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. 2019 Jul 5:47:41.
doi: 10.1186/s41182-019-0172-7. eCollection 2019.

Women's overall satisfaction with health facility delivery services in Ghana: a mixed-methods study

Kwame K Adjei  1 , Kimiyo Kikuchi  2 , Seth Owusu-Agyei  1   3 , Yeetey Enuameh  1   4 , Akira Shibanuma  5 , Evelyn Korkor Ansah  3   6 , Junko Yasuoka  7 , Kwaku Poku-Asante  1 , Sumiyo Okawa  5 , Margaret Gyapong  3 , Charlotte Tawiah  1 , Abraham Rexford Oduro  8 , Evelyn Sakeah  8 , Doris Sarpong  9 , Keiko Nanishi  10 , Gloria Quansah Asare  11 , Abraham Hodgson  6 , Masamine Jimba  5 ; Ghana EMBRACE Implementation Research Project Team
Collaborators, Affiliations

Women's overall satisfaction with health facility delivery services in Ghana: a mixed-methods study

Kwame K Adjei et al. Trop Med Health. .

Abstract

Background: Skilled birth delivery has increased up to nearly 74% in Ghana, but its quality has been questioned over the years. As understanding women's satisfaction could be important to improving service quality, this study aimed to determine what factors were associated with women's overall satisfaction with delivery services quantitatively and qualitatively in rural Ghanaian health facilities.

Results: This cross-sectional, mixed methods study used an explanatory sequential design across three Ghana Health Service research areas in 2013. Participants were women who had delivered in the preceding 2 years. Two-stage random sampling was used to recruit women for the quantitative survey. Relationships between women's socio-demographic characteristics and their overall satisfaction with health facility delivery services were examined using univariate and multiple logistic regression analyses. For qualitative analyses, women who completed the quantitative survey were purposively selected to participate in focus group discussions. Data from the focus group discussions were analyzed based on predefined and emerging themes. Overall, 1130 women were included in the quantitative analyses and 136 women participated in 15 focus group discussions. Women's mean age was 29 years. Nearly all women (94%) were satisfied with the overall services received during delivery. Women with middle level/junior high school education [adjusted odds ratio (AOR) = 0.50, 95% confidence interval (CI) = (0.26-0.98)] were less likely to be satisfied with overall delivery services compared to women with no education. Qualitatively, women were not satisfied with the unconventional demands, negative attitude, and unavailability of healthcare workers, as well as the long wait time.

Conclusions: Although most women were satisfied with the overall service they received during delivery, they were not satisfied with specific aspects of the health services; therefore, higher quality service delivery is necessary to improve women's satisfaction. Additional sensitivity training and a reduction in work hours may also improve the experience of clients.

Keywords: Child health; Client satisfaction; Ghana; Maternal health; Mixed methods; Pregnancy.

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Conflict of interest statement

Ethics approval and consent to participateBefore implementing the study, ethical clearance was obtained from the Ethical Review Committee (ERC) of the research and development division (RDD) of the GHS; the research ethics committee (REC) of the University of Tokyo, Japan; the institutional review board (IRB) of the Dodowa HRC; the institutional ethics committee (IEC) of the Kintampo HRC; and the Institutional Review Board of the Navrongo HRC. Written informed consent was sought from all participating women, who were informed about the study purpose, its risks and benefits, privacy, confidentiality, conflicts of interest, and that participation was voluntary. Women aged below 18 years provided assent and their guardians provided consent. Strict confidentiality was enforced throughout.Competing interestsThe authors declare that they have no competing interests.

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