title: Using mixed methods to evaluate perceived quality of care in southern Tanzania.
abstract: OBJECTIVE
  To compare perceived quality of maternal and newborn care using quantitative and qualitative methods.
  
  
  METHODS
  A continuous household survey (April 2011 to November 2013) and in-depth interviews and birth narratives.
  
  
  METHODS
  Tandahimba district, Tanzania.
  
  
  METHODS
  Women aged 13-49 years who had a birth in the previous 2 years were interviewed in a household survey. Recently delivered mothers and their partners participated in in-depth interviews and birth narratives.
  
  
  METHODS
  None.
  
  
  METHODS
  Perceived quality of care.
  
  
  RESULTS
  Quantitative: 1138 women were surveyed and 93% were confident in staff availability and 61% felt that required drugs and equipment would be available. Drinking water was easily accessed by only 60% of respondents using hospitals. Measures of interaction with staff were very positive, but only 51% reported being given time to ask questions. Unexpected out-of-pocket payments were higher in hospitals (49%) and health centres (53%) than in dispensaries (31%). Qualitative data echoed the lack of confidence in facility readiness, out-of-pocket payments and difficulty accessing water, but was divergent in responses about interactions with health staff. More than half described staff interactions that were disrespectful, not polite, or not helpful.
  
  
  CONCLUSIONS
  Both methods produced broadly aligned results on perceived readiness, but divergent results on perceptions about client-staff interactions. Benefits and limitations to both quantitative and qualitative approaches were observed. Using mixed methodologies may prove particularly valuable in capturing the user experience of maternal and newborn health services, where they appear to be little used together.
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Tara
authors.initials: T
authors.lastname: Tancred
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Joanna
authors.initials: J
authors.lastname: Schellenberg
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Tanya
authors.initials: T
authors.lastname: Marchant
mesh_terms: D000293:Adolescent; D000328:Adult; D002662:Child Health Services / Q000592:standards*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007407:Interviews as Topic; D008427:Maternal Health Services / Q000592:standards*; D008875:Middle Aged; D017060:Patient Satisfaction; D036301:Qualitative Research; D011785:Quality Assurance, Health Care / Q000379:methods*; D011787:Quality of Health Care / Q000592:standards; D013636:Tanzania; D055815:Young Adult
keywords: maternal and newborn health; mixed methods; perceived quality of care; quality of care
references.citation: J Natl Med Assoc. 2008 Sep;100(9):1052-8
references.pmid: 18807434
references.citation: East Afr Med J. 2004 Jun;81(6):293-9
references.pmid: 16167676
references.citation: Health Serv Res. 2005 Dec;40(6 Pt 2):1996-2017
references.pmid: 16316435
references.citation: Implement Sci. 2014;9:112
references.pmid: 25149316
references.citation: Bull World Health Organ. 2004 Aug;82(8):572-9
references.pmid: 15375446
references.citation: PLoS Med. 2012;9(8):e1001282
references.pmid: 22879817
references.citation: BMC Pregnancy Childbirth. 2015;15:97
references.pmid: 25928085
references.citation: Bull World Health Organ. 1999;77(4):356-60
references.pmid: 10327716
references.citation: East Afr Med J. 2005 Nov;82(11):547-53
references.pmid: 16463747
references.citation: Bull World Health Organ. 2001;79(6):512-7
references.pmid: 11436472
references.citation: Am J Public Health. 2009 Sep;99(9):1666-72
references.pmid: 19608959
references.citation: Health Technol Assess. 2002;6(32):1-244
references.pmid: 12925269
references.citation: BMC Pregnancy Childbirth. 2014;14:188
references.pmid: 24894497
references.citation: BMC Public Health. 2005;5:140
references.pmid: 16372911
references.citation: Midwifery. 2014 Jun;30(6):610-9
references.pmid: 24252712
references.citation: BMC Pregnancy Childbirth. 2014;14:248
references.pmid: 25069534
references.citation: Patient Prefer Adherence. 2009 Nov 03;3:77-85
references.pmid: 19936148
references.citation: Soc Sci Med. 2001 May;52(9):1359-70
references.pmid: 11286361
references.citation: Int J Qual Health Care. 1998 Apr;10(2):93-104
references.pmid: 9690882
references.citation: Health Aff (Millwood). 2007 May-Jun;26(3):w296-309
references.pmid: 17389637
references.citation: Malawi Med J. 2010 Mar;22(1):5-9
references.pmid: 21618840
references.citation: Health Policy Plan. 2012 Sep;27(6):505-15
references.pmid: 22080515
references.citation: Int J Qual Health Care. 2004 Dec;16(6):447-52
references.pmid: 15557354
references.citation: Health Policy Plan. 2002 Mar;17(1):42-8
references.pmid: 11861585
references.citation: Qual Health Care. 1992 Sep;1(3):151-2
references.pmid: 10136853
references.citation: Int J Qual Health Care. 2012 Dec;24(6):595-600
references.pmid: 22789667
references.citation: Implement Sci. 2014;9(1):41
references.pmid: 24690284
references.citation: Eur J Obstet Gynecol Reprod Biol. 2014 Mar;174:35-40
references.pmid: 24332094
references.citation: BMC Fam Pract. 2014;15:128
references.pmid: 24974196
references.citation: Int J Qual Health Care. 2008 Dec;20(6):384-91
references.pmid: 18799468
references.citation: BMC Pregnancy Childbirth. 2009;9:34
references.pmid: 19671156
references.citation: Trop Med Int Health. 2006 Sep;11(9):1442-51
references.pmid: 16930267
references.citation: Int J Health Care Qual Assur. 1994;7(7):22-30
references.pmid: 10140849
references.citation: J Clin Nurs. 2006 Jan;15(1):93-102
references.pmid: 16390528
references.citation: Int J Qual Health Care. 2006 Dec;18(6):414-21
references.pmid: 17012306
references.citation: Milbank Mem Fund Q. 1966 Jul;44(3):Suppl:166-206
references.pmid: 5338568
references.citation: Glob Health Action. 2013;6:22635
references.pmid: 24267316
references.citation: Iran J Public Health. 2010;39(2):52-62
references.pmid: 23113007
references.citation: Birth. 2005 Mar;32(1):4-10
references.pmid: 15725199
references.citation: Int J Qual Health Care. 2006 Feb;18(1):30-4
references.pmid: 16234300
references.citation: Soc Sci Med. 2000 Jul;51(1):103-13
references.pmid: 10817473
references.citation: BMC Pregnancy Childbirth. 2014;14:45
references.pmid: 24456544