title: Barriers to the involvement of clients in family planning service development: lessons learnt from experience.
abstract: BACKGROUND
  Client involvement in service development underpins the Department of Health strategy for sexual health improvement in the UK. Participatory approaches to user consultation have been effectively piloted in this context but the responses of service providers to these data are rarely documented.
  
  
  OBJECTIVE
  Recruiting clinic users and training clinic users to interview their fellow clinic users on sexual health service use and to document staff responses to the results of this consultation.
  
  
  METHODS
  Clinic users interviewed young clinic users (aged <25 years) using a time line to generate a description of their first clinic visit. The results were presented to staff with a questionnaire requesting their views.
  
  
  RESULTS
  Forty-six clients were interviewed. More comments were made on the waiting room than any other aspect of clinic use. These comments were almost exclusively negative. The waiting room was described as uncomfortable, insufficiently confidential and lacking refreshment and entertainment. Most clients were happy with the clinical consultation. Both positive and negative comments on this aspect of service use related to staff attitudes. The priorities of clients and staff were different and potentially conflicting. Whereas staff are keen that the waiting room should appear tidy, clients require refreshments or children's toys that generate mess. Staff see the clinical service as the most important aspect of a clinic visit while users may view their comfort while waiting for long periods as equally important.
  
  
  CONCLUSIONS
  This methodology documents clients' experiences (positive and negative) of a specific service and generates practical suggestions for improvement. Further work is required to identify common goals for staff and clients. An iterative process of staff and client consultation may ensure that future service development proceeds in a direction that meets the needs of both groups.
authors.affiliation: Department of Reproductive Health, Southwark Primary Care Trust, St Giles Hospital, St Giles Road, London SE5 7RN, UK. paulab@smithg3.demon.co.uk
authors.forename: Paula
authors.initials: P
authors.lastname: Baraitser
authors.forename: Geraldine
authors.initials: G
authors.lastname: Blake
authors.forename: Kirsty Collander
authors.initials: KC
authors.lastname: Brown
authors.forename: Johanna
authors.initials: J
authors.lastname: Piper
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000592:standards; D000328:Adult; D000554:Ambulatory Care Facilities / Q000592:standards*; D001294:Attitude to Health; D005193:Family Planning Services / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D009819:Office Visits; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000523:psychology; D017060:Patient Satisfaction; D000297:Psychology, Adolescent; D011795:Surveys and Questionnaires; D006113:United Kingdom