Evaluation of the World Health Organization's family planning decision-making tool: improving health communication in Nicaragua.
OBJECTIVE
The World Health Organization has led the development of a Decision-Making Tool for Family Planning Clients and Providers (DMT) to improve the quality of family planning counseling. This study investigates the DMT's impact on health communication in Nicaragua.


METHODS
Fifty nine service providers in Nicaragua were videotaped with 426 family planning 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.


RESULTS
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.


CONCLUSIONS
The DMT proved effective both as a job aid for providers and a decision-making aid for clients, regardless of the client's level of education.


CONCLUSIONS
Job and decision-making aids have the potential to improve health communication, even or especially when clients have limited education and providers have limited training and supervision.
Kim
Young Mi
YM
Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Baltimore, MD 21202-4024, USA. ykim@jhuccp.org
Davila
Claudia
C
Tellez
Carolina
C
Kols
Adrienne
A
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001294:Attitude to Health; D003142:Communication; D003661:Decision Support Techniques; D004522:Educational Status; D005193:Family Planning Services / Q000193:education*; D005260:Female; D006282:Health Personnel / Q000193:education / Q000523:psychology; D006301:Health Services Needs and Demand; D006801:Humans; D007318:Inservice Training; D008297:Male; D008875:Middle Aged; D009527:Nicaragua; D010353:Patient Education as Topic / Q000379:methods* / Q000592:standards; D010358:Patient Participation / Q000379:methods / Q000523:psychology; D011369:Professional-Patient Relations; D011795:Surveys and Questionnaires; D017749:Total Quality Management; D014743:Videotape Recording; D014944:World Health Organization