Data from: Do experiences and perceptions about quality of care differ among social groups in Nepal? : A study of maternal healthcare experiences of women with and without disabilities, and Dalit and non-Dalit women

Background: Suboptimal quality of care and disparities in services by
healthcare providers are often reported in Nepal. Experience and
perceptions about quality of care may differ according to women’s
socio-cultural background, individual characteristics, their exposure and
expectations. This study aimed to compare perceptions of the quality of
maternal healthcare services between two groups that are consistently
considered vulnerable, women with disabilities from both the non-Dalit
population and Dalit population and their peers without disabilities from
both non-Dalit and Dalit communities. Methods: A cross-sectional survey
was conducted among 343 total women that included women with disabilities,
Dalits and non-Dalits. Women were recruited for interview, who were aged
15–49 years, had been pregnant within the last five years and who had used
maternal care services in one of the public health facilities of Rupandehi
district. A 20-item, Likert-type scale with four sub-scales or dimensions:
‘Health Facility’, ‘Healthcare Delivery’, ‘Inter-personal’ and ‘Access to
Care’ was used to measure women’s perceptions of quality of care.
Chi-square test and t test were used to compare groups and to assess
differences in perceptions; and linear regression was applied to assess
confounding effects of socio-demographic factors. The mean score was
compared for each item and separately for each dimension. Results: All
groups, women with disabilities and women without disabilities, Dalit and
non-Dalit rated their perceptions and experiences of quality of care lowly
in a number of items. While perceived quality of care between women with
disabilities and without disabilities in the ‘Health Facility’ dimension
and associated items, was found to differ (p<0.05), this difference
was linked to disability status, but was not linked to caste differences.
For example, differences in mean scores relating to ‘Cleanliness and
Facilities’, ‘Open and Friendliness’ and ‘Compassion and Kindness’ were
highly significant (p<0.001), with women with disabilities rating
these as better than women without disabilities. On the other hand, women
without disabilities rated the ‘Availability of cash Incentives’ more
highly (p<0.01). No significant differences were found between
Dalit and non-Dalit women in perceived quality of care, except in relation
to ‘Cleanliness and facilities’, which Dalit women rated lower than
non-Dalits (p<0.05). Conclusions: Perceptions about the quality of
care differed significantly by disability status but not by caste. All
groups rated the quality of healthcare delivery, interpersonal and
personal factors as well as access to services ‘low.’ Poor service user
experiences and perceptions of quality of care undermine opportunities to
translate increased healthcare coverage into improved access and outcomes.
Greater attention is required by policy makers, health planners and
providers to the improvement of quality of care in health facilities.