Primary care in five European countries: A citizens’ perspective on the quality of care for children

Janine A. van Til*, Catharina G.M. Groothuis-Oudshoorn, Eline Vlasblom, Paul L. Kocken, Magda M. Boere-Boonekamp

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)


Objective As part of the Models of Child Health Appraised (MOCHA) project, this study aimed to answer the following research questions: 1) How do European citizens perceive the quality of primary health care provided for children? And 2) What are their priorities with respect to quality assessment of primary health care aimed at satisfying children’s needs? Methods Nine potential attributes of quality of primary care were operationalized in 40 quality aspects. An online survey was used to elicit opinions in a representative sample of citizens of Germany, the Netherlands, Poland, Spain, and the United Kingdom. Data collection comprised: background characteristics; perceived quality of primary health care for children; and priority setting of quality aspects. Descriptive analysis was performed and differences between groups were tested using Chi-Square test and ANOVA. Results Valid results were obtained from 2403 respondents. Mean satisfaction with quality of primary care ranged from 5.5 (Poland) to 7.2 (Spain). On average, between 56% (Poland) and 70% (Netherlands) of respondents had a positive perception of the primary health care system for children in their country. The ability of a child to limit their parents’ access to the child’s medical records was judged most negatively in all countries (average agreement score 28%, range 12–36%). The right of a child to a confidential consultation was judged most differently between countries (average agreement score 61%, range 40–75%). Overall top-10 priorities in ensuring high quality primary care were: timeliness (accessibility); skills/ competences, management, facilities (appropriateness); no costs (affordability); information, dignity/respect (continuity); and swift referrals, collaboration (coordination). Discussion Between countries, significant differences exist in the perceived quality of primary care and priorities with regard to quality assessment. Taking into account the citizens’ perspective in decision-making means that aspects with low perceived quality that are highly prioritized warrant further action.

Original languageEnglish
Article numbere0224550
JournalPLoS ONE
Issue number11
Publication statusPublished - 1 Nov 2019

Bibliographical note

Funding Information:
This study was funded by the European Commission through the Horizon 2020 Framework under the grant agreement number: 634201. factsheet/en. Project: Models of Child Health Appraised (MOCHA). All contributing authors (JvT; MBB; CGO; EV; PK) received funding through this source for this project. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The research group wishes to thank the respondents in the participating five countries for completing the questionnaire. In addition, they want to thank Mitch Blair and Michael Rigby for critically reading and reviewing the manuscript, and all work package leaders within MOCHA for their comments on the quality aspects of primary health care for children.

Publisher Copyright:
© 2019 van Til et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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