“I Got What I Came for”: A Qualitative Exploration into Family Planning Client Satisfaction in Dosso Region, Niger

Abstract

Background

Client satisfaction is recognized as an important construct for evaluating health service provision, yet the field of family planning (FP) lacks a standard approach to its measurement. Further, little is known about satisfaction with FP services in Niger, the site of this study. This study aims to understand what features of FP visits were satisfactory or dissatisfactory from a woman’s perspective and reflect on the conceptualization and measurement of satisfaction with FP services.

Methods

Between February and March 2020, 2720 FP clients (ages 15–49) were interviewed across 45 public health centers in Dosso region, Niger using a structured survey tool. The focus of this paper is on a random sub-sample of 100 clients who were additionally asked four open-ended questions regarding what they liked and disliked about their FP visit. Responses were audio-recorded, translated into French, transcribed, translated into English, coded, and analyzed thematically.

Results

FP clients described nine key visit attributes related to their satisfaction with the visit: treatment by the provider, content of the counseling, wait time, FP commodity availability, privacy, cleanliness/infrastructure, visit processes and procedures, cost, and opening hours. The reason for FP visit (start, continue, or change method) was an important driver of the dimensions which contributed to satisfaction. Pre-formed expectations about the visit played a critical role in shaping satisfaction, particularly if the client’s pre-visit expectations (or negative expectations) were met or not and if she obtained what she came for.

Conclusion

This study makes a significant contribution by identifying visit attributes that are important to FP clients in Dosso region, Niger, and highlights that satisfaction with FP services is shaped by more than just what occurs on the day of service. We propose a conceptual framework to understand satisfaction with FP services that can be used for future FP programming in Niger.

Keywords:

• client satisfaction
• family planning
• contraception
• Niger

Abbreviations

CSI, Centre de Santé Intégré; FP, family planning; HIC, high income countries; LMIC, low- and middle-income countries; SPA, Service Provision Assessment.

Data Sharing Statement

Information about the study, survey tools and data are available at: https://dataverse.unc.edu/dataverse/fafc. A formal request needs to be made and a data sharing agreement will have to be made before sharing the data.

Ethics Approval

All study procedures, informed consent procedures and materials, and data collection tools were reviewed and approved by the Niger Comité National d’Ethique pour la Recherche en Santé (CNERS) and by the Institutional Review Board at the University of North Carolina at Chapel Hill (Number: 19-3042). All study methods were performed in accordance with the relevant guidelines and regulations. Additionally, all respondents voluntarily provided written informed consent to participate in the survey. The informed consent form specifies that the conversation will be recorded, data will be de-identified and will be kept confidential until destroyed. The form also indicates that de-identified data from the study will be utilized to answer research questions without asking for additional consent. Only 2 respondents who participated in the open-ended questions were ages 15–17 and both of these young women were married; women ages 15–17 seeking family planning services were considered emancipated minors. Additionally, the Niger Comité National d’Ethique pour la Recherche en Santé (CNERS) and the Institutional Review Board at the University of North Carolina at Chapel Hill both approved that these respondents could provide informed consent on their own behalf. In Niger, married adolescents are called emancipated youth, and according to the ethics committee, they can consent to participate in a study. This study complies with the Declaration of Helsinki.

Acknowledgments

We would like to thank Pathfinder International for their collaboration and cooperation with this study. We would also like to thank the study participants who gave their time for the data collection.

An earlier version of this paper was presented at the European Conference on Tropical Medicine and International Health as an oral presentation with interim findings. The poster’s abstract was published in “Abstracts of the 12th European Congress on Tropical Medicine and International Health, 28 September - 1 October 2021, Bergen, Norway” in Tropical Medicine and International Health, Volume 26, Issue S1: https://onlinelibrary.wiley.com/toc/13653156/2021/26/S1.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Funding

This work was supported, in whole or in part, by the Bill & Melinda Gates Foundation [INV-009814]. Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the author accepted manuscript version that might arise from this submission. We also received general support from the Population Research Infrastructure Program through an award to the Carolina Population Center [P2C HD050924] at The University of North Carolina at Chapel Hill. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the Carolina Population Center or the Bill & Melinda Gates Foundation.

Disclosure

The authors declare that they have no conflicts of interest in relation to this work.