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
- Curricula Cover Process, Tailoring
- Adopt Proven Training Methods
- Many Contribute to Transfer of Learning
- 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
Best Practices in Training
Over the past decade there has been a shift in both the content and format of CPI training in family planning and reproductive health. Until the mid-1990s training emphasized the acquisition of knowledge, particularly information about contraception. Since then, curricula have increasingly focused on interpersonal communication skills and the relationship between client and provider. At the same time, there has been a systematic effort to identify and adopt more effective training practices.
Advances in measuring CPI performance also have contributed to stronger training. Behavioral checklists such as the Quick Investigation of Quality (QIQ) (104) and the MAQ checklist (138), while not created for training purposes, can help planners develop measurable performance objectives for trainees and assess whether they have been met (see table 2 and box, Evaluating CPI Training Programs).
Reproductive health programs can improve the quality of CPI by adopting these new approaches to curricula, training practices, and performance assessment and by applying them to both preservice education and in-service training. Some skills are relatively easy to address with training, including assuring method choice, greeting clients, and paraphrasing clients’ questions (148). Some significant challenges for CPI training remain, however, such as addressing the social distance between clients and providers and overcoming providers’ reluctance to discuss side effects with clients.
Curricula Cover Process, Tailoring
No matter what their subject, effective training curricula share certain characteristics. Their learning objectives are SMART—that is, Specific, Measurable, Attainable, Realistic, and Time-bound. Varied training techniques and activities can be employed, but all encourage participation, build on trainees’ existing knowledge, and support the achievement of specified learning objectives. The overall curriculum and sections within it follow a logical, announced order. Clear, detailed instructions for the trainer are included, and the instructions contain all of the guidance, information, and examples necessary for the trainer to organize the session, create an effective learning environment, conduct the training, and evaluate it. Materials are laid out and presented in a way that makes them easy to use for both trainer and participants (161).
As for content, CPI curricula recognize that a family planning consultation is a continuum with several important moments: establishing and maintaining rapport, exchanging information, sharing decision-making, and planning next steps. Practical curricula teach providers structured approaches to counseling that help them organize the process and remember the important moments in the interaction (132). Curricula may cover communication habits designed to keep consultations on track and use time efficiently—such as always asking a client seeking a family planning method, “Do you have a method in mind?”
At the same time, providers must react and respond to each client’s unique needs, so CPI curricula also teach providers how to tailor the interaction to the client’s individual situation, health status, and information needs. By focusing on the client’s needs, the provider is more likely to give the client the method that she or he prefers rather than one that the provider chooses. When clients obtain the method they want, they are more satisfied and use the method longer (54, 118).
Tailoring information to the client’s circumstances and priorities has the added benefit of using limited counseling time more effectively (1). When family planning programs in Jamaica, Honduras, and Brazil decided to add a sexuality focus, providers concentrated on the clients’ needs and discussed information relevant to those needs rather than delivering a set lecture on methods (12). Thus they could make time for better counseling without lengthening consultations.
In addition to fostering individualized and interactive counseling, strong CPI curricula provide strategies to prevent information overload, advise how to deal with misinformation and rumors, and encourage use of take-home reminders for clients.
Most current CPI training materials focus on:
- The counseling process, including the decision-making process embedded within it,
- Listening skills,
- Understanding the client’s needs and priorities,
- Respecting a client’s choice of family planning method,
- Addressing the client’s risk for STIs,
- Using simple language,
- Technical knowledge of contraception, family planning, and reproductive health,
- Counseling about side effects, and
- Meeting the needs of special groups, such as men, adolescents, and post-abortion clients.
|
In Senegal two health care providers attending a CPI training workshop practice counseling one another. Proven training methods, such as modeling and super-vised practice, increase the effectiveness of CPI training. |
While these topics are important, training materials often do not give enough attention to other significant issues, including social distance, gender-related issues such as violence against women, and issues of sexuality (148). Despite the considerable coverage given to contraceptives, curricula also are weak when it comes to assisting with method switching, addressing the advantages of family planning methods, and suggesting how different methods might affect a client’s daily life. More also needs to be done to encourage and help clients to communicate with their sexual partners about family planning and preventing STIs (see chapter 6, Moving Beyond Family Planning).
The provider needs to understand the client as a person. Training curricula should address communication skills that enable providers to elicit and meet clients’ needs. Providers can learn how to help clients identify their reproductive goals, how to respond to clients’ concerns and misconceptions, and how to explore sensitive areas such as sexual practices and violence—and to do so in a manner that makes the client feel as comfortable as possible. Teaching these skills may pose a challenge if providers are used to dealing with a medical problem rather than a person and do not feel confident discussing a client’s personal situation. As trainers help providers master these new skills, they also must help providers eliminate unhelpful behavior, such as interrupting and showing disrespect (74, 130).
Training also can help providers understand the special challenges facing certain groups of clients—due to their age, gender, or life circumstances—and to respond appropriately, without passing judgment. For example, providers who work with adolescents need to know about sexuality, puberty, and other concerns of youth, and they must be aware of youth-friendly referral resources. They also must respect young clients’ autonomy (11). Male clients and couples also present challenges to providers who are used to dealing only with women (125).
Training can help providers clarify their values and attitudes. Training curricula increasingly focus on the counseling relationship and how the provider’s belief system influences the interaction. Providers need to understand and take into account their own attitudes regarding:
- Their role as medical experts,
- Their perception of and respect for the client, and
- Family planning and other services that they offer.
By establishing a trusting relationship with providers, trainers can promote the open exploration of their beliefs.
Training can help providers understand how their values affect their counseling practices—for example, by making them reluctant to offer contraceptives to unmarried adolescents or to explore domestic violence. This kind of training also can encourage providers to learn strategies to counteract their own biases, to persevere during difficult or awkward interactions with clients, and to see their own nervousness as a challenge rather than a limitation (89).
Exploring personal values and feelings also helps providers develop their ability to connect with clients and quickly draw out clients’ needs and concerns. This requires both self-awareness and empathy—that is, providers must understand the sources of their own feelings at the same time that they experience and appreciate clients’ feelings (47).
Training can increase providers’ self-efficacy—that is, their confidence in their own abilities (9, 89)—by helping them master essential skills and knowledge (16). Self-efficacy is an important bridge between knowing what to do and taking action (10, 89). In other words, if providers feel confident that they have the counseling skills needed to help clients, they are more likely to use their skills.
