Using health worker opinions to assess changes in structural components of quality in a Cluster Randomized Trial

BMC Health Services Research

Mike English³  Elizabeth Allen¹  Jim Todd⁴  Stephen Ntoburi¹  Charles Opondo²  Philip Ayieko²  Naomi Muinga² 

[1] Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK;KEMRI/Wellcome Trust Research Programme, Nairobi, Kenya;Department of Paediatrics, University of Oxford, Oxford, UK;Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK

关键词: Health services research;    Paediatrics;    Child health;    Quality improvement;   

Others  :  1130665
DOI  :  10.1186/1472-6963-14-282

 received in 2013-07-23, accepted in 2014-06-20,  发布年份 2014

【 摘 要 】

Background

The ‘resource readiness’ of health facilities to provide effective services is captured in the structure component of the classical Donabedian paradigm often used for assessment of the quality of care in the health sector. Periodic inventories are commonly used to confirm the presence (or absence) of equipment or drugs by physical observation or by asking those in charge to indicate whether an item is present or not. It is then assumed that this point observation is representative of the everyday status. However the availability of an item (consumables) may vary. Arguably therefore a more useful assessment for resources would be one that captures this fluctuation in time. Here we report an approach that may circumvent these difficulties.

Methods

We used self-administered questionnaires (SAQ) to seek health worker views of availability of key resources supporting paediatric care linked to a cluster randomized trial of a multifaceted intervention aimed at improving this care conducted in eight rural Kenyan district hospitals. Four hospitals received a full intervention and four a partial intervention. Data were collected pre-intervention and after 6 and 18 months from health workers in three clinical areas asked to score item availability using an 11-point scale. Mean scores for items common to all 3 areas and mean scores for items allocated to domains identified using exploratory factor analysis (EFA) were used to describe availability and explore changes over time.

Results

SAQ were collected from 1,156 health workers. EFA identified 11 item domains across the three departments. Mean availability scores for these domains were often <5/10 at baseline reflecting lack of basic resources such as oxygen, nutrition and second line drugs. An improvement in mean scores occurred in 8 out of 11 domains in both control and intervention groups. A calculation of difference in difference of means for intervention vs. control suggested an intervention effect resulting in greater changes in 5 out of 11 domains.

Conclusion

Using SAQ data to assess resource availability experienced by health workers provides an alternative to direct observations that provide point prevalence estimates. Further the approach was able to demonstrate poor access to resources, change over time and variability across place.

【 授权许可】

   
2014 Muinga et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Bryce J, Boschi-Pinto C, Shibuyo K, Black R, WHO: WHO estimates of the causes of death in children. Lancet 2005, 365:1147-1152.
• [2]WHO/UNICEF: Management of the Child with a Serious Infection or Severe Malnutrition: Guidelines for Care at the First-Referral Level in Developing Countries. Geneva; 2000.
• [3]World Health Organisation: Pocket book of hospital care for children: guidelines for the management of common illnesses with limited resources. Geneva: WHO; 2005.
• [4]Irimu G, Wamae A, Wasunna A, Were F, Ntoburi S, Opiyo N, Ayieko P, Peshu N, English M: Developing and introducing evidence based clinical practice guidelines for serious illness in Kenya. Arch Dis Child 2008, 93(9):799-804.
• [5]English M, Esamai F, Wasunna A, Were F, Ogutu B, Wamae A, Snow R, Peshu N: Assessment of inpatient paediatric care in first referral level hospitals in 13 districts in Kenya. Lancet 2004, 363:1948-1953.
• [6]English M, Esamai E, Wasunna A, Were F, Ogutu B, Wamae A, Snow RW, Peshu N: Delivery of paediatric care at the first-referral level in Kenya. Lancet 2004, 364:1622-1629.
• [7]Nolan TAP, Cunha AJ, Muhe L, Qazi S, Simoes EA, Tamburlini G, Weber M, Pierce NF: Quality of hospital care for seriously ill children in less-developed countries. Lancet 2000, 357:106-110.
• [8]Aiken AM, Mturi N, Njuguna P, Mohammed S, Berkley JA, Mwangi I, Mwarumba S, Kitsao BS, Lowe BS, Morpeth SC, Hall AJ, Khandawalla I, Scott JAG: Risk and causes of paediatric hospital-acquired bacteraemia in Kilifi District Hospital, Kenya: a prospective cohort study. Lancet 2011, 378(9808):2021-2027.
• [9]Donabedian A: The quality of care: How can it be assessed? JAMA 1988, 260(12):1743-1748.
• [10]English M, Ntoburi S, Wagai J, Mbindyo P, Opiyo N, Ayieko P, Opondo C, Migiro S, Wamae A, Irimu G: An intervention to improve paediatric and newborn care in Kenyan district hospitals: Understanding the context. Implement Sci 2009, 4(1):42.
• [11]Penfold S, Shamba D, Hanson C, Jaribu J, Manzi F, Marchant T, Tanner M, Ramsey K, Schellenberg D, Schellenberg JA: Staff experiences of providing maternity services in rural southern Tanzania - a focus on equipment, drug and supply issues. BMC Health Serv Res 2013, 13(1):61.
• [12]English M, Gathara D, Mwinga S, Ayieko P, Opondo C, Aluvaala J, Kihuba E, Mwaniki P, Were F, Irimu G, Wassuna A, Mogoa W, Nyamai R: Adoption of recommended practices and basic technologies in a low-income setting. Arch Dis Child 2014, 99(5):452-456.
• [13]National Coordinating Agency for Population and Development (NCAPD) [Kenya], Ministry of Medical Services (MOMS) [Kenya], Ministry of Public Health and Sanitation (MOPHS) [Kenya], Kenya National Bureau of Statistics (KNBS) [Kenya], ICF Macro: Kenya Service Provision Assessment Survey 2010. Nairobi, Kenya: National Coordinating Agency for Population and Development, Ministry of Medical Services, Ministry of Public Health and Sanitation, Kenya National Bureau of Statistics, and ICF Macro; 2011.
• [14]Githinji S, Kigen S, Memusi D, Nyandigisi A, Mbithi AM, Wamari A, Muturi AN, Jagoe G, Barrington J, Snow RW, Zurovac D: Reducing Stock-Outs of Life Saving Malaria Commodities Using Mobile Phone Text-Messaging: SMS for Life Study in Kenya. PLoS ONE 2013, 8(1):e54066.
• [15]Ayieko P, Ntoburi S, Wagai J, Opondo C, Opiyo N, Migiro S, Wamae A, Mogoa W, Were F, Wasunna A, Fegan G, Irimu G, English M: A Multifaceted Intervention to Implement Guidelines and Improve Admission Paediatric Care in Kenyan District Hospitals: A Cluster Randomised Trial. PLoS Med 2011, 8(4):e1001018.
• [16]English M, Irimu G, Wamae A, Were F, Wasunna A, Fegan G, Peshu N: Health systems research in a low-income country: easier said than done. Arch Dis Child 2008, 93(6):540-544.
• [17]Nzinga J, Ntoburi S, Wagai J, Mbindyo P, Mbaabu L, Migiro S, Wamae A, Irimu G, English M: Implementation experience during an eighteen month intervention to improve paediatric and newborn care in Kenyan district hospitals. Implement Sci 2009, 4(1):45.
• [18]English M, Nzinga J, Mbindyo P, Ayieko P, Irimu G, Mbaabu L: Explaining the effects of a multifaceted intervention to improve inpatient care in rural Kenyan hospitals – interpretation based on retrospective examination of data from participant observation, quantitative and qualitative studies. Implement Sci 2011, 6(1):124.
• [19]Ntoburi S, Hutchings A, Sanderson C, Carpenter J, Weber M, English M, Panel* tPQoHCI: Development of paediatric quality of inpatient care indicators for low-income countries - A Delphi study. BMC Pediatr 2010, 10(1):90.
• [20]Hamel MJ, Adazu K, Obor D, Sewe M, Vulule J, Williamson JM, Slutsker L, Feikin DR, Laserson KF: A Reversal in Reductions of Child Mortality in Western Kenya, 2003–2009. Am J Trop Med Hyg 2011, 85(4):597-605.
• [21]Smith PG: Field Trials of Health Intervention in Developing Countries: A Toolbox. Oxford, UK: Macmillan Education; 1996. [Revised edition (September 18, 1996) edition]
• [22]Pett MA, Lackey NR, Sullivan JJ: Making Sense of Factor Analysis: The Use of Factor Analysis for Instrument Development in Health Care Research: SAGE Publications. 2003.
• [23]DeCoster J: Overview of Factor Analysis. 1998.
• [24]Barasa EW, Ayieko P, Cleary S, English M: A Multifaceted Intervention to Improve the Quality of Care of Children in District Hospitals in Kenya: A Cost-Effectiveness Analysis. PLoS Med 2012, 9(6):e1001238.
• [25]Streiner D, Norman G: Health measurement scales: a practical guide to their development and use. 4th edition. Oxford, UK: Oxford University Press; 1989.
• [26]Nzinga J, Mbindyo P, Mbaabu L, Warira A, English M: Documenting the experiences of health workers expected to implement guidelines during an intervention study in Kenyan hospitals. Implement Sci 2009, 4(1):44.
• [27]Gouws E, Bryce J, Pariyo G, Armstrong Schellenberg J, Amaral J, Habicht JP: Measuring the quality of child health care at first-level facilities. Soc Sci Med 2005, 61(3):613-625.
• [28]Campbell H, Duke T, Weber M, English M, Carai S, Tamburlini G, Group PHI: Global Initiatives for Improving Hospital Care for Children: State of the Art and Future Prospects. Pediatrics 2008, 121(4):e984-e992.