title: Perceived quality of reproductive care for girls in a competitive voucher programme. A quasi-experimental intervention study, Managua, Nicaragua.
abstract: OBJECTIVE
  To determine whether female adolescents from low-income areas in Managua were satisfied with the sexual and reproductive health (SRH) care provided through a competitive voucher programme and to analyse the determinants of their satisfaction.
  
  
  METHODS
  A community-based quasi-experimental intervention study from 2000 to 2002.
  
  
  METHODS
  Low-income areas of Managua.
  
  
  METHODS
  Distribution of 28,711 vouchers giving adolescents free-access to SRH care in 19 clinics; training and support for health care providers.
  
  
  METHODS
  A random sample of 3009 girls from 12 to 20 years completed self-administered questionnaires: 700 respondents had used this care in the last 15 months, 221 with voucher (users-with-voucher) and 479 without voucher (users-without-voucher).
  
  
  METHODS
  User satisfaction; Satisfaction with clinic reception; Clarity of doctors' explanations.
  
  
  RESULTS
  User satisfaction was significantly higher in users-with-voucher compared with users-without-voucher [Adjusted odds-ratio (AOR) = 2.2; 95% confidence interval (95% CI) = 1.2-4.0]. Voucher use was associated with more frequent satisfaction with clinic reception, especially among sexually active girls not yet pregnant or mother (AOR = 6.9; 95% CI = 1.5-31.8). The clarity of doctors' explanations was not perceived differently (AOR = 1.4; 95% CI = 0.9-2.2). User satisfaction was highly correlated to satisfaction with clinic reception and clarity of doctors' explanations (P < 0.001). Longer consultation times, shorter waiting times, older age, and having a female doctor positively influenced user satisfaction.
  
  
  CONCLUSIONS
  Voucher use by teenage girls was associated with a better perceived SRH care. This is an important result, given the crucial role user satisfaction plays in adoption and continued use of health care and contraceptives. Though more research is needed, confidential and guaranteed access appear key factors to voucher success.
authors.affiliation: ICAS Managua, Nicaragua. liesbethmeuwissen@yahoo.com
authors.forename: Liesbeth E
authors.initials: LE
authors.lastname: Meuwissen
authors.forename: Anna C
authors.initials: AC
authors.lastname: Gorter
authors.forename: J A
authors.initials: JA
authors.lastname: Knottnerus
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000191:economics / Q000592:standards*; D003267:Contraception; D004522:Educational Status; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008389:Marketing of Health Services; D009527:Nicaragua; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011203:Poverty; D015397:Program Evaluation; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D034121:Reproductive Health Services / Q000191:economics / Q000592:standards*; D011795:Surveys and Questionnaires; D017664:Uncompensated Care / Q000191:economics