The effect of a family health-team approach on the quality of health care for Palestinian infants in Jordan: a mixed methods study

Abstract

BackgroundThe United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides primary health care for Palestinian refugees in the Middle East. Recently, a family health-team approach was implemented to provide patient-centred instead of disease-centred care. Teams comprise at least one doctor, one nurse, and one clerk, and each team is appointed a certain number of families. The aim of this study was to assess the effect of this approach on the quality of infant care in Jordan. MethodsIn this cross-sectional study, we compared care in an intervention health centre with care in a control centre. Data on the effectiveness of care of all infants aged 19–23 months were collected through medical record review between April and June, 2014. Effectiveness was assessed comparing immunisation, anaemia, and growth monitoring data. Patient-centeredness was assessed through semi-structured interviews with parents. Written consent was provided by all participants. Ethical approval was obtained from UNRWA's Ethics Office. FindingsThe parents of 437 infants were included in the intervention group, and the parents of 552 infants were included in the control group. The odds for attending all growth monitoring visits were higher in the intervention group than in the control group (odds ratio [OR] 2·8, 95% CI 1·90–4·34). The odds for receiving iron to treat anaemia were also higher in the intervention group than in the control group (4·76, 1·28–17·7). We found no difference in anaemia screening rates (0·75, 0·40–1·40), attendance of follow-up visits for anaemia (0.7, 0·29–1·69), or vaccination rates (1·20, 0·68–2·11). Interviews (n=11) revealed waiting times at health centres to be perceived as barriers for parents when seeking care for their infants. Acceptability and continuity of care were not perceived as barriers. InterpretationWhereas the family health-team approach has the potential to improve infant care in terms of growth monitoring and anaemia treatment, results might be attributable to other causes as data used in this study date back to when the approach had only been implemented for 3 months. FundingFondsendesk, VU University Amsterdam, the Netherlands, the Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) Headquarters, Amman, Jordan.