RIAS Works - Resources by Subject

Family Planning

Abdel-Tawab N, Roter D. The relevance of client-centered communication to family planning settings in developing countries: lessons from the Egyptian experience. Soc Sci Med. 2002 May; 54(9):1357-68.
(Family Planning, Egypt)
Concern for client's rights in the provision of reproductive health services in the developing world has prompted intense efforts by international experts to promote client-centered models of communication as a replacement for more provider-centered approaches. Nonetheless, the usefulness or feasibility of cross-cultural transplantation of client-centered models of communication has not been examined. The present study examines the feasibility, acceptability, and effectiveness of client-centered models of communication in 31 family planning clinics in Egypt. Consultations between 34 physicians and 112 clients requesting family planning methods were audio-taped and analyzed for physician communication style. Client satisfaction was measured through exit interviews. Method continuation was determined through home interviews at 3 and 7 months from the index visit. Based on audio-tape analysis, two-thirds of physician consultations were characterized as physician-centered and one-third as client-centered. Client-centered consultations were only one minute longer than physician-centered consultations. A client-centered consultation was associated with a three-fold increase in the likelihood of client satisfaction and method continuation at 7 months. A high proportion of solidarity statements (positive talk) by the physician was predictive of client satisfaction whereas a high proportion of disagreement statements and directive instructions by the physician were predictive of method discontinuation. The study findings suggest that in Egypt, as in more developed countries, client-centered models of communication are likely to produce better client outcomes than provider-centered models, with no substantial changes in the structure of services.

Kim YM, Kols A, Martin A, Silva D, Rinehart W, Prammawat S, Johnson S, Church K. Promoting informed choice: evaluating a decision-making tool for family planning clients and providers in Mexico. Int Fam Plan Perspect. 2005 Dec;31(4):162-71.
(Family Planning, Decision-Making, Mexico)
CONTEXT: The World Health Organization (WHO) has developed a decision-making tool to be used by providers and clients during family planning visits to improve the quality of services. It is important to examine the tool's usability and its impact on counseling and decision-making processes during family planning consultations. METHODS: Thirteen providers in Mexico City were videotaped with family planning clients three months before and one month after attending a training session on the WHO decision-making tool. The videotapes were coded for client-provider communication and eye contact, and decision-making behaviors were rated. In-depth interviews and focus group discussions explored clients' and providers' opinions of the tool. RESULTS: After providers began using the decision-making tool, they gave clients more information on family planning, tailored that information more closely to clients' situations and more often discussed HIV/AIDS prevention, dual protection and condom use. Client involvement in the decision-making process and client active communication increased, contributing to a shift from provider-dominated to shared decision making. Clients reported that the tool helped them understand the provider's explanations and made them feel more comfortable talking and asking questions during consultations. After one month of practice with the decision-making tool, most providers felt comfortable with it and found it useful; however, they recommended some changes to the tool to help engage clients in the decision-making process. CONCLUSIONS: The decision-making tool was useful both as a job aid for providers and as a decision aid for clients.

Kim YM, Kols A, Mwarogo P, Awasum D. Differences in counseling men and women: family planning in Kenya. Patient Educ Couns. 2000 Jan;39(1):37-47
(Gender, Family Planning, Kenya)
A comparison of family planning sessions with male and female clients in Kenya found distinct gender differences. Most men came for information, while women wanted to adopt, continue, or change contraceptive methods. Consultations with men and couples were more than twice as long as consultations with women. Men communicated actively (for example, by volunteering extra information, asking questions, and expressing worries) during 66% of their turns to speak, compared with 27% for women. Providers offered men more detailed information than women, asked them fewer questions, issued fewer instructions, and responded more supportively. These communication patterns may be seen as a reflection of Kenyan gender roles and men's and women's different reasons for seeking family planning services. Kenyan providers need to improve the quality of their interactions with women. They also need to anticipate men's outspokenness and understand the male agenda if they are to counsel men effectively. PIP: This study analyzes and compares transcripts of family planning consultations collected from two different family planning associations in Kenya to explore the possible differences in counseling women and men. A comparison of 358 family planning sessions at 25 service delivery sites in urban and rural areas found distinct gender differences. Most men came for information, while women opted to adopt, continue, or change contraceptive methods. Men participated more actively in the sessions during 66% of their turns to speak, compared with 27% for women. Men were offered more detailed information than women, were asked fewer questions, were issued fewer instructions, and were given more support by the providers. Such communication patterns may be seen as a reflection of Kenyan gender roles and men's and women's different reasons for seeking family planning services. The findings indicate that Kenyan providers need to improve the quality of their interactions with women, and that they also need to anticipate men's outspokenness and understand the male agenda for effective counseling.

Kim YM, Kols A, Prammawat S, Rinehart W. Sequence analysis: responsiveness of doctors to patient cues during family planning consultations in Mexico. Patient Educ Couns. 2005 Jul;58(1):114-7.
(Interaction Analysis, Family Planning)
(Abstract not available.)

Kirimlioglu N, Elcioglu O, Yildiz Z. Client participation and provider communication in family planning counselling and the sample study from Turkey. Eur. J Contracept. Reprod. Health Care. 2005 Jun;10(2):131-141.
(Family Planning, Turkey)
Background The family planning program in Turkey was established in 1965 to curb the rapid increase in population growth. The last Demographic and Health Survey showed that about 64 % of married women in Turkey used contraception. OBJECTIVES: This study examines of behavior of family planning clients and provider in Eskisehir/Turkey, to see whether they can achieve this ideal partnership. METHODS: Consultation between 83 physicians, 222 nurses and 324 clients requesting family planning methods were audio-taped and analyzed for physicians and nurses communication style. Data were collected from 3 hospital and 14 small health units that give services in Eskisehir. The audio-taped consultations were coded using an adaptation of the RIAS which has been used extensively in both developed and developing countries and in statistical analyzing chi(2) and t test were utilized. RESULTS AND CONCLUSIONS: The single strongest factor was providers giving biomedical and technical information. The qualitative analysis of audiotapes found that most of clients' questions concern contraceptive side effects and symptoms. The next category social talk, consisted largely of greetings. Most of the providers (87.6 %) are women. The results show that providers dominate most counseling session and clients rarely take on active role.

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