title: Towards client-centered counseling: development and testing of the WHO Decision-Making Tool.
abstract: OBJECTIVE
  To describe development and testing of a counseling tool intended to inform family planning clients while helping the family planning provider facilitate the client's decision-making process; and to discuss challenges and requisites for shifting to shared decision-making from the extremes of decision-making dominated by the provider, on one hand, or unaided by the provider, on the other. DEVELOPMENT OF THE TOOL: The WHO Decision-Making Tool for Family Planning Clients and Providers is derived from evidence-based principles of client-centered care and counseling. This article discusses how these principles are manifested in the Tool and how the Tool aids both provider and client in improving counseling.
  
  
  METHODS
  Development of the Tool involved formative workshops with providers in Indonesia, Mexico, South Africa and Trinidad and Tobago and observational evaluation research in Indonesia, Mexico, and Nicaragua. Analysis of videotaped counseling sessions quantitatively assessed client-provider communication and decision-making. Also, focus-group discussions, interviews, and a questionnaire collected qualitative data from providers and clients.
  
  
  RESULTS
  In general, use of the Tool improved providers' counseling performance: they engaged clients more and gave more and better tailored information. For clients, the Tool increased their communication and involvement. Both the Nicaraguan and Mexican studies found marked shifts toward the client in the locus of decision-making after introduction of the Tool.
  
  
  CONCLUSIONS
  Use of the tool improves the performance of both providers and clients in family planning counseling and decision-making. There are challenges, however, at the levels of both the provider and the organization in sustaining these changes and scaling up such initiatives in quality of care.
authors.affiliation: Jura Editorial Services, Gex, France. sarah@jura-eds.com
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Johnson
authors.forename: Young Mi
authors.initials: YM
authors.lastname: Kim
authors.forename: Kathryn
authors.initials: K
authors.lastname: Church
mesh_terms: D000293:Adolescent; D000328:Adult; D003376:Counseling; D003657:Decision Making; D003661:Decision Support Techniques; D019317:Evidence-Based Medicine; D005193:Family Planning Services / Q000193:education*; D005260:Female; D006282:Health Personnel / Q000193:education*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D010358:Patient Participation; D018802:Patient-Centered Care; D011369:Professional-Patient Relations; D015397:Program Evaluation; D036301:Qualitative Research; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D014743:Videotape Recording; D014944:World Health Organization