OBJECTIVES: To evaluate whether participation in a competitive voucher programme designed to improve access to and quality of sexual and reproductive health care (SRH-care), prompted changes in doctors' knowledge, attitudes and practices. METHODS: The voucher programme provided free access to SRH-care for adolescents. Doctors received training and guidelines on how to deal with adolescents, a treatment protocol, and financial incentives for each adolescent attended. To evaluate the impact of the intervention on doctors, nearly all participating doctors (n = 37) were interviewed before the intervention and 23 were interviewed after the intervention. Answers were grouped in subthemes and scores compared using nonparametric methods. RESULTS: The initial interviews disclosed deficiencies in doctors' knowledge, attitudes and practices relating to adolescent SRH-issues. Gender and age of the doctor were not associated with the initial scores. Comparing scores from before and after the intervention revealed significant increases in doctors' knowledge of contraceptives (P = 0.003) and sexually transmittable infections (P < 0.001); barriers to contraceptive use significantly diminished (P < 0.001 and P = 0.003); and some attitudinal changes were observed (0 = 0.046 and P = 0.11). Doctors became more aware of the need to improve their communication skills and were positive about the programme. CONCLUSIONS: This study confirmed provider related barriers that adolescents in Nicaragua may face and reinforces the importance of focusing on the quality of care and strengthening doctors' training. Participation in the voucher programme resulted in increased knowledge, improved practices and, to a lesser extent, in changed attitudes. A competitive voucher programme with technical support for the participating doctors can be a promising strategy to prompt change.
OBJECTIVES: To evaluate whether participation in a competitive voucher programme designed to improve access to and quality of sexual and reproductive health care (SRH-care), prompted changes in doctors' knowledge, attitudes and practices. METHODS: The voucher programme provided free access to SRH-care for adolescents. Doctors received training and guidelines on how to deal with adolescents, a treatment protocol, and financial incentives for each adolescent attended. To evaluate the impact of the intervention on doctors, nearly all participating doctors (n = 37) were interviewed before the intervention and 23 were interviewed after the intervention. Answers were grouped in subthemes and scores compared using nonparametric methods. RESULTS: The initial interviews disclosed deficiencies in doctors' knowledge, attitudes and practices relating to adolescent SRH-issues. Gender and age of the doctor were not associated with the initial scores. Comparing scores from before and after the intervention revealed significant increases in doctors' knowledge of contraceptives (P = 0.003) and sexually transmittable infections (P < 0.001); barriers to contraceptive use significantly diminished (P < 0.001 and P = 0.003); and some attitudinal changes were observed (0 = 0.046 and P = 0.11). Doctors became more aware of the need to improve their communication skills and were positive about the programme. CONCLUSIONS: This study confirmed provider related barriers that adolescents in Nicaragua may face and reinforces the importance of focusing on the quality of care and strengthening doctors' training. Participation in the voucher programme resulted in increased knowledge, improved practices and, to a lesser extent, in changed attitudes. A competitive voucher programme with technical support for the participating doctors can be a promising strategy to prompt change.
Authors: Ben Bellows; Catherine Kyobutungi; Martin Kavao Mutua; Charlotte Warren; Alex Ezeh Journal: Health Policy Plan Date: 2012-03-21 Impact factor: 3.344
Authors: Claire Watt; Timothy Abuya; Charlotte E Warren; Francis Obare; Lucy Kanya; Ben Bellows Journal: PLoS One Date: 2015-04-02 Impact factor: 3.240
Authors: Elissa C Kennedy; Siula Bulu; Jennifer Harris; David Humphreys; Jayline Malverus; Natalie J Gray Journal: BMC Health Serv Res Date: 2013-10-31 Impact factor: 2.655
Authors: Paul C Hewett; Karen Austrian; Erica Soler-Hampejsek; Jere R Behrman; Fiammetta Bozzani; Natalie A Jackson-Hachonda Journal: BMC Public Health Date: 2017-05-05 Impact factor: 3.295
Authors: Lina Jaruseviciene; Miguel Orozco; Marcia Ibarra; Freddy Cordova Ossio; Bernardo Vega; Nancy Auquilla; Joel Medina; Anna C Gorter; Peter Decat; Sara De Meyer; Marleen Temmerman; Alexander B Edmonds; Leonas Valius; Jeffrey V Lazarus Journal: Glob Health Action Date: 2013-05-15 Impact factor: 2.640
Authors: Peter Decat; Erica Nelson; Sarah De Meyer; Lina Jaruseviciene; Miguel Orozco; Zoyla Segura; Anna Gorter; Bernardo Vega; Kathya Cordova; Lea Maes; Marleen Temmerman; Els Leye; Olivier Degomme Journal: BMC Public Health Date: 2013-01-14 Impact factor: 3.295