Does courtesy bias affect how clients report on objective and subjective measures of family planning service quality? A comparison between facility- and home-based interviews

Figures & data

Table 1 Characteristics of study participants

Indicators	Exit interview (n=1,369) %	Home interview (n=1,359) %
Socioeconomic and demographic
Participants’ age, mean (SE)	31.9 (0.3)	31.2 (0.3)
Education
None/no formal/some primary	53.9	52.9
Complete primary or higher	46.1	47.1
Living children, mean (SE)	4.4 (0.2)	4.2 (0.2)
Wealth quintile
Poorest	11.4	9.4
Poor	19.3	17.9
Medium	21.7	28.6
Wealthy	33.0	29.7
Wealthiest	14.6	14.1
Behaviors pertaining to contraception
Ever been to index health facility (study site)	55.0	48.2
Prior use of any modern contraceptive in the last 3 months*	60.7	47.1
Travel time of health facility
≤15 minutes	34.5	39.3
>15 minutes	65.5	60.7
Meeting with community health worker before visiting health facility	59.4	66.0
Type of contraceptive method received
Short-acting (oral pill, condom, injectable)	39.6	35.1
Long-acting (intrauterine device, implant)	36.8	44.1
Permanent (female sterilization)a	23.6	20.9

Notes:

* p<0.05.

a No case of male sterilization was observed during the survey. Data presented as percentage unless otherwise mentioned.

Table 2 Client’s responses regarding the quality of services and satisfaction by the type of survey and service delivery channel

Indicators	NGO clinics		Social franchise centers		Outreach camps
	Exit interview (n=230) %	Home interview (n=216) %	Exit interview (n=976) %	Home interview (n=983) %	Exit interview (n=163) %	Home interview (n=160) %
Satisfaction
Structural dimension	p=0.3587		p=0.0453		p=0.6856
Satisfied with less than 3 dimensions	3.5	8.3	7.8	12.4	13.5	8.1
3	15.2	18.1	12.5	13.3	12.9	15.6
4	28.7	29.2	19.4	19.3	16.0	10.6
Satisfied with all 4 dimensions	52.6	44.4	60.4	54.9	57.7	65.6
Procedural dimension	p=0.2494		p=0.0219		p=0.5590
Satisfied with less than 3 dimensions	3.0	6.9	4.5	7.4	11.0	6.3
3	2.6	5.1	3.8	5.5	5.5	10.0
4	13.9	9.3	8.5	11.6	7.4	15.6
5	18.7	24.5	13.0	12.3	12.3	11.9
Satisfied with all 6 dimensions	61.7	54.2	70.2	63.2	63.8	56.3
Service quality
Interpersonal communication	p=0.0231		p=0.2911		p=<0.0001
Met 2 or less standards	5.7	13.4	11.3	13.5	39.3	8.1
Met 3 standards	22.6	31.5	29.0	25.6	44.8	15.6
Met all 4 standards	71.7	55.1	59.7	60.8	16.0	76.3
Information given to clients	p=0.1269		p=0.4006		p=0.0001
Met 2 or less standards	1.3	1.9	4.2	5.5	31.3	1.3
Met 3 standards	5.7	10.7	10.9	12.0	15.3	6.9
Met all 4 standards	93.0	87.5	84.9	82.5	53.4	91.9
Choice of methods	p=0.5344		p=0.6557		p=0.1352
Met 2 or less standards	8.2	4.6	6.9	6.3	29.5	6.9
Met 3 standards	25.7	31.5	29.9	27.5	40.5	42.5
Met all 4 standards	66.1	63.9	63.2	66.3	30.1	50.6

Note: p-values in bold denote statistically significant differences.

Abbreviation: NGO, nongovernmental organization.

Table 3 Ordered logit: aOR for client’s perceived satisfaction and service quality overall and by service delivery channel

Independent variable	Perceived satisfaction				Service quality
NGO clinics	Structural care		Procedural care		Interpersonal relations		Information given to clients		Choice of methods
	aOR	(95% CI)	aOR	(95% CI)	aOR	(95% CI)	aOR	(95% CI)	aOR	(95% CI)
Place of interview (home)	Ref		Ref		Ref		Ref		Ref
Exit interview	1.35	(0.75, 2.43)	1.27	(0.58, 2.77)	2.14*	(1.18, 3.85)	2.07*	(1.01, 4.24)	0.96	(0.49, 1.85)
Social franchise centers
Place of interview (home)	Ref		Ref		Ref		Ref		Ref
Exit interview	1.33*	(1.03, 1.72)	1.43***	(1.12, 1.84)	1.07	(0.83, 1.38)	1.56*	(1.12, 2.18)	0.98	(0.72, 1.32)
Outreach camps
Place of interview (home)	Ref		Ref		Ref		Ref		Ref
Exit interview	1.27	(0.34, 4.73)	2.43	(0.49, 11.97)	0.09***	(0.03, 0.36)	0.10*	(0.02, 0.68)	0.45	(0.1, 1.95)

Notes:

* p<0.05;

*** p<0.001; adjusted for respondent’s age, education, number of children, wealth quintile, prior use of contraceptive in the last 3 months, ever been to index health facility, travel time to health facility, type of method received, and interaction with community health worker before visiting the health facility.

Abbreviations: aOR, adjusted odds ratios; CI, confidence interval; NGO, nongovernmental organization; Ref, reference category.

Table S1 Ordered probit: adjusted coefficients for client’s perceived satisfaction and service quality overall and by service delivery channel

Independent variable	Perceived satisfaction				Service quality
	Structural care		Procedural care		Interpersonal relations		Information given to clients		Choice of methods
NGO clinics
Place of interview (home)	Ref		Ref		Ref		Ref		Ref
Exit interview	0.21	(−0.14, 0.55)	0.16	(−0.31, 0.63)	0.45*	(0.11, 0.78)	0.33¥	(−0.01, 0.68)	−0.05	(−0.44, 0.34)
Social franchise centers
Place of interview (home)	Ref		Ref		Ref		Ref		Ref
Exit interview	0.17*	(0.02, 0.33)	0.22***	(0.07, 0.36)	0.05	(−0.1, 0.2)	0.22*	(0.05, 0.39)	−0.02	(−0.2, 0.16)
Outreach camp
Place of interview (home)	Ref		Ref		Ref		Ref		Ref
Exit interview	0.05	(−0.68, 0.77)	0.37	(−0.42, 1.15)	−1.36***	(−2.02, −0.7)	−1.3***	(−2.14, −0.46)	−0.48	(−1.28, 0.32)

Notes:

* p<0.05;

*** p<0.001;

¥ p<0.10 (marginally significant); adjusted for respondent’s age, education, number of children, wealth quintile, prior use of contraceptive in the last 3 months, ever been to index health facility, travel time to health facility, and interaction with community health worker before visiting the health facility.

Abbreviations: NGO, nongovernmental organization; Ref, reference category.

Table S2 Characteristics of study participants by sites and by survey

Indicators	NGO clinics		Social franchise centers		Outreach camps
	Exit interview (n=230) %	Home interview (n=216) %	Exit interview (n=976) %	Home interview (n=983) %	Exit interview (n=163) %	Home interview (n=160) %
Socioeconomic and demographic
Participants’ age, mean (SE)			p=0.037
	32.1	31.2	30.3	30.9	33.1	32.6
Education
None/no formal/some primary	32.6	45.4	50.5	51.5	79.1	61.9
Complete primary or higher	67.4	54.63	49.5	48.5	20.9	38.1
Living children, mean (SE)	3.8	3.8	3.6	3.8	5.0	5.8
Wealth quintile
Poorest	2.2	3.7	4.1	5.2	28.2	19.4
Poor	4.8	4.2	14.9	12.8	38.7	36.9
Medium	16.9	18.5	29.8	29.3	18.4	36.9
Wealthy	43.9	40.3	41.3	42.2	13.5	6.9
Wealthiest	32.2	33.3	9.8	10.5	1.2	0.0
Behaviors pertaining to contraception
Ever been to index health facility (study site)	66.9	62.9	69.6	66.9	28.2	15.0
Prior use of any modern contraceptive in the last 3 months					p=0.0071
	61.3	62.9	68.8	63.7	52.2	15.0
Travel time of health facility
≤15 minutes	29.1	38.4	51.3	47.4	19.0	28.8
>15 minutes	70.9	61.6	48.7	52.6	81.0	71.2
Meeting with community health worker before visiting health facility	p=0.0304
	24.4	37.0	75.8	76.0	79.1	83.8
Type of contraceptive method received			p<0.0001
Short-acting (oral pill, condom, injectable)	45.7	43.1	61.4	40.9	11.7	21.3
Long-acting (intrauterine device, implant)	49.1	42.6	36.5	58.1	24.5	31.2
Permanent (female sterilization)a	5.2	14.4	2.1	1.1	63.8	47.5

Notes: p-values are only shown for differences that were statistically significant.

a No case of male sterilization was observed during survey.

Abbreviation: NGO, nongovernmental organization.