96 Chapter 4 We found that a high level of comfort during the aCTG was associated with being highly satisfied. Women in a less than completely comfortable position were less likely to be highly satisfied. This finding corresponds with a report from the Netherlands Institute for Health Services Research (NIVEL), that examined performance indicators for consumer and patient satisfaction.23 The report showed that the quality of basic physical facilities that influence comfort during medical examination is decisive for the satisfaction of care. To increase the level of satisfaction even further, a comfortable position for women during the aCTG should be ensured. The other significant and possible clinically relevant association was found for the variable “gestational age”. Women were more likely to be highly satisfied when the aCTG was performed at between 33 and 36 weeks gestation. Further research will be needed to explain this finding. In this study, almost half of the respondents considered a primary care midwife the most suitable healthcare provider for performing an aCTG, and 36.4% did not have a preference. This partly contradicts the study by Hofstede et al.; they found that 82% of the patients thought medical specialists were more competent than general practitioners in diagnostic examinations. This difference in findings may partly be related to differences in patient populations: we examined the preference of healthy women, while Hofstede’s study investigated the preferences of patients with a complication. There is also evidence that the extent to which women know their care provider also affects how women assess their care.19 Strengths and Limitations To our knowledge, this is the first study focusing on the satisfaction of healthy women with aCTG in primary midwife-led care. The large study population of 1227 healthy women with a specific aCTG indication contributed to the reliability of the results, which is the main strength of this study. Another strength of this study was using the CQ-I to measure the quality of care experienced by healthcare users. The CQ-I is a standardized method for measuring patient satisfaction and with a Cronbach’s α of 0.8, the internal consistency is good. The study by Delnoij et al. states that the recognition of the CQ-I by the medical profession implies that healthcare professionals accept the notion that patient satisfaction is an independent but integral part of the quality of care.15 For maternity care specifically, a study by Nair et al. showed the important impacts of information provision, communication, and patient satisfaction on the quality of care.15 A limitation of the study is that data related to possible confounders such as ethnicity and parity were lacking, as these questions were not included in the questionnaire. For that reason, adjusting for these variables was not possible, which may have biased our findings. In terms of age, the national proportion of pregnant women aged 30 to
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