1. Quality of Care – Client Perspectives
Christabel Kambala

2. Experiential dimension of
care
Objectives
• Reconstruct process of care
• Assess the clients’ perception of
quality of care

3. Methods
• Cross-sectional facility-based survey among
clients- baseline
• Structured questionnaire with close-ended
questions on:
• Socio-demographic characteristics
• Process of care-services received
• Perceived quality of care
• Convenience sampling: Women interviewed
as they leave ANC, delivery, and PNC (exit
interviews)

4. Perceived quality of Care
measurement
• Made of statements assessing quality of care
components about how the women perceived the
quality of care on that day.
• The statements were read to the women and were
to agree or disagree and rate their perceived quality
of care, using a 10 point scale (10 as complete
agreement and 1 as complete disagreement).
• The higher the score the more highly quality was
rated.

5. Dimensions of perceptions
(Latent variables)
Overall Perceived quality of
Care
Interpersonal
Relationships
She/he listened to me
She/he behaved in a
gentle manner
Environment
and conditions
of the room
I was set up
comfortably.
The room was clean
& hygienic
Health
services in
general
The HW were well
coordinated
The quality of care
was higher than I
expected

6. Interviewer side

7. Interviewee side

8. Sample size
ANC
DELIVERY
PNC
BALAKA
77
36
61
DEDZA
102
65
75
MCHINJI
74
59
47
NTCHEU
135
44
49
TOTAL
388
204
232

9. Results: Characteristics of women (%)
Variable
ANC
n=388
Delivery
n=204
PNC n=232
Age
<20
20-29
>30
23
53
24
20
58
22
21
57
22
Marital status
non-married
Married
2
98
7
93
6
94
Education
None
Primary
Secondary & above
38
39
23
42
44
14
45
37
18
Literacy
Illiterate
Literate
34
66
34
66
39
61

10. Results: Characteristics of women (%)
Variable
ANC
n=388
Delivery
n= 204
PNC
n=232
Gravid
1
2-3
>3
31
35
34
31
37
37
32
38
30
Number of children
1 child
2-3 children
>3 children
35
20
45
4
36
60
3
64
33
History of miscarriage : no miscarriage
miscarriage
86
14
89
11
79
21
History of still birth
96
4
97
3
94
6
no premature birth 94
premature birth
6
94
6
90
10
Premature birth
no still birth
still birth

11. Results: Experiences (%)
Variable
ANC, N=388
Delivery, N=204
PNC, N=232
Wait time above 1 hour
23
3
22
Not done
Self introduction by HW
60
60
56
Explanation of exam
procedures
27
40
24
Explanation of medication
22
30
37
Consent seeking
28
41
27
Encouraged to ask questions
37
61
47
Encouraged to have guardian
46
50
55
Confidentiality
6
4
8
Bp measurement
38
-
58
Bp measurement before del
-
37
-
Bp measurement after del
-
57
-
Baby weighed
-
-
23

12. Results: Perceived quality of ANC care
• Interpersonal relationships: 10 items – mean
rating =9
• Environment and conditions of the ANC
examination room- 7 items- mean rating=9
• ANC health services in general-10 itemsmean rating=9
• Overall: mean=9

13. Factors significantly associated with perceived
quality of ANC care. N=388
Variable
Chi-square
P-value
Self introduction by HW (+)
6.071
0.0137
Explanation of exam procedures (+)
5.569
0.0183
Explanation of medication (+)
8.414
0.0037
Consent (+)
12.527
0.0004
Encouragement to ask questions (+)
11.872
0.0006
Confidentiality (+)
8.577
0.0034
Bp Measurement (+)
5.952
0.0147

14. Next Steps
• Analysis PNC and delivery data
• Bivariate
• Regression model on determinants of
perception

15. Thank you!