Dataset Information

Quality of care in contraceptive services provided to young people in two Ugandan districts: a simulated client study.

ABSTRACT:

Background

Low and inconsistent use of contraceptives by young people contributes to unintended pregnancies. This study assessed quality of contraceptive services for young people aged 15-24 in two rural districts in Uganda.

Methods

Five female and two male simulated clients (SCs) interacted with 128 providers at public, private not-for-profit (PNFP), and private for profit (PFP) health facilities. After consultations, SCs were interviewed using a structured questionnaire. Six aspects of quality of care (client's needs, choice of contraceptive methods, information given to users, client-provider interpersonal relations, constellation of services, and continuity mechanisms) were assessed. Descriptive statistics and factor analysis were performed.

Results

Means and categorized quality scores for all aspects of quality were low in both public and private facilities. The lowest quality scores were observed in PFP, and medium scores in PNFP facilities. The choice of contraceptive methods and interpersonal relations quality scores were slightly higher in public facilities. Needs assessment scores were highest in PNFP facilities. All facilities were classified as having low scores for appropriate constellation of services. Information given to users was suboptimal and providers promoted specific contraceptive methods. Minority of providers offered preferred method of choice and showed respect for privacy.

Conclusions

The quality of contraceptive services provided to young people was low. Concurrent quality improvements and strengthening of health systems are needed.

SUBMITTER: Nalwadda G

PROVIDER: S-EPMC3221686 | biostudies-literature | 2011

REPOSITORIES: biostudies-literature

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Publications

Quality of care in contraceptive services provided to young people in two Ugandan districts: a simulated client study.

Nalwadda Gorrette G Tumwesigye Nazarius M NM Faxelid Elisabeth E Byamugisha Josaphat J Mirembe Florence F

PloS one 20111121 11

<h4>Background</h4>Low and inconsistent use of contraceptives by young people contributes to unintended pregnancies. This study assessed quality of contraceptive services for young people aged 15-24 in two rural districts in Uganda.<h4>Methods</h4>Five female and two male simulated clients (SCs) interacted with 128 providers at public, private not-for-profit (PNFP), and private for profit (PFP) health facilities. After consultations, SCs were interviewed using a structured questionnaire. Six asp ...[more]

PMID: 22132168

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Project description:BackgroundHormonal contraceptive pills have evolved as a common form of contraception worldwide. Pharmacists play a vital role in providing safe and effective access to these medicines. In many developing countries such as the United Arab Emirates (UAE), these medicines are available to the general public without the presentation of a prescription which requires the pharmacist to shoulder responsibility by assessing and educating patients to assure their appropriate use.ObjectivesTo evaluate community pharmacists' current practice of dispensing and counseling on hormonal contraceptives.MethodsSimulated patient methodology was used in this study. A single simulated patient visited community pharmacies requesting an oral contraceptive as per a preplanned scenario. Information from the visits were recorded on a data collection form including: pharmacist assessing patient eligibility to take hormonal contraceptives, selecting the appropriate oral contraceptive, providing complete counseling on how to use the pill, adherence, missed dose handlings and side effects of the medication. The Pharmacist was prompted by the simulated patient to provide the information if they did not provide spontaneous counseling. The quality of pharmacists' counseling was rated and consequently coded as complete, incomplete or poor.ResultsA total of 201 community pharmacies were visited. More than 92% of the pharmacists did not ask the simulated patient any question to assess their eligibility to use contraceptives. Twenty three pharmacists (11.4%) selected the proper product. One hundred seventeen (58.2%) of the pharmacists provided spontaneous counseling on how to use the pill, 17 of them had their counsel rated as complete, but none of the pharmacists provided spontaneous counseling regarding adherence or side effects of the medications. On prompting, 10 pharmacists (12%) provided complete counseling regarding how to use oral contraceptives, 14 pharmacists (7.0%) provided complete counseling on adherence and missing dose handling and five pharmacists (2.5%) provided complete counseling about expected side effects.ConclusionsPharmacists' practice regarding hormonal contraceptive dispensing and counseling was suboptimal in this study. Areas needing intervention were related to pharmacist assessment of eligibility for oral contraceptive use, choice of optimal oral contraceptive for patient-specific co-morbidities and provision of adequate counseling regarding proper use, adherence and missed dose handlings.

Project description:The availability of a variety of modern contraceptive methods is necessary but insufficient to provide a high-quality contraceptive service to postabortion clients. Women, especially young women, must be empowered to make informed choices about which methods they receive, including whether to use contraception following an abortion service. In this study, we conducted 2,488 client exit interviews with abortion clients after their induced abortion service or postabortion care visit in Ipas-supported health facilities in eight countries: Argentina, Bolivia, Ethiopia, Kenya, Mexico, Nepal, Nigeria, and Uganda. We evaluated the quality of postabortion contraceptive counseling across two domains of contraceptive counseling: information exchange and interpersonal communication. We measured the association between these quality elements and two outcomes: 1) client-perceived choice of contraceptive method and 2) whether or not the client received a modern contraceptive method. We examined these relationships while adjusting for sociodemographic and confounding variables, such as the client feeling pressure from the provider to accept a particular method. Finally, we determined whether associations identified differ by age group: under 25 and 25+. Information exchange and interpersonal communication both emerged as important counseling domains for ensuring that clients felt they had the ability to choose a contraceptive method. The domain of information exchange was associated with having received a contraceptive method for all abortion clients, including young abortion clients under 25. Nearly 14% of clients interviewed reported pressure from the provider to accept a particular contraceptive method; and pressure from the provider was significantly associated with a client's perception of not having a choice in selecting and receiving a contraceptive method during her visit to the facility. Improving interpersonal communication, strengthening contraceptive information exchange, and ensuring clients are not pressured by a provider to accept a contraceptive method, must all be prioritized in postabortion contraceptive counseling in health facilities to ensure postabortion contraceptive services are woman-centered and rights-based for abortion clients.

Project description:ContextProviders can help clients achieve their personal reproductive goals by providing high-quality, client-centered contraceptive counseling. Given the individualized nature of contraceptive decision making, provider attention to clients' preferences for counseling interactions can enhance client centeredness. The objective of this systematic review was to summarize the evidence on what preferences clients have for the contraceptive counseling they receive.Evidence acquisitionThis systematic review is part of an update to a prior review series to inform contraceptive counseling in clinical settings. Sixteen electronic bibliographic databases were searched for studies related to client preferences for contraceptive counseling published in the U.S. or similar settings from March 2011 through November 2016. Because studies on client preferences were not included in the prior review series, a limited search was conducted for earlier research published from October 1992 through February 2011.Evidence synthesisIn total, 26 articles met inclusion criteria, including 17 from the search of literature published March 2011 or later and nine from the search of literature from October 1992 through February 2011. Nineteen articles included results about client preferences for information received during counseling, 13 articles included results about preferences for the decision-making process, 13 articles included results about preferences for the relationship between providers and clients, and 11 articles included results about preferences for the context in which contraceptive counseling is delivered.ConclusionsEvidence from the mostly small, qualitative studies included in this review describes preferences for the contraceptive counseling interaction. Provider attention to these preferences may improve the quality of family planning care; future research is needed to explore interventions designed to meet preferences.Theme informationThis article is part of a theme issue entitled Updating the Systematic Reviews Used to Develop the U.S. Recommendations for Providing Quality Family Planning Services, which is sponsored by the Office of Population Affairs, U.S. Department of Health and Human Services.

Project description:BackgroundMost (94%) of global maternal deaths occur in low- and middle-income countries due to preventable causes. Maternal health care remains a key pillar in improving survival. Antenatal care (ANC) guidelines recommend that pregnant women should be provided with information about postnatal care in the third trimester. However, the utilization of postnatal care services is limited in developing countries including Tanzania. The aim of this study was to investigate the practice of health care workers in providing information on postnatal care to pregnant women during antenatal care visits.MethodsA cross sectional study was conducted among health care workers from 27 health facilities that offer reproductive and child health services in Busega district Northwest Tanzania. A simulated client approach was utilized to observe quality of practice among health care workers with minimal reporting bias (i.e., the approach allows observing participants at their routine practices without pretending). Selected pregnant women who were trained to be simulated clients from the community within facility catchment area attended antenatal care sessions and observed 81 of 103 health care workers. Data analyses were carried out using STATA 13.ResultsOnly 38.73% (95% CI; 28.18-49.49%) of health care workers were observed discussing subtopics related to postnatal care during the ANC visit. Few health care workers (19.35%), covered all eight subtopics recommended in the ANC guidelines. Postnatal danger signs (33.33%) and exclusive breast feeding (33.33%) were mostly discussed subtopics by health care workers. Being a doctor/nurse/clinical officer is associated by provision of postnatal education compared to medical attendant, aOR = 3.65 (95% CI; 1.21-12.14).ConclusionThe provision of postnatal education during ANC visits by health care workers in this district was limited. This situation could contribute to the low utilization of postnatal care services. Health care workers need to be reminded on the importance of delivering postnatal education to pregnant women attending ANC clinic visits. On job training can be used to empower health care workers of different cadres to deliver postnatal health education during ANC visits. These efforts could increase women's utilization of postnatal care and improve outcomes for mothers and newborns.

Dataset Information

Quality of care in contraceptive services provided to young people in two Ugandan districts: a simulated client study.

Background

Methods

Results

Conclusions

Publications

Quality of care in contraceptive services provided to young people in two Ugandan districts: a simulated client study.

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