Allotey Naa-Korkor, Appiah Evans K, Torpey Kwasi
Ethics and Research Management, Research and Development Division, Ghana Health Service, Accra, GHA.
Disease Control, Tolon District Health Directorate, Tolon, GHA.
Cureus. 2025 Aug 16;17(8):e90209. doi: 10.7759/cureus.90209. eCollection 2025 Aug.
Introduction Although there is a global increase in modern contraceptive uptake, some countries, including Ghana, have stalled, particularly in the northern part of the country. One contributory factor is the quality of family planning services provided at health facilities. Conventional methods used to assess the quality of care in health facilities may not be effective in identifying quality issues in areas like reproductive health. Nevertheless, mystery client (MC) surveys and feedback have been used globally to identify sensitive issues that conventional methods may have missed. However, there is limited evidence of their use in family planning services in Ghana. This study, therefore, aimed to use the MC approach with feedback to improve the quality of family planning service delivery based on specific actionable points in Northern Ghana. Methods Three rounds of mystery client surveys were completed in a quasi-experimental design with no control group in eight health facilities in 2019. Different sets of mystery clients were used, and feedback was given to health workers after each survey. Quality of care was graded using 13 actionable points. These actionable points include "Warm reception", "Confidentiality and Privacy", "Service available 24/7", "Identifying wandering clients", "Availability of preferred commodity", among others. The total score for each health facility was calculated, and the mean score for the eight facilities was determined. T-test and repeated-measures ANOVA were used to determine whether service improvement was significant. Minutes of feedback sessions were documented, and content analysis was done to identify relevant themes and codes. Results Grading for the three rounds of the mystery client surveys showed consistent service improvement for successive rounds. The mean scores of the quality of family planning services increased from 20.0 (±6.9) to 30.4 (±6.2), and the p-value is 0.0032. Some identified themes from the content analysis of the feedback sessions included "risk of identification of MCs by health workers", "reactions of health workers to their performance", and "district health authorities' decision to adopt the MC approach into their monitoring strategies". Conclusion Using successive mystery client surveys with the associated feedback based on specific actionable points improved the quality of family planning services. Decision makers should incorporate mystery client surveys with feedback in their monitoring strategies to identify sensitive issues that would be missed using conventional methods.
引言 尽管全球现代避孕措施的采用率有所上升，但包括加纳在内的一些国家却出现了停滞，尤其是在该国北部地区。一个促成因素是卫生设施提供的计划生育服务质量。用于评估卫生设施护理质量的传统方法可能无法有效识别生殖健康等领域的质量问题。然而，神秘顾客（MC）调查和反馈已在全球范围内用于识别传统方法可能遗漏的敏感问题。然而，在加纳的计划生育服务中使用这些方法的证据有限。因此，本研究旨在采用带有反馈的MC方法，根据加纳北部的具体可操作要点来提高计划生育服务的质量。
方法 2019年，在没有对照组的准实验设计中，对八个卫生设施进行了三轮神秘顾客调查。使用了不同组的神秘顾客，每次调查后都向卫生工作者提供反馈。护理质量使用13个可操作要点进行评分。这些可操作要点包括“热情接待”、“保密和隐私”、“全天候服务”、“识别徘徊的顾客”、“提供首选商品”等。计算每个卫生设施的总分，并确定八个设施的平均分。使用t检验和重复测量方差分析来确定服务改进是否显著。记录反馈会议的纪要，并进行内容分析以识别相关主题和编码。
结果 三轮神秘顾客调查的评分显示，连续几轮的服务持续改进。计划生育服务质量的平均分从20.0（±6.9）提高到30.4（±6.2），p值为0.0032。从反馈会议的内容分析中确定的一些主题包括“卫生工作者识别神秘顾客的风险”、“卫生工作者对其表现的反应”以及“地区卫生当局决定将神秘顾客方法纳入其监测策略”。
结论 使用连续的神秘顾客调查以及基于具体可操作要点的相关反馈提高了计划生育服务的质量。决策者应将带有反馈的神秘顾客调查纳入其监测策略，以识别使用传统方法会遗漏的敏感问题。
