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Communication style can affect method continuation.

Several studies have described communication styles used by family planning providers during client consultations in developing countries, (1) but a recent study in Egypt has gone a step further to show how interaction style might affect clients' contraceptive behavior. Using a primarily qualitative design and a quantitative analysis, the study conducted by investigators from the Johns Hopkins School of Public Health, Baltimore, MD, USA, found that physician-centered communication was more prevalent than client-centered communication. But client-centered interaction was associated with greater client satisfaction and, notably, greater contraceptive method continuation. (2)

In physician-centered interactions, the provider determines the best family planning option for the client In client-centered interactions, the provider helps the client decide what method is best for her The provider offers technical information but also helps the client understand the information and responds to the client's questions and concerns.

The prospective, observational research took place in 31 family planning clinics that were part of a family planning project in Egypt that promotes client-centered reproductive health care. Thirty-four physicians and 112 female clients attending the clinics to obtain new family planning methods or switch methods were studied. All 112 client-provider consultations were audiotaped, and the tapes were quantitatively analyzed to determine the providers' communication styles. Clients also completed an exit questionnaire in which they rated multiple attributes of the consultation, as well as their overall satisfaction with the interaction, using a numerical scale. In addition, 93 clients who intended long-term use of their chosen contraceptives were questioned at home three and seven months after their initial consultations to determine rates of method continuation. (Physicians and clients also completed questionnaires to determine their background and sociodemographic characteristics.)

Only one-third of the client-provider consultations were classified as client-centered Yet clients who had client-centered interactions were three times more likely than those who had physician-centered interactions to report satisfaction and continued method use at seven months The most significant predictor of method discontinuation among all clients was a high proportion of provider statements of disagreement with clients. But clients were also more likely to discontinue use if providers used instructive or directive statements during consultations.

To improve family planning programs in Egypt, the researchers recommended that program managers increase efforts to establish client-centered communication models in their clinics and include these models in provider training. "Training of health care providers should emphasize the importance of treating clients nicely, involving clients in decision-making, and treating clients as ... complete human being[s]. [with] physical, emotional, and social needs," they stated.


(1.) Kim YM, Odalla D, Thuo M, et al. Client participation and provider communication in family planning counseling: transcript analysis in Kenya. Health Commun 1999;11(1):1-19; Kim YM, Kols A, Odalla D, et al. Analysis of client-provider interactions in family planning consultations in primary health care clinics in Kenya, Ghana, and Indonesia. Communication in Health Care Conference, Amsterdam, June 10-12, 1998; Miller K, Miller R, Askew I, et al. Clinic-Based Family Planning and Reproductive Health Services in Africa: Findings from Situation Analysis Studies. New York: Population Council, 1998.

(2.) 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 Pled 2002;54(q):1357-68.
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Author:Wright, Kerry L.
Geographic Code:7EGYP
Date:Dec 22, 2002
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