优化孕产妇医疗服务可及性：印度本地治里公共与私立产前护理服务双重利用的混合方法研究

Optimizing Maternal Healthcare Access: A Mixed Method Study on Dual Utilization of Public and Private Antenatal Care Services in Puducherry, India.

作者信息

Madhusoodanan L Swathy, Thulasingam Mahalakshmy, Rajaa Sathish, Meenu Sai, Bhattacharya Debajyoti, Arikrishnan Kalaiselvy, Kar Sitanshu Sekhar

机构信息

Department of Preventive and Social Medicine, JIPMER, Puducherry, India.

出版信息

Indian J Community Med. 2025 Aug;50(Suppl 1):S76-S82. doi: 10.4103/ijcm.ijcm_785_23. Epub 2025 Feb 6.

DOI:10.4103/ijcm.ijcm_785_23

PMID:40949516

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12430846/

Abstract

BACKGROUND

Access to antenatal care (ANC) services has improved. However, it is also noted that some antenatal women seek multiple healthcare services. Exploring this practice will identify gaps in service provision and pave the path toward improving the quality of services.

OBJECTIVE

This study aimed to measure the concurrent use of public and private healthcare services for various components of ANC and understand the reasons for the dual utilization.

METHODOLOGY

This explanatory mixed-method study enrolled 177 mothers residing in Puducherry, who had given birth in the last three years. A pretested, semi-structured questionnaire was administered, and six key informant interviews were conducted. Integration was performed in the interpretation stage, and a joint display was used to depict the results. We adopted the Donabedian model during the analysis and organized the codes under these major themes[1] Access;[2] Delivery of the Services;[3] and Quality of Care.

RESULT

Most pregnant women (81.9%, 95% CI = 75.2%-86.8%) sought care from both public and private healthcare facilities, however, they preferred public facilities for delivery (74.6%, 95% CI = 67.6%-80.4%). The qualitative analysis revealed three major themes[1] Access;[2] Delivery of the Services;[3] and Quality of Care. Primary reasons for opting for private facilities included perceived superior ANC quality, organized care evident in scheduled appointments, reduced waiting time, frequent ultrasounds, personalized medication, and enhanced rapport with family. Women also believed that visits to government facilities are essential to avail the monetary benefits and have a seamless admission during delivery. They felt that government hospitals perform fewer cesarean sections.

CONCLUSION

Strengthening public-private partnerships could enhance antenatal care utilization, benefiting pregnant women and streamlining healthcare delivery.

摘要

背景

获得产前保健（ANC）服务的情况有所改善。然而，也注意到一些孕妇寻求多种医疗服务。探究这种做法将有助于找出服务提供方面的差距，并为提高服务质量铺平道路。

目的

本研究旨在衡量孕妇在产前保健的各个环节同时使用公共和私人医疗服务的情况，并了解双重利用的原因。

方法

这项解释性混合方法研究纳入了177名居住在本地治里、在过去三年内生过孩子的母亲。采用了经过预测试的半结构化问卷，并进行了六次关键信息访谈。在解释阶段进行整合，并使用联合展示来呈现结果。我们在分析过程中采用了唐纳贝迪安模型，并将编码按照以下主要主题进行组织：[1]可及性；[2]服务提供；[3]护理质量。

结果

大多数孕妇（81.9%，95%置信区间 = 75.2%-86.8%）同时在公共和私人医疗机构寻求护理，然而，她们更倾向于在公共机构分娩（74.6%，95%置信区间 = 67.6%-80.4%）。定性分析揭示了三个主要主题：[1]可及性；[2]服务提供；[3]护理质量。选择私人机构的主要原因包括认为产前保健质量更高、预约安排体现出的有序护理、等待时间缩短、频繁的超声检查、个性化用药以及与医护人员更好的关系。女性还认为前往政府机构就诊对于获得经济利益和分娩时顺利入院至关重要。她们觉得政府医院进行剖宫产的比例较低。