This is a cross-sectional, quantitative study using a structured questionnaire to interview parents of premature infants in the Neonatal Care Units of a provincial and a more specialized (higher level) national hospital. The data collection period lasted from January to June 2018.
The national hospital system of Vietnam is divided into four levels: a national, a provincial, a district and a community level based on the difference in number of hospital beds, health workers, medical technologies and medical services provided. Therefore, at the community level, only very basic services provided while the national level hospitals offer the most specialized care and are designed to provide the highest quality of care in the country.
Since most preterm infants with specialized care needs are treated either at provincial or at national hospitals, we purposively selected one large hospital from each level for this study: Vietnam National Children’s Hospital (VNCH) and Thanh Hoa Pediatric Hospital (THPH).
Thanh Hoa Pediatric Hospital is the only provincial public pediatric hospital in Thanh Hoa province with 1050 beds. Thanh Hoa province is located in the North Central Coast region of Vietnam and comprises a total population of 3.5 million people across 24 districts. The primary economic activities in this province are agriculture, forestry, fishery, and tourism. It is also an industrial center . The neonatal care unit of the hospital admits an average of 200 infants and 22 preterm infants per month. The infant-nurse and infant-doctor ratios in the neonatal care unit were 4.6 and 18.2 in 2018, respectively.
Vietnam National Children’s Hospital is a national referral hospital located in Hanoi City, the capital of Vietnam. The hospital is the largest pediatric hospital in Northern Vietnam with 1900 beds. It is the primary referral hospital for all 38 provinces of northern Vietnam (with a total population of 43 million people) as well as a center for research, teaching, and postgraduate training in newborn diseases. The neonatal care unit of this hospital is responsible for the diagnosis, treatment, and care of all premature infants and newborns referred to from lower-level facilities, including all provincial hospitals for specialized care. The estimated average number of neonates and preterm infants admitted in this unit are around 450 neonates and 110 infants per month. The infant-nurse and infant-doctor ratios in the neonatal care unit were 4.8 and 22.5 in 2018, respectively.
We interviewed parents (mother or father) of preterm babies admitted to the two neonatal care units for 6 months, from January to June of 2018. The inclusion criteria for interviewees were that parents were at least 18 years old and literate, that their child was being treated and had stayed at least 7 days in the neonatal care unit at the time of interview, and they were willing to participate in the study.
Sample size and sampling methods
Based on the list of preterm infants admitted in neonatal care unit each week, we met parents in neonatal care units of two hospitals and invited them to participate in our study. If they were willing to participate in the study, parents selected a convenient place for the interview, often outside the neonatal care unit, and filled out the study questionnaire. If both parents were available, the mother was given preference and only she was interviewed. The interview was conducted by members of our research team.
We interviewed all parents who have met the above criteria between January and June 2018. After 6 months of data collection, the total number of parents participated in our study was 340 parents: 90 parents in Thanh Hoa Pediatric Hospital and 250 parents in Vietnam National Children’s Hospital.
Data collection tools and variables
Data collection tools
Data was collected through a two-part questionnaire: the first part comprised 13 questions capturing socio-economic characteristics of parents and clinical characteristics of preterm infants. The second part of the questionnaire comprised of 22 satisfaction questions covering three dimensions: care and treatment, communication, and hospital environment measuring parental satisfaction on a five-point Likert scale. Level of agreement for each statement in the questionnaire was scored from 1 to 5 with 1 indicating the lowest level of agreement (totally disagree) and 5 indicating the highest level of agreement (totally agree). The questionnaire was developed for this study (see Additional file 1) and the first version of the questionnaire was based on McPherson’s Parental Satisfaction Survey (PSS)  and EMPATHIC questionnaire , which both measure parent satisfaction in paediatric intensive care units. Back-forward translation was conducted and then we dropped questions inappropriate for the context of Vietnamese hospitals. This second version was pilot-tested with 30 parents in both hospitals to make sure that respondents understand the questions clearly and the questions covered all satisfaction areas. There were no changes in the contents of the second version, only few words had been changed after the pilot test.
Cronbach’s alpha for the adapted questionnaire was 0.93: For the 7 items in the care and treatment component, Cronbach’s alpha was 0.84; for the 12 items on the communication scale and the 3 items on the hospital environment scales Cronbach’s alpha was 0.90 and 0.76, respectively.
The primary outcome of interest was parental satisfaction with the level of care provided. Parental satisfaction was modeled as the average satisfaction score measured across the 22 questions asked.
Social-demographic characteristics of parents as well as clinical characteristics of premature babies included: gender of respondents (female, male); marriage status (married, divorced/separated); parental age group (15–25, 26–35, 35+ years); ethnicity (Kinh, others); level of education (high school and lower, undergraduate and postgraduate); job (farmer/fisherman/worker, officer, freelancer, students); residence (rural, urban); income per month (≤1.950.000 VND, > 1.950.000 VND); gender of the child (female, male); gestational age (32–37, 28–31, < 28 weeks); birth weight (≥2500 g, 1500-2499 g, 1000-1499 g, < 1000 g); health status of the infant (improved, no change or worsen); and length of stay (≤14 days, > 14 days).
Firstly, descriptive statistics (percentage, mean, min, max) for all variables of interest were calculated. Following this, we estimated the average difference in satisfaction score between caregivers at the provincial and caregivers at the national hospital, both unconditional and conditional on all infants’ and parents’ characteristics. The main independent variable of interest for this analysis was a dichotomous variable for treatment at the national hospital, with the provincial hospital serving as reference group. Thirdly, we estimated the same differences by population group. Our data was stratified according to income, length of stay, and health status of infants. We then estimated the difference in satisfaction between two hospitals adjusting for parent and child characteristics.