Table of Contents
Chapters
- Promoting Dialogue
- Supporting the Client’s Role
- Improving Providers’ Performance
- Table: Activities to Improve CPI
- Box: Supervisors Can Improve CPI
- Best Practices in Training
- Evaluating the Quality of CPI
- Moving Beyond Family Planning
- Bibliography
This issue was prepared in collaboration with the Maximizing Access and Quality (MAQ) Initiative of the United States Agency for International Development's Office of Population and Reproductive Health. The MAQ Initiative supports research and evidence-based interventions to promote access and quality of reproductive health and family planning services.
Published by the Information & Knowledge for Optimal Health (INFO) Project, Center for Communication Programs, The Johns Hopkins University Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA.
Volume XXXI, Number 4,
Fall 2003
Series Q, Number 1
Maximizing Access to Quality
Promoting Dialogue
The interaction between a health care client and provider contributes the vital human connection that leads to meeting the client’s needs. Client-provider interaction (CPI) can influence clients’ perceptions of the quality of care, their decisions about returning to the same provider or service site, their understanding of and adherence to medical regimes, their continuation of contraception, and even decisions about whether and when to have more children (1, 2, 48, 82, 93, 107, 115, 133). Clearly, better CPI can improve reproductive and other health programs, creating more satisfied and empowered clients and better health outcomes.
What is CPI? The term encompasses all face-to-face communication between clients and health care providers. One type of CPI, counseling, holds special importance for reproductive health care. Counseling is a dialogue in which providers use communication skills and technical knowledge to help clients make or confirm health decisions, such as choosing a contraceptive method or opting for HIV testing, and then help clients plan and prepare to carry out those decisions.
In addition to their primary providers, clients also interact with other staff at health facilities, including other midwives, nurses, and doctors as well as receptionists and guards. Because all these interactions can shape clients’ experience, they, too, deserve attention.
By definition, CPI involves two-way communication be-tween clients and providers—that is, a dialogue. Cus-tomarily, however, health care professionals and their technical concerns have dominated these interactions and the decisions that flow from them. In recent years there has been growing recognition of the importance of the client’s role in consultations. For family planning an important turning point came in 1994, when the International Conference on Population and Development (ICPD) in Cairo endorsed reproductive health care focused on individuals’ needs and rights (157).
Most reproductive health programs now emphasize client-centered care, which places clients’ needs and concerns first and encourages greater client participation in the decision-making process (28, 150). In particular, clients’ informed choice has become an avowed goal for family planning programs (159). Informed choice is a logical outcome of effective CPI, because good CPI gives clients the information they need to make sound decisions along with help considering their options.
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A health worker in Ethiopia counsels a woman about her family planning choices. Counselors are most effective when they focus on the client’s needs and concerns and give clients the information and assistance they need to make healthy decisions. |
Harvey NelsonThe field of family planning has played a pioneering role in investigating the need for and nature of good CPI and exploring related issues such as informed choice and client-centered counseling. Experienced providers of family planning have learned much about how to interact effectively with clients. By drawing on this body of knowledge and applying lessons learned through experience, reproductive health programs can further improve the quality of CPI. This report synthesizes key insights on improving CPI collected by members of the Maximizing Access and Quality (MAQ) Initiative of the United States Agency for International Development and its Cooperating Agencies (see www.maqweb.org).
There are many ways for health care programs to promote dialogue between clients and providers. To support the client’s role as an informed decision-maker, programs can ensure that providers understand and respond to clients’ concerns and priorities. At the same time, they also can encourage clients to participate more actively in consultations (see chapter 2, Supporting the Client's Role). Programs can improve providers’ performance by addressing all of the factors that influence their ability to communicate, ranging from providers’ knowledge and skills to job expectations and the work environment (see chapter 3, Improving Providers' Performance). Programs also can increase the impact of training—the activity most commonly used to improve providers’ communication skills—by adopting proven training practices (see chapter 4, Best Practices in Training). No matter what measures a program takes to improve CPI, careful evaluation can help refine their design and implementation and assess their impact (see chapter 5, Evaluating the Quality of CPI). Lessons learned about improving CPI can strengthen family planning programs and be fruitfully applied to integrated sexual and reproductive health services such as HIV/AIDS prevention and care for victims of violence (see chapter 6, Moving Beyond Family Planning).
