评估肯尼亚计划生育咨询的质量及其决定因素：卫生机构出口访谈分析。
Assessing quality of family planning counseling and its determinants in Kenya: Analysis of health facility exit interviews.
机构信息
Department of Health Sciences/Global Health Unit, University Medical Center Groningen, Groningen, The Netherlands.
Department of Monitoring Evaluation and Research, Jhpiego, Johns Hopkins University Affiliate, Nairobi, Kenya.
出版信息
PLoS One. 2021 Sep 10;16(9):e0256295. doi: 10.1371/journal.pone.0256295. eCollection 2021.
BACKGROUND
Available evidence suggests that provision of quality of care in family planning services is crucial to increasing uptake and continuation of use of contraception. Kenya achieved a modern contraceptive prevalence rate of 60% in 2018, surpassing its 2020 target of 58%. With the high prevalence, focus is geared towards improved quality of family planning services. The objective of this study is to examine the quality of family planning counseling and its associated factors in health facilities in Kenya.
METHODS
We conducted a secondary analysis of the 2019 Kenya Performance Monitoring and Action, client exit data of women who had received family planning services. Quality of counseling was assessed using the Method Information Index Plus. We conducted a multivariable ordinal logistic regression analysis of data from 3,731 women to establish determinants of receiving quality family planning services.
RESULTS
The Method Information Index Plus score for higher-quality counseling was 56.7%, lower-quality counseling 32.4%, and no counseling 10.9%. Women aged 15-24 years (aOR = 0.69, 95% CI = 0.56-0.86, p = 0.001) had lower odds of receiving better counseling compared to women aged 35 years and above. Those with no education (aOR = 0.52, 95% CI = 0.33-0.82, p = 0.005), primary (aOR = 0.56, 95% CI = 0.44-0.71, p<0.001) and secondary (aOR = 0.79, 95% CI = 0.65-0.98, p = 0.028) were less likely to receive better counseling compared to those with tertiary education. Women who received long acting and reversible contraception methods (aOR = 1.75, 95% CI = 1.42-2.17, p<0.001), and those who were method switchers (aOR = 1.24, 95% CI = 1.03-1.50, p = 0.027), had a higher likelihood of receiving better quality of counseling as compared to those on short-term methods and those who were continuers, respectively.
CONCLUSION
The quality of family planning counseling in Kenya is still sub-optimal considering that some women receive no form of counseling at service delivery point. There is need to review the existing FP guidelines and training packages to increase focus on the quality of counseling services offered by health providers. Social accountability strategies that empower women to demand quality services should be included in community-level family planning interventions.
背景
现有证据表明，提供计划生育服务的质量对于提高避孕措施的使用率和持续率至关重要。肯尼亚在 2018 年实现了现代避孕药具使用率达到 60%的目标，超过了 2020 年 58%的目标。随着使用率的提高，重点转向了提高计划生育服务的质量。本研究旨在调查肯尼亚卫生机构中计划生育咨询的质量及其相关因素。
方法
我们对 2019 年肯尼亚绩效监测和行动的客户退出数据进行了二次分析，该数据来自接受计划生育服务的女性。使用方法信息指数加（Method Information Index Plus）评估咨询质量。我们对 3731 名妇女的数据进行了多变量有序逻辑回归分析，以确定接受优质计划生育服务的决定因素。
结果
高质量咨询的方法信息指数加评分占 56.7%，低质量咨询占 32.4%，无咨询占 10.9%。与 35 岁及以上的女性相比，15-24 岁的女性（比值比（OR）=0.69，95%置信区间（CI）=0.56-0.86，p=0.001）接受更好咨询的可能性较低。未接受教育（OR=0.52，95%CI=0.33-0.82，p=0.005）、小学（OR=0.56，95%CI=0.44-0.71，p<0.001）和中学（OR=0.79，95%CI=0.65-0.98，p=0.028）的女性接受更好咨询的可能性较低，与接受高等教育的女性相比。接受长效可逆避孕方法（OR=1.75，95%CI=1.42-2.17，p<0.001）和方法转换者（OR=1.24，95%CI=1.03-1.50，p=0.027）的女性，与接受短期方法和继续使用方法的女性相比，接受更好质量咨询的可能性更高。
结论
考虑到一些女性在服务提供点根本没有接受任何形式的咨询，肯尼亚计划生育咨询的质量仍不理想。需要审查现有的计划生育准则和培训包，以更加注重卫生提供者提供的咨询服务质量。应在社区一级计划生育干预措施中纳入赋予妇女权力以要求提供优质服务的社会问责战略。
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