School of Public Health, Faculty of Medicine, Imperial College London, Medical School Building, St Mary's Hospital, Norfolk Place, London, W2 1PG, UK.
Evans School of Public Policy and Governance, University of Washington Seattle, University of Washington, Box 353055, Seattle, WA, 98195-3055, USA.
BMC Health Serv Res. 2022 Jun 4;22(1):746. doi: 10.1186/s12913-022-08085-0.
Antenatal care (ANC) is a service that can reduce the incidence of maternal and neonatal deaths when provided by skilled healthcare workers. Patient satisfaction is an important health system responsiveness goal which has been shown to influence adherence to healthcare interventions. This study aims to assess the determinants of pregnant women's satisfaction with ANC across Kenya, Tanzania, and Malawi using nationally representative Service Provision Assessment data.
Patient satisfaction was conceptualised mainly based on Donabedian's theory of healthcare quality with patient characteristics, structure, and process as the major determinants. Bivariate and multivariate analyses were conducted to identify the potential determinants.
Findings show that satisfaction was negatively associated with women's age (AOR: 0.95; 95% CI: 0.92-0.99) and having a secondary (AOR: 0.39; 95% CI: 0.17-0.87) or tertiary education (AOR: 0.41; 95% CI: 0.17-0.99) in Kenya. Women on their first pregnancy were more likely to report satisfaction in Tanzania (AOR: 1.62; 95% CI: 1.00-2.62) while women were less likely to report being satisfied in their second trimester in Malawi (AOR: 0.31; 95% CI: 0.09-0.97). The important structural and process factors for patient satisfaction included: private versus public run facilities in Kenya (AOR: 2.05; 95% CI: 1.22-3.43) and Malawi (AOR: 1.85; 95% CI: 0.99-3.43); level of provider training, that is, specialist versus enrolled nurse in Tanzania (AOR: 0.35; 95% CI: 0.13-0.93) or clinical technician in Malawi (AOR: 0.08; 95% CI: 0.01-0.36); and shorter waiting times across all countries.
Findings highlight the importance of professional proficiency and efficient service delivery in determining pregnant women's satisfaction with ANC. Future studies should incorporate both patient characteristics and institutional factors at health facilities into their conceptualisation of patient satisfaction.
产前护理 (ANC) 是一项服务，当由熟练的医疗保健工作者提供时，可以降低产妇和新生儿死亡的发生率。患者满意度是医疗体系响应性的一个重要目标，已证明它会影响对医疗干预的遵守。本研究旨在使用全国代表性的服务提供评估数据评估肯尼亚、坦桑尼亚和马拉维的孕妇对 ANC 的满意度的决定因素。
患者满意度主要基于 Donabedian 的医疗保健质量理论进行概念化，患者特征、结构和过程是主要决定因素。进行了单变量和多变量分析以确定潜在的决定因素。
研究结果表明，满意度与女性的年龄呈负相关（AOR：0.95；95%CI：0.92-0.99），在肯尼亚，具有中学（AOR：0.39；95%CI：0.17-0.87）或高等教育（AOR：0.41；95%CI：0.17-0.99）的女性更有可能报告满意度较低。坦桑尼亚的首次怀孕的女性更有可能报告满意度（AOR：1.62；95%CI：1.00-2.62），而在马拉维，女性在第二个三个月报告满意度较低（AOR：0.31；95%CI：0.09-0.97）。对患者满意度很重要的结构和过程因素包括：肯尼亚（AOR：2.05；95%CI：1.22-3.43）和马拉维（AOR：1.85；95%CI：0.99-3.43）的私营与公营设施之间的差异；提供者培训水平，即坦桑尼亚的专家与注册护士（AOR：0.35；95%CI：0.13-0.93）或马拉维的临床技术人员（AOR：0.08；95%CI：0.01-0.36）之间的差异；以及所有国家的较短的等待时间。
研究结果强调了专业水平和高效服务提供在确定孕妇对 ANC 的满意度方面的重要性。未来的研究应该将患者特征和医疗机构的机构因素纳入他们对患者满意度的概念化中。
