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Stated Preference Research in Reproductive and Maternal Healthcare Services in Sub-Saharan Africa: A Systematic Review

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Abstract

Background and Objective

Understanding the preferred choice of healthcare service attributes for women is important, particularly in sub-Saharan Africa where resources are constrained and improving reproductive and maternal healthcare services is of high importance. The aim of this systematic review was to identify attributes of reproductive and maternal healthcare services in sub-Saharan Africa, and summarise the factors shaping women’s preference to access these services.

Methods

PubMed/MEDLINE, EMBASE, PsycINFO and CINAHL were searched from the inception of each database until March 2021 for published studies reporting stated preferences for maternal and reproductive healthcare services in sub-Saharan Africa. Data were extracted using a predefined extraction sheet, and the quality of reporting of included studies was assessed using PREFS and ISPOR (International Society for Pharmacoeconomics and Outcomes Research) checklists. The Donabedian’s model for quality of healthcare was used to categorise attributes into “structure”, “process” and “outcome”.

Results

A total of 13 studies (12 discrete choice experiments and one best-worst scaling study) were included. Attributes related to the structure of healthcare services (e.g. availability of technical equipment, medications or diagnostic facilities, having good system conditions) are often included within the studies, and are considered the most important by women. Of the three dimensions of quality of healthcare, the outcome dimension was the least frequently studied across studies. All except one study explored women’s preferences and the participants were pregnant women, women aged 18–49 years who had recently given birth and women living with human immunodeficiency virus. The included studies came from five sub-Saharan Africa countries of which Ethiopia and South Africa each contributed three studies. All of the included studies reported on the purpose, findings and significance of the study. However, none of the studies reported on the differences between responders vs non-responders. Nine of the 13 studies employed the ISPOR checklist and reported each item including the research question and the methods for identifying and selecting attributes, and provided the findings in sufficient detail and clarity.

Conclusions

Aligning maternal healthcare service provision with women’s preferences may foster client-oriented services and thereby improve service uptake and better patient outcomes.

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Authors and Affiliations

  1. Centre for Applied Health Economics, School of Medicine, Building G05 2.44A, Gold Coast Campus, Griffith University, Gold Coast, QLD, 4222, Australia

    Daniel Erku, Paul Scuffham & Katrina Gething

  2. Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia

    Daniel Erku, Paul Scuffham & Katrina Gething

  3. Centre for Research and Engagement in Assessment of Health Technology (CREATE), Gold Coast, QLD, Australia

    Daniel Erku

  4. Curtin School of Population Health, Curtin University, Perth, WA, Australia

    Richard Norman & Gizachew A. Tessema

  5. Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia

    Alemayehu B. Mekonnen

  6. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada

    Gebremedhin B. Gebretekle

  7. Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON, Canada

    Gebremedhin B. Gebretekle

  8. School of Public Health, The University of Queensland, Brisbane, QLD, Australia

    Yibeltal Assefa

  9. School of Public Health, University of Adelaide, Adelaide, SA, Australia

    Gizachew A. Tessema

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  1. Daniel Erku
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Correspondence to Daniel Erku.

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Authors’ Contributions

DE: conceptualisation; data curation; formal analysis; methodology; roles/writing, original draft; writing, review and editing; PS: conceptualisation; data curation; methodology; project administration; supervision; writing, review and editing; RN: conceptualisation; data curation; methodology; writing, review and editing; AM: conceptualisation; methodology; formal analysis; writing, review and editing; Katrina Gething: formal analysis; methodology; writing, review and editing; GBG: conceptualisation; data curation; methodology; supervision; writing, review and editing; YA: conceptualisation; methodology; supervision; writing, review and editing; and GAT: conceptualisation; data curation; methodology; supervision; roles/writing, original draft; writing, review and editing.

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Erku, D., Scuffham, P., Gething, K. et al. Stated Preference Research in Reproductive and Maternal Healthcare Services in Sub-Saharan Africa: A Systematic Review. Patient 15, 287–306 (2022). https://doi.org/10.1007/s40271-021-00553-9

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  • DOI: https://doi.org/10.1007/s40271-021-00553-9

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