Measuring the Quality of Reproductive Health Services in Mexico and the United States
CitationHolt, Kelsey. 2017. Measuring the Quality of Reproductive Health Services in Mexico and the United States. Doctoral dissertation, Harvard T.H. Chan School of Public Health.
AbstractA focus on quality of care in health services is important from both public health and human rights perspectives. From a public health perspective, a central premise underlying quality improvement work is that improving quality, including interpersonal aspects of care, will lead to better health outcomes. Good communication between providers and patients in various areas of health care has been shown to be highly correlated with adherence to treatment. From a human rights perspective, the Right to Health, as established by the United Nations Committee on Economic, Social, and Cultural Rights, entitles all people to healthcare information, services, and commodities that are available, accessible, acceptable, and of good quality.
Avedis Donabedian’s foundational framework specifies three dimensions for the assessment of the quality of medical care: structure (attributes of material resources, human resources, and organizational structure); process (actual care given and received); and outcome (health, behavior, knowledge, satisfaction effects of the processes of care). This dissertation is grounded in Donabedian’s framework and focused on the assessment of process dimensions of care, specifically the nature of health care providers’ communication with women about sexual and reproductive health issues. Both technical and interpersonal elements of health care provider performance, as described by Donabedian, are integral to good communication with patients and are touched upon in the dissertation.
The papers of this dissertation contribute to understanding the quality of physician-patient interactions in sexual and reproductive health services in the United States and improving measurement of individuals’ experiences with contraceptive care in Mexico. Papers 1 and 3 are quantitative analyses of nationally representative survey data on United States primary care physicians’ training, practices, and opinions related to providing pregnancy options counseling and referrals for unintended pregnancy (Paper 1) and information and counseling related to a number of preventive services for women of reproductive age (Paper 3). Paper 2 focuses on developing a new scale to measure women’s experiences with contraceptive counseling in Mexico. This paper includes conceptual development of a measurement framework (Part A) and formative qualitative research with contraception clients to develop the scale’s item pool and ensure content validity (Part B).
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