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ORIGINAL ARTICLE
Open Access

Measuring Service Quality and Assessing Its Relationship to Contraceptive Discontinuation: A Prospective Cohort Study in Pakistan and Uganda

Karen T. Chang, Nirali M. Chakraborty, Amanda M. Kalamar, Waqas Hameed, Ben Bellows, Karen A Grépin, Agha Xaher Gul, Sarah E.K. Bradley, Lynn M. Atuyambe and Dominic Montagu
Global Health: Science and Practice September 2020, 8(3):442-454; https://doi.org/10.9745/GHSP-D-20-00105
Karen T. Chang
aMetrics for Management, Baltimore, MD, USA.
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Nirali M. Chakraborty
aMetrics for Management, Baltimore, MD, USA.
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  • For correspondence: nirali@m4mgmt.org
Amanda M. Kalamar
bPopulation Services International, Washington, DC, USA.
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Waqas Hameed
cAga Khan University, Karachi, Pakistan.
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Ben Bellows
dPopulation Council, Washington, DC, USA.
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Karen A Grépin
eUniversity of Hong Kong, Hong Kong, China.
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Agha Xaher Gul
fMarie Stopes Society, Karachi, Pakistan.
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Sarah E.K. Bradley
gAbt Associates, Rockville, MD, USA.
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Lynn M. Atuyambe
hMakerere University, Kampala, Uganda.
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Dominic Montagu
aMetrics for Management, Baltimore, MD, USA.
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  • FIGURE 1.
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    FIGURE 1.

    Adapted Facility-Level Quality of Care Framework

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    FIGURE 2.

    Cumulative Probability of Modern Method Discontinuation Among Women in Need in Pakistan and Uganda

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    TABLE 1.

    Descriptive Statistics and Cronbach’s Alpha Scores for Each Facility Quality Domain in Pakistan and Uganda

    DomainPakistanUganda
    RangeRange
    Score RangeNo. of items (N=36)MinMaxMean (μ)SD(σ)Alpha(α)Score RangeNo. of items (N=20)MinMaxMean (μ)SD (σ)Alpha(α)
    Readiness for choice0–1475.4214.0012.201.94.700–211.002.001.500.51n/aa
    Readiness for management support0–1261.7711.838.022.88.840–1055.0010.008.901.81.89
    Client-centered readiness0–740.006.924.061.57.660–633.006.005.071.17.79
    Interpersonal skills0–840.678.005.491.94.90n/ab
    Technical competence0–22113.6421.5315.694.01.800–1077.0014.0011.832.41.83
    Information provision0–630.006.002.971.91.970–841.008.006.202.02.65
    Structural privacyc0–210.002.001.450.61n/aan/ac
    • Abbreviations: n/a, not applicable; SD, standard deviation.

    • ↵a The structural privacy variable in Pakistan and the readiness for choice domain in Uganda each contained only 1 item; alpha not calculated.

    • ↵b No variables were grouped into the interpersonal skills domain in Uganda.

    • ↵c The structural privacy variable did not group well with variables in other domains in Pakistan. In Uganda, the structural privacy variable was included in the client-centered readiness domain.

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    TABLE 2.

    Unadjusted and Adjusted Hazard Ratios for Discontinuation of Modern Contraception in Pakistan, by Quality Domain

    Unadjusted Univariate ModelModel 1Unadjusted Full ModelModel 2Adjusted Reduced ModelaModel 3
    Facility Quality DomainHR (95% CI)P-valueHR (95% CI)P-valueHR (95% CI)P-value
    Readiness for choice0.89b (0.77, 1.03).100.94i (0.81, 1.10).430.92j (0.80, 1.05).20
    Readiness for management support1.02c (0.90, 1.15).770.91i (0.76, 1.09).30
    Client-centered readiness1.14d (0.90, 1.44).271.23i (0.92, 1.65).16
    Interpersonal skills0.80e (0.69, 0.92).0020.97i (0.76, 1.25).83
    Technical competence0.92f (0.86, 0.98).0081.00i (0.90, 1.11).99
    Information provision0.79g (0.68, 0.91).0011.06i (0.79, 1.42).72
    Structural privacy0.37h (0.24, 0.57)<.0010.36i (0.18, 0.71).0030.40j (0.26, 0.61)<.001
    Age category (35–49, ref)——
     15–241.96 (1.01, 3.78).05
     25–341.70 (1.02, 2.83).04
    Use short-acting method1.80 (1.14, 2.86).01
    • Abbreviations: CI, confidence interval; HR, hazard ratio; ref, reference category; SE, standard error.

    • ↵a Adjusted for participants’ age and short-acting versus long-acting method use at baseline.

    • ↵b Theta (shared frailty term): t=0.88, SE=0.33, P<.001.

    • ↵c Theta (shared frailty term): t=0.99, SE=0.35, P<.001.

    • ↵d Theta (shared frailty term): t=0.98, SE=0.34, P<.001.

    • ↵e Theta (shared frailty term): t=0.68, SE=0.28, P<.001.

    • ↵f Theta (shared frailty term): t=0.72, SE=0.30, P<.001.

    • ↵g Theta (shared frailty term): t=0.63, SE=0.29, P<.001.

    • ↵h Theta (shared frailty term): t=0.47, SE=0.23, P=.001.

    • ↵i Theta (shared frailty term): t=0.44, SE=0.22, P=.001.

    • ↵j Theta (shared frailty term): t=0.55, SE=0.27, P<.001.

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    TABLE 3.

    Unadjusted and Adjusted Hazard Ratios for Discontinuation of Modern Contraception in Uganda, by Quality Domain

    Unadjusted Univariate ModelModel 1Unadjusted Full ModelModel 2Adjusted Reduced ModelaModel 3
    Facility Quality DomainHR (95% CI)P-valueHR (95% CI)P-valueHR (95% CI)P-value
    Readiness for choice0.79 (0.42, 1.47).460.59 (0.28, 1.23).16
    Readiness for management support0.96 (0.82, 1.13).640.60 (0.42, 0.86).0050.67 (0.51, 0.89).005
    Client-centered readiness1.05 (0.78, 1.41).761.30 (0.92, 1.82).13
    Interpersonal skills——————
    Technical competence1.07 (0.91, 1.25).431.47 (1.07, 2.02).021.32 (0.97, 1.78).07
    Information provision1.03 (0.89, 1.18).731.05 (0.87, 1.25).64
    Age category (35–49, ref)—
     15–241.93 (0.62, 6.03).26
     25–342.54 (1.01, 6.39).05
    Use short-acting method7.64 (3.91, 14.92)<.001
    • Abbreviations: CI, confidence interval; HR, hazard ratio; ref, reference category.

    • ↵a Adjusted for participants’ age and short-acting versus long-acting method use at baseline.

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Global Health: Science and Practice: 8 (3)
Global Health: Science and Practice
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September 30, 2020
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Measuring Service Quality and Assessing Its Relationship to Contraceptive Discontinuation: A Prospective Cohort Study in Pakistan and Uganda
Karen T. Chang, Nirali M. Chakraborty, Amanda M. Kalamar, Waqas Hameed, Ben Bellows, Karen A Grépin, Agha Xaher Gul, Sarah E.K. Bradley, Lynn M. Atuyambe, Dominic Montagu
Global Health: Science and Practice Sep 2020, 8 (3) 442-454; DOI: 10.9745/GHSP-D-20-00105

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Measuring Service Quality and Assessing Its Relationship to Contraceptive Discontinuation: A Prospective Cohort Study in Pakistan and Uganda
Karen T. Chang, Nirali M. Chakraborty, Amanda M. Kalamar, Waqas Hameed, Ben Bellows, Karen A Grépin, Agha Xaher Gul, Sarah E.K. Bradley, Lynn M. Atuyambe, Dominic Montagu
Global Health: Science and Practice Sep 2020, 8 (3) 442-454; DOI: 10.9745/GHSP-D-20-00105
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