Evaluation of the World Health Organization's Family Planning Decision-making Tool: Improving Health Communication in Nicaragua

Published in Patient Education and Counseling (Volume 66, Issue 2, May 2007, Pages 235-242), this evaluation report (available for purchase only) examines a strategy for family planning (FP) counseling: the use of a decision-making tool (DMT) in the form of a flipchart designed to foster patient-physician communication. Developed by the World Health Organization (WHO), Department of Reproductive Health and Research, and the INFO Project at the Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs, the tool is designed to be interactive in that one page for the client includes helpful pictures and key points and a corresponding page for providers features with key points and reference information. The tool also includes evidence-based technical information on 14 family planning methods, including medical eligibility criteria, side effects, when to start, and how to use each method. The tool is designed to be easily revised to suit different programme and country contexts.

This study investigates the DMT's impact on health communication in Nicaragua. As part of the research 59 service providers were videotaped with 426 FP clients 3 months before and 4 months after attending a training workshop on the DMT. The videotapes were coded for both provider and client communication. Researchers found that after the intervention: "providers increased their efforts to identify and respond to client needs, involve clients in the decision-making process, and screen for and educate new clients about the chosen method. While the DMT had a smaller impact on clients than providers, in general clients did become more forthcoming about their situation and their wishes. The DMT had a greater impact on sessions in which clients chose a new contraceptive method, as compared with visits by returning clients for a check-up or resupply."

The authors find that this strategy - use of the DMT to foster high-quality health communication - proved effective both as a job aid for providers (even those with limited training and/or supervision) and a decision-making aid for clients (even those with limited education). One specific example cited is that, as more and more people use family planning, continuing clients outnumber new clients by a widening margin. Continuing clients have a variety of reasons for returning to the clinic. Some are satisfied with their method and are returning for re-supply. Others have concerns about their method and want additional counseling, while still others want a different method. Providers can use the DMT to counsel clients based on their reasons for returning. It includes a special section focused specifically on the needs of returning clients. The evaluators conclude that, when providers establish a positive interpersonal relationship with their clients and give them good service - by listening to, understanding, and responding to their needs - their clients are more likely to return to the clinic.

Editor's note: Please click here to learn about this tool. It has, as of this writing, been translated into 16 languages: Arabic, Bahasa Indonesia, Bengali, Burmese, Chinese, Dari, Divehi, Farsi, French, Hindi, Kosovar, Mongolian, Nepali, Romanian, Spanish, Turkish, and Vietnamese. To download the tool in English, click here. A limited number of printed copies are available as samples or for programme use. Please contact the INFO Project via e-mail at orders@jhuccp.org.)