Sie sind auf Seite 1von 7

DOI Number: 10.5958/j.0976-5506.4.2.

047

Determinants of Youth Friendly Services Influencing


Client Satisfaction: A Study of Client's Perspectives in
India

Sunil Mehra1, Ruchi Sogarwal2, Vandana Nair3, Mahasweta Satpati4, Ramanand Tiwari4,
Kaushlendra Dwivedi4
1
Executive Director, Senior Technical Advisor, 3Assistant Director, 4Regional Manager, MAMTA Health Institute for
2

Mother and Child, New Delhi, India

ABSTRACT

Study analyzes key determinants of Youth Friendly Health Services that influence the client's satisfaction
level. Data from 120 clients were collected from selected four districts of Uttar Pradesh and Bihar States
of India. Multivariate logistic regression model was applied to understand the independent effect of
important predictors. Overall only 32.0% clients were satisfied with the services. Positive association is
observed with the educational status of the clients. If the parents/guardians are supportive, clients are
4.4 times more likely to get overall satisfaction from the services. 92% clients are less likely to get
satisfied, if there is a fear of privacy disclosure to parents. Hence, privacy and confidentiality in services
and support of parents/guardians play a significant role in affecting client satisfaction as compared to
other determinants of the services. Study will enable decision-makers to improve the quality of health
care effectively, keeping a balance between providers' and clients' perspectives.

Keywords: Youth, Reproductive Health, Satisfaction, Health Services

INTRODUCTION world, standards for quality have been developed for


ascertaining the performance of health facility for
There is a growing recognition that “adolescent- adolescents. Standards are valuable in strengthening
friendly” health services are needed if adolescents are program implementation, monitoring and evaluation
to be adequately provided with preventative and as they set clear performance goals against which
curative health care. Under the Reproductive and Child performance can be monitored, assessed and/or
Health Programme-II, Government of India has a compared.
mandate to provide affordable quality of “Adolescent
Friendly Health Services (AFHS)” and hence ARSH Evidence indicates that satisfaction surveys have
clinics are established within the existing public health been widely used to address the issues of access and
system1-2. The strategy of AFHS influences the health performance3-6. Indeed, they have been instrumental in
care seeking behaviour of adolescents and in turn helping government agencies to identify target groups,
impacts the health indicators positively. The key clarify objectives, define measures of performance, and
‘friendly’ characteristics of services for adolescents are develop performance information systems 7-8 .
at the levels of the clients, providers and health system, Supportively, client satisfaction is a dominant concern
which in turn are the determinants of the quality of the that is intertwined with strategic health services
services2. In recent years developing countries have decisions 8-11. Client satisfaction evaluations may
become increasingly interested in assessing the quality provide the only means for clients to express concerns
of their health care. In a number of countries around the about the services received, and to express their views
about new services that are needed. The present study
analyzes the key determinants of YFHS that influence
Corresponding author: the client’s satisfaction level that would help decision
Ruchi Sogarwal
makers to implement programmes tailored to clients’
Senior Technical Advisor
perceived needs.
MAMTA Health Institute for Mother and Child,
B-5, Greater Kailash Enclave II, New Delhi
E-mail: ruchi.dr@gmail.com

47. RUCHI--221-226.pmd 221 5/17/2013, 2:41 PM


222 Indian Journal of Public Health Research & Development. April-June 2013, Vol. 4, No. 2

MATERIALS AND METHOD mathematical form as:

In the present article, data from baseline survey of log [p/(1-p)] = b0 + b1*x1 + b2*x2 + ... + bk*xk + ei
intervention project on “Improving Reproductive and
Sexual Health of Young People by Increasing the Age where b 1, b 2, b 3 etc. are the logistic regression
at Marriage in India” has been utilized. Since 2008, coefficients and log [p/(1-p)] is called the log odds or
MAMTA-Health Institute for Mother and Child12 is logit of the event. Hosmer - Lemeshow test was applied
being implementing the project with the goal to improve to understand the goodness of fit of the model.
adolescent sexual and reproductive health by increasing
age at marriage and delayed first pregnancy among RESULTS
young people aged 10-24 years.
a. Socio-demographic characteristics of clients
The baseline data was collected by trained by “Satisfaction level”
researchers during April-July, 2012 from Hardoi and
In all, 32.0% clients reported that they were satisfied
Siddharth Nagar districts in Uttar Pradesh and
with the services received from the ARSH clinics. Female
Nalanda and Vaishali districts in Bihar state. Again
clients reported more satisfaction (36.4%) in contrast to
from each selected district, one Primary Health Center
male clients (25.4%). Positive association was observed
(PHC) was covered to collect data from the clients. A
with the educational status of the clients. Clients who
consecutive sample of 120 clients consisting equal
were educated up to intermediate and above reported
number of males and females was interviewed from
high level (37.2%) of satisfaction in comparison to the
selected PHCs, however, the question on satisfaction
clients who were educated up to middle school (25.0%)
level was reported by 114 clients only.
and high school (27.0%). Differentials in satisfaction
Statistical Analysis were seen by the religious background of the clients.
25.0% Muslim clients and 30.9% Hindu clients reported
Chi-square (x2) test was used to check the association to be satisfied. Varying level of client satisfaction has
between the variables. The service related variables been reported by caste, marital status and status of the
which are found significantly associated with client studentship. Less percentage (28.1%) of student clients
satisfaction as a result of x2 were used in Multivariate were reportedly satisfied in comparison to the clients
logistic regression model to assess the likelihood of who were not students (34.0%). No clear pattern was
getting satisfied from the services using the observed by income level of the household. (Table 1)
Table 1: Socio-demographic Characteristics of Clients by ‘Satisfaction level’

Characteristics Satisfaction Number*


Yes No
Age of the Clients
Less than 20 Years 31.1 68.9 61
20 Years and above 30.2 69.8 53
Sex of the Clients
Male 25.4 74.6 59
Female 36.4 63.6 55
Educational Qualification
Uneducated 33.3 66.7 6
Up to Middle School 25.0 75.0 28
High school 27.0 73.0 37
Intermediate and Above 37.2 62.8 43
Religion
Hindu 30.9 69.1 110
Muslim 25.0 75.0 4
Caste/Tribe
Scheduled Caste/Scheduled Tribe 35.0 65.0 40
Other Backward Class 23.1 76.9 52
Others 40.9 59.1 22

47. RUCHI--221-226.pmd 222 5/17/2013, 2:41 PM


Indian Journal of Public Health Research & Development. April-June 2013, Vol. 4, No. 2 223

Table 1: Socio-demographic Characteristics of Clients by ‘Satisfaction level’ (Contd.)

Characteristics Satisfaction Number*


Yes No
Marital Status
Ever Married 27.8 72.2 36
Never Married 32.4 67.6 68
Student
Yes 28.1 71.9 64
No 34.0 66.0 50
Monthly Income of Household (in Rs.)
Less than Rs. 1500 22.2 77.8 18
Rs. 1501-3000 38.9 61.1 36
Rs. 3001-5000 26.9 73.1 26
More than Rs. 5000 34.8 65.2 23
Total 32.0 68.0 114
*Total number may not be 114 due to missing cases.

b. Characteristics of Youth Friendly Services by doctor; clients’ belief about confidentiality of


influencing client satisfaction: information; provision of information demanded and
support of parents. Less percentage (23.8%) of clients
32.0%, 38.0% and 25.8% clients were satisfied who were satisfied if the time given by the doctor was not
reported convenient day and hours of the facility; appropriate. Additionally, 32.0% clients were satisfied
waiting area availability below average level of if they got the information wanted and about 36% clients
cleanliness status. The variation in client satisfaction were satisfied if parent’s attitude was supportive.
is not siginificant by appropriateness of the time given (Table-2)*×2 is significant, p<00.1
Table 2: Characteristics of Youth Friendly Health Services Influencing Client Satisfaction
Characteristics Client’s Overall Satisfaction
Yes No Number
Day and Hours are Convenient
No 21.4 78.6 14
Yes 32.0 68.0 100
Waiting Area Available*
No 0.0 100.0 14
Yes 38.2 61.8 89
Cleanliness
Below average 25.8 74.2 66
Average and above 37.5 62.5 48
Privacy Maintained
No 30.6 69.4 72
Yes 31.0 69.0 42
Time Given by Doctor is Appropriate
No 23.8 76.2 42
Yes 34.7 65.3 72
Suggestion Given by Doctor
Not Satisfactory 26.1 73.9 46
Satisfactory 39.1 60.9 46
Information will be Kept Confidential*
No 35.2 64.8 91
Yes 13.0 87.0 23
Got the Information You Wanted*
No 0.0 100.0 8
Yes 32.4 67.6 105
Supportiveness of Parents*
No 15.4 84.6 26
Yes 35.6 64.4 87
2
*× is significant, p<00.1

47. RUCHI--221-226.pmd 223 5/17/2013, 2:41 PM


224 Indian Journal of Public Health Research & Development. April-June 2013, Vol. 4, No. 2

Results from multivariate logistic regression are three times more likely to get satisfied. Even after
analysis in which only significant Odds Ratio (OR) of controlling the effect of privacy, information and services
three different regression models is shown in Table-3. demanded and availability of waiting area, the also the
Model I presented unadjusted OR for client satisfaction likelihood of getting satisfied is more among the clients
whereas Model II presents adjusted OR for three whose parents and guardians were supportive
indicators i.e. ‘Staff at YFHS informing the Parents/ (Model-II). In Model III after controlling the effect of
Guardians if an unmarried visits the Facility’; socio-economic and demographic characteristics of the
‘Provision of information and services demanded’; and clients, ‘support of parents/guardians’ and ‘privacy
‘Availability of waiting area’. In Model III OR was and confidentiality’ are significantly associated with
adjusted for all important socio-economic and the client satisfaction. If the parents/guardians are
demographic characteristics. supportive, clients are 4.4 times more likely to get
satisfied from the services. Further, 92% clients are less
Model I shows that ‘if Parents/Guardians are likely to get satisfied, if fear exists of getting privacy
supportive for Reproductive Health Services’, clients disclosed to parents.

Table 3: Results from Logistic Regression Analysis-Likelihood of Client’s Satisfaction


Characteristics Odds Ratios
Model I Model II Model III
Parents/Guardians Supportive for 3.045** 2.843** 4.431**
Reproductive Health Servicesa
Staff at YFHS may Inform to the 0.277** — 0.080*
Parents/Guardians b
Received the Information and Services — — —
that Wantedc
Waiting Area Availabled — — —
Caste/Tribe
Other Backward Class®
Scheduled Caste/Scheduled Tribe — — 4.666**
Others — — 7.075**

Note: Only significant Odds Ratios are Presented in the Table; *p<0.05, **p<0.10; ®Reference category;

Model I à Unadjusted; Model II à Adjusted for Characteristics b, c and d; and

Model III à Adjusted for Characteristics b, c, d, Age of the Clients, Sex of the Clients, Educational Qualification,
Religion, Marital Status, Currently Student and Monthly Income of Household.

DISCUSSION should be a first priority15-18. In our study sample,


‘privacy and confidentiality’ of the information is found
The provision of health care is expected to respond to be one of the most important factors that are
directly to the client’ preferences and demands; and significantly associated with the client satisfaction even
efficacy of the treatment are enhanced by greater client after adjusting other determinants of YFHS. Findings
satisfaction13-14. The paper deals with satisfaction rate are similar to other studies that show that the fear about
among the clients consulting the YFHS. Varying level lack of confidentiality is a major reason for young
of client satisfaction has been reported by people‘s reluctance to seek help19-23 and hence health
appropriateness of the time given by doctor; clients’ services might not be acceptable to young people, even
belief that information will be kept confidential; if available and accessible.
provision of information desired; and support of
parents. More clients’ differentials in satisfaction were The second most important determinant of the client
observed including the availability of waiting area at satisfaction prominent in our study was the support of
health facility, convenient day and hour and clean parents and guardians. Surveys show that most
surroundings. Although there is relatively little adolescents will seek routine medical care with their
published evidence on what determines client parents’ knowledge24. Making parental involvement
satisfaction among adolescents, the findings from this drastically affects adolescent decision-making, and
study are quite unexpected given that most of the reduces the likelihood of timely treatment. A survey
literature on ‘adolescent-friendly’ service programs conducted by American Medical Association found
emphasize that attitudes of health care providers that the doctors were more likely than the general public

47. RUCHI--221-226.pmd 224 5/17/2013, 2:41 PM


Indian Journal of Public Health Research & Development. April-June 2013, Vol. 4, No. 2 225

to favor confidentiality for adolescent clients, even when Ethical clearance


it meant withholding information from parents24-26.
However, the health care provider ’s duty of Ethical approval was sought from the Institutional
confidentiality becomes complicated when the interests Review Board. Informed consent was obtained from all
of an adolescent’s parents or guardian must be factored the participants prior to the interview.
into the provider-client relationship. Study highlights
the gap between the perspective of client satisfaction as REFERENCES
an element representative of quality of care and high
quality health care from a professional point of view. 1. National Commission for Human Development
(NCHD), WHO. Health Services for Adolescents:
This research has certain limitations. Our study is the Way Forward in Mongolia. Review of Existing
restricted to the perspectives of the clients on health Health Services for Adolescents. Ulaanbaatar,
services; nonetheless, it has recognized various Mongolia: NCHD, WHO, 2002.
elements in the YFHS that need to be addressed to 2. Implementation Guideline on RCH II, May, 2006.
reduce the number of unsatisfied clients. The study “Adolescent Reproductive Sexual Health
corroborates findings with other studies that the Strategy” for State and District Programme
perception and judgment of quality are highly Managers, NRHM, Ministry of Health & Family
individualistic and dynamic; consequently client welfare, Government of India.
satisfaction reflects only part of the quality of the entire 3. Andaleeb SS: Service quality perceptions and
health care process. This aspect should not be patient satisfaction: a study of hospitals in a
overestimated nor should it replace the notion of quality developing country. Soc Sci Med 2001, 52:1359-
care27-28. 1370.
4. Myburgh NG, Solanki GC, Smith MJ, Lalloo R:
Government of India is committed to provide Patient satisfaction with health care providers in
‘adolescent friendly’ health services and improve the South Africa: the influences of race and
‘quality of services’ as a means of increasing the access socioeconomic status. Int J Qual Health Care 2005,
and utilization of services by young people. According 17 (6):473-7.
to WHO, the health services from the user’s perspective 5. Langseth P, Langan P, Talierco R: Service delivery
must be accessible and acceptable. From the provider’s survey (SDS): a management tool. The Economic
and manager ’s perspective, services must be Development Institute of the World Bank; 1995.
appropriate, comprehensive, effective and equitable. 6. WHO: World health report: health systems
With this context, client satisfaction emerges as an
improving performance. Geneva, Switzerland;
important way to attract more young people. However,
2000.
it is well evident that the clients and laypersons may
7. Mauerhofer, A, Bertchold, A, Akré, C., Michaud,
understand quality in a different way from health care
PA, and Suris, JS, 2010. “Female adolescents’ views
professionals28. Our study reveals with evidence that
on a youth-friendly clinic”. SWISS MED WKLY
convenient day and hour, time spent by doctor and other
2010; 140 (1–2): 18–23· www.smw.ch.
determinants of the YFHS play a lesser role in affecting
8. Ginsburg KR, Menapace AS, Slap GB. Factors
client satisfaction as compared to assurance for privacy
affecting the decision to seek health care: the voice
and confidentiality and supportive role of parents. The
of adolescents. Pediatrics. 1997; 100 (6): 922–30.
results of research will enable decision-makers to
9. Kapphahn CJ, Wilson KM, Klein JD. Adolescent
improve the quality of health care effectively, keeping a
girls’ and boys’ preferences for provider gender
balance between providers’ and clients’ perspectives.
and confidentiality in their health care. J Adolesc
Health. 1999; 25(2):131–42.
ACKNOWLEDGEMENTS 10. Rutishauser C, Esslinger A, Bond L, Sennhauser
Authors acknowledge to European Union for FH. Consultations with adolescents: the gap
providing funding support. International Center for between their expectations and their experiences.
Research on Women is also acknowledged for their Acta Paediatr. 2003; 92(11):1322–6.
technical support in research. 11. Farrant B, Watson PD. Health care delivery:
perspectives of young people with chronic illness
Conflict of interest and their parents. J Paediatr. Child Health. 2004;
40(4):175–9.
The authors declare that they have no conflict of 12. MAMTA Health Institute for Mother and Child.
interest www.mamta-himc.org.
13. Calnan M. Towards a conceptual framework for
Source of support
lay evaluation of health care. Social Science and
Funding support was provided by European Union. Medicine, 1988, 27: 927–933.

47. RUCHI--221-226.pmd 225 5/17/2013, 2:41 PM


226 Indian Journal of Public Health Research & Development. April-June 2013, Vol. 4, No. 2

14. Fitzpatrick R. Surveys of patient satisfaction: I. 22. Gleeson C, Robinson M, Neal R. A review of
Important general considerations. British Medical teenager’s perceived needs and access to primary
Journal, 1991, 302: 1129–1132. health care: implications for health services. Prim
15. Transgrud R. Adolescent Reproductive Health in Health Care Res Dev 2002; 3: 184–93.
East and Southern Africa: Building Experience, 23. Elster AB, Marcell AV. Health care of adolescent
Four Case Studies: A Report Prepared for the males: overview, rationale, and recommendations.
Regional Adolescent RH Network. Nairobi, Adolesc Med 2003; 14: 525–40.
Kenya: Family Care International, 1998. 24. Gans JE, McManus MA, Newacheck PW.
16. Bender S. Attitudes of Icelandic young people Adolescent Health Care: Use, Costs and Problems
toward sexual and reproductive health services. of Access. [Profiles of Adolescent Health Series, v.
Fam Plann Perspect 1999;31:294 –301. 2]. Chicago, IL: American Medical Association,
17. Ginsburg K, Slap G, Cnann A, et al. Adolescents’ 1991.
perceptions of factors affecting their decisions to 25. Marks A, Malizio J. Hoch J. et al. Assessment of
seek health care. JAMA 1995; 273(24):1913– 8. health needs and willingness to utilize health care
18. Tugsdelger Sovd, Kristin Mmari, Varja Lipovsek resources of adolescents in a suburban
and Semira Manaseki-Holland. Acceptability as population. J Pediatr 1983;102:456-460.
a key determinant of client satisfaction: lessons 26. Resnick MD, Litman TJ, Blum RW. Physicians’
from an evaluation of AFHS in Mongolia. Journal attitudes toward confidentiality of treatment for
of Adolescent Health. 2006; 38, 519–526. adolescents: findings from the upper Midwest
19. WHO. Global consultation on adolescent health regional survey. J Adolesc Health 1992; 13:616-
services a consensus statement. Geneva: 612.
Department of Child and Adolescent Health and 27. Brian W. Patient satisfaction: a valid concept?
Development, WHO, 2001. Social Science and Medicine, 1994, 38: 509–516.
20. Sanci LA, Sawyer SM, Kang MS, Haller DM, 28. Jorge Mendoza Aldana, Helga Piechulek, and
Patton GC. Confidential health care for Ahmed Al-Sabir. Client satisfaction and quality
adolescents: reconciling clinical evidence with of health care in rural Bangladesh. Bulletin of the
family values. Med J Aust 2005; 183: 410–14. WHO, 2001, 79 (6).
21. WHO. Adolescent friendly health services: an
agenda for change. Geneva: WHO, 2002.

47. RUCHI--221-226.pmd 226 5/17/2013, 2:41 PM


Reproduced with permission of the copyright owner. Further reproduction prohibited without
permission.

Das könnte Ihnen auch gefallen