Assessing the Gap Between Women's Expectations and Perceptions of the Quality of Intrapartum Care in Jordan: A Two-Stage Study Using the SERVQUAL Model.

INTRODUCTION: Although Jordan has made significant progress toward expanding the utilization of facility-based intrapartum care, prior research highlights that poor service quality is still persistent. This study aimed to identify quality gaps between women's expectations and perceptions of the actual intrapartum care received, while exploring the contributing factors. METHODS: Utilizing a pre-post design, quality gaps in intrapartum care were assessed among 959 women pre- and postchildbirth at a prominent tertiary hospital in northern Jordan. Data were gathered using the SERVQUAL scale, measuring service quality across reliability, responsiveness, tangibles, assurance, and empathy dimensions. RESULTS: The overall mean gap score between women's expectations and perceptions of the quality of intrapartum care was -0.60 (±0.56). The lowest and highest mean gap scores were found to be related to tangibles and assurance dimensions, -0.24 (±0.39) and -0.88 (±0.35), respectively. Significant negative quality gaps were identified in the dimensions of assurance, empathy, and responsiveness, as well as overall service quality (p < 0.001). The MLR analyses highlighted education (ß = 0.61), mode of birth (ß = -0.60), admission timing (ß = -0.41), continuity of midwifery care (ß = -0.43), physician's gender (ß = -0.62), active labour duration (ß = 0.37), and pain management (ß = -0.33) to be the key determinants of the overall quality gap in intrapartum care. CONCLUSION: Our findings underscore the importance of fostering a labour environment that prioritizes enhancing caregivers' empathetic, reassuring, and responsive skills to minimize service quality gaps and enhance the overall childbirth experience for women in Jordan. PATIENT OR PUBLIC CONTRIBUTION: This paper is a collaborative effort involving women with lived experiences of childbirth, midwives, and obstetrics and gynaecologist physicians. The original idea, conceptualization, data generation, and coproduction, including manuscript editing, were shaped by the valuable contributions of stakeholders with unique perspectives on intrapartum care in Jordan.

A case-control study of risk factors for hepatitis B virus infection in North Jordan.

Jordan is a country with intermediate endemicity for hepatitis B virus (HBV) infection where risk factors for viral transmission and their relative contributions are not well known. A case-control study of 100 hepatitis B virus seropositive patients and another 100 seronegative controls was conducted. Univariate analysis and logistic regression model were performed to examine probable risk factors for acquisition of hepatitis B virus infections. Logistic-regression analysis showed that significant risk factors for acquisition of hepatitis B virus infection were sharing toothbrushes (odds ratio = 10.167; 95% confidence interval, 1.181-87.509), unhygienic dental care (odds ratio = 2.455; 95% confidence interval, 1.294-4.658), and living abroad for at least 1 year (odds ratio = 20.018; 95% confidence interval, 2.268-176.685). The presence of these risk factors emphasizes the need for both increasing the use of hepatitis B vaccines and risk-targeted public health education. Development and enforcement of appropriate infection control guidelines for dental care services are also necessary to curtail HBV transmission. Further research that controls for confounding factors is needed to assess the relative contribution of the identified risk factors in the Jordanian community.

Comparison of clinical associations and laboratory abnormalities in children with moderate and severe dehydration.

OBJECTIVES: To search for possible early clinical associations and laboratory abnormalities in children with severe dehydration in northern Jordan. PATIENTS AND METHODS: We prospectively evaluated 251 children with acute gastroenteritis. Dehydration assessment was done following a known clinical scheme. Probable clinical associations and laboratory abnormalities were examined against the preassigned dehydration status. RESULTS: Children with severe dehydration had significantly more hypernatremia and hyperkalemia, less isonatremia, and higher mean levels of urea, creatinine, and glucose (P < 0.005). Receiver operating characteristic curves showed statistically significant area under the curve values for laboratory variables. These area under the curve values were 0.991 (95% confidence interval [CI] 0.980-1.001) for serum urea, 0.862 (95% CI 0.746-0.978) for sodium, 0.850 (95% CI 0.751-0.949) for creatinine, 0.69 (95% CI 0.555-0.824) for potassium, and 0.684 (95% CI 0.574-0.795) for glucose (P < 0.05 for all). Certain independent serum cutoff levels of urea, creatinine, sodium, glucose, and potassium had high negative predictive value (100%), whereas other cutoff values for each, except potassium, had high positive predictive value (100%) for severe dehydration. Historic clinical characteristics of patients did not correlate to dehydration degree. CONCLUSIONS: Serum urea, creatinine, sodium, potassium, and glucose were useful independently in augmenting clinical examination to diagnose the degree of dehydration status among children presenting with gastroenteritis. Serum urea performed the best among all. On the contrary, none of the examined historical clinical patterns could be correlated to the dehydration status. Larger and multicenter studies are needed to validate our results and to examine their impact on final outcomes.

Adverse events in Jordanian hospitals: types and causes.

Adverse events in health care have become an important issue for health-care professionals, administrators, health policy-makers, public and patients. Literature on adverse events in Jordan is scarce. The purpose of the study was (i) to identify the common types and major causes of adverse events in Jordanian hospitals from the nurses' perspective; and (ii) to estimate the frequency of adverse events in Jordanian hospitals. Qualitative and quantitative data regarding the perceived types, causes and incidence of adverse events were collected using a web-based questionnaire. A total of 75 valid responses with qualitative and quantitative data were obtained. The results indicated (i) that medication errors, wrong diagnosis, hospital acquired infections, bed sores and falls were the most common types of adverse events; and (ii) that workload and inadequate staffing, technical performance, negligence and poor ethics, poor management, psychosocial job demands and written guidelines were the most common causes of adverse events. On average, participants in the study believed that adverse events occurred in about 28% of all hospital admissions. Nurse and hospital administrators and health policy-makers should develop and institute effective strategies and policies to prevent or minimize the occurrence of adverse events.

Turnover rate among registered nurses in Jordanian hospitals: an exploratory study.

The aim of this study is to (i) determine the turnover rate among registered nurses in Jordanian hospitals; and (ii) compare the turnover rate between (a) male and female registered nurses; (b) northern, middle and southern regions; (c) public, private and university hospitals; (d) rural and urban hospitals; and (e) general and specialized hospitals. A descriptive, cross-sectional retrospective survey design was used. A structured interview method was utilized to collect data. A proportional random sample of 25% of the total number of Jordanian hospitals was taken. The results showed that the overall turnover rate was 36.6%. There were variations according to geographical region, health sector and place of residence. Turnover among registered nurses in Jordanian hospitals is considered a problem that requires effective strategies to deal with. Further research is required to identify the causes, and to explain the differences in the turnover rates according to the different study variables.

Screening and correlates of depression and HbA1 C in United Arab Emirates (UAE) women with diabetes.

PURPOSE: The aim was to identify the relationship between socio-demographic characteristics of United Arab Emirates (UAE) women with diabetes and depression and to explore any differences between depressed and nondepressed patients in relation to glycemic control. DESIGN AND METHODS: One hundred eighty-two subjects completed the Beck Depression Inventory-II and a socio-demographic questionnaire (i.e., age, national status, economic status, level of education, and employment status). Glycemic control was assessed by glycosylated hemoglobin (HbA1C ). FINDINGS: Ninety-two subjects were diagnosed with diabetes mellitus. A statistically significant higher incidence of depression was found in the subject group with diagnosed diabetes mellitus than in the nondiabetic subject group. A statistically significant relationship was found between depression status and type of diabetes (Type 1). A positive relationship between poor glycemic control and higher levels of depression was identified. A positively significant relationship was found between national status and level of depression among the diabetic sample, among whom at least half showed poor glycemic control (HbA1C levels > 7.5). PRACTICE IMPLICATIONS: Early detection of depression among women with diabetes is crucial to enhance treatment regimen adherence and glycemic control. As the UAE diabetic women are at even greater risk than other diabetic women, they need to be very carefully screened and evaluated for depression.