Omondi Aduda D.S., Ouma C., Onyango R., Onyango M., Bertrand J.
School of Public Health and Community Development, Maseno University, Maseno, Kenya; Department of Biomedical Sciences and Technology, School of Public Health and Community Development, Maseno University, Maseno, Kenya; Department of Public Health, School of Public Health and Community Development, Maseno University, Maseno, Kenya; FHI360, Kisumu Office, Kisumu, Kenya; Department of Global Health Systems and Development, Tulane University, New Orleans, LA, United States
Omondi Aduda, D.S., School of Public Health and Community Development, Maseno University, Maseno, Kenya; Ouma, C., Department of Biomedical Sciences and Technology, School of Public Health and Community Development, Maseno University, Maseno, Kenya; Onyango, R., Department of Public Health, School of Public Health and Community Development, Maseno University, Maseno, Kenya; Onyango, M., FHI360, Kisumu Office, Kisumu, Kenya; Bertrand, J., Department of Global Health Systems and Development, Tulane University, New Orleans, LA, United States
Background: Considerable conceptual and operational complexities related to service quality measurements and variability in delivery contexts of scaled-up medical male circumcision, pose real challenges to monitoring implementation of quality and safety. Clarifying latent factors of the quality instruments can enhance contextual applicability and the likelihood that observed service outcomes are appropriately assessed. Objective: To explore factors underlying SYMMACS service quality assessment tool (adopted from the WHO VMMC quality toolkit) and; determine service quality performance using composite quality index derived from the latent factors. Study design: Using a comparative process evaluation of Voluntary Medical Male Circumcision Scale-Up in Kenya site level data was collected among health facilities providing VMMC over two years. Systematic Monitoring of the Medical Male Circumcision Scale-Up quality instrument was used to assess availability of guidelines, supplies and equipment, infection control, and continuity of care services. Exploratory factor analysis was performed to clarify quality structure. Results: Fifty four items and 246 responses were analyzed. Based on Eigenvalue >1.00 cut-off, factors 1, 2 & 3 were retained each respectively having eigenvalues of 5.78; 4.29; 2.99. These cumulatively accounted for 29.1% of the total variance (12.9%; 9.5%; 6.7%) with final communality estimates being 13.06. Using a cut-off factor loading value of ≥0.4, fifteen items loading on factor 1, five on factor 2 and one on factor 3 were retained. Factor 1closely relates to preparedness to deliver safe male circumcisions while factor two depicts skilled task performance and compliance with protocols. Of the 28 facilities, 32% attained between 90th and 95th percentile (excellent); 45% between 50th and 75th percentiles (average) and 14.3% below 25th percentile (poor). Conclusion: the service quality assessment instrument may be simplified to have nearly 20 items that relate more closely to service outcomes. Ranking of facilities and circumcision procedure using a composite index based on these items indicates that majority performed above average. © 2014 Omondi Aduda et al.
article; circumcision; controlled study; exploratory research; factorial analysis; health care delivery; health care facility; health care quality; infection control; instrument validation; Kenya; patient care; patient safety; performance measurement system; practice guideline; protocol compliance; quality control; reference value; scale up; Systematic Monitoring of the Medical Male Circumcision Scale Up; circumcision; human; male; quality control; safety; standards; Circumcision, Male; Factor Analysis, Statistical; Health Facilities; Humans; Kenya; Male; Quality Control; Safety