Agreement between the observation and client's report was measured by Cohen's kappa and percent agreement. Regressions were performed on the number of danger signs the client knew, with the level of agreement on the counseling on danger signs as the main independent variable. Results The study found little agreement between the observation of counseling and the client's report that the counseling occurred, despite the fact that the exit interview with the client was performed immediately following the ANC visit with the provider. The level of positive agreement between observation and client's report was 17% in Haiti, 33% in Malawi, and 23% in Senegal. Clients' overall knowledge of danger signs was low; in all three countries the mean number of danger signs known was 1.5 or less. The regression analysis found that, in order to show a significant increase in knowledge of danger signs, it was important for the client to report that it took place. Conclusions Ideally, there should be 100% positive agreement that counseling occurred. To achieve this level requires raising both the level of counseling on danger signs of pregnancy complications and its quality. While challenges exist, providing counseling that is more client-centered and focuses on the client's needs could improve quality and thus could increase the client's knowledge of danger signs.
目标 作为产前保健（ANC）访视的一部分，就妊娠并发症的危险信号提供咨询可提高孕妇的意识，以便在出现危险信号时她们能及时寻求帮助。本研究考察了在ANC访视期间医护人员的观察与客户在出院访谈中的报告之间关于危险信号咨询的一致程度，以及这种一致性与客户对危险信号的知晓水平之间的关联。方法 该分析使用了来自海地、马拉维和塞内加尔的服务提供与评估（SPA）调查的数据。观察与客户报告之间的一致性通过科恩kappa系数和一致百分比来衡量。以关于危险信号咨询的一致程度作为主要自变量，对客户知晓的危险信号数量进行回归分析。结果 研究发现，尽管在与医护人员进行ANC访视后立即对客户进行了出院访谈，但在咨询观察与客户报告咨询已发生之间几乎没有一致性。观察与客户报告之间的正向一致程度在海地为17%，在马拉维为33%，在塞内加尔为23%。客户对危险信号的总体知晓水平较低；在所有三个国家，已知危险信号的平均数量为1.5个或更少。回归分析发现，为了使危险信号的知晓有显著增加，客户报告咨询已发生很重要。结论 理想情况下，关于咨询已发生的正向一致率应为100%。要达到这一水平，需要提高关于妊娠并发症危险信号的咨询水平及其质量。虽然存在挑战，但提供更以客户为中心、关注客户需求的咨询可以提高质量，从而可以增加客户对危险信号的知晓。
