A Clinic-based Intervention Study Of The Quality Of Service At The Public STD Clinics In Shanghai

Sexually transmitted diseases (STDs) have long been recognized as a major public problem in Shanghai. In recent years, despite a series of measures taken by the government, but the incidence rate is still quite high. Previous studies showed that high quality of services was one of the most effective ways to prevent and control the STDs/HIV. But some previous studies, which from Shanghai showed that the quality of service was poor, and could not achieve the desired.To evaluate the quality of service at the public STDs clinics in Shanghai, explore a feasible way of improving quality of service, and to assess the effectiveness of improving quality of service at the public STDs clinics in Shanghai.The basic design of the program was an intervention research. We selected six public STD clinics in Shanghai as the study field and randomly assigned them into the intervention group and the control group. Each group included three clinics. For the intervention group, a series of intervention measures including qualified advocacy and mobilization, IEC related services, training, supervising, following up and intergrated counseling, partner notification and condom promotion were implemented for the service providers, while routine work conducted in the control group. According to the proposal, the baseline survey, intervention and evaluation have been conducted. Quantitative and quality methods were combined as the data collection techniques. The quantitative methods comprised questionnaire investigation through exit interview with STD clients and self-administered questionnaire investigation with service providers. The qualitative methods included in-depth interview with STD clients and service providers in STD facilities, structured observation by professor in STD/HIV area, and etc.During the baseline survey,860 eligible clients finished the exit-interview survey, and 448 of them were in the control group and 412 were in the intervention group. There were 869 eligible clients accomplished the questionnaires in the evaluation survey with 418 in the control group and 451 in the intervention group.For the intervention group, the subjects' median and P25-P75 of total scores of diagnosis and treatment were 75.00 (62.50,81.25) and 81.25 (68.75,93.75) in the baseline and evaluation period, respectively; for the control group, the scores were 68.75 (62.50,75.00) in the baseline, and 68.75(62.50,81.25) in the evaluation. Comparing the results, there was no significant difference before and after the intervention for the control group (Z=0.69, p=0.4872); The mean score in evaluation period was higher than that in baseline period (Z=-10.24, p<0.0001) for the intervention group. There was no significant different between the two group in the baseline period (Z=1.51, p=0.1305), in the evaluation period the score of intervention was higher than control group (Z=-11.01, p<0.0001). Adjusting the gender and age of the clients, the result suggested that the intervention activities improved the quality of diagnosis and treatment at the experiment clinics.The score on health promotion was 40.91 (27.27,54.55) in the baseline period for the intervention group, and was 72.73 (59.09,81.82) in the evaluation. For the control group, there was 36.36 (31.82,45.45) and 40.91(36.36,50.00) in the baseline and evaluation respectively. After testing the null hypothesis, we found the scores were higher in the evaluation period, whether the control group or intervention (Z=-20.04, p<0.0001; Z=4.51, p<0.0001), but the there was a lager difference in the intervention group. For the control group, there was not a significant difference (Z=1.75, p=0.0804); For the intervention group, the score was higher in the evaluation. Adjusting the gender and age of the clients, the result indicated that the intervention activities enhanced the quality of service in health promotion for STD patients in STD clinics. The median (P25, P75) scores of clients'knowledge on sexually transmitted diseases and the HIV/AIDS were 45.16 (29.03,64.52) and 70.97 (61.29,77.42) for the intervention group in the baseline and evaluation period; and accordingly there were 48.39 (35.48,58.06) and 51.61 (29.03,61.29) for the control group. The score was higher in the evaluation period for the intervention group (Z=-19.31, p<0.0001), yet there was no significant difference for the control group (Z=1.38, p=0.1665). Before the intervention the score was higher for the control group (Z=-2.39, p=0.0166), but after the intervention the score of intervention was higher (Z=-16.73, p<0.0001). Adjusting the gender, age, education and occupation of the clients, we found the intervention activities improved the clients' knowledge, but the clients' knowledge still need to be improved.Satisfaction of services for the diagnosis, treatment, health education, condom promotion, partner notification and counseling were measured by the questionnaire survey. We tested a series of supposes and got the same results which indicates that the intervention increased the clients'satisfaction to the service in STD clinics. [CONCLUSION]The integrated intervention measures improved the quality of service at the public STD clinics in Shanghai, increased the clients' knowledge on sexually transmitted diseases and HIV/AIDS, and enhanced the clients'satisfaction level on the service at the same time. But the interventions still need to be amended to improve the quality of STD of service.