Department of Disease Control, London School of Hygiene & Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK.
Save the Children, Blantyre, Malawi.
BMC Health Serv Res. 2022 Apr 28;22(1):572. doi: 10.1186/s12913-022-07983-7.
Postpartum women represent a considerable share of the global unmet need for modern contraceptives. Evidence suggests that the integration of family planning (FP) with childhood immunisation services could help reduce this unmet need by providing repeat opportunities for timely contact with FP services. However, little is known about the clients' experiences of FP services that are integrated with childhood immunisations, despite being crucial to contraceptive uptake and repeat service utilisation.
The responsiveness of FP services that were integrated with childhood immunisations in Malawi was assessed using cross-sectional convergent mixed methods. Exit interviews with clients (n=146) and audits (n=15) were conducted in routine outreach clinics. Responsiveness scores across eight domains were determined according to the proportion of clients who rated each domain positively. Text summary analyses of qualitative data from cognitive interviewing probes were also conducted to explain responsiveness scores. Additionally, Spearman rank correlation and Pearson's chi-squared test were used to identify correlations between domain ratings and to examine associations between domain ratings and client, service and clinic characteristics.
Responsiveness scores varied across domains: dignity (97.9%); service continuity (90.9%); communication (88.7%); ease of access (77.2%); counselling (66.4%); confidentiality (62.0%); environment (53.9%) and choice of provider (28.4%). Despite some low performing domains, 98.6% of clients said they would recommend the clinic to a friend or family member interested in FP. The choice of provider, communication, confidentiality and counselling ratings were positively associated with clients' exclusive use of one clinic for FP services. Also, the organisation of services in the clinics and the providers' individual behaviours were found to be critical to service responsiveness.
This study establishes that in routine outreach clinics, FP services can be responsive when integrated with childhood immunisations, particularly in terms of the dignity and service continuity afforded to clients, though less so in terms of the choice of provider, environment, and confidentiality experienced. Additionally, it demonstrates the value of combining cognitive interviewing techniques with Likert questions to assess service responsiveness.
产后妇女在全球未满足的现代避孕需求中占相当大的比例。有证据表明，将计划生育（FP）与儿童免疫服务相结合，通过为及时接触 FP 服务提供重复机会，有助于减少这种未满足的需求。然而，尽管这对于避孕的采用和重复服务的利用至关重要，但对于与儿童免疫相结合的 FP 服务，人们对其客户体验知之甚少。
采用横断面收敛混合方法评估马拉维与儿童免疫相结合的 FP 服务的响应能力。在常规外展诊所对 146 名客户进行了离职访谈，并对 15 次审计进行了审核。根据客户对每个领域的积极评价比例，确定了 8 个领域的响应能力得分。还对认知访谈探针的定性数据进行了文本摘要分析，以解释响应能力得分。此外，还使用 Spearman 秩相关和 Pearson 的卡方检验来确定各领域评分之间的相关性，并检查各领域评分与客户、服务和诊所特征之间的关联。
各领域的响应能力评分存在差异：尊严（97.9%）；服务连续性（90.9%）；沟通（88.7%）；易于获取（77.2%）；咨询（66.4%）；保密性（62.0%）；环境（53.9%）和提供者选择（28.4%）。尽管有些领域的得分较低，但 98.6%的客户表示他们会向对 FP 服务感兴趣的朋友或家人推荐该诊所。提供者选择、沟通、保密性和咨询评分与客户对 FP 服务的独家使用一个诊所呈正相关。此外，还发现诊所内服务的组织和提供者的个人行为对服务响应能力至关重要。
这项研究表明，在常规外展诊所中，当 FP 服务与儿童免疫相结合时，服务可以具有响应能力，特别是在为客户提供的尊严和服务连续性方面，尽管在提供者选择、环境和保密性方面的体验较少。此外，它还展示了结合认知访谈技术和李克特量表评估服务响应能力的价值。
