The postpartum period refers to the first hour after the placenta departs to six weeks after delivery, which is a critical time in the mother's life [1]. Women experience a variety of physical, psychological and psychological complications during childbirth and the postpartum period that may interfere with their lives [2]. Inadequate follow-up care affects maternal health and mother-infant communication, postpartum depression, post-traumatic stress disorder, sexual function, maternal role compliance, and breastfeeding problems [3].
In fact, women need regular follow-up care, health education and advice, and frequent postpartum examinations. Most primiparous mothers are unprepared to breastfeed and require the support of family, friends and health care providers [5].
The health care system and people are being considered; hence the demand for quality management activities in service and manufacturing organizations is increasingly expanding [8]. Health-care evaluation can determine the quality of program performance, the progress of implementation, and the rate of failure or success of the program [14].
With the increasing complexity of health care, monitoring and evaluating the quality of health services has become critical [15]. Despite various tools and models in the field of health, several studies have been conducted using the SERVQUAL model [16, 17]. The model most scholars agree on is the SERVQUAL model, or quality gap, first proposed by Parasuraman et al. [18].
The SERVQUAL model assesses five dimensions of service quality, including the tangible dimension, reliability, responsiveness, assurance, and empathy.
Since not communicating with service recipients leads to concealment of problems, needs and disruptions to correct information [26], it is necessary to consider service providers' view of the situation as compared to ideal conditions as the most effective principle in improving the delivery of services. On the other hand, the period is a special and sensitive time in women's lives. Therefore, this study aimed to determine the quality of postpartum care from the viewpoint of service providers using SERVQUAL model in Sanandaj comprehensive health centers in 2017.

 

This study is a cross-sectional and descriptive-analytical one that was conducted in 2017. This study included all women who referred to Sanandaj comprehensive health centers for postpartum care. Inclusion criteria included the willingness of cases to participate in the study, to live in Sanandaj and to receive comprehensive health services. In case of failure to complete the questionnaire, the individual would be excluded from the study. The sampling method is classified. The city was divided into five areas: north, south, east, west and center, and three comprehensive health centers were randomly selected from each area. Considering 50% of negative variance of quality, reliability of 95% and accuracy of 5% 384 individuals were selected by available. After selecting the samples, the objectives of the study were carefully explained to the participants and assured that their information would be kept confidential. Individuals who signed the consent form to participate in the study were included in the study. Each participant in the study responded to the questionnaire on different days during each successive period. Data were collected using a two-part questionnaire. The first part was demographic characteristics and the second part was SERVQUAL questionnaire.
 The validity of the questionnaire was confirmed by content experts. The reliability of the questionnaire was also assessed by the researchers, who reported a 2% Cronbach's alpha coefficient in all cases [32-35]. Statistical data were analyzed using SPSS 23 (SPSS Inc., Chicago, IL., USA) and descriptive statistics, t-tests, and analysis of variance.

 

In all five dimensions of quality of services there was a negative quality gap. The highest mean quality was in the reliability dimension (-1.82) and the lowest mean gap was related to the responsiveness dimension (-1.55). Also, there was no significant relationship between age, education level and number of children and quality gap (P>0.05) (Tables 1,2).
 

Table 1. Mean scores of perception, expectation and gap of five dimensions of postpartum quality of service

 

Table 2. Mean scores of perception, expectation and quality gap in each of the dimensions of service quality

The postpartum period is one of the most important periods in the life of mothers, which has made the need for quality care more urgent. It is also an important time to evaluate services, improve their quality and organize them. According to the results of the present study, the overall quality gap in all five dimensions of postpartum service quality in comprehensive health centers is negative. The negative quality gap means that customers' expectations are higher than their perceptions. There is also a gap between clients' expectations of their centers and their perceptions, and their expectations are not sufficiently met.

 

The results showed that there is a gap between expectations and perception of service providers, and efforts to meet needs and achieve expectations are necessary.

 

The present study is the result of a Master's Degree in Midwifery Education at the Faculty of Nursing and Midwifery of Kurdistan University of Medical Sciences. We are grateful to the Vice-Chancellor for Research and all participants in this study.

 

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.