MATERNAL SATISFACTION WITH MATERNAL-INFANT NURSING CARE IN CAMPECHE , MEXICO

Objective: Evaluate and compare maternal-satisfaction (global and areas) with maternal-child nursing care (MSMINC) and to explore the relationship of MSMINC with wait time, length of visit, and maternal age and education. Methods: Cross-sectional descriptive study comprising 213 mothers. Group 1 (n = 84), mothers of children aged <1 year, and Group 2 (n = 129), mothers of children between 1 and 4 years of age. The patient satisfaction scale was applied. Results: Global MSMINC was 76.26 and 79.21 for Groups 1 and 2, respectively. No associated factors were found in Group 1. In Group 2, wait time was associated with MSMINC in the technicalprofessional area (F = 3.13; df = 128; B = –0.21; p = 0.01). Conclusions: The fact that these study participants identified only MSMINC-associated factors in the technical-professional area may indicate that care is centered on technical procedures. Given that MSMINC-associated factors were not identified in Group 1, we recommend exploration of maternal expectations and perceptions of care.


INTRODUCTION
One indicator of healthcare quality is patient satisfaction, also denominated consumer satisfaction or client satisfaction.Several studies have considered patient satisfaction as a predictor of treatment compliance, on-going use of healthcare services, recommending healthcare services to others (1) , and a valuable feedback to evaluate health programs (2) .At present, there is no consensus regarding what the concept of patient satisfaction encompasses.
Nevertheless, an early definition of patient satisfaction in outpatient settings with nursing care defines patient satisfaction as an attitude reflecting the extent of congruence between what patients expect and their perception of the care they received (3) .
Regarding pediatric preventive care in the U.S. and Canada, the main aim of pediatric preventive care, identified as well-child care, well-baby care, health supervision and periodic health care, is to maintain health and prevent diseases.The basic unit of well-child care is the health supervision visit, which can be performed by physicians or nurses.The contents of each visit are infant age-specific, and each visit can be divided into three components: a) detection; b) health promotion and disease prevention, and c) patient handling and follow-up (4) .
In Mexico, maternal-infant nurse (MIN) at the Mexican Social Security Institute (IMSS) deliver health A literature review showed that there are several factors (independent variables) associated with patient satisfaction (dependent variable), including the following: a) wait time; b) length of visit (5) ; c) age of patient, and d) educational level of patient (6) .Wait time comprises a factor of service access (2) .A study conducted at public and private hospitals identified that one half (42.54%) or 870 respondents felt that they had not waited for services.
The majority of individuals who sought care at private hospitals experienced less wait time than those at public hospitals (7) .
Another study assessing parental satisfaction with healthcare for young children in a sample of 2,068 participants that employed telephone interviews found that perceiving the visit length as short was a factor associated with low satisfaction (8) .At the IMSS, duration of well-child care visit is 10 min; it was usually the mother who attended the visit to the MIN with her children.
Other factors that have been explored as associated with parental satisfaction with the healthcare their children receive include parental age and parental education.One study identified that satisfaction is lower for children whose mothers are <20 years of age (odds ratio [OR], 0.30; 95% confidence interval [95% CI], 0.15-0.62)than for children with an older mother; maternal education is not associated with any satisfaction measurement (8) .
One important dimension of patient management that lacks well-child care-related satisfaction measurements, according to literature in the U.S., is that there is no instrument to assess satisfaction levels associated with parents' perspective on preventive healthcare for children aged <3 years.
Measuring instruments for the parents' satisfaction were designed to assess parental satisfaction with neonatal intensive care, for parents of children with special-needs care, parental perceptions of pediatric in-patient quality of care, and pediatric familial satisfaction (1,(9)(10)(11) .
Given that the previously mentioned instruments are not applied in outpatient settings, we consider that the Patient Satisfaction Scale (PSS) can

RESULTS
Most mothers in Group 1 were married (85.70%) and were homemakers (61.90%).The average age of their children was 8.94 ± 22.35 months.The majority of Group 2 mothers were also married (91.50%) and homemakers (65.90%), while the average age of their children was 24.04 ± 9.63 months.
Table 1 presents the descriptive statistics of independent variables.In Group 1 mothers, maximum wait time was 90 min and 5 min was the minimum length of the visit; in Group 2 mothers, maximum wait time was 35 min and minimum length of the visit was 5 min.In terms of study limitations and implications for future research, there are several of the former in this study, including that measurements of wait time and length of visit were carried out according to maternal perceptions.
MSMINC was evaluated by PSS (3) .This promotion and supervisory care to the pediatric population aged <5 years, considering the following aspects: vaccination surveillance; nutritional surveillance; identification of factors involved in a poor prognosis; clinic evaluation and classification; adequate treatment; maternal training on identification of warning signs, general patient care at home, and stimulating healthcare and treatment in well-child care to check the child's growth and development.The following must be registered at each visit: age; weight; height, and performance of psychomotordevelopment evaluation.Given the baby's rapid growth and development during the first year of life, visits to the MIN are scheduled every 2 months.Moreover, the MIN is responsible for providing nutritional and weaning education related to exclusive breastfeeding during the first 4 months.If complementary feeding is required after this age, the MIN provides commercial infant-formula donations (30 cans) during scheduled visits until the age of 12 months.After the first year of life and up to the age of 4 years, visits to the MIN are scheduled every 6 months.

Ta b l e 3
i l l u s t ra t e s t h e r e l a t i o n s h i p o f MSMINC with four independent variables.In Group 1, none of the four variables was associated with maternal satisfaction.On the other hand, in Group 2, only the model (technical-professional area) exhibited a significant relationship (r 2 =0.063; p = 0.017) with the four independent variables.The variable contributing to this model was wait time to be seen at their consultation (β= -0.164; p = 0.021).

CONCLUSIONS
Information published with respect to parental satisfaction with the preventive healthcare received by their children is scarce.The results of the present study contribute to knowledge of the MSMINC at a Family Medicine Unit in the Mexican state of Campeche and explore the relationship of certain factors identified in the literature with the MSMINC.In Group 2 mothers, wait time was associated with MSMINC in the technical-professional area.This factor is an indicator of patient healthcare access at public or private institutions.Because we were unable to identify MSMINC-associated factors in Group 1, it is necessary to identify maternal expectations or perceptions of well-child care that permit Group 1 mothers to distinguish important maternal satisfaction domains.
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 P SS wa s d e s i g n e d t o evaluate patient satisfaction with nursing care in outpatient settings.
Mothers were approached when they left the MIN's office.When she indicated that she was the child's mother, she received explanations on the research objectives 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 voluntarily by means of written informed consent.
Maternal satisfaction with maternal-infant nursing care… Flores-Peña Y, Vázquez R.dela Gala SE, Cerda-Flores RM.Rev Latino-am Enfermagem 2009 setembro-outubro; 17(5):645-50 www.eerp.usp.br/rlaebeused to evaluate maternal satisfaction with maternal-infant nursing care (MSMINC) (dependent variable).This global scale consists of three subscales,METHODSStudy design and sample Cross-sectional descriptive study.The convenience sample included 213 volunteer and unrelated mothers who together with their children attended well-child care visits to an MIN at a Family Medicine Unit in the southeastern Mexican state of Campeche from August to October, 2006.Inclusion criteria comprised mothers having attended the visit to the MIN, and that mothers have at least 6 th -grade education.No mother refused to participate, and all questionnaires were applied by the same researcher.and subscales.Third, we compared means and variances of MSMINC (global and areas) for Groups 1 and 2, using the Student t and Levene tests.And fourth, in order to explore the maternal satisfaction r e l a t i o n s h i p ( g l o b a l a n d a r e a s ) w i t h f o u r

Table 1 -
Descriptive statistics of independent variables in both groups of mothers SD, Standard deviation.

Table 2 -
Comparison of maternal satisfaction with Maternal-infant nursing care (MSMINS) between the two