Measures of family planning service quality associated with contraceptive discontinuation: an analysis of Measurement, Learning & Evaluation (MLE) project data from urban Kenya

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Abstract

Introduction: Several measures to assess family planning service quality (FPQ) exist, yet there is limited evidence on their association with contraceptive discontinuation. Using data from the Measurement, Learning & Evaluation (MLE) Project, this study investigates the association between FPQ and discontinuation-while-in-need without switching in five cities in Kenya. Two measures of FPQ are examined – the Method Information Index (MII) and a comprehensive service delivery point (SDP) assessment rooted in the Bruce Framework for FPQ.

Methods: Three models were constructed: two to assess MII reported in household interviews (as an ordinal and binary variable) among 1,033 FP users, and one for facility-level quality domains among 938 FP users who could be linked to a facility type included in the SDP assessment. Cox proportional hazards ratios were estimated where the event of interest was discontinuation-while-in-need without switching. Facility-level FPQ domains were identified using exploratory factor analysis (EFA) using SDP assessment data from 124 facilities.

Results: A woman’s likelihood of discontinuation-while-in-need was approximately halved whether she was informed of one aspect of MII (HR: 0.45, p < 0.05), or all three (HR: 0.51, p < 0.01) versus receiving no information, when MII was assessed as an ordinal variable. Six facility-level quality domains were identified in EFA. Higher scores in information exchange, privacy, autonomy & dignity and technical competence were associated with a reduced risk of discontinuation-while-in-need (p < 0.05).

Conclusions: The MII has potential as an actionable metric for FPQ monitoring at the health facility level. Furthermore, family planning facilities and programs should emphasize information provision and client-centered approaches to care alongside technical competence in the provision of FP care.

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Best practices in exploratory factor analysis: four recommendations for getting the most from your analysis

Anna B. Costello, Jason Osborne (2005)

Exploratory factor analysis (EFA) is a complex, multi-step process. The goal of this paper is to collect, in one article, information that will allow researchers and practitioners to understand the various choices available through popular software packages, and to make decisions about “best practices” in exploratory factor analysis. In particular, this paper provides practical information on making decisions regarding (a) extraction, (b) rotation, (c) the number of factors to interpret, and (d) sample size.

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When the patient is the expert: measuring patient experience and satisfaction with care

Elysia Larson, Jigyasa Sharma, Meghan Bohren … (2019)

Abstract In 2018, three independent reports were published, emphasizing the need for attention to, and improvements in, quality of care to achieve effective universal health coverage. A key aspect of high quality health care and health systems is that they are person-centred, a characteristic that is at the same time intrinsically important (all individuals have the right to be treated with dignity and respect) and instrumentally important (person-centred care is associated with improved health-care utilization and health outcomes). Following calls to make 2019 a year of action, we provide guidance to policy-makers, researchers and implementers on how they can take on the task of measuring person-centred care. Theoretically, measures of person-centred care allow quality improvement efforts to be evaluated and ensure that health systems are accountable to those they aim to serve. However, in practice, the utility of these measures is limited by lack of clarity and precision in designing and by using measures for different aspects of person-centeredness. We discuss the distinction between two broad categories of measures of patient-centred care: patient experience and patient satisfaction. We frame our discussion of these measures around three key questions: (i) how will the results of this measure be used?; (ii) how will patient subjectivity be accounted for?; and (iii) is this measure validated or tested? By addressing these issues during the design phase, researchers will increase the usability of their measures.

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Fundamental elements of the quality of care: a simple framework.

J Bruce (2015)

This article argues for attention to a neglected dimension of family planning services--their quality. A framework for assessing quality from the client's perspective is offered, consisting of six parts (choice of methods, information given to clients, technical competence, interpersonal relations, follow-up and continuity mechanisms, and the appropriate constellation of services). The literature is reviewed regarding evidence that improvements in these various dimensions of care result in gains at the individual level; an even scarcer body of literature is reviewed for evidence of gains at the level of program efficiency and impact. A concluding section discusses how to make practical use of the framework and distinguishes three vantage points from which to view quality: the structure of the program, the service-giving process itself, and the outcome of care, particularly with respect to individual knowledge, behavior, and satisfaction with services.

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Author and article information

Contributors

Karla Feeser: Role: Formal AnalysisRole: MethodologyRole: Writing – Original Draft Preparation

ORCID: https://orcid.org/0000-0003-0030-9449

Nirali M. Chakraborty: Role: ConceptualizationRole: Writing – Review & Editing

ORCID: https://orcid.org/0000-0003-1015-7477

Lisa Calhoun: Role: InvestigationRole: Writing – Review & Editing

Ilene S. Speizer: Role: SupervisionRole: Writing – Review & Editing

Journal

Journal ID (nlm-ta): Gates Open Res

Journal ID (iso-abbrev): Gates Open Res

Journal ID (pmc): Gates Open Res

Title: Gates Open Research

Publisher: F1000 Research Limited (London, UK )

ISSN (Electronic): 2572-4754

Publication date (Electronic): 29 January 2020

Publication date Collection: 2019

Volume: 3

Electronic Location Identifier: 1453

Affiliations

[1 ]Metrics for Management, Baltimore, MD, 21201, USA

[2 ]Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516, USA

[1 ]Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA

[1 ]Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

Metrics for Management, USA

[1 ]Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA

Metrics for Management, USA

Author notes

[a ] karlafeeser@ 123456gmail.com

No competing interests were disclosed.

Competing interests: No competing interests were disclosed.

Author information

Karla Feeser https://orcid.org/0000-0003-0030-9449

Nirali M. Chakraborty https://orcid.org/0000-0003-1015-7477

Article

DOI: 10.12688/gatesopenres.12974.2

PMC ID: 7042708

PubMed ID: 32140663

SO-VID: 97cf8298-5503-4864-8bea-bef2446e2185

License:

This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date accepted : 10 January 2020

Funding

Funded by: Bill and Melinda Gates Foundation

Award ID: OPP1181398

Award ID: OPP52037

This work was supported by the Bill and Melinda Gates Foundation through a grant to the Measurement, Learning & Evaluation Project [OPP52037] and International Conference on Family Planning [OPP1181398]. The contents of this paper are solely the responsibility of the authors and do not necessarily represent the official views of the funder.

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Measures of family planning service quality associated with contraceptive discontinuation: an analysis of Measurement, Learning & Evaluation (MLE) project data from urban Kenya

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Most cited references 36

Best practices in exploratory factor analysis: four recommendations for getting the most from your analysis

When the patient is the expert: measuring patient experience and satisfaction with care

Fundamental elements of the quality of care: a simple framework.

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