Jiwani Safia S, Mutua Martin Kavao, Jacobs Choolwe, Musukuma Mwiche, Njeri Anne, Adero Godfrey, Ngosa Dennis, Abajobir Amanuel, Faye Cheikh Mbacké, Boerma Ties, Amouzou Agbessi
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
African Population and Health Research Centre, Nairobi, Kenya.
J Glob Health. 2025 Mar 28;15:04090. doi: 10.7189/jogh.15.04090.
Experience of care is typically measured through client exit surveys administered in the facility. Evidence suggests that such measures suffer from courtesy reporting bias whereby respondents do not accurately report on their experiences while in the facility. We explored the presence of courtesy bias by comparing women's reported experience of person-centred maternity care (PCMC) from facility-based client exit surveys to mobile phone-based surveys out of the facility in Nairobi and Lusaka's urban informal settlements.
We randomly and independently sampled women in the facilities for either a facility-based survey (n = 233 in Lusaka and n = 112 in Nairobi) or a mobile phone-based survey (n = 203 in Lusaka and n = 300 in Nairobi) within one to two weeks of facility discharge. The questionnaire included a validated PCMC scale. After adjusting for differences in women's characteristics across groups, we compared PCMC scores between facility and phone-based samples. We ran multilevel linear regression models to assess PCMC by survey modality in each city.
In both cities, over 70.0% of women were aged 20-34 years and were married, at least two thirds had secondary education, and over 95.0% were unaccompanied during labour/delivery. The overall PCMC score was 69.3% among women surveyed on the phone compared to 70.2% among those surveyed in the facility in Nairobi. In Lusaka, it was 57.5% on the phone compared to 56.8% in-facility. We found no statistically significant differences in PCMC scores between survey modalities in both cities, after adjusting for differences in women's characteristics.
We did not detect significant courtesy reporting bias in PCMC in facility-based client exit surveys in the context of urban informal settlements in Nairobi and Lusaka. Experience of PCMC can be measured through in-facility client exit surveys or mobile phone surveys. However, it is critical to address challenges related to a mobile phone-based approach.
护理体验通常通过在医疗机构内进行的患者出院调查来衡量。有证据表明，此类测量存在礼貌性报告偏差，即受访者不会准确报告他们在医疗机构期间的体验。我们通过比较在基于医疗机构的患者出院调查中女性报告的以产妇为中心的护理（PCMC）体验与在内罗毕和卢萨卡城市非正式住区进行的基于手机的医疗机构外调查，来探究礼貌性偏差的存在情况。
在患者出院后的一到两周内，我们在医疗机构中随机且独立地抽取女性进行基于医疗机构的调查（卢萨卡233例，内罗毕112例）或基于手机的调查（卢萨卡203例，内罗毕300例）。问卷包括一个经过验证的PCMC量表。在调整了各组女性特征的差异后，我们比较了基于医疗机构和基于手机的样本的PCMC得分。我们运行了多水平线性回归模型，以按每个城市的调查方式评估PCMC。
在两个城市中，超过70.0%的女性年龄在20 - 34岁之间且已婚，至少三分之二的女性接受过中等教育，超过95.0%的女性在分娩时无人陪伴。在内罗毕，接受手机调查的女性的总体PCMC得分为69.3%，而在医疗机构接受调查的女性为70.2%。在卢萨卡，手机调查的得分为57.5%，医疗机构内调查的得分为56.8%。在调整了女性特征的差异后，我们发现两个城市中不同调查方式的PCMC得分没有统计学上的显著差异。
在内罗毕和卢萨卡城市非正式住区的背景下，我们在基于医疗机构的患者出院调查中未检测到PCMC方面存在显著的礼貌性报告偏差。PCMC体验可以通过医疗机构内的患者出院调查或手机调查来衡量。然而，应对与基于手机的方法相关的挑战至关重要。
