CLIENT SATISFACTION & ASSOCIATED FACTORS

AMONG WOMEN ATTENDING FAMILY PLANNING

SERVICE AT YEKA SUBCITY HEALTH CENTER, ADDIS
ABABA, ETHIOPIA,2022

By: Bezawit Nigatu

Lewi Girma
Nishan Zinabu

A PAPER REPORT SUBMITTED TO RIFT VALLEY UNIVERSITY,

DEPARMENT OF PUBLIC HEALTH FOR PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR BACHELOR OF SCIENCE DEGREE IN
NURSING PROGRAM

ADVISOR: TOFIK MOHAMMED (MPH)

JUNE 2022
ADDIS ABEBA, ETHIOPIA

1
 RIFT VALLEY UNIVERSITY

CLIENT SATISFACTION & ASSOCIATED FACTORS

AMONG WOMEN ATTENDING FAMILY PLANNING
SERVICE AT HEALTH CENTER, ADDIS ABABA, ETHIOPIA,
2022

By: Bezawit Nigatu

Lewi Girma
Nishan Zinabu

A PAPER REPORT SUBMITTED TO RIFT VALLEY UNIVERSITY,

DEPARMENT OF PUBLIC HEALTH FOR PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR BACHELOR OF SCIENCE DEGREE IN
NURSING PROGRAM

ADVISOR: TOFIK MOHAMMED (MPH)

JUNE 2022
ADDIS ABEBA, ETHIOPIA

2
 ABSTRACT
Introduction: Client satisfaction influences the use of family planning and other reproductive
health services. This study aimed to assess the magnitude of client satisfaction with family
service and its associated factors among reproductive-age women.
Methods: We conducted a facility-based cross-sectional study. A total of 422 clients, nested
in one health facilities, were included in the analysis. Systematic sampling was employed to
select study units for the exit interview. Data collection instruments for this study were pre-
tested semi-structured questionnaires. Client satisfaction was assessed using fifteen Likert-
scaled question items. Each item of question has 5 points ranging from 1 (strongly disagree) to
5 (strongly agree) and, finally, mean was computed. The pre-coded data were entered into Epi
Data version 4.2.0 and exported to SPSS version 25 for analysis. Logistic regression analysis
was carried out to identify independently associated factors at a confidence interval of 95%
and a significance level of p-value less than 0.05.
Results: Magnitude of client satisfaction with family planning service was 87.7% [95% CI:
85%-91%]. Age between 25-34 (AOR= 3.07;955 CI:1.10-8.62). Educational level those who
were primary school (AOR=0.22;95%:CI 0.07-0.70). Those with repeated visit
(AOR=7.80;95% CI:2.50-24.48) were factors significantly associated with client satisfaction.
Conclusion and recommendation: The finding of this study concludes that only more than
two-third of the clients are satisfied with the family planning service delivered at Public Health
facilities of Yeka sub city. Frequency of visit, age and educational status were the predictors
of client satisfaction with family planning service. Hence, in order to improve client satisfaction
with family planning service in Yeka sub city, Addis Ababa, Ethiopia, it is better to give
attention to repeat family planning service visitor, for those age between 25-34, and those with
education status of primary school. Finally, Researchers are recommended to assess
determinants of family planning service satisfaction using a strong study design.
Keywords: client satisfaction, family planning service, Southern Ethiopia

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 ACKNOWLEDGEMENT
First of all, we pleased to extend our heartfelt gratitude to Rift Valley University for giving us
this opportunity.

We would also like to express our thank as a congregation to our advisor Mr. Tofik Mohammed
(MPH) whose guidance and counseling has been valuable. We will forever be grateful for the
encouraging advices we received from the start to finish of this work and enormous support
and for the compassion he have shown us during our study.

Lastly, we really thank for Addis Abeba city health bureau to give us information for important
inputs during the preparation of this paper, and study participants who were voluntary to give
us necessary information during the study.

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 LIST OF ACCROMY /ABREVATION
CPR contraceptive prevalence rate

EDHS Ethiopian demographic health survey

FP Family planning

GO Governmental organization

HSTP Health sector transformation plan

IRB Institutional Review Board

NGO Non-governmental organization

SPSS Statistical package for social science

SSA Sub Saharan Africa

WHO world health organization

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 TABLE OF CONTENTS

Contents
ABSTRACT ............................................................................................................................................................. i
ACKNOWLEDGEMENT ..................................................................................................................................... ii
LIST OF ACCROMY /ABREVATION.............................................................................................................. iii
TABLE OF CONTENTS...................................................................................................................................... iv
LIST OF FIGURES................................................................................................................................................. vi
1.INTRODUCTION ...............................................................................................................................................1
1.1. Background .................................................................................................................................................1
1.2. Statement of the problem ...........................................................................................................................3
1.3. SIGNIFICANCE OF THE STUDY ..........................................................................................................5
2.LETRATURE REVIEW ....................................................................................................................................6
2.1. Magnitude ....................................................................................................................................................6
2.2. Factors associated with client satisfaction among women attending family planning service ............7
2.3. Conceptual frame work ..............................................................................................................................8
3.OBJECTIVES OF THE STUDY .......................................................................................................................9
3.1. General objective ........................................................................................................................................9
3.2. Specific objective .........................................................................................................................................9
4.METHODS AND MATERIALES ...................................................................................................................10
4.1. Study area and period ..............................................................................................................................10
4.2. Study design ..............................................................................................................................................10
4.3. Population ..................................................................................................................................................10
4.4. Sample Size and Sampling Techniques...................................................................................................11
4.5. sampling procedure ..................................................................................................................................11
4.6. Study variable ...........................................................................................................................................11
4.7. Operational definition ..............................................................................................................................12
4.8. Data collection tools and process .............................................................................................................12
4.9. Data quality assurance .............................................................................................................................13
4.10. Data processing and analysis .................................................................................................................13
4.11. Ethical clearance .....................................................................................................................................14
4.12. Plan for utilization and dissemination of the result.............................................................................14
5.RESULT .............................................................................................................................................................15
6.DISCUSSION ....................................................................................................................................................21
7.Limitations of the study ....................................................................................................................................22
8.Conclusions and recommendation ...................................................................................................................22
REFERENCE .......................................................................................................................................................23
ANNEX 1 INFORMED CONCENT .....................................................................................................................27
ANNEX -2 QUESTIONAIRRE ............................................................................................................................29

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 LIST OF TABLES

table 5. 1 distribution of respondent by their sociodemographic characteristics ............. 15

table 5. 2. health facility and service providers related factors ................................................ 16
table 5. 3 .Level of satisfaction of clients with different components of in the family planning
service at Yeka sub city health center ...................................................................................... 18
table 5. 4. Factors Associated with Client Satisfaction on Family Planning Services. Yeka
subcity, Addis Ababa 2022 ...................................................................................................... 19

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 LIST OF FIGURES

figure 2 1 conceptual frame work of client satisfaction and associated factors among women
attending family planning service in Yeka sub city health center, Addis Abeba ,2022 ............ 8

figure 5 1 Level of satisfaction among women attending family planning service at Yeka sub
city health center, Addis Ababa from February to June 2022 ................................................. 19

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 1.INTRODUCTION
1.1. Background
Rapid population growth resulting from high fertility rate and reduced mortality has become a
new challenge of concern in sub-Saharan Africa (SSA). Family planning (FP) is the decision
of individuals or couples to decide when and how many children they have and among the
practical strategies that not only slow the population growth but also reduce maternity and child
mortality due to outcomes of unintended pregnancies. (1).

Client satisfaction in family planning services is a crucial indicator that measures the extent to
which a client is gratified with the services received from healthcare providers. It therefore,
reflects the gap between the expected service and the experience of the service, from the client’s
point of view. (2). The satisfaction of clients is an essential component of quality and hence is
expected to improve through better compliance with the service, and at the same time, satisfied
clients will generate demand in the community and assist in the recruitment of new clients who
can use the services (3). Client satisfaction has been recognized as an essential component in
the evaluation of health-care quality. One of the factors that influences the use of family
planning and other reproductive health services is client satisfaction with healthcare services.
(4).

Client satisfaction is also an essential determinant of service uptake and continuation because
satisfied clients are more likely to revisit the service and pass on a positive message to others
and continue the use of particular family planning methods. (2). It also signals other aspects of
quality of care including structural and process issues of quality of care in FP services. It
reflects the perception of healthcare consumers (FP clients) on the quality of care on existing
health services. (5).

Studies from developing countries have found that not being satisfied with family planning
services is a prime reason for high rates of discontinuation, reduced utilization of FP services,
non-compliance, and high rates of unintended pregnancy. (2,5,6). Evidence from several
studies shows that client satisfaction is affected by different factors. Those are;
sociodemographic factors: marital status, educational status, and age, (6,7) service provider
level factors: provision of information on potential side effects, ensuring privacy, examining
during the visit, (4) service organization factors: using educational materials, informed choice,
waiting time, urban facilities, the sanitary condition of the room. (5,7,8). However, there is
scarce information on client satisfaction with FP services in Addis Abeba, specifically in the
study area. In Ethiopia, more than one-third (37%) of women who commence contraception
1
discontinue use within 12 months, according to the Ethiopian Demographic and Health Survey
(EDHS) 2016 report (9).

The Ethiopian government introduced the health sector transformation plan (HSTP) intending
to increase the contraceptive prevalence rate (CPR) to 55% and reduce the unmet need for FP
use to 10% by 2020, but the progress is slow as EDHS 2019 found CPR to be 41% (10,11).
Thus, improving client satisfaction with FP services could be one strategy to contribute to the
achievement of the goal. Therefore, assessments of client satisfaction are needed to know the
current status plan for program improvement. Therefore, this study tried to assess client
satisfaction with family planning services and its associated factors at the public health
facilities of Addis Ababa, Ethiopia.

2
 1.2. Statement of the problem
Maternal mortality represents an important worldwide public health topic. The United Nations
estimates that approximately 303 000 maternal deaths occurred globally in 2015,
corresponding to a maternal mortality ratio (MMR) of 216 per 100 000 live births (12).
Although this ratio represents a 43% decrease in MMR since 1990, the number of deaths is still
quite high. From the 2013 World Health Organization. It has been shown that family planning
(FP) positively contributes to the reduction of maternal deaths. It has been estimated that the
uptake of contraception in countries with high birth rates has the potential to prevent up to 32%
of maternal deaths and nearly 10% of infant deaths (13). Other authors have estimated a 29%
reduction in maternal deaths per year if the unmet need for FP is satisfied (14).
In Africa (primarily in Sub-Saharan Africa), the contraceptive utilization remains low and
fecundity, fertility rate, and unmet need for modern contraceptives are high (15,16). However,
at this moment, the progress of using modern contraceptive method is estimated to be fast in
under developed countries mainly in Africa. Between 2017 and 2030, utilization of modern
contraceptive is expected to increase from 43 to 56% in Eastern Africa. In Ethiopia, more than
one-third (37%) of women who commence contraception discontinue use within 12 months,
according to the Ethiopian Demographic and Health Survey (EDHS) 2016 report. (9).

Client satisfaction is an essential determinant of service uptake and continuation because

satisfied clients are more likely to revisit the service and pass on a positive message to others
and continue the use of particular family planning methods. (2). It also signals other aspects of
quality of care including structural and process issues of quality of care in FP services. It
reflects the perception of healthcare consumers (FP clients) on the quality of care on existing
health services (5).

Studies from developing countries have found that not being satisfied with family planning
services is a prime reason for high rates of discontinuation, reduced utilization of FP services,
non-compliance, and high rates of unintended pregnancy. (2,5,6). Evidence from several
studies shows that client satisfaction is affected by different factors. Those are;
sociodemographic factors: marital status, educational status, and age, (6,7) service provider
level factors: provision of information on potential side effects, ensuring privacy, examining
during the visit, (4) service organization factors: using educational materials, informed choice,
waiting time, urban facilities, the sanitary condition of the room. (8,5,7)

3
Integrating family planning services into maternal health services can be an effective strategy
for reducing unmet need, especially in situations where maternity care is a woman’s primary
contact with the health care system. Antenatal care provides an opportunity for postpartum
family planning education, allowing women to establish healthy birth spacing practices. This
strategy also benefits women by increasing their participation in the workforce, which in turn
raises household income and allows women to invest in themselves and their families.

The Ethiopian government introduced the health sector transformation plan (HSTP) intending
to increase the contraceptive prevalence rate (CPR) to 55% and reduce the unmet need for FP
use to 10% by 2020, but the progress is slow as EDHS 2019 found CPR to be 41%. (10) Thus,
improving client satisfaction with FP services could be one strategy to contribute to the
achievement of the goal. However, there is scarce information on client satisfaction with FP
services in the study area.

Therefore, assessments of client satisfaction are needed to know the current status plan for
program improvement. Therefore, this study tried to assess client satisfaction with family
planning services and its associated factors at public health facilities of Yeka Sub city health
center, Addis Ababa, Ethiopia.

4
 1.3. SIGNIFICANCE OF THE STUDY
The study generates a comprehensive empirical data on client satisfaction & associated factors
among women attending family planning service. This particular study will contribute
something to the existing knowledge base either by adding new evidences or strengthening the
existing ones. Moreover, the information obtained from this research will be used as a good
insight to health professionals, policy makers, researchers, other GOs and NGOs aspiring to
give attention towards client satisfaction & associated factors among women attending family
planning service. Besides, it would produce preliminary data and evidence to those who want
to conduct further research in the area. It had an important implication for service, education
and research. Therefore, this study will fill the gap and programmers in health center and the
town health bureau could use this study result for planning purpose.

5
 2.LETRATURE REVIEW
2.1. Magnitude
Client satisfaction has been recognized as an essential component in the evaluation of health-
care quality. One of the factors that influences the use of family planning and other reproductive
health services is client satisfaction with healthcare services. (17,18)
Globally, up to 225 million women who want to prevent pregnancy are not using effective and
safe contraceptive methods [19]. Most of the women with an unmet need for contraceptives
live in 69 of the poorest countries [20]. This unmet need is due to both a rapidly growing
population and a shortage of FP services [19].
According to the united nations projections, by 2025 the world would contain over 8 billion
people, of which some 6.8 billion would live in developing countries. Fertility is high among
sub-Saharan African countries at an average of 5.3 children per women (20).

According to the 2015 United Nations report, around 303,000 maternal deaths were reported
globally with a maternal mortality ratio of 216 per 100,000 live births [22]. Although it is noted
that there is 43% decrease in maternal mortality from 1990, the death rate is still high.

In 2017, 63% of married or in-union women of reproductive age (15-49 years) group were
using some form of contraceptive method in the world, but the utilization was very low
particularly in Africa (36%) [23].

According to study done in the united states the magnitude of client satisfaction among women
attending family planning was 88% (24). Similar study done in Jordan, Egypt and Indonesia
show that the magnitude of client satisfaction was 83%,85% and 97% (25-27).
Study done in Mexico shows that the magnitude of client satisfaction among women attending
family planning service was 80% (28). Similarly, according to study done in Bangladesh the
magnitude of client satisfaction was 75% (29).
In Africa family planning utilization is weak. However, according to study done in Tanzania
and Mozambique the magnitude of client satisfaction was 91% and 86% respectively (30-31).

In Ethiopia, according to 2016 Ethiopian Demographic Health Survey report 412 pregnancy -
related deaths per 100,000 live births were occurred [32] Previous evidences revealed that
family planning service utilization positively contributes to the reduction of maternal deaths.

Study done in Tembaro, southern Ethiopia show that magnitude of client satisfaction with
family planning services was found to be 46% (33).Similarly studies conducted in Jigijiga
(41.7%),(34) Wonji (45%)(35) eastern Ethiopia (42%).(36) This finding is lower than studies

6
conducted in Bahirdar (66.1%),(37) Hossana (75.3%),(38) west Shawa (62.6%),(39)
countrywide Ethiopia (58.5%),(40).
2.2. Factors associated with client satisfaction among women attending family
planning service
Evidence from several studies shows that client satisfaction is affected by different factors.
Those are; sociodemographic factors: marital status, educational status, and age,(41,42) service
provider level factors: provision of information on potential side effects, ensuring privacy,
examining during the visit,(43,44,,41-43) service organization factors: using educational
materials, informed choice, waiting time, urban facilities, the sanitary condition of the
room(42,44).
Study conducted in Hossana,Ethiopia shows that predators of client satisfaction with family
planning service were age ,education level,visit,parity,client experience with contraceptive
,methods shift, history of unintended pregnancy, advised on about contraceptive ,privacy,
waiting time ,opening hours of clinic ,and perception on cleanness of the facilities(45).

7
 2.3. Conceptual frame work

Socio-demographic factors
➢ age,
➢ marital status,
➢ educational status,
➢ occupation status of
respondent, religion,
➢ ethnicity
➢ residence
➢ frequency of visit

Client provider
interaction
➢ Privacy Facility-related
➢ The information factors
given about
➢ distance from
contraceptive home,
method, ➢ time
➢ The information consultation,
given about other Client satisfaction
➢ waiting time,
methods, ➢ clinic sanitation
➢ education material,
and etc
the status
of decision, partners’
attitude, respect/
courtesy).

Obstetrics related factors

➢ Parity
➢ Number of unwanted
pregnancies
➢ Number of unintended
pregnancies
➢ and etc.

figure 2 1 conceptual frame work of client satisfaction and associated factors among women attending
family planning service in Yeka sub city health center, Addis Abeba ,2022

8
 3.OBJECTIVES OF THE STUDY
3.1. General objective
➢ To assess the client satisfaction and associated factors among women attending family
planning services in Yeka sub city health center Addis Ababa,2022
3.2. Specific objective
➢ To determine the magnitude of client satisfaction among women attending family
planning services in Yeka sub city health center Addis Ababa,2022

➢ To identify factors associated with client satisfaction among women attending family
planning services in Yeka sub city health center Addis Ababa,2022

9
 4.METHODS AND MATERIALES
4.1. Study area and period
The study was conducted in Yeka sub city health center located in Addis Abeba, Ethiopia.
Women who come for family planning was 11,000 annually, and the study was conducted from
Feb to June 2022.
4.2. Study design
Institution based cross sectional study was conducted from Feb to June 2022
4.3. Population
4.3.1. Source population
All women from 15-40 years using family planning in Yeka sub city health center, Addis
Abeba, Ethiopia.

4.3.2. Study population

All women of the reproductive age group (15-49 years) who were attending family planning
clinics at the Yeka sub city health centres were included.
4.3.3. Study unit

Sampled reproductive age group (15-49 years) of women who were attending family planning
clinics at the Yeka sub city health centre were included in the study.
4.3.4. Inclusion and exclusion criteria

➢ Non-pregnant women of reproductive age in the following age groups: 20–45 years
and 15–19 years (70% and 20% of the total sample, respectively), and men in the
following age groups: adults and adolescents < 19 years old (at least 10% of the total
sample);
➢ Users who had attended the clinic previously, or first-time users who had completed
their first appointment; and
➢ Users who had not permanently altered their fertility (through tubal ligation,
hysterectomy or vasectomy).
Exclusion criteria

➢ Pregnant women

➢ Users who had not attended the health center previously, or first-time users who had
not completed their first appointment

10
 ➢ Users who had permanently altered their fertility (through tubal ligation, hysterectomy
or vasectomy).
➢ Users who were mentally disabled and could not gave information
4.4. Sample Size and Sampling Techniques
The sample size was determined by using both single and double population proportion
formula. The following assumptions was used to calculate sample size for the first objective:
95% confidence level (1.96), 5% margin of error, and proportion (P) of the family planning
clients satisfied with service given in a facility-based study done in Tambaro which was 46%.
Accordingly, the sample size was calculated by using the formula:
n= (z (α/2))2p(1-p)/d2
where n= sample size,
Z(α/2) = critical value of normal distribution,
P=population proportion, and
d= margin of error.
So that the sample size was 384.The sample size for the second objective was determined using
double population proportion formula with the assumptions of 95% CI, 5% margin of error,
80% power, and unexposed to the exposed ratio of 1:1 and odds ratio of 3.04(10). The sample
size became 274.Sothat the final sample size was 422 with 10% non-response rate.
4.5. sampling procedure
The study population (n) was further be allocated to each of the selected facilities proportional
to the size of their client flow. For this allocation, a sampling fraction (=n/N) was used for all
the facilities proportionally, making it proportional to size. The study participants were
randomly interviewed from each facility until the calculated sample size achieved.
4.6. Study variable
4.6.1. Dependent variable
• Client satisfaction
4.6.2. Independent variable
• Socio-demographic factors (like marital status, educational status, and age etc.)

• service provider level factors: provision of information on potential side effects,

ensuring privacy, examining during the visit

• service organization factors: using educational materials, informed choice, waiting

time, urban facilities, the sanitary condition of the room

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4.7. Operational definition
Clients’ satisfaction: A person’s overall orientation towards a total experience of health care.
It comprises both cognitive and emotional facets and relates to previous experiences,
expectations, and social networks [46].
Clients’ overall satisfaction level: First the overall satisfaction was computed by adding the
mean score of 12 satisfaction items with 5 points Likert scale (ranging from strongly disagrees
to strongly agree). The threshold score for satisfaction was determined using the demarcation
threshold formula, which is (total highest score-total lowest score)/2+Total lowest score
[47,48]. Clients’ overall satisfaction was dichotomized as “satisfied” (if the score is equal and
above the threshold score of satisfaction) coded as “1”, and “not satisfied” (if the score is less
than the threshold score of satisfaction) coded as “0”.
Quality of contraceptive counselling: For the observational checklist, for quality of
contraceptive counselling items, the items reported to be done were scored “1” and the items
not done were scored “0”. The scores of the items were summed up for a total score of 20
points. Scores of ≤ 9 (≤ 45%) were classified as poor, scores of 10-15 (50%-75%) classified as
moderate and ≥ 16 (≥ 80%) were classified as good [49].
Contraceptive counselling: is a type of client provider interaction that involves two-way
communication between a health care provider and a client to confirm or facilitate informed
decision making by the client, or assist the client address problems or concerns [50].
4.8. Data collection tools and process
4.8.1. Data collection instruments

Data collection was accomplished by a semi-structured (mixed) questionnaire prepared in

English and translated to Amharic and then back to English by language experts to keep
consistency for socio-demographic characteristics of client satisfaction, health facility-related
factors (frequency of visit, opening time convenience, privacy maintained during counselling
and procedure, cleanliness of the clinic, waiting time and rooms having posters with key
messages of family planning), information given and provider-related factors (appointments
made for follow-up, clinical staff show respect, providers explain how the method works,
providers demonstrate how to use the method, providers describe the possible side-effect,
providers describe what to do when a problem occurs and providers describe the possibility of
changing the method when there is complication) and other interpersonal characteristics.

12
In this study, client satisfaction (outcome variable) was assessed using fifteen Likert-scaled
question items. Each item of the question had 5-points, one denoting “1” strongly disagree, two
‘‘2” disagree, three “3” not sure, four “4” agree and five “5” strongly agree. Finally, the mean
was computed, and by classifying to above/equal and below the mean the response was
categorized in to “Satisfied (coded as 1)” and “Not-satisfied (coded as 0)”, respectively.

The data was collected by one health officer, two clinical nurses after recruited and trained as
a data collector for one day concerning the aim of the study, contents of the questionnaire,
definition of terms in the questionnaire, issues of confidentiality and privacy.

4.8.2. Data collection procedure

So-demographic characteristics of client satisfaction, health facility-related factors (frequency

of visit, opening time convenience, privacy maintained during counselling and procedure,
cleanliness of the clinic, waiting time and rooms having posters with key messages of family
planning), information given and provider-related factors (appointments made for follow-up,
clinical staff show respect, providers explain how the method works, providers demonstrate
how to use the method, providers describe the possible side-effect, providers describe what to
do when a problem occurs and providers describe the possibility of changing the method when
there is complication) and other interpersonal characteristics.
4.9. Data quality assurance
The following measure was under taken so as to control the quality of the data. The data
collectors were trained for one day. The semi-structured questionnaire was checked to avoid
printing errors before data collection started. The name of the data collectors was recorded so
as to enhance the responsibility to any incomplete data. Data collectors were summit the
collected data to supervisor in daily basis and the supervisors were check the completeness of
the data. Code cleaning was done. Before the actual data collection, the check list was tested
on 21 respondents who were out of the study area which were not randomly choose to actual
data collection and not included in the actual study period.

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
4.10. Data processing and analysis
The collected data was entered and cleaned by using Epinfo software version 7.2.1.0 and
analyzed using SPSS version 21.0 (IBM, New York, USA) software using descriptive statistics

13
(mean and standard deviation). Socio- demographic and other variables of client were
presented by frequency tables, graphs and other summary statistic. In order to investigate the
normality of data distribution, histogram was used. Bivariate analysis was used to check
association between dependent and independent variables. Odds ratio, Chi-square, and 95% CI
for odds ratio were computed to assess the strength of association.

All variables that had significant association with p-value <0.25 in the bivariate analysis was
the candidate for multivariable logistic regression. Multivariable logistic regression model will
be fitted to identify factors affecting the elderly outcome.
4.11. Ethical clearance
The ethical issue of this study was approved by the ethical committee of the Rift Valley
University, department of public health and official permission to undertake the study was
obtained from the Addis Abeba health bureau. The supportive staffs of Yeka sub city health
center was informed about the purpose of the study and verbal consent was obtained.
Confidentiality of client information were assured and information recorded anonymously. The
name of the participants and any participant identifier were not written on the questionnaire.
To keep privacy participant was asked alone in separate room.

4.12. Plan for utilization and dissemination of the result

The result of the study was submitted to the Rift Valley University, department of public health,
Addis Ababa health bureau and to the targeted health facility and to NGOs working on this
area. Further attempt will be made to publish it on national and international scientific journals.

14
 5.RESULT
Socio-Demographic Characteristics
We interviewed a total of 422 clients from one family planning service delivery points. The
response rate was 100%. Three hundred eighty (90%) were urban dwellers. More than three-
quarters of the respondents, 85.3%, were repeat clients. The mean age was 29.8 + 4.3 SD years
old with a range between 16 and 46 years. More than half of the participants, 52%, were
between 25 and 34 years old. Most of the respondents, 87.7%, were married, and 9.5% were
single, the rest widowed and divorced. Almost half of the respondents, 42.7%, reported
completing primary-level education, and 45.3% reported completing high school. More than
one third of the participant (42.7%) were house wife. (Table 5.1)
table 5. 1 distribution of respondent by their sociodemographic characteristics
Sociodemographic number percent

Age
15-24 130 40.3
25-29 114 27.3
30-34 80 19
35+ 72 17.1
Marital status
Married 370 87.7
Others 52 12.3
Educational status
Unable to read and write 20 4.7
Primary school 180 42.7
Secondary school
Preparatory 31 7.3
Occupation
Merchant 73 17.3
House wife 180 42.7
Private employee 68 16.1
Daily labourer 101 23.9
Religion
Orthodox 170 40.3
Muslim 114 27.0
Protestant 30 19
Others 58 13.7
Ethnicity
Oromo 117 27.7
Amhara 158 37.4
Gurage 62 14.7
Tigre 69 16.4

15
Others 16 3.8
Residence
Urban 380 90
Rural 42 10
Frequency of visit
New visit 62 14.7
Repeat 360 85.3

Health Facility and Service Providers Related Factors

As to health facility related variables,401 (95%) of participant received the method they wanted
,127(30%) of client experienced side effects on the method they were using,51 (12%) had an
unwanted pregnancy,295 (69.9%) of the clients were informed on the side effect of the
method,367 (87%) reported that they were politely treated by the service provider ,169 (40%)
of them shifted the method from one to the other,64 (15%) of the participant had history of
unintended pregnancy,295 (69.9%) were told the method side effect,13 (3%) had got written
information about the method side effect,148 (35.1%) were told to return if they had a
problem,380 (90%) treated with respect and courtesy by the care provider,367 (87%) of them
were treated with respect and courtesy at the reception desk,397 (94.1%) of them were
respected when they asked to share sensitive issue,359(85.1%) had enough privacy during
examination and procedure,420 (99.5%) of them told that time of opening the health centre is
convenient,401 (95%) of them told that health center was clean,93 (22%) of them told that the
waiting time was long.
table 5. 2. health facility and service providers related factors
variable category Number percentage

Have you received the method you wanted Yes 401 95

No 21 5

Have you history of face side effect Yes 127 30.1

No 295 69.9

Have you history of shifting method Yes 169 40

No 253 60

Have you history of unintended pregnancy Yes 64 15.2

No 358 84.8

Number of unwanted pregnancies once 35 8.3

Twice and above 16 3.8

16
Were you told about the methods side effect Yes 295 69.9

No 127 30.1

Have you got written information about the side effect Yes 13 3.1

No 409 96.9

Did the provider told you to return if you have a problem Yes 148 35.1

No 274 64.9

Were you treated with respect and courtesy by the care provider Yes 380 90

No 42 10

Were you treated with respect and courtesy at the reception desk Yes 367 87

No 55 13

Were your privacy were respected when you were Yes 397 94.1

asked to share sensitive issue No 25 5.9

Did you have enough privacy during examination and procedure Yes 359 85.1

No 63 14.9

The hours this health center open is convenient for you Yes 420 99.5

No 2 0.5

Is the health facility were clean Yes 401 95

No 21 5.0

Was the waiting time was long Yes 93 22

No 329 78

17
table 5. 3 .Level of satisfaction of clients with different components of in the family planning
service at Yeka sub city health center

Characteristics 1(NO, %) 2(NO,%) 3(NO,%) 4(N0,%) 5(NO,%)

Service providers were respectful 0(0) 9(2.1) 27(6.4) 188(44.5) 198(46.5)

Service providers have shown concern 0(0) 5(1.2) 41(9.7) 154(36.5) 222(52.6)

Service providers have shown comfort 0(0) 4(0.9) 31(7.3) 160(37.9) 227(53.8)

Mutual understanding between provider and you 0(0) 7(1.7) 23(5.5) 173(41.5) 219(51.9)

Trust with service provider 0(0) 16(3.8) 40(9.5) 191(45.3) 175(41.5)

The provider was cooperative 0(0) 11(2.6) 19(4.5) 170(40.3) 222(52.6)

Service provider gave adequate information 0 13(3.1) 26(6.2) 187(44.3) 196(46.4)

Waiting room has enough sitting chairs 0(0) 47(11.1) 28(6.6) 159(37.7) 188(44.5)

Attractiveness of the clinic 1(2) 25(5.9) 15(3.6) 143(33.9) 238(56.4)

Location of health center 0(0) 7(1.7) 20(4.7) 172(40.8) 223(52.8)

Waiting time to get service 0(0) 57(13.5) 17(4) 173(41) 175(41.5)

Waiting time at clinic 0(0) 69(16.4) 13(3.1) 139(32.9) 201(47.6)

Working hours of clinic 0(0) 27(6.4) 16(3.8) 187(44.3) 192(45.5)

Service provider exampled procedure 2(0.5) 40(9.5) 64(15.2) 161(38.2) 155(36.7)

Service provider explanation was clear and straight forward 23(5.5) 18(4.3) 188(44.5) 193(45.7)

(1) very dissatisfied (2) dissatisfied (3) neither/nor (4) somewhat satisfied (5) satisfied

The Magnitude of Client Satisfaction

The overall client satisfaction with family planning services was 87.7% [95% CI: 85%-91%].

18
figure 5 1 Level of satisfaction among women attending family planning service at Yeka sub
city health center, Addis Ababa from February to June 2022

Factors Associated with Client Satisfaction

In bivariate analysis, age, educational level of the participants, waiting time, frequency of visit,
having treatment with respect and courtesy, having waiting time long, having convenient
opening time of the health centre, having information about the side effect by health provider.
The result from multivariable logistic regression was that those clients between the age of 25-
34 were three times higher odds to be satisfied with the family planning service as compared
to others [AOR= 3.07; 95% CI: 1.10–8.62]. Clients whose educational level of primary school
possessed 78% fewer odds of satisfaction with the family planning services as compared to
those whose educational level was that of primary education [AOR = 0.22;95% CI: 0.07–0.70].
clients who were repeat visit had eight times higher odds of being satisfied with services than
those who waited for more than new visit [AOR=7.80; 95% CI: 2.50–24.48].
table 5. 4. Factors Associated with Client Satisfaction on Family Planning Services. Yeka
subcity, Addis Ababa 2022

satisfication
variable category satisfied non satisfied COR AOR
Age 15-24 130 0 0.66(0.35–1.26) 0.77(0.16–3.78)

25-34 220 0 0.75(0.50–1.12) 3.07(1.10–8.62) *

35+ 20 52 1
Educational status Informal education 20 0 1
Primary 180 0 0.49(0.27–0.87) 0.22(0.07–0.70) *

Secondary 170 21 4.01(2.59–6.20) 2.31(0.88–6.10)

Preparatory and above 0 31 0.83(0.48–1.42) 0.41 (0.13–1.35)

Frequency of visit new visit 62 0 32.7(16.7–64) 7.80(2.48–24.48) *

Repeat visit 308 52 1 1

Treated with respect and courtesy yes 370 10 21(12.5–35.4) 7.16(2.89–17.69)

No 0 42 1
Waiting time long Yes 93 0 6.67(4.31–10.3) 1.87(0.62–5.66)

No 277 93 1
Opening time convenient Yes 370 50 1.92(1.22–3.01) 0.43(0.14–1.30)

No 2 0 1

19
Have you got written information Yes 13 0 4.27(2.76–6.61) 3.14(1.02–9.76)

No 52 357 1
Notes: *Significant p-value <0.05

20
 6.DISCUSSION
The magnitude of client satisfaction with family planning service was found to be 87.7% [95%
CI: 85%-91%]. Moreover, age, educational level, and frequency of visit are all factors that are
significantly associated with client satisfaction. The magnitude of client satisfaction with
family planning services was found to be 87.7%.
This finding was consistent with studies conducted in Hossana (75.3%), (45), Mozambique
(86%), (31) Bangladesh (75), (29) and Mexico (80%). (28)
The study conducted was higher than study done in Jigijiga (41.7%),(34),Wonji (45%)(35)
,eastern Ethiopia(42%) (36), Bahirdar (66.1%)(37),west Shawa (62.6%),(39) country wide
Ethiopia (58.5),(40) .The probable reasons for the discrepancy among the studies might be
due to socio-demographic differences among the different study populations.
This study is higher than study conducted in Tembaro district, southern Ethiopia 46% (33). the
discrepancy happened due to socioeconomic difference between the study population
The magnitude of satisfaction in this study was lower than study done in Indonesia and
Tanzania which was 95 and 91 respectively (27,31). This might be difference is due to
socioeconomic difference between the study participants.
The odds of reporting satisfaction are higher among clients from age between 25-34 as
compared to clients of different age. The odds of reporting satisfaction are lower among clients
with the educational level of preparatory and higher as compared to clients with a primary level
of education. A higher educational level could mean that expectations could be higher because
satisfaction can be affected by hope.
The odd of reporting satisfaction is higher among client with new visit as compared to repeat
visit.
A woman who comes for family planning service for the first time were more likely to be
satisfied with the family planning service rendered by public facilities in Yeka sub city, health
centre than who had two and more family planning visits. This might be due to the fact that the
doses of service given for first family planning service users is more comprehensive than those
clients who are frequently using on it. A new visit client could not have the opportunity to see
the service given at other health facility. This result is consistent with the result obtained from
study done in Bahir dar city (37).

21
 7.Limitations of the study
Since the study was cross- sectional study it is not far from pitfalls of cross -sectional study.
We didn’t find comparable findings with higher level of satisfaction to compare our findings
for discussion. We have used a mean satisfaction score which is not far from the limitations of
using mean. There might be courtesy bias too.

8.Conclusions and recommendation

The finding of this study concludes that only more than two-third of the clients are satisfied
with the family planning service delivered at Public Health facilities of Yeka subcity.
Frequency of visit, age and educational status were the predictors of client satisfaction with
family planning service. Hence, in order to improve client satisfaction with family planning
service in Yeka subcity, Addis Ababa, Ethiopia, it is better to give attention to repeat family
planning service visitor, for those age between 25-34, and those with education status of
primary school. Finally, Researchers are recommended to assess determinants of family
planning service satisfaction using a strong study design.

22
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Kenya and Ghana. BMC Health Serv Res. 2011;11(1):203. doi:10.1186/1472-6963-11-203
29.Aldana JM, Piechulek H, Al-sabir A. Client satisfaction and quality of health care in rural
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36. Ndziessi G, Bintsene-Mpika G, Bileckot R. User satisfaction with family planning services
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37. Asrat W, Mekonnen T, Bedimo M. Assessment of women’s satisfaction with family planning
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0079-4
38. Argago T, Hajito K, Kitila S. Client’s satisfaction with family planning services and
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83.doi:10.5897/IJNM2015.0163

25
39. Birhanu Z, Assefa T., Woldie M, et al. Determinants of satisfaction with health care
provider interactions at health centers in Central Ethiopia: a cross sectional study. BMC
Health Serv Res. 2010;10:78.
40. Tessema G, Mahmood MA, Gomersall JS, et al. Client and facility-level determinants of
quality of care in family planning services in Ethiopia: multilevel modelling. PLoS One.
2017;12(6): e0179167. doi: 10.1371/journal.pone.0179167
41. Bintabara D, Ntwenya J, Maro II, et al. Client satisfaction with family planning services
in the area of high unmet need: evidence from Tanzania Service Provision Assessment
Survey, 2014–2015. Reprod Health. 2018;15(1). doi:10.1186/s12978-018-0566-8
42. Wakjira B. Assessment of Client Satisfaction on Family Planning Services Utilization in
Wonji Hospital, Ethiopia, 2016. JBR J Clin Diagnosis Res. 2017;5:1.
43.. Kaoje UA, Oche MO, Isah BA, et al. Determinants of client satisfaction with family
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Sokoto, Northern Nigeria. Sahel Med J. 2015;18(1):20. doi:10.4103/ 1118-8561.152154
44. Argago T, Hajito K, Kitila S. Client’s satisfaction with family planning services and
associated factors among family planning users in Hossana Town Public Health Facilities,
South Ethiopia: facility-based cross-sectional study. Int J Nurs Midwifery. 2015;7(5):74–
83.doi:10.5897/IJNM2015.0163
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26
 ANNEX 1 INFORMED CONCENT
Part I. Information sheet and consent form (English version)
Title of the Research Project: To assess the client satisfaction and associated factors among
women attending family planning services in Yeka health center, Addis Abeba, Ethiopia 2022
cross sectional study.
Name of Principal Investigators.: Bezawit Nigatu, Lewi Girma, and Nishan Zinabu
Name of the Organization: Rift valley university
Introduction

We are planning to conduct study on client satisfaction and associated factors among women
attending family planning services in Yeka health center, Addis Abeba, central part of Ethiopia.
We wish to find out ways by which we can identify the magnitude and develop strategic
interventions so as to address the problem. We value your input to make this study a successful
one.

Purpose of the Research Project

The aim of this study is to identify client satisfaction and associated factors among women
attending family planning services in Yeka health center,Addis Abeba,Ethiopia 2022

Procedure

You are randomly selected to be one of the study participants. If you are willing to participate
in this study, you will be requested to sign the consent form after you clearly understand the
aim of this study. Finally, you are kindly requested to give your genuine response in the
interview questionnaire.

Risk and /or Discomfort

By participating in this research project, you may have some discomfort. There are no or
minimal anticipated risk but you will take time about 25 minutes for interview.

Benefits of being in the study

There may not be direct benefits to you for giving us information for the study but your
participation is likely to help us client satisfaction and associated factors among women
attending family planning services. Ultimately this will help us to provide information for
planners to implement interventions.

Confidentiality and Privacy Protections:

27
You do not need to tell your name to the data collector. All your responses and the results
obtained will be kept confidentially by using coding system whereby no one will have access
to your responses.

Incentives/Payments for Participating

You will not be provided any incentives or payment to take part in this project.

Right to Refusal or Withdraw

You have the full right to refuse from participating in this research. You have also the full right
to withdraw from this study at any time you wish.

Contacts and Questions:

If you have any questions about the study, please ask now. If you have questions later, want
additional information, or wish to withdraw call the researcher conducting the study.

Bezawit Nigatu, Lewi Girma, and Nishan Zinabu

Tele:

Email:
Consent

If you have read this form and have willingness to participate in this study, put your name and
signature as follow:

Name of Participant _________________Signature ____________ Date_________

Name of consent receiver ______________Signature ___________ Date_________

Thank You for willingness to participate

28
 ANNEX -2 QUESTIONAIRRE
RIFT VALLEY UNIVERSITY
PUBLIC HEALTH DEPARTMENT
Introduction -These questionnaires will be answered by the respondents participating in this
study. There are different sections with multiple instructions. The first part will be about
sociodemographic and economic factors. Others will be evaluated subsequently after the
completion of this part.

Instruction -Please fill all questionnaires carefully. There are skip patterns when necessary to
move on to the next number. Move to the indicated number. Following those rules will save
your time in general and enhance data collection activities in particular. Before letting the
participant to go, take some to check for the completeness of your questionnaire.

Questionnaire designed to assess “The client satisfaction and associated factors among women
attending family planning services in Yeka sub city health center, Addis Ababa, Ethiopia
2022’’
Name of data collector________________________ Date___________________

Q. Question Choices Ski Rema

N p rk
Part One: Socio-demographic and economic characteristics of the respondent.
101 Age in years …………………...
102 Sex 1.Male
2.Female
103 Religion 1.Orthodox
2. Muslim
3. Catholic
4.Protestant
90.Others/specify
104 Ethnicity 1. Oromo

2. Amhara

3. Tigray

90. Other specifies

it………………
105 Current marital status 1. Married
.
2. Single

29
 3. Divorced

4. widowed

5.Separeted

106 Educational status 1.Unable to read and

write

2.Read and write only

3.Primary school
(Grade 1–8)

4.Secondary school
(Grade 9-10

5.Preparatory school
(Grade 11-12)

6.College and above

107 Occupation 1. Government employ.

2. Merchant Maid
3. House wife and
retired
4. Daily laborer
5. Private employee
90.Others

108 Residence 1.Urban

2.Rural

109 Frequency of visit 1.new visit

2.Repeat visit

PART TWO: OBSTETRICS AND HEALTH RELATED SERVICE

201 Have you received the 1.Yes
method you wanted 2.No
202 Have you history of face 1.Yes
side effect on method 2. No

30
203 Have you history of shifting 1.Yes
method 2. No
204 Have you history of 1.Yes
unintended pregnancy 2. No
205 Numbers of unwanted
pregnancy
206 Were you told about the 1.Yes
methods side effects 2. No
207 Have you got written 1.Yes
information about the side 2. No
effect
208 Did the provider tell you to 1.Yes
return if you have a problem 2. No
209 Were you treated with 1.Yes
respect and courtesy by the 2. No
care provider
210 Were you treated with 1.Yes
respect and courtesy at the 2. No
reception desk
211 Were your privacy were 1.Yes
respected when you were 2. No
when you were asked to
share sensitive issue
212 Did you have enough 1.Yes
privacy during examination 2. No
and procedure
213 The hours this health center 1.Yes
open is convenient for you 2. No
214 Is the working hours of the 1.Yes
health center delay for 2. No
getting the service
215 Is the health facility were 1.Yes
clean 2. No
216 Was the waiting time was 1.Yes
long 2. No
PART THREE: LEVEL OF SATISFICATION
characteristics Very Dissatisfied Neither/no Som Satisfi
dissatisfied (2) r (3) ewha ed (5)
(1) t
satisf
ied
(4)
301 Service provider were
respectful
302 Service provider have
shown concern
303 Service provider have
shown comfort

31
304 Mutual understanding
between service provider
and you
305 Trust with service provider
306 The provider was
cooperative
307 Service providers gave
opportunity to take part in
decision
308 Service provider gave
adequate information
309 Service provider
explanation was clear and
straight forward
310 Service provider explained
procedures
311 Cleanliness of the clinic
312 Waiting room has enough
sitting chairs
313 Attractiveness of the clinic
314 Waiting room ventilation
315 Location of the health
center
316 Waiting time to get service
317 Waiting time at health
center
318 Working hours of health
center

ASSURANCE OF PRINCIPAL INVESTIGATOR

The undersigned research work is our original work for partial fulfilment of degree in Nursing
department.

Name of the student: Bezawit Nigatu, Lewi Girma, and Nishan Zinabu

(BSc)

Date. ____________________ Signature _________________

APPROVAL FORMS OF ADVISORS

1. Name of the primary advisor: Mr. Tofik Mohammed (MPH)

Signature __________________________ Date. ____________________

32
Name of the secondary advisor:

Signature __________________________ Date. ____________________

33