Validation of Two Quality of Care Measures: Results from a Longitudinal Study of Reversible Contraceptive Users in India

Abstract

Bruce's quality of care framework, developed nearly three decades ago, brought needed international attention to family planning services. Various data collection efforts exist to measure the quality of contraceptive services. Our study validates two process quality measures and tests their predictive validity related to contraceptive continuation among 2,699 married women who started to use a reversible contraceptive method in India. We assessed four process quality domains with 22 items, which were reduced to 10 items using exploratory factor analysis. Weighted additive indices were calculated for the 22-and 10item measures. Scores were trichotomized into high, medium, and low process quality received. The predictive validity of the two measures was assessed related to modern contraceptive continuation three months later. The adjusted odds of continuing a modern contraceptive three months later was nearly three times greater (AOR: 2.78; 95% CI: 1.83-4.03) for women who received high process quality at enrollment compared with low quality with the 22-item measure, and 2.2 times greater (95% CI: 1. 46-3.26) with the 10-item measure. Results suggest that the 22-and 10-item measures are valid, and while the larger 22-item measure can be used in special studies, the 10-item measure is more suited for routine data collection and monitoring. I n 1990, Bruce articulated a framework to assess quality of care in family planning (FP) services (Bruce 1990). Since then, there have been many efforts to measure quality (Tumlinson 2016) and assess its effect on contraceptive uptake (Koenig, Hossain, and Whittaker 1997), contraceptive continuation (RamaRao et al.

Contraceptive use dynamics in India: A prospective cohort study of modern reversible contraceptive users

“…Measures of quality were broken down into four domains of process quality (Jain, Townsend & Ramarao 2018;Jain et al 2019a):…”

Positioning family planning quality within health financing for UHC: Connecting the discourse

“…A seven-country study of health insurance schemes (Ross et al, 2018) concluded that despite the formal inclusion of FP services in the national benefits packages examined, actual integration of these services faced challenges, with implications for the availability of FP services in practice. A study in India also found that use of FP under the national health insurance scheme was low, estimated at 2%, with poorer families less likely to know of its inclusion (Mozumdar et al, 2019).…”

“…There are many tools to assess the quality of FP services, however, there is lack of agreement on their routine use (Sprockett 2017). Recent studies have validated quality measures appropriate for routine reporting in FP service delivery settings, finding that higher values on the FP quality measures were associated with increased contraceptive use and reduced discontinuation (Jain et al, 2013;Jain and Winfrey, 2017;Chakraborty et al, 2019;Jain et al, 2019;Holt et al, 2019). While the evidence and the validated metrics are promising, measurement of rights such as client autonomy in service delivery settings can be further improved (Bertrand et al, 2014;Cole et al, 2019).…”

Validation of the Interpersonal Quality of Family Planning Scale in a rural Indian setting

“…However, tools that attempt to systematically measure the quality of FP care based on client report rarely focus on the dimensions of individuals' experiences with counseling [ 2 ]. Only a few existing tools designed to measure the quality of contraceptive counseling have assessed for reliability and validity in low- and middle-income countries (LMICs) [ 8 , [12] , [13] , [14] ]. Sudhinaraset et al, developed and validated the Person-Centered Family Planning scale in India and Kenya as a 20- or 22-item measure capturing two primary domains: autonomy, respectful care and communication; and health facility environment [ 14 ].…”

“…Sudhinaraset et al, developed and validated the Person-Centered Family Planning scale in India and Kenya as a 20- or 22-item measure capturing two primary domains: autonomy, respectful care and communication; and health facility environment [ 14 ]. Jain et al developed and validated a contraceptive care measure in India, both a longer 22-item and shorter 10-item form, capturing information exchange and interpersonal relations between provider and client on four domains: respectful care, method selection, effective use of method selected and continuity of contraceptive care [ 12 ]. Holt et al, developed and validated the Quality of Contraceptive Counseling scale in Mexico as a 22-item measure of FP client experiences with providers, focusing on three domains: information exchange, interpersonal relationship and disrespect/abuse [ 13 ].…”