Quality Of Care For Families Research Articles

Client and facility level determinants of quality of care in family planning services in Ethiopia: Multilevel modelling.

IntroductionOver the last two decades, while contraceptive use has improved in Ethiopia, the contraceptive prevalence rate remains low. In addition to socio-demographic and cultural factors, the quality of care in Family Planning (FP) services is an important determining factor of FP utilization. However, little research exists on the determinants of quality of care in FP services in Ethiopia. This study aims to identify the client and facility level determinants of quality of care in FP services in Ethiopia.MethodsThis study was based on the first Ethiopian Services Provision Assessment Plus (ESPA+) survey conducted in 2014. A total of 1247 clients nested in 374 health facilities were included in the analysis. Multilevel mixed-effects logistic regression modelling was conducted. The outcome variable, client satisfaction, was created using polychoric principal component analysis using eleven facets that reflect client satisfaction.ResultsThe results showed that both client-level and facility-level factors were associated with quality of care in FP services in Ethiopia. At the client-level; provision of information on potential side effects of contraceptive method (AOR = 5.22, 95% CI: 2.13–12.80), and number of history and physical assessments (AOR = 1.19, 95% CI: 1.03–1.34) were positively associated with client satisfaction, whereas waiting times of 30 minutes to two hours (AOR = 0.11, 95% CI: 0.03–0.33) was negatively associated with client satisfaction. At the facility-level; urban location (AOR = 4.61, 95% CI: 1.04–20.58), and availability of FP guidelines/protocols for providers (AOR = 4.90, 95% CI: 1.19–20.19) had positive significant effect on client satisfaction.ConclusionQuality improvement programs in FP services in Ethiopia should focus on shortening waiting times and provision of information about the potential side effects of contraceptive methods. It is also important to improve health providers’ skills in thorough client history taking and physical assessment. Further distribution and implementation of best practice guidelines for providers working in the FP services must be a priority.

Quality of care in family planning services in Senegal and their outcomes

BackgroundHigh quality of care in family planning (FP) services has been found to be associated with increased and continued use of contraceptive methods. The interpersonal skills and technical competence of the provider is one of the main components of quality of care. To study the process component of quality of care, the distribution of the FP counseling topics was examined by client, provider and facility characteristics. To assess the outcomes of quality of care, client satisfaction and their knowledge of their method’s protection from STIs were used. This study examined the factors associated with these outcomes with a focus on provider counseling and training.MethodsData from the 2012–2013 Senegal Service Provision Assessment survey was used for the analysis. The survey included a representative sample of the health facilities in Senegal and collects data by observing the clients’ FP visits and conducting exit interviews. The main outcomes of interest were provider’s counseling in FP, client’s satisfaction with FP services and client’s knowledge of their method’s protection from STIs. Several covariates were used in the analysis which represent client, provider and facility characteristics.ResultsThe level of counseling was inadequate-- very low proportions of providers that performed different types of counseling. Counseling was more likely to be provided to new than returning clients. Approximately 84% of the clients were very satisfied with services but only 58% had correct knowledge of their method’s protection from STIs. Clients were significantly less likely to be very satisfied when their providers counseled on side effects and when to return, and counseling provided on method’s protection from STIs did not significantly improve knowledge in this area. Clients seen by a provider with FP training had almost twice the odds of having correct knowledge about their method’s protection from STIs compared with clients seen by a provider with no recent training.ConclusionsThe percentage of providers offering FP counseling to their clients was relatively low and was ineffective on the client-focused outcomes. Interventions may be required for more effective counseling methods that are client-centered as well as providing more FP training to providers.

Research progress of family caregivers of patients with permanent colostomy

Enterostomy are a common surgical procedure in the treatment of rectal cancer, has more than 100 000 each year in our country requires enterostomy patients, whereas patients with postoperative rehabilitation and nursing leave the family caregivers, the study found that with baseline levels of care for people, and increased mortality 63% of caregivers within five years, attaches great importance to the caregivers of patients with life can avoid the occurrence of another patient, at the same time also can improve the quality of family care, reduce the demand for medical and waste. Therefore, this article will from the permanent patients underwent colostomy care burden of family caregivers, health education needs, psychological burden to understand colostomy caregivers are faced with the problem of our country, explore the mental and physical health of the caregivers related factors, provide the basis for effective follow disease intervention. Key words: Intestinal stoma; Family caregivers; Intervening measure

Factors Determining Quality of Care in Family Planning Services in Africa: A Systematic Review of Mixed Evidence.

BackgroundImproving use of family planning services is key to improving maternal health in Africa, and provision of quality of care in family planning services is critical to support higher levels of contraceptive uptake. The objective of this systematic review was to synthesize the available evidence on factors determining the quality of care in family planning services in Africa.MethodsQuantitative and qualitative studies undertaken in Africa, published in English, in grey and commercial literature, between 1990 and 2015 were considered. Methodological quality of included studies was assessed using standardized tools. Findings from the quantitative studies were summarized using narrative and tables. Client satisfaction was used to assess the quality of care in family planning services in the quantitative component of the review. Meta-aggregation was used to synthesize the qualitative study findings.ResultsFrom 4334 records, 11 studies (eight quantitative, three qualitative) met the review eligibility criteria. The review found that quality of care was influenced by client, provider and facility factors, and structural and process aspects of the facilities. Client’s waiting time, provider competency, provision/prescription of injectable methods, maintaining privacy and confidentiality were the most commonly identified process factors. The quality of stock inventory was the most commonly identified structural factor. The quality of care was also positively associated with privately-owned facilities. The qualitative synthesis revealed additional factors including access related factors such as ‘pre-requisites to be fulfilled by the clients and cost of services, provider workload, and providers’ behaviour.ConclusionThere is limited evidence on factors determining quality of care in family planning services in Africa that shows quality of care is influenced by multiple factors. The evidence suggests that lowering access barriers and avoiding unnecessary pre-requisites for taking contraceptive methods are important to improve the quality of care in family planning services. Strategies to improve provider behavior and competency are important. Moreover, strategies that minimize client waiting time and ensure client confidentiality should be implemented to ensure quality of care in family planning services. However, no strong evidence based conclusions and recommendations may be drawn from the evidence. Future studies are needed to identify the most important factors associated with quality of care in family planning services in a wider range of African countries.

Factors determining quality of care in family planning services in Africa: a systematic review protocol.

The objective of this systematic review is to identify and synthesize the best available quantitative and qualitative evidence to understand the factors determining quality of care in family planning services in Africa.The review question for the quantitative component of the review is:What factors, including facility, provider and client characteristics, are associated with quality of care in family planning services in Africa?The review question for the qualitative component of the review is:What are client and provider experiences and/or perceptions of factors that affect quality of care in family planning services in Africa?

Development and Validation of a Gender Ideology Scale for Family Planning Services in Rural China

The objectives of this study are to develop a scale of gender role ideology appropriate for assessing Quality of Care in family planning services for rural China. Literature review, focus-group discussions and in-depth interviews with service providers and clients from two counties in eastern and western China, as well as experts’ assessments, were used to develop a scale for family planning services. Psychometric methodologies were applied to samples of 601 service clients and 541 service providers from a survey in a district in central China to validate its internal consistency, reliability, and construct validity with realistic and strategic dimensions. This scale is found to be reliable and valid, and has prospects for application both academically and practically in the field.

Nursing Support for Parents of Hospitalized Children

Background: Having a child in hospital is a stressful experience for most parents. Support from nurses can assist parents to maintain their parenting role and promote quality pediatric nursing care. Aims and objectives: The aim of the study is to describe the quality of nurse-parent support in Iranian parents of hospitalized children in pediatric sites. Methods: This was a descriptive study using a convenience sample. Two hundred and thirty parents (183 mothers and 47 fathers) with hospitalized children took part in this survey that used the Nurse Parent Support Tool (NPST). This validated instrument has 21 items and 4 subscales (Informational Giving and Communication Support; Emotional Support; Appraisal Support and Instrumental Support), and was translated into Farsi. Results: The total mean of the NPST was M = 4.1 (SD = 0.7). There was a significant difference between gender of the parents and the Instrumental Support subscale. Also, there was significant difference between among education level of parents and Emotional Support. In addition, there was significant difference related to the gender of the child and Information Giving and Communication Support and Appraisal Support. There was no significant difference in any of the subscales when analyzed for length of hospitalization, kind of diseases and age of children. Conclusions: The findings indicate that parents received a high level of support from nurses. Nurses can promote the quality of family care and should be aware of the importance of the several types of nursing support in meeting the requests of parents. It is important that nurses continue to develop their knowledge about types of communication with the family, especially in providing support for the parent role.

Healthy Steps for Young Children: Sustained Results at 5.5 Years

We sought to determine whether Healthy Steps for Young Children has sustained treatment effects at 5.5 years, given early findings demonstrating enhanced quality of care and improvements in selected parenting practices. Healthy Steps was a clinical trial that incorporated developmental specialists and enhanced developmental services into pediatric care in the first 3 years of life. A total of 5565 children were enrolled at birth and followed through 5.5 years. Healthy Steps was evaluated at 6 randomization and 9 quasi-experimental sites. Computer-assisted telephone interviews were conducted with mothers when Healthy Steps children were 5.5 years of age. Outcomes included experiences seeking care, parent response to child misbehavior, perception of child's behavior, and parenting practices to promote development and safety. Logistic regression was used to estimate overall effects of Healthy Steps, adjusting for site and baseline demographic characteristics. A total of 3165 (56.9%) families responded to interviews (usual care: n = 1441; Healthy Steps: n = 1724). Families that had received Healthy Steps services were more satisfied with care (agreed that pediatrician/nurse practitioner provided support, 82.0% vs 79.0%; odds ratio: 1.25 [95% confidence interval: 1.02-1.53]) and more likely to receive needed anticipatory guidance (54.9% vs 49.2%; odds ratio: 1.33 [95% confidence interval: 1.13-1.57]) (all P < .05). They also had increased odds of remaining at the original practice (65.1% vs 61.4%; odds ratio: 1.19 [95% confidence interval: 1.01-1.39]). Healthy Steps families reported reduced odds of using severe discipline (slap in face/spank with object, 10.1% vs 14.1%; odds ratio: 0.68 [95% confidence interval: 0.54-0.86]) and increased odds of often/almost always negotiating with their child (59.8% vs 56.3%; odds ratio: 1.20 [95% confidence interval: 1.03-1.39]). They had greater odds of reporting a clinical or borderline concern regarding their child's behavior (18.1% vs 14.8%; odds ratio: 1.35 [95% confidence interval: 1.10-1.64]) and their child reading books (59.4% vs 53.6%; odds ratio: 1.16 [95% confidence interval: 1.00-1.35]). There were no effects on safety practices. Sustained treatment effects, albeit modest, are consistent with early findings. Universal, practice-based interventions can enhance quality of care for families with young children and can improve selected parenting practices beyond the duration of the intervention.

“Mothers of invention”: maternal empowerment and convenience consumption

PurposeThe paper explores how the complex relationship between consumption and production evolves as women enact their roles as mothers, and reconstruct their self‐identity through their use or avoidance of convenience products.Design/methodology/approachQualitative, individual interviews are used to allow an in‐depth analysis of the life stories of the group of respondents. An interpretive analysis reveals the purpose, patterns and rules followed by these individuals in their actions.FindingsConvenience consumption empowers these “mothers of invention” to instrumental and emotional autonomy through their rejection of unnecessary drudgery, and enables them to negotiate the role of caretaker within the family.Research limitations/implicationsThe implications of the study suggest that there is a role for marketing to remove any vestiges of guilt in convenience consumption by addressing the issues of sustainability, nutrition, quality and value in convenience products. Future research should investigate whether these findings resonate cross‐culturally and across broader socio‐economic groups.Originality/valueThe paper reveals the importance of reinforcing the connections between a better quality of family care and love. The paper also demonstrates the importance of the interactions of the family members on convenience consumption. These findings are important for marketing practitioners and academics researching family consumption.

Quality assessment of family planning services in urban health centers of Shahid Beheshti Medical Science University, 2004

Quality of family planning services is now considered as a global concern and importance. The purpose of the present study is to assess quality of family planning services in the urbanhealth centers of Shahid Beheshti Medical Science University. This was a descriptive study to assess structure, process and outcome of the family planning care services. A total of 15 health centers of Shahid Beheshti Medical Science University were randomized and the quality of provided care by 65 family planning care providers of these health centers were observed and assessed using checklists. A total of 75 family planning clients were interviewed to assess their knowledge about their selected family planning method all of whom completed the related forms of satisfaction with the services. The tools for data collection were two observational checklists, and two questionnaires with subsequent data analyzed using SPSS 11.5. In total 75 clients with an average age 24 (7 +/- 4) (mean +/- SD) participated in the study. The provision of family planning services by 65 providers was assessed by observation at three intervals. Of the providers, 60 (92.3 per cent) were midwives. Mean satisfaction score of clients was 83.3 +/- 9.05 percent meaning clients were highly satisfied with the services. Mean knowledge score of clients about their family planning method of use was 59.1 +/- 18 percent, which shows their moderate knowledge about their method of use. A more advanced tool to assess quality of care of family planning services with more focus on special care for the contraceptives was developed. Quality of care in family planning services of Shahid Beheshti Medical Science University health centers showed adequate facilities and equipment and to have trained personnel however their client's knowledge about the selected method was moderate. Therefore, interventional programs are needed to improve counseling and the educational process of clients, which should be considered in future research and planning of the programs.

Assessment of quality of care in family planning services in Jimma Zone, Southwest Ethiopia

Background: Providing quality of care in family planning services is an important task for care providers so as to increase service utilization and coverage; however, little is known about the existing quality of care in such services. Objective: To assess quality of care in family planning services in Jimma Zone, southwest Ethiopia. Methods: A cross-sectional survey was conducted from January 20-24,2003 in eight service delivery points in Jimma zone. Three modules consisting six elements of quality in accordance with Bruce-Jain framework were used; observation was made during 687 clients interacting with their providers (the number of providers was 17), exit interview was made with 635 clients, and facility audit was also carried out. Results: More than 80% of unmarried clients were getting the service from non-governmental clinic. Sixty-nine (10.9%) and 14(8.1% of those who reported problem) clients expressed dissatisfaction with waiting time and solutions given by the provider respectively. Method unavailability was the reason in most service delivery points for providing methods different from clients' choices. Most clients were not told method specific and other relevant information. Provider's special training and the time of the training have shown statistically significant difference on six and two quality of care indicators respectively. Majority of the service delivery points did not have copy of guideline and mechanism to make programmatic change based on clients' feedback; all were not supervised in the last three months prior to data collection. Conclusion: Several constraints in the provision of the service are identified and recommendations are forwarded accordingly. [Ethiop.J.Health Dev. 2003;18(1):8-18]

Monitoring Quality of Care in Family Planning Programs: A Comparison of Observations and Client Exit Interviews

Monitoring quality of care in family planning programs is important but the complexity and subjectivity of the topic create many challenges. The Quick Investigation of Quality (QIQ) was developed to monitor quality of care by using observations of client-provider interactions exit interviews with clients and facility audits. The QIQ was field-tested in multiple countries in 1998-99. Using linked data for 583 clients in Ecuador 539 in Uganda and 736 in Zimbabwe this analysis examines the comparability of results from observations and exit interviews. For a given indicator levels of agreement between data from observations and interviews varied across countries but within a country results were consistent between instruments. For the three countries combined agreement was good to excellent (kappas 0.47-0.98) on 13 of 14 indicators examined; observations and exit interviews yielded consistent responses in 63-99% of cases. Agreement was highest on the indicators that measured interpersonal relations. Inconsistencies reflected primarily that clients received information outside of the observed client-provider interaction. Observations and client exit interviews provide very similar results for many indicators. However while some programs may opt for one instrument over the other because of resource constraints the combination provides a fuller assessment of quality of care. (authors)

A Study on Knowledge, Attitude, Practice and Quality of Care in Family Planning at Dessie Zuria District.

Objective: To assess the knowledge, attitude and practice of Family Planning Programme of Dessie Zuria Woreda's female residents who are in childbearing age and to observe the quality of care in FP at health institution level. Method: The type of the study is cross-sectional study. We have conducted community based KAP survey in 1998 in Dessie Zuria Woreda. The Woreda's female residents were interviewed about Family planning and regarding quality care in Family Planning the health institution and health personnel were assessed . In the rural area, the peasant associations were selected by random sampling methods and the village by cluster sampling. In town the urban dweller associations were selected by random sampling. After calculating the sample size the desired number of study population was 1599 women. Concerning the quality of care assessment all the health institutions and all the health personnel who are conducting Family Planning programme in the woreda were included. Results: The most common source of information concerning FP in the urban area are Health personnel (64.6%), Mass media (14%) and similarly in the rural area, Health personnel contribute 80.3%. Among the study population 53.3% are not using Family Planning. It was observed that 75.2% of the rural and 36% of the urban are not using any means of contraceptive methods. When we compare the illiterate and those above six grades in relation to using Family planning service. Those above six grades are using the service 3.36 times more than illiterate ( P Conclusion: Expansion of service at community level with the support of CBDs, ensuring the availability of mix-contraceptive and conducting in-service training on FP is recommended. Key words: Family planning, Contraceptives, Information Education Communication, Counselling, Fertility. [J Ethiopia Med Pract. 2001:3(2):70–76 ]

Diagnosis of fragile-X syndrome: the experiences of parents.

In order to assess some aspects of the quality of care for families seeking the cause of their child(ren)s intellectual disability, a postal questionnaire was sent to parents of children with fragile-X syndrome, who were members of the UK Fragile-X Society. Although the interval taken to get a diagnosis ('lagtime') has fallen over time, other aspects of care could still be improved. Most families feel that having a diagnosis is an advantage, but many still find the diagnostic process distressing and feel unsupported. Not all families are referred for genetic counselling, and even those who are do not always understand or retain the information given. Most families feel that having a diagnosis is a benefit rather than a disadvantage.

Reproductive rights in practice: a feminist report on quality of care

* Contents * 1. Introduction * 2. Studying Quality of Care in Family Planning * 3. Study Design * 4. Family Planning: Policy Versus Practice * 5. Country Case Studies: Thailand, Bangladesh, Nigeria, Kenya, Mexico, Bolivia, Finland, Netherlands * 6. Conclusions * 7. Recommendations for Action

Knowledge generation for the HIV-affected family.

To examine the current literature about HIV-affected families in regard to knowledge development and priorities for future research. The current view of HIV focuses largely on HIV-infected individuals. There is a paucity of relevant research and a need to make explicit the priorities for knowledge generation about HIV-affected families. HIV family literature, 1980-1996, was reviewed and categorized and serves as the context for presenting future priorities for knowledge generation about HIV-affected families. Priorities identified were designing and testing family-level services; determining epidemiology of the phenomenon of HIV family caregiving; who gives care and why, what caregivers do, the outcomes of caregiving, quality of family care, and relationships A critical need is to address in-depth the problems that have limited knowledge development about HIV-affected families. This explication of issues and questions to understand HIV-affected families can stimulate future research.

Quality of Care in Family Planning Services in Morocco

This study was conducted to heighten awareness of quality of care as a programmatic issue in the Moroccan governmental family planning program and to test modified Situation Analysis instruments for measuring quality of care. Data were collected from 50 service-delivery points in five provinces to measure six elements of quality in accordance with the Bruce/Jain framework. A procedure for calculating quality-indicator scores is presented. Although facilities varied by province and within provinces, most had the equipment and supplies needed to deliver services; service personnel were trained and regularly supervised; the service-delivery points scored well on mechanisms to ensure continuity of use. Notable shortcomings included a dearth of materials for counseling and a widespread unavailability of the Ovrette pill. This study raises issues regarding the complexity of measuring quality, the ownership of results, and the appropriateness of a centralized study of quality in a decentralized program.

Quality of care in family medicine/general practice, WONCA/SIMG Congress, The Hague, Netherlands, June 1993

Quality of care in family medicine/general practice, WONCA/SIMG Congress, The Hague, Netherlands, June 1993

Quality of care in family planning in Latin America.

The majority of family planning programs in Latin America have been implemented in response to the region's population growth and aimed mainly at obtaining quantitative results, leaving quality, from the user's point of view, in second place. Recent decades have witnessed an increasing concern for quality of care in family planning because most researchers and service providers began to realize that when contraceptive methods are delivered without maintaining high quality levels, continuation rates are usually low and the image of methods and services is impaired. This paper reviews the level of quality of services in family planning in Latin America following Judith Bruce's framework and proposes, some activities that may improve it. The analysis found severe deficiencies in almost all the elements mentioned by Bruce, mainly in choice, technical competence, and mechanisms for improving continuity. The authors propose that to improve quality, services should (a) generate top management commitment to quality, (b) stay close to the client/user, (c) improve work conditions of providers/health workers, (d) measure quality, and (e) reward quality. The authors' conclusions are that (a) better quality services lead to better program results, (b) high quality is cost-effective, (c) managerial commitment is critical to improvement of quality, and (d) quality of care is not a luxury; it is necessary and possible in all settings.

Session 13 The quality of care in family planning services

Session 13 The quality of care in family planning services