title: Effects of ethnic attributes on the quality of family planning services in Lima, Peru: a randomized crossover trial.
abstract: Most studies reporting ethnic disparities in the quality of healthcare come from developed countries and rely on observational methods. We conducted the first experimental study to evaluate whether health providers in Peru provide differential quality of care for family planning services, based on the indigenous or mestizo (mixed ethnoracial ancestry) profile of the patient. In a crossover randomized controlled trial conducted in 2012, a sample of 351 out of the 408 public health establishments in Metropolitan Lima, Peru were randomly assigned to receive unannounced simulated patients enacting indigenous and mestizo profiles (sequence-1) or mestizo and then indigenous profiles (sequence-2), with a five week wash-out period. Both ethnic profiles used the same scripted scenario for seeking contraceptive advice but had distinctive cultural attributes such as clothing, styling of hair, make-up, accessories, posture and patterns of movement and speech. Our primary outcome measure of quality of care is the proportion of technical tasks performed by providers, as established by Peruvian family planning clinical guidelines. Providers and data analysts were kept blinded to the allocation. We found a non-significant mean difference of -0.7% (p = 0.23) between ethnic profiles in the percentage of technical tasks performed by providers. However we report large deficiencies in the compliance with quality standards of care for both profiles. Differential provider behaviour based on the patient's ethnic profiles compared in the study did not contribute to deficiencies in family planning outcomes observed. The study highlights the need to explore other determinants for poor compliance with quality standards, including demand and supply side factors, and calls for interventions to improve the quality of care for family planning services in Metropolitan Lima.
authors: Interculturality and Gender Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands.
authors: Maria-Elena
authors: ME
authors: Planas
authors: Epidemiology, STD and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors: Patricia J
authors: PJ
authors: García
authors: Gender and Diversity Division, Inter- American Development Bank, Washington, DC, United States of America.
authors: Monserrat
authors: M
authors: Bustelo
authors: Epidemiology, STD and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors: Cesar P
authors: CP
authors: Carcamo
authors: Office of Strategic Planning and Development Effectiveness, Inter- American Development Bank, Washington, DC, United States of America.
authors: Sebastian
authors: S
authors: Martinez
authors: Education Division, Inter- American Development Bank, Washington, DC, United States of America.
authors: Hugo
authors: H
authors: Nopo
authors: Gender and Diversity Division, Inter- American Development Bank, Washington, DC, United States of America.
authors: Julio
authors: J
authors: Rodriguez
authors: Executive Vice-President Division, Inter- American Development Bank, Washington, DC, United States of America.
authors: Maria-Fernanda
authors: MF
authors: Merino
authors: Gender and Diversity Division, Inter- American Development Bank, Washington, DC, United States of America.
authors: Andrew
authors: A
authors: Morrison
mesh_terms: D018592:Cross-Over Studies; D003695:Delivery of Health Care; D005006:Ethnicity; D005193:Family Planning Services / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D010568:Peru / Q000453:epidemiology; D011787:Quality of Health Care