WITHDRAWN: Do provider behaviors influence client satisfaction of family planning services in Togo? Evidence from a cross-sectional facility survey

Abstract

BackgroundStrengthening quality of family planning care is a key objective in Togo to improve maternal and reproductive health. Structural attributes or inputs to care, and process attributes or content of care, including providers’ interaction with clients, are key factors determining quality of care. Client satisfaction with family planning services is linked to contraceptive uptake and continuation, yet the relationship between quality of care elements and client satisfaction of family planning services has not been assessed in Togo, particularly process factors related to client-provider interactions. MethodsWe conduct a secondary analysis using data from a facility-based survey. The survey was conducted in August 2016 in six health districts of Lomé Togo, including a facility audit (N=16), client observations (N=1096) and client exit interviews with women of reproductive age (N=1089). We used multi-variable logistic regression to assess the association between factors related with service structure and process, including provider-client interaction and client perception of provider treatment as a proxy for client satisfaction.ResultsWe did not find a relationship between structural attributes of quality and client perception of provider treatment. Among process attributes, we found that several behaviors related to interpersonal skills, including encouraging clients to ask questions and asking clients to describe any concerns they have with their method, and providers use of visual aids were significantly associated with client perception of provider treatment. ConclusionThe quality of care a woman receives when seeking to adopt or continue family planning methods is essential to improving use of family planning service. Family planning programs must address provider related behaviors that may inhibit the uptake and continuation of contraceptive use, and strengthen inter-personal skills, which may improve client perception of provider treatment with services and facilitate their continued use.