ASSESSMENT OF SATISFACTION WITH POSTNATAL CARE SERVICES 
AMONG WOMEN WHO DELIVERED IN EMBU HOSPITAL, EMBU COUNTY, 
KENYA 

 

 

 

 

 

 

JOYCE. W. WACHIRA (B.Sc.N) 

Q139/CE/20842/2012 

 

 

 

 

 

 

A RESEARCH THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE 
REQUIREMENT FOR THE AWARD OF THE DEGREE OF MASTER OF 
PUBLIC HEALTH (REPRODUCTIVE HEALTH) IN THE SCHOOL PUBLIC 
HEALTH AND APPLIED HUMAN SCIENCES OF KENYATTA UNIVERSITY 

 

 

 

 

SEPTEMBER, 2021 

 


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DECLARATION 

 

 

 


DEDICATION 

This research is devoted to my mother, Margaret Wachira who has been a tower of 
strength wherever I felt like giving up. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


ACKNOWLEDGEMENT 

To begin with, I am thankful to the All powerful Lord for granting me sufficient grace 
and power during my study. 

I truly thank my able supervisors Dr. George Otieno and Dr. Harun Kimani both of 
Kenyatta University for their proficient direction and tireless effort in assisting me amid 
the course of the entire study. 

I am appreciative to the Department of Population, Reproductive Health and Community 
Resource Management and Kenyatta University for the opportunity to go through this 
course. 

In conclusion, I too pass my true appreciation to my atomic family members for their 
mental bolster amid this period. 

 

 

 

 

 

 

 

 

 

 

 

 


TABLE OF CONTENTS 

DECLARATION............................................................................................................... ii 
DEDICATION................................................................................................................... ii 
ACKNOWLEDGEMENT ............................................................................................... iv 
TABLE OF CONTENTS ................................................................................................. v 
LIST OF TABLES ........................................................................................................... ix 
LIST OF FIGURES .......................................................................................................... x 
ABBREVIATIONS AND ACRONYMS ........................................................................ xi 
DEFINITION OF TERMS............................................................................................. xii 
ABSTRACT .................................................................................................................... xiii 
CHAPTER ONE: INTRODUCTION ............................................................................. 1 
1.1 Background Information ........................................................................................... 1 
1.2 Problem Statement .................................................................................................... 4 
1.3 Justification ............................................................................................................... 6 
1.4 Research questions .................................................................................................... 6 
1.5 Null hypothesis .......................................................................................................... 7 
1.6 Main Objective .......................................................................................................... 7 
1.7 Specific objectives..................................................................................................... 7 
1.8 Significance of the study ........................................................................................... 7 
1.9 Limitations ................................................................................................................ 8 
1.10 Delimitations ........................................................................................................... 8 
1.11 Theoretical framework ............................................................................................ 8 
1.12 Conceptual framework .......................................................................................... 10 
CHAPTER TWO: LITERATURE REVIEW .............................................................. 13 
2.1 Introduction ............................................................................................................. 13 
2.2 Theoretical Literature Review ................................................................................. 13 
2.2.1 SERVQUAL Model of Care............................................................................. 13 
2.2.2 Reliability ......................................................................................................... 14 
2.2.3 Responsiveness ................................................................................................. 14 
2.2.4 Assurance.......................................................................................................... 15 
2.2.5 Tangibles .......................................................................................................... 15 
2.2.6 Empathy ............................................................................................................ 16 
2.3 Client satisfaction with Health care services........................................................... 16 
2.4 Socio-demographic factors ...................................................................................... 18 
2.5 Health system factors .............................................................................................. 20 
2.6 Quality maternal health services ............................................................................. 22 
2.7 Overview of Postnatal Care .................................................................................... 24 
2.8 Women.s Perceptions and Experiences in In-Hospital Postnatal Care ................... 26 
2.9 Studies Related to Satisfaction of Postnatal Women .............................................. 28 
2.10 Studies on ways of improving postnatal care services .......................................... 30 
2.11 Summary of literature review ................................................................................ 30 
2.12 Synopsis of gaps in the literature review .............................................................. 32 
CHAPTER THREE: MATERIALS AND METHODS .............................................. 34 
3.0 Introduction ............................................................................................................. 34 
3.1 Study design ............................................................................................................ 34 
3.2 Study variables ........................................................................................................ 34 
3.2 .1 Independent variables ...................................................................................... 34 
3.2.2 Dependent variables ......................................................................................... 34 
3.3 Study area ................................................................................................................ 35 
3.4 Target population .................................................................................................... 35 
3.4.1 Inclusion criteria ............................................................................................... 35 
3.4.2 Exclusion criteria .............................................................................................. 35 
3.5 Sampling technique and sample size determination ............................................... 36 
3.6 Data collection tools ................................................................................................ 37 
3.7 Pretesting ................................................................................................................. 37 
3.7.1 Validity of research instruments ....................................................................... 38 
3.7.2 Reliability of the research instruments ............................................................. 38 
3.8 Data collection procedures ...................................................................................... 39 
3.9 Data analysis ........................................................................................................... 39 
3.10 Logistical and Ethical considerations .................................................................... 40 
CHAPTER FOUR: RESULTS ...................................................................................... 41 
4.0 Introduction ............................................................................................................. 41 
4.1 Characteristics of the study participants.................................................................. 41 
4.2 Obstetric characteristics of respondents .................................................................. 43 
4.2.1 Times attended Embu Hospital......................................................................... 43 
4.2.2 Admission during previous delivery................................................................. 43 
4.2.3 Mode of Delivery.............................................................................................. 44 
4.2.4 Sex of Baby ...................................................................................................... 45 
4.2.5 Number of Children .......................................................................................... 45 
4.3 Description of the health systems attributes ............................................................ 46 
4.4 Evaluation of Satisfaction with Postnatal Care Services ........................................ 49 
4.5 Perception on quality of postnatal care ................................................................... 51 
4.6 Expectations ............................................................................................................ 54 
4.6.1 Support by the service providers ...................................................................... 54 
4.6.2 Cleanliness of the hospital equipment .............................................................. 54 
4.6.3 Supply of Medicine .......................................................................................... 55 
4.7 Association between satisfaction with postnatal care services, socio-demographic 
attributes and selected obstetric factors ......................................................................... 56 
4.8 Association between satisfaction with postnatal care services and health system 
factors ............................................................................................................................ 58 
4.8.1 Orientation ........................................................................................................ 59 
4.8.2 Information ....................................................................................................... 60 
4.8.3 Communication ................................................................................................ 61 
4.8.4 Comfort and Care ............................................................................................. 62 
4.9 Association between satisfaction with PNC services and perceptions on quality of 
care ............................................................................................................................... 65 
4.9.1 Tangibles .......................................................................................................... 65 
4.9.2 Reliability ......................................................................................................... 66 
4.9.3 Responsiveness ................................................................................................. 67 
4.9.4 Assurance.......................................................................................................... 68 
4.9.5 Empathy ............................................................................................................ 69 
4.10 Hypothesis testing ................................................................................................. 70 
4.11 Summary of study findings ................................................................................... 71 
CHAPTER FIVE: DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS.......................................................................................................................................... 72 
5.1 Introduction ............................................................................................................. 72 
5.2 Discussion of the Findings ...................................................................................... 72 
5.2.1 Influence of socio demographic characteristics on satisfaction ....................... 72 
5.2.2 Health system factors influence on satisfaction ............................................... 74 
5.2.3 Women.s satisfaction with postnatal care ........................................................ 77 
5.2.4 Influence of perceived quality of care on women.s satisfaction ...................... 79 
5.3 Conclusion ............................................................................................................... 84 
5.4 Recommendations ................................................................................................... 85 
5.5 Recommendations for Further Studies .................................................................... 86 
REFERENCES ................................................................................................................ 87 
APPENDICES ................................................................................................................. 94 
Appendix I: Consent Form................................................................................................ 94 
Sehemu Ya I : Ruhusa Ya Kufanya Utafiti ....................................................................... 97 
Appendix II: Postnatal Client Exit Interview Questionnaire ............................................ 99 
Appendix III: Focused Group Discussion Questions...................................................... 108 
Appendix IV: Key Informant Interview Guide ............................................................... 111 
Appendix V: Map of Kenya Showing Embu Hospital ................................................... 112 
Appendix VI: Kenyatta University Ethics Committee Approval .................................. 113 
Appendix VII: National Commission For Science And Technology Approval ............. 114 
Appendix VIII: Ministry of Education Approval ........................................................... 115 
Appendix IX: County Director of Health Embu Approval ............................................. 116 
Appendix X: County Commissioner of Embu Approval ................................................ 117 
Appendix XI: Embu Hospital Approval ......................................................................... 118 


 

 


LIST OF TABLES 

Table 4. 1 – Socio-Demographic Characteristics of the Respondents ............................. 42 
Table 4. 2 - Description of Selected Health Systems Attributes ...................................... 48 
Table 4. 3– Satisfaction With Postnatal Care Services .................................................... 50 
Table 4. 4– Perception on Quality of Postnatal Care Services ......................................... 53 
Table 4. 5- Association Between Satisfaction With Postnatal Care Services, Socio-
Demographic Factors and Selected Obstetric Factors .................................... 57 
Table 4. 8- Association Between Satisfaction With Pnc Services and Health System 
Factors (Orientation Statements) ................................................................. 60 
Table 4. 9- Association Between Satisfaction With Pnc Services and Information 
Statements ..................................................................................................... 61 
Table 4. 10 - Association Between Satisfaction With Pnc Services and Health System 
Factors (Communication Statements) .......................................................... 62 
Table 4. 11- Association Between Comfort and Care Components of The Health System 
And Satisfaction With Pnc Services ............................................................ 64 
Table 4. 13 - Association Between Satisfaction With Pnc Services and Perceptions on 
The Quality of Care (Tangible Statements) ................................................. 66 
Table 4. 14 - Association Between Satisfaction With Pnc Services and Perceptions of 
The Reliability of The Quality of Care ........................................................ 67 
Table 4. 15 - Association Between Satisfaction With Pnc Services and Perception of 
Responsiveness ............................................................................................ 68 
Table 4. 16 - Association Between Satisfaction With Pnc Services and Perception of 
Assurance ..................................................................................................... 69 
Table 4. 17 - Association Between Satisfaction With Pnc Servicesand Perception of 
Empathy ....................................................................................................... 70 

LIST OF FIGURES 

Figure 1.1 Theoretical Framework………………………………………………………..9 

Figure 1.2 The Conceptual Framework……………………………………...….............11 

Figure 4.1 Number of Times Attended Embu Hospital ................................................... 43 

Figure 4.3 Mode of Delivery............................................................................................ 44 

Figure 4.4 Baby.s Sex ...................................................................................................... 45 

Figure 4.5 Number of Children ........................................................................................ 46 

Figure 4.6 Support by The Service Providers .................................................................. 54 

Figure 4.7 Cleanliness of The Hospital Equipment ......................................................... 55 

 

 

 

 

 


ABBREVIATIONS AND ACRONYMS 

CMS -Centre for Medicare and Medicaid services 

C/S -Caesarian section 

FGD - Focused Group Discussion 

HIV -Human Immunodeficiency virus 

IUCD -Intra uterine copper device 

JOURN - Journal 

JPSNCQ - Jipi.s Postnatal Satisfaction with Nursing Care Questionnaire 

KDHS -Kenya Demographic Health survey 

SDG - Sustainable Development goal 

MOH - Ministry of Health 

PMH - Pumwani Maternity Hospital 

PNC -Postnatal care 

RR -Relative ratio 

RPO -Referring providers to others 

SPSS -Statistical Package for Social Sciences 

UK -United Kingdom 

US -United States 

UPAD - Using providers again for different treatments 

UNICEF - United nations International Children.s Emergency Fund 

UPAS -Using providers again for the same treatment 

WHO - World Health Organization 


DEFINITION OF TERMS 

Client : A woman within the reproductive age (15-49) years who 

comes for delivery services. 

Client satisfaction : How well the service provider meets the clients. 

expectations and fulfillment of needs. 

Infant : A baby from birth to one year. 

Perceived quality of care: The client.s thoughts about the postnatal services which 

are given in the hospital depending on her self- reported 
satisfaction level. 

Postpartum period : Time beginning from the birth of the placenta up to 

discharge from the facility. 

Postpartum services : Care given to the infants and their mothers immediately 

after delivery up to six weeks. 

Quality care : Provision of health care services which meets the needs of 

clients as well as the external standards set with the 
expectation that the health care providers are sensitive to 
the women.s needs and portray adequate clinical skills . 

 

 

 

 

 

 


ABSTRACT 

Satisfaction among patients has progressively been acknowledged as a salient outcome 
within the delivery system of health care and there are numerous studies being done 
among developing countries. Majority of the women report low satisfaction with the 
postnatal care services compared to the other maternity care phases. The World Health 
Organization advocates that the women.s satisfaction should be surveyed as a tool geared 
towards improvement of effectiveness and quality of maternal health care. The purpose 
of the study was assessment of satisfaction with the postnatal services offered in Embu 
Hospital among women who delivered in this facility. This study was directed by the 
following specific objectives; determining women.s satisfaction with postnatal care 
services, determining influence of socio-demographic factors on women.s satisfaction 
with postnatal care, establishing health system factors influencing satisfaction of 
postnatal women and establishing the influence of perceived quality of care on women.s 
satisfaction. Research design used was descriptive cross-sectional. The population 
studied were postnatal women 15-49 years who had delivered in Embu hospital. The 
study applied systematic random sampling method and the sample size was 225 
respondents. A structured client exit questionnaire, interviews with key informants and 
focused group discussion guide were used to collect data. Pretesting was done in Chuka 
hospital to ensure validity of the instruments. Reliability of research tools was decided 
through test-retest strategy. Authority to conduct this research was obtained from the 
Kenyatta University Ethical Review Committee and approval acquired from the National 
Commission for Science, Technology and Innovation. The study generated both 
quantitative and qualitative data. The statistical package for social scientists (SPSS 
version 20) was used for data coding and entry and analysis through descriptive and 
inferential statistics. Percentages, frequencies and cross tabulations were adopted to 
present data. The study outcomes uncovered that most women 54.6% were satisfied with 
postnatal care services provided with only 45.4% being dissatisfied. Findings from this 
study also showed that socio-demographic factors like age (P=0.759), marital status 
(P=0.667), education level (P=0.717), occupation (P=0.194) and monthly income 
(P=0.385) did not have a significant relationship with women.s satisfaction with 
postnatal care. The study noted that the health system factor that influenced postnatal 
women.s satisfaction was comfort and care (P= 0.008). Pertaining influence of perceived 
quality on satisfaction, it was noted that women from the FGD.s associated quality with 
tangibles like clean hospital environment, availability of resources and staff. Majority of 
the key informants ranked the quality of postnatal services as good. The study concluded 
that some women 45.4% were still dissatisfied with the postnatal care services provided 
in this facility. The study recommends that the county government in liaison with the 
hospital administration should have frequent patient satisfaction surveys which can help 
to provide feedback to customers hence improving the satisfaction of the clients. 
Recruitment and employment of more qualified staff by the county government to 
enhance the quality of postnatal care provided. 

 


CHAPTER ONE: INTRODUCTION 

1.1 Background Information 

Numerous women report lower satisfaction with the care and bolster they receive amid 
the postnatal period than the other stages of their maternity care (Cheyne, Skar, Paterson, 
David and Hodgkiss, 2013). There is mounting evidence within the UK, US, Australia 
and Belgium that women continue to report how unsatisfied they are with routine 
standard postnatal care (Crowther, Maclver and Lau, 2019). 

The World Health Organization advocates that satisfaction of women should be assessed 
frequently as a tool of improvement of the effectiveness and quality of maternal care 
(WHO, 2011). It accentuates emphasis on satisfaction of clients as a means of auxiliary 
avoidance of maternal mortality, since satisfied women have a higher likelihood of 
adherence to the recommendations by the health providers (Morris, Jahangir and Sethi, 
2013). 

Satisfaction with postnatal care is an essential criterion of the quality of postnatal care 
provided by nurses in the postnatal wards (Bixy Centre for Global Reproductive Health, 
2011). Similarly, immediate postnatal care services help identify and address maternal 
and neonatal complications early; help reduce maternal mortality and morbidity thus help 
achieve the sustainable development goals target on maternal health (Kamau, 2019). In 
2017, Sub Saharan Africa, the maternal mortality proportion was 542 deaths per 100,000 
live births. The global estimates for the year 2017 reports that approximately 1000 
women die worldwide each day in the postpartum period. In the developing countries 
80% of these maternal deaths occur within the first week postnatally (WHO and UNFPA, 


2019). In 2019 there were about 2.4 million neonatal deaths globally with approximately 
6,500 neonatal deaths occurring daily (WHO, 2020). 

According to a maternity survey on the encounter of women with maternity services in 
the UK in 2014, the study showed that women had more satisfaction with pregnancy care 
(87%), labour and birth care (87%) and were moderately satisfied with postnatal care 
(80%). This still shows that there is a gap that requires to be tended to raise the 
satisfaction with postnatal care (Redshaw & Henderson, 2017). A Cohort study 
conducted in Sweden comparing mothers who gave birth in 2006 and 2017, showed a 
greater proportion of women were „very satisfied. with the larger aspects of postnatal 
care in 2017 as opposed to 2006 (Ohm, Parment and Hidingson, 2020). 

Satisfaction of clients has progressively received recognition as a salient outcome within 
the health care delivery systems and is being studied more within the developing 
countries (Xesfingi and Vosikis, 2016). A study conducted on postnatal care quality and 
satisfaction of patients in Nepal in 2015 showed that 48% of postnatal women were 
highly satisfied with the services offered at the maternity unit while 38% were fairly 
satisfied. Most women 79% were satisfied with the information provided by service 
providers, 73% health providers skill, 74% politeness exhibited by staff, 75% satisfied 
the facility cleanliness and 73% with the degree of privacy exhibited during the postnatal 
check-up (Acharya, Sharma, Dulal and Aryal, 2018). 

Lamadah and El-Nagger (2012) conducted a study in Cairo, Egypt on satisfaction of 
women with nursing care quality during postnatal period and the discharge teaching plan 
at a maternity hospital at Ain Shams city. A total of 104 postpartum mothers were 
recruited. The study reported that (71.0%) of the mothers were unsatisfied with the 


quality of services given in the postpartum period. Another 83.0% of women were 
unsatisfied with the instructions during discharge. More satisfaction was reported among 
the rural area residents, housewives, older women, low education, and low parity. The 
study concluded that the difference observed was statistically significant. 

In South Africa a cross sectional study done in Limpopo region on clients satisfaction 
with midwifery care showed that among the 79 mothers who were interviewed, only 
16.5% who were unsatisfied, a higher percentage 51.9% were satisfied, whereas 32.5% 
were neutral with the services they received during intrapartum and immediate postnatal 
period (Lumadi & Buch, 2011). 

Kenya still faces the challenge of high maternal mortality rate, currently estimated around 
362 deaths per every 100,000 live births. This is beyond SDG targets of 70 per every 
100,000 by 2030. This drawback is majorly accelerated by paucity to quality maternal 
health services predominantly during delivery and postnatal period (KDHS, 2014). On 
June 1st 2013, the Kenyan government took the initiative of addressing the problem by 
introducing a policy on free maternity care services in all the public health facilities 
(Ministry of Health, 2015). In July, the head of public health and sanitation approximated 
a 10% surge of deliveries in the country, with rise of 50% in some counties (Bourbannais, 
2013). Embu hospital which is the study site at the time had approximately 250 deliveries 
per month, which has since doubled (Embu hospital records, 2015). 

This policy has been faced by numerous challenges since its introduction. There is scarce 
or sluggish distribution of funds for the program, insufficient infrastructure, equipment 
and staffing. With the rolling out of the free maternity services, hospitals have also 
reported overcrowding in maternity wards due to high numbers, and the mothers being 


forced to depart from the hospital early to accommodate others or even share beds 
postnatally. The new policy has resulted in nurses being strained, overtime working hours 
and high workload resulting in as few as 2 nurses assisting more than 20 mothers at any 
given time (Bourbannais, 2013). In the midst of these challenges, it was salient to 
conduct a study among the postnatal women who had delivered in Embu hospital to 
determine their satisfaction with the quality of services offered. Measuring satisfaction 
would aid in understanding the patients. experiences during the postpartum period with 
the aim of obtaining information on the quality of health care services and pinpoint any 
problem areas. 

1.2 Problem Statement 

The Kenyan government launched the national expanded free maternity services 
program, entitled „Linda Mama. which was an achievement towards improving access to 
quality newborn and maternal services across the country. Through this program the 
country would also attain its goals on health as outlined in the Kenya Vision 2030 and 
also SDG No. 3 about good health and wellbeing of the postnatal mothers (Appleford, 
2019). However, since the program started there has been an influx of clients in 
government facilities seeking maternal health services. This increase in clients against a 
gradient of few health care workers may pose a challenge in the quality of postnatal 
services offered. Other challenges that the program faces include shortage of resources 
and financial constraints. These could translate to lower levels of satisfaction in public 
hospitals. 

The expectancy fulfillment theory propounds the magnitude of inconsistency between 
experiences and expectations normally determines satisfaction (gap model). The greater 


the perceived fulfillment of expectations the more noteworthy the fulfilment and the 
lower the perceived fulfillment of desires the lower the level of fulfilment (Serrano, Shah 
and Abramoff, 2018). When the client.s expectations are lower they are met easily and 
greater satisfaction is reported, but greater expectations are more difficult to meet and 
lower satisfaction is reported. Nonetheless, increased care quality can result in increased 
care expectations, and extremely high expectations might be unfeasible and more difficult 
to satisfy. A surplus in delivery of postnatal care against what the client hoped, predicted 
or expected results to more satisfaction, on the contrary when the expectations are not 
met this results in increased dissatisfaction. The postnatal women expect that the public 
health facility offers quality services and that all their needs will be met. Failure to which 
this could translate to lower level of client satisfaction. 

According to statistics from Embu hospital maternity department between 400 to 500 
women deliver their babies every month (Embu Hospital Records, 2015). The satisfaction 
of approximately 4,800-6,000 women who delivered their babies each year in Embu 
hospital was incognito. It was therefore essential and pertinent to assess client satisfaction 
with the postnatal care offered in this maternity unit, particularly because it serves as a 
referral hospital for more than half of women in Eastern region. It.s also important to 
investigate into the satisfaction issue due to the free maternity health policy, as no study 
has been done so far in Embu hospital. Health workers cannot understand the quality of 
care offered to mothers unless it.s assessed through client satisfaction. Hence, this 
satisfaction study on postnatal women will provide a means for assessing the care given 
and a spring board for its advancement. 


1.3 Justification 

Postnatal care is the most abandoned area in the health care delivery system despite being 
a very crucial time for the provision of interventions for the mothers and their newborn 
(Bixy Centre for Global Reproductive Health, 2011). As a result, serious complications 
which account for more than sixty five percent of all postnatal deaths occur within this 
period. More than 80% of these deaths can be averted through access to quality 
professional care during delivery and postnatal period (WHO, 2013). Hence maternal 
satisfaction studies are important since client fulfilment is an instrument of auxiliary 
avoidance of maternal mortality. In Kenya, the issue of fulfilment of women concerning 
postnatal services should to be investigated. Most of the studies have focused on the 
general satisfaction with outpatient services and prenatal services. Detecting the gap in 
the current literature, the present research aimed at examining the satisfaction of postnatal 
women who are the main consumers of maternal care in Embu hospital. 

Health facilities may also derive benefit from this research by being in a better position to 
get feedback from the postnatal clients, hence identifying any areas of improvement in 
their service delivery. 

This ponder will also enrich any literature gaps; hence act as a basis for future reference. 
The study also hopes to make recommendations to policy makers on the different ways of 
improving the postnatal quality and women.s satisfaction. 

1.4 Research questions 

1. What is the level of satisfaction with postnatal care among the postnatal women? 
2. What is the influence of socio- demographic characteristics on satisfaction with 
postnatal care? 



3. What are the health systems factors influencing satisfaction of postnatal women? 
4. What is the influence of perceived quality of care on the satisfaction of women? 


1.5 Null hypothesis 

H01 Socio-demographic factors do not influence the women.s satisfaction with postnatal 
care services 

H02 Health system factors do not influence the women.s level of satisfaction with 
postnatal care services 

H03 Perceived quality of care does not influence the women.s level of satisfaction with 
postnatal care services 

1.6 Main Objective 

The main objective of the study was assessment of the women.s level of satisfaction with 
the postnatal care services in Embu Hospital. 

1.7 Specific objectives 

1. To determine the level of women.s satisfaction with the postnatal care provided to 
them. 
2. To determine the influence of socio- demographic characteristics on the level of 
satisfaction with postnatal care. 
3. To establish the health system factors influencing satisfaction of postnatal women. 
4. To establish the influence of perceived quality of care on women.s satisfaction. 


1.8 Significance of the study 

The discoveries generated in this research will be useful to the Division of Reproductive 
Health, Ministry of Health (MOH) in appreciating the effects of the free maternal health 


services scheme in Kenya, as this will be a reflection of findings that pertains one of the 
level 5 hospitals. Policy direction and intervention strategies may be reviewed as a result. 
Findings will also serve as locality specific data that may be useful literature for other 
researchers on issues of maternal health. 

1.9 Limitations 

Proper timing for interviewing the postnatal women was not clear for all clients since 
some mothers had delivered through caesarian section. 

Women who had inadequate information on services that should be offered to them and 
lower service quality expectations, might have recorded higher satisfaction even if 
services offered did not meet the standards of care. 

Women with low self-esteem issues, or those cognizant about the status differences 
between themselves and service providers, might have felt compelled to demonstrate 
gratitude and satisfaction with the services given. 

1.10 Delimitations 

The researcher and team tried to liase with the postnatal nurses to ensure the women were 
interviewed just prior to discharge from the facility. 

Women were affirmed and request to give honest responses concerning the care that was 
given. The women were assured verbally and instructions given in writing that nothing 
would happen to them, even if gave a negative report concerning services received. 

1.11 Theoretical framework 

This study assumes Expectancy- disconfirmation theory which is a widely accepted 
theory on client satisfaction processes. Expectations are strong beliefs about a service 


encounter. Someone.s expectations can be determined by prior service encounter or 
communication from staff such as the nurses, doctors or other health personnel (Serrano, 
Shah and Abramoff, 2018). Based on this theory being dissatisfied or satisfied arises 
when the clients compare the performance of a product or service with the foreordained 
measures of performance (customers. expectations). There are three possible outcomes, 
positive disconfirmation which is reported when the performance is perceived to be better 
than the predetermined expectations of the client. This results in elated customers who 
are usually satisfied. Zero disconfirmation occurs when execution is viewed to equate to 
the desires, hence clients are likely to be fulfilled. Ultimately, negative disconfirmation 
happens when execution is lower than desires leading to dissatisfied consumers (Shinde, 
2018). Therefore, when the postnatal women.s service expectations were met this was 
likely to determine how satisfied the woman was with the care given. Previous 
experiences with the postnatal care services in this facility was also likely to have 
influence whether the woman was satisfied with services or not. Most women seek 
services in the same facility if the past experience was good. 

 


Patient.s 
expectations 

Patient.s past 
experiences 

Patient.s perceptions 
about the services 

Patient’s 
satisfaction 

Satisfied 

Not Satisfied 

 

.Positive 
disconfirmation 
.Zero 
disconfirmation 
.Negative 
disconfirmation 


 

Figure 1.1 Theoretical Framework Source (Author, 2016) 

 

 

 

 

 

 

 

 

 

1.12 Conceptual framework 

The conceptual framework for this study is demonstrated in Figure 1.2. An independent 
variable is the factor manipulated or selected by the researcher to determine its 
relationship with satisfaction of women with postnatal care. This independent variable is 
assumed to cause changes to occur in another variable (Mugenda, 2003). Socio-
demographic factors, health system factors and quality of service dimensions are the 
independent variables. The socio-demographic variables included age, education, 
occupation, newborn.s sex and mode of delivery. The health system factors included 
information, communication patterns of health providers, orientation, staffing, comfort 
and care given to the woman. The perceived quality of care included responsiveness, 
assurance, tangibility, empathy and reliability. Tangibility dimension consisted of 
physical facilities, equipments and personnel appearance. Reliability entailed 
performance the guaranteed services in a dependable and accurate manner. 
Responsiveness focused on assisting clients willingly and providing services promptly. 


Assurance dimension consisted of the information exhibited and employee.s 
courteousness, their confidence and level of inspiration. Empathy dimensions will deal 
with the individualized attention given to the postnatal women. 

The intervening variable is something that explains the relationship between the 
dependent and independent variables. It comes amidst the dependent and independent 
variable (Mugenda, 2003). For this study, the policy guidelines and the standard 
operating procedures were considered as intervening variables. 

A dependent variable is the variable that the researcher manipulates or changes and is 
assumed to have an explicit effect on the independent variable (Mugenda 2003). 
Women.s satisfaction in this case was being influenced by the three independent 
variables namely; socio-demographic variables, health system factors and perceived 
quality of care. High level of satisfaction was indicated by the women being loyal to the 
hospital and recommending other women to come to the hospital to receive postnatal 
care. 

 


Socio-demographic 
factors 

.Respondents age 
.Education level 
.Occupation 
. Newborn sex 
.Type of delivery 


Health system 
factors 

.Information 
.Communication 
.Orientation 
.Comfort & care 
.Staffing 


 Dependent 

 variables 

WOMEN 
SATISFACTION 
WITH POSTNATAL 
CARE SERVICES 

.Satisfied 
.Not satisfied 


Intervening 
variables 

.Policy 
guidelines 
.Standard 
operating 
procedures 


 

Perceived Quality 
of services 

.Reliability 
.Responsiveness 
.Assurance 
.Tangibles 
.Empathy 


 

Independent variables 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 1. 2 - The conceptual framework (Adopted and modified from Kamau, 2019 
model) 

 


CHAPTER TWO: LITERATURE REVIEW 

2.1 Introduction 

The section highlights the literature on satisfaction of women with the postnatal care 
services. The literature is presented based on the study objectives. The literature sources 
include journal articles from the internet, Google scholar, Pubmed, WHO publications 
and KDHS publications. 

2.2 Theoretical Literature Review 

2.2.1 SERVQUAL Model of Care 

The SERVQUAL model evolved and was actualized by the three American promoting 
experts Parusamann, Zeithaml and Berry in 1988. It is a strategy to assess the experiences 
of customers on service quality. This model can be used to expose shortcomings in the 
delivery of services to clients and ways of addressing them, which is referred to as “Gap 
analysis”. It is used to compare the service quality that is expected and the service quality 
that has been experienced. Based on this the center is continuously about clients. needs 
and not on the measuring framework or organizations perception. When the customer.s 
needs are being determined, the crevice between customers. desires and the genuine 
service they experience need to be considered. The satisfaction gap results from the 
substantial difference between the client.s expectations about a service and the first hand 
services they experience. At long last this results in the biggest gap in the experience of 
quality (Kar, 2016). 

The SERVQUAL model aids in bridging the gap between the expectations of the 
customer and their needs. This model previously had ten components for measuring 
quality service namely; communication, security, responsiveness, credibility, reliability, 


competence, access, courtesy, understanding the customer and tangibles. All these 
components have been merged to RATER model which comprises of five components 
namely; Responsiveness, Assurance, Tangibility, Empathy and Reliability (Kalaja, 
Myshketta and Scalera, 2016). 

2.2.2 Reliability 

It.s the health providers. willingness to perform promised service in a correct and 
dependable manner (Kalaja et al, 2016). According to Essiam (2013), reliability of the 
service means that the patient is seen according to their expectations and the capacity to 
treat problems faced by the clients. In Tanzania most clients reported they were satisfied 
with the physical examination done, but were least satisfied with the aspect of 
prescription of the drugs by physicians (Khamis and Njau, 2014). 

2.2.3 Responsiveness 

A responsive service is the actual experience of the client.s interaction with the health 
system. The clients always have an expectation that the health workers will respond 
promptly when needed. The expectation is that the hospitals have the required equipment 
that are functioning and have the ability for making quick diagnosis of various diseases. 
Moreover, clients always expect that all the endorsed medicines are accessible and 
promptly given (Pena, Silva, Tronchin and Melleiro, 2013). A study conducted in 
Pumwani hospital in Kenya among 280 mothers revealed that most of these women 
(85%) were satisfied with the waiting time to be attended which took less than 30 
minutes. Only 4.9% of the women reported that they waited to be attended to for more 
than 1 hour, meaning that this facility observed the service charter (Onyango and Kaikai, 
2014). 


2.2.4 Assurance 

The level of knowledge, courtesy and the skills exhibited by the health workers provides 
a sense of affirmation that they have the patient.s best intrigues in mind and they will 
deliver services with judgement, decency and beneficence. Assurance in health care is 
manifested by staff who ensure reports from the lab are correctly interpreted, disease are 
diagnosed competently and appropriate answers to all questions are given and client 
safety observed. Nurses have a crucial role in addressing the clients. issues in a 
competent way. Further, the more the assurance from the health provider, the greater the 
level of satisfaction of patients (Pena et al., 2013). Clients seeking services in 
Mwanamanyala hospital in Tanzania reported that the staff treated their information with 
a lot of confidentiality and they felt that staff had adequate knowledge to answer their 
questions (Khamis and Njau, 2014). 

2.2.5 Tangibles 

Tangibility is an aspect of service quality that the clients can feel. Clients need the 
physical evidence that the facility is going to provide satisfactory services. Good physical 
appearance of the health facilities, hospital equipments, health personnel and written 
materials such as posters create positive impressions. The health facility should be clean 
and organized. The staff, restrooms, equipment, wards and beds should also be neat and 
properly handled since this can influence the client.s impressions about the hospital (Pena 
et al., 2013). A research conducted at Nyandarua Hospital in Kenya on perceived quality 
of services showed that women had a satisfaction index of 69% on the tangibility aspect. 
Most women (61%) reported that the facility had well maintained and modern 


equipment.s, with 100% of respondents reporting that the staff were clean and well 
groomed (Katuti, 2018). 

2.2.6 Empathy 

This dimension defines the ability to connect and affirm the customer.s feelings. The 
health workers must always portray empathy as they attend to their clients. In nursing, the 
midwives must be very careful about the post natal period as it.s a period when the 
woman experiences a lot of changes psychologically and she must adjust positively. 
Therefore, empathy must be portrayed to help the woman adjust to her new life of 
motherhood in order for her to give proper care to her baby (Pena et al, 2013). A 
systematic review was conducted among 15 Sub-Saharan African countries and the 
results showed that women preferred health workers who are kind, respectful, attentive, 
and very supportive to the women.s needs (Lythgoe, Lowe, McCauley and Hannah, 
2021). 

2.3 Client satisfaction with Health care services 

Satisfaction of clients is the degree to which their desires for different services are 
achieved. Satisfaction has two major constituents. The client expectations and the real or 
perceived quality of services offered in the hospital. When a patient engages with the 
hospital, they usually have some expectations concerning the quality of services it should 
provide. The patient.s education level, income level, culture background, aspiration 
levels and views about the world normally exerts some level of influence what to expect 
(Ismail and Yunan, 2016). 


The satisfaction of clients shows the quality of health services. Great client satisfaction 
studies are not ends in themselves; they are a vehicles for improvement of services to the 
public. The information on the degree of client satisfaction serves two key purposes. It 
highlights improvement areas in the quality of services given and amendments to be done 
when the client.s expectations are more than what a particular program was meant to 
provide (Xensfingi and Vosikis, 2016). 

There are different rationales for determining clients. satisfaction within the health sector. 
These include: -Allowing initiation of quality improvement efforts and exhibiting value 
for public money utilized. Secondly is determining whether programs are working from 
the customers. point of view and the kind of changes required. Another reason is to 
identify what the clients value most. It also helps in offering feedback to staff about how 
clients perceive their services and supporting objectives that are cost effective. Lastly it 
assists to ensure that programs and services are delivered in an effective and efficient 
manner, considering the objectives, aims, tasks, responsibilities and resources available 
(Tinker, 2018). 

Client satisfaction is defined as the ratio of client perception and client expectation. The 
way a client.s expresses how satisfied or dissatisfied they are is a judgement on the 
quality of care given in that facility (Singh, 2012). Paul and Meesala (2016) pointed a 
strong association between the satisfaction level and service quality. They postulate that 
the client.s views on quality services results in satisfaction of the mind. 

In health sector, the satisfaction of customers is very important just like the other service 
sectors. Any hospital can accomplish satisfaction of patients by provision of quality 


health services, keeping in mind the patients expectations and continuous improvement of 
services provided (Karaca and Duna, 2018). 

Health care is among the speediest growing service in both developing and developed 
countries (WHO, 2019). Clients nowadays are referred to as healthcare customers, noting 
that most people consciously decide to purchase the services from providers that best 
meet their healthcare needs. Therefore, the quality of health care and client satisfaction 
are two important health outcomes and quality measurements. Creation of health care 
standards and ensuring the needs of the patient are met are key drivers in achievement of 
high quality. Patients expect to receive quality health care services, in a comfortable and 
safe environment. They also expect to be attended to by caring and empathetic staff, who 
ensure efficient processes, accurate information is gathered and staff who exhibit high 
level of professionalism at all times (Michael, 2018). Subsequently, the patient is core in 
the health care quality plan (WHO, 2019). 

2.4 Socio-demographic factors 

Health care satisfaction depends on numerous variables like socioeconomic class, 
educational level, marital status and age. Educational attainment has been shown to have 
an influence on satisfaction, the trend being that more satisfaction is associated with low 
education levels. A research survey among 411 women in North Iran on maternal 
satisfaction with health and health care services revealed a significant relationship 
between satisfaction with health services and the level of education (P=0.026), health 
services and age (P=0.031) and number of children (P=0.018) (Mirzaei, Ghadikolaee, 
Bazzaz and Ziaee, 2015). Another study in Nepal conducted among 178 postnatal 
mothers showed that those with primary and low level of education were more satisfied 


compared to the respondents who had the secondary and above level of education (P-
value 0.241). Multiparous women were 2.352 times more likely to be satisfied than 
primiparous (P-value 0.111) (Panth and Kafle, 2018). 

A Greek study on satisfaction of women with postnatal care was conducted between 
January 2015 to July 2017 among 300 women. The results showed no correlation 
between age of mothers, number of children and satisfaction level. Education was shown 
to be statistically significant with a P value <0.0001 (Panagopoulou, Kalokairinou, 
Tvazella and Tziaferi, 2018). 

A study conducted in 2013 in Turkey among 300 women on satisfaction with postnatal 
care in a government hospital in Fazil city reported that most women (56%) were aged 
between 20 to 29 years, 47.7% had schooled upto primary level, 81% were housewives, 
33% were university graduates. Most women (53.7%) had delivered via Caesarean 
section. In this study only 32.3% of the women were satisfied with postnatal care with 
67.7% reporting dissatisfaction. Most women reported they were not given information 
relating to postnatal care (Zeyneloglu, Kisa, Badem and Ozberk, 2017). 

A Greek study that was done in Athens on satisfaction of women with health services 
they received while delivering, among 139 mothers showed there was no significant 
relationship between occupation and marital status with the services provided by 
midwives or the doctors. Mothers who had delivered through spontaneous vaginal births 
were more satisfied with midwives than the women who had caesarean section 
(Sachsanidis, 2018). A Kenyan study assessing satisfaction with maternity services in 
public facilities among postnatal women in Nairobi County showed that satisfaction 


increased with decreased family monthly income (p=0.001). In this study 43.5% (n=88) 
of the women with high satisfaction level were housewives (p=0.002) (Okari, 2018). 

2.5 Health system factors 

 The health system factors include: orientation, communication, information, comfort and 
care, staffing and service provider.s availability, equipment and drug availability, 
customer care service or client reception. 

An evaluation study that was done among 100 postnatal mothers satisfaction at El-Shatby 
Hospital in Egypt revealed that 36% of the mothers were unsatisfied with the orientation 
during admission. Another 33% felt they were not satisfied with the orientation to the 
health team members and the postnatal unit. Only 15% of these women reported 
satisfaction with the communication aspect since nurses communicated in mothers own 
language. Another 45% of the mothers reported satisfaction with the comfort and care 
given in this facility. Regarding postnatal information given, 36% reported they were 
educated on postnatal exercises and importance of family planning, 37% education on 
signs and symptoms of neonatal conditions (Battawi and Haffiz, 2017). 

A study done in Pumwani maternity hospital (PMH) on the determinants of client 
satisfaction, among 280 postnatal mothers showed a significant association between 
patient waiting time and client satisfaction. Long waiting time showed an association 
with low satisfaction. Findings also reported 45% of the women being unsatisfied with 
the comfort and cleanliness of this facility, while 34.6% were satisfied and 7.9% very 
satisfied. Another 24% of the clients felt they were not treated with courtesy. While 29% 
felt the hospital had inadequate health providers. The researcher concluded that the 


facility was understaffed since there were many clients with only very few nurses and 
doctors (Nyongesa, Onyango and Kakai, 2012). 

Communication is the main ingredient in the maternal health care provider-client 
relationship. Safe motherhood, provision of basic health care as well as emotional and 
psychological support is enhanced through effective communication during antenatal 
care, delivery care and postpartum period. In a South African study conducted among 
260 women in a hospital, findings revealed that 43% of these women and 63% reported 
satisfaction with information received from the doctors and nurses respectively (Khumalo 
and Rwakaikara, 2020). 

In a study done in Iran among 411 postnatal mothers 96.6% of the women reported 
satisfaction with communication skills portrayed by midwives. Another 86.6% were 
satisfied with the interpersonal characteristics of the midwives (Mirzaei, Ghadikolaee, 
Bazzaaz and Ziaee, 2015). Studies in Poland revealed that women prefer both verbal 
(asking questions, providing information) and non-verbal communication (touching and 
maintaining eye contact) and perceived this as being helpful in the early postpartum 
period (Baranoska, Pawlika, Kieresnowaska, et al, 2021). 

Lamadah et al, (2012) conducted a study in Cairo- Egypt at Ain shams maternity hospital 
on perspectives of women towards the nursing care quality during the postpartum period. 
The descriptive study randomly selected 104 postnatal women. The results showed that 
87.5% were dissatisfied since they received brief information, 82.7% were unsatisfied 
due to lack of decision making pertaining baby care and themselves, while 83.7% was 
due to lack of relevant advice. Most of the mothers (62.2%) said they were not given a 


chance to raise any questions, 63.5% reported nurses never listened to their complaints. 
The conclusion was that more focus should be geared towards quality of postpartum 
examinations and health talks relating to mothers and neonates. 

2.6 Quality maternal health services 

The quality of care provided by the health provider influences utilization in numerous 
ways, however not much is known concerning how this relationship works. Research has 
reported that when services offered meet the right quality this affects the decisions about 
seeking the care. When customers are able to access different facilities, it is often their 
perception about the quality of care, related their experiences or those of others known to 
them, other than how near they are to these services which determines the choice of the 
facility. The effectiveness of treatment and the measure of dissatisfaction with the 
services received usually shapes a patient.s, friends and family.s views about the care, 
which determines the health seeking behavior. Literature also records that views about 
maternity care depends on the information the women gets from family members and 
acquintances (Kieft, De Brouwer, Franke and Delnoij, 2014). 

Shi and Singh (2014), reported that quality can be explained in two ways: - Quality being 
a satisfaction index which is dependent on someone.s experiences concerning aspects of 
a medical service viz. dignity, security, level of independence, comfort, privacy, decision 
making ability and individual preferences. Secondly quality as a measurement of how 
satisfied individuals are with life and their self-perceptions about health following 
medical interventions. 


Meesala and Paul (2016), explained the tri-component model where the loyalty of clients 
about a medical service provider is measured using three dimensions namely. Usage of 
Providers Again for Different Treatments (UPAD), and Referral of service Providers to 
Others (RPO), Using Providers Again for the Same Treatment (UPAS). This model, has 
shown that all loyalty measures outlined above are dependent on the overall quality of 
services. They postulated that the quality of maternity care has three lateral constructs; 
which are nurse.s performance, doctor.s performance and the quality of operations. 

Evidence suggests that some of the procedures specific to childbirth and postnatally in a 
hospital may instill fear and dislike and which can inhibit utilization of services. Some 
women are not comfortable exposing their genitalia within the hospital ward and some 
hate the positions used during the postnatal check- ups. When the right quality of care is 
given the woman dignity is upheld, and ensures respect is maintained (Bohren, Vogel, 
Hunter, et al, 2015). 

A systematic review on what determines women.s satisfaction with the maternity health 
care services identified the key factors defining quality health care services: - the patient-
provider interactions, accessibility to services , physical structure of facility and health 
workers technical competence. The women interviewed described quality health care 
services as a polite and attentive physician, should be very knowledgeable, provide health 
care services within well-equipped and clean facilities. Women also reported that 
quality health services should demonstrate positive provider-client interactions. They 
highlighted that the first thing the patient faces while using health services was a 
respectful attitude from the health providers. Women also felt that the technical 
competence of the provider is crucial in ensuring quality of health care. Women reported 


that medicines and equipment.s should always be available. Also medical personnel and 
wide variety of services are also key in ensuring the quality of services. How clean the 
facility is, ensuring patient comfort and appropriate hygiene and sanitation conditions are 
also crucial measures for quality of health care service (Svirastava, Avan, Rajbangshi and 
Sanghitta, 2015) 

Pain after child birth also affects satisfaction and views on the quality of care given. 
Some studies revealed that women who develop self-control and high self-confidence in 
controlling the pain, their satisfaction was much greater. Continuous support during the 
labour process and within the postnatal period, information and joint deliberation in 
decision making are also important variables (Okumu and Oyugi, 2018). 

Dansereu et al, (2015) in their study opined that satisfaction of patients was determined 
by the quality of care. From this study, satisfaction was dependent on three key aspects of 
the healthcare organization. These are patients. views about quality healthcare service, 
good healthcare organization and good healthcare providers. 

2.7 Overview of Postnatal Care 

The WHO defines postpartum period as the timing from one hour following placenta 
delivery upto six weeks after birth. Postnatal care entails individualized care given to a 
woman and her neonate to meet their needs after child birth. However in this study, it will 
focus on the immediate postnatal period majorly within the first week before the client is 
discharged from the health facility (WHO, 2013). 

Women who give birth are ideally encouraged to stay at the hospital for at least 24 hours 
before they are discharged home. This enables the health workers to make observations to 


the newborn and mother. This helps in determining the best feeding option and ensure 
early detection of maternal and neonatal complications. In case the health worker 
identifies any risk factors for both the mother and the baby, then they are observed for 
another two days to ensure the baby is feeding, kept warming and complications are 
managed. Kangaroo mother care is also encouraged for mothers with low birth weight 
babies. Mothers are also advised on when to bring their newborns back when they notice 
danger signs. They are given a return date for post natal checkup, which increases the 
attendance with their babies (WHO, 2013). 

The key role of the health provider in the postpartum period involves:-monitoring of the 
vital signs, monitoring for signs of abnormal bleeding, pallor, physical examination for 
both mother and baby, counseling and advice on infant feeding, infant care, self-care, and 
insert postpartum IUCD as a method of family planning (MOH and MPHS, 2012). 

The postnatal period is a very susceptible time and extremely crucial for the woman. 
Women experience a lot of physical, psychological, mental, emotional and social changes 
that impact the quality of life, and majority of the women especially primigravidas are 
overwhelmed by the numerous demands of motherhood. Hormonal changes may 
influence maternal behavior, such as bonding between the mother and baby, hence she 
requires a lot of education and social support from the health worker to enable her take 
good care of the baby (WHO, 2015). 

The postnatal period quality of care is determined by the care encircling childbirth. In 
Kenya skilled care is available in most facilities, however the health providers are often 
very busy to think about giving health talks on the importance of postnatal check-up for 


the new mothers and the babies which results in a multitude of complications (MOH and 
MPHS, 2012). 

2.8 Women’s Perceptions and Experiences in In-Hospital Postnatal Care 

Many studies have identified what women want and require from their postnatal care. 
Overwhelmingly, women report that they value individualized attention and care from 
midwives and other staff who are compassionate, positive and friendly. In Australia a 
study conducted, noted that postnatal women needed good support system and 
acknowledgment during the postnatal period. Further emphasis should be on maternal 
role development to enhance transition into motherhood (Emmanuel et al., 2011). In a 
study done in Canada on experiences of women on inpatient postpartum care reported 
that most mothers had positive experiences during the postnatal period. Most of the 
women 72.5% found that nurses were beneficial with assistance on breastfeeding and 
81.8% helpful in baby care. More than half 59.4% reported that the postnatal care being 
excellent while 33.7% rated the care being extremely good (Ziabakhsh, 2018). 

It is rare however, that women report receiving individualized care where a midwife 
listens to their needs and concerns. In a research conducted in Western Australia, women 
rated midwives. ability to provide adequate emotional support after birth as poor 
(Fenwick et al, 2010). Women have also described the in-hospital environment as noisy, 
concerned about lack of privacy and constant interruptions and therefore not conducive to 
rest and recovery (Adatia, Law and Haggerty, 2014). 

Most women are dissatisfied with the way information is provided in the postnatal unit. 
Researchers report that the information provided to women is rarely individualized to 


women.s specific concerns. Women commonly describe inadequate information, lack of 
guidance and support about post birth health concerns, baby care and breastfeeding 
(Panth and Kafle, 2018). In a national survey conducted in 2015 in Australia on postnatal 
services showed that women needed help in the following areas; breast feeding help 68%, 
baby care 65%, care of mother and body changes 58%, emotional support 46%. Fifty 
seven percent were positive and 41% negative about the performance of their midwife in 
the postnatal period (Burgess, Curie and David, 2015). 

A study conducted by Luxford et al (2010) depicted that factors influencing satisfaction 
with hospital experience included, speed and efficiency of services, comfort received, 
information given, communication, emotional support, dignity and respect accorded. A 
study conducted in 2014 in Iran hospitals, showed that clients preferred the following 
qualities of health care services; cleanliness of the hospital environment and comfort 
offered, good communication by the nursing staff, doctor communication skill and 
responsive services by the hospital personnel. Patients normally define quality of health 
service based on attributes like being respectful and compassionate compared to the 
technical competence of doctors and other staff (Mosadeghrad, 2014). 

The previous experiences during hospitalizations and the length of stay at the hospital 
well also influenced patient satisfaction. The patients with more experience of 
hospitalization have more realistic expectations and are therefore easily satisfied. When 
the length of postnatal hospital stay is reduced this poses a risk on the quality of care of 
both mother and baby. The study also shows that the choice of the hospital by the patients 
presumably reflects good previous experiences at that hospital (Bowers and Cheyne, 
2016). 


Numerous studies were conducted in the UK on the experiences of women on postpartum 
care. More than three quarters of the women in these surveys reported satisfaction with 
the kind of care they received. Eighty three percent and 86% of the women reported good 
and excellent postnatal care. These women also reported being dissatisfied with aspects 
such as lack of orientation to the ward, cleanliness and noise in the environment (Malouf, 
Henderson and Alderdice, 2019). 

2.9 Studies Related to Satisfaction of Postnatal Women 

Studies in the UK of mothers experience with maternity services established that women 
were more satisfied prenatal and intrapartal care than with postnatal care. This is a major 
shift compared to situation in Scotland where most mothers reported satisfaction with 
postnatal care (Care Quality Commission, 2013). 

In 2015 a study was conducted in Nepal on maternal satisfaction with the quality of 
services which showed that 48% of postnatal clients reported satisfaction with the 
services offered at the health facility and 38% fairly satisfied. Majority 79% reported 
being satisfied with information given by the provider, 73% with the level of skills of the 
health provider, 74% staff politeness, 75% facility cleanliness and 73% with the degree 
of privacy offered during the postnatal checkups (Acharya, Sharma, Dulal and Aryal, 
2018). 

A cross sectional study was done in Mozambique on mothers satisfaction with care after 
child birth. The study revealed that most women (92.5%) were satisfied with services 
given and 94.2% would recommend that a family member delivers in the same health 
facility. Only few of the mothers (49.8%) were satisfied with the assistance on feeding 


the baby. Majority of the women 93% were also satisfied with the level of respect and 
privacy (Mucombi, Hogberg, Lampa et al., 2019). 

In Ethiopia a study done in Amhara region on client satisfaction with postnatal care 
showed that 63% of the women were satisfied and 37% being dissatisfied with postnatal 
care (Adane and Wassihun, 2020). An observational comparative study was conducted in 
Brazil among 50 adolescents and 51 adults. The study showed that adolescent scored 
lower than adults in their satisfaction level with nursing care provided. The post-
caesarean adolescent mothers were less satisfied than mothers who had delivered through 
spontaneous vaginal delivery. Dissatisfaction was also reported on the availability of the 
nurse.s and nurse- client communication. Adolescents also scored lower than the adults 
with the satisfaction with baby care (p=0.004) (Passarrelli, Lopes, Merighe, et al., 2018). 

A descriptive study on evaluation of satisfaction levels as perceived by postnatal mothers 
following nursing care and factors that influence their satisfaction. The sampling method 
used was purposive to come up with a sample size of 100 women. Data was collected 
using the Jipi.s postnatal satisfaction with nursing care questionnaire (JPSNQ. The results 
reported that (1%) of postnatal mothers were satisfied and (36%) of postnatal mothers 
had moderate satisfaction whereas and (60%) had minimum satisfaction with the nursing 
care provided. Orientation to the ward and facility was found to have the least 
satisfaction. Therefore, the opinions of patients concerning their expectations and 
satisfaction with the nursing care is considered as a relevant opportunity for nurses to 
make improvement in the quality of care provided (Rajagopal, 2012). 


2.10 Studies on ways of improving postnatal care services 

In a study conducted in Cairo, the mothers suggested different ways of improving 
postpartum services. Majority 72.1% suggested that women needed more information 
about breast feeding. Another 67.3% reported that health workers should educate mothers 
on the care of babies. While 66.3% suggested that time spent with nurses should be 
increased. Another 70.2% suggested importance of having a companion, while 64.5% 
said that nurses should do home visits and follow ups to mothers after hospital discharge 
(Lamadah et al., 2012). 

A study done in Central Shanghai- China on the mothers perspectives on quality of 
postpartum care reported that the quality of care can be improved through greater 
emphasis on health education about child care and more time allocation on discussing 
questions relating to the postnatal period (Nnebue et al., 2014) . 

2.11 Summary of literature review 

A number of studies have been done around the world investigating the satisfaction of 
women with postnatal care in various hospitals. A study was done by Nyongesa et al, in 
2012 on client satisfaction determinants at Pumwani maternity hospital. The findings of 
the study suggest that lower levels of satisfaction was influenced by long client waiting 
time. The findings also showed that the facility was understaffed, yet the facility had very 
many clients. A study in Egypt, by Lammaddah et al, (2012) on quality of postpartum 
care showed that mothers are not satisfied as they received brief information, lacked 
relevant advice, lacked opportunity for asking relevant questions and nurses did not offer 
a listening ear. 


Mugambi and Kiruthu, (2015) in their study on service quality dimensions in health care 
noted that the five dimensions of quality care likely to affect client satisfaction. These 
are; reliability, responsiveness, assurance, tangibles and empathy. In an American study 
on women.s perception of key factors defining quality health services. Women who were 
interviewed viewed quality health care as attentive and polite physician, who is very 
knowledgeable and provides services in a clean, well equipped environment. Women 
were of the view that quality health care services should include a positive client-provider 
interaction. In 2015 Danserau and colleagues conducted a research on influence of 
perceived quality as a determinant of patient satisfaction. From this study the providers. 
behavior was a significant predictor of the clients. satisfaction. 

Research done in Australia by Jenkins et al, (2014) reported that the most essential aspect 
of postnatal care is having a midwife sitting and listening to the woman.s needs and 
concerns. Most women are dissatisfied with the way information is provided in the 
postnatal unit. However, a survey conducted in the UK in 2017 showed that 74% of the 
women felt they were treated understanding and kindness during the postnatal period. 
This was a significant increase from a previous survey in 2013 where only 63% reported 
similar findings. Most of the women 69% also felt that the hospital rooms were clean 
(Care Quality Commission, 2017). 

Satisfaction of women within the postnatal period is conceded as crucial framework of 
assessing the quality of services offered to the clients. Amid all these studies it is evident 
that most women are dissatisfied with the quality of postnatal care services given. It is 
from this perspective that the researcher intends to conduct a study in Embu hospital, to 


investigate if the women delivering in this facility are satisfied with the services offered 
during the postnatal period. 

2.12 Synopsis of gaps in the literature review 

There are numerous studies done on postnatal women.s satisfaction across the globe in 
both developed and developing countries. However, in Kenya there is limited literature 
on satisfaction with postnatal care services. In Embu Hospital there were no previous 
studies done to assess the satisfaction with postnatal care services offered. Further the 
hospital did not have a system for routinely assessing the satisfaction with the postnatal 
care services offered. The study therefore aimed at making a contribution to the scientific 
body of knowledge and help create understanding on the level of satisfaction among the 
women who delivered in Embu Hospital. This would shed light to the hospital 
management on whether they should improve their service delivery so that it can result in 
improved satisfaction of the clients seeking delivery services in this facility. Generating 
evidence of the level of satisfaction among women with postnatal care is critical in 
informing policy change and improving service delivery. Most studies have also shown 
that health system factors and socio-demographic factors have an influence on 
satisfaction of women with the postnatal care. Therefore the study also established 
whether these factors were significant and if they influenced the women.s satisfaction. 
Assessment of quality is a key component in the maintenance and improvement of the 
quality of care provided by a health system. The assessment of quality of care offered by 
health workers is considered an essential component of a health system assessment. 
There is an emerging trend where the quality of care offered by health providers is 
assessed from the perspective of clients and the providers themselves. The assessment by 


clients helps to identify their perceptions about the services they receive, while that of 
providers establishes the performance in clinical practice. Hence the researcher.s interest 
to determine the views of these women on what they perceive to be quality care and if it 
affected their satisfaction with the services offered in this facility. Furthermore, the 
outcome of this study would provide a benchmark for subsequent satisfaction studies in 
Embu hospital and in other similar settings. 

 

 

 

 


CHAPTER THREE: MATERIALS AND METHODS 

3.0 Introduction 

The chapter gives a description of the study design, study variables, study area, 
population targeted, sampling methods and determining the size of the sample, tools for 
data collection, pretesting, reliability and validity of research tools, procedures to collect 
data, data analysis, logistical and the ethical considerations. 

3.1 Study design 

A cross-sectional descriptive study design was utilized in assessment of client.s 
satisfaction with the postnatal care services offered at Embu hospital. Descriptive 
research is a description of phenomena and the situation as it exists (Nassaji, 2015). It 
was cross sectional since it studied individuals at one point in time. The benefit of cross 
sectional research design is collection of data on different kinds of people in a remarkably 
short period of time (Setia, 2016). 

3.2 Study variables 

3.2 .1 Independent variables 

Socio-demographic factors like age of respondents, level of education and occupation, 
their marital status and income status. Health system factors like hospital information, 
communication, orientation, comfort and care, staffing. Perceived quality of care which 
include reliability, assurance, responsiveness, tangibles and empathy. 

3.2.2 Dependent variables 

Women satisfaction level with postnatal care services among women who delivered at 
Embu Hospital. This was measured using satisfaction index derived from a set of 


statements assessed using a Likert scale with five scores. The scores ranged from fully 
satisfied, satisfied, neutral, dissatisfied and very dissatisfied. 

3.3 Study area 

The research was done at Embu hospital in Embu County. The hospital is a referral 
hospitals in eastern region and also a training institution. The hospital has six hundred 
and eighteen bed capacity, with outpatient services, inpatient services and maternity 
health care services. The hospital admits approximately 5,400 postnatal women in the 
postnatal unit every year. The neighboring facilities and clinics refer women with 
complications during labour, delivery or during the postnatal period. 

3.4 Target population 

The research targeted the postnatal mothers who had delivered in Embu hospital, either 
normal or Caesarian section delivery between the months of September to October 2016. 
From the facility data approximately 450 women deliver in the facility on monthly basis. 

3.4.1 Inclusion criteria 

Postnatal mothers who had delivered a healthy infant in Embu hospital and had the 
willingness to participate in this study. Mothers who also gave an informed consent 
participated in this study. The study also included health care providers working in 
postnatal unit in Embu hospital who gave an informed consent to take part in this 
research. 

3.4.2 Exclusion criteria 

Postnatal mothers with major postpartum complications like puerperal psychosis. 


3.5 Sampling technique and sample size determination 

Systematic random sampling method was used. This involved selecting every Kth case 
from the sampling frame. The sampling interval (Kth) was determined by dividing the 
study population with the desired sample size. The sampling frame was established from 
the admission/discharge register in the postnatal ward. Therefore 450 was divided by 205. 
This gave 2.19, which is approximately 2. Every 2nd woman in the list of the postnatal 
register was selected to participate in this study. The starting point was determined by 
picking of a random number. 

Fischer et al, 1998 sample size formulae was used. 

n =z2 p 

 d2 

n- Represents the desired size of sample (if the population is greater than 10,000) 

z - Represents the significance level (at 5% significance level its value is 1.96) 

p - Represents the proportion of women satisfied with postnatal care services. 
Assumed to be 50% (0.50). In Kenya women of reproductive age utilizing 
postnatal care services is 51% based on the reports by the Kenya Demographic 
Health survey (KDHS, 2014). 

q - 1-p 

d -is the margin of error (it has been take as 5%). 

(1.96)2(0.50) (0.50) = 0.873964 =384 

(0.05)2 0.0025 

nf= n/1+n/N 

nf – is the desired size of sample (if the population is less than 10,000) 


N - the estimate of the population size 

=384 

1+384/450 

=205 respondents 

10% of the respondents were included to cater for attrition, which gave a sample 
size of 225 respondents. 

3.6 Data collection tools 

Client exit interview questionnaires (Appendix II) were used which consisted structured, 
unstructured and matrix questions. This questionnaire determined whether the socio-
demographic characteristics influenced the women.s level of satisfaction, it also sought to 
determine the satisfaction with postnatal care, establish health system factors influencing 
satisfaction of postnatal women and establish the influence of perceived quality of care 
on women.s satisfaction. The questionnaire was adopted and modified from JIPI.s 
postnatal client exit questionnaire. Focused group discussions guide (Appendix III) were 
also used to obtain qualitative data from postnatal women which was done one week after 
the quantitative data collection. Key informant interviews guide (Appendix IV) were also 
be used to assess the health workers opinions concerning postnatal services. The focused 
group discussion questions and the key informant interview questions were constructed 
based on the key themes to ensure the specific objectives were met. 

3.7 Pretesting 

The data collection tool was pretested in Chuka hospital which was 60 km from Embu 
Hospital, three weeks before the actual study. This ensured that the validity of the 
instruments and reliability of instruments were achieved. The pretesting sample was 10% 


of the sample size. Recruitment was done and four research assistants trained by the 
researcher for two days. The training focused on the usage of the research instruments 
and ways of collecting data. After the training they participated in the pretesting. The 
research assistants were registered nurses, who had antecedent experience in research. 
Pretesting was done for three days, with each research assistant administering six 
questionnaires. Thereafter they conducted two focused group discussions and interviewed 
two key informants each. After pretesting the researcher was able to develop the final 
revised tools for data collection. 

3.7.1 Validity of research instruments 

Validity is the scope in which the research survey is accurate and gives meaningful 
inferences drawn from the results. It is the measure in which the findings obtained from 
the analyzed data represent the phenomena being studied (Heale and Twycross, 2015). 
The research instruments were pretested in Chuka hospital with a sample that was 
homogeneous with the actual sample. The results obtained from the pretesting was used 
to adjust the instruments accordingly. 

3.7.2 Reliability of the research instruments 

Reliability is the standard in which instruments used in research produces consistent 
results following repeated trials (Heale and Twycross, 2015). Test- retest method was 
used as a way of determining the reliability of the research instruments. The same 
respondents were requested to fill in the questionnaire at different times. The correlation 
between the first and second set of responses was determined. Reliability was 0.85. The 
values was greater than 0.7 in the second set, then the test-retest reliability was assumed 
to be good. 


3.8 Data collection procedures 

The researchers collected data after receiving an approval letter from the medical 
superintendent, Embu Level 5 hospital. The study subjects filled a letter of consent 
(Appendix I) which indicated their willingness to participate in this study. The 
respondents were given assurance on the confidentiality of information given, the 
purpose of conducting this study was elaborately explained, potential benefits and 
potential risks associated with participation highlighted. 

Data was collected between the month of September and October 2016. Every day the 
research team collected data from morning to evening including weekends for a duration 
of 1 month. The researcher regularly counterchecked the accuracy and completeness of 
the questionnaires and the completed questionnaires awarded numbers after completion 
of the work. The researcher together with the research assistants administered 45 
questionnaires each within the period of data collection. Focused group discussions were 
also conducted and each group involved a group of 8 women. The information was 
recorded and stored for easy analysis. Nurses who worked in the postnatal ward acted as 
the key informants. The nurses selected had to have worked in the postnatal ward for at 
least 3 months. This ensured that these nurses were well acquainted with all processes 
and activities that take place in the postnatal unit. Data was then collected from them 
through asking questions and taking notes. 

3.9 Data analysis 

Coding, sorting and entry of quantitative data was done on the computer. Descriptive 
statistics namely frequencies and percentages were used in the analysis of quantitative 
data. Pie charts, graphs and frequency tables were used for data presentation and easy 


interpretation. Inferential statistics mainly Chi-square was used to test the association 
between the variables. To perform these analyses, version 20 of the Statistical Package 
for Social Sciences (SPSS) was used. Qualitative data generated from FGD.s and 
interviews was analyzed thematically to identify recurring issues that appeared during the 
analysis of data. 

3.10 Logistical and Ethical considerations 

Authority to undertake this research was sought from the Kenyatta University Ethical 
Review Committee (See Appendix VI). Research approval was also acquired from the 
National Commission for Science, Technology and Innovation (NACOSTI) (See 
Appendix VII). Research authorization was also sought from the Ministry of Education 
(See Appendix VIII), County Director of Health (See Appendix IX), County 
Commissioner of Embu (See Appendix X) and the Embu hospital administration 
(Appendix XI). During the study the participants gave written informed consent (see 
Appendix I) to participate in this study and confidentiality was maintained. Feedback will 
be given to the relevant authorities after the completion of the study. 

 


CHAPTER FOUR: RESULTS 

4.0 Introduction 

This chapter displays the data analysis and presentation of results which were done 
according to the study objectives. The sample size was 225 respondents. However, after 
data collection only 205 questionnaires were fully filled equating to a response rate of 
91%. Three focused group discussions of 8 women each and 10 key informants were also 
used to obtain the qualitative data on the satisfaction levels with postnatal care among 
women who had delivered in Embu Hospital, Embu County. 

4.1 Characteristics of the study participants 

Socio-demographic characteristics of the respondents 

The Table 4.1 demonstrates the socio-demographic characteristics. Majority were 
married (75.6%, n=155) and Christians (91.7%, n=188). Those who were aged between 
fifteen and 24 years constituted 31.2% (n=64) of the study participants while 40.5% 
(n=83) and 11.2% (n=23) were between 25 to 34 years and 45 years and above, 
respectively. Additionally, 28.8% (n=59) and 43.4% (n=89) of the study participants had 
schooled up to primary and secondary school level respectively. Analysis of the 
occupations of the respondents showed that 17.1% (n=35) were employed while 22.4% 
(n=46) and 27.8% (n=57) of the respondents were engaged in farming and business 
respectively. Respondents who earned less than KSh. 10,000 per month were 37.1% 
(n=76). Further, 2.4% (n=5) of the women had a monthly income of more than KSh. 
40,000. 

 

 

 


Table 4. 1 – Socio-demographic characteristics of the respondents 

Characteristic 

Number (n=205) 

% 

Age (years) 

 

 

15-24 

64 

31.2 

25-34 

83 

40.5 

35-44 

35 

17.1 

=45 

23 

11.2 

Marital status 

 

 

Single 

41 

20 

Married 

155 

75.6 

Divorced 

3 

1.5 

Separated 

6 

2.9 

Religion 

 

 

Christian 

188 

91.7 

Muslim 

12 

5.9 

Others 

5 

2.4 

Education 

 

 

Primary 

59 

28.8 

Secondary 

89 

43.4 

College 

43 

21.0 

University 

14 

6.8 

Occupation 

 

 

Agriculture/Farmer 

46 

22.4 

Businesswoman 

57 

27.8 

Employed (public/private) 

35 

17.1 

Unemployed 

63 

30.7 

Others/student 

4 

2.0 

Monthly income (KSh.) 

 

 

Below 10,000 

76 

37.1 

10,000 - 20,000 

53 

25.9 

21,000 - 30,000 

51 

24.9 

31,000 - 40,000 

20 

9.7 

 > 40,000 

5 

2.4 



 

 

 

 


91, 44% 

59, 29% 

25, 12% 

30, 15% 

NUMBER OF TIMES ATTENDED EMBU HOSPITAL 

Times attended Embu Hospital

First time

Twice

Thrice

= 4 
4.2 Obstetric characteristics of respondents 

4.2.1 Times attended Embu Hospital 

A larger percentage of the respondents 44.4% (n=91) were visiting Embu Hospital for the 
first time, while 14.6% (n=30) were visiting Embu hospital for more than four times. 
These women were likely to have been pleased with the health services received during 
their previous visits to this facility prompting them to come again. 

 

Figure 4.1 Number of times attended Embu Hospital 

 

4.2.2 Admission during previous delivery 

The women were asked if they were admitted in this facility for their previous delivery. 
Only 47.3% (n=97) had ever been admitted in this facility for previous delivery, whereas 
52.7% (n=108) did not have previous admissions in this facility. 


47% 

53% 

Admission During the Previous Delivery 

Admission during the

previous delivery

Yes

No

66.3 

33.7 

0

10

20

30

40

50

60

70

NORMAL VAGINAL 
DELIVERY 

CAESARIAN SECTION 

Mode of Delivery 

 

Figure 4.2 Admission during previous delivery 

4.2.3 Mode of Delivery 

Most respondents 66.3% (n=136) had a normal vaginal delivery, while 33.7% (n=69) 
had a caesarean section. 

 

Figure 4.3 Mode of Delivery 

 


57% 

43% 

Sex of the baby 
Sex of the baby 

Male

Female

4.2.4 Sex of Baby 

In this study most women 56% (n=116) had male babies, whereas 43.4% (n=89) had 
female babies. 

 

Figure 4.4 Baby’s sex 

4.2.5 Number of Children 

Most women 41.9% (n=86) had only one child, while only 1.5% (n=3) respondents had 
more than four children. This may be attributed to the high uptake of family planning 
methods within this region. 


11.7 

41.9 

24.9 

16.6 

3.4 

1.5 

0

5

10

15

20

25

30

35

40

45

None

1

2

3

4

More than 4

Number of children 
Number of children 

 

Figure 4.5 Number of Children 

4.3 Description of the health systems attributes 

Analysis of the items assessing the orientation aspects of the health system attributes 
revealed that the items „warm welcome. and „orientation to the toilet, bathrooms, 
washing area and the availability of safe drinking water. had the highest satisfaction 
scores of 87.3% and 82.0% respectively. Nevertheless, not all clients were comfortable 
with the orientation given as affirmed by an FGD participant who reported that "There 
was no orientation done in this ward. I was oriented by the other patients who had stayed 
in this ward for a longer time" (FGD participant, Embu hospital). On the information 
subscale, the items „informed about informed consent before any procedure. and „Nurses 
conveyed messages, which I hesitated to ask the doctor. had the highest satisfaction 
scores of 87.3% and 49.8% respectively. Assessment of the facet of communications 
showed that the items „All my questions were answered promptly and with a positive 
attitude., „Nurses exhibited good public relations skills with myself and the family 
members., „Nurses were able to communicate in my own language and talked freely. and 


„Nurses were able to answer all the doubts, and questions concerning my health and that 
of my baby. were rated as satisfactory by, respectively, 92.7%, 95.6%, 94.6% and 93.2% 
of the respondents.. The comfort and care items namely „Nurses were very calm and 
approachable., „Nurses helped me to keep myself clean and properly groomed., „During 
my entire hospital stay I felt safe and secure throughout the day and night. and „The 
hospital was calm with no noise at night in the ward. were rated as satisfactory by 92.7%, 
93.2%, 97.1% and 88.8% of the study participants. The item „The food served was good. 
had the lowest satisfaction scores of 56.6% as depicted in Table 4.2. 


Table 4. 2 - Description of selected health systems attributes 

 Item 

Satisfied 

[n(%)] 

Not 
satisfied 

[n(%)] 

Orientation 

 

 

I was welcomed in a warm manner which made me comfortable on 
admission 

179(87.3) 

26(12.7) 

I was given orientation to all the health care team members in the 
postnatal ward 

93(45.4) 

112(54.6) 

I was oriented to toilet, bathroom, washing area and availability of 
safe drinking water 

168(82.0) 

37(18.0) 

I was oriented about visiting hours for family and doctors 

112(54.6) 

93(45.4) 

Information 

 

 

I was informed about ward routines 

77(37.6) 

128(62.4) 

I was informed about the rules and regulations of the hospital 

60(29.3) 

145(70.7) 

Nurses conveyed the messages, which I hesitated to ask the doctor 

102(49.8) 

103(50.2) 

I was informed about informed consent before any procedure 

179(87.3) 

26(12.7) 

Communication 

 

 

All questions asked were answered promptly and with a positive 
attitude 

190(92.7) 

15(7.3) 

Nurses maintained good public relations skills with myself and the 
family members 

196(95.6) 

9(4.4) 

Nurses communicated in my own language and were free to talk 

194(94.6) 

11(5.4) 

Nurses answered all the doubts, asked by me concerning my health 
and that of my baby 

191(93.2) 

14(6.8) 

The doctor who attended to me was polite 

126(61.5) 

79(38.5) 

The doctor explained to me what was wrong with me 

121(59.0) 

84(41.0) 

Comfort and care 

 

 

Nurses were calm and approachable 

190(92.7) 

15(7.3) 

Nurses aided me in cleaning myself and grooming 

191(93.2) 

14(6.8) 

Throughout my hospital stay I felt safe and secure during the day 
and night 

199(97.1) 

6(2.9) 

The hospital was calm with no noise at night in the wards 

182(88.8) 

23(11.2) 

Time spent with my visitors was adequate 

131(63.9) 

74(36.1) 

The food served was good 

116(56.6) 

89(43.4) 

The toilets and sanitary areas were clean 

146(71.2) 

59(28.8) 

My privacy was respected by all staff 

176(85.9) 

29(14.1) 



 

 

 


4.4 Evaluation of Satisfaction with Postnatal Care Services 

The findings on the seventeen items used to assess satisfaction of women with postnatal 
care services offered at Embu Hospital are shown in Table 4.3. The items with the 
highest satisfaction scores were: „I was given a birth notification for my baby. (95.1%), „I 
was taught about weaning of my baby and immunizations.(94.6%), „I was assisted in 
positioning the baby during and after feeding and was taught on burping the baby after 
breast feeding. (91.7%), „I was informed about the family planning methods and when to 
start. (92.7%) and „I was advised on the postpartum visits and their importance.(95.1%). 
The lowest satisfaction scores were recorded for the items: „The nurses observed my vital 
signs frequently. (52.7%), „I was taught concerning the involution of the uterus. (52.7%), 
„I was assisted in early ambulation after caesarean section. (42.1%), „I was educated on 
lochia and ways of detecting excessive bleeding during the postnatal period.(70.2%). The 
overall satisfaction of the postnatal women in Embu hospital was 54.6%. These findings 
were further verified from an FGD where a participant reported that “When I came to this 
hospital I expected it was better than other public hospitals but I am disappointed” (FGD 
participant, Embu Hospital). Another participant reported that “I am dissatisfied with the 
services in this facility because students are not supervised by qualified staff, some staff 
have poor attitude, there are few nurses on night duty and more attention is given to the 
primigravidas” (FGD participant, Embu hospital). 

Most key informant felt that the women were satisfied with the postnatal services given. 
One nurse reported that “Mothers return to deliver here meaning the services are good”. 
Another informant reported that “I believe the women are satisfied since I have not 
experienced any complaints” (Key informants, Embu Hospital). However, the key 


informants were of the opinion that the staff –patient ratio was short of what is 
recommended. One key informant was of the opinion that “There is need to increase the 
number of staff. The shortage of staff is making us not to deliver the best services since 
we are not able to attend to all patients”. This was further reaffirmed by an informant 
who reported that “More nurses should be employed to ensure the NCK ratio of 1:6 and 
ensure at least 3 nurses per shift” (Key informant, Embu Hospital). 

Table 4. 3– Satisfaction with postnatal care services 

No. 

Item 

Satisfied 

[n(%)] 

Not 
satisfied 

[n(%)] 

1 

I was assisted to go to the toilet and given information on personal 
hygiene in the postnatal period 

182(88.8) 

23(11.2) 

2 

I was assisted in perineal toilet and educated on how to keep my 
perineum hygienic 

180(87.8) 

25(12.2) 

3 

I was assisted in early ambulation (getting out of bed after C/S) 

29(42.1) 

40(57.9) 

4 

The nurses observed my vital signs frequently. 

108(52.7) 

97(47.3) 

5 

I was taught about involution of the uterus. 

108(52.7) 

97(47.3) 

6 

I was taught on breast care and breast minor problems in postnatal 
period and their management. 

188(91.7) 

17(8.3) 

7 

I was educated on nutrition during the postpartum period. 

191(93.2) 

14(6.8) 

8 

I was informed about lochia and ways of detecting excessive 
bleeding during the postnatal period. 

144(70.2) 

61(29.8) 

9 

I was educated on detection of signs and symptoms of infection 
during the puerperium period. 

133(64.9) 

72(35.1) 

10 

I was informed about the family planning methods and when to 
start. 

190(92.7) 

15(7.3) 

11 

I was advised on the postpartum visits and their importance. 

195(95.1) 

10(4.9) 

12 

I was assisted in bathing, eye care, cord care and diaper care for 
the baby. 

193(94.1) 

12(5.9) 

13 

Nurses taught me on how to identify the signs of infection for the 
baby. 

189(92.2) 

16(7.8) 

14 

I was assisted to position my baby during and after feeding and 
burping my baby after breast feeding. 

188(91.7) 

17(8.3) 

15 

I was taught about bonding ,attachment and rooming in. 

184(89.8) 

21(10.2) 

16 

I was educated about immunizations and when to wean my baby. 

194(94.6) 

11(5.4) 

17 

I was given a birth notification for my baby 

195(95.1) 

10(4.9) 

 

Overall 

112(54.6) 

93(45.4) 



 


4.5 Perception on quality of postnatal care 

The women who strongly agreed with the tangible statements: „Embu hospital.s 
equipment.s were well maintained., „Cleanliness and hygiene in this hospital were 
excellent. and „The staff were clean and well groomed. were 81.5%, 95.1% and 98.0% 
respectively. Assessment of reliability of the services showed that 92.7%, 89.8%, 84.4% 
and 62.0% of the respondents agreed or strongly agreed with the statements: „This 
hospital provided treatment, diagnostic tests and other services without delays., „The 
hospital stay period was short., „Nurses monitored my health status regularly/every day. 
and „Doctors checked my health status daily. respectively. On the responsiveness 
subscale, the items with highest proportion of respondents who (strongly) agreed with it 
were: „Nurses were helpful to me. (92.7%) and „The waiting time to receive daily 
services was not so long (Less than 1 hour) (90.7%). On the same subscale, the statement 
„Doctors were always available for any review. had the lowest number of respondents 
who strongly agreed with it (71.7%). The respondents who strongly agreed with the 
assurance statements: „The doctors were competent and skillful., „Nurses were very 
respectful., „Doctors were knowledge and they answered all my questions. and „Nurses 
were very knowledgeable and able to respond to my questions. were 70.2%, 86.3%, 
74.1% and 80.5% respectively. Analyses of the responses to the items on the empathy 
subscale showed that the item „Doctors spent enough time to check and advise me. had 
the lowest percentage of the respondents who either strongly agreed or just agreed with it 
(67.3%). The items which had the highest number of women who either agreed or 
strongly agreed with it were: „Nurses in this facility were very caring. (95.1%), „Nurses 


were spending enough time to check and advise me. (92.2%) and „Nurses listened to me 
attentively. (86.8%). The findings are shown in Table 4.4. 

Perception on quality of care findings were further verified by a respondent from the 
focused group discussion who reported that “Quality care involved; concerned staff 
attending to your problems, enough and knowledgeable staff”. Another woman was of 
the opinion that “Quality care is the care given to mothers and babies and entails good 
services for both and helping mothers and babies if they have any issues”. There was also 
a respondent who reported that “Quality care entails timely services, availability of 
resources, hygiene of the facility, safe procedures, affordable services and ensuring 
confidentiality of patient information” (FGD participants Embu Hospital). According to a 
key informant quality postnatal care is “Care for the mother and baby to prevent any 
complications after delivery”. Another key informant reported that “Quality postnatal 
care entails offering all services given as per the set standards by Ministry of Health and 
WHO” (Key informant, Embu Hospital). 


Table 4. 4– Perception on quality of postnatal care services 

Item 

(Strongly) 
disagree [n(%)] 

(Strongly) 
agree [n(%)] 

Tangible statements 

 

 

Embu hospital has well maintained equipment 

38(18.5) 

167(81.5) 

Cleanliness and hygiene in this hospital were excellent 

10(4.9) 

195(95.1) 

The staff were clean and well groomed 

4(2.0) 

201(98.0) 

Reliability statements 

 

 

Hospital provided treatment, tests and other services 
without delays 

15(7.3) 

190(92.7) 

The hospital stay period was short 

21(10.2) 

184(89.8) 

Nurses monitored my health status regularly/every day. 

32(15.6) 

173(84.4) 

Doctors checked my health status daily 

78(38.0) 

127(62.0) 

Responsiveness statements 

 

 

Nurses responded immediately when called by me 

36(17.6) 

169(82.4) 

Nurses were helpful to me. 

15(7.3) 

190(92.7) 

Doctors were always available for any review 

58(28.3) 

147(71.7) 

The waiting time to be admitted was not long (Less 
than 1 hour) 

42(20.5) 

163(79.5) 

The waiting time to be served daily was not so long 
(Less than 30 minutes) 

19(9.3) 

186(90.7) 

Assurance statements 

 

 

The doctors were competent and skillful 

61(29.8) 

144(70.2) 

Nurses were very respectful 

28(13.7) 

177(86.3) 

Doctors were knowledgeable and answered all my 
questions 

53(25.9) 

152(74.1) 

Nurses were knowledgeable and able to respond to my 
questions 

40(19.5) 

165(80.5) 

Empathy statements 

 

 

Nurses in this facility were very caring 

10(4.9) 

195(95.1) 

Doctors listened to me attentively 

51(24.9) 

154(75.1) 

Nurses listened to me attentively 

27(13.2) 

178(86.8) 

Nurses were spending enough time to check and give 
me advise 

16(7.8) 

189(92.2) 

Doctors were spending enough time checking on me 
and advising me 

67(32.7) 

138(67.3) 




11% 

42% 

44% 

3% 

Support by the service providers 

Not good

Acceptable

Excellent

No expectation

4.6 Expectations 

4.6.1 Support by the service providers 

Inquiries into the expectations of the respondents with regard to postnatal care services 
showed that 42.0% (n=86) and 44% (n=90) of the respondents expected, respectively, 
„acceptable. and „excellent. support to be provided by the service providers. 

 

Figure 4.6 Support by the service providers 

4.6.2 Cleanliness of the hospital equipment 

Those who rated their expectations as „acceptable. and „excellent. with regard to 
cleanliness of hospital equipment were 46.3% (n=95) and 45.4% (n=93) respectively. 


5.40% 

46.30% 

45.40% 

2.90% 

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

NOT GOOD 

ACCEPTABLE 

EXCELLENT 

NO EXPECTATION 

Cleanliness of the hospital equipment 

 

Figure 4.7 Cleanliness of the hospital equipment 

4.6.3 Supply of Medicine 

On the supply of medicine, 47.8% (n=98) and 41.5% (n=85) of the respondents reported 
that their expectations were „acceptable. and „excellent. respectively. In Embu hospital 
some of the women highlighted that the supply of medicine was not adequate. This was 
further affirmed by an FGD participant who reported that “There were no pain 
medications given”. Another participant reported that “The supply of linen is not enough 
and the taps also run out of water” (FGD participant, Embu hospital). This was further 
reaffirmed by a key informant who reported that “There is need to increase supplies both 
pharmaceutical and non-pharmaceutical” (Key informant, Embu hospital). 


7% 

48% 

41% 

4% 

Supply of medicine 

Not good

Acceptable

Excellent

No expectation

 

Figure 4.8 Supply of medicine 

 

4.7 Association between satisfaction with postnatal care services, socio-demographic 
attributes and selected obstetric factors 

Table 4.5 and 4.6 presents the findings on the evaluation of the association between 
socio-demographic attributes of the study respondents, selected obstetric factors and 
satisfaction with postnatal care services. Being the first visit to the hospital had 80% 
higher odds of being satisfied with PNC (Odds Ratio 1.798 (95% confidence interval (CI) 
1.026 - 3.153), p= 0.040). Women who had normal vaginal delivery had 61% less 
likelihood of being satisfied with PNC as compared to their counterparts with a Caesarian 
section delivery (OR 0.389 (95% CI 0.211 - 0.718), p = 0.002). The rest of the attributes 
were not statistically significantly predictive of satisfaction with PNC. They included the 
age of respondents, the marital status, religious affiliation, education level, occupation, 
monthly income, being admitted during the previous delivery, number of children and sex 
of the baby. A significantly lower proportion of satisfaction with PNC was reported 


among mothers who had normal delivery when compared to those who had delivered 
through Caesarian section (47.1% versus 69.6% respectively). 

Table 4. 5 Association between satisfaction with postnatal care services, socio-
demographic factors and selected obstetric factors 

Factor 

Satisfaction with PNC 

OR (95% CI) 

P-Value 

 

Satisfied 
[n(%)] 

Not satisfied 
[n(%)] 

 

 

Age (years) 

 

 

 

 

15-24 

31(48.4) 

33(51.6) 

0.861(0.332-2.235) 

0.759 

24-34 

48(57.8) 

35(42.2) 

1.257(0.498-3.176) 

 

35-44 

21(60.0) 

14(40.0) 

1.375(0.476-3.974) 

 

45 and above 

12(52.2) 

11(47.8) 

Ref 

 

Marital status 

 

 

 

 

Single 

26(52.0) 

24(48.0) 

0.869(0.459-1.647) 

0.667 

Married 

86(55.5) 

69(44.5) 

Ref 

 

Divorced 

2(66.6) 

1(33.4) 

 

 

Separated 

4(66.6) 

2(33.4) 

 

 

Religion 

 

 

 

 

Christian 

105(55.9) 

83(44.1) 

1.807(0.660-4.951) 

0.244 

Muslims 

7(58.3) 

5(41.6) 

Ref 

 

Others 

3(60.0) 

2(40.0) 

 

 

Education 

 

 

 

 

Primary 

32(54.2) 

27(45.8) 

1.144(0.552-2.373) 

0.717 

Secondary 

51(57.3) 

38(42.7) 

1.296(0.664-2.527) 

 

College 

29(67.4) 

14(32.5) 

Ref 

 

University 

4(28.5) 

10(71.4) 

 

 

Occupation 

 

 

 

 

Farmer 

27(58.7) 

19(41.3) 

1.650(0.773-3.523) 

0.194 

B/woman 

35(61.4) 

22(38.6) 

1.848(0.901-3.787) 

 

Employed 

19(54.3) 

16(45.7) 

1.379(0.607-3.132) 

 

Unemployed/student 

31(46.3) 

36(53.7) 

Ref 

 

Monthly income 

 

 

 

 

below 10,000 

38(50.0) 

38(50.0) 

0.667(0.270-1.669) 

0.385 

10,000-20,000 

31(58.5) 

22(41.5) 

0.939(0.356-2.475) 

 

21,000-30,000 

28(54.9) 

23(45.1) 

0.812(0.307-2.145) 

 

> 30,000 

15(60.0) 

10(40.0) 

Ref 

 



 


Table 4.6 -Obstetric characteristics 

First time attending Embu hospital 

OR (95% CI) 

P-value 

Yes 

57(62.6) 

34(37.4) 

1.798(1.026-3.153) 

0.040 

No 

55(48.2) 

59(51.8) 

Ref 

 

Admitted during previous delivery 

 

 

Yes 

50(51.5) 

47(48.5) 

0.789(0.455-1.370) 

0.400 

No 

62(57.4) 

46(42.6) 

Ref 

 

Number of children 

 

 

 

 

None 

13(54.2) 

11(45.8) 

0.977(0.398-2.401) 

0.960 

1 

47(54.7) 

39(45.3) 

0.997(0.560-1.791) 

 

2+ 

52(54.7) 

43(45.3) 

Ref 

 

Mode of delivery 

 

 

 

 

Normal vaginal 
delivery 

64(47.1) 

72(52.9) 

0.389(0.211-0.718) 

0.002 

Caesarian section 

48(69.6) 

21(30.4) 

Ref 

 

Baby’s sex 

 

 

 

 

Male 

68(58.6) 

48(41.4) 

1.449(0.831-2.526) 

0.191 

Female 

44(49.4) 

45(50.6) 

Ref 

 



 

4.8 Association between satisfaction with postnatal care services and health system 
factors 

The health system attributes were subdivided into four major domains as shown in table 
4.7. Comfort and care domain had a P- Value of 0.008 meaning it was significantly 
associated with the women.s level of satisfaction with postnatal care. 

 

 

 

 

 

 

 


 

Table 4. 7 - Health systems attributes 

Domain 

Category 

Satisfaction with 
PNS 

OR (95% CI) 

P-
value 

 

 

Yes 

No 

 

 

Orientation 

Satisfied 

71(55.0) 

58(45.0) 

1.045(0.592-1.846) 

0.879 

 

Unsatisfied 

41(53.9) 

35(46.1) 

 REF 

 

Information 

Satisfied 

61(56.0) 

48(44.0) 

1.121(0.646-1.946) 

0.684 

 

Unsatisfied 

51(53.1) 

45(46.9) 

 REF 

 

Communication 

Satisfied 

112(55.4) 

90(44.6) 

0.446(0.382-0.520) 

0.092 

 

Unsatisfied 

0(0.0) 

3(100.0) 

 REF 

 

Comfort and care 

Satisfied 

112(56.3) 

87(43.7) 

0.437(0.373-0.512) 

0.008 

 

Unsatisfied 

0(0.0) 

6(100.0) 

 REF 

 



 

4.8.1 Orientation 

The findings on the assessment of the association between satisfaction with PNC services 
and items on the orientation subscale of the health system attributes are presented in 
Table 4.8. A higher proportion of the respondents who were rated as satisfied based on 
the item „I was given orientation to the toilet, bathroom, washing area and area with safe 
drinking water. were satisfied with PNC when compared to their colleagues who had a 
contrary opinion (57.7% and 40.5% respectively). Nevertheless, the observed association 
did not achieve any statistical significance (OR 2.004 (95% CI 0.971-4.134), p = 0.057). 
Similarly, the other items on the orientation subscale were not associated with 
satisfaction with PNC. 


Table 4. 8- Association between satisfaction with PNC services and health system 
factors (orientation statements) 

Item 

Satisfaction with PNC 

Or (95% CI) 

P-value 

 

Satisfied 

Not satisfied 

 

 

I was given a warm welcome that made me 
comfortable on admission 

 

 

 

Satisfied 

101(56.4) 

78(43.6) 

1.766(0.768-4.058) 

0.177 

Not satisfied 

11(42.3) 

15(57.7) 

Ref 

 

I was oriented to the members of the health 
care team within the postnatal unit 

 

 

 

Satisfied 

55(59.1) 

38(40.9) 

1.397(0.802-2.433) 

0.238 

Not satisfied 

57(50.9) 

55(49.1) 

Ref 

 

I was given orientation to the toilet, 
bathroom, washing area and area with safe 
drinking water 

 

 

 

Satisfied 

97(57.7) 

71(42.3) 

2.004(0.971-4.134) 

0.057 

Not satisfied 

15(40.5) 

22(59.5) 

Ref 

 

I was oriented on the visiting 
hours for family members and 
doctors 

 

 

 

 

Satisfied 

60(53.6) 

52(46.4) 

0.910(0.523-1.581) 

0.737 

Not satisfied 

52(55.9) 

41(44.1) 

Ref 

 



 

The findings on orientation were further affirmed from an FGD where a participant 
reported that “No orientation was done to me in the postnatal ward, you have to find your 
way out” (FGD participant, Embu Hospital). 

4.8.2 Information 

None of the variables assessing the information attributes of the health system were 
associated with satisfaction with PNC services as shown in Table 4.9. However, one 
participant from the FGD felt that staff did not give her information and reported that 
“Niligoogle about breastfeeding na nilingangana tu na mtoto wangu”. Another 
respondent reported that when she asked about cord care the nurse told her “Ni normal 
enda tu itapona” (FGD participants, Embu Hospital). 


Table 4. 9- Association between satisfaction with PNC services and information 
statements 

Item 

Satisfaction with PNC 

OR (95% CI) 

P-value 

 

Satisfied 

Not 
satisfied 

 

 

I was informed about ward routines 

 

 

 

Satisfied 

47(61.0) 

30(39.0) 

1.518(0.855-2.697) 

0.153 

Not satisfied 

65(50.8) 

63(49.2) 

Ref 

 

I was informed about the 
hospital rules and regulations 

 

 

 

 

Satisfied 

38(63.3) 

22(36.7) 

1.657(0.893-3.074) 

0.108 

Not satisfied 

74(51.0) 

71(49.0) 

Ref 

 

Nurses conveyed messages, which I 
hesitated to ask the doctor 

 

 

 

Satisfied 

54(52.9) 

48(47.1) 

0.873(0.503-1.513) 

0.628 

Not satisfied 

58(56.3) 

45(43.7) 

Ref 

 

I was told about informed 
consent before any procedure 

 

 

 

 

Satisfied 

100(55.9) 

79(44.1) 

1.477(0.647-3.372) 

0.353 

Not satisfied 

12(46.2) 

14(53.8) 

Ref 

 



 

4.8.3 Communication 

The item „Nurses were able to communicate in my own language and were free to talk. 
was associated with satisfaction with PNC with those who said that they were satisfied 
having about 6-fold increment in odd of being satisfied with PNC (OR 5.893 (95% CI 
1.240 - 27.995), p = 0.025). The other variables assessing the communication attributes 
of the health system failed to reach statistical significance in their association with 
satisfaction with PNC (Table 4.10). However, an FGD participant reported that “Most 
nurses and doctors do not communicate with us before and after doing procedures on us 
or our babies” (FGD participant, Embu Hospital). 

 


Table 4. 10 - Association between satisfaction with PNC services and health system 
factors (communication statements) 

Item 

Satisfaction with 
PNC 

OR (95% CI) 

P-Value 

 

Satisfied 

[n (%)] 

Not 
Satisfied 

[n (%)] 

 

 

 

All the questions were answered 
promptly with a positive attitude 

 

 

 

 

Satisfied 

105(55.3) 

85(44.7) 

1.412(0.492-4.050) 

0.520 

Not satisfied 

7(46.7) 

8(53.3) 

Ref 

 

Nurses maintained good public relations 
skills with myself and the family members 

 

 

 

Satisfied 

109(55.6) 

87(44.4) 

2.506(0.609-10.307) 

0.305 

Not satisfied 

3(33.3) 

6(66.7) 

Ref 

 

Nurses communicated with me in 
my own language and were free to 
talk 

 

 

 

 

Satisfied 

110(56.7) 

84(43.3) 

5.893(1.240-7.995) 

0.025 

Not satisfied 

2(18.2) 

9(81.8) 

Ref 

 

Nurses answered all the doubts, asked by me 
concerning my health and that of my baby 

 

 

 

Satisfied 

107(56.0) 

84(44.0) 

2.293(0.741-7.097) 

0.141 

Not satisfied 

5(35.7) 

9(64.3) 

Ref 

 

The doctor who attended to me was polite 

 

 

 

Satisfied 

71(56.3) 

55(43.7) 

1.196(0.680-2.104) 

0.533 

Not satisfied 

41(51.9) 

38(48.1) 

Ref 

 

The doctor explained to me what 
was wrong with me 

 

 

 

 

Satisfied 

69(57.0) 

52(43.0) 

1.265(0.723-2.213) 

0.409 

Not satisfied 

43(51.2) 

41(48.8) 

Ref 

 



 

 

4.8.4 Comfort and Care 

Although not statically significant, more satisfaction with PNC was observed among 
those who were satisfied with „Nurses helped me in keeping myself clean and well 
groomed. compared to those who reported on the contrary (56.5% against 28.6% 


respectively, OR 3.253 (95% CI 0.985 - 10.739), p = 0.053). Higher levels of satisfaction 
with PNC was observed among those who rated the food served in the hospital as 
satisfactory compared to those who rated it as unsatisfactory (60.3% versus 47.2% 
respectively). Nevertheless, the association was statistically insignificant (OR 1.703 (95% 
CI 0.974 - 2.976), p = 0.061). Reporting satisfaction with „Nurses were calm and 
approachable. was associated with higher, albeit insignificant, proportions of satisfaction 
with PNC (56.3% among the satisfied compared to 33.3% among the unsatisfied, OR 
1.703 (95% CI 0.974 - 2.976), p = 0.061). The findings on the rest of the items are shown 
on Table 4.11. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

Table 4. 11- Association between comfort and care components of the health system 
and satisfaction with PNC services 

Item 

Satisfaction with 
PNC 

OR (95% CI) 

P-value 

 

Satisfied 

Not 
satisfied 

 

 

Nurses were calm and approachable 

 

 

 

Satisfied 

107(56.3) 

83(43.7) 

2.578(0.849-7.832) 

0.085 

Not satisfied 

5(33.3) 

10(66.7) 

Ref 

 

Nurses helped me in keeping 
myself clean and properly 
groomed 

 

 

 

 

Satisfied 

108(56.5) 

83(43.5) 

3.253(0.985-10.739) 

0.053 

Not satisfied 

4(28.6) 

10(71.4) 

Ref 

 

I felt safe/secure during my hospital stay 

 

 

 

Satisfied 

111(55.8) 

88(44.2) 

6.307(0.724-54.971) 

0.094 

Not satisfied 

1(16.7) 

5(83.3) 

Ref 

 

The ward was calm with no noise at night 

 

 

 

Satisfied 

103(56.6) 

79(43.4) 

2.028(0.835-4.925) 

0.113 

Not satisfied 

9(39.1) 

14(60.9) 

Ref 

 

Time spent with my visitors was adequate 

 

 

 

Satisfied 

72(55.0) 

59(45.0) 

1.037(0.585-1.838) 

0.900 

Not satisfied 

40(54.1) 

34(45.9) 

Ref 

 

The food served was good 

 

 

 

 

Satisfied 

70(60.3) 

46(39.7) 

1.703(0.974-2.976) 

0.061 

Not satisfied 

42(47.2) 

47(52.8) 

Ref 

 

The toilets and sanitary areas were clean 

 

 

 

Satisfied 

82(56.2) 

64(43.8) 

1.239(0.676-2.271) 

0.489 

Not satisfied 

30(50.8) 

29(49.2) 

Ref 

 

My privacy was respected by all staff 

 

 

 

Satisfied 

98(55.7) 

78(44.3) 

1.346(0.613-2.956) 

0.458 

Not satisfied 

14(48.3) 

15(51.7) 

Ref 

 



 

 

 

 


4.9 Association between satisfaction with PNC services and quality of care 
perceptions 

The findings revealed no significant level of association between the satisfaction of 
postnatal women and quality care dimensions at Embu hospital. The findings are depicted 
on table 4.12. 

Table 4.12 Association between quality care dimensions and satisfaction with PNC 
services 

Domain 

Category 

Satisfaction with PNS 

OR (95% CI) 

P-
value 

 

 

Yes 

No 

 

 

Tangibility 

Satisfied 

112(54.9) 

92(45.1) 

0.451(0.388-0.525) 

0.454 

 

Not-satisfied 

0(0.0) 

1(100.0) 

 REF 

 

Reliability 

Satisfied 

111(55.2) 

90(44.8) 

3.700(0.378-36.180) 

0.331 

 

Not-satisfied 

1(25.0) 

3(75.0) 

 REF 

 

Responsiveness 

Satisfied 

112(55.2) 

91(44.8) 

0.448(0.385-0.522) 

0.205 

 

Not-satisfied 

0(0.0) 

2(100.0) 

 REF 

 

Assurance 

Satisfied 

112(54.6) 

93(45.4) 

------- 

 ----- 

 

Not-satisfied 

0(0.0) 

0(0.0) 

REF 

 

Empathy 

Satisfied 

112(54.6) 

93(45.4) 

------- 

 ------- 

 

Not-satisfied 

0(0.0) 

0(0.0) 

REF 

 

Service 

Satisfied 

30(66.7) 

15(33.3) 

1.902(0.951-3.804) 

0.066 

 

Not-satisfied 

82(51.3) 

78(48.8) 

 REF 

 



 

4.9.1 Tangibles 

No significant associations were observed between satisfaction with PNC services and 
tangible statements on the perceptions on quality of care given (Table 4.13). However, 
43.8% of clients were not satisfied with the toilet and sanitary facilities cleanliness. This 
was further affirmed by an FGD participant who reported that “The hygiene in this place 
is not good, the washrooms are not clean and some patients defecate on the floor. Some 
sinks don’t have running water” (FGD participant, Embu hospital) 

 

 


Table 4. 13 - Association between satisfaction with PNC services and perceptions on 
the quality of care (tangible statements) 

Statement/Response 

Satisfaction with 
PNC 

OR (95% CI) 

P-value 

 

Satisfied 

Not 
satisfied 

 

 

Hospital has well-maintained 
equipment 

 

 

 

 

(Strongly) disagree 

20(52.6) 

18(47.4) 

0.906(0.447-1.835) 

0.784 

(Strongly) agree 

92(55.1) 

75(44.9) 

Ref 

 

Cleanliness and hygiene in this hospital were excellent 

 

 

(Strongly) disagree 

3(30.0) 

7(70.0) 

0.338(0.085-1.346) 

0.191 

(Strongly) agree 

109(55.9) 

86(44.1) 

Ref 

 

The staff were clean and well groomed 

 

 

 

(Strongly) disagree 

1(25.0) 

3(75.0) 

0.270(0.028-2.643) 

0.331 

(Strongly) agree 

111(55.2) 

90(44.8) 

Ref 

 



 

4.9.2 Reliability 

Table 4.14 displays the results of the evaluation of the relationship between satisfaction 
with PNC services and perceptions of the reliability of the quality of care. Mothers who 
disagree or strongly disagreed with the statement „Hospital stay period was short. were 
significantly less likely to have been satisfied with PNC when assessed against those who 
were in (strong) agreement with the statement (19.0% vs. 58.7%, OR 0.166 (95% CI 
0.054 - 0.512), p = 0.001). Other statements addressing reliability perceptions with 
respect to QOC were not associated with satisfaction with PNC. 

 

 

 

 


Table 4. 14 - Association between satisfaction with PNC services and perceptions of 
the reliability of the quality of care 

Statement/Response 

Satisfaction with 
PNC 

OR (95% CI) 

P-value 

 

Satisfied 

Not 
satisfied 

 

 

Hospital provided 
services without delays 

 

 

 

 

(Strongly) disagree 

5(33.3) 

10(66.7) 

0.388(0.128-1.178) 

0.085 

(Strongly) agree 

107(56.3) 

83(43.7) 

Ref 

 

Hospital stay period was short 

 

 

 

(Strongly) disagree 

4(19.0) 

17(81.0) 

0.166(0.054-0.512) 

0.001 

(Strongly) agree 

108(58.7) 

76(41.3) 

Ref 

 

Nurses monitored my health status 
regularly/every day 

 

 

 

(Strongly) disagree 

15(46.9) 

17(53.1) 

0.691(0.324-1.473) 

0.337 

(Strongly) agree 

97(56.1) 

76(43.9) 

Ref 

 

Doctors checked my 
health status daily 

 

 

 

 

(Strongly) disagree 

40(51.3) 

38(48.7) 

0.804(0.457-1.416) 

0.450 

(Strongly) agree 

72(56.7) 

55(43.3) 

Ref 

 



 

4.9.3 Responsiveness 

Disagreeing (disagree or strongly disagree) with the statement „The waiting time for daily 
services was not lengty (less than 1 hour). was associated with about 80% decrement in 
the likelihood of being satisfied with PNC services (OR 0.166 (95% CI 0.054 - 0.512), p 
= 0.001). Other statements evaluating the perception of responsiveness with respect to 
QOC were not significant predictors of satisfaction with PNC in the study population 
(Table 4.15). To further reaffirm whether the hospital provided services in a responsive 
manner, one respondent from the FGD reported that “These health workers did not assist 
on time” (FGD participant, Embu Hospital). 

 


Table 4. 15 - Association between satisfaction with PNC services and perception of 
responsiveness 

Statement/Response 

Satisfaction with 
PNC 

OR (95% CI) 

P-value 

 

Satisfied 

Not 
satisfied 

 

 

Nurses responded immediately 
when called by me 

 

 

 

 

(Strongly) disagree 

21(58.3) 

15(41.7) 

1.200(0.579-2.486) 

0.623 

(Strongly) agree 

91(53.8) 

78(46.2) 

Ref 

 

Nurses were helpful to me 

 

 

 

 

(Strongly) disagree 

6(40.0) 

9(60.0) 

0.528(0.181-1.543) 

0.237 

(Strongly) agree 

106(55.8) 

84(44.2) 

Ref 

 

Doctors were always available 
for any review 

 

 

 

 

(Strongly) disagree 

30(51.7) 

28(48.3) 

0.849(0.462-1.562) 

0.599 

(Strongly) agree 

82(55.8) 

65(44.2) 

Ref 

 

Waiting time for admission 
services was not long 

 

 

 

 

(Strongly) disagree 

19(45.2) 

23(54.8) 

0.622(0.314-1.230) 

0.170 

(Strongly) agree 

93(57.1) 

70(42.9) 

Ref 

 

Waiting time for the daily 
services was not long 

 

 

 

 

(Strongly) disagree 

4(21.1) 

15(78.9) 

0.193(0.062-0.603) 

0.002 

(Strongly) agree 

108(58.1) 

78(41.9) 

Ref 

 



 

4.9.4 Assurance 

Table 4.16 shows the association between satisfaction with PNC services and perception 
of assurance with QOC. No statement in this subscale was associated with satisfaction 
with PNC services. 

 

 

 

 


Table 4. 16 - Association between satisfaction with PNC services and perception of 
assurance 

Statement/Response 

Satisfaction with 
PNC 

OR (95% CI) 

P-value 

 

Satisfied 

Not 
satisfied 

 

 

The doctors were competent 
and skillful 

 

 

 

 

(Strongly) disagree 

31(50.8) 

30(49.2) 

0.804(0.441-1.465) 

0.475 

(Strongly) agree 

81(56.3) 

63(43.8) 

Ref 

 

Nurses were very respectful 

 

 

 

 

(Strongly) disagree 

14(50.0) 

14(50.0) 

0.806(0.363-1.790) 

0.596 

(Strongly) agree 

98(55.4) 

79(44.6) 

Ref 

 

Doctors were knowledgeable 
and would answer all my 
questions 

 

 

 

 

(Strongly) disagree 

29(54.7) 

24(45.3) 

1.005(0.536-1.882) 

0.989 

(Strongly) agree 

83(54.6) 

69(45.4) 

Ref 

 

Nurses were very 
knowledgeable and able to 
respond to my questions 

 

 

 

 

(Strongly) disagree 

23(57.5) 

17(42.5) 

1.155(0.575-2.321) 

0.685 

(Strongly) agree 

89(53.9) 

76(46.1) 

Ref 

 



 

4.9.5 Empathy 

All the statements on the perception of empathy with respect to the QOC failed to show 
significant associations with PNC as shown in Table 4.17. However, an FGD participant 
differed with the majority when she reported that “Nurses in this facility are not 
concerned about us. “Another participant reported that “Niligoogle about breast feeding 
na nikangangana na mtoto wangu bila usaidizi wowote”. Therefore, a section of the 
respondents still felt some nurses were not empathetic enough. 

 

 

 


Table 4. 17 - Association between satisfaction with PNC services and perception of 
empathy 

Statement/Response 

Satisfaction with 
PNC 

OR (95% CI) 

P-value 

 

Satisfied 

Not 
satisfied 

 

 

Nurses in this facility were very caring 

 

 

 

(Strongly) disagree 

5(50.0) 

5(50.0) 

0.822(0.231-2.932) 

0.758 

(Strongly) agree 

107(54.9) 

88(45.1) 

Ref 

 

Doctors listened to me attentively 

 

 

 

(Strongly) disagree 

28(54.9) 

23(45.1) 

1.014(0.537-1.917) 

0.965 

(Strongly) agree 

84(54.5) 

70(45.5) 

Ref 

 

Nurses listened to me attentively 

 

 

 

(Strongly) disagree 

15(55.6) 

12(44.4) 

1.044(0.462-2.357) 

0.918 

(Strongly) agree 

97(54.5) 

81(45.5) 

Ref 

 

Nurses spent enough time to check and advise me 

 

 

(Strongly) disagree 

4(25.0) 

12(75.0) 

0.250(0.078-0.804) 

0.804 

(Strongly) agree 

108(57.1) 

81(42.9) 

Ref 

 

Doctors spent enough time to check and 
advice the patient 

 

 

 

(Strongly) disagree 

33(49.3) 

34(50.7) 

0.725(0.404-1.302) 

1.302 

(Strongly) agree 

79(57.2) 

59(42.8) 

Ref 

 



 

 

4.10 Hypothesis testing 

Hypothesis 1: Relationship between socio-demographic factors and satisfaction of 
women with postnatal care services. As reported in Table 4.5, the findings showed that 
the variables were statistically insignificant. The P-Value was greater than 0.05, hence 
the researcher accepted the null hypothesis that stated that socio-demographic factors do 
not influence the satisfaction of women with postnatal care services. 

Hypothesis 2: Relationship between health system factors and satisfaction of women with 
postnatal care. The table 4.7 reports a statistical significant association between health 


system factors (comfort and care P=0.08) and the women.s level of satisfaction. Hence 
the assumed null hypothesis was rejected at P<0.05. 

Hypothesis 3: The relationship between the perceptions on quality of care and women.s 
satisfaction with postnatal care services. Table 4.12 revealed there was no association 
between the quality of care and the postnatal women.s satisfaction with the services 
offered in Embu Hospital. The P value was more than 0.05, hence we accept the 
hypothesis that states that perceived quality of care does not influence the women.s level 
of satisfaction with postnatal care services. 

4.11 Summary of study findings 

The socio-demographic characteristics showed that most of the respondents 40.5% 
(n=83) were aged between 25 to 34 years with only a minority 11.2% (n=23) being aged 
above 35 years. This means that most women in Embu hospital gave birth early. The 
study also showed that only a minority 6.8% (n=14) who had studied up to university 
level and 43.4% (n=89) up to secondary level. The socio demographic variables were not 
statistically significant. Age (P=0.759), marital status (P=0.667), religion (P=0.244), 
education (P=0.717), occupation (P=0.194) and monthly income (P=0.385). 

The only health system factor that influenced women.s satisfaction with postnatal care 
was comfort and care (p=0.008). Other health system factors were not statistically 
significant, orientation (p=0.879), information (p=0.684), communication (p=0.092). The 
perceived quality of care was not statistically associated with the women.s satisfaction 
level with postnatal care. Tangibility (p=0.454), reliability (p=0.331), responsiveness 
(p=0.205) and service expectation (p=0.066). 


CHAPTER FIVE: DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS 

5.1 Introduction 

The chapter covers the discussion of study findings, the conclusions drawn and the 
recommendations arising from this study to analyze levels of satisfaction with postnatal 
services among women who delivered in Embu hospital, Embu County, Kenya. 

5.2 Discussion of the Findings 

5.2.1 Influence of socio demographic characteristics on satisfaction 

Findings from this study reported that the socio-demographic characteristics did not have 
a significant association with the satisfaction of postnatal women. The most satisfied 
women (57.8%) were aged between 25-34 years. Hence age partially influenced 
satisfaction with younger women being more satisfied than their older counterparts. 
These findings are similar to a survey done by Panagopoulou et al (2018) among 300 
Greek women on satisfaction with postnatal care which was conducted between January 
2015 to July 2017. The results also revealed there was no association between maternal 
age and the women.s satisfaction. Another study conducted in 2013 in Turkey among 300 
women on satisfaction with postnatal care in a government hospital in Fazil city showed 
that most women (56%) were between 20 to 29 years. These results are almost similar 
with findings from Embu Hospital meaning that these age groups are more fertile hence 
constituting the majority of women delivering. However, the results are contrary to a 
study by Lazzrini, Mariani and Semanzato et al (2020) in an Italian study exploring the 
relationship between mother.s satisfaction and other quality indicators. The findings 
revealed that 40.9% of the women were 35 years and above. 


The respondent.s marital status was not associated with women.s satisfaction level. 
These findings are congruent with a study by Sachsanidis (2018) on satisfaction with 
childbirth services among 139 mothers in Greece which showed no significant 
association between marital status and their satisfaction. Results in Embu hospital 
showed that most women (75.6%) were married, which was similar with findings from 
Lazzarini et al (2020) who showed that in the Italian study 95.2% of the women were 
married. This shows that there are no geographical differences in the marital status of the 
respondents across the globe. 

The educational level was not associated with satisfaction. The women.s level of 
education seemed not to have an important bearing on whether they were satisfied with 
the postnatal services. These results differ with study findings by Panagopoulou (2018) 
from a Greek survey on women.s satisfaction which showed a relationship between 
satisfaction with postnatal care services and level of education (p=0.0001). Higher 
satisfaction was associated with low education level among these women. Another study 
done by Tocchioni et al (2018) on socio-demographic factors that determine women.s 
satisfaction in Italy differs with the current study since it showed that patients who were 
highly educated were more satisfied with the care provided than those with lesser 
education. 

The study also revealed no significant relationship between satisfaction and the monthly 
income earned by the women visiting this facility (p=0.385). Most postnatal women in 
Embu hospital earned low income with monthly income less than Ksh 10,000. The 
findings are incongruent with findings by Okari (2018) on satisfaction with maternity 


care services in Nairobi County which showed that maternal satisfaction among postnatal 
women increased with decreased family monthly income with a P value of 0.001. 

The women.s occupation did not influence the women.s satisfaction. This differs from an 
Egyptian study by Lamadah and El-Nagger (2012) on quality of postpartum care which 
showed that housewives were more satisfied than women who were working. 

From this study women who delivered vaginally were less satisfied than their 
counterparts who had delivered via C/S with a P value of (0.002). Women who were also 
visiting Embu for their first time were more satisfied as compared to those who were 
visiting the facility for consecutive times with a P value (0.040). This differs with a study 
conducted by Sachsanidis (2018) on satisfaction with health services in a Greek study 
conducted in Athens among 139 mothers which showed that women who had caesarean 
section were less satisfied with the midwives than those who had delivered through 
normally. 

5.2.2 Health system factors influence on satisfaction 

Health system factors form the pillar of any health care facility. They have a great impact 
in determining whether the clients receive the expected care or not. In a postnatal care 
setting the following health system factors are essential; orientation, information, 
communication, safety, staffing and availability of supplies. 

Orientation is essential to every client in a health care setting. In Embu Hospital most 
(87.3%) patients were given warm welcome that made them comfortable during 
admission. However, 54.6% were dissatisfied with the orientation to the health care team 
members in the postnatal unit. The results are similar with an evaluation study that was 
done among 100 postnatal mothers. satisfaction at El-Shatby Hospital in Egypt which 


reported that 36% of the mothers were dissatisfied with the orientation during admission. 
Another 33% felt they were not satisfied with the orientation to the health team members 
and the postnatal unit (Battawi and Hafiz, 2017). 

Information is power hence an important aspect while dealing with every client. None of 
the variables relating to information influenced women satisfaction with postnatal care 
services. This differs with a research in Egypt that evaluated the quality of postpartum 
care which showed that 87.5% of the women were dissatisfied since they received very 
brief information (Nyongesa et al, 2012). 

Communication is the main ingredient in maternal health care. The study findings 
showed that nurses maintained good public relations skills and were able to communicate 
in the client.s local language (P= 0.025). This showed that in Embu hospital the patient 
provider relationship was good and had time for their clients. This may be attributed to 
the reasons why the patient would always come back for services in this facility and 
referral for other friends. However, this contrasts with an observational comparative 
study conducted in Brazil among 50 adolescents and 51 adults. The results showed that 
adolescent mothers were dissatisfied with the nurse.s availability and nurse- client 
communication (Passarrelli, Lopes, Merighe, et al, 2018). 

Safety of the client is also essential in a health care setting. Finding of this study showed 
a relationship between the client.s safety and their level of satisfaction with postnatal care 
given with (P=0. 094). In Embu hospital only 2.9% of the respondents who felt they were 
not safe and secure in this facility. This portrayed that the security was tight in this 


facility. These findings differ with those published by Battawi and Haffiz (2017) where 
he reported that 22% of the patients did not feel safe and secure at night. 

Staffing is one of the management functions. Every work place needs adequate number of 
staff to ensure productivity and satisfaction of the customers. The findings in Embu 
hospital portrayed that a section of the client.s 18% still felt there was need to increase 
the number of staff. These study findings are congruent with a research conducted in 
Pumwani maternity hospital which showed that 29% of the clients felt that the hospital 
had inadequate health providers (Nyongesa et al, 2012). 

Privacy and confidentiality are some of the patients. rights that must be adhered to in any 
health care setting. Majority of the clients (56%) were satisfied with 44% not satisfied 
with the aspect of privacy. These findings indicated that privacy is not upheld at all 
times. These findings concur with an Australian study which portrayed that most women 
were concerned about lack of privacy in the maternity setting. 

Comfort and care of the patient was another indicator of health system factors. Some 
aspects used to measure this included; noise at night, food, assistance in keeping patients 
clean and well-groomed and cleanliness of the toilet/sanitary facilities. In this study a lot 
of women reported satisfaction since there was no noise at night and the food offered was 
good. Most of the respondents also reported that nurses greatly assisted them in keeping 
themselves clean and well groomed. However only 28% were dissatisfied with 
cleanliness of the toilets and sanitary areas. This study is similar with findings by 
Nyongesa et al (2012) at Pumwani hospital on determinants of maternal satisfaction 
which reported that 45% of the mothers were unsatisfied with the overall comfort and 
cleanliness. 


Supplies and resources contribute to efficient health care systems. Therefore, all hospital 
managers must ensure that every department has all the necessary resources to ensure 
patients receive timely quality services. In Embu hospital some of the women felt that the 
supply of medicine was inadequate. According to WHO (2013) it is always the client.s 
expectation to have the prescribed drugs available and promptly administered. Svirastava 
et al (2015) reports that women view the availability of equipment.s, medicine, 
appropriate and qualified personnel and numerous services as imperious to the service 
quality. 

5.2.3 Women’s satisfaction with postnatal care 

Women become satisfied when they receive better and good services after giving birth. 
The results showed that in Embu hospital larger number women (54.6%) reported 
satisfaction with the postnatal care provided to them with only 45.4% being dissatisfied 
with the overall postnatal care provided in Embu Hospital. The findings are congruent 
with those in Nepal in a study conducted in 2015 on satisfaction with maternal health 
services that showed that 48% of postnatal mothers were very satisfied with the services 
provided. Other studies in Mozambique reported 92.5% of the women being satisfied and 
63% reporting satisfaction with postnatal care services in Ethiopia (Achanya et al, 2018, 
Mucombi et al, 2019). However, studies conducted in UK reported that less women were 
satisfied with the postnatal services offered. The different findings may be due to 
difference in their cultural settings of the service providers and also receivers. 

According to MOH and MPHS (2012) the key role of health providers during the 
postnatal period includes: monitoring of the vital signs, monitoring for signs of abnormal 
bleeding, pallor, physical examination of both mother and baby, counseling the mother 


on nutrition, breast feeding and infant care/self-care and advise on family planning and 
immunizations, teaching on how to identify signs of infections for both mother and baby. 
All the ten key informants were able to confirm that they provided the postnatal services 
to women prescribed by the World Health Organization and Ministry of Health. 
According to this study it was noted that more than 90% of the women were satisfied 
with information on family planning, breast care, information on nutrition, sleep and rest 
in the post-partum period, postpartum visits and their importance. However, 57.6 % of 
the women were dissatisfied with assistance in early ambulation, 47.3% checking of the 
vital signs. In any health care setting the nurses have a major role in monitoring of 
clients. vital signs in order to detect any maternal and neonatal complications postnatally. 
Women postnatally can get puerperal sepsis, postpartum hemorrhage and mastitis. 
Neonates can also get neonatal sepsis, Asphyxia as some of the complications which can 
easily be detected during monitoring of vital signs. Nnebue et al (2014) in a similar study 
postulated that women should be educated and given the right information on postnatal 
care. This helps the woman in making informed choices about their care and that of the 
baby and increases their satisfaction and confidence with the quality of care provided. 

 According to WHO (2013) mothers require a lot of education and social support from 
the health worker to enable her take good care of the baby. More than 90% of the mothers 
felt that nurses assisted them in baby care, nurses taught them how to identify signs of 
neonatal infections, taught them on breast attachment and positioning during 
breastfeeding and taught them concerning immunizations. This study concurs to the 
findings from Cairo where mothers suggested different ways of improving postpartum 
services. From that study 72% of the women suggested the need for more advice on 


breastfeeding, 62.3% thought that the health providers should give advice relating to both 
mother and baby. A study by Ziabakhsh (2018) further showed that 72.5% of the 
respondents felt that midwives were very instrumental in instilling information on infant 
care. 

Majority of the women suggested the following to help improve their satisfaction with 
postnatal care: Employment of more staff, staff to supervise students, staff should change 
their attitude, improve on general cleanliness of the ward and washrooms, paying more 
attention to primigravidas and giving them more information, improving on availability 
of resources and close monitoring of patients. progress. These findings contradict those 
from a study in Cairo where mothers suggested the need for more advice on breastfeeding 
and increased time with the nurses (Lamadah et al, 2012). 

5.2.4 Influence of perceived quality of care on women’s satisfaction 

Quality is a measure of satisfaction that is dependent on someone.s experiences on some 
aspects of the health service. In Embu the women.s perception on the quality of care was 
measured through questions that targeted a few dimensions of quality care and also 
focused group discussion questions. 

Majority of the women were able to define quality differently based on their own 
perception. Many reported it was the provision of the best services to women after 
delivery. Others commented on cleanliness of the hospital environment, provision of 
medicines as expected, availability of resources and supplies like water and linen, 
concerned staff attending to all client.s needs, enough and knowledgeable staff, staff who 
are courteous, timely services. The results are in line with those of Svivastava et al 
(2015) who reported that women felt quality maternal services included attentive and 


polite physician, appropriately knowledgeable, respectful care providers, availability of 
medications and equipment.s, cleanliness, comfort and sanitary hygienic conditions. 
Luxford et al (2010) in his study also associated women satisfaction with some key 
aspects of quality care which includes; being treated with respect, courtesy, the 
availability of staff, and the confidence in providers, physical comfort of clients and 
receiving information. 

The health providers were also able to define quality postnatal care. Majority of them 
commented on giving of all services as per the standards/guidelines stipulated by 
Ministry of Health and World Health Organization. Majority of the key informants also 
commented on the ideal care given to prevent maternal and neonatal mortality. Most key 
informant defined quality as the provision of the best services to ensure women are 
satisfied and attending them promptly. This is in line with WHO (2013) who defined 
health care quality as “consisting of proper performance (according to standards) of 
interventions that are known to be safe, that are affordable to the society, and that have 
ability to produce impact on mortality and morbidity.” 

Majority of the key informants ranked the quality of postnatal services as good, with only 
40% who said the services were average. Majority of them also thought they offered high 
quality services since the women they served were always satisfied. Findings from the 
key informants noted that the quality of services affected the satisfaction of the mothers 
since most nurses reported that the reason why they thought women were satisfied was 
because they offered quality postnatal services. 


The study also sought to assess the five dimensions of quality care which affect client.s 
level of satisfaction. The first dimension measured was tangibility. A hospital which is 
clean, organized and with good physical appearance, with good and neat staff. If the 
hospital premises, restrooms, equipment.s, wards and beds are well maintained this can 
influence a patient.s impressions about the hospital. From this study 81.5% agreed that 
Embu hospital had well maintained equipment.s. However, it was also noted that most 
key informants recommended that more modern equipment.s should be purchased as this 
would enhance efficiency while serving clients. This compares to a study conducted in 
Nyandarua Hospital in Kenya on perceived quality of services which showed that women 
had a satisfaction index of 69% on the tangibility aspect. Most women (61%) reported 
that the facility had well maintained and modern equipment.s (Katuti, 2018). The study 
findings in Embu also concluded that most of the staff were clean and well groomed. 
These findings concur with those published by WHO (2013) which showed that most 
health workers value neatness and good appearance. 

The second dimension was reliability, which means that the client receives the required 
treatment and is seen according to her expectations (WHO, 2015). The study evaluated 
the extent to which hospital provided treatment, diagnosis tests and other services without 
delays. Majority of the respondents (92.7%) agreed that Embu hospital provided services, 
treatment and diagnostic tests without any delays. Majority of the respondents also 
reported that the hospital stay period was short and waiting time to receive daily services 
was not long. These findings concur with the study done in Pumwani maternity hospital 
(PMH) on the determinants of client satisfaction, among 280 postnatal mothers which 


showed that the patient waiting time influenced their satisfaction. When the waiting time 
was long this was associated with low levels of satisfaction (Nyongesa et al, 2012). 

The third dimension of quality was responsiveness, which means that clients always 
expect the hospital personnel to act quickly when needed and all the prescribed drug be 
available and are administered promptly. Most women (92.7%) strongly agreed that the 
nurses were very helpful. On the aspect of availability of doctors always for any review it 
was noted that only 71.7% who strongly agreed, while the others strongly disagreed. This 
is in congruence with the Bangladesh study on patient satisfaction which showed that 
most patients were satisfied with nurse.s responsiveness but a larger percentage 
dissatisfied with doctor.s responsiveness. This may be attributed to the fact that nurses 
are always available for 24 hours as compared to the doctors who usually are called upon 
when need be. On the issue of availability of drugs most women from the focused group 
discussions reported they were not satisfied since they did not receive pain medications 
as expected and were not reviewed by the doctors daily. This is similar to a study by 
Okumu and Oyugi (2018) which noted that pain control after childbirth affected the 
satisfaction and perception of care received. 

This study found that in Embu hospital majority of respondents strongly agreed 90.7% 
that waiting time for admission services and daily services was not long. The study 
concluded that waiting time for daily services was short which was associated with 
higher levels of client satisfaction. In Pumwani hospital longer waiting time for services 
was associated with lower levels of satisfaction (Onyango and Kaikai, 2014). 

The fourth dimension of quality care is assurance. The nurses and the doctors need to be 
knowledgeable, highly skilled and courteous since this can provide a sense of assurance 


to the client, hence may be significant in influencing their satisfaction with the service. 
Pena et al (2013) postulates that when the perceived assurance from the health providers 
is high, then there will be greater satisfaction of patients. The study noted that generally 
nurses in Embu hospital were very respectful, both nurses and doctors were also 
perceived to be knowledgeable and therefore the respondents were satisfied. The findings 
are in line with those of Mwanamanyala hospital in Tanzania where clients reported that 
the staff treated their information with a lot of confidentiality and they felt that staff had 
adequate knowledge to answer their questions (Khamis and Njau, 2014). 

Empathy was also another dimension of quality in this study. The clients report greater 
satisfaction when they receive more empathy from the service provider. This is similar to 
this study in Embu which noted that nurses were very caring, doctors and nurses listened 
attentively and they also spent enough time to check clients and advise them. These 
findings are supported by findings from systematic reviews done among 15 Sub-Saharan 
African countries which revealed that women prefer health workers who are respectful, 
very supportive, kind hearted and attentive to the women.s needs (Lythgoe, Lowe, 
McCauley and Hannah, 2021). 

 

 

 

 

 

 


5.3 Conclusion 

In this study it was concluded that most women were satisfied with postnatal care 
services provided to them, however there is still 45.4% who are dissatisfied with the 
services. Hence the hospital still needs to improve their services since women become 
satisfied when they receive better and good services after giving birth. 

The study concluded that no significant association was found between socio-
demographic characteristics and satisfaction with postnatal care. 

The study also concluded that the health system factors that influenced satisfaction of 
postnatal women was comfort and care. Therefore, every hospital should ensure patient 
comfort to ensure patient.s expectations are met. 

The study also found that women had different perceptions relating to the quality of care 
and this may have influence on their satisfaction with the service given. Quality was 
defined based on the various dimensions of tangibility, empathy, reliability, 
responsiveness and assurance. To support these women were found to define quality as 
physical appearance and cleanliness of the facility, availability of resources, concerned 
staff, meeting client.s expectations, receiving prompt/timely attention and knowledgeable 
staff. 

 

 

 

 

 


5.4 Recommendations 

These recommendations are hereby suggested: 

1. The county government of Embu together with the hospital administration should 
have frequent patient satisfaction surveys which can help to provide feedback to 
health workers and the customers. This will help identify any gaps in client 
satisfaction and measures can be instituted on improvement of the satisfaction level of 
clients. 
2. The Ministry of Health, National and County Government of Embu should develop a 
specific policy for effective implementation, timely reimbursement and effective 
utilization of the free maternity services funds at the county and public hospitals. 
They should recruit and deploy more qualified staff to ensure quality care is given to 
patients. They should also ensure provision of adequate supplies, drugs and 
equipment.s for effective service delivery. 
3. The hospital management should organize periodic trainings of their staff on 
customer care. These training will equip staff on how to handle the postnatal women 
which can result in better quality service, hence improving the satisfaction levels of 
clients. 
4. Communication between the mothers and the health workers should be enhanced to 
allow effective passing of information related to post-natal care. The hospital 
management through the Information Technology department should issue 
information brochures to all postnatal mothers after delivery to ensure they are 
sensitized to the whole postnatal process. 



5. The hospital management should include postnatal care services in the hospital 
service charter to ensure no delays in the postnatal services. 
6. Research studies on client satisfaction should be conducted in the other departments 
of the hospital to enhance change across the entire hospital. 


5.5 Recommendations for Further Studies 

This study assessed postnatal women.s satisfaction with care offered at Embu Hospital. 
There is need to research on quality of intrapartum care services in Embu Hospital to 
ensure patient satisfaction with the entire process of labour and delivery. 

The study focused on key objective of the study which was analysis of postnatal care 
services in Embu Hospital only, thus the same study should be done in other hospitals 
within the Sub Counties and in the rest of 47 Counties to enable generalization of results. 

 

 

 

 

 

 

 

 

 

 

 

 


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APPENDICES 

Appendix I: Consent Form 

My name is Joyce Wambere Wachira, student from Kenyatta University undertaking 
MPH. I am conducting a study on “Assessment of satisfaction with postnatal care 
services among women who delivered in Embu Hospital, Embu County, Kenya”. Kindly 
take your time to discuss this study with your family, friends, or anyone else you wish to. 
You are allowed to decide whether to join, or not to join this study. The results of this 
research study may be published, but the name or identity of participants or their place of 
work will not be revealed. They will be used in improving service quality in this region 
and other counties across Kenya. 

Procedures to be followed 

When you decide to participate in the study, you will be asked some questions on 
postnatal care services. Information given will be recorded in the questionare. Kindly 
remember that r participation in this study is voluntary and have the right to refuse to 
participate. The researcher can decide to stop the study or remove you from the study at 
any time deemed it is in your best interest. They can remove you from the study without 
your consent. Feel free to ask any questions relating to this study at any time. You can 
also refuse to respond to any questions asked or stop this interview at any time. You may 
stop being a participant at any time without any dire consequences. 

Discomforts and risks 

This study has no known risk. You can decide not to answer any of the questions if it 
causes any form of discomfort. 


Benefits 

You may expect the following benefit from this research: When you participate in this 
study it will help us to learn about postnatal care and how the services can be improved. 
However, we can.t guarantee that you will benefit from participating in this study. Others 
people may be beneficiaries in the future from the information we find in this study. 

Reward 

No reward is given for agreeing to participate in this study. 

Confidentiality 

The following steps will help to keep information confidential, and protect it from 
unauthorized disclosure, tampering, or damage. No name will not be documented on the 
questionnaire. After the data collection all the questionnaires will be kept in a locked 
cabinet and every information shared will be kept private. 

Contact information 

In case of any questions you can contact the researcher on 0725751986 or Dr. George 
Otieno on 0719506770 or Dr. Harun Kimani on 0725552475 or the Kenyatta University 
Ethical Review Committee Secretariat on kuerc@ku.ac.ke. 

Participant’s Statement 

The above information concerning participation in the current study is clear to me. I have 
been given the opportunity to ask questions and all the questions have been answered to 
my satisfaction. My participation in this study is voluntary. I understand that my records 
will treated with privacy and I can leave the study at any time I wish. I clearly understand 
that I will still get the same type of care and medical treatment whether I decide to leave 


the study or not and that any of my decisions will not change the care I will receive from 
this facility today or in future. 

Participant.s Signature …………………… 

Date _______________ 

Investigator’s statement 

I, the undersigned, have explained to the volunteer participant in a language she 
understands, all the procedures to be followed in the study and any risks and benefits 
involved. 

Name of Interviewer ………………………… 

__________________ ___________________ 

Interviewer Signature Date 

 

 

 

 

 

 

 

 


Sehemu Ya I : Ruhusa Ya Kufanya Utafiti 

Jina (Joyce Wambere Wachira) ni mwanafunzi wa chuo kikuu cha Kenyatta ambaye 
anaomba kushiriki kwenu katika utafiti ambapo lengo lake ni kujua kama akina mama 
waliojifungua wametosheka na huduma walizopata kwa hii hospitali ya Embu. Kushiriki 
kwenu kutajumuisha kujibu maswali ambayo yanaonyesha hoja kuhusu utafiti. 

Utafiti hautahusisha ushiriki wa moja kwa moja. Muda wa kushiriki ambao unatarajiwa 
ni saa moja. Hakuna shida ambazo zinajulikana kama utakubali kushiriki. Utafiti hauna 
manufaa ya moja kwa moja lakini jamii inaweza kufaidika kama utafiti unakuwa na 
uwezekano. Matokeo ya utafiti huu, yanaweza kuchapishwa lakini majina ya mshiriki au 
pahali pa kazi hapatatajwa. Mtafiti wakati wowote atakua huru ili asishawishiwe 
kutengeneza matokeo ya utafiti kwa njia isiofaa. 

Data yote itakayo kusanywa italidwa vilivyo kabla na baada ya utafiti. Washiriki 
hawatalipwa fidia kwa kushiriki kwao. 

Ikiwa una swali lolote kuhusu utafiti huu ama kushiriki kwako unaweza kuwasiliana na: 

1. Joyce Wambere Wachira ( mtafiti) simu: 07251986 
2. Dkt. George Otieno simu : 0719506770 
3. Dkt. Harun Kimani simu: 0725552475 


Au sekta ya sayansi ya afya chuoni Kenyatta kwa mtandao ufuatao kuerc@ku.ac.ke. 

“Nimesoma habari hiyo ilivyo, mahitaji, madhara na manufaa ya utafiti huu nimeelezwa, 
ninajua madhara yanayohusika na ninaelewa ya kwamba nina uhuru wa kutoendelea 
kushiriki wakati wowote bila kuadhibiwa au kupoteza faida zangu. Ninatia sahihi fomu 
hii ya ruhusa bila kulengeza malalamizi yoyote rasmi, haki na ukarabati. 

 


Sahihi ya Mshiriki……………………………………………. Tarehe ………………….. 

“Ninakubali nimemweleza mshiriki umbo na maana, faida zilizoko na madhara 
yanayotarajiwa katika kushiriki utafiti huu. Nimejibu maswali yote yaliyoulizwa na 
nimeshuhudia sahihi iliyo hapo juu” 

“ Nimempatia mshiriki nakala ya fomu hii iliyotiwa sahihi” 

 

Mtafiti: ………………………….. 

Sahihi …………………………………………………….. Tarehe …………………….. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Appendix II: Postnatal Client Exit Interview Questionnaire 

Levels of satisfaction with the postnatal care services among women who delivered at 
Embu hospital, Embu county, Kenya. 



 

INSTRUCTIONS 

a) Sign the consent form before filling the questionnaire. 
b) Give sincere responses to all the items in the questionnaire. 


Questionnaire code 

Date of data collection 

 

SOCIO- DEMOGRAPHIC CHARACTERISTICS 

Please tick or circle the correct answer 

NO 

ITEM 

RESPONSE OPTION 

REMARKS 

1. 


What is your age 
group? 

1=15-24 2= 25-34 

3=35-44 4= 45 and above 

 

2. 


What.s your marital 
status? 

1 Single 2 Married 3 Divorced 

4 Separated 

 

3. 


What.s your highest 
level of education? 

1 Primary 2 Secondary 

 

3 College 4 University 

 

4. 


What.s your religion? 

1 Christian 2 Muslim 

3 Other (specify)……………… 

 

5. 


What.s your average 
monthly income? 

1 Below ksh 10,000 

2 Ksh 10,000- 20,000 

3 Ksh21,000- 30,000 

4 Ksh 31,000-40,000 

5 Ksh 40,000 and above 

 

6. 


What.s your 
occupation? 

1 Agriculture 

2 Business 

3 Employed 

 




4 Unemployed 

5 Other (specify)…………………. 

7. 


How many times have 
you attended Embu 
hospital in the last 3 
years? 

1 First time 

2 Twice 

3 Thrice 

4 Four times and above 

 

8. 


Have you been 
admitted previously in 
this facility for delivery 
services? 

1 Yes 

2 No 

 

9. 


How many children do 
you have? 

1 None 

2 One 

3 Two 

4 Three 

5 Four 

6 More than four 

 

10. 


What was your mode 
of delivery? 

1 Normal Vaginal Delivery 

2 Caesarian section 

For normal delivery, did you have 
any tears or episiotomy? 

22 Yes 

33 No 

 

11. 


What.s the sex of your 
baby? 

1 Male 

2 Female 

 

12. 


What were your 
reasons for choosing 
this hospital? 

1 Modern facilities available 

2 Quality of services 

3 Not far from home 

4 Referred from another facility 

5 Convenient 

6 Availability of good nurses 

7 Availability of good doctors 

9 Any other reason 
(Specify)………………………… 

 

 

HEALTH SYSTEM FACTORS 

BASED ON YOUR EXPERIENCE IN THIS HOSPITAL. KINDLY TICK ( v) 
WHETHER YOU WERE FULLY SATISFIED (FS), SATISFIED (S), 
UNDECIDED (U), NOT SATISFIED (NS), EXTREMELY DISSATISFIED 
(ED) WITH THE FOLLOWING. 

 

 

 




ORIENTATION 

 

ITEM 

1 

FS 

2 

S 

3 

U 

4 

NS 

5 

ED 

13. 


I was welcomed warmly which 
made me comfortable during 
admission 

 

 

 

 

 

14. 


I was given orientation to the 
members of the health team in 
the post natal unit 

 

 

 

 

 

15. 


I was oriented to toilet, 
bathroom, washing area and 
availability of safe drinking 
water 

 

 

 

 

 

16. 


I was oriented about visiting 
hours for family and doctors 

 

 

 

 

 

 

 

 

 

 

INFORMATION 

 

 

ITEM 

1 

FS 

2 

S 

3 

U 

4 

NS 

5 

ED 

17. 


I was informed about ward routines 

 

 

 

 

 

18. 


I was informed about the hospital 
rules and regulations 

 

 

 

 

 

19. 


Nurses conveyed messages, which I 
was hesitant to ask the doctor 

 

 

 

 

 

20. 


I was told about informed consent 
before any medical procedure 

 

 

 

 

 

 

 

COMMUNICATION 

 

 

ITEM 

1 

FS 

2 

S 

3 

U 

4 

NS 

5 

ED 

21. 


All questions were answered in a 
prompt way and with positive 
attitude 

 

 

 

 

 




22. 


Nurses maintained good public 
relations skills with family members 
and myself 

 

 

 

 

 

23. 


Nurses were communicating in my 
own language and talked freely 

 

 

 

 

 

24. 


Nurses were answering all my 
doubts, and questions concerning 
my health and that of my baby 

 

 

 

 

 

25. 


The doctor who attended to me was 
polite 

 

 

 

 

 

26. 


The doctor explained to me what 
was wrong with me 

 

 

 

 

 

 

COMFORT AND CARE 

 

 

ITEM 

1 

FS 

2 

S 

3 

U 

4 

NS 

5 

ED 

27. 


Nurses were calm and approachable 

 

 

 

 

 

 

28. 


Nurses aided me to keep myself 
clean and well groomed 

 

 

 

 

 

29. 


I felt safe and secure during my 
hospital stay during the day and 
night 

 

 

 

 

 

30. 


The hospital was calm and no noise 
at night in the ward 

 

 

 

 

 

31. 


Time spent with my visitors was 
adequate 

 

 

 

 

 

32. 


The food served was good 

 

 

 

 

 

 

33. 


The toilets and sanitary areas were 
clean 

 

 

 

 

 

 

34. 


My privacy was respected by all 
staff 

 

 

 

 

 

 

SPECIFIC TO POSTNATAL CARE 

 

ITEM 

1 

FS 

2 

S 

3 

U 

4 

NS 

5 

ED 

35. 


I was assisted with personal hygiene 
in the postnatal period and going to 
the toilets. 

 

 

 

 

 

36. 


I was aided in perineal toileting and 

 

 

 

 

 




informed about perineal hygiene 

37. 


I was assisted in early 
ambulation(getting out of bed after 
C/S) 

 

 

 

 

 

38. 


The nurses observed my vital signs 
frequently. 

 

 

 

 

 

39. 


I was educated about involution of 
the uterus. 

 

 

 

 

 

40. 


I was taught about breast care and 
detection of breast minor problems 
in postnatal period and their 
management. 

 

 

 

 

 

41. 


I was educated on nutrition, sleep 
and rest in the postpartum period. 

 

 

 

 

 

42. 


I was informed about lochia 
(discharge) flow and how to detect 
excessive bleeding during the 
postnatal period. 

 

 

 

 

 

43. 


I was told about episiotomy care and 
told how to detect signs and 
symptoms of infection. 

 

 

 

 

 

44. 


I was informed about the family 
planning methods and when to start. 

 

 

 

 

 

45. 


I was advised on the post partum 
visits and their importance. 

 

 

 

 

 

46. 


I was assisted to give bath and 
diaper care, cord care, eye care for 
the baby. 

 

 

 

 

 

47. 


Nurses taught me on how to identify 
the signs of infection for the baby. 

 

 

 

 

 

48. 


I was assisted in positioning the 
baby during and after feeding and 
taught on burping my baby after 
breast feeding. 

 

 

 

 

 

49. 


I was taught about bonding 
,attachment and rooming in. 

 

 

 

 

 

50. 


I was educated about weaning of my 
baby and immunizations. 

 

 

 

 

 

51. 


I was given a birth notification for 
my baby 

 

 

 

 

 




 

 

Client satisfaction 

52. 


Overall, what was your satisfaction with the postnatal services in this facility? 

1 Extremely dissatisfied 

2 Not satisfied 

3 Undecided 

4 Satisfied 

5 Fully satisfied 

53. 


If not satisfied above, kindly identify some of the reasons that made you 
disatisfied with the services you 
received………………………………………………………………………… 

 

54. 


Can you recommend this health facility to your family members and friends? 

1 Yes 

2 No 

55. 


Would you choose to visit Embu hospital for other health care services? 

1 Yes 2 No 

 

 

 

QUALITY OF CARE 

BELOW IS A LIST OF FEATURES DESCRIBING YOUR PERCEPTION 
ABOUT EMBU HOSPITAL.FOR EACH STATEMENT,PLEASE SHOW THE 
EXTENT TO WHICH YOU BELIEVE THIS HOSPITAL HAS THE FEATURE 
DESCRIBED BY THE STATEMENT.TICK IN THE BOXES TO SHOW 
YOUR FEELINGS ABOUT THIS FACILITY. 

 

TANGIBLE STATEMENTS 

 

 

1 

Agreeing 

strongly 

2 

Agreeing 

3 

Disagreeing 

4 

Disagreeing 

strongly 

56. 


Embu hospital has well 
maintained equipment and 
modern equipments 

 

 

 

 

57. 


Cleanliness and hygiene in this 
hospital is good 

 

 

 

 

58. 


The staff were clean and well 
groomed 

 

 

 

 

 

 

RELIABILITY 
STATEMENTS 

1 

Agreeing 

strongly 

2 

Agreeing 

3 

Disagreeing 

4 

Disagreeing 




strongly 

 

59. 


This hospital provides 
treatment, diagnostic tests and 
other services without any 
delays 

 

 

 

 

60. 


The hospital stay period was 
short 

 

 

 

 

61. 


Nurses monitored my health 
status regularly/everyday. 

 

 

 

 

62. 


Doctors checked my health 
status daily 

 

 

 

 

 

RESPONSIVENESS 
STATEMENTS 

1 

Agreeing 
strongly 

2 

Agreeing 

3 

Disagreeing 

4 

Disagreeing strongly 

63. 


Nurses were responding 
immediately when called 

 

 

 

 

64. 


Nurses were helpful to me. 

 

 

 

 

65. 


Doctors were always available 
for any review 

 

 

 

 

66. 


Waiting time for admission 
services was not long 

 

 

 

 

67. 


Waiting time for daily services 
was not long 

 

 

 

 

 

ASSURANCE 
STATEMENTS 

1 

Agreeing 
strongly 

2 

Agreeing 

3 

Disagreeing 

4 

Disagreeing strongly 

 

68. 


The doctors were competent 
and skillful 

 

 

 

 

69. 


Nurses were very respectful 

 

 

 

 

 

70. 


Doctors were knowledgeable 
and answered my questions 

 

 

 

 

71. 


Nurses were very 
knowledgeable and able to 
respond to my questions 

 

 

 

 

 

 




 

EMPATHY STATEMENTS 

1 

Agreeing 
strongly 

2 

Agreeing 

3 

Disagreeing 

4 

Disagreeing strongly 

72. 


Nurses in this facility were 
very caring 

 

 

 

 

73. 


Doctors listened to me 
attentively 

 

 

 

 

74. 


Nurses listened to me 
attentively 

 

 

 

 

75. 


Nurses spent adequate time to 
check and advice me 

 

 

 

 

76. 


Doctors spent adequate time to 
check and advice me 

 

 

 

 

77. 


Generally, what.s your rating of the quality of services you have received in this 
facility? 

1 Excellent 2 Good 3 Fair 4 Poor 5 Very poor 

 

78. 


Which areas do you think, quality of care was not observed since you were 
admitted in the postnatal ward?.................................................................... 

 

79. 


What are your recommendations on ways of improving the quality of postnatal 
services in this 
facility?............................................................................................................... 

 

 

 

SERVICE EXPECTATIONS 

 

Before visiting this facility, what were your expectations towards the following 
issues:- 

80. 


Cost of services 

1 Free 2 Acceptable 3 High 4 No expectation 

81. 


Support by the service providers (doctors, nurses, laboratory technicians and 
support staff) 

1 Not good 

2 Acceptable 

3 Excellent 

4 No expectation 

82. 


Cleanliness of the hospital equipment 

1 Not good 

2 acceptable 

3 Excellent 




4 No expectation 

83. 


Supply of medicine 

1 Not good 

2 Acceptable 

3 Excellent 

4 No expectation 

84. 


Adequacy of staff 

1 Few 

2 Enough 

3 Adequate 

85. 


Were your expectations met, by choosing to deliver in Embu provincial hospital? 

1 Yes 

2 No 

86. 


If No above, what can be done next time to ensure your expectations are met? 

…………………………………………………………………………… 

 

 

THANKYOU FOR YOUR PARTICIPATION 



 

 

 

 

 

 

 

 

 

 

 

 


Appendix III: Focused Group Discussion Questions 

Guide for qualitative research on levels of satisfaction with postnatal services among 
women who delivered in Embu hospital, Embu County, Kenya 

Introduction 

Note for facilitator: 

. Welcome the participants 
. Introduce self 
. Assure participants of confidentiality and anonymity 


General questions 

1. What do you understand by postnatal care? 
2. During your last delivery, what services did you receive in the hospital before 
discharge? Did you enjoy your previous hospital stay? 
3. What are some of the expectations you had before visiting this hospital? 
4. How would you describe your experience in the postnatal ward? Probe;(good, 
worse) 
5. What is the best thing about your experience in the postnatal ward? What is your 
worst thing? 


Key questions 

Health system factors 

6. How would you rank this facility in terms of hygiene, comfort, competence of the 
health providers, their courtesy? Why? Was it good, fair or poor? 


Note: Explore each aspect (hygiene, comfort, competence and courtesy) 


7. What would you say about the orientation, information given and communication 
aspects in this facility? Probe (Were you oriented to the postnatal unit? Did you get 
adequate information about the facility?) 
8. What would you say about the staffing in the postnatal unit? Probe (Adequate, 
shortage, highly skilled, knowledgeable, able to give assistance) 
9. Did you get the required services on time?(Pain medication, review by doctor, nurse 
consultation, admission process) 


Perceived quality of care 

10. What does quality of care mean to you? What factors play a role in the quality of 
services? 
11. How should the service be to be considered quality health service? Probe: How is the 
quality affected by: 
I. Availability of health care services, providers ,equipment.s and drugs 
II. Affordability of health services 
III. Performance of providers-knowledge and skills 
IV. Attitude of staff towards the clients 
V. Privacy, confidentiality and trust 
VI. Facility physical appearance and personnel. 
12. Do you think the quality of care of services influences your satisfaction of postnatal 
care? 


Level of satisfaction with postnatal care 

13. What services have you received during your postnatal period in this facility? 



I. Postnatal examination of the mother. Probe on activities (general examination, 
vital signs, maintenance of privacy) 
II. Postpartum examination of the baby. Probe (Head circumference, length of the 
baby, weight of baby, checking for any abnormalities/head to toe examination,) 
III. Post-partum health advices. Probe (personal and baby hygiene, breast 
examination, breast feeding and positioning, cord care, family planning, 
immunizations) 
14. To what extent are you satisfied with the postnatal services given? Why/Why not? 
15. Do you have any complaints about the services given? Probe 
16. What would you comment about the length of the hospital stay in the postnatal 
period? (Probe: Enough, too short, should be longer) 


Closing 

17. What are some of your suggestions to help in improvement of women.s satisfaction 
with postnatal care in this facility? 


 

Thank the women for their participation 

Ask if there is anything they would like to add or if they have any other 
questions. 

 

 

 

 

 


Appendix IV: Key Informant Interview Guide 

Cadre of health worker…………………….Date conducted……………….. 

1. How is the uptake of postnatal care services in this facility? 
2. What are the specific postnatal services you are offering in this ward? 
3. What challenges have you experienced as a health care provider in offering postnatal 
care? 


Probe (workload, staffing, space, equipment, medicine) 

4. In your opinion, how would you rate/rank the quality of postnatal services you offer 
in this facility? 
5. What defines quality postnatal care from your perspective as a health provider? 
6. From your perspective, do you think the women are satisfied with the postnatal care 
services offered? What makes you think they are satisfied/not satisfied? 
7. What would you recommend for better satisfying postnatal services for women 
coming to deliver in this facility? 


 

THANKYOU FOR YOUR PARTICIPATION 

 

 


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Appendix V: Map of Kenya Showing Embu Hospital 

 

 


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Appendix VI: Kenyatta University Ethics Committee Approval 

 


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Appendix VII: National Commission For Science And Technology Approval 

 


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Appendix VIII: Ministry of Education Approval 

 


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Appendix IX: County Director of Health Embu Approval 

 


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Appendix X: County Commissioner of Embu Approval 

 


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Appendix XI: Embu Hospital Approval