Women awareness and satisfaction toward health services provided at family health centers

Introduction

Health services as primary care is the most frequently used in any health care system. The World Health Organization (WHO) defined that it is essential health care services made universal accessible to individuals and families in a community by means acceptable to all peoples. Health centers generally introduce health services in terms of primary care as preventive and curative services, mostly adapted to local needs (Radhi, 2016).

The mission of the Family Health centers is to improve the well-being of families by increasing public awareness and professional education and assuring access to a system of care that is family-centered and community-based. This system should include preventive, early detection, treatment, habilitative and rehabilitative services. The Family Health centers administer and coordinate programs and services concerned with health promotion and disease prevention for families, including women of childbearing age, mothers, infants, children and youth (Kuo et al., 2012).

In Egypt Community health centers (CHCs) provided primary health care to over 20 million patients in 2011, 60% of whom are women and 25% of whom are women of childbearing age (Woodet al., 2013). Health centers play a central role in women’s health, it is projected that health center capacity will virtually double by 2019, and accordingly, the role of health centers in the provision of women’s health care services can be expected to grow significantly (Neuhausen et al., 2012).

Health services provided by family health centers related to family medicine, internal medicine, pediatrics, obstetrics, or gynecology, that are furnished by physicians and where appropriate, physician assistants, nurse practitioners, and nurse-midwives^. Diagnostic, laboratory, and radiologic services , Preventive health services including: prenatal and perinatal care; appropriate cancer screening; well-child services; immunizations for vaccine-preventable diseases as may be appropriate for particular centers(Wood et al., 2014).

Woman satisfaction in the primary health care is a key marker for the quality of health care delivery and this internationally accepted factor needs to be studied repeatedly for smooth functioning of the health care systems. woman' satisfaction has long been considered as an important component when measuring health outcome and quality of care in both developed and developing countries and constitutes a significant indicator of the health care quality (Mohamed et al. 2015).

Community health nurse plays key roles and providing community health services in disease and injury prevention, disability alleviation and health promotion, as well as managing and providing care and follow-up across a broad range of settings. Community health nursing promotes and protects the health of populations through a combination of knowledge derived from nursing, social and public health sciences (WHO, 2017).

Significance of the Study

The Egyptian Health system started to face many difficulties due to the increase in the population, the emergence of new health problems, the economic crises and the problems of the gap in the system itself. Regarding the main health indicators for Egypt, these can include maternal and child health indicators, chronic disease indicators and infectious diseases indicators which illustrate the main burden of disease in Egypt (Ebeid, 2016). Internationally a multi-state study done by Robert 2016) found that health center patients had 24% lower spending as compared to non-health center patients across all services. Health Center Program is effective to provide high quality and comprehensive primary health care services in underserved communities (Nocon et al., 2016).

Health centers improve health outcomes by emphasizing the care management of patients with multiple health care needs and the use of key quality improvement practices, including health information technology. Health centers reduce costs to health systems; the health center model of care has been shown to reduce the use of more costly providers of care, such as emergency departments and hospitals (Laiteerapong et al., 2014). 

Health improvement strategies with a focus on increasing mothers’ knowledge and awareness about the services given, the benefits of these services (Coast et al., 2014), complications related to pregnancy and delivery should be designed and implemented. Skilled attendants at the Health Post level should be trained and assigned to provide home delivery (ten Hoope et al., 2014).

Aim of the Study:

The current study aimed to assess women awareness and satisfaction toward health services provided at family health centers.

Research Questions:

1)       What is the level of women awareness toward health services provided at family health centers?

2)       What is the women satisfaction concerning the health care services provided at family health center?

3)       Is there a relationship between the demographic characteristics and the level of women awareness, and their satisfaction with the health services provided by family health centers?

Subjects and Methods

Study design:- 

A descriptive research design was used for the current study.

Setting:-

The study was conducted at Family health centers (FHC) at Assiut city. Assiut city includes (9) family health centers (4) centers were selected randomly that providing  numerous services such as providing obligatory vaccination, family planning services, and antenatal care and post natal care including women attending FHC for family planning and antenatal care. In the following villages (Zawia village, Dronka village, Menqbad village, Bani Hussein village (.

The Menqbad Family Health Center is located in the village of Menqbad in Assiut. serving northeast of Assiut city and has a population of around 47,000 inhabitants. Zawia FHC is located in the village of Zawiya in Assiut. Located next to the gas station cooperation, serves the south-western city of Assiut and has a population of around 34,200 inhabitants, Dronka FHC is located in the village of Dronka in the city of Assiut. Located next to the local unit in Dronka, and serves the south-western city of Assiut with has a population of around 46,000 inhabitants and finally Bani Hussein, located in the village of Bani Hussein in the city of Assiut. Located near the police station Bani Hussein, and serves the northeast of the city of Assiut, with has a population of around 16,000 inhabitants. This (4) Family Health Center is one of the villages of Assiut center at Assiut city.

Subject:

A multistage random sample was used in this study. Assiut city includes (9) family health centers (4) centers were selected randomly. The total number of attendance of family health centers in the last six months in 2017 was (65153) attendance. by using software EPI /info, version 3, 3 with 99 % confidence interval (CI).The estimated sample size found to be ( 657 ) attendance and increased 10% to be ( 723 ) attendance to avoid drop-out and refuse. Divided into (10%) from each center as follows:

Table (1):- Sample size related to each family health center:

Multistage random sample of the woman participated according to inclusion criteria for 6 months from October 2018 to March 2019.

Inclusion criteria:

1- Women 18 years and above.

2- Having at least one experience in dealing with the primary care facility, and       willing to participate in the study.

Data Collection Tools

Data was collected through the utilization of structured interviewing questionnaire which was developed & translated into Arabic language by the investigators after extensive review of literature. it consisted from three parts as follows:

Part (1): Personal Data Questionnaire:-

Covers the data related to general characteristics (age, sex, residence, marital status, occupation, and level of education, no. of children…..etc.

Part (2): The women awareness about health services (Assessment Tool Questionnaire):

The women awareness about health services (Assessment tool questionnaire) was developed to assess woman awareness about health services Provided by family health centers such as, The type of services you receive from the centers, Pregnant care services, Pre-marital screening services, Pharmacy Services, Laboratory Services, Family Medicine Files, does your family have a folder in the family health center, referral Services, , Family planning services, Health education services, Follow - up of children services, Medical examination services……..etc. It was adapted from (Ebeid, 2016).

Scoring system: The scoring system for the collected data regarding women's awareness was score (2) degree was given for each (yes) answer and a score (1) degree was given for (No) answer. The total score of awareness was (180) degree. The score was calculated by summing up and converted into a percentage score as the following.

• *Good:  if the percent score is 50% or more.
• *Poor: if scored less than 50%.

Part (3): The women Satisfaction about health services (Assessment Tool    Questionnaire):

Was developed by (Dyer et al., 2016) Likert Scale checklist to assess women Satisfaction with acceptance of health services provided by family health centers, It consisted of (30) items such as Health services provided at the family health center are acceptable, meets your family needs, and good quality, The method of medical examination in the clinics of the center, The center buildings, Waiting places are ready, Cleanliness of the place, Dental services, Emergency services in the center, Skilled center’ physicians, System of recording and extracting files...……..etc.

Scoring system: the scoring for women's satisfaction was (2) degree for satisfactory response, (1) degree for unsatisfactory, and zero degrees for I do not know. The score was calculated by summing up and converted into a percentage score as follows. If Responses of (50%) or more indicate that the woman is satisfied with the acceptance of the health services provided by the family health center. If Responses less than (50%) indicate unsatisfied women and un-acceptance of the health services provided by the family health center.

Content Validity

The content validity of the data collection tools was determined the tools were submitted to five experts in community health nursing to test their validity. The tools were examined for content coverage, the sequence of items, clarity, relevance, applicability, wording, length, format, and overall appearance. Based on experts` comments and recommendations; minor modifications had been made such as rephrasing and rearrangements of some sentences.

Reliability

The tool was tested for internal reliability (reliability referred to the consistency of measurement and was frequently assessed using the test-retest reliability method). To achieve the reliability of the questionnaire, the instrument was designed with great care matching questions with objectives for the study. Tools reliability was done to identify the extent of tools items were measurable with the study concept and its correlation with apiece other. Cronbach’s alpha reliability was 0.757 it used to check the stability of the internal consistency of the instrument.

Ethical Consideration

Approval was sought from the Provincial and district ethical committee before undertaking the research. The purpose of the study was explained to all participants by the investigator. The participant had ethical rights to agree or refuse to participate in the study. Oral consent was obtained from every participant. Every participant was informed that the information and data obtained was confidential and used only for the study.

Study Procedure

Official permissions were obtained from the Research Ethical Committee of Faculty of Nursing, as well as Assiut directorate of health, then of the previously selected family health centers. This letter included a brief explanation of the objectives of the study and permission was requested from each Manager to carry out the study.     

After extensive review of relevant national and international literature, tool of data collections was developed by the investigator in 2018. Prior to data collection, tool for data collection translated from English to Arabic version language and transverse translation again from Arabic to English.

The data collection study was carried out from the beginning of October 2018 and finished at March 2019. The researchers attended in family health center to collect data with average of three days per week to collect data, at official work time by using the structured interview questionnaire sheet. At the beginning of interview the researchers greeted each woman, utilizing proper channel of communication and explained the purpose of the study and taken their oral consent before being involved in the study after explanation of the nature of the study its benefits and there are no risks or cost in participation, and there are voluntary participation and confidentiality of each subject who agree to participate to fill the questionnaire.

The questionnaire sheet was filed by investigators during 15 - 20 minute or more for each woman and about 10 -12 woman in every day depending on the response of each women. Finally the investigators thanked the participants for their cooperation.

Results

Table 1: Distribution of demographic  data among studied women at family health centers (n=723)

Table 1: Showed that more than half of the study sample (58.9%) were in age group 18- <30 years, while the least percentage was (1.7%) in the age group 54 and more years with age mean and standard deviation 29.8±8.48 years. As regard the level of education the more than one third (34.8%) of the women were illiterate, and the minority of them (13.3%) had university education. As regards occupation status the highest percentage (93.5%) was housewives while the lowest percentage (6.5%) of them was working. Lastly the marital status the highest percentages were married (89.1%) while the lowest percentages were widow (1.4%). As regard the reproduction status for married women the highest percentage (87.4%) have children while the lowest percentage (12.6%) was do not have children.

Figure (1) Percentage distribution of awareness among studied women regarding health services provided at family health centers.

Figure 1: As regarding the awareness of health services provided at family health centers it was shows that 99.6% of the studied sample aware about this health services.

Table 2: Distribution of studied women awareness related to the health services provided by the family health center (n=723)

Table 2: Declared that the majorities (90.3%, 92.7%, 94.3%, and 97%) of the studied women was aware with health services provided by the family health centers such as follow - up of children, compulsory vaccinations for children, tetanus vaccinations for pregnant women, and antenatal care respectively.

Figure (2) Total score of the studied women regarding their satisfaction about health services provided at the family health center (n=723)

Regarding the studied sample satisfaction of availability services provided at the family health center Figure (2) show that 99.6% are satisfy about health services.

Table 3: Pearson correlation between the studied women personal data, awareness and satisfaction with the health services provided at the family health center (n=723)

Pearson correlation coefficient (r), P-value insignificant P≥0.05,   *significant P<0.05, and **highly significant P<0.01

As regarding the Pearson correlation between the study sample personal data, awareness and satisfaction with the health services provided at the family health center Table (3)showed that there was weak positive correlation between the studied women reproductive status in relation to awareness and satisfaction P<0.01. In addition, there were statistical weak negative correlation between age and educational level in relation to women awareness P < 0.039 & .019 respectively. 

Table 4: Relation between the studied women awareness and satisfaction with the health services provided at the family health center and the name of Family health center (n=723)

(X²)Chi-square test, P-value insignificant (NS) P ≥0.05, *significant P<0.05, and **highly significant P<0.01

Table 4: showed that 36.5% of satisfied women was from Zawia family health center followed by 30.9% of them was from Menqbad family health center while 38.6% of unsatisfied women was from Dronka family health centers with highly statistical significance differences which P- value ≤ 0.000.

Table 5: Relation between studied women personal data and their awareness with the health services provided at the family health center (n=723)

(X²)Chi-square test, P-value insignificant (NS) P ≥0.05, *significant P<0.05, and **highly significant P<0.01

         Table 5: Show that there is no significant relationship between study sample personal data and awareness with the health services provided at the family health center P-value ≥0.05.

         Table 6: Relation between studied women personal data and their satisfaction with the health services provided at the family health center (n=723)

         (X²)Chi-square test, P-value insignificant (NS) P ≥0.05, *significant P<0.05, and **highly significant P<0.01

Regarding the relation between study sample personal data and satisfaction with the health services provided at the family health center Table 6 show that there wasn’t significant relationship between study sample personal data and satisfaction with the health services provided at the family health center P-value ≥ 0.05