Client satisfaction and associated factors among family planning service users in public health facilities of zuway dugda district, arsi zone, oromia, Ethiopia

doi:10.21203/rs.3.rs-4972607/v1

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Research Article

Client satisfaction and associated factors among family planning service users in public health facilities of zuway dugda district, arsi zone, oromia, Ethiopia

https://doi.org/10.21203/rs.3.rs-4972607/v1

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Background: Dissatisfaction with family planning services is a significant cause of high rates of discontinuation, reduced utilization of family planning services, noncompliance, and high rates of unintended pregnancy. Risk factor of client satisfaction varies across different settings according to sociocultural variations. However, there is a dearth of evidences on those factors in the country and the study area in particular. Thus, this study aimed at assessing the level and factors associated with client satisfaction of FP services among family planning users.

Objective: The objective of this study was to assess client’s satisfaction and associated factors among women family planning users at Zuway Dugda district Oromia, Ethiopia.

Method: A facility-based cross-sectional study was conducted among reproductive-age women attending a family planning unit in Zuway Dugda district, from August 1, 2023 to September 30, 2023. A total of 315 clients were selected by simple random sampling and interviewed using a pre-tested structured questionnaire. The collected data were entered using the EPI-INFO7.2.6 and analyzed using Statistical Package for the Social Science (SPSS) version 25.0. Bi-variable and multivariable logistic regression analysis was performed to see the association between outcome and explanatory variables. Finally, multivariable logistic regression analysis was done to identify factors associated with client satisfaction. Confidence interval of 95% with respective odds ratio was used to show strength of association and the level of significance was taken at α < 0.05.

Results: The overall client satisfaction of this study was 61.9% (95% CI :( 0.56 - 0.67)). Waiting time [AOR = 1.79 (1.06-3.00)], follow-up [AOR = 2.23 (1.30-3.80)], demonstrate how to use method [AOR = 1.94 (1.11-3.38)] and method side effect explained [AOR = 2.41 (1.37-4.24)] were factors associated with client satisfaction among family planning users.

Conclusion: The overall level of client satisfaction with family planning services was low in this study area compared to other studies. This study found out that waiting time, follow-up, demonstrate how to use method and method side effect explained were factors associated with client satisfaction among family planning users.

Client Satisfaction

Family Planning

Zuway Dugda district

The World Health Organization (WHO) defines family planning as “the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through use of contraceptive methods and the treatment of involuntary infertility [1]Family planning also have a role in the reduction of maternal morbidity and mortality by their ability in reducing the absolute number of pregnancies among all women, reducing the number of pregnancies among high-risk women, and unwanted pregnancies that might otherwise end in abortion [2]

Globally, estimated 160 million women and adolescents had an unmet need for family planning, with over half of the women with unmet need living in Sub-Saharan Africa and South Asia 3More than one in five married women in Ethiopia have unmet needs for family planning, according to the 2016 Ethiopia Demographic and Health Survey (EDHS), with a total fertility rate of 4.6 4. Studies conducted in different regions of Ethiopia have also revealed that the unmet need for family planning ranged from 16.2 to 44% [3–5]

Client satisfaction is the degree of discrepancy between expectations and experience of users to service and satisfaction has been proposed to occur when experiences are equal to, or better than, expectations. It is also best indicator of quality of care that represents the needs, preferences and subjective experience of clients from the client point of view [6]

Assessment of the Family planning (FP) client satisfaction for service delivery in health facilities is receiving growing recognition as a strategy for monitoring and evaluation of primary health care program in developing countries [7–10] Good quality of family planning service helps individuals and couples meet their reproductive health needs safely and effectively. Thus it can help for increasing family planning users and could be control morbidity, mortality rate and unplanned population growth [11]

Globally, of all unintended pregnancies, 61 per cent end in abortion, that is, 73 million abortions annually[12]. Unsafe abortions cause around 39,000 deaths every year and result in millions more women hospitalized with complications; most of these deaths are concentrated in lower-income countries[1, 8]

In Africa (primarily in Sub-Saharan Africa), the contraceptive utilization remains low and fecundity, fertility rate, and unmet need for modern contraceptives are high [7, 8, 11, 13, 14]. In Sub-Saharan Africa 56% of women use modern contraceptive method with lowest proportion of contraceptive utilization; and 37% of women who want to avoid pregnancy do not use any method in the region. Among the 41 countries where fewer than half of the women with a need for family planning have that need satisfied with modern methods, 22 countries are in sub-Saharan Africa 20.

Use of family planning helps to avoid unwanted pregnancy, reduce maternal morbidity and mortality by one-third and reduce poverty and hunger by supporting women’s economic empowerment and education and their ability to make decisions [15] Clients’ impressions of the facility and their providers likely informed their service expectations and confidence in their contraceptive methods. The average difference in the probability of discontinuing contraception was 8.2 percentage-points between dissatisfied women and satisfied women 22 Dissatisfaction with family planning services is a significant cause of high rates of discontinuation, reduced utilization of FP services, noncompliance, and high rates of unintended pregnancy 11,22–24

In Ethiopia, the highest level of client satisfaction among family planning service users was reported in Illu Ababor and Dire Dawa, which accounts for 78% and 79% respectively [16]Other studies have found that the client satisfaction level among family planning service users was in Ethiopia was 62.8% in Asalla Town[17], 66.1% in Bahir Dar city[16] 41.7% in Jigjiga town[18], 46% in Tembaro District [19]

Despite many studies have been conducted on the client satisfaction among family planning service users, evidence shows that client satisfaction varies by region, health facility and service delivery point within a facility [20]Since there are sociocultural variations in the different regions of Ethiopia; there are also variations in the client satisfaction among family planning users across settings among these diverse groups. Therefore, this study aims to assess of client satisfaction and its associated factors among family planning services in public health facilities of Zuway Dugda district Oromia, Ethiopia.

Study design, Area and Period

Facility based cross sectional study design was conducted in zuway dugda district from August 1, 2023 to September 30, .Zuwey Dugda district is located at 222km South East to main city of Ethiopia, Addis Ababa and 47 km away from Assela Town, capital city of Arsi Zone. Zuwey Dugda district has 157,233 populations, 32,757 households, 34,749 women of reproductive age group and 29,293 non pregnant women residing in 2 urban and 28 rural kebelse. There are 6 health centers and 32 Health posts that provide health service for the community by 58 health extension workers and 84 health workers. All health centers and health posts provide family planning service

Study population, and eligibility criteria

Sampled reproductive age group (15-49 years) of women who were attending family planning clinics at the public health facilities of Zuway dugda district during data collection were study population. The study includes all females in the reproductive age group (15-49) who were using family planning service at the selected health facilities during data collection period. Women who were seriously ill, unable to communicate, or mentally ill during the data collection period were excluded from the study.

Sampling Size Determination and sampling procedure

A single population proportion formula was used to calculate the sample size for the first objective with assumption of 75.3% the population proportion of client satisfaction obtained from previous study conducted in Hossana town public health facilities [21], 95% confidence level, 5% margin of error and a 10% non-response rate.

An additional 10% non-response rate the total sample size is becomes 315.

There are 36 public health facilities providing family planning service in Zuway Dugda District and eleven public health facilities were selected by lottery method. The number of women to be selected and interviewed in each facility was assigned proportionally for eleven facilities, based on average client load for each facility one month preceding data collection obtained from HMIS monthly report and a monthly average of 1202 clients visited the family planning unit of the eleven selected public health facilities. The study subjects were selected by simple random sampling technique. Finally the study participants were consecutively interviewed from each health facilities until the calculated sample size will be achieved

Study Variable

Dependent variable

Client satisfaction (yes/no)

Independent variable

Socio-Demographic related variables: Age, Religion, Residence, Ethnicity Marital status, Educational level, Occupation, and Income.

Reproductive health related Variables: Gravid, Parity, Abortion. Family size, unintended pregnancy, family planning information, source of information, type of family planning users, Type of family planning used, received the method requested

Health facility-related factors: Distance of health facility, waiting time, opening time convenience, working hour convenience, rooms having posters with key messages on family planning, waiting place adequate with latrine and water supply, facility cleanness

Provider –client interaction related variables: Informed about available methods, received adequate information, Get service by preferred provider, privacy, Confidentiality, Consultation time, follow-up, Explain the method, Demonstrate how to use, Method side effects explained, what to do when experienced any problem, Method changing, Pregnancy checked, STI Checked, Communication with providers, Get service with short period, Providers give good service, Counseling clear and satisfactory, Preference of provider sex

Operational definitions

Client Satisfaction: Clients’ opinion of care received from FP services. “Client satisfaction” defined as when a respondent either agreed or strongly agreed to have been satisfied with the health services received at the visited facility. In the study nineteen items related to satisfaction, on the five likert scale value ranging from 1 (very dissatisfied) to 5 (very satisfied) was used to assess study participant's satisfaction with family planning service and mean score of the satisfaction was used to dichotomize each respondent’s satisfaction score (above or equal to mean score categorized as Satisfied” and below mean score categorized as Not-satisfied”) [20]

Distance from home to service delivery point – estimated based on the time taken to reach the Family planning services facility, near if it took less or equal to 30 minutes and far if it took more than 30 minutes for clients to get the facility from home[22]

Waiting time: a minute a client had to wait before receiving Family planning service. The acceptable waiting time is less than 30 minutes, exceeding this standard was taken as unacceptable[22]

Data collection procedure and Data quality control

Data was collected by using structured questionnaires, which was adapted from different studies [7, 9, 13, 21] Data collection was carried out by six clinical nurses as data collectors and three- BSC Nurse as supervisor who has previous experience in data collection. A data collector and supervisor were recruited and trained for one day by the principal investigator about the purpose of the study and how to collect the data. The data collection process was followed by the supervisors and principal investigator on daily basis. The data was collected by face to face exit interview. The questionnaire has five parts: The first part addresses socio- demographic characteristics, the second part of the questionnaire is reproductive health related variables, the third part covers health facility-related factors, the fourth part contains provider –client interaction related variables and fifth part is client satisfaction measuring items. To minimize observational bias, the participants were well informed about the risks, benefits, confidentiality, and the right of stopping/rejecting their responses at any time during the interview.

The research questionnaire was prepared in English version and translated into local language (Afan Oromo) then retranslated to English by language expert. Before data collection, one day training was given for data collectors and supervisors by the principal investigator about the purpose of the study, data handling and how to interview the subjects. The questionnaire was pre tested on 5% (16) of the calculated sample size in nearby health facility which is preceding the actual data collection period in order to test and clarity tools and estimation of interview time. The result of this pretest study verifies clarity of the data collection tool and helps to familiarize principal investigator with the instrument and to make necessary corrections accordingly.

There was a close follow-up by supervisors and the principal investigator including observation of how data collectors were interviewed the respondents. The principal investigator and supervisors was closely monitoring the whole data collection process daily, with the provision of necessary feedback. The questionnaires filled was reviewed and checked for completeness by the supervisors and the principal investigator during the data collection day. The collected data were checked for completeness, accuracy, clarity, and consistency by the principal investigator. Any error found during the process was corrected immediately. Data coding, and verification was done before data entry. Double data entry was used to make comparisons of two data cells and resolve if there is any difference.

Data Processing and Analysis

The data were checked for completeness, consistency, cleaned, coded, entered into Epi-info version 7.2.6 and exported to statistical Package for Social Sciences (SPSS) version 25.0 for analysis. Descriptive statistics including graphs, charts, and percentage was computed to describe the data. The binary logistic regression model was used to test the association between outcome and explanatory variables. Variables that were found to be ≤ 0.25 P-value in the bivariate analysis were entered in to multivariable logistic regression model. Multi-collinearity was checked by using tolerance test. The variable without multi-collinearity was entered into multivariable model. Finally, multivariable logistic regression analysis was done to identify factors associated with client satisfaction. During multivariable analysis, model fitness was checked using the Hosmer and Lemeshow`s goodness of fitness test (p = 0.314). The strength of association was assessed by using an adjusted odds ratio (AOR) at 95% confidence interval (CI) and statistical significance was declared at P-value < 0.05.

Socio‑Demographic characteristics of respondents

A total of 312 women were participated in the study giving a response rate of 99% and 222 (71.2%) of them were rural residents. The age of the mothers was ranged from 18 to 39 years with mean of 27.29 (± 4.546) years; and 127 (40.7%) of them were found to be in the age category of 25–29 years. About 38.8% women have attained primary school and majority of them 229 (73.4%) were housewife (Table 1)

Table 1

Socio-demographic characteristics of respondents among family planning service users in public health facilities of Zuway Dugda District, Arsi Zone, Ethiopia, 2023.
Variables	Categories	Frequency	Percentage
Age	18–24	80	25.7
	25–29	127	40.7
	30–34	85	27.2
	35–49	20	6.4
Place of residence	Rural	222	71.2
Place of residence	Urban	90	28.8
Ethnicity	Oromo	273	87.5
	Amhara	21	6.7
	Others*	18	5.8
Religion	Muslim	251	80.4
	Orthodox	28	9.0
	Protesta	27	8.7
	Others**	6	1.9
Marital status	Married	276	88.5
	Single	21	6.7
	Others***	15	4.8
Occupation	House wife	228	73.1
	Farmer	29	9.3
	Government employee	25	8.0
	Merchant	21	6.7
	Others****	9	2.9
Educational status	No formal education	38	12.2
	Read and write	59	18.9
	Primary	121	38.8
	Secondary	67	21.5
	College and above	27	8.7
Monthly income	≤ 2500	103	33.0
Monthly income	> 2500	209	67.0
* Zay, Silte, Gurage,Catholic, Wakefata, Divorced, Widowed, *** Student, Daily laborers

Reproductive and Contraceptive history of Participants

This study found that, 129(41.3%) of women had 2–3 pregnancies and 276 (88.5%) had no history of abortion. Among the total study participants, 225 (72.1%) were repeat family planning users. About 201 (64.4%) participants had received their preferred methods and the rest 111 (35.6%) not received their preferred method [Table-2].

Table 2

Reproductive and Contraceptive history related characteristics among family planning service users in public health facilities of Zuway Dugda District, Arsi Zone, Ethiopia, 2023.
Variables	Categories	Frequency	Percentage
Gravidity	< 2	102	32.7
	2–3	129	41.3
	>=4	81	26.0
Parity	< 2	186	59.6
	2–3	88	28.2
	>=4	38	12.2
History of abortion	No	276	88.5
History of abortion	Yes	36	11.5
Unintended pregnancy	No	272	87.2
Unintended pregnancy	Yes	40	12.8
Heard about family planning	Yes	312	100.0
Source of information	Health professionals	245	78.5
	Media	53	17.0
	Friends	14	4.5
Family planning users	New	87	27.9
Family planning users	Repeat	225	72.1
Received the method requested	No	111	35.6
Received the method requested	Yes	201	64.4
Reasons for not getting the preferred methods	Providers said not appropriate	76	68.5
	Methods temporary out of stock	21	18.9
	Trained personal absent	14	12.6
* Friends, Neighbors

According to finding of this study, the most common contraceptive method used was Implants 198(63.5%).

Health Facility related characteristics

This study found that 246 (84.6%) of respondents took less than thirty minutes to reach health facilities. Majority of the respondents, 272 (87.2%) convenient with opening hours of clinic and about 191 (61.2%) respondents responded that service waiting time after arrival of at service delivery was less than thirty minutes. In addition, 83.7% of the respondents responded that the family planning waiting room had posters with a family planning message. [Table 3]

Table 3

Health Facility related characteristics of respondents among family planning service users in Zuway Dugda District public health facilities, Arsi Zone, Ethiopia, 2023.
Variables	Categories	Frequency	Percentage
Distance from health facility	< 30 minutes	264	84.6
Distance from health facility	> 30 minutes	48	15.4
Waiting time get service	< 30 minutes	191	61.2
Waiting time get service	> 30 minutes	121	38.8
Opening time convenience	No	40	12.8
Opening time convenience	Yes	272	87.2
Working hour convenience	No	45	14.4
Working hour convenience	Yes	267	85.6
Waiting room has a poster on family planning	No	51	16.3
Waiting room has a poster on family planning	Yes	261	83.7
Waiting place adequate with latrine, water supply	No	118	37.8
Waiting place adequate with latrine, water supply	Yes	194	62.2
Facility cleanness	No	85	27.2
Facility cleanness	Yes	227	72.8

Provider-client interaction related characteristics of participants

This study revealed that, 220 (70.5%) of respondents were obtained adequate information on the method and 224 (71.8%) responded that privacy maintained during the consultation and examination for participants. Majority of respondents, 220(70.5%) scheduled for a follow up and appointment and 230(74%) provider demonstrated how to use the family planning method. In addition, 230 (73.7%) of participants responded that family planning method side effect were explained to them. About 256(82.1%) and 247(79.2%) of respondents received service with short period of time and clear and satisfactory counseling respectively [Table 4].

Table 4

Provider–client interaction related characteristics of respondents among family planning service users in Zuway Dugda District public health facilities, Arsi Zone, Ethiopia, 2023.
Variables	Categories	Frequency	Percentage
Informed about various available family planning methods	No	108	34.6
Informed about various available family planning methods	Yes	204	65.4
Provided ensured adequate information on the methods	No	92	29.5
Provided ensured adequate information on the methods	Yes	220	70.5
Get service by preferred provider	No	49	15.7
Get service by preferred provider	Yes	263	84.3
privacy during the consultation and examination	No	88	28.2
privacy during the consultation and examination	Yes	224	71.8
Confidentiality was maintained	No	25	8.0
Confidentiality was maintained	Yes	287	92.0
Consultation time	Too short	73	23.4
	Too long	30	9.6
	Right time	209	67.0
Follow-up schedule	No	92	29.5
Follow-up schedule	Yes	220	70.5
Explain the method	No	116	37.2
Explain the method	Yes	196	62.8
Demonstrate how to use	No	81	26.0
Demonstrate how to use	Yes	231	74.0
Describe side effects	No	82	26.3
Describe side effects	Yes	230	73.7
Explain what to do when experience any problem	No	100	32.1
Explain what to do when experience any problem	Yes	212	67.9
Explain possibility of changing	No	99	31.7
Explain possibility of changing	Yes	213	68.3
Pregnancy checked	No	99	31.7
Pregnancy checked	Yes	213	68.3
STI Checked	No	102	32.7
STI Checked	Yes	210	67.3
Communication of the providers	Easy to understand	278	89.1
	Difficult to understand	17	5.4
	Don’t understand	17	5.4
Get service with short period	No	56	17.9
Get service with short period	Yes	256	82.1
Providers give good service for you	No	85	27.2
Providers give good service for you	Yes	227	72.8
Counseling was clear and satisfactory	No	65	20.8
Counseling was clear and satisfactory	Yes	247	79.2
Preference of services providers sex	Female	178	57.1
Preference of services providers sex	Male	134	42.9

Client satisfaction

The majority of the respondents were satisfied with the easily understanding with provider (78.2%), maintaining privacy (75.3%), assuring confidentiality (77.5%), treated with respect (77.2%) and providers shown them IEC materials (76.6%) respectively [Table 5].

Table 5

Client’s response to satisfaction on family planning service in public health facilities of zuway Dugda district, Arsi zone, Ethiopia, 2023.
Variable	Very dissatisfied N (%)	Dissatisfied N (%)	Neutral N (%)	Satisfied N (%)	Very satisfied N (%)
Received adequate information	49(15.7)	70(22.4)	142(45.5)	39(12.5)	12(3.9)
All available methods explained	53(17.0)	87(27.9)	112(35.9)	30(9.6)	30(9.6)
Advantages of FP method Explained	32(10.3)	46(14.7)	66(21.2)	102(32.7)	66(21.2)
Method side effect explained	47(15.1)	49(15.7)	96(30.8)	86(27.6)	34(10.9)
Opportunity to ask questions	18(5.8)	49(15.7)	94(30.1)	106(34.0)	45(14.4)
Satisfied with answer given	18(5.8)	42(13.5)	94(30.1)	109(34.9)	49(15.7)
Providers show IEC materials	12(3.8)	26(8.3)	35(11.2)	117(37.5)	122(39.1)
Easy to understand provider	0(0)	1(0.3)	67(21.5)	146(46.8)	98(31.4)
Received service by preferred provider	5(1.6)	9(2.9)	62(19.9)	181(58.0)	55(17.6)
Privacy maintained	0(0)	16(5.1)	61(19.6)	180(57.7)	55(17.6)
Confidentiality assured	0(0)	8(2.6)	62(19.9)	186(59.6)	56(17.9)
Treated with respect	10(3.2)	31(9.9)	30(9.6)	137(43.9)	104(33.3)
Served on first come, first served basis	0(0)	21(6.7)	158(50.6)	85(27.2)	48(15.4)
Waiting time convenient	22(7.1)	15(4.8)	105(33.7)	102(32.7)	68(21.8)
Access to easily reach health facility	59(18.9)	53(17.0)	49(15.7)	48(15.4)	103(33.0)
Guiding signs to locate the clinic	4(1.3)	11(3.5)	123(39.4)	124(39.7)	50(16.0)
Opening hours of clinic convenient	0(0)	0(0)	145(46.5)	121(38.8)	46(14.7)
The Waiting place a with Latrine, water supply	8(2.6)	22(7.1)	91(29.2)	142(45.5)	49(15.7)
Follow-up schedule	31(9.9)	25(8.0)	151(48.4)	76(24.4)	29(9.3)

Prevalence of client satisfaction level: Overall, 193 (61.9%) respondents were satisfied (95% CI :( 0.56–0.67)) with the family planning service received

Factors associated with client satisfaction

Received method requested, waiting time to get service, privacy maintained, received adequate information, follow-up schedule, demonstrated how to use method, method side effect explained, get service with short period and counseling was clear and satisfactory were found to be candidate variables for multivariable analysis in bivariate model at p-value less than 0.25.

After adjusting variables in a multivariable logistic regression analysis, waiting time to get service, follow-up schedule, demonstrated how to use method and method side effect explained were factors associated with client satisfaction among family planning users.

The odd of client satisfaction was 1.79 times higher among clients who wait for less than 30 minutes than those who waited for more than 30 minutes to get family planning service [AOR = 1.79 (1.06-3.00)]. Clients who received follow-up schedule had 2.23 times higher odds of being satisfied with the family planning services as compared to those who do not given schedule for follow-up [AOR = 2.23 (1.30–3.80)]. Clients who were shown demonstration how to use the method had 1.94times higher odds of being satisfied with the family planning services as compared to their counterpart[AOR = 1.94 (1.11–3.38)]. Clients who received a clear description of the side effect of the methods had 2.41 times higher odds of being satisfied with the family planning services as compared to their counterpart [AOR = 2.41 (1.37–4.24)] [Table 6].

Table 6

Bivariate and multivariate logistic regression analysis of factors associated with client satisfaction among family planning service users in Zuway Dugda District public health facilities, Arsi Zone, Ethiopia, 2023.
Variable	Category	Satisfaction status		COR[95%CI]	AOR [95%CI]
Variable	Category	Dissatisfied N (%)	Satisfied N (%)	COR[95%CI]	AOR [95%CI]
Educational status	No formal education	13 (10.9)	25 (13.0)	1	1
	Read and write	22 (18.5)	37 (19.2)	0.87 (0.37–2.05)	0.78 (0.30–1.98)
	Primary	46 (38.7)	75 (38.9)	0.85 (0.39–1.87)	0.72 (0.31–1.68)
	Secondary	24 (20.2)	43 (22.3)	0.93 (0.40–2.15)	0.78 (0.31–1.96)
	College and above	14 (11.8)	13 (6.7)	0.48 (0.18–1.33)*	0.38 (0.13–1.15)
Received the method requested	No	50 (42.0)	59 (30.6)	1	1
Received the method requested	Yes	69 (58.0)	134 (69.4)	1.65 (1.02–2.65)*	1.62 (0.95–2.79)
Waiting time to get service	< 3o minutes	64(53.8)	127 (65.8)	1.65 (1.04–2.64)*	1.79 (1.06-3.00)**
Waiting time to get service	> 30 minutes	55 (46.2)	66 (34.2)	1	1
Privacy maintained	No	40 (33.6)	48 (24.9)	1	1
Privacy maintained	Yes	79 (66.4)	145 (75.1)	1.53 (0.93–2.52)*	0.90 (0.44–1.83)
Received adequate information	No	54 (45.4)	63 (32.6)	1	1
Received adequate information	Yes	65 (54.6)	130 (67.4)	0.58 (0.36–0.93)*	1.23 (0.62–2.44)
Follow-up schedule	No	47 (39.5)	45 (23.3)	1	1
Follow-up schedule	Yes	72 (60.5)	148 (76.7)	2.15 (1.31–3.53)*	2.23 (1.30–3.80)**
Demonstrated how to use method	No	42 (35.3)	39 (20.2)	1	1
Demonstrated how to use method	Yes	77 (64.7)	154 (79.8)	2.15 (1.29–3.60)*	1.94 (1.11–3.38)**
Method side effect explained	No	46 (38.7)	36 (18.7)	1	1
Method side effect explained	Yes	73 (61.3)	157 (81.3)	2.75 (1.64–4.61)*	2.41 (1.37–4.24)**
Get service with short period	No	31 (26.1)	25 (13.0)	1	1
Get service with short period	Yes	88 (73.9)	168 (87.0)	2.37 (1.32–4.26)*	1.86 (0.97–3.57)
Clear and satisfactory counseling	No	32 (26.9)	33 (17.1)	1	1
Clear and satisfactory counseling	Yes	87 (73.1)	160 (82.9)	1.78 (1.03–3.10)*	1.65 (0.90–3.01)

*Candidate variables for multivariable analysis at p-value ≤ 0.25, **statistically significant at p < 0.05 in multivariable logistic regression; 1 = used as reference category.

The Prevalence of client satisfaction with the family planning service received in this study was 61.9% with [95% CI (0.56 − 0.167)]. This finding was in line with findings in Asalla Town − 62.8%[10], Bahir Dar city-66.1%[23]. The result was high when compared with study done in Jigjiga town-41.7% [24] Tembaro District-46% [19]Jimma Town public hospitals − 46%[25], AdamaTown-52% [17] These discrepancies might be tailored to differences in socio-demographic, sample size, likert scale item questions and the difference in duration between the studies.

The prevalence of client satisfaction observed in the current study was less than studies conducted in the Egypt-85% [26] Kenya-81%[27], Port Harcourt Nigeria-87.2% [24] Sokoto Nigeria-85%[28], Indonesia-97%[29]. Variations in the level of client satisfactions among family planning users reported among studies may be due to a difference in the setting, socio-cultural differences between respondents, health service quality and study period due to the increase in expectation of clients to the service they are going to receive with rapid advancement in technology and peoples thinking..

Waiting time to get service was an independent risk factor for client satisfaction among family planning users. The respondents were more satisfied with waiting time less than 30 minute to receive care as compared with clients who had to wait more than 30 minute. This finding is supported by the study conducted in Sokoto Nigeria[28], Bahirdar [23]Hossana [21] A possible reason is that limited number of service providers and thus specific working hours, which may lead to longer stays for FP recipients and also waiting is often a negative experience that leads to frustration, stress and anxiety which leads to client dissatisfaction.

The odds of client satisfaction were 2.23 times higher among women who had follow-up appointments when compared with those who do not received follow-up appointments. This might be during follow up visit, help to identify misunderstandings, answer questions, make further assessments, adjust treatments and promotes good working relationship between the provider and client.

In this study, family planning users who were demonstrated how to use family planning of their choice were about 1.94 times more likely satisfied with the services compared to their counterparts. This finding is consistent with the studies conducted Illu Ababor [16]Jigjiga town[24]. This might be due to clients demonstrated how to use the method will have a better understanding of how to use the methods and will be more likely to continue using them, which can ultimately lead to higher client satisfaction

The other factor that showed significant association was clear description of side effects. The odd of client satisfaction is higher among clients who get a clear description of the side effects of the method as compared to their counterparts. This finding is in line with the findings of the studies done in Tembaro District[19], Jigjiga town[23], This might be due to the fact that providing clients with accurate information about the side effects of family planning methods; they can make informed decisions and manage their expectations. This can lead to improved client satisfaction and better continuity of care. Also women might be dissatisfied due to not informed about possible side effects during counseling by providers; they may be concerned and frightened by unanticipated side effects.

Limitation of the study

Subjective measurement of satisfaction makes the study difficult to assess and compare satisfaction. Another design related limitation is that we cannot establish a temporal sequence for a cause-effect relationship and also the study lacks support of qualitative data. Since data collection method was face-to-face interview, there might be possibility of social desirability bias. Furthermore, this study is institutional based; therefore, the results of this study cannot be generalized to mothers attending health institutions outside the study area and at the community level.

The overall level of client satisfaction with family planning services was low in this study area compared to other studies. This study found out that waiting time, follow-up, demonstrate how to use method and method side effect explained were factors associated with client satisfaction among family planning users. Thus, minimizing waiting time, ensuring post service follow up appointment, clear description of method side effects would improve client satisfaction. In addition, Health care providers should consistently utilize job aids and information, education, and communication materials during consultation to show how to use a method.

AOR

Adjusted Odds Ratio

ANC

Antenatal Care

Confidence Intervals

COR

Crude Odds Ratio

Odds Ratio

PNC

Postnatal Care

SPSS

Statistical Package for Social Sciences

Ethical Approval and Consent to Participate

Ethical approval was obtained from the Institutional Ethical Review Board of Adama Hospital and Medical College, with the study’s proposal was formally presented to both the Oromia Regional Health Office and the zuway dugda District Health Office to secure official approval for carrying out research activities within the selected hospital Participants were informed of the study's purpose and benefits during the data collection period and informed written consent was obtained to ensure their decision to participate or refuse. To uphold respondents' rights and ensure confidentiality, anonymity, and privacy, safeguards were enacted, and all of the study's procedures followed the principles outlined in the Helsinki Declaration

Consent for publication

Not applicable

Availability of data and material

All data and materials are available from the corresponding author without undue reservation.

Competing interests

The authors declare that they have no competing interests.

Funding

This study received no specific funding from any funding agency.

Acknowledgments

The authors extend their sincere appreciation to Adama general Hospital and Medical College, along with the zuway dugda district health office, for their invaluable assistance throughout the study. Special thanks are also extended to the dedicated team of data collectors, supervisors, and all the study participants for their crucial contributions.

Authors’ contributions

YAB contributed to the conception and design of the study, as well as the data curation, and analysis. YA, YMN, MSG, and BLS drafted the manuscript. YMN critically reviewed the draft manuscript and wrote the final version. MAK and WDG advised the study. All authors read and approved the final manuscript.

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No competing interests reported.

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Client satisfaction and associated factors among family planning service users in public health facilities of zuway dugda district, arsi zone, oromia, Ethiopia

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Abstract

Introduction

Methods

Results

Socio‑Demographic characteristics of respondents

Reproductive and Contraceptive history of Participants

Health Facility related characteristics

Provider-client interaction related characteristics of participants

Client satisfaction

Factors associated with client satisfaction

Discussion

Limitation of the study

Conclusion

Abbreviations

Declarations

References

Additional Declarations

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