Qualidade dos serviços da rede cegonha em João Pessoa: avaliação da satisfação utilizando modelagem de equações estruturais

Abstract

The Stork Network is a Brazilian government program that brings a proposal to restructure the perinatal care with the goals of reducing maternal and infant mortality, to qualify health services and a humanized care modeling. The actions range from the qualification of prenatal care with improved access to tests and structuring of care network, through the structuring of hospitals and vaginally home, encouraging good obstetric practices and the reduction of unnecessary procedures. With the process of implementing this initiative, comes the challenge of analyzing the program. It carried out a qualitative and quantitative research. At first it was carried out to assess the implementation of Stork Network in Joao Pessoa, with unstructured interviews to managers, health professionals and users, and a focus group with doulas. In a second step, from a systematic literature review and elements of quantitative analysis, it built a tool for assessing the quality of the services, based on the satisfaction of women. This instrument was applied to 463 women. They were conducted exploratory factor analysis to evaluate the theoretical model, and after the confirmatory factor analysis to assess the relationship between the variables. Evaluating the implementation of the program in João Pessoa, we can see a partial implementation of the initiatives, even without birth center in the state, and with an incipient change in the care model, but with important initiatives in some institutions, such as improving the access to the companion, and inserting doulas services. The proposed satisfaction model initially has undergone some changes from the analysis, and the final model was composed of 22 variables grouped into four dimensions: prenatal care, technical quality, infrastructure and responsiveness. Prenatal construct was the most direct effect on satisfaction of women (0.45), followed by technical quality.