Client and facility level determinants of quality of care in family planning services in Ethiopia: Multilevel modelling

Gizachew Assefa Tessema, Mohammad Afzal Mahmood, Judith Streak Gomersall, Yibeltal Assefa, Theodros Getachew Zemedu, Mengistu Kifle, Caroline O. Laurence

Research output: Chapter in Book/Report/Conference proceedingChapter

5 Citations (Scopus)

Abstract

INTRODUCTION: Over the last two decades, while contraceptive use has improved in Ethiopia, the contraceptive prevalence rate remains low. In addition to socio-demographic and cultural factors, the quality of care in Family Planning (FP) services is an important determining factor of FP utilization. However, little research exists on the determinants of quality of care in FP services in Ethiopia. This study aims to identify the client and facility level determinants of quality of care in FP services in Ethiopia., METHODS: This study was based on the first Ethiopian Services Provision Assessment Plus (ESPA+) survey conducted in 2014. A total of 1247 clients nested in 374 health facilities were included in the analysis. Multilevel mixed-effects logistic regression modelling was conducted. The outcome variable, client satisfaction, was created using polychoric principal component analysis using eleven facets that reflect client satisfaction., RESULTS: The results showed that both client-level and facility-level factors were associated with quality of care in FP services in Ethiopia. At the client-level; provision of information on potential side effects of contraceptive method (AOR = 5.22, 95% CI: 2.13-12.80), and number of history and physical assessments (AOR = 1.19, 95% CI: 1.03-1.34) were positively associated with client satisfaction, whereas waiting times of 30 minutes to two hours (AOR = 0.11, 95% CI: 0.03-0.33) was negatively associated with client satisfaction. At the facility-level; urban location (AOR = 4.61, 95% CI: 1.04-20.58), and availability of FP guidelines/protocols for providers (AOR = 4.90, 95% CI: 1.19-20.19) had positive significant effect on client satisfaction., CONCLUSION: Quality improvement programs in FP services in Ethiopia should focus on shortening waiting times and provision of information about the potential side effects of contraceptive methods. It is also important to improve health providers' skills in thorough client history taking and physical assessment. Further distribution and implementation of best practice guidelines for providers working in the FP services must be a priority.
LanguageEnglish
Title of host publicationPLoS ONE
PublisherPublic Library of Science
ISBN (Print)1111111111
DOIs
Publication statusPublished - 1 Jun 2017

Publication series

NamePLoS ONE
Volume12

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Tessema, G. A., Mahmood, M. A., Gomersall, J. S., Assefa, Y., Zemedu, T. G., Kifle, M., & Laurence, C. O. (2017). Client and facility level determinants of quality of care in family planning services in Ethiopia: Multilevel modelling. In PLoS ONE (PLoS ONE; Vol. 12). Public Library of Science. https://doi.org/10.1371/journal.pone.0179167
Tessema, Gizachew Assefa ; Mahmood, Mohammad Afzal ; Gomersall, Judith Streak ; Assefa, Yibeltal ; Zemedu, Theodros Getachew ; Kifle, Mengistu ; Laurence, Caroline O. / Client and facility level determinants of quality of care in family planning services in Ethiopia: Multilevel modelling. PLoS ONE. Public Library of Science, 2017. (PLoS ONE).
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abstract = "INTRODUCTION: Over the last two decades, while contraceptive use has improved in Ethiopia, the contraceptive prevalence rate remains low. In addition to socio-demographic and cultural factors, the quality of care in Family Planning (FP) services is an important determining factor of FP utilization. However, little research exists on the determinants of quality of care in FP services in Ethiopia. This study aims to identify the client and facility level determinants of quality of care in FP services in Ethiopia., METHODS: This study was based on the first Ethiopian Services Provision Assessment Plus (ESPA+) survey conducted in 2014. A total of 1247 clients nested in 374 health facilities were included in the analysis. Multilevel mixed-effects logistic regression modelling was conducted. The outcome variable, client satisfaction, was created using polychoric principal component analysis using eleven facets that reflect client satisfaction., RESULTS: The results showed that both client-level and facility-level factors were associated with quality of care in FP services in Ethiopia. At the client-level; provision of information on potential side effects of contraceptive method (AOR = 5.22, 95{\%} CI: 2.13-12.80), and number of history and physical assessments (AOR = 1.19, 95{\%} CI: 1.03-1.34) were positively associated with client satisfaction, whereas waiting times of 30 minutes to two hours (AOR = 0.11, 95{\%} CI: 0.03-0.33) was negatively associated with client satisfaction. At the facility-level; urban location (AOR = 4.61, 95{\%} CI: 1.04-20.58), and availability of FP guidelines/protocols for providers (AOR = 4.90, 95{\%} CI: 1.19-20.19) had positive significant effect on client satisfaction., CONCLUSION: Quality improvement programs in FP services in Ethiopia should focus on shortening waiting times and provision of information about the potential side effects of contraceptive methods. It is also important to improve health providers' skills in thorough client history taking and physical assessment. Further distribution and implementation of best practice guidelines for providers working in the FP services must be a priority.",
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Tessema, GA, Mahmood, MA, Gomersall, JS, Assefa, Y, Zemedu, TG, Kifle, M & Laurence, CO 2017, Client and facility level determinants of quality of care in family planning services in Ethiopia: Multilevel modelling. in PLoS ONE. PLoS ONE, vol. 12, Public Library of Science. https://doi.org/10.1371/journal.pone.0179167

Client and facility level determinants of quality of care in family planning services in Ethiopia: Multilevel modelling. / Tessema, Gizachew Assefa; Mahmood, Mohammad Afzal; Gomersall, Judith Streak; Assefa, Yibeltal; Zemedu, Theodros Getachew; Kifle, Mengistu; Laurence, Caroline O.

PLoS ONE. Public Library of Science, 2017. (PLoS ONE; Vol. 12).

Research output: Chapter in Book/Report/Conference proceedingChapter

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T1 - Client and facility level determinants of quality of care in family planning services in Ethiopia: Multilevel modelling

AU - Tessema, Gizachew Assefa

AU - Mahmood, Mohammad Afzal

AU - Gomersall, Judith Streak

AU - Assefa, Yibeltal

AU - Zemedu, Theodros Getachew

AU - Kifle, Mengistu

AU - Laurence, Caroline O.

PY - 2017/6/1

Y1 - 2017/6/1

N2 - INTRODUCTION: Over the last two decades, while contraceptive use has improved in Ethiopia, the contraceptive prevalence rate remains low. In addition to socio-demographic and cultural factors, the quality of care in Family Planning (FP) services is an important determining factor of FP utilization. However, little research exists on the determinants of quality of care in FP services in Ethiopia. This study aims to identify the client and facility level determinants of quality of care in FP services in Ethiopia., METHODS: This study was based on the first Ethiopian Services Provision Assessment Plus (ESPA+) survey conducted in 2014. A total of 1247 clients nested in 374 health facilities were included in the analysis. Multilevel mixed-effects logistic regression modelling was conducted. The outcome variable, client satisfaction, was created using polychoric principal component analysis using eleven facets that reflect client satisfaction., RESULTS: The results showed that both client-level and facility-level factors were associated with quality of care in FP services in Ethiopia. At the client-level; provision of information on potential side effects of contraceptive method (AOR = 5.22, 95% CI: 2.13-12.80), and number of history and physical assessments (AOR = 1.19, 95% CI: 1.03-1.34) were positively associated with client satisfaction, whereas waiting times of 30 minutes to two hours (AOR = 0.11, 95% CI: 0.03-0.33) was negatively associated with client satisfaction. At the facility-level; urban location (AOR = 4.61, 95% CI: 1.04-20.58), and availability of FP guidelines/protocols for providers (AOR = 4.90, 95% CI: 1.19-20.19) had positive significant effect on client satisfaction., CONCLUSION: Quality improvement programs in FP services in Ethiopia should focus on shortening waiting times and provision of information about the potential side effects of contraceptive methods. It is also important to improve health providers' skills in thorough client history taking and physical assessment. Further distribution and implementation of best practice guidelines for providers working in the FP services must be a priority.

AB - INTRODUCTION: Over the last two decades, while contraceptive use has improved in Ethiopia, the contraceptive prevalence rate remains low. In addition to socio-demographic and cultural factors, the quality of care in Family Planning (FP) services is an important determining factor of FP utilization. However, little research exists on the determinants of quality of care in FP services in Ethiopia. This study aims to identify the client and facility level determinants of quality of care in FP services in Ethiopia., METHODS: This study was based on the first Ethiopian Services Provision Assessment Plus (ESPA+) survey conducted in 2014. A total of 1247 clients nested in 374 health facilities were included in the analysis. Multilevel mixed-effects logistic regression modelling was conducted. The outcome variable, client satisfaction, was created using polychoric principal component analysis using eleven facets that reflect client satisfaction., RESULTS: The results showed that both client-level and facility-level factors were associated with quality of care in FP services in Ethiopia. At the client-level; provision of information on potential side effects of contraceptive method (AOR = 5.22, 95% CI: 2.13-12.80), and number of history and physical assessments (AOR = 1.19, 95% CI: 1.03-1.34) were positively associated with client satisfaction, whereas waiting times of 30 minutes to two hours (AOR = 0.11, 95% CI: 0.03-0.33) was negatively associated with client satisfaction. At the facility-level; urban location (AOR = 4.61, 95% CI: 1.04-20.58), and availability of FP guidelines/protocols for providers (AOR = 4.90, 95% CI: 1.19-20.19) had positive significant effect on client satisfaction., CONCLUSION: Quality improvement programs in FP services in Ethiopia should focus on shortening waiting times and provision of information about the potential side effects of contraceptive methods. It is also important to improve health providers' skills in thorough client history taking and physical assessment. Further distribution and implementation of best practice guidelines for providers working in the FP services must be a priority.

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Tessema GA, Mahmood MA, Gomersall JS, Assefa Y, Zemedu TG, Kifle M et al. Client and facility level determinants of quality of care in family planning services in Ethiopia: Multilevel modelling. In PLoS ONE. Public Library of Science. 2017. (PLoS ONE). https://doi.org/10.1371/journal.pone.0179167