Study design
A hospital-based cross-sectional survey was conducted from September 2009 to November 2009.
Study area
This study was conducted in three public referral hospitals of Amhara region, northwest Ethiopia. These three referral hospitals were University of Gondar Teaching and Referral Hospital (UOGTRH), Felege Hiwot referral hospital (FRH), and Dessie referral hospital (DRH). Each referral hospital's catchment population is estimated to be 5-7 million people.
Study population
Selected mothers who visited the three referral hospitals for delivery service during the data collection period were the study population.
Sample size
The sample size for this study was determined using single population proportion formula considering the assumptions: Proportion of delivering mothers satisfied with hospital delivery care service as 56% (p = 0.56) [11]. Level of significance to be 5% (α = 0.05), Z α/2= 1.96 and margin of error to be 5% (d = 0.05). Adding non responses rate of 10%, a total sample size of 417 delivering mothers were included.
Sampling Procedure
The total sample size was allocated proportionally to each of the hospitals by reviewing the number of deliveries attended in the 1st and 2nd quarter of 2009. Data were collected from every other postnatal woman who received delivery care in the three hospitals.
Data collection instrument
The data collection instrument was closed-ended questionnaire. Delivery service satisfaction related questions were adopted from the Donabedian quality assessment framework [8] and presented using a 5- scale likert scale (1-very dissatisfied, 2-dissatisfied, 3-neutral, 4-satisfied, and 5-very satisfied).
The first draft of the English questionnaire was translated to Amharic language by independent translators then back to English language to check for consistency. The questionnaire was pre tested on 40 postnatal mothers at the University of Gondar Teaching and Referral Hospital one month prior to the actual data collection.
Data collection
Six female nurses who were fluent in Amharic and who were not working in the study sites were recruited for data collection. Three days (two days theoretical and one day practical) training was given before the actual data collection.
Data analysis
The completed questionnaires were checked for completeness and consistency by the investigators. Data was entered, cleaned and analyzed using SPSS version 16 (SPSS Inc., Chicago). During analysis, the responses of 'very satisfied' and 'satisfied' were classified as satisfied and responses of 'very dissatisfied', 'dissatisfied' and 'neutral' as unsatisfied. Neutral responses were classified as dissatisfied considering that they may represent a fearful way of expressing dissatisfaction. This is likely because the interview was undertaken within the hospitals and mothers may have been reluctant to express their dissatisfaction feeling of the services they received.
For the overall satisfaction level, those who were satisfied in greater or equal to 75% of the items were categorized under "satisfied" and those who were satisfied in less than 75% of the items were categorized as "un satisfied". Descriptive statistics was computed for the study variables. Frequency distribution tables were used to describe most of the findings and graphs were also plotted for some. To determine factors associated with mother's satisfaction bivariate binary logistic regression and multivariate stepwise logistic regression were applied. Adjusted odds ratio was used to determine the strength of association between selected variables.
Ethical considerations
The study proposal was approved by Institutional Review Board of the College of Medicine and Health Sciences of the University of Gondar. Informed oral consent was obtained from each study participant. Confidentiality was assured by making the questionnaire anonymous.