Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
North Carolina State University, Raleigh, NC, USA.
Reprod Health. 2021 Oct 30;18(1):215. doi: 10.1186/s12978-021-01261-1.
In low-and-middle income countries (LMICs), accurate measures of the elements of quality care provided by a health worker through family planning services (also known as process quality) are required to ensure family's contraceptives needs are being met. There are many tools used to assess family planning process quality of care (QoC) but no one standardized method. Those measuring QoC in LMICs should select an appropriate tool based the program context and financial/logistical parameters, but they require data on how well each tool measures routine clinical care. We aim to synthesize the literature on validity/comparability of family planning process QoC measurement tools through a quantitative systematic review with no meta-analysis.
We searched six literature databases for studies that compared quality measurements from different tools using quantitative statistics such as sensitivity/specificity, kappa statistic or absolute difference. We extracted the comparative measure along with other relevant study information, organized by quality indicator domain (e.g. counseling and privacy), and then classified the measure by low, medium, and high agreement.
We screened 8172 articles and identified eight for analysis. Studies comparing quality measurements from simulated clients, direct observation, client exit interview, provider knowledge quizzes, and medical record review were included. These eight studies were heterogenous in their methods and the measurements compared. There was insufficient data to estimate overall summary measures of validity for the tools. Client exit interviews compared to direct observation or simulated client protocols had the most data and they were a poor proxy of the actual quality care received for many measurements.
To measure QoC consistently and accurately in LMICs, standardized tools and measures are needed along with an established method of combining them for a comprehensive picture of quality care. Data on how different tools proxy quality client care will inform these guidelines. Despite the small number of studies found during the review, we described important differences on how tools measure quality of care.
在中低收入国家（LMICs），需要通过计划生育服务（也称为过程质量）准确衡量卫生工作者提供的质量护理要素，以确保家庭的避孕需求得到满足。有许多工具用于评估计划生育过程质量（QoC），但没有一种标准化方法。在 LMICs 中衡量 QoC 的工具应该根据项目背景和财务/后勤参数选择合适的工具，但他们需要有关每种工具如何衡量常规临床护理的数据。我们旨在通过一项不进行荟萃分析的定量系统评价，综合计划生育过程 QoC 测量工具的有效性/可比性文献。
我们在六个文献数据库中搜索了比较使用定量统计学（如敏感性/特异性、kappa 统计或绝对差异）的不同工具的质量测量结果的研究。我们提取了比较测量值以及其他相关研究信息，按质量指标领域（例如咨询和隐私）组织，并按低、中、高一致性对测量值进行分类。
我们筛选了 8172 篇文章，确定了 8 篇进行分析。研究比较了来自模拟客户、直接观察、客户退出访谈、提供者知识测验和病历审查的质量测量值。这些八项研究在其方法和比较的测量值方面存在异质性。没有足够的数据来估计工具的有效性的总体汇总衡量标准。与直接观察或模拟客户协议相比，客户退出访谈有更多的数据，对于许多测量值来说，它们只是实际获得的质量护理的一个很差的代理。
要在 LMICs 中一致、准确地衡量 QoC，需要标准化工具和措施，以及结合这些工具的综合质量护理的既定方法。关于不同工具如何代理质量客户护理的数据将为这些指南提供信息。尽管在审查过程中发现的研究数量很少，但我们描述了工具如何衡量护理质量的重要差异。
