Integrated delivery of family planning and childhood immunisation services: a mixed methods assessment of service responsiveness
Abstract Background Postpartum women represent a considerable share of the global unmet need for modern contraceptives. Evidence suggests that the integration of family planning (FP) with childhood immunisation services could help reduce this unmet need by providing repeat opportunities for timely c...
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| Format: | Article |
| Language: | English |
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BMC
2022-04-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-022-07983-7 |
| _version_ | 1818264231362953216 |
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| author | Jessie K. Hamon Misozi Kambanje Shannon Pryor Alice S. Kaponda Erick Mwale Helen E. D. Burchett Susannah H. Mayhew Jayne Webster |
| author_facet | Jessie K. Hamon Misozi Kambanje Shannon Pryor Alice S. Kaponda Erick Mwale Helen E. D. Burchett Susannah H. Mayhew Jayne Webster |
| author_sort | Jessie K. Hamon |
| collection | DOAJ |
| description | Abstract Background Postpartum women represent a considerable share of the global unmet need for modern contraceptives. Evidence suggests that the integration of family planning (FP) with childhood immunisation services could help reduce this unmet need by providing repeat opportunities for timely contact with FP services. However, little is known about the clients’ experiences of FP services that are integrated with childhood immunisations, despite being crucial to contraceptive uptake and repeat service utilisation. Methods The responsiveness of FP services that were integrated with childhood immunisations in Malawi was assessed using cross-sectional convergent mixed methods. Exit interviews with clients (n=146) and audits (n=15) were conducted in routine outreach clinics. Responsiveness scores across eight domains were determined according to the proportion of clients who rated each domain positively. Text summary analyses of qualitative data from cognitive interviewing probes were also conducted to explain responsiveness scores. Additionally, Spearman rank correlation and Pearson’s chi-squared test were used to identify correlations between domain ratings and to examine associations between domain ratings and client, service and clinic characteristics. Results Responsiveness scores varied across domains: dignity (97.9%); service continuity (90.9%); communication (88.7%); ease of access (77.2%); counselling (66.4%); confidentiality (62.0%); environment (53.9%) and choice of provider (28.4%). Despite some low performing domains, 98.6% of clients said they would recommend the clinic to a friend or family member interested in FP. The choice of provider, communication, confidentiality and counselling ratings were positively associated with clients’ exclusive use of one clinic for FP services. Also, the organisation of services in the clinics and the providers’ individual behaviours were found to be critical to service responsiveness. Conclusions This study establishes that in routine outreach clinics, FP services can be responsive when integrated with childhood immunisations, particularly in terms of the dignity and service continuity afforded to clients, though less so in terms of the choice of provider, environment, and confidentiality experienced. Additionally, it demonstrates the value of combining cognitive interviewing techniques with Likert questions to assess service responsiveness. |
| first_indexed | 2024-12-12T19:31:37Z |
| format | Article |
| id | doaj.art-29d5a1f23e0a4b8a94b0614e35ab742d |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-12T19:31:37Z |
| publishDate | 2022-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-29d5a1f23e0a4b8a94b0614e35ab742d2022-12-22T00:14:24ZengBMCBMC Health Services Research1472-69632022-04-0122111110.1186/s12913-022-07983-7Integrated delivery of family planning and childhood immunisation services: a mixed methods assessment of service responsivenessJessie K. Hamon0Misozi Kambanje1Shannon Pryor2Alice S. Kaponda3Erick Mwale4Helen E. D. Burchett5Susannah H. Mayhew6Jayne Webster7Department of Disease Control, London School of Hygiene & Tropical Medicine (LSHTM)Save the ChildrenSave the ChildrenSave the ChildrenSave the ChildrenDepartment of Public Health, Environments and Society, LSHTMDepartment of Global Health and Development, LSHTMDepartment of Disease Control, London School of Hygiene & Tropical Medicine (LSHTM)Abstract Background Postpartum women represent a considerable share of the global unmet need for modern contraceptives. Evidence suggests that the integration of family planning (FP) with childhood immunisation services could help reduce this unmet need by providing repeat opportunities for timely contact with FP services. However, little is known about the clients’ experiences of FP services that are integrated with childhood immunisations, despite being crucial to contraceptive uptake and repeat service utilisation. Methods The responsiveness of FP services that were integrated with childhood immunisations in Malawi was assessed using cross-sectional convergent mixed methods. Exit interviews with clients (n=146) and audits (n=15) were conducted in routine outreach clinics. Responsiveness scores across eight domains were determined according to the proportion of clients who rated each domain positively. Text summary analyses of qualitative data from cognitive interviewing probes were also conducted to explain responsiveness scores. Additionally, Spearman rank correlation and Pearson’s chi-squared test were used to identify correlations between domain ratings and to examine associations between domain ratings and client, service and clinic characteristics. Results Responsiveness scores varied across domains: dignity (97.9%); service continuity (90.9%); communication (88.7%); ease of access (77.2%); counselling (66.4%); confidentiality (62.0%); environment (53.9%) and choice of provider (28.4%). Despite some low performing domains, 98.6% of clients said they would recommend the clinic to a friend or family member interested in FP. The choice of provider, communication, confidentiality and counselling ratings were positively associated with clients’ exclusive use of one clinic for FP services. Also, the organisation of services in the clinics and the providers’ individual behaviours were found to be critical to service responsiveness. Conclusions This study establishes that in routine outreach clinics, FP services can be responsive when integrated with childhood immunisations, particularly in terms of the dignity and service continuity afforded to clients, though less so in terms of the choice of provider, environment, and confidentiality experienced. Additionally, it demonstrates the value of combining cognitive interviewing techniques with Likert questions to assess service responsiveness.https://doi.org/10.1186/s12913-022-07983-7family planningchildhood immunisationsintegrationservice deliveryresponsiveness |
| spellingShingle | Jessie K. Hamon Misozi Kambanje Shannon Pryor Alice S. Kaponda Erick Mwale Helen E. D. Burchett Susannah H. Mayhew Jayne Webster Integrated delivery of family planning and childhood immunisation services: a mixed methods assessment of service responsiveness BMC Health Services Research family planning childhood immunisations integration service delivery responsiveness |
| title | Integrated delivery of family planning and childhood immunisation services: a mixed methods assessment of service responsiveness |
| title_full | Integrated delivery of family planning and childhood immunisation services: a mixed methods assessment of service responsiveness |
| title_fullStr | Integrated delivery of family planning and childhood immunisation services: a mixed methods assessment of service responsiveness |
| title_full_unstemmed | Integrated delivery of family planning and childhood immunisation services: a mixed methods assessment of service responsiveness |
| title_short | Integrated delivery of family planning and childhood immunisation services: a mixed methods assessment of service responsiveness |
| title_sort | integrated delivery of family planning and childhood immunisation services a mixed methods assessment of service responsiveness |
| topic | family planning childhood immunisations integration service delivery responsiveness |
| url | https://doi.org/10.1186/s12913-022-07983-7 |
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