Measuring client-perceived quality of maternity services in rural Vietnam

Objective. To examine the feasibility, reliability and validity of a 20-item scale for measuring perceived quality of maternity services provided at commune health centres in rural Vietnam. Design. A survey of 200 women who gave birth in July-August 2000 and 196 pregnant women in 34 communes in Quang Xuong District, Thanh Hoa Province, Vietnam. Main outcome measures. Inter-rater reliability, internal consistency and factor structure of the scale were examined. The associations between perceived quality and client characteristics were also investigated. Results. The instrument had relatively good inter-rater reliability and internal consistency. Except for two items: 'good clinical examination' and 'adequacy of health workers for women's health', the scale exhibited good agreement between the two raters, with kappa values ranging from 0.54 to 0.84. The Cronbach's alpha coefficients for the dimensions 'health care delivery', 'health facility', 'interpersonal aspects of care' and 'access to services' were 0.72, 0.64, 0.72 and 0.33, respectively. Respondents were positive on items related to the dimensions 'interpersonal aspects of care' and 'access to services', but negative on the dimensions 'health care delivery' and 'health facility'. The maternity status of clients was found to influence the perceived quality of maternity services. Conclusions. The feasibility, reliability and validity of the instrument were established in the context of rural Vietnam. Its application in evaluating other health care programmes should be an important follow-up action for the Vietnamese government.