GATHER Step Ask, Population Reports, Series J, Number 48

GATHER Elements:	Greet	Ask	Tell	Help	Explain	Return	Charts	Contents

ASKING—

Why and How to Ask Questions

In GATHER, A stands for “Ask.” The provider questions effectively and listens actively to the client’s answers.

Why ask questions?

To learn why the client has come.
To help the client express needs and wants.
To help the client express feelings and attitudes, and so to learn how the client feels.
To help the client think clearly about choices.
To show the client that you care.
To learn the client’s knowledge and experience with family planning and other reproductive health.
To learn about behavior and situations that could affect the client’s reproductive health and health choices.

You may need to ask all clients certain questions for your records. But the most important questions bring out what clients really want and how they feel. The best questions lead to answers that suggest more questions—like conversation between friends. No list of standard questions suits all clients.

How can you “question effectively”?

Use a tone of voice that shows interest, concern, and friendliness.
Use words that clients understand.
Ask only one question at a time. Wait with interest for the answer.
Ask questions that encourage clients to express their needs. Examples are: “How would you feel if you became pregnant soon?” “How do you think your spouse feels about family planning?”
Use words such as “then?” “and?” “oh?” These words encourage clients to keep talking.
When you must ask a delicate question, explain why— for example, asking about number of sexual partners to find out about STD risk.
Avoid starting questions with “why.” Sometimes “why” sounds as if you were finding fault.
Ask the same question in other ways if the client has not understood.

KEY WORDS FOR ASKING
"What do you hope that we can do for you today?"

Some clients are shy about telling their needs, purposes, or hopes. Still, if you do not find out what they really want, they may leave disappointed. They may not follow instructions. They may not come back. They even may complain about the care you gave them. So it often helps to ask the client politely but directly what the client hopes for on this visit.

Suggested discussion: What is a friendly, respectful way to ask your clients this question?

Open questions work better!	The questions below are *open questions.* They invite clients to give full, honest answers. They help clients think about their choices. The answer to an open question often suggests the next question. "Could you please tell me your reasons for coming?" "What have you heard about this method?" "What questions do you have about family planning?" "How do you feel about that?"	The questions below are *closed questions.* They require a specific answer, often just "yes" or "no." They cut off discussion. Some of these are also *leading questions.* They push the client to answer in the way that the questioner wants. "Are you here for family planning?" "Have you heard of this method?" "Don't you prefer this method?" "Don't you think young women should avoid sex before they are married?"
*Suggested discussion:* Think of other open and closed questions. Which are better? Also, how can you turn a closed question into an open question?

Open questions work better!

The questions below are open questions. They invite clients to give full, honest answers. They help clients think about their choices. The answer to an open question often suggests the next question.

"Could you please tell me your reasons for coming?"
"What have you heard about this method?"
"What questions do you have about family planning?"
"How do you feel about that?"

The questions below are closed questions. They require a specific answer, often just "yes" or "no." They cut off discussion. Some of these are also leading questions. They push the client to answer in the way that the questioner wants.

"Are you here for family planning?"
"Have you heard of this method?"
"Don't you prefer this method?"
"Don't you think young women should avoid sex before they are married?"

Suggested discussion: Think of other open and closed questions. Which are better? Also, how can you turn a closed question into an open question?

Responding to Client's Feelings

Family planning and other reproductive health concerns can be a very private matter for clients. When they talk about these subjects, they may feel embarrassed, confused, worried, or afraid. These feelings affect their decisions. Some feelings may make choices difficult. Some feelings may lead to choices that clients regret later.

How can you help clients deal with their feelings? First, ask about feelings and help clients talk about them. Give your full attention. Listen actively and question effectively. Watch clients’ body movements and expressions. These can help you learn what clients feel.

Once you recognize clients’ feelings, let them know in clear and simple words that you understand. This is called “reflecting feelings.” At right are two examples.

You cannot change clients’ feelings. Only they can do that. But when you reflect feelings, you are showing that you understand. You also are saying that it is all right to feel that way.

As clients talk about their feelings, they understand themselves better. Then they may find it easier to make wise and healthy choices.

Reflecting Feelings

Example 1 Provider and client discuss family planning.

Example 2 Provider and client discuss the pill.

Can You Talk About Sex? Even for experienced health care providers, discussing sex can be difficult. Using sexual terms or slang can be embarrassing. As a result, providers may not volunteer important information, answer clients’ questions fully, or ask important questions about sexual behavior. Providers may even try to influence a client’s choice of methods to avoid explaining use of condoms or vaginal methods, for example.

But reproductive health and sex cannot be separated. To make healthy decisions, clients often need to discuss sexual behavior. Therefore providers need to be comfortable with hearing and using sexual terms and also with using pictures or models of the body. Here are suggested exercises that can make discussing sex easier:

Make a list of terms and slang related to sex. Discuss how you feel about hearing and using these words. Compare the words for men with those for women. Do these words avoid negative meanings? Which words would you rather use? Do your clients understand these words?
When alone, look at your face in a mirror and say the words that make you uncomfortable. With practice, you will be more at ease and confident.
Practice using pictures or a model to show clearly how to put a condom on a penis.

Clients, too, often find it hard to talk about sex. Here are some tips for helping them:

Give clients sensitive information in other forms. Then they can take it into account even if they do not want to discuss it openly. For example, posters, pamphlets, videos, radio, and TV can explain the risks of having more than one sex partner, the signs of STDs, or the need for condoms.

Starting discussion about sex is often the most difficult step. How can you gently let clients know that you are willing to discuss sex but will not force them to do so? You might ask, “Did you see the wall chart about STDs in the waiting area? Did it raise any questions?” or “Some women say they worry that their husbands have other sex partners, but they don’t know how to talk with their husbands about it. How do you think you would handle that situation?” From here, you can lead gradually to more personal discussion if the client is willing.

Advising Without Controlling
Most clients want to make their own decisions with some advice or guidance from the provider. Two principles are important to giving advice:

Each client’s wishes—and not the provider’s wishes—determine how much advice to give. Different clients will want more or less advice.

Good advice helps clients make their own decisions. Good advice should not be controlling—that is, it should not make decisions for clients.

A provider can give advice and protect the client’s right to informed choice at the same time (see Informed Choices—Every Client's Right). (Hint: Asking questions instead of making statements can help to avoid controlling.)

Advising (Try This!) Controlling (Avoid This!)

Telling the client clearly that the decision is hers or his, while offering help, too: “Together we can think through your decision, but the choice is yours.”
Helping clients think about the effects of their choices—both good and bad: “The Pill gives some women upset stomachs at first. What if this happened to you?”
Helping clients think about their own lives: “With your schedule, what might remind you to take a pill every day?”
Taking cues from the client: “You said that you had several sex partners in the last year. This makes me think that you may need to protect yourself from STDs.”
Mentioning common experiences of other people like the client. Be balanced: “With injectables, some women are happy when monthly bleeding stops, but other women avoid injectables for this reason.”
Respecting each client’s decisions about their own lives: “I understand that you must leave home and work in the city most of the time. Since that is so….”
Giving advice when not asked: “Well, if you want my opinion....”

Substituting your decision for the client’s: “If I were you, I would….”
Expressing personal judgments or criticism about the client’s behavior: “Doing that is wrong. You should know better.”
Demanding a quick decision with no time to consider: “That’s the list of methods we have. Now which do you want?”
Stating the client’s decision for her (or him): “I am sure you don’t want this method.” Instead, ask the client to state his or her own choice or wishes, and then reflect them back.
Using the words should, always, must, and never.
Cutting off the client: “Time is short. Let’s move on….”
Assuming that all similar people have exactly the same needs: “You are not married, and all unmarried people need condoms for STD protection.”

Suggested exercises:

Advising (Try This!)	Controlling (Avoid This!)
Telling the client clearly that the decision is hers or his, while offering help, too: “Together we can think through your decision, but the choice is yours.” Helping clients think about the effects of their choices—both good and bad: “The Pill gives some women upset stomachs at first. What if this happened to you?” Helping clients think about their own lives: “With your schedule, what might remind you to take a pill every day?” Taking cues from the client: “You said that you had several sex partners in the last year. This makes me think that you may need to protect yourself from STDs.” Mentioning common experiences of other people like the client. Be balanced: “With injectables, some women are happy when monthly bleeding stops, but other women avoid injectables for this reason.” Respecting each client’s decisions about their own lives: “I understand that you must leave home and work in the city most of the time. Since that is so….”	Giving advice when not asked: “Well, if you want my opinion....” Substituting your decision for the client’s: “If I were you, I would….” Expressing personal judgments or criticism about the client’s behavior: “Doing that is wrong. You should know better.” Demanding a quick decision with no time to consider: “That’s the list of methods we have. Now which do you want?” Stating the client’s decision for her (or him): “I am sure you don’t want this method.” Instead, ask the client to state his or her own choice or wishes, and then reflect them back. Using the words should, always, must, and never. Cutting off the client: “Time is short. Let’s move on….” Assuming that all similar people have exactly the same needs: “You are not married, and all unmarried people need condoms for STD protection.”

Try to name at least 2 more examples of advising and of controlling. Discuss the difference.
In role-playing, pretend you are a specific client choosing a family planning method (see Teach Yourself Better Counseling). First, a colleague advises you without controlling. Then another colleague tries controlling your decisions. Discuss how these different approaches made you feel. Also discuss how each approach might affect what a client would do.

How to “Listen Actively”

Accept your clients as they are. Treat each as an individual.
Listen to what your clients say and also how they say it. Notice tone of voice, choice of words, facial expressions, and gestures.
Put yourself in your client’s place as you listen.
Keep silent sometimes. Give your clients time to think, ask questions, and talk. Move at the client’s speed.
Listen to your client carefully instead of thinking what you are going to say next.
Every now and then repeat what you have heard. Then both you and your client know whether you have understood.
Sit comfortably. Avoid distracting movements. Look directly at your clients when they speak, not at your papers or out of the window.

Countering False Rumors
Asking clients what they have heard about family planning methods or STDs often turns up rumors.

What are rumors?

Unreliable information passed around the community, mostly by word of mouth. Rumors become widely known and are believed to be true, but often they are inaccurate or false. The original source is usually forgotten.

Where do rumors about reproductive health start?

Unintended mistakes when a person passes on what he or she has heard.
Traditional beliefs about the body and health.
Exaggerations to make a story more entertaining.
Unclear explanation from health care providers— or no explanation at all.
People trying to explain something that has no obvious explanation, such as an unexpected side effect.
Errors or exaggerations in news reports or mass-media entertainment.
Someone trying to hurt the reputation of family planning, other reproductive health care, or health care providers.

Tips for dealing with false rumors that clients have heard:

Clearly ask all new family planning clients what they have heard and what concerns they have about methods. These questions may bring out rumors.
Explain politely why the rumor is not true. Also explain what is true in ways that the client understands.
Find out what the client needs to know to have confidence in the family planning method, other reproductive health care, or the provider. Find out who the client will believe.
Be aware of traditional beliefs about health. This awareness can help you understand rumors. It also can help you explain health matters in ways that clients can easily understand.
Encourage clients to check with a health care provider if they are not sure about what they hear.

Tips for dealing with false rumors in the community:

Find a credible, respected person who can tell people the truth and counter the rumor. Community leaders and satisfied users can be especially good.
Try to figure out why the rumor started. Perhaps a real event needs to be explained.
If rumors are circulating or perhaps even appear in the news, your director can contact reporters and editors and help them learn the true story. Your director could offer to be interviewed or to make a broadcast. Also, your director could offer to help reporters check out any future rumors.
Encourage people to check first with health care providers before they repeat rumors.

Suggested discussion: Think of one family planning rumor you have heard and one STD rumor. How could these rumors have started? What could be done to counter these rumors?

GATHER Elements: Greet Ask Tell Help Explain Return Charts Contents

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