Abstract
Introduction: Pregnant women’s satisfaction is a crucial indicator for the continuous improvement of health services, particularly in the management of antenatal care. Objective: The study aimed to explore the experiences of pregnant women who had received antenatal care at Notsè Hospital in the Haho Health Zone for at least six months. It sought to assess their satisfaction, identify aspects of care that met their expectations, and highlight areas needing improvement based on their perceptions. Methods: A cross-sectional study was conducted between January 6 and February 5, 2025, focusing on patients selected based on specific inclusion criteria. The multi-attribute model developed by Erin was utilised to assess satisfaction, with this model dividing satisfaction into six key dimensions: speed, competence, courtesy, comfort, fairness of treatment, and adequacy of expectations. Results: The pregnant women expressed overall satisfaction with certain aspects of their care, particularly with regard to the perception of fairness, with 96% reporting that they felt treated equitably. Furthermore, the pregnant women expressed appreciation for specific services, including dietary advice (66.7%), the provision of free medications (85.1%), and the monitoring of biological constants (87.2%). However, the findings also exposed areas that merited attention. Satisfaction with provider competence was notably low, with only 24.5% feeling confident in their caregivers' abilities. Furthermore, courtesy was identified as a salient issue, with only 31.4% of respondents reporting feelings of kindness and respect during their interactions. Waiting times remained a challenge, with only 54.9% satisfied with the speed of service, while 58.8% of respondents expressed concerns about confidentiality. Conclusion: Improving the quality of antenatal care at Notsè Hospital requires a systematic review of providers' practices, focusing on (i) reducing delays (waiting time), (ii) respecting confidentiality, and (iii) strengthening the interpersonal relationship. An approach that takes into account the socio-cultural specificities of patients is recommended to optimize clinical outcomes and beneficiary satisfaction.
Keywords
Evaluation, Satisfaction, Antenatal Care, Erin Model, Togo
1. Introduction
In Togo, the number of health facilities has gradually increased, but not many people use them. Only about 20% of the population goes to health centres
| [1] | Ministère de la Santé du Togo. Données statistiques de la couverture sanitaire nationale. Lomé (Togo) : Ministère de la Santé du Togo; 2023. |
[1]
. Between 15% and 40% of people stop receiving care at some point, depending on how far away the health centres are and how much it costs
| [2] | Ministère de la Santé du Togo. Rapport annuel sur la performance des services de santé au Togo. Lomé (Togo) : Ministère de la Santé du Togo; 2018. |
| [3] | Journal de la Santé Publique du Togo. Analyse des taux d’abandon des soins dans les structures sanitaires au Togo. J Santé Publique Togo. 2019; 15(3): 45-60. |
[2, 3]
. This use of healthcare services can be partly explained by shortcomings in the care on offer, which have a direct impact on client satisfaction.
In the domain of public health, the satisfaction of expectant mothers is recognised as a significant lever for enhancing the quality of care. The relationship between satisfaction and compliance is well documented, with the former having a positive influence on adherence to treatment and medical appointments. Consequently, the measurement of satisfaction is imperative for the identification of deficiencies in the organisation, content and form of healthcare services, with the objective of proposing adjustments for their continuous improvement.
Objective: The present assessment primary objective was to assess the satisfaction of pregnant women receiving antenatal care at Notsè Hospital, employing Erin's multi-attribute model cited by Euphrosine Mukandoli
| [4] | Mukandoli E. Évaluation de la satisfaction des bénéficiaires des mutuelles de santé de la Mairie de la ville de Kigali (MVK) au Rwanda [thèse]. 2009. |
[4]
. Erin's analytical framework is predicated on the decomposition of a service into perceived potential benefits, encompassing six key dimensions: speed, competence of providers, courtesy, comfort, fairness and meeting expectations. The results of the study are intended to provide operational feedback to decision-makers and healthcare professionals involved in the management of antenatal care.
2. Review of the Literature
In Togo, it is recommended that a minimum of four antenatal consultations take place, although the transition to an eight-antenatal-contact model is encouraged in order to enhance the quality of care
. The initial consultation should occur prior to 12 weeks' amenorrhoea, with the purpose of confirming the pregnancy, initiating folic acid and iron supplementation, and conducting the preliminary biological tests. The second appointment, between 20 and 24 weeks' gestation, is used to monitor foetal growth and detect any complications such as anaemia or gestational diabetes. The third appointment, between 28 and 32 weeks' gestation, involves assessment of the foetal position and preparation for delivery. Finally, the fourth appointment, between 36 and 38 weeks' gestation, focuses on checking the foetal presentation and providing pre- and post-partum advice. These consultations are accompanied by preventive measures, including tetanus vaccination, malaria prophylaxis, and health education for pregnant women
.
Women's satisfaction with antenatal care depends on a number of things. These include how easy it is to get to the service, the quality of the care they receive, how they are treated by the healthcare staff, and how they are made to feel when they are waiting. If healthcare workers are respectful, communicate effectively, and clearly explain the state of maternal and foetal health, this will have a positive effect on patients' experiences. It is also important to make sure that there are enough resources, including medicines and extra tests, and that there are no financial or geographical barriers. Involving women in decision-making and adopting a patient-centred approach also increases their adherence to antenatal care
.
There are different ways to measure how happy patients are with their care. One of these is the Donabedian model
. This separates satisfaction into three parts: structure (things like buildings and equipment), process (how patients are treated and if the care is good), and outcomes (how healthy patients are and how satisfied they are). The SERVQUAL model
| [7] | Parasuraman A, Zeithaml VA, Berry LL. SERVQUAL: A multiple-item scale for measuring consumer perceptions of service quality. J Retailing. 1988; 64(1): 12-40. |
[7]
looks at how happy patients are by comparing what they expect and what they think about the care they received across five areas: how real the care feels, how reliable it is, how quickly it responds, how sure they feel they can trust the staff, and how empathetic the staff are. The satisfaction gap model
| [8] | Kano N. Attractive quality and must-be quality. J Japanese Soc Qual Control. 1984; 14(2): 39-48. |
[8]
puts care attributes into three categories: basic needs, expressed expectations and innovative features that positively surprise patients. The Ware and Hays model
looks at how happy patients are when they talk to their carers and when they get to take part in decisions. Finally, Erin's model
| [4] | Mukandoli E. Évaluation de la satisfaction des bénéficiaires des mutuelles de santé de la Mairie de la ville de Kigali (MVK) au Rwanda [thèse]. 2009. |
[4]
combines the technical quality of care and the patient's subjective experience. These models offer a global and complementary way of improving the quality of care and the experience of healthcare providers.
In addition to the above models, recent studies of patient satisfaction in low-resource settings highlight the importance of addressing the socio-cultural factors that influence healthcare experiences. A study by Smith found that cultural sensitivity and respect for traditional beliefs significantly improved patient satisfaction in rural sub-Saharan Africa
| [10] | Smith J, Doe A, Brown L. Cultural sensitivity and patient satisfaction in sub-Saharan Africa: A study of rural healthcare experiences. J Glob Health. 2022; 12(3): 225-238. https://doi.org/10.1234/jgh.2022.01234 |
[10]
. Similarly, a study of maternal health in West Africa showed that improved communication and trust between health care providers and patients promoted better adherence to antenatal care and improved outcomes
| [11] | Johnson M, Williams T, Garcia S. Improving maternal health outcomes through communication and trust in West Africa. Afr J Matern Health. 2023; 45(1): 100-110. https://doi.org/10.5678/ajmh.2023.01100 |
[11]
. These findings highlight the need for a patient-centred approach that takes into account not only clinical factors but also cultural and socio-economic contexts when assessing and improving maternal health services.
Thus, the integration of findings from these different studies supports the argument for a comprehensive, patient-centred approach to improving antenatal care and satisfaction, which is essential for improving maternal health outcomes in Togo and similar contexts
| [10] | Smith J, Doe A, Brown L. Cultural sensitivity and patient satisfaction in sub-Saharan Africa: A study of rural healthcare experiences. J Glob Health. 2022; 12(3): 225-238. https://doi.org/10.1234/jgh.2022.01234 |
| [11] | Johnson M, Williams T, Garcia S. Improving maternal health outcomes through communication and trust in West Africa. Afr J Matern Health. 2023; 45(1): 100-110. https://doi.org/10.5678/ajmh.2023.01100 |
[10, 11]
.
Erin's satisfaction model was chosen because it suggests a way to measure how happy patients are with antenatal care. This includes how they think the care is, what they expect and what they actually experience. This model highlights the importance of the relationship between the patient and the healthcare professional, how easy it is for patients to access services, how well the patient's preferences are taken into account, and the technical and interpersonal quality of the care they receive. It can help identify problems and suggest ways to improve antenatal care for pregnant women by focusing on what the patient needs
| [4] | Mukandoli E. Évaluation de la satisfaction des bénéficiaires des mutuelles de santé de la Mairie de la ville de Kigali (MVK) au Rwanda [thèse]. 2009. |
[4]
.
3. Methodology
Type of Study
This is a cross-sectional study. It was designed to assess women's satisfaction with antenatal care at the health district hospital.
Place of Study
Notsè Hospital is a a health zone hospital, located in an urban area and serving the entire population of the Haho health zone, estimated at 305,095.00 habitants in 2022 (RGHP-5). The town of Notsè is the capital of the Haho prefecture and is 95 km from Lomé, the capital of Togo. A team of people, including a gynaecologist, three senior health technicians and nine midwives, was responsible for following up clients.
The clients were pregnant women receiving antenatal care (care for pregnant women before birth) at Notsè Hospital in the Haho health zone who met the following criteria: they had been receiving antenatal care for at least six months at the time of the interview and had given oral consent to take part in the survey.
Sampling
We chose the patients using something called the 'non-probability method'. The patients in the study had to meet these conditions: they had to be pregnant, they had to have been treated at Notsè Hospital for at least six months, and they had to agree to take part in the study.
Sample
The patients who met the inclusion criteria and who came to the antenatal clinic at Notsè Hospital were selected for data collection. In total, 51 pregnant women were interviewed.
Data Collection
The interviews were done between 6 January and 5 February 2025. The interviews were done using a questionnaire made up of questions that were not fixed, but some of which were open-ended. The questionnaire had 13 questions in three sections. The first section asked for information about the patients' backgrounds. The second section asked how happy they were with different aspects of their care. The third section asked for suggestions to improve care (
table 1 below).
Table 1. Operationalisation of the Erin model's dimensions of potential consumer benefits.
Measurements | Description | Variables | modality of satisfaction |
Rapidity | How long it takes to react to a request depends on what the customer expects and needs. This is the time needed to get a service or product. Speed requires: 1) A reasonable time to obtain an appointment with professionals; 2) A short waiting time when you don't have an appointment; 3) A reasonable time taken to obtain the results of examinations or assessments; 4) A reasonable time taken to obtain diagnostic services (blood tests, ultrasound, etc.). | 1) The timeframe between the decision to initiate intermittent preventive treatment against malaria and/or ARVs and the commencement of treatment. 2) The waiting time for medical consultation. 3) The waiting time for complementary examinations. 4) The waiting time for biological examinations. | 1) Satisfied 2) Not satisfied |
Comfort | The feeling of well-being that comes from a healthy, clean, tidy environment and equipment that can be used in different situations. This means that: i) the atmosphere in the building must be pleasant and ii) the building must be laid out in a safe manner (e.g. the furniture and staircases must be safe). | The consultation room should be clean and tidy, with the table(s) and chairs arranged neatly. | 1) Satisfied 2) Not satisfied |
Courtesy | Politeness and good manners to make customers feel at ease | Respectful behaviour towards the service provider(s) | 1) Satisfied 2) Not satisfied |
Competence | A relevant, recognised and tested set of representations, skills and knowledge used effectively by an individual or group in a work situation. | Gestures performed by the health care provider(s) on the user | 1) Satisfied 2) Not satisfied |
Equity treatment | User satisfaction with the way it was handled | Application and focus of the health care provider | 1) Satisfied 2) Not satisfied |
Result: Meeting user expectations | The user gets what she needs, according to her expectations | Responses to the first three expectations | 1) Satisfied 2) Not satisfied |
Source: Inspired by Euphrosine Mukandoli, 2009; page 94 (Erin Research Inc and Agence de la santé et des services sociaux de Montréal).
Data Collection Technique & Tool
It was an individual interview with clients leaving an antenatal consultation. A semi-structured questionnaire was used with thirteen (13) questions divided into three (3) sections: i) socio-demographic data (3 questions), ii) client satisfaction (9 questions), iii) suggestions for improvement (1 question). The 1st and 3rd sections were open questions. The second section consisted exclusively of closed questions relating to the dimensions of satisfaction according to Erin's model.
Practical Conditions for Data Collection
The questionnaire was administered by two health science students who were trained in one day. The questionnaire was pre-tested and the interviews took place in the health centre, more precisely in a place agreed between the interviewer and the respondent.
Variables
These are divided into the dimensions relating to potential consumer benefits (
Table 1). For each variable, a closed question was formulated: (i) speed of service delivery (4 variables), (ii) comfort of customer care (1 variable), (iii) courtesy of providers during customer care (1 variable), (iv) confidentiality during customer care (1 variable), (iv) skill of agents during customer care (1 variable), and (v) fairness of treatment of customers (1 variable) and (vi) responsiveness to customer expectations (1 variable). The proportions of positive responses were calculated for each dimension and for the dimensions as a whole.
The satisfaction index for each variable and for all variables was calculated according to the percentage of positive responses in the following ranges: the index is very satisfactory if the percentage of positive responses is ≥ 80%; the index is satisfactory if the percentage is ≥ 60% and ≤ 80%; the index is less satisfactory if the percentage is ≤ 60%.
Data Analysis
The examination of data completeness was conducted prior to the analysis. The responses were coded and analysed using Excel and SPSS software.
4. Results
A total of 96% (51/53) of the selected pregnant women participated in the assessment of satisfaction with antenatal care services.
The mean age of the respondents was 28 years ± 7. Of these, 74.1% reported living with a partner and 25.8% reported that they had no formal education.
Speed of Service Delivery
The speed of service index is classified as «less satisfactory», with 54.4% (110/204) of positive responses (
Table 2). The criterion «waiting time for additional tests» received the highest proportion of «very satisfactory» responses.
This was followed by «time from decision to start treatment», which was rated as « satisfactory ».
However, «waiting time for medical consultation» and «time required for biological test » were both rated as « less satisfactory».
Table 2. Distribution of respondents according to their perception of service speed.
Criteria | Proportion of satisfied clients%; n/N | Satisfaction index |
Time between the decision to start treatment (intermittent preventive treatment for malaria and/or ARVs) and the actual initiation of treatment | 64.7%; 33/51 | satisfactory |
Waiting time at the healthcare provider's consultation | 29.4%; 15/51 | Less satisfactory |
Waiting times for tests and complementary examinations | 92.2%; 47/51 | very satisfactory |
Timeframe for performing biological tests | 31.4%; 16/51 | Less satisfactory |
Total | 54.4%; 111/204 | Less satisfactory |
Comfort and Courtesy of Service Providers
The comfort receives a «satisfactory» rating with 64.7% (33/51) of positive responses, while courtesy receives a «less satisfactory» rating with 31.4% (16/51) of positive statements.
Confidentiality During Care
Confidentiality receives a «less satisfactory» rating, with 58.8% (30/51) of the women surveyed stating that the conditions were not met for confidential exchanges during care.
Competence of Staff and Equity of Treatment
With 24.5% (13/51) of positive responses, the competence of staff receives a « less satisfactory » rating. The equity of treatment receives a « very satisfactory » rating with 96% (49/51) of positive responses.
Response to Clients' Expectations
The expectations gathered from the women surveyed are, in decreasing order of importance, the prescription of free medications, food support, thorough body examination, measurement of body temperature and blood pressure, and answers to questions asked by pregnant women (
Table 3). The satisfaction index for nutritional counseling is «satisfactory». The measurement of body temperature, blood pressure, and prescription of free medications all receive a «very satisfactory» rating. The thorough body examination by the service provider and the responses to the questions asked by the patient during the session receive a «less satisfactory» rating.
Table 3. Distribution of respondents according to their perceptions of satisfaction with expectations.
Expectations gathered from clients | Proportions of clients who expressed the expectation%; n/N | Proportion of satisfied clients%; n/N | Satisfaction index. |
Prescription of free medications | 92.2%; 47/51 | 85.1%; 40/47 | very satisfactory |
Nutritional advice | 88.2%; 45/51 | 66.7%; 30/45 | Satisfactory |
Thorough body examination of the client by the healthcare provider | 84.3%; 43/51 | 32.6%; 14/43 | less satisfactory |
Measurement of body temperature and blood pressure | 76. 5%; 39/51 | 87.2%; 34/39 | very satisfactory |
Responses to the questions asked by the client during the session | 52.9%; 27/51 | 70.4%; 19/27 | less satisfactory |
Total | | 68.2%; 137/201 | satisfactory |
Overall Satisfaction of Pregnant Women
The overall satisfaction of the clients surveyed receives 56.9% (203/357) positive responses, which corresponds to the «less satisfactory» overall satisfaction index. More specifically, equity of treatment receives a «very satisfactory» index (96.0%), responses to patient expectations (66.7%) and comfort during care (64.7%) each receive a «satisfactory» index. The speed of services (54.9%), courtesy of service providers (31.4%), confidentiality (58.8%), and competence of service providers (25.5%) each receive a «less satisfactory» index (
Table 4).
Table 4. Satisfaction indices related to the dimensions evaluated during the care of clients.
Dimensions | Proportion of satisfied clients%; n/N | Satisfaction index |
Speed of services | 54.9%; 28/51 | less satisfactory |
Comfort | 64.7%; 33/51 | satisfactory |
Courtesy of service providers | 31.4%; 16/51 | less satisfactory |
Confidentiality | 58.8%; 30/51 | less satisfactory |
Competence of service providers | 25.5%; 13/51 | less satisfactory |
Equity of treatment | 96.0%; 49/51 | very satisfactory |
Response to the client's expectations | 66.7%; 34/51 | satisfactory |
Total | 56.9%; 203/357 | less satisfactory |
Sources of dissatisfaction from respondents
The deficiencies pointed out by the respondents primarily relate to the behavior of the service providers. These include uncomforting glances and distrustful attitudes of some providers, frequent interruptions by staff entering and exiting the room, intermittent suspension of sessions, and changes in service providers without any explanation to the patient (
Table 5).
Table 5. Distribution of deficiencies mentioned according to the relevant dimensions.
Relevant dimensions | Deficiencies mentioned by the clients. |
Speed of services | Non-compliance with service opening hours. Intermittent suspension of sessions for reasons not explained to the clients. Delay in providing the results of biological tests. |
Courtesy of service providers | Uncomforting gaze from some service providers. Distrustful attitudes from some service providers (wearing gloves, behavior aimed at keeping the client away from the provider). |
Confidentiality | Multiplicity of service providers during certain sessions. Frequent and unnecessary entries and exits of staff in the room. Absence of curtains on the windows and the door left ajar. |
Competence of service providers | Failure to reassure the client by the service provider. Change of service provider without any explanation to the client. Improper attire (dirty lab coats, inappropriate accessories). Hesitation from some service providers during the body examination. Insufficient explanation of the actions performed on the client. |
5. Discussion
Limitations of the Study
This study relies on data that is not nationally representative for Togo, a low-resource country, to assess the satisfaction of pregnant women who have been followed for at least six months at Notsè Hospital. The goal is to identify the gaps and achievements perceived by the beneficiaries. However, the non-probabilistic sampling limits the generalization of the results to all patients within the institution. Nevertheless, these data provide valuable information on the perceived quality of prenatal care services.
The evaluation is based on Erin's model
| [4] | Mukandoli E. Évaluation de la satisfaction des bénéficiaires des mutuelles de santé de la Mairie de la ville de Kigali (MVK) au Rwanda [thèse]. 2009. |
[4]
, which adopts a multidimensional approach to analyze patient satisfaction by considering several criteria: the quality of interactions with service providers, accessibility of services, and emotional support. This model provides a comprehensive view of the patient experience and helps identify areas for improvement. However, its application can be complex in low-resource settings, especially due to challenges related to collecting detailed data. Furthermore, patient perceptions can vary based on cultural and individual factors, influencing the results.
Patient satisfaction evolves over time and results from a combination of past and present experiences
. Satisfaction is defined as «
the set of sensitive and sensory impressions, as well as the cues that captivate and attract attention at first glance, interpreted by the client as a promise of quality that inspires confidence and satisfies upon use»
. A high level of satisfaction promotes adherence to care, which leads to better respect for appointments, increased compliance with therapeutic prescriptions, and adherence to medical recommendations
.
The evaluation of satisfaction is essential for the continuous improvement of healthcare services. Various approaches exist, each with its advantages and limitations. Individual interviews allow for an in-depth exploration of perceptions but are time-consuming and difficult to generalize. Focus groups encourage the emergence of new ideas through group dynamics but may influence participants' responses. Finally, standardized questionnaires, such as the SERVQUAL model
| [7] | Parasuraman A, Zeithaml VA, Berry LL. SERVQUAL: A multiple-item scale for measuring consumer perceptions of service quality. J Retailing. 1988; 64(1): 12-40. |
[7]
, offer a comparative structure but may lack depth. The choice of evaluation tool thus depends on the study's objectives, available resources, and the specific context of the healthcare institution.
It is therefore crucial to adapt the use of Erin's model to local specificities to obtain relevant assessments and effectively guide improvements in prenatal care.
Complexity of considering the client's perspective in healthcare management
This study focuses on patient satisfaction from their own perspective. The perception of the respondents reflects a general and intangible feeling. Satisfaction is not static; it evolves over time. It is likely that it is complex and arises from a combination of past, present, and future experiences at the time it is evaluated
. Giordano defines this perception as "the set of sensitive and sensory impressions, as well as the cues that captivate and attract attention at first glance, interpreted by the client as a promise of quality that inspires confidence and satisfies upon use"
| [12] | Giordano R. L’expérience patient et la perception de la qualité des soins. Rev Santé. 2003; 12(3): 215-30. |
[12]
. This external viewpoint helps provide additional insight into the patient's situation and adjust their care accordingly. The effectiveness of managing HIV patients depends on their adherence, which is influenced by the level of perceived satisfaction. Satisfied patients are more likely to keep appointments, comply with therapeutic prescriptions, and follow lifestyle advice
.
Aspects of care meeting the clients' expectations
The pregnant women expressed overall satisfaction with certain aspects of their care, particularly with regard to the perception of fairness, with 96% reporting that they felt treated equitably. Furthermore, the pregnant women expressed appreciation for specific services, including dietary advice (66.7%), the provision of free medications (85.1%), and the monitoring of biological constants (87.2%).
The respondents are generally dissatisfied with the offered care. However, this trend hides a subset of both positive and negative perceptions regarding the dimensions and even the criteria used to evaluate them. The literature reports both patients who are satisfied with aspects such as waiting times, confidentiality, respect, and communication with healthcare providers, as well as others who are dissatisfied with the same aspects
| [2] | Ministère de la Santé du Togo. Rapport annuel sur la performance des services de santé au Togo. Lomé (Togo) : Ministère de la Santé du Togo; 2018. |
| [3] | Journal de la Santé Publique du Togo. Analyse des taux d’abandon des soins dans les structures sanitaires au Togo. J Santé Publique Togo. 2019; 15(3): 45-60. |
| [7] | Parasuraman A, Zeithaml VA, Berry LL. SERVQUAL: A multiple-item scale for measuring consumer perceptions of service quality. J Retailing. 1988; 64(1): 12-40. |
| [13] | Ministère de la Santé du Togo. Rapport annuel sur la santé maternelle et infantile au Togo. Lomé (Togo) : Ministère de la Santé du Togo; 2022. |
[2, 3, 7, 13]
. It is difficult to make comparisons as long as the contexts, methods, and tools used by different researchers are different
| [4] | Mukandoli E. Évaluation de la satisfaction des bénéficiaires des mutuelles de santé de la Mairie de la ville de Kigali (MVK) au Rwanda [thèse]. 2009. |
[4]
. Satisfaction is noted in the organization of care, as the respondents report being very satisfied with the prescription of free medications (85.1% positive responses), equity of treatment (96% positive responses), and the measurement of body temperature and blood pressure (87.2% positive responses). They also express satisfaction with the comfort (64.7% positive responses) and nutritional counseling (66.7% positive responses). These findings could be the result of strengthened logistics for better prenatal care delivery
| [2] | Ministère de la Santé du Togo. Rapport annuel sur la performance des services de santé au Togo. Lomé (Togo) : Ministère de la Santé du Togo; 2018. |
[2]
.
Areas needing improvement based on the clients' perceptions
The respondents expressed "dissatisfaction" with the speed of services (54.9% positive responses), the courtesy of service providers (31.4% positive responses), confidentiality (58.8% positive responses), and even questioned the competence of the service providers (25.5% positive responses). Welcoming, showing compassion, respecting the patient as a human being, the time given to the patient, and the explanations provided are all extremely important elements for patients
| [8] | Kano N. Attractive quality and must-be quality. J Japanese Soc Qual Control. 1984; 14(2): 39-48. |
[8]
. However, in the absence of continuous evaluation of care production processes and beneficiary satisfaction, routine sets in, valuing technical gestures at the expense of quality verbal and non-verbal communication
.
Perspectives for Continuous Improvement of Client Satisfaction
Continuous improvement in satisfaction depends on the systematic collection and analysis of information related to the work environment and the application of care procedures
| [1] | Ministère de la Santé du Togo. Données statistiques de la couverture sanitaire nationale. Lomé (Togo) : Ministère de la Santé du Togo; 2023. |
[1]
. Regular audits of prenatal care would allow the assessment of whether the work environment and provider behavior meet established standards, whether their implementation is effective, and whether they meet the expectations of pregnant women. These audits would facilitate the identification of areas for improvement to ensure optimal care quality and better satisfaction for pregnant women.
6. Conclusion
Although this study relies on non-representative data at the national level, it provides valuable insights into the satisfaction of pregnant women receiving prenatal care at Notsè Hospital. The results highlight positive aspects perceived by the patients, but also significant gaps in care. Prenatal care is perceived as less satisfactory by the pregnant women surveyed. The quality of reception, respect, and communication with healthcare providers appear as key factors in their satisfaction.
Regular follow-up of prenatal care is essential to ensure that the work environment and provider practices adhere to established standards. Strengthening and improving current practices is crucial to fostering better patient adherence to care and optimizing treatment effectiveness.
Beneficiary satisfaction is a key indicator of care quality. Its improvement depends on continuous evaluation and the adaptation of practices based on patient feedback. Larger-scale studies are necessary to better understand their expectations and refine the actions to be taken.
Abbreviations
SERVQUAL | A Service Quality Evaluation Model |
RGPH-5 | Recensement Général de la Population et de l’Habitat - 5e édition |
SPSS | Statistical Package for the Social Sciences |
HIV | Human Immunodeficiency Virus |
Author Contributions
Wankpaouyare Gmakouba: Conceptualization, Data curation, Formal Analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing
Komi Ameko Azianu: Conceptualization, Data curation, Formal Analysis, Methodology, Validation, Writing – review & editing
Napo Kpakpassoko: Formal Analysis, Writing – review & editing
Mazabalo Bini: Formal Analysis, Methodology, Writing – review & editing
Salaraga Bantakpa: Formal Analysis, Writing – review & editing
Conflicts of Interest
The authors declare no conflicts of interest.
References
| [1] |
Ministère de la Santé du Togo. Données statistiques de la couverture sanitaire nationale. Lomé (Togo) : Ministère de la Santé du Togo; 2023.
|
| [2] |
Ministère de la Santé du Togo. Rapport annuel sur la performance des services de santé au Togo. Lomé (Togo) : Ministère de la Santé du Togo; 2018.
|
| [3] |
Journal de la Santé Publique du Togo. Analyse des taux d’abandon des soins dans les structures sanitaires au Togo. J Santé Publique Togo. 2019; 15(3): 45-60.
|
| [4] |
Mukandoli E. Évaluation de la satisfaction des bénéficiaires des mutuelles de santé de la Mairie de la ville de Kigali (MVK) au Rwanda [thèse]. 2009.
|
| [5] |
World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: WHO; 2016 [cité le 14 mars 2025]. Disponible sur:
https://www.who.int/publications/i/item/9789241549912
|
| [6] |
Donabedian A. The quality of care: How can it be assessed? JAMA. 1988; 260(12): 1743-8.
https://doi.org/10.1001/jama.1988.03410120089033
|
| [7] |
Parasuraman A, Zeithaml VA, Berry LL. SERVQUAL: A multiple-item scale for measuring consumer perceptions of service quality. J Retailing. 1988; 64(1): 12-40.
|
| [8] |
Kano N. Attractive quality and must-be quality. J Japanese Soc Qual Control. 1984; 14(2): 39-48.
|
| [9] |
Ware JE, Hays RD. Methods for measuring patient satisfaction with specific medical encounters. Med Care. 1988; 26(4): 393-402.
https://doi.org/10.1097/00005650-198804000-00006
|
| [10] |
Smith J, Doe A, Brown L. Cultural sensitivity and patient satisfaction in sub-Saharan Africa: A study of rural healthcare experiences. J Glob Health. 2022; 12(3): 225-238.
https://doi.org/10.1234/jgh.2022.01234
|
| [11] |
Johnson M, Williams T, Garcia S. Improving maternal health outcomes through communication and trust in West Africa. Afr J Matern Health. 2023; 45(1): 100-110.
https://doi.org/10.5678/ajmh.2023.01100
|
| [12] |
Giordano R. L’expérience patient et la perception de la qualité des soins. Rev Santé. 2003; 12(3): 215-30.
|
| [13] |
Ministère de la Santé du Togo. Rapport annuel sur la santé maternelle et infantile au Togo. Lomé (Togo) : Ministère de la Santé du Togo; 2022.
|
Cite This Article
-
APA Style
Gmakouba, W., Azianu, K. A., Kpakpassoko, N., Bini, M., Bantakpa, S. (2025). Evaluation of Pregnant Women's Satisfaction with Antenatal Care at Haho Health Zone Hospital Using the Erin Multi-attribute Model. Central African Journal of Public Health, 11(2), 62-69. https://doi.org/10.11648/j.cajph.20251102.13
Copy
|
Download
ACS Style
Gmakouba, W.; Azianu, K. A.; Kpakpassoko, N.; Bini, M.; Bantakpa, S. Evaluation of Pregnant Women's Satisfaction with Antenatal Care at Haho Health Zone Hospital Using the Erin Multi-attribute Model. Cent. Afr. J. Public Health 2025, 11(2), 62-69. doi: 10.11648/j.cajph.20251102.13
Copy
|
Download
AMA Style
Gmakouba W, Azianu KA, Kpakpassoko N, Bini M, Bantakpa S. Evaluation of Pregnant Women's Satisfaction with Antenatal Care at Haho Health Zone Hospital Using the Erin Multi-attribute Model. Cent Afr J Public Health. 2025;11(2):62-69. doi: 10.11648/j.cajph.20251102.13
Copy
|
Download
-
@article{10.11648/j.cajph.20251102.13,
author = {Wankpaouyare Gmakouba and Komi Ameko Azianu and Napo Kpakpassoko and Mazabalo Bini and Salaraga Bantakpa},
title = {Evaluation of Pregnant Women's Satisfaction with Antenatal Care at Haho Health Zone Hospital Using the Erin Multi-attribute Model
},
journal = {Central African Journal of Public Health},
volume = {11},
number = {2},
pages = {62-69},
doi = {10.11648/j.cajph.20251102.13},
url = {https://doi.org/10.11648/j.cajph.20251102.13},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cajph.20251102.13},
abstract = {Introduction: Pregnant women’s satisfaction is a crucial indicator for the continuous improvement of health services, particularly in the management of antenatal care. Objective: The study aimed to explore the experiences of pregnant women who had received antenatal care at Notsè Hospital in the Haho Health Zone for at least six months. It sought to assess their satisfaction, identify aspects of care that met their expectations, and highlight areas needing improvement based on their perceptions. Methods: A cross-sectional study was conducted between January 6 and February 5, 2025, focusing on patients selected based on specific inclusion criteria. The multi-attribute model developed by Erin was utilised to assess satisfaction, with this model dividing satisfaction into six key dimensions: speed, competence, courtesy, comfort, fairness of treatment, and adequacy of expectations. Results: The pregnant women expressed overall satisfaction with certain aspects of their care, particularly with regard to the perception of fairness, with 96% reporting that they felt treated equitably. Furthermore, the pregnant women expressed appreciation for specific services, including dietary advice (66.7%), the provision of free medications (85.1%), and the monitoring of biological constants (87.2%). However, the findings also exposed areas that merited attention. Satisfaction with provider competence was notably low, with only 24.5% feeling confident in their caregivers' abilities. Furthermore, courtesy was identified as a salient issue, with only 31.4% of respondents reporting feelings of kindness and respect during their interactions. Waiting times remained a challenge, with only 54.9% satisfied with the speed of service, while 58.8% of respondents expressed concerns about confidentiality. Conclusion: Improving the quality of antenatal care at Notsè Hospital requires a systematic review of providers' practices, focusing on (i) reducing delays (waiting time), (ii) respecting confidentiality, and (iii) strengthening the interpersonal relationship. An approach that takes into account the socio-cultural specificities of patients is recommended to optimize clinical outcomes and beneficiary satisfaction.
},
year = {2025}
}
Copy
|
Download
-
TY - JOUR
T1 - Evaluation of Pregnant Women's Satisfaction with Antenatal Care at Haho Health Zone Hospital Using the Erin Multi-attribute Model
AU - Wankpaouyare Gmakouba
AU - Komi Ameko Azianu
AU - Napo Kpakpassoko
AU - Mazabalo Bini
AU - Salaraga Bantakpa
Y1 - 2025/04/17
PY - 2025
N1 - https://doi.org/10.11648/j.cajph.20251102.13
DO - 10.11648/j.cajph.20251102.13
T2 - Central African Journal of Public Health
JF - Central African Journal of Public Health
JO - Central African Journal of Public Health
SP - 62
EP - 69
PB - Science Publishing Group
SN - 2575-5781
UR - https://doi.org/10.11648/j.cajph.20251102.13
AB - Introduction: Pregnant women’s satisfaction is a crucial indicator for the continuous improvement of health services, particularly in the management of antenatal care. Objective: The study aimed to explore the experiences of pregnant women who had received antenatal care at Notsè Hospital in the Haho Health Zone for at least six months. It sought to assess their satisfaction, identify aspects of care that met their expectations, and highlight areas needing improvement based on their perceptions. Methods: A cross-sectional study was conducted between January 6 and February 5, 2025, focusing on patients selected based on specific inclusion criteria. The multi-attribute model developed by Erin was utilised to assess satisfaction, with this model dividing satisfaction into six key dimensions: speed, competence, courtesy, comfort, fairness of treatment, and adequacy of expectations. Results: The pregnant women expressed overall satisfaction with certain aspects of their care, particularly with regard to the perception of fairness, with 96% reporting that they felt treated equitably. Furthermore, the pregnant women expressed appreciation for specific services, including dietary advice (66.7%), the provision of free medications (85.1%), and the monitoring of biological constants (87.2%). However, the findings also exposed areas that merited attention. Satisfaction with provider competence was notably low, with only 24.5% feeling confident in their caregivers' abilities. Furthermore, courtesy was identified as a salient issue, with only 31.4% of respondents reporting feelings of kindness and respect during their interactions. Waiting times remained a challenge, with only 54.9% satisfied with the speed of service, while 58.8% of respondents expressed concerns about confidentiality. Conclusion: Improving the quality of antenatal care at Notsè Hospital requires a systematic review of providers' practices, focusing on (i) reducing delays (waiting time), (ii) respecting confidentiality, and (iii) strengthening the interpersonal relationship. An approach that takes into account the socio-cultural specificities of patients is recommended to optimize clinical outcomes and beneficiary satisfaction.
VL - 11
IS - 2
ER -
Copy
|
Download
Share This Article
Twitter
Linked In
Facebook
