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Paediatr Perinat Epidemiol. 1998 Oct;12 Suppl 2:98-115.

Conceptual bases and methodology for the evaluation of women's and providers' perception of the quality of antenatal care in the WHO Antenatal Care Randomised Controlled Trial.

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Population Council, Regional Office for Latin America and the Caribbean, Mexico DF, Mexico.


In this paper, we describe the conceptual bases and methodology used to assess women's and providers' perception of the quality of antenatal care, as part of a large randomised trial in four developing countries. Information has been obtained by applying both qualitative and quantitative methodologies. The focus group discussions and in-depth interviews have contributed useful insights into the cultural milieu in which care is provided, users' and providers' expectations, and their concept of quality. Based on these findings, we developed two standardised questionnaires, one being administered to a representative sample of pregnant women (n = 1600) and the other for all care providers. In this paper we present some of the findings of the focus group discussions and in-depth interviews with women in one country as an example of the kind of information we have obtained. Women expressed their point of view concerning a reduced number of visits, type of provider, information that they get during clinical encounters and interpersonal relations with health professionals. The qualitative information, together with the data we obtain from the surveys, will highlight the aspects that will have be to considered if the new model of care is to be introduced on a routine basis.


Measurement of the subjective dimension of the quality of health care, including the perceptions of patients and providers, is seldom attempted. The World Health Organization (WHO) Antenatal Care Randomized Controlled Trial, underway in 53 clinics in Argentina, Cuba, Thailand, and Saudi Arabia, will apply both quantitative and qualitative methodologies to an assessment of client and staff satisfaction with a new prenatal care program. Specifically, the study addresses user and provider perceptions of quality in the context of a wide spectrum of ethnic backgrounds, social strata, organization of health services, and medical cultures. The research instrument consists of questions that explore the preferences of 1600 women and their providers in terms of the number of prenatal care visits, provider type and gender, time spent in the waiting room and with the provider, and amount and appropriateness of information received during the visits. Preliminary results from focus groups and in-depth interviews indicate that women are concerned about the safety of the reduced number of visits during pregnancy (four for low-risk women) inherent in the experimental regimen, prefer to receive care from specialists rather than family practitioners, are confused by the technical language used by providers, and want more information on the psychosocial aspects of pregnancy. Such qualitative information, together with data obtained from questionnaires, will highlight areas that must be addressed if the new prenatal care model is to be introduced on a routine basis.

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