Acceptability as a key determinant of client satisfaction: lessons from an evaluation of adolescent friendly health services in Mongolia

Purpose: The primary focus of this study is to investigate which characteristics of health service quality are most likely to determine client satisfaction with health services among adolescents in Mongolia. Methods: Data were gathered from 1301 male and female clients. Exit interviews were used to measure client satisfaction; 82 clinics were visited. All clients between the ages of 10 and 19 years were asked to participate in the client exit interview; those who agreed to participate completed the questionnaire. Bivariate and multivariate analyses were conducted to determine significant associations between service satisfaction and the independent variables. All variables showing a significant bivariate association with service satisfaction (p ≤ .05) were retained for logistic regression analyses. Results: The strongest determinant to client satisfaction related to acceptability: adequate facility physical environment, receiving adequate information about the facility, and if the facility was private (i.e., other people didn't know the services the client received). Additionally, clients who said they received some interruptions, either by other health workers or clients, were significantly less likely to be satisfied with the services. Conclusions: This study demonstrates the importance of understanding and measuring different aspects of health service quality in defining client satisfaction. Although both accessibility and acceptability of services have been shown to be important in other studies, characteristics relating to acceptability emerged as critical in determining client satisfaction among adolescents in Mongolia. Efforts to improve health service delivery to adolescents need to understand and address the "adolescent friendly" characteristics that are most salient, and least fulfilled, in each particular context.