Quality of care through client's eyes: One case study from a reproductive health center in Nicaragua

Through the lens of the International Conference on Population and Development (ICPD), women's rights in sexual and reproductive health are the foundation for reproductive health programs. Keystone to women's rights are client-centered services and quality of care. Some quantitative studies have been conducted to assess quality of care and client's level of satisfaction with services, however, few qualitative studies of client's perspectives have been made. One NGO which embodies the spirit of this rights-based approach served as the site for a descriptive qualitative study on client's perspectives of quality of care. This research utilized a grounded theory phenomenological approach in order to capture women's subjective experiences. Triangulation was achieved through thirty semi-structured interviews with clients, three focus groups, and participatory observation. Purposive sampling was employed for interviews and snowball sampling for focus groups. Data were coded and analyzed using Atlas.ti. Using Bruce's quality of care framework as a reference, findings uncovered rich and subjective contextual perceptions of what quality of care means to Nicaraguan women. Insight was also gained on how women's perception of agency and empowerment are closely associated with the length and type of service received. As few qualitative studies of client's perspectives on quality of care have been made, this research will add to the global knowledge of women's subjective experiences of quality of care and its influence on their perceived ability to experience agency in their reproductive lives; a timely finding as the next World Population Conference is scheduled to take place in 2015.