Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique.
BMC Health Serv Res. 2019 Aug 1;19(1):538. doi: 10.1186/s12913-019-4369-6.
Antenatal care (ANC) provides a range of critical health services during pregnancy that can improve maternal and neonatal health outcomes. In Mozambique, only half of women receive four or more ANC visits, which are provided for free at public health centers by maternal and child health (MCH) nurses. Waiting time has been shown to contribute to negative client experiences, which may be a driver of low maternity care utilization. A recent pilot study of a program to schedule ANC visits demonstrated that scheduling care reduces waiting time and results in higher rates of complete ANC. This study aims to explore client experiences with waiting time for ANC in standard practice and care and after the introduction of appointment scheduling.
This study uses a series of qualitative interviews to unpack client experiences with ANC waiting time with and without scheduled care, in order to better understand the impact of waiting time on client experiences. Thirty-eight interviews were collected in May to June 2017 at three pilot study clinics in southern Mozambique, with a focus on two paired intervention and comparison facilities sharing similar facility characteristics. Data were analyzed using inductive thematic analysis methods using NVivo software.
Clients described strong motivations to seek ANC, pointing to the need to address convenience of care, and highlighted direct and indirect costs of seeking care that were exacerbated by long waiting times. Direct costs include time and transport costs of going to the clinic, while indirect costs include being unable to fulfill household and work obligations. Other barriers to complete ANC utilization of four or more visits include transport costs, negative provider experiences, and delayed ANC initiation, which limit the potential number of clinic contacts.
Findings demonstrate that the scheduling intervention improves the client experience of seeking care by allowing women to both seek ANC and fulfill other productive obligations. Innovation in healthcare delivery should consider adapting models that minimize waiting times.
产前护理（ANC）在怀孕期间提供一系列关键的健康服务，可以改善母婴健康结果。在莫桑比克，只有一半的妇女接受四次或更多次 ANC 检查，这些检查由母婴健康（MCH）护士在公共卫生中心免费提供。等待时间已被证明会导致负面的客户体验，这可能是低产妇保健利用率的驱动因素。最近一项关于安排 ANC 检查的试点研究表明，预约护理可以减少等待时间并提高 ANC 完成率。本研究旨在探讨在标准护理和护理中以及在引入预约护理后，客户对 ANC 等待时间的体验。
本研究使用一系列定性访谈来剖析客户在有和没有预约护理的情况下对 ANC 等待时间的体验，以更好地了解等待时间对客户体验的影响。2017 年 5 月至 6 月，在莫桑比克南部的三个试点研究诊所收集了 38 次访谈，重点是两个配对的干预和比较设施，这些设施具有相似的设施特征。使用 NVivo 软件对数据进行了归纳主题分析方法的分析。
客户描述了强烈的 ANC 寻求动机，指出需要解决护理便利性问题，并强调了寻求护理的直接和间接成本，这些成本因长时间等待而加剧。直接成本包括去诊所的时间和交通成本，而间接成本包括无法履行家庭和工作义务。未能完成四次或更多次 ANC 利用的其他障碍包括交通成本、负面的提供者体验和 ANC 启动延迟，这限制了诊所接触的潜在次数。
研究结果表明，预约干预通过允许妇女同时寻求 ANC 和履行其他生产性义务，改善了寻求护理的客户体验。医疗保健提供方面的创新应考虑适应最小化等待时间的模式。
