TY - JOUR
T1 - Understanding client and provider perspectives of antenatal care service quality
T2 - A qualitative multi-method study from Tanzania
AU - Sheffel, Ashley
AU - Heidkamp, Rebecca
AU - Mpembeni, Rose
AU - Bujari, Peter
AU - Gupta, Jaya
AU - Niyeha, Debora
AU - Aung, Tricia
AU - Bakengesa, Victor
AU - Msuya, John
AU - Munos, Melinda
AU - Kennedy, Caitlin
N1 - Funding Information:
The authors wish to thank Health Promotion Tanzania for their assistance with data collection and conducting interviews. We are grateful to the regional and district health authorities, health facility managers, health providers, and community leaders in Tanga Region, Tanzania and to the women who generously shared their time and insights in this research. We would also like to thank the members of the NEP Technical Task Team (Clement Kihinga, Deogratius Malamsha, and Yasinta Tabu) as well as Elizabeth Fox and Katharine Shelley at JHSPH for their contribution to the study. In addition, the authors wish to acknowledge Global Affairs Canada for their support of the National Evaluation Platform as well as the Tanzania National Bureau of Statistics, the home institution of the National Evaluation Platform in Tanzania, who helped make this work possible. This work was completed as part of the National Evaluation Platform project with funding from the Department of Global Affairs Canada. The funder had no role in the study design, data collection, analysis and interpretation of data, or manuscript writing.
Publisher Copyright:
© 2019 The Author(s).
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Background Measures of quality of care in low-and middle-income countries (LMICs) rarely include experience of care. This gap in service quality metrics may be driven by a lack of understanding of client and provider perspectives. Understanding these perspectives is a critical first step in not only improving metrics, but also in improving service delivery. This study identifies the items antenatal care (ANC) clients and health care providers in Tanzania associate with a quality ANC service and explores the experience of care domain from both client and provider perspectives. Methods We conducted semi-structured interviews with15 providers and 35 clients in Tanzania that included a free-listing activity to elicit items clients and providers associate with quality ANC services. We analyzed the free-listing for rank order and frequency to identify the most salient items, which were included in the second phase of data collection. We then conducted semi-structured interviews with a pile sort activity with the same 15 providers and 32 new clients to understand the importance of the items identified in the free-listing. We used a thematic analysis driven by the framework approach to analyze interview data. Results Both clients and providers perceived quality of ANC as being comprised of items related to experience of care, provision of care, and cross-cutting essential physical and human resources. The free-listing findings illuminated that the experience of care was equally important to clients and providers as the availability of physical and human resources and the content of the care delivered. In addition, clients and providers perceived that a positive patient care experience-marked by good communication, active listening, keeping confidentiality, and being spoken to politely-increased utilization of health services and improved health outcomes. Conclusions The experience of care in LMICs is an overlooked, yet critically important topic. Understanding the experience of care from those who receive and deliver services is key to measuring and improving the quality of ANC. Our research highlights the importance of incorporating experience of care into future quality improvement activities and quality measures. By doing so, we identify barriers and facilitating factors of practical use to policy-makers and governments in LMICs.
AB - Background Measures of quality of care in low-and middle-income countries (LMICs) rarely include experience of care. This gap in service quality metrics may be driven by a lack of understanding of client and provider perspectives. Understanding these perspectives is a critical first step in not only improving metrics, but also in improving service delivery. This study identifies the items antenatal care (ANC) clients and health care providers in Tanzania associate with a quality ANC service and explores the experience of care domain from both client and provider perspectives. Methods We conducted semi-structured interviews with15 providers and 35 clients in Tanzania that included a free-listing activity to elicit items clients and providers associate with quality ANC services. We analyzed the free-listing for rank order and frequency to identify the most salient items, which were included in the second phase of data collection. We then conducted semi-structured interviews with a pile sort activity with the same 15 providers and 32 new clients to understand the importance of the items identified in the free-listing. We used a thematic analysis driven by the framework approach to analyze interview data. Results Both clients and providers perceived quality of ANC as being comprised of items related to experience of care, provision of care, and cross-cutting essential physical and human resources. The free-listing findings illuminated that the experience of care was equally important to clients and providers as the availability of physical and human resources and the content of the care delivered. In addition, clients and providers perceived that a positive patient care experience-marked by good communication, active listening, keeping confidentiality, and being spoken to politely-increased utilization of health services and improved health outcomes. Conclusions The experience of care in LMICs is an overlooked, yet critically important topic. Understanding the experience of care from those who receive and deliver services is key to measuring and improving the quality of ANC. Our research highlights the importance of incorporating experience of care into future quality improvement activities and quality measures. By doing so, we identify barriers and facilitating factors of practical use to policy-makers and governments in LMICs.
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U2 - 10.7189/JOGH.09.011101
DO - 10.7189/JOGH.09.011101
M3 - Article
C2 - 31275570
AN - SCOPUS:85069269415
SN - 2047-2978
VL - 9
JO - Journal of global health
JF - Journal of global health
IS - 1
M1 - 011101
ER -