The Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), (CIN 13-410) at the Durham VA Health Care System, Durham, NC, USA.
Franklin and Marshall College, Lancaster, Pennsylvania, USA.
Reprod Health. 2021 Feb 23;18(1):47. doi: 10.1186/s12978-021-01105-y.
Integrating family planning into child immunization services may address unmet need for contraception by offering family planning information and services to postpartum women during routine child immunization visits. However, policies and programs promoting integration are often based on insubstantial or conflicting evidence about its effects on service delivery and health outcomes. While integration models vary, many studies measure integration as binary (a facility is integrated or not) rather than a multidimensional and varying continuum. It is thus challenging to ascertain the determinants and effects of integrated service delivery. This study creates Facility and Provider Integration Indexes, which measure capacity to support integrated family planning and child immunization services and applies them to analyze the extent of integration across 400 health facilities.
This study utilizes cross-sectional health facility (N = 400; 58% hospitals, 42% primary healthcare centers) and healthcare provider (N = 1479) survey data that were collected in six urban areas of Nigeria for the impact evaluation of the Nigerian Urban Reproductive Health Initiative. Principal Component Analysis was used to develop Provider and Facility Integration Indexes that estimate the extent of integration in these health facilities. The Provider Integration Index measures provider skills and practices that support integrated service delivery while the Facility Integration Index measures facility norms that support integrated service delivery. Index scores range from zero (low) to ten (high).
Mean Provider Integration Index score is 5.42 (SD 3.10), and mean Facility Integration Index score is 6.22 (SD 2.72). Twenty-three percent of facilities were classified as having low Provider Integration scores, 32% as medium, and 45% as high. Fourteen percent of facilities were classified as having low Facility Integration scores, 38% as medium, and 48% as high.
Many facilities in our sample have achieved high levels of integration, while many others have not. Results suggest that using more nuanced measures of integration may (a) more accurately reflect true variation in integration within and across health facilities, (b) enable more precise measurement of the determinants or effects of integration, and (c) provide more tailored, actionable information about how best to improve integration. Overall, results reinforce the importance of utilizing more nuanced measures of facility-level integration.
将计划生育纳入儿童免疫服务中，可以在为常规儿童免疫接种期间为产后妇女提供计划生育信息和服务，从而满足对避孕措施的需求。然而，促进整合的政策和计划通常基于关于其对服务提供和健康结果影响的不充分或相互矛盾的证据。虽然整合模式不同，但许多研究将整合衡量为二元（设施是否整合）而不是多维和变化的连续体。因此，确定综合服务提供的决定因素和效果具有挑战性。本研究创建了设施和提供者整合指数，用于衡量支持计划生育和儿童免疫整合服务的能力，并将其应用于分析 400 个卫生设施的整合程度。
本研究利用了在尼日利亚六个城市收集的横断面卫生设施（N=400；58%为医院，42%为初级保健中心）和医疗保健提供者（N=1479）调查数据，用于评估尼日利亚城市生殖健康倡议的影响评估。主成分分析用于开发提供者和设施整合指数，以估计这些卫生设施的整合程度。提供者整合指数衡量支持整合服务提供的提供者技能和实践，而设施整合指数衡量支持整合服务提供的设施规范。指数得分范围从 0（低）到 10（高）。
提供者整合指数的平均得分为 5.42（SD 3.10），设施整合指数的平均得分为 6.22（SD 2.72）。23%的设施被归类为提供者整合得分较低，32%为中等，45%为高。14%的设施被归类为设施整合得分较低，38%为中等，48%为高。
我们样本中的许多设施已经达到了较高的整合水平，而许多其他设施尚未达到。结果表明，使用更细致的整合衡量标准可能（a）更准确地反映卫生设施内和之间的整合实际变化，（b）能够更精确地衡量整合的决定因素或效果，以及（c）提供有关如何最好地改进整合的更具体、更可行的信息。总体而言，结果强调了利用更细致的设施层面整合衡量标准的重要性。
