TABLES: Monitoring Quality of Care in Family Planning Programs: A Comparison of Observations And Client Exit Interviews

	International Family Planning Perspectives Volume 27, Number 2, June 2001
	Monitoring Quality of Care in Family Planning Programs: A Comparison of Observations And Client Exit Interviews TABLES

Figure 1. Quality of care indicators measured by the Quick Investigation of Quality, by type of indicator, according to measurement instrument, 1998-1999
Indicator	Client exit interviews	Observations	Facility audit
Provider
Demonstrates good counseling skills (composite)	X	X
Assures client of confidentiality	X
Asks client about reproductive intentions	X	X
Discusses with client which method she would prefer	X	X
Mentions STDs or HIV/AIDS (initiates or responds)	X	X
Discusses dual method use	X	X
Treats client with respect/courtesy	X	X
Tailors key information to the client's particular needs	X
Gives accurate information on the method accepted	X	X
Gives instructions on when to return	X	X
Follows infection control procedures outlined in guidelines		X
Recognizes/identifies contraindications consistent with guidelines		X
Performs clinical procedures according to guidelines		X
Other staff
Treat clients with dignity and respect	X
Client
Participates actively in discussion and selection of method, is "empowered" (composite)	X	X
Receives her method of choice	X	X
Believes the provider will keep her information confidential	X
Facility
Has all (approved) methods available			X
Has basic items needed for delivery ofmethods available through service delivery point			X
Offers privacy for pelvic examination/IUD insertion	X	X	X
Has mechanisms to make programmatic changes on the basis of client feedback			X
Has received a supervisory visit in past _ months			X
Has adequate storage for contraceptives and medicines			X
Has state-of-the-art clinical guidelines			X
Has acceptable waiting time	X		X
Notes: The two composite indicators were not included in the analysis because measures that they are based on differed across countries. Five indicators that do not appear on this list were also included in the study: provider sees client in privacy for counseling, asks client if she has any concerns or problems, tells client how to use the method, gives information on side effects and explains that the method does not protect against HIV/AIDS.

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Table 1. Percentage of visits exhibiting quality care, by measurement instrument; percentage agreement between instruments; and kappa coefficients indicating strength of agreement--all by country, according to quality of care indicator
Indicator	Ecuador (N=583)				Uganda (N=539)				Zimbabwe (N=736)
Indicator	Observations	Interviews	Agreements	Kappa	Observations	Interviews	Agreements	Kappa	Observations	Interviews	Agreements	Kappa
Interpersonal relations
Provider treats client with respect/courtesy	99	99	99	0.99	99	99	99	0.98	99	99	99	0.98
Provider sees client in private for counseling	99	87	88	0.74	87	88	82	0.63	97	95	92	0.85
Facility offers privacy for pelvic examination/IUD insertion*	99	93	93	0.85	95	82	82	0.65	98	98	97	0.94
Provider asks client if she has any concerns or problems†	84	87	76	0.54	87	86	81	0.61	u	u	u	u
Choice of methods
Provider discusses client's fertility intentions‡	53	63	62	0.23	63	53	63	0.26	40	35	70	0.40
Provider discusses with client which method she would prefer§	99	98	98	0.95	74	85	69	0.38	90	94	87	0.76
Client receives her method of choice§	80	84	91	0.82	76	81	82	0.64	89	87	95	0.88
Information given clients
Provider tells the client how to use the method**	85	97	85	0.70	94	93	89	0.77	85	82	83	0.64
Provider gives accurate information on the method accepted**	84	75	75	0.50	94	100	94	0.78	85	96	83	0.66
Provider gives information on side effects**	71	80	75	0.49	86	77	78	0.57	70	65	70	0.41
Appropriate constellation of services
Provider mentions STDs or HIV/AIDS	13	27	79	0.57	22	30	69	0.38	12	15	84	0.68
Provider explains that method does not protect against HIV/AIDS††	19	34	73	0.46	40	59	63	0.27	10	52	55	0.08
Provider encourages dual method use††	19	36	74	0.48	26	49	62	0.25	46	57	79	0.62
Mechanisms for continuity
Provider gives instructions on when to return	94	96	91	0.81	94	94	91	0.81	83	72	70	0.41
Clients receiving a pelvic examination or IUD insertion: Ecuador (N=403), Uganda (N=34) and Zimbabwe (N=138). †Returning clients only: Ecuador (N=353) and Uganda (N=300). ‡New clients only: Ecuador (N=177), Uganda (N=137) and Zimbabwe (N=198). §New clients with a method preference: Ecuador (N=109), Uganda (N=88) and Zimbabwe (N=150). *New clients who received a method: Ecuador (N=145), Uganda (N=111) and Zimbabwe (N=191). ††New clients who received a nonbarrier method: Ecuador (N=130), Uganda (N=109) and Zimbabwe (N=169). Notes: u=unavailable. Kappa coefficients, which correct for the proportion of responses that would agree because of chance alone, are adjusted for prevalence and bias.

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Table 2. Percentage of visits exhibiting quality care, by measurement instrument; percentage agreement between instruments; kappa coefficients indicating strength of agreement; and assessment of bias--for all three countries combined, by quality of care indicator
Indicator	Observations	Interviews	Agreements	Kappa	Evidence
Provider actions with client (objective)
Provider discusses with client which method she would prefer†	88	93	85	0.71	No
Provider gives instructions on when to return	89	86	83	0.66	Yes
Provider asks client if she has any concerns or problems‡	86	86	79	0.57	No
Provider discusses client's fertility intentions§	51	49	65	0.30	No
Information given to client (objective)
Provider tells client how to use the method**	87	90	85	0.69	No
Provider mentions STDs or HIV/AIDS	15	23	78	0.56	Yes
Provider gives information on side effects**	74	73	74	0.48	No
Provider encourages dual method use††	32	48	74	0.47	Yes
Provider explains that method does not protect against HIV/AIDS††	21	48	63	0.26	Yes
Provider gives accurate information on the method accepted**	87	91	84	0.67	Yes
Interpersonal relations (subjective)
Provider treats client with respect/courtesy	99	99	99	0.98	No
Client receives her method of choice†	83	84	90	0.80	No
Provider sees client in private for counseling	95	91	88	0.75	Yes
Facility offers privacy for pelvic examination/IUD insertion‡‡	99	94	93	0.86	Yes
Based on McNemar's test for bias, p<.05. †New clients with a method preference (N=347). ‡Returning clients (N=653). §New clients only (N=512). New clients who received a method in Ecuador (N=447). ††New clients who received a nonbarrier method (N=408). ‡‡Clients receiving a pelvic examination or having an IUD inserted (N=575). Note:* Kappa coefficients, which correct for the proportion of responses that would agree because of chance alone, are adjusted for prevalence and bias.

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Figure 2. Kappa coefficients indicating the comparability of 14 indicators measured through observation and client exit interviews