Measuring women's perceived ability to overcome barriers to healthcare seeking in Burkina Faso

Abstract

BackgroundIn sub-Saharan Africa, women must overcome numerous barriers when they need modern healthcare. Respect of gender norms within the household and the community may still influence women's ability to obtain care. A lack of gender-sensitive instruments for measuring women's ability to overcome barriers compromises attempts to adequately quantify the burden and risk of exclusion they face when seeking modern healthcare. The aim of this study was to create and validate a synthetic measure of women's access to healthcare from a publicly available and possibly internationally comparable population-based survey.MethodSeven questionnaire items from the Burkina Faso 2003 DHS were combined to create the index. Cronbach's alpha coefficient was used to test the reliability of the index. Exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) were applied to evaluate the factorial structure and construct validity of the index while taking into account the hierarchical structure of the data.ResultsThe index has a Cronbach's alpha of 0.75, suggesting adequate reliability. In EFA, three correlated factors fitted the data best. In CFA, the construct of perceived ability to overcome barriers to healthcare seeking emerged as a second-order latent variable with three domains: socioeconomic barriers, geographical barriers and psychosocial barriers. Model fit indices support the index's global validity for women of reproductive age in Burkina Faso. Evidence for construct validity comes from the finding that women's index scores increase with household living standard.ConclusionThe DHS items can be combined into a reliable and valid, gender-sensitive index quantifying reproductive-age women's perceived ability to overcome barriers to healthcare seeking in Burkina Faso. The index complies conceptually with the sector-cross-cutting capability approach and enables measuring directly the perceived access to healthcare. Therefore it can help to improve the design and evaluation of interventions that aim to facilitate healthcare seeking in this country. Further analyses may examine how far the index applies to similar contexts.

Re-thinking health literacy: using a capabilities approach perspective towards realising social justice goals

“…Capability approach-informed evaluation has as a starting point the capabilities people value, and assessment focuses on intervention and policy capability-enhancing properties, rather than on the health literacy levels or choices people actually make. For example, Nikiema and colleagues focused on individuals' ability to overcome barriers that obstruct their access to needed care (55). In this way intervention and evaluation are more aligned with social justice principles.…”

Beyond our labour pains: women experiences of informal payments and delivery room conditions at birth in the Bongo district of Ghana

“…After the initial census, eligible women with varied populations of and for Boko, Amanga and Namoo communities respectively were recorded. 32,38,62 To ensure homogeneity across all study communities and meet available resources for data collection, an average quota of 30 women in each community were purposively selected as eligible survey respondents. Where a household had more than one eligible woman on our initial household entry, a woman with a recent birth was chosen.…”

“…This view supports a study in West Africa which indicated that women with poor living conditions were more likely to be associated with a lower perceived ability to overcome their barriers to health seeking. 32 Surprisingly, women who have ever paid informally and those with lower parity levels were more willing to pay informally again and did not see these payments as acts of corruption. This is potentially possible because women who payed informally might have received friendlier services before and anticipate obtaining the same level of services from facility staff.…”

Validation studies for population-based intervention coverage indicators: design, analysis, and interpretation

“…Historically, validation research on DHS and MICS MNCH intervention coverage indicators has focused primarily on content validity, construct validity, and cognitive interviewing, as well as assessments of data quality [ 6 - 10 ]. All of these methods provide valuable information about survey questions and data; however, they cannot quantify the extent to which survey-based measures of intervention coverage differ from the objective “truth” that they seek to measure (criterion validity).…”