Self-perceived evaluation of prenatal care: a hierarchical analysis by the users of Primary Health Care services in Brazil

Dea, Bruna Di; Andrade, Fernanda; Silva Junior, Manoelito Ferreira

doi:10.1590/1806-93042021000200014

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Revista Brasileira de Saúde Materno Infantil

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ORIGINAL ARTICLES • Instituto de Medicina Integral Prof. Fernando Figueira 21 (2) • Apr-Jun 2021 • https://doi.org/10.1590/1806-93042021000200014 copy

Self-perceived evaluation of prenatal care: a hierarchical analysis by the users of Primary Health Care services in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

to analyze the factors associated with positive self-perceived evaluation of prenatal care among users of Primary Health Care (PHC).

Methods:

the analytical cross-sectional study was carried out with secondary data from the 3rd Module of the 2nd cycle (2013 / 2014) of the External Evaluation of the Improvement of Access and Quality of Primary Care Program (PMAQ-AB – Portuguese acronym), collected from users in the Basic Health Units (BHU) that joined the PMAQ-AB in Brazil. The hierarchical analysis was performed using a theoretical model and logistic regression was performed between the self-perceived evaluation (positive - very good/good or negative - regular/poor/very bad) and the sociodemographic characteristics, prenatal care and health service evaluation (p<0.05).

Results:

the sample consisted of 9,922 women and 81.7% rated care as very good/good. In the final model, positive evaluation was associated to women with incomplete higher education or over (OR=1.05; CI95%=1.01-1.09; p=0.010), who underwent the VDRL exam (OR=1.07; CI95%=1.01-1.14; p=0.020), consultation with the same professional (OR=1.07; CI95%=1.02-1.12; p=0.010), received guidance on the gynecological preventive exam (OR=1.05; CI95%=1.01-1.08; p=0.007), believed that guidance helped with pregnancy and child care (OR=1.24; CI95%=1.05-1.46; p=0.012), evaluated the BHU structure as very good/good (OR=1.19; CI95%=:1.14-1.24; p<0.001) and would not change BHU or team (OR=1.62; CI95%=1.48-1.68; p<0.001).

Conclusion:

the positive evaluation of prenatal care was associated with sociodemographic factors, prenatal care and health service evaluation.

Key words:
Prenatal care; Quality of health care; Self-perception

Variables	Self-perceived evaluation of the care received from the health team						p ^* * Chi-square test (p<0,05).
	Total		Very good/ Good		Regular/ Bad/ Very bad
	n	%	n	%	n	%
Age (years) (n=9922)							<0.001
16-19	1246	12.6	976	12.0	270	14.9	<0.001
20-34	7476	75.3	6087	75.0	1389	76.9
35 or over	1200	12.1	1052	13.0	148	8.2
Race (n=9785)							<0.001
Another	6955	71.1	5600	70.0	1355	75.8
Caucasian	2830	28.9	2397	30.0	433	24.2
Schooling (n=9919)
Incomplete EE	2859	28.8	2311	28.5	548	30.3	<0.001
Incomplete HS	3110	31.4	2477	30.5	633	35.0
Completed HS	3273	33.0	2725	33.6	548	30.3
Incomplete HE or over	677	6.8	599	7.4	78	4.3
Job (n=9922)
No	7457	75.2	6038	74.4	1419	78.5	0.001
Yes	2465	24.8	2077	25.6	388	21.5
Own income (n=2170)
< 1 minimum wage	691	31.8	556	30.4	135	39.7	<0.001
1 or over	1469	68.2	1274	69.6	205	60.3
Bolsa FamíliaProgram (n=9907)
Not beneficiary	5228	52.8	4347	53.6	881	48.8	<0.001
Beneficiary	4679	47.2	3756	46.4	923	51.2

Variables	Self-perceived evaluation of the care received from the health team						p ^* * Chi-square test (p<0.05).
	Total		Very good/ Good		Regular/ Bad/ Very bad
	n	%	n	%	n	%
Clinical and Laboratory procedures							<0.001
Did you have your belly measured ?(n=9649)							<0.001
No	315	3.3	214	2.7	101	5.7
Yes	9334	96.7	7668	97.3	1666	94.3
Did you have your blood pressure checked? (n=9922)							<0.001
No	115	1.2	75	0.9	40	2.2
Yes	9807	98.8	8040	99.1	1767	97.8
Did you have your mouth examined? (n=9922)							<0.001
No	5038	50.8	3776	46.5	1262	69.8
Yes	4884	49.2	4339	53.5	545	30.2
Did you have your breasts examined? (n=9922)							<0.001
No	4334	43.7	3204	39.5	1130	62.5
Yes	5588	56.3	4911	60.5	677	37.5
Did you have a Papanicolaou test? (n=9922)							<0.001
No	6422	64.7	5125	63.2	1297	71.8
Yes	3500	35,3	2990	36.8	510	28.2
Did you get a gynecological examination? (n=9922)							<0.001
No	5811	58.6	4566	56.3	1245	68.9
Yes	4111	41.4	3549	43.7	562	31.1
Clinicai and Laboratory procedures Did you have a urine test? (n=9846)							<0.001
No	239	2.4	175	2.2	64	3.6
Yes	9607	97.6	7883	97.8	1724	96.4
Did you get an HIV examination? (n=9726)							<0.001
No	504	5.2	369	4.6	135	7.7
Yes	9922	94.8	7593	95.4	1629	92.3
Did you get the VDRL examination? (n=8835)							<0.001
No	1116	12.6	800	11.0	316	19.9
Yes	7769	87.4	6497	89.0	1272	80.1
Did you get an ultrasound examination? (n=9736)							<0.001
No	592	6.1	157	8.9	435	5.5
Yes	9144	93.9	7540	91.1	1604	94.5
Did you have a glucose test? (n=9570)							<0.001
No	1338	14.0	939	12.0	399	23.2
Yes	8232	86.0	6909	88.0	1323	76.8
Did you get a tetanus vaccination? (n=9692)							<0.001
No	1048	10.8	802	10.1	246	14.0
Yes	8644	89.2	7135	89.9	1509	86.0
Did you get a ferrous sulfate prescription? (n=9874)							<0.001
No	326	3.3	249	3.1	77	4.3
Yes	9548	96.7	7829	96.9	1719	95.7
Were you prescribed vitamin B9? (n=9814)							<0.001
No	659	6.7	492	6.1	167	9.4
Yes	9155	93.3	7538	93.9	1617	90.6
Number of appointments? (n=9284)							<0.001
Up to 5	1461	15.7	1137	14.9	324	19.3
6 appointments or over	7823	84.3	6470	85.1	1353	80.7
Did you need emergency care during							<0.001
pregnancy? (n=9893)
No	6616	66.9	5476	67.6	1140	63.4
Yes	3277	33.1	2619	32.4	658	36.6
Service organization
Was prenatal care provided by a physician? (n=9136)
No	2333	25.5	1793	24.1	540	32.1	<0.001
Yes	6806	74.5	5662	75.9	1141	67.9
Was prenatal care provided by a nurse? (n=9136)							<0.001
No	2400	26.3	2026	27.2	374	22.2
Yes	6736	73.7	5429	72.8	1307	77.8
Service organization
Did you have appointments with the same
professional? (n=9922)						<0.001	<0.001
No	1323	13.3	940	11.6	383	21.1
Yes	8599	86.7	7171	88.4	1428	78.9
Did you leave the BHU with the next appointment
already scheduled? (n=9892)							<0.001
Never / Almost never/ Usually	1323	13.4	940	11.6	383	21.3
Always	8569	86.6	7151	88.4	1418	78.7
Health guidance
Instructions about diet/weight (n=9922)							<0.001
No	1194	12.0	742	9.1	452	25.0
Yes	8728	88.0	9393	90.1	1355	75.0
Instructions about breastfeeding (n=9922)							<0.001
No	915	9.2	560	7.0	351	19.4
Yes	9007	90.8	7551	93.0	1456	80.6
Instructions about childcare (n=9922)							<0.001
No	1467	14.8	920	11.3	547	30.3
Yes	8455	85.2	7195	88.7	1260	69.7
Instructions about the gynecological preventive
exam (n=9922)							<0.001
No	3443	34.7	2450	30.2	993	55.0
Yes	6479	65.3	5665	69.8	814	45.0
Instructions about the pregnant woman support
group (n=9816)							<0.001
No	4432	45.2	3332	41.5	1100	61.7
Yes	5384	54.8	4700	58.5	684	38.3
Participating in the pregnant woman support
group (n=9838)							<0.001
No	3859	39.2	4656	57.9	1323	73.9
Yes	5979	60.8	3391	42.1	468	26.1
Getting information about the maternity
hospital (n=9840)							<0.001
No	4191	42.6	3172	39.4	1019	56.6
Yes	5649	57.4	4869	60.6	780	43.4

Variables	Self-perceived evaluation of the care received from the health team						p ^* * Chi-square test (p<0.05).
	Total		Very good/ Good		Regular/ Bad/ Very bad
	n	%	n	%	n	%
Did the guidance help you to learn about pregnancy and childcare? (n=9848)
No	956	9.7	521	6.5	435	24.4	<0.001
Yes	8852	90.3	7546	93.5	1346	75.6
Did the pregnant woman support group
help? (n=3847)
No	58	1.5	40	1.2	18	3.9	<0.001
Yes	3789	98.5	3340	98.8	449	96.1
Evaluation of the BHU structure (n=9903)
Regular/Bad/Very bad	3710	37.5	2325	28.7	1385	77.0	<0.001
Very good/Good	6193	62.5	5779	71.3	414	23.0
Would you like to change the health team or BHU? (n=9922)							<0.001
No	7904	79.7	7150	88.1	754	41.7
Yes	2018	20.3	965	11.9	1053	58.3

Variables (Ref.)	Gross analysis					Adjusted analysis
	Gross analysis				Model 1			Model 2^* * Good-of-fit: Likelihood Ratio Chi-square Pearson: 99.344 (p<0.001).
	OR	CI95%	p	OR	CI95%	p	OR	CI95%	p
Sociodemographic characteristics
Age (<20 years)
20-34 years	1.62	1.35-1.94	<0.001
>34 years	1.97	1.58-2.45	<0.001
Race (Others)
Caucasian	1.34	1.19-1.51	<0.001
Schooling ( incomplete EE)
Incomplete HS	1.54	1.20-1.99	<0.001	1.00	0.96-1.03	0.765	0.99	0.96-1.02	0.462
Completed HS	1.96	1.53-2.52	<0.001	1.03	0.99-1.07	0.073	1.01	0.98-1.04	0.423
Incomplete HE or over	1.82	1.31-2.35	0.001	1.07	1.04-1.13	<0.001	1.05	1.01-1.09	0.010
Job (No)
Yes	1.51	1.19-1.92	0.001
Own income (< 1 minimum wage)
1 or over	1.04	1.02-1.06	<0.001
Bolsa Família(Not beneficiary)
Beneficiary	1.04	1.02-1.05	<0.001
Prenatal care
Clinical and laboratory procedures
Did you have your belly
measured? (No)
Yes	2.17	1.70-2.77	<0.001
Did you have your blood pressure
checked? (No)
Yes	2.43	1.65-3.57	<0.001
Did you have your mouth
examined? (No)
Yes	2.66	2.38-2.97	<0.001	1.03	0.99-1.06	0.105
Did you have your breasts
examined? (No)
Yes	2.56	2.30-2.84	<0.001	1.04	1.00-1.07	0.050
Did you get a Papanicolaou
test? (No)
Yes	1.48	1.32-1.66
Did you get a gynecological
examination? (No)
Yes	1.72	1.54-1.92	<0.001	0.98	0.95-1.00	0.090
Did you get a urine test? (No)
Yes	1.67	1.25-2.24	<0.001
Did you have an HIV
examination? (No)
Yes	1.70	1.39-2.09	<0.001	1.12	1.04-1.22	0.005
Did you have a VDRL
examination? (No)
Yes	2.02	1.75-2.33	<0.001	1.12	1.04-1.20	0.003	1.07	1.01-1.14	0.020
Did you have an ultrasound
examination? (No)
	1.70	1.40-2.05	<0.001	1.07	0.98-1.16	0.122
Did you get a glucose test? (No)
YesYes	2.22	1.95-2.53	<0.001	1.10	1.02-1.18	0.007
Did you get a tetanus
vaccination? (No)
Yes	1.45	1.24-1.69	<0.001	0.90	0.93-1.02	0.188
Were you prescribed ferrous
sulfate? (No)
Yes	1.41	1.08-1.83	<0.001
Were you prescribed vitamin
B9? (No)
Yes;	1.58	1.32-1.90	<0.001
Number of appointments (up to 5)
6 appointments or over	1.08	1.04-1.12	<0.001	0.96	0.92-1.02	0.162
Did you need emergency care
during pregnancy (yes)
No	1.03	1.00-1.05	<0.001
Service organization Was the prenatal care provided by a physician? (No)
Yes	1.50	1.33-1.68	<0.001
Was the prenatal care provided by a nurse? (Yes)
No	1.03	1.01-1.05	0.011	1.04	1.01-1.07	0.017
Were all your appointments with the same professional? (No)
Yes	1.60	1.40-1.80	<0.001	1.07	1.02-1.12	0.003	1.07	1.02-1.12	0.010
Did you leave the BHU with the next appointment already scheduled? (Never/ Almost never / usually)
Always	2.06	1.80-2.34	<0.001	1.09	1.03-1.16	0.002
Health guidance Instructions about diet/weight (No)
Yes	3.31	2.91-3.78	<0.001	1.08	0.98-1.19	0.133
Instructions about breastfeeding (No)
Yes	3.23	2.79-3.73	<0.001
Instructions about child care (No)
Yes	3.40	3.01-3.83	<0.001	1.14	1.03-1.26	0.008
Instructions about gynecological preventive examination (No)
Yes	2.82	2.54-3.13	<0.001	<0.001 1.07	1.02-1.11	0.001	1.05	1.01-1.08	0.007
Instructions about pregnant woman support group (No)
Yes	2.27	2.04-2.52	<0.001
Participating in the pregnant woman support group (No)
Yes	2.06	1.84-2.31	<0.001
Information about the maternity hospital (No)
Yes	2.00	1.81-2.22	<0.001	1.03	0.99-1.06	0.061
Service evaluation Did guidance help to learn about pregnancy and childcare? (No)
Yes	4.68	4.07-5.38	<0.001				1.24	1.05-1.46	0.012
Pregnant woman group helped (No)
Yes	3.35	1.90-5.89	<0.001
BHU structure evaluation (Regular/Bad/Very bad)
Very good/Good	8.32	7.37-9.37	<0.001				1.19	1.14-1.24	<0.001
Desire to change team or BHU
(Yes)
No	1.86	1.77-1.95	<0.001				1.62	1.48-1.78	<0.001

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[1] Author’s contribution

Di Dea B and Andrade F organized the database, prepared the table and wrote the scientific article; Silva-Junior MF participated in the study design, data analysis and final review of the article. All authors approved the final version of the article.