MATERNAL SATI SFACTI ON W I TH MATERNAL- I NFANT NURSI NG CARE
I N CAM PECH E, M EXI CO
Yolan da Flor es Peñ a1 Silv ia Est hela Vázquez R. de la Gala2 Ricar do Mar t ín Cer da Flor es3
Flor es- Peña Y, Vázquez R. de la Gala SE, Cer da- Flor es RM. Mat er nal sat isfact ion w it h m at er nal- infant nur sing car e in Cam pech e, Mex ico. Rev Lat in o- am En fer m agem 2 0 0 9 set em br o- ou t u br o; 1 7 ( 5 ) : 6 4 5 - 5 0 .
Obj ect iv e: Ev alu at e an d com par e m at er n al- sat isf act ion ( global an d ar eas) w it h m at er n al- ch ild n u r sin g car e ( MSMI NC) an d t o ex plor e t h e r elat ion sh ip of MSMI NC w it h w ait t im e, len gt h of v isit , an d m at er n al age an d educat ion. Met hods: Cr oss- sect ional descr ipt iv e st udy com pr ising 213 m ot her s. Gr oup 1 ( n = 84) , m ot her s of childr en aged < 1 year , and Gr oup 2 ( n = 129) , m ot her s of childr en bet w een 1 and 4 year s of age. The pat ient sat isfact ion scale w as applied. Result s: Global MSMI NC w as 76.26 and 79.21 for Gr oups 1 and 2, r espect ively. No associat ed fact or s w er e found in Gr oup 1. I n Gr oup 2, w ait t im e w as associat ed w it h MSMI NC in t he t echnical-pr ofessional ar ea ( F = 3.13; df = 128; B = –0.21; p = 0.01) . Conclusions: The fact t hat t hese st udy par t icipant s ident ified only MSMI NC- associat ed fact or s in t he t echnical- pr ofessional ar ea m ay indicat e t hat car e is cent er ed on t echnical pr ocedur es. Giv en t hat MSMI NC- associat ed fact or s w er e not ident ified in Gr oup 1, w e r ecom m end ex plor at ion of m at er nal ex pect at ions and per cept ions of car e.
DESCRI PTORS: child car e; m at er nal- child nur sing
SATI SFACCI ÓN MATERNA CON EL CUI DADO DE LA ENFERMERA MATERNO
I N FAN TI L EN CAMPECHE, MÉJI CO
El obj et iv o de est e est udio fue ev aluar y com par ar la sat isfacción m at er na ( global/ ár eas) con el cuidado de la enfer m er a m at er no infant il ( MSMI NC) y ex plor ar la r elación de MSMI NC con el t iem po de esper a, dur ación de la v isit a, edad y educación m at er na. Se t r at a de un est udio descr ipt iv o t r ansv er sal. Par t icipar on 213 m adr es. Gr upo 1, n = 84 m adr es de niños < 1 año y Gr upo 2, n = 129, m adr es de niños 1 a 4 años. Se aplicó la Escala de Sat isfacción del Pacient e. Se obt uvier on los siguient es r esult ados: MSMI NC global fue 76.26 y 79.21 en los Gr upos 1 y 2, r espect ivam ent e. No se encont r ar on fact or es asociados en el gr upo 1. En el Gr upo 2, el t iem po de esper a se asoció con MSMI NC en el ár ea t écnico pr ofesional ( F = 3.13; df = 128; B = –0.21; p = 0.01) . Se con clu y e q u e las p ar t icip an t es id en t if icar on solam en t e f act or es asociad os a la MSMI NC en el ár ea t écn ico p r of esion al lo q u e p r ob ab lem en t e in d ica q u e el cu id ad o est á cen t r ad o en p r oced im ien t os t écn icos. No se ident ificar on fact or es asociados en el Gr upo 1. Se r ecom ienda explor ar las expect at ivas y per cepciones m at er nas sobr e el cuidado.
DESCRI PTORES: cu idado del n iño; en fer m er ía m at er noin fan t il
SATI SFAÇÃO MATERNA COM O CUI DADO DA ENFERMEI RA MATERNO- I NFANTI L
EM CAM PECH E, M ÉXI CO
Obj et iv o: Av aliar e com par ar a sat isf ação m at er n a ( global e ár eas) com o cu idado da en f er m eir a m at er n o-infant il ( SMAEMI ) e explor ar a r elação da SMAEMI com o t em po de esper a e dur ação da visit a, idade e educação da m ãe. Mét odos: Est udo descr it iv o- t r ansv er sal com a par t icipação de 213 m ães. Gr upo 1, n = 84 m ães de cr ianças < 1 ano e Gr upo 2, n = 129 m ães de cr ianças de 1 a 4 anos. Aplicou- se a Escala de Sat isfação do Pacien t e. Resu lt ad os: O r esu lt ad o g lob al SMAEMI f oi 7 6 . 2 6 e 7 9 . 2 1 p ar a Gr u p os 1 e 2 , r esp ect iv am en t e. Fat or es associados não for am encont r ados no Gr upo 1. No Gr upo 2, t em po de esper a foi associado à SMAEMI na ár ea t écnico- pr ofissional ( F = 3.13; gl = 128; B = –0.21; p = 0.01) . Conclusões: O fat o de que os par t icipant es nest e est udo ident ificar am som ent e fat or es associados à SMAEMI na ár ea t écnico- pr ofissional pode indicar que o cu idado est á focado em pr ocedim en t os t écn icos. Fat or es associados à SMAEMI n ão for am iden t ificados n o Gr upo 1 , pelo que r ecom enda- se ex plor ar as ex pect at iv as e per cepções das m ães com r elação ao cuidado.
DESCRI TORES: cu idado da cr ian ça; en fer m agem m at er n o- in fan t il
1RN, Ph.D., Full Pr ofessor A, Faculdad de Enfer m er ía, Univer sidad Aut ónom a de Nuevo León, Mexico, e- m ail: yolaflo@hot m ail.com ; 2M.Sc. in Nur sing Science,
Associat e Pr ofessor A, Higher School of Nur sing, Univer sidad Aut ónom a de Cam peche, Mexico, e- m ail: silest vaz@hot m ail.com ; 3Ph.D. in Genet ics, Cent r o de
I nvest igación Biom édica del Nor est e, I nst it ut o Mexicano del Segur o Social, Mexico, e- m ail: r icar docer da_m x@yahoo.com .m x.
I NTRODUCTI ON
O
ne indicat or of healt hcare qualit y is pat ient sat isfact ion, also denom inat ed consum er sat isfact ionor client sat isfact ion. Several st udies have considered
p a t i e n t s a t i s f a c t i o n a s a p r e d i c t o r o f t r e a t m e n t
co m p l i a n ce , o n - g o i n g u se o f h e a l t h ca r e se r v i ce s,
r ecom m en din g h ealt h car e ser v ices t o ot h er s( 1 ), an d
a v aluable feedback t o ev aluat e healt h pr ogr am s( 2).
At pr esent , t her e is no consensus r egar ding
w hat t he concept of pat ient sat isfact ion encom passes.
Nevert heless, an early definit ion of pat ient sat isfact ion
in out pat ient set t ings w it h nursing care defines pat ient
sat isf act ion as an at t it u d e r ef lect in g t h e ex t en t of
con gr u en ce bet w een w h at pat ien t s ex pect an d t h eir
per cept ion of t he car e t hey r eceiv ed( 3).
Reg ar d in g p ed iat r ic p r ev en t iv e car e in t h e
U.S. and Canada, t he m ain aim of pediat r ic pr event ive
car e, id en t if ied as w ell- ch ild car e, w ell- b ab y car e,
h eal t h su p er v i si o n an d p er i o d i c h eal t h car e, i s t o
m aint ain healt h and pr ev ent diseases. The basic unit
of w ell- child care is t he healt h supervision visit , w hich
ca n b e p e r f o r m e d b y p h y si ci a n s o r n u r se s. Th e
cont ent s of each visit are infant age- specific, and each
v i s i t c a n b e d i v i d e d i n t o t h r e e c o m p o n e n t s : a )
det ect ion; b) healt h pr om ot ion and disease pr event ion,
and c) pat ient handling and follow - up( 4).
I n Mexico, m at er nal- infant nur se ( MI N) at t he
Mexican Social Securit y I nst it ut e ( I MSS) deliver healt h
p r o m o t i o n a n d su p e r v i so r y ca r e t o t h e p e d i a t r i c
populat ion aged < 5 y ear s, consider ing t he follow ing
a s p e c t s : v a c c i n a t i o n s u r v e i l l a n c e ; n u t r i t i o n a l
surveillance; ident ificat ion of fact ors involved in a poor
p r o g n o s i s ; c l i n i c e v a l u a t i o n a n d c l a s s i f i c a t i o n ;
adequat e t r eat m ent ; m at er nal t r aining on ident ificat ion
of w ar ning signs, gener al pat ient car e at hom e, and
st im ulat ing healt hcare and t reat m ent in w ell- child care
t o ch eck t h e ch ild ’s g r ow t h an d d ev elop m en t . Th e
follow ing m ust be r egist er ed at each visit : age; w eight ;
h e i g h t , a n d p e r f o r m a n c e o f p s y c h o m o t o r
-d ev elop m en t ev alu at ion .
Gi v e n t h e b a b y ’ s r a p i d g r o w t h a n d
developm ent during t he first year of life, visit s t o t he
MI N ar e sch ed u led ev er y 2 m on t h s. Mor eov er, t h e
MI N i s r e sp o n si b l e f o r p r o v i d i n g n u t r i t i o n a l a n d
w eaning educat ion r elat ed t o ex clusiv e br east feeding
dur ing t he fir st 4 m ont hs. I f com plem ent ar y feeding
i s r e q u i r e d a f t e r t h i s a g e , t h e M I N p r o v i d e s
com m er cial infant - for m ula donat ions ( 30 cans) dur ing
scheduled visit s unt il t he age of 12 m ont hs. Aft er t he
fir st year of life and up t o t he age of 4 year s, visit s t o
t he MI N ar e scheduled ev er y 6 m ont hs.
A l i t er at u r e r ev i ew sh o w ed t h at t h er e ar e
sev er al f act or s ( in d ep en d en t v ar iab les) associat ed
w i t h p a t i e n t s a t i s f a c t i o n ( d e p e n d e n t v a r i a b l e ) ,
in clu d in g t h e f ollow in g : a) w ait t im e; b ) len g t h of
visit( 5); c) age of pat ient , and d) educat ional lev el of
p at ien t( 6 ). Wait t im e com p r ises a f act or of ser v ice
access( 2 ). A st u d y con d u ct ed at p u b lic an d p r iv at e
h osp it als id en t if ied t h at on e h alf ( 4 2 . 5 4 % ) or 8 7 0
r espondent s felt t hat t hey had not w ait ed for ser vices.
The m aj or it y of individuals w ho sought car e at pr ivat e
h osp it als ex p er ien ced less w ait t im e t h an t h ose at
public hospit als( 7).
Anot her st udy assessing par ent al sat isfact ion
w it h healt hcar e for young childr en in a sam ple of 2,068
par t icipant s t hat em ployed t elephone int er view s found
t hat per ceiv ing t he v isit lengt h as shor t w as a fact or
a sso ci a t e d w i t h l o w sa t i sf a ct i o n( 8 ). At t h e I MSS,
durat ion of w ell- child care visit is 10 m in; it w as usually
t he m ot her w ho at t ended t he visit t o t he MI N w it h her
ch ild r en .
Ot h er f act o r s t h at h av e b een ex p l o r ed as
a s s o c i a t e d w i t h p a r e n t a l s a t i s f a c t i o n w i t h t h e
healt hcar e t heir childr en r eceiv e include par ent al age
an d p ar en t al ed u cat i o n . On e st u d y i d en t i f i ed t h at
sat isfact ion is low er for childr en w hose m ot her s ar e
< 2 0 y e a r s o f a g e ( o d d s r a t i o [ OR] , 0 . 3 0 ; 9 5 %
con f id en ce in t er v al [ 9 5 % CI ] , 0 . 1 5 – 0 . 6 2 ) t h an f or
childr en w it h an older m ot her ; m at er nal educat ion is
not associat ed w it h any sat isfact ion m easur em ent( 8).
O n e i m p o r t a n t d i m e n s i o n o f p a t i e n t
m a n a g e m e n t t h a t l a c k s w e l l - c h i l d c a r e - r e l a t e d
sat isfact ion m easur em ent s, accor ding t o lit er at ur e in
t h e U. S., is t h at t h er e is n o in st r u m en t t o assess
sat isfact ion levels associat ed w it h parent s’ perspect ive
on pr ev ent iv e healt hcar e for childr en aged < 3 y ear s.
Measu r in g in st r u m en t s f or t h e p ar en t s’ sat isf act ion
w er e d esig n ed t o assess p ar en t al sat isf act ion w it h
neonat al int ensiv e car e, for par ent s of childr en w it h
special- needs car e, par ent al per cept ions of pediat r ic
i n - p a t i e n t q u a l i t y o f ca r e , a n d p e d i a t r i c f a m i l i a l
sat isfact ion( 1,9–11).
Gi v e n t h a t t h e p r e v i o u s l y m e n t i o n e d
inst r um ent s ar e not applied in out pat ient set t ings, w e
b e u s e d t o e v a l u a t e m a t e r n a l s a t i s f a c t i o n w i t h
m at er n al- in f an t n u r sin g car e ( MSMI NC) ( d ep en d en t
variable) . This global scale consist s of t hree subscales,
i n c l u d i n g t e c h n i c a l - p r o f e s s i o n a l , e d u c a t i o n a l
r elat ionship, and t r ust ing r elat ionship( 3).
The I MSS envisions t he delivery of healt hcare
at a h igh lev el of pat ien t sat isf act ion . To dat e, f ew
st u dies h av e ev alu at ed t h e MSMI NC. Th er ef or e, w e
car r ied ou t t h is st u dy w it h t h e follow in g obj ect iv es:
1) To evaluat e and com par e t he MSMI NC ( global and
ar eas) in t w o Mex ican m at er n al gr ou ps ( m ot h er s of
childr en < 1 year of age, and m ot her s of childr en 1–4
y ears of age) at an I MSS Fam ily Medicine Unit in t he
Mex ican st at e of Cam p ech e, an d 2 ) t o ex p lor e t h e
r elat ionship of cert ain fact or s w it h t he MSMI NC ( global
an d ar eas) .
METHODS
St udy design and sam ple
Cr o s s - s e c t i o n a l d e s c r i p t i v e s t u d y. Th e
co n v e n i e n ce sa m p l e i n cl u d e d 2 1 3 v o l u n t e e r a n d
u n r elat ed m ot h er s w h o t oget h er w it h t h eir ch ildr en
at t ended w ell- child car e v isit s t o an MI N at a Fam ily
Med icin e Un it in t h e sou t h east er n Mex ican st at e of
Cam peche fr om August t o Oct ober, 2006.
Gi v e n t h e b a b y ’ s r a p i d g r o w t h a n d
developm ent during t he first year of life, visit s t o t he
MI N ar e sch ed u led ev er y 2 m on t h s. Mor eov er, t h e
MI N i s r e sp o n si b l e f o r p r o v i d i n g n u t r i t i o n a l a n d
w e a n i n g e d u c a t i o n r e l a t e d w i t h e x c l u s i v e
b r e a s t f e e d i n g d u r i n g t h e f i r s t 4 m o n t h s . I f
com plem ent ar y feeding is r equir ed aft er t his age, t he
MI N pr ovides com m er cial infant for m ula donat ions ( 30
ca n s) d u r i n g sch ed u l ed v i si t s u n t i l t h e a g e o f 1 2
m ont hs. Aft er t he fir st year of life and up t o t he age
of 4 y ear s, v isit s t o t he MI N ar e scheduled ev er y 6
m ont hs. I n accordance w it h t hese crit eria, t he sam ple
w as classified int o t w o gr oups: Gr oup 1, m ot her s of
c h i l d r e n a g e d < 1 y e a r ( n = 8 4 ) , a n d Gr o u p 2 ,
com posed of m ot her s of childr en bet w een 1–4 y ear s
of age ( n = 129) .
I n clu sion cr it er ia com p r ised m ot h er s h av in g
a t t e n d e d t h e v i si t t o t h e MI N, a n d t h a t m o t h e r s
h a v e a t l e a s t 6t h- g r a d e e d u c a t i o n . N o m o t h e r
r ef u sed t o p ar t icip at e, an d all q u est ion n air es w er e
a p p l i e d b y t h e s a m e r e s e a r c h e r. M o t h e r s w e r e
ap p r oach ed w h en t h ey lef t t h e MI N’s of f ice. Wh en
sh e in d icat ed t h at sh e w as t h e ch ild ’s m ot h er, sh e
r e ce i v e d e x p l a n a t i o n s o n t h e r e se a r ch o b j e ct i v e s
a n d w a s i n v i t e d t o p a r t i c i p a t e i n t h e s t u d y
v olu n t ar ily b y m ean s of w r it t en in f or m ed con sen t .
Nex t , t h e m ot h er w as t ak en t o an ot h er of f ice aw ay
f r om t h e MI N ar ea, w h er e sh e w er e ask ed t o an sw er
t h e st u d y i n st r u m en t . No eco n o m i c co m p en sat i o n
w as p r ov id ed t o t h e m ot h er s f or t h eir p ar t icip at ion
in t h e st u d y. Th is st u d y w as car r ied ou t in lin e w it h
et h i cal g u i d el i n es p r o p o sed i n t h e Gen er al Heal t h
Law f or Healt h Resear ch of Mex ico.
Measu r em en t s
Th e PSS ( d ep en d en t v ar iab le) con sist ed of
25 it em s t hat evaluat e pat ient sat isfact ion w it h nur sing
ca r e i n a m b u l a t o r y se t t i n g s. I t i s a se l f - a p p l i e d
i n s t r u m e n t w i t h t h r e e s u b s c a l e s : a ) Te c h n i c a l
-p r o f e ssi o n a l a r e a ( se v e n i t e m s) r e l a t e d w i t h t h e
funct ions of inst rum ent al nur sing car e) ; b) educat ional
r e l a t i o n sh i p a r e a ( si x i t e m s) , a b o u t i n f o r m a t i o n
exchange bet w een m ot her s and nur ses, and c) t r ust ing
r elat ionship ar ea ( w it h 12 it em s) , including ver bal and
n o n - v e r b a l c o m m u n i c a t i o n m e a s u r e m e n t s . Th e
r el i a b i l i t y co ef f i ci en t r ep o r t ed w a s 0 . 9 1 2 a n d t h e
aut hor of t he PPS does not pr ov ide r efer ence v alues
f o r cl a ssi f y i n g sa t i sf a ct i o n sco r es a t t h e d i f f er en t
lev els( 3 ).
Th e in st r u m en t em p loy s a 1 – 5 Lik er t scale
w it h 10 negat iv ely dir ect ed it em s t hat w er e r ecoded
f o r st a t i st i ca l a n a l y si s ( So ci a l Re se a r ch Me t h o d s,
2 0 0 8 ) . I n ad d it ion , t h e q u est ion n air e in clu d ed f ou r
independent v ar iables: w ait t im e and lengt h of v isit
a s p e r c e i v e d b y t h e m o t h e r, m a t e r n a l a g e a n d
m at er n al edu cat ion .
An al y si s
D a t a w e r e a n a l y z e d u s i n g S PS S V 1 2 . 0
sof t w ar e. Fir st , d escr ip t iv e st at ist ics of in d ep en d en t
v a r i a b l e s w a s p e r f o r m e d f o r G r o u p s 1 a n d 2 .
S e c o n d , w e d e t e r m i n e d M S M I N C [ v a l u e s w e r e
t r an sf or m ed in t o a r at io scale ( 0 – 1 0 0 ) ] f or g lob al
a n d s u b s c a l e s . Th i r d , w e c o m p a r e d m e a n s a n d
v ar ian ces of MSMI NC ( g lob al an d ar eas) f or Gr ou p s
1 an d 2 , u sin g t h e St u d en t t an d Lev en e t est s. An d
f ou r t h , in or d er t o ex p lor e t h e m at er n al sat isf act ion
in d ep en d en t v ar iab les ( w ait t im e an d len g t h of v isit
a s p e r ce i v e d b y t h e m o t h e r, m a t e r n a l a g e , a n d
m at er n al ed u cat ion ) , w e p er f or m ed m u lt ip le lin ear
r eg r ession an aly sis f or Gr ou p s 1 an d 2 . A p v alu e
of < 0 . 0 5 w as con si d er ed si g n i f i can t .
RESULTS
M o s t m o t h e r s i n Gr o u p 1 w e r e m a r r i e d
( 8 5 . 7 0 % ) a n d w e r e h o m e m a k e r s ( 6 1 . 9 0 % ) . Th e
a v e r a g e a g e o f t h e i r ch i l d r e n w a s 8 . 9 4 ± 2 2 . 3 5
m ont hs. The m aj or it y of Gr oup 2 m ot her s w er e also
m ar r ied ( 91. 50% ) and hom em ak er s ( 65. 90% ) , w hile
t he av er age age of t heir childr en w as 24. 04 ± 9. 63
m on t h s.
Table 1 pr esent s t he descr ipt ive st at ist ics of
independent var iables. I n Gr oup 1 m ot her s, m axim um
w ait t im e w as 9 0 m in and 5 m in w as t he m inim um
len g t h of t h e v isit ; in Gr ou p 2 m ot h er s, m ax im u m
w ait t im e w as 35 m in and m inim um lengt h of t he visit
w as 5 m in.
Tab le 2 sh ow s t h e d escr ip t iv e st at ist ics of
MSMI NC g l o b a l a n d a r e a s. Fo r Gr o u p 1 , a v e r a g e
m at er nal global sat isfact ion w as 76.26 and for Gr oup
s r e h t o
M Independent
s e l b a i r a
v Mean SD
e u l a V m u m i n i
M Maximum
1 p u o r
G Waititme(min) 20.51 18.05 3 90
) n i m ( t i s i v f o h t g n e
L 14.43 6.55 5 45
) s r a e y ( e g a l a n r e t a
M 27.11 4.81 19 44
n o it a c u d e l a n r e t a M ) s r a e y
( 10.26 3.21 3 17
2 p u o r
G Waititme(min) 12.52 5.43 5 35
) n i m ( t i s i v f o h t g n e
L 13.81 5.43 5 35
) s r a e y ( e g a l a n r e t a
M 28.52 4.02 17 39
n o it a c u d e l a n r e t a M ) s r a e y
( 9.86 2.60 5 35
n o i t c a f s i t a s l a n r e t a
M Group1 Group2 Studentttest Pvalue Levenetest Pvalue
D S ± n a e
M Mean±SD
l a n o i s s e f o r p -l a c i n h c e
T 80.74±9.34 83.80±8.67 -2.445 0.015 0.257 0.613
p i h s n o it a l e r l a n o it a c u d
E 75.99±10.93 80.07±10.53 -2.721 0.007 0.335 0.564
p i h s n o it a l e r g n it s u r
T 73.57±9.41 75.83±9.30 -1.727 0.086 0.123 0.726
n o it c a f s it a s l a b o l
G 76.26±7.86 79.21±7.75 -2.700 0.008 0.021 0.885
2 , av er ag e m at er n al sat isf act ion w as 7 9 . 2 1 . Wh en
Gr o u p s 1 an d 2 w er e co m p ar ed b y m ean s o f t h e
St udent t t est , a significant difference am ong aver ages
w a s f o u n d i n t h e a r ea s o f t ech n i ca l - p r o f essi o n a l ,
t r u st in g r elat ion sh ip an d global sat isf act ion . On t h e
ot her hand, w hen t he t w o gr oups w er e com par ed w it h
t h e Lev en e t est , n o si g n i f i can t d i f f er en ces am o n g
v ar ian ces w er e f ou n d.
Ta b l e 1 - D e s c r i p t i v e s t a t i s t i c s o f i n d e p e n d e n t
v ar iables in bot h gr oups of m ot her s
SD, St andar d deviat ion.
Table 2 - Com par ison of m at er n al sat isfact ion w it h Mat er n al- in fan t n u r sin g car e ( MSMI NS) bet w een t h e t w o
gr oups of m ot her s
Gr oup 1: Mot her s of childr en < 1 year of age; Gr oup 2: m ot her s of childr en 1–4 year s of age. SD, St andar d deviat ion.
Ta b l e 3 i l l u s t r a t e s t h e r e l a t i o n s h i p o f
MSMI NC w it h f ou r in d ep en d en t v ar iab les. I n Gr ou p
1 , n on e of t h e f ou r v ar iab les w as associat ed w it h
m at er n al sat isf act ion . On t h e ot h er h an d , in Gr ou p
2 , o n l y t h e m o d e l ( t e c h n i c a l - p r o f e s s i o n a l a r e a )
ex h ib it ed a sig n if ican t r elat ion sh ip ( r2= 0 . 0 6 3 ; p = 0 . 0 1 7 ) w i t h t h e f o u r i n d e p e n d e n t v a r i a b l e s. Th e
v ar i ab l e co n t r i b u t i n g t o t h i s m o d el w as w ai t t i m e
t o b e seen at t h ei r co n su l t at i o n (β= – 0 . 1 6 4 ; p =
0 . 0 2 1 ) .
Table 3 - Relat ionship of m at er nal sat isfact ion w it h t he four co- var iables by gr oup
* Technical- pr ofessional = 79.247 –0.164X1 –0.029X2 + 0.050X3 + 0.566X4.
Co- var iables: X1 = w ait t im e in m in, X2 = lengt h of visit in m in, X3 = m at er nal age, X4 = m at er nal educat ional level.
s r e h t o
M Maternalsatisfaction df R2 pvalue
1 p u o r
G Technical-professional 83 0.023 0.756
p i h s n o it a l e r l a n o it a c u d
E 83 0.025 0.731
p i h s n o it a l e r g n it s u r
T 83 0.045 0.454
n o it c a f s it a s l a b o l
G 83 0.035 0.576
2 p u o r
G Technical-professional* 128 0.092 0.017
p i h s n o it a l e r l a n o it a c u d
E 128 0.033 0.373
p i h s n o it a l e r g n it s u r
T 128 0.039 0.285
n o it c a f s it a s l a b o l
DI SCUSSI ON
The aim s of t his st udy w er e as follow s: 1) To
evaluat e and com par e t he MSMI NC ( global and ar eas)
in t w o Mex ican m at er nal gr oups ( m ot her s of childr en
< 1 year of age and m ot her s of childr en 1–4 year s of
age) at an I MSS Fam ily Medicine Unit in t he Mexican
st at e of Cam peche, and 2) t o explor e t he r elat ionship
of MSMI NC w it h w ait t im e, lengt h of visit , and m at er nal
age and educat ion.
Wit h r esp ect t o t h e f ir st aim of t h is st u d y,
m a t e r n a l sa t i sf a ct i o n w a s l o w e r t h a n t h e r e su l t
r epor t ed in ot her st udies car r ied out in t he U.S. t hat
evaluat ed m at ernal sat isfact ion in t erm s of healt hcare
for young childr en( 8) and parent al sat isfact ion w it h early
p ed iat r ic car e an d im m u n izat ion of y ou n g ch ild r en ,
a n d a p p l i ca t i o n o f o t h e r su r v e y s f o u n d m a t e r n a l
sat isfact ion w it hin t he r ange of 8 3 . 4 – 8 7 . 7 , or found
h ealt h car e classified as ex cellen t by t h e m aj or it y of
m ot her s( 12) and t hat m at er nal sat isfact ion w as higher
for bot h groups of m ot her s in t he t echnical- pr ofessional
ar ea in com par ison w it h ot her ar eas. Wit h r espect t o
t he second aim , w e obt ained significant findings only
in Group 2 m ot hers in t he t echnical- professional area
and t he v ar iable t hat dem onst r at ed cont r ibut ion w as
w ait t im e.
Com parison is difficult in t erm s of our findings
w it h ot her result s due t o variat ions in scales em ployed
in ot h er st u d ies, d if f er en t d om ain s cov er ed b y t h e
d if f er en t in st r u m en t s, cu lt u r al d if f er en ces( 9 - 1 1 ) an d
variat ion in dat a collect ion m et hods( 12). How ever, ot her
st udies conduct ed in t he U.S. can be m ent ioned, w hich
ev alu at ed m at er n al sat isf act ion w it h h ealt h car e f or
y ou n g ch ild r en an d p ar en t al sat isf act ion w it h ear ly
p ed iat r ic car e an d im m u n izat ion of y ou n g ch ild r en .
A p p l i c a t i o n o f o t h e r s u r v e y s f o u n d m a t e r n a l
sat isfact ion w it hin t he r ange of 8 3 . 4 – 8 7 . 7 , or found
h ealt h car e classified as ex cellen t by t h e m aj or it y of
m ot her s( 1 3 ).
W h en Gr o u p s 1 a n d 2 w er e co m p a r ed b y
m eans of t he St udent t t est , a significant differ ence
a m o n g a v e r a g e s w a s f o u n d i n t h e t e c h n i c a l
-p r o f essi o n al ar ea, t r u st i n g r el at i o n sh i -p an d g l o b al
sa t i sf a ct i o n ; m e a n sa t i sf a ct i o n w a s h i g h e r i n t h e
t ech n ical- p r of ession al ar ea, an d t h is f in d in g m ig h t
indicat e t hat MI N car e is or ient ed t ow ar ds per for m ing
t ech n ical p r oced u r es.
Th e se r e su l t s a r e i n a g r e e m e n t w i t h t h e
f in d in g s of ot h er au t h or s, w h o h av e r ep or t ed t h at
healt h pr act ices ar e focused on t he accom plishm ent
of procedures( 14- 15), and not on educat ive quer ies and/
or t he est ablishm ent of a t r ust ing r elat ionship, w hich
pr obably per suades m ot her s t o assess only t echnical
pediat r ic car e aspect s. I n addit ion, accor ding t o t he
obser v at ions of 8 7 w ell- child car e v isit s t o MI N, t he
a u t h o r s i d e n t i f i e d t h a t M I N c a r e i s r e d u c e d t o
perform ing t echnical procedures, such as child- w eight
v e r i f i c a t i o n , m e a s u r e m e n t o f h e i g h t , c h e s t a n d
abdom in al cir cu m fer en ce, com par ison of w eigh t an d
h eig h t m easu r em en t s w it h r ef er en t ial p ar am et er s,
u p d a t i n g t h e v a c c i n a t i o n f o r m , a n d p r o v i d i n g a
pr escr ipt ion for infant for m ula ( for childr en < 1 y ear
of age)( 14).
To ex plor e t h e r elat ion sh ip of MSMI NC w it h
w a i t t i m e , l e n g t h o f v i si t , a n d m a t e r n a l a g e a n d
educat ion, only w ait t im e dem onst r at ed a cont r ibut ion
i n MSMI NC i n Gr o u p 2 m o t h e r s i n t h e t e ch n i ca l
-p r of ession al ar ea. Th is f in d in g w as con sist en t w it h
ot her st udies t hat ident ified t hat par ent s of childr en
w it h delay ed car e hav e low er global sat isfact ion( 8).
Nev er t h eless, w e w er e u n able t o det er m in e
fact or s associat ed w it h MSMI NC in Gr oup 1 m ot her s,
despit e ident ificat ion of a m axim um 90- m in w ait t im e.
I n t his r egar d, one can m ent ion t he findings of a st udy
ent it led The Nur sing Wor k Pr ocess in Care for Healt hy
Childr en at a Social Secur it y I nst it ut ion in Mexico. I n
t h i s s t u d y, c o n d u c t e d b y m e a n s o f q u a l i t a t i v e
i n t er v i ew s o f Mex i can m o t h er s at an I MSS Fam i l y
Medicine Unit , t he aut hor s r epor t ed t hat m ot her s of
childr en aged 1–4 y ear s ident ified w ell- child car e as
t heir being ensur ed t hat t heir child w as gr ow ing and
d e v e l o p i n g a d e q u a t e l y. Th i s w a s d i f f e r e n t f r o m
m ot h er s of ch ild r en < 1 y ear of ag e, w h o r ef er r ed
t heir part icular int erest in visit ing t he MI N as receiving
com m er cial in f an t - f or m u la d on at ion s( 1 4 ). Du r in g t h e
f ir st y ear of t h e ch ild ’s lif e, t h e MI N p r ov id es t h e
m ot her w it h infant for m ula at t he r at e of six cans per
p r og r am m ed v isit ; t h is sit u at ion p r ob ab ly p r ov id es
m ot ivat ion t o at t end t he w ell- child car e visit m ore t han
t hat of r eceiv ing pr ev ent iv e car e.
Th er ef or e, w e con sider ed t h at ot h er f act or s
cou ld be cau sin g t h is sit u at ion : fir st , w e con sider ed
t h at t h e m ain m ot iv at ion t o at t en d w ell- ch ild car e
a p p o i n t m e n t s w i t h MI N i n t h i s g r o u p l i e s i n t h e
provision of an infant - form ula donat ion; consequent ly,
m o t h e r s d i d n o t p e r c e i v e M I N c a r e . S e c o n d ,
inst it ut ional fact ors like lengt h of visit ( 10 m in at t his
inst it ut ion) w as t he sit uat ion indicat ed by MI N st aff as
a f a ct o r t h a t p r e v e n t e d t h e e st a b l i sh m e n t o f a n
CONCLUSI ONS
I nfor m at ion published w it h r espect t o par ent al
sat isf act ion w it h t h e pr ev en t iv e h ealt h car e r eceiv ed
by t heir children is scarce. The result s of t he present
st u dy con t r ibu t e t o k n ow ledge of t h e MSMI NC at a
Fam ily Medicine Unit in t he Mexican st at e of Cam peche
and explore t he relat ionship of cert ain fact ors ident ified
in t he lit er at ur e w it h t he MSMI NC.
I n Gr oup 2 m ot her s, w ait t im e w as associat ed
w it h MSMI NC in t he t echnical- pr ofessional ar ea. This
fact or is an indicat or of pat ient healt hcar e access at
public or privat e inst it ut ions. Because w e w ere unable
t o ident ify MSMI NC- associat ed fact or s in Gr oup 1, it
i s n ecessa r y t o i d en t i f y m a t er n a l ex p ect a t i o n s o r
p er cep t ion s of w ell- ch ild car e t h at p er m it Gr ou p 1
m ot her s t o dist inguish im por t ant m at er nal sat isfact ion
d om ain s.
I n t er m s of st udy lim it at ions and im plicat ions
for fu t u r e r esear ch , t h er e ar e sev er al of t h e for m er
in t his st udy, including t hat m easurem ent s of wait t im e
a n d l en g t h o f v i si t w er e ca r r i ed o u t a cco r d i n g t o
m at er n al p er cep t ion s.
M S M I N C w a s e v a l u a t e d b y PS S( 3 ). T h i s
i n s t r u m e n t m a y b e c o n s i d e r e d a s o u t d a t e d ;
m o r e o v e r, t h e o r i g i n a l PS S w a s d e s i g n e d t o
ev a l u a t e p a t i en t sa t i sf a ct i o n w i t h n u r si n g ca r e i n
o u t p at i en t set t i n g s.
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