Measurement of the quality of family planning services

The quality of health services is a subject of increasing interest to health care providers and organizations responsible for financing and promoting health services. The importance of the client's perspective (and by inference, the perspective of potential clients, as well) is now well established, but efforts to define and measure quality have thus far been limited to the perspective of experts even when the experts claim to speak for the clients. In this paper we utilize family planning programs to explore issues of the quality of health services. We propose that a better understanding of the view of quality actually held by family planning program clients will clarify the influence of quality on the use of services, a clarity that has not been possible by looking at quality only as defined by providers, managers or experts. We review the literature on quality of services and identify the gaps in research that must be filled if a better understanding of what quality is and how it relates to service outcomes is to be obtained. A first step must be the research required to develop a set of measures of quality that reflects the multi-dimensional nature of quality, includes the clients' view of services in the definition of quality, and incorporates methodologies required to ascertain the true view of clients. Finally, we suggest that dimensions of quality identified as important for clients as a group will be more predictive of use of services than dimensions identified as important to providers.     

Elements of cultural competence in an Australian Aboriginal maternity program

Background

Pregnancy, labour and neonatal health outcomes for Australian Aboriginal women and their infants are frequently worse than those of the general population. Provision of culturally competent services may reduce these differences by improving access to timely and regular antenatal care. In an effort to address these issues, the Aboriginal Maternity Group Practice Program commenced in south metropolitan Perth, Western Australia, in 2011. The program employed Aboriginal Grandmothers, Aboriginal Health Officers and midwives working in a partnership model with pre-existing maternity services in the area.

Client satisfaction with developmental disabilities services

Data from a representative sample of 312 developmentally disabled clients of Florida's Department of Health and Rehabilitative Services are analyzed to discover the characteristics of the clients and to determine the extent to which the clients are satisfied with various services, reasons for any dissatisfaction that exists, and the factors which are related to satisfaction with services. Clients are least likely to be satisfied with the caregiver support services and the vocational and rehabilitative services they receive. Across all categories, reasons most often given for dissatisfaction with services are inappropriateness and insufficient amount. The factors most strongly related to client satisfaction with services are age, living arrangements, and number of services received. Adolescents are less likely than persons at other ages to be satisfied with the services they receive, persons living in a family setting are less likely than persons in nonfamily settings to be satisfied with services, and the greater the number of services received the lower the likelihood of client satisfaction. Combined with information showing that most of the clients have multiple disabilities, these data suggest that the service delivery system does a better job of delivering some services than others. A slot oriented program such as that in Florida may pay insufficient attention to the existence of multiple needs among persons who are developmentally disabled and to providing services to the networks which form the client's economic and social support system.     

No One Is Immune: A Community Education Partnership Addressing HIV/AIDS and Older Adults

There has been a dramatic increase in the number of new HIV diagnoses among people aged 50 to 64 in the United States, and according to the Centers for Disease Control and Prevention (CDC), in just 7 years (by 2015) 50% of those living with AIDS will be aged 50 or older. To address this public health concern, viable HIV/AIDS prevention and treatment options for individuals over the age of 50 are necessary. This article discusses the No One Is Immune initiative that planned, implemented, and coordinated evidence- based HIV/AIDS prevention and education programs specifically tailored for middle-aged and older adults. Guided by the health belief model, an educational conference entitled "Sexuality, Medication, and HIV/AIDS in Middle and Later Adulthood" was conducted along with research activities that assessed HIV/AIDS knowledge gained using both qualitative and quantitative measures. This project can be replicated by other providers within the aging network.     

Men Who Have Sex With Men in Kisumu,Kenya: Comfort in Accessing Health Services and Willingness to Participate in HIV Prevention Studies

Men who have sex with men (MSM) are a crucial and marginalized at risk population for HIV in Africa but are poorly studied. Like other areas of Africa, homosexuality is illegal in Kenya. We assessed MSM comfort in accessing health services and willingness to participate in HIV prevention research in Kisumu, Kenya—an area of high HIV prevalence. We conducted a two-phase formative study with individual interviews (n = 15) and a structured survey (n = 51). Peer contact or snowball method (n = 43, 84.3%) was the primary recruitment strategy used to locate MSM. Exact logistic regression models were used for survey data analysis. Over 60% (32/51) of survey participants were not very comfortable seeking health services from a public hospital. Almost all MSM (49/51; 96.1%) reported willingness to be contacted to participate in future HIV research studies. Efforts to provide facilities that offer safe and confidential health services and health education for MSM is required. Continued community engagement with the MSM population in Kenya is needed to guide best practices for involving them in HIV prevention research.     

Changes in HIV/AIDS knowledge and testing behavior in Africa: how much and for whom?

Demographic and Health Survey data from nine African countries make it clear that HIV/AIDS prevention knowledge has been increasing. Still, in many cases, fewer than half of adult respondents can identify specific prevention behaviors. Knowledge is lowest in rural areas and among women. HIV testing generally remains rare but is highly variable across countries, likely reflecting differences in the supply of testing services. In most cases, schooling and wealth impacts on prevention knowledge have either been stable or have increased; hence, in the majority of contexts, initial disparities in knowledge by education and wealth levels have persisted or widened.

Knowledge and Attitudes About HIV/AIDS Among Community-Living Older Women: Reexamining Issues of Age and Gender

ABSTRACT

Although older women face unique risks related to HIV/AIDS, little empirical data is available regarding HIV/AIDS among women over the age of 65. In the present study, 160 community-living older women and men completed questionnaires regarding knowledge and attitudes about HIV/AIDS. Findings showed that although older women were less likely to talk to their physician about HIV than men, they maintained greater knowledge and generally dispelled myths about viral transmission. However, most older women believed that HIV/AIDS had limited personal relevance, possessed virtually no knowledge of age and gender specific risk factors, and professed HIV-associated stigma. These findings highlight the need for gender and age specific prevention programs.     

The effect of welfare eligibility on the labor force participation of women of Mexican origin in California

The relationship between AFDC, Food Stamp, and Medi-Cal Program eligibility, on the one hand, and labor force participation, on the other, was analyzed by comparing the labor force participation rates of women of Mexican origin who were fully eligible for these programs with those of less eligible women. Marital status, husband's income, and legal residence in the United States were used to define levels of program eligibility for this sample. The effects of education, English fluency, age, the number and ages of children, and the number of other adults in the household (excluding the mother and spouse) were controlled in logistic regression procedures. The results of the multivariate analyses show that AFDC, food stamps, and Medi-Cal combined inhibit the labor force participation of unmarried mothers. There is no evidence, however, that food stamps and Medi-Cal influence the labor force participation of married mothers. Earnings information on this sample of California women indicate that welfare benefits for unmarried mothers are highly competitive with net earnings, primarily because of the cost childcare. The data imply that free or subsidized childcare would increase labor force participation and reduce AFDC enrollment.     

The effects of monetized food aid on reproductive behavior in rural Honduras

This article presents research findings on the question of whether the monetization of non-emergency food aid has adversely influenced national family planning program efforts in Honduras. Women receiving food aid in the form of cash coupons are compared in the study with women receiving food rations and a third group of women with similar characteristics who were not food aid recipients on three types of outcomes: recent fertility, fertility preferences, and contraceptive use. The health facilities where study subjects received health/family planning services and food aid benefits were also compared to assess possible adverse cross-program effects on family planning service delivery. A sample selection model was used in the analysis to control for unobserved differences between comparison groups. No compelling evidence for adverse demand- or supply-side effects of monetized food aid on family planning efforts was observed. The most striking study finding was the extremely high level of unmet need for family planning.     

Measuring the Effect of Tourism Services on Travelers’ Quality of Life: Further Validation

Neal, Sirgy and Uysal (1999) developed a model and a measure to capture the effect of tourism services on travelers quality of life (QOL). They hypothesized that travelers overall life satisfaction is derived from satisfaction with the primary life domains (e.g., family, job, health). Specifically, overall life satisfaction is derived from two sources of satisfaction, namely satisfaction with non-leisure life domains and satisfaction with leisure life. Satisfaction with leisure life is derived from satisfaction with leisure experiences that take place at home and satisfaction with travel/tourism experiences. Satisfaction with travel/tourism experiences results from satisfaction with trip reflections of the traveler (e.g., what the traveler remembers regarding perceived freedomfrom control, perceived freedom from work, involvement, arousal, mastery, and spontaneity experienced during the trip) and satisfaction with travel/tourism services. Satisfaction with travel/tourism services was hypothesized further to be derived from satisfaction with the service aspects of travel/tourism phases – pre-trip services, en-route services, destination services, and return-trip services. The model was tested using a study of university faculty and staff. The original model was extended by hypothesizing the moderation effect of length of stay. Specifically, we hypothesized that the relationshipsin the model are likely to be more evident in relation to travelers who have more time to experience the tourism services than those who do not. A survey of 815 consumers of travel/tourism services who reside in Southwest Virginia was conducted. As predicted, the data confirmed hypotheses as established in the original model. Satisfaction with tourism services affects travelers QOL through the mediating effects of satisfaction with travel/tourism experiences, and satisfaction with leisure life. Furthermore, the moderating effect of length of stay was confirmed by the data. In sum, this replication and extension study provided additional validational support of the original tourism services satisfaction measure in relation to QOL-related measures.     

A double epidemic: crystal methamphetamine drug use in relation to HIV transmission among gay men

Emerging research on methamphetamine use among gay men suggests that growth in the use of this drug could present serious problems for HIV/AIDS prevention within the gay community. This article summarizes current studies on the extent, role, and context of methamphetamine use among gay men and its relationship to high risk sexual behaviors related to HIV transmission. Methamphetamine is often used by gay men to initiate, enhance, and prolong sexual encounters. Use of the drug is, therefore, associated with particular environments where sexual contact among gay men is promoted, such as sex clubs and large "circuit" parties. Research with gay and bisexual men indicates that methamphetamine use is strongly associated with risky sexual behaviors that may transmit HIV. This relationship, coupled with emerging evidence that methamphetamine use is on the rise among gay men, suggests that the drug could exacerbate the HIV/AIDS epidemic among this community. The article offers recommendations for further research and suggestions for prevention programs regarding methamphetamine use by gay men.     

Quality of Life in Older Adults: Benefits from Caring Services in Hong Kong

Many older adults are in need of care. Therefore, older people would generally benefit from the use of caring services, notably including home care, residential care, nursing, and medical services. The contributory factors underlying caring services tend to be a caring perspective that aspires to sustain older peoples social relationships and real-life involvement. To gauge the benefits from various social and health services, the present study relies on a large-scale survey of 3000 older adults in Hong Kong, using quality of life as a criterion. Results showed that an older adult who had used (ordinary or enhanced) home care services for a longer time turned out to have appreciably more improvement in quality of life. Besides, those who joined an interest group more frequently were higher in quality of life, including the health domain. On the other hand, frequent use of medical and meal-to-home services were signals that reflected problems detrimental to the older users quality of life. Despite this, the quality of clinics or hospitals, as perceived by the older adult, was the most beneficial. As such, caring services that foster older adults interests, cater to their health care needs, and embody quality can have principal contribution to their users quality of life.     

Social Economic Accounts System (SEAS): Toward a comprehensive,community-level assessment procedure

While most research on social and economic indicators has been developed from the national perspective, this article presents a comprehensive community-level Social Economic Accounts System (SEAS). The system is designed to enable social scientists, program developers, and public policy officials to better understand the effects of various types of public investments upon the quality of life of individuals, the relative social position of groups of people, and the social well-being of the community. In order to be useful for such diverse purposes as development of community theory, program evaluation, and policy formulation, the SEAS is: community-wide, covering most aspects of community life which may influence or be influenced by investment projects; systematic in its approach to causal factors behind the patterns of stability and change in key variables; sensitive to distinguishing features of communities which indicate special needs and which may affect the operation and success of investment projects; applicable to time series analyses for recording and evaluating change; and, oriented toward the comparison of communities receiving investment projects and to other communities and norms. The SEAS builds upon community social and economic theory, the program perspectives of federal and state categorical programs (e.g. health care, education), and the public policy orientations of community and national development. Data have been specified for 15 sectors of community life (e.g. education, economic base, health), and organized under three generic sets of items: state variables (i.e., data describing the lives of people in the community), system variables (i.e., data describing the operations of institutions which affect people's lives), and relevant condition variables (i.e., data describing system external variables which have an effect upon the state and system characteristics). More than 400 items are included in the SEAS.     

Pregnant adolescent women’s perceptions of depression and psychiatric services in the United States

Problem

Adolescent mothers and their children are at high-risk for depression and the associated negative educational, social, health, and economic outcomes.

Knowledge and attitudes about HIV/AIDS among community-living older women: reexamining issues of age and gender

Although older women face unique risks related to HIV/ AIDS, little empirical data is available regarding HIV/AIDS among women over the age of 65. In the present study, 160 community-living older women and men completed questionnaires regarding knowledge and attitudes about HIV/AIDS. Findings showed that although older women were less likely to talk to their physician about HIV than men, they maintained greater knowledge and generally dispelled myths about viral transmission. However, most older women believed that HIV/AIDS had limited personal relevance, possessed virtually no knowledge of age and gender specific risk factors, and professed HIV-associated stigma. These findings highlight the need for gender and age specific prevention programs.     

Family planning program effects on contraceptive use in Morocco, 1992–1995

This study illustrates the use of panel data and a fixed-effects estimator to investigate the impact of family planning program inputs on contraceptive utilization in Morocco during the 1992–1995 period. By controlling the potential bias resulting from common unobserved determinants of program resource allocation decisions and program outcomes, the methodology helps overcome an important constraint to the use of non-experimental study designs in undertaking meaningful impact assessments. Data from a panel of women interviewed in both the 1992 and 1995 Morocco Demographic and Health Surveys were used in the study, along with program data from Service Availability Modules undertaken in conjunction with each survey round. The results indicate that changes in the family planning supply environment, in particular increased presence of nurses trained in family planning and the level of infrastructure at public clinics, played a significant role in the increased use of modern contraceptives during the study period.     

Introducing the female condom to drug users in Brazil

Brazil is currently the number two country in the world for reported cases of AIDS, and the rate of heterosexually acquired cases is on the rise. Moreover, because of the changing focus of the epidemic, the ratio of male to female cases dropped from 28 : 1 in 1984 to 2.7 : 1 in 1997. While women's risk of infection continues to grow, there is evidence to suggest that traditional approaches to HIV risk reduction have not effectively addressed women's special needs. Within such a setting this study sought to introduce drug-involved women to the female condom – a female-controlled method of protection from HIV. As part of a larger HIV/AIDS intervention study targeting low-income, cocaine users, the primary aim of this initiative was to assess the level of acceptability of this new device among women at high-risk for HIV infection in Rio de Janeiro, Brazil. In conjunction with individual pre-test HIV prevention counseling, clients participated in a detailed education/demonstration session with the female condom. Women were asked to try the female condom with their partners and to report their experiences at two points of contact. Outcome data indicate that a sizable proportion (71.1%) of the sexually active women used the female condom during vaginal sex on one or more occasions. In addition, many women continued to use the female condom as a method of risk reduction over the three-month follow-up period. These data suggest that the female condom can have an important role in HIV prevention efforts in Brazil.     

中国老年艾滋病的流行状况分析

艾滋病在中国的迅速流行已是不争的事实,但是人们普遍认为“艾滋病是年轻人的病”。调查资料显示,50岁及以上的老年艾滋病病毒感染者报告人数已达到全国感染者的1/10,并呈快速增长趋势。老年感染人群的主要感染渠道以既往有偿献血感染为主。老年艾滋病病毒(HIV)感染者和艾滋病(AIDS)病人增多无论对家庭还是对社会均产生严重的后果,在艾滋病预防和控制战役中,老年是一个不可忽略的人群,应引起高度重视。     

City Effect and Urban Overload as Program Indicators of the Regional Policy

The paper explores the constraints of an optimal regional policy, and itidentifies them through program indicators of city effect and overload.Based on a `programming approach to the regional analysis, and on the``optimal centrality' concept as meeting point of the city-effect andcity-overload curves, the paper outlines a core list of indicators ofcity-effect and overload, quantifying their dimensions (as findings ofresearch conducted for the European Commission, from 20 cities in 4countries of the EU: France, Germany, Italy and United Kingdom).Further, a ``strategy' for an appropriate urban-regionalreorganization, and for an appropriate `ambit of measuring urban lifequality, is outlined. And finally the misleading risks of comparisons inthe wrong spatial `ambit of data collecting about quality of life, arediscussed.