Abstract
BackgroundChanges in the values, attitudes, and interactions of both service users and health care providers are central to social accountability processes in reproductive health. However, there is little consensus on how best to measure these latent changes. This paper reports on the adaptation and validation of measures that capture these changes in Tanzania and Ghana.MethodsThe CaPSAI theory of change determined the dimensions of the measure, and we adapted existing items for the survey items. Trained data collectors used a survey to collect data from 752 women in Tanzania and 750 women in Ghana attending contraceptive services. We used reliability analysis, exploratory, and confirmatory factor analysis to assess the validity and reliability of these measures in each country.ResultsThe measure has high construct validity and reliability in both countries. We identified several subscales in both countries, 10 subscales in Tanzania, and 11 subscales in Ghana. Many of the domains and items were shared across both settings.ConclusionThe study suggests that the multi-dimensional scales have high construct validity and reliability in both countries. Though there were differences in the two country contexts and in items and scales, there was convergence in the analysis that suggests that this measure may be relevant in different settings and should be validated in new settings.Trial registrationACTRN12619000378123.
Highlights
Changes in the values, attitudes, and interactions of both service users and health care providers are central to social accountability processes in reproductive health
Exploratory, and confirmatory factor analysis to assess the validity and reliability of these measures in each country. The development of these measures is part of a more extensive complex intervention study, Community and Provider Social Accountability Intervention (CaPSAI), undertaken in Tanzania and Ghana [36]. These countries were selected based on the following criteria: (1) existence of a national civil society organization (CSO) partner with experience in social accountability, (2) low modern contraceptive prevalence rate, (3) availability of contraceptive services at the point of contact where cost is not a barrier to access, (4) an enabling environment in terms of the potential for the health system to respond to the social accountability, and (5) the existence of formal structures linking the community with the health system
The mean age of the women that participated in the survey was 28.4 in Ghana and 27.8 in Tanzania
Summary
Attitudes, and interactions of both service users and health care providers are central to social accountability processes in reproductive health. Evidence increasingly indicates the positive effects of social accountability on improving the quality of care and experience in other health sectors and concerning contraception [5, 13, 38]. We define social accountability as “citizens’ efforts at ongoing meaningful collective engagement with public institutions for accountability in the provision of public goods.” ([18], pg 161). It is often best recognized through the tools used to facilitate the process, such as community scorecards, social audits, and participatory budget. The all-important changes in service users and providers’ norms, values, and attitudes are often not measured, possibly because they are not observable but rather latent and multi-dimensional
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