Moving Toward Patient-Centered Care in Africa: A Discrete Choice Experiment of Preferences for Delivery Care among 3,003 Tanzanian Women.
OBJECTIVE
In order to develop patient-centered care we need to know what patients want and how changing socio-demographic factors shape their preferences.


METHODS
We fielded a structured questionnaire that included a discrete choice experiment to investigate women's preferences for place of delivery care in four rural districts of Pwani Region, Tanzania. The discrete choice experiment consisted of six attributes: kind treatment by the health worker, health worker medical knowledge, modern equipment and medicines, facility privacy, facility cleanliness, and cost of visit. Each woman received eight choice questions. The influence of potential supply- and demand- side factors on patient preferences was evaluated using mixed logit models.


RESULTS
3,003 women participated in the discrete choice experiment (93% response rate) completing 23,947 choice tasks. The greatest predictor of health facility preference was kind treatment by doctor (β = 1.13, p<0.001), followed by having a doctor with excellent medical knowledge (β = 0.89 p<0.001) and modern medical equipment and drugs (β = 0.66 p<0.001). Preferences for all attributes except kindness and cost were changed with changes to education, primiparity, media exposure and distance to nearest hospital.


CONCLUSIONS
Care quality, both technical and interpersonal, was more important than clinic inputs such as equipment and cleanliness. These results suggest that while basic clinic infrastructure is necessary, it is not sufficient for provision of high quality, patient-centered care. There is an urgent need to build an adequate, competent, and kind health workforce to raise facility delivery and promote patient-centered care.
Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America.
Elysia
E
Larson
Epidemiology Department, Mailman School of Public Health, Columbia University, New York, NY, United States of America.
Daniel
D
Vail
Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania.
Godfrey M
GM
Mbaruku
Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania.
Angela
A
Kimweri
Averting Maternal Death and Disability Program, Mailman School of Public Health, Columbia University, New York, NY, United States of America.
Lynn P
LP
Freedman
Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America.
Margaret E
ME
Kruk
D000328:Adult; D000349:Africa; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D010342:Patient Acceptance of Health Care; D057240:Patient Preference; D018802:Patient-Centered Care; D019035:Rural Health Services; D012959:Socioeconomic Factors; D013636:Tanzania; D055815:Young Adult