Feeser Karla, Chakraborty Nirali M, Calhoun Lisa, Speizer Ilene S
Metrics for Management, Baltimore, MD, 21201, USA.
Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516, USA.
Gates Open Res. 2020 Jan 29;3:1453. doi: 10.12688/gatesopenres.12974.2. eCollection 2019.
Several measures to assess family planning service quality (FPQ) exist, yet there is limited evidence on their association with contraceptive discontinuation. Using data from the Measurement, Learning & Evaluation (MLE) Project, this study investigates the association between FPQ and discontinuation-while-in-need without switching in five cities in Kenya. Two measures of FPQ are examined - the Method Information Index (MII) and a comprehensive service delivery point (SDP) assessment rooted in the Bruce Framework for FPQ. Three models were constructed: two to assess MII reported in household interviews (as an ordinal and binary variable) among 1,033 FP users, and one for facility-level quality domains among 938 FP users who could be linked to a facility type included in the SDP assessment. Cox proportional hazards ratios were estimated where the event of interest was discontinuation-while-in-need without switching. Facility-level FPQ domains were identified using exploratory factor analysis (EFA) using SDP assessment data from 124 facilities. A woman's likelihood of discontinuation-while-in-need was approximately halved whether she was informed of one aspect of MII (HR: 0.45, p < 0.05), or all three (HR: 0.51, p < 0.01) versus receiving no information, when MII was assessed as an ordinal variable. Six facility-level quality domains were identified in EFA. Higher scores in information exchange, privacy, autonomy & dignity and technical competence were associated with a reduced risk of discontinuation-while-in-need (p < 0.05). The MII has potential as an actionable metric for FPQ monitoring at the health facility level. Furthermore, family planning facilities and programs should emphasize information provision and client-centered approaches to care alongside technical competence in the provision of FP care.
虽然存在多种评估计划生育服务质量（FPQ）的措施，但关于这些措施与避孕措施停用之间关联的证据有限。本研究利用测量、学习与评估（MLE）项目的数据，调查了肯尼亚五个城市中FPQ与有需求时未更换避孕措施而停用之间的关联。研究考察了两种FPQ测量方法——方法信息指数（MII）和基于布鲁斯FPQ框架的综合服务提供点（SDP）评估。构建了三个模型：两个用于评估1033名计划生育服务使用者在家庭访谈中报告的MII（作为有序变量和二元变量），另一个用于评估938名可与SDP评估中包含的设施类型相关联的计划生育服务使用者的设施层面质量领域。在感兴趣的事件为有需求时未更换避孕措施而停用的情况下，估计了Cox比例风险比。利用来自124个设施的SDP评估数据，通过探索性因素分析（EFA）确定了设施层面的FPQ领域。当MII作为有序变量进行评估时，与未获得任何信息相比，女性被告知MII的一个方面（风险比：0.45，p<0.05）或所有三个方面（风险比：0.51，p<0.01）时，有需求时停用的可能性大约减半。在EFA中确定了六个设施层面的质量领域。信息交流、隐私、自主性与尊严以及技术能力得分较高与有需求时停用风险降低相关（p<0.05）。MII有潜力作为卫生设施层面FPQ监测的一个可操作指标。此外，计划生育设施和项目应在提供计划生育服务时，除了强调技术能力外，还应注重信息提供和以客户为中心的护理方法。
