Quality of perinatal care services from the user\u2019s perspective: a Dutch study applies the World Health Organization\u2019s responsiveness concept

Jacoba Van Der Kooy,Erwin Birnie,Gouke J Bonsel,Nicole B Valentine,Semiha Denktas,Johanna P De Graaf,Eric A P Steegers

doi:10.1186/s12884-017-1464-8

Abstract

BackgroundThe concept of responsiveness was introduced by the World Health Organization (WHO) to address non-clinical aspects of service quality in an internationally comparable way. Responsiveness is defined as aspects of the way individuals are treated and the environment in which they are treated during health system interactions.The aim of this study is to assess responsiveness outcomes, their importance and factors influencing responsiveness outcomes during the antenatal and delivery phases of perinatal care.MethodThe Responsiveness in Perinatal and Obstetric Health Care Questionnaire was developed in 2009/10 based on the eight-domain WHO concept and the World Health Survey questionnaire. After ethical approval, a total of 171 women, who were 2 weeks postpartum, were recruited from three primary care midwifery practices in Rotterdam, the Netherlands, using face-to-face interviews. We dichotomized the original five ordinal response categories for responsiveness attainment as ‘poor’ and good responsiveness and analyzed the ranking of the domain performance and importance according to frequency scores. We used a series of independent variables related to health services and users’ personal background characteristics in multiple logistic regression analyses to explain responsiveness.ResultsPoor responsiveness outcomes ranged from 5.9% to 31.7% for the antenatal phase and from 9.7% to 27.1% for the delivery phase. Overall for both phases, ‘respect for persons’ (Autonomy, Dignity, Communication and Confidentiality) domains performed better and were judged to be more important than ‘client orientation’ domains (Choice and Continuity, Prompt Attention, Quality of Basic Amenities, Social Consideration). On the whole, responsiveness was explained more by health-care and health related issues than personal characteristics.ConclusionTo improve responsiveness outcomes caregivers should focus on domains in the category ‘client orientation’.

Highlights

The concept of responsiveness was introduced by the World Health Organization (WHO) to address non-clinical aspects of service quality in an internationally comparable way
The ReproQ asks essentially the same set of questions for the three different phases of perinatal care but, for purposes of this paper, we focus on two phases - the antenatal and delivery phases – the most important for the infant mortality challenge mentioned earlier
About 70% of women were between the ages of 25 and 34, only 4% had no or low education, half were of Dutch origin and about half came from underprivileged neighbourhoods, and most had a high proficiency of spoken Dutch (89%)

Summary

Introduction

The concept of responsiveness was introduced by the World Health Organization (WHO) to address non-clinical aspects of service quality in an internationally comparable way. Quality of care literature supports the view that non-clinical aspects of health care, such as service quality, are important aspects of the system’s performance too and, may affect clinical outcomes [1,2,3]. An important approach to measuring service quality is the concept of ‘responsiveness’, which was introduced by the World Health Organization in the World Health Report 2000 to compare service quality in an internationally comparable way. Being based on utility theory, the concept separates the utility individuals derive from clinical and non-clinical aspects, and from a policy perspective can be used to make trade-offs between nonclinical quality and clinical quality. Human rights law argues that the responsiveness features of a health system are important in their own right [10,11,12]

Objectives

Methods

Results

Discussion

Conclusion