Impact of the World Health Organization's Decision-Making Tool for Family Planning Clients and Providers on the quality of family planning services in Iran.
OBJECTIVE
We investigated whether use of the World Health Organization's (WHO's) Decision-Making Tool (DMT) for Family Planning Clients and Providers would improve the process and outcome quality indicators of family planning (FP) services in Iran.


METHODS
The DMT was adapted for the Iranian setting. The study evaluated 24 FP quality key indicators grouped into two main areas, namely process and outcome. The tool was implemented in 52 urban and rural public health facilities in four selected and representative provinces of Iran. A pre-post methodology was undertaken to examine whether use of the tool improved the quality of FP services and client satisfaction with the services. Quantitative data were collected through observations of counselling and exit interviews with clients using structured questionnaires.


RESULTS
Different numbers of FP clients were recruited during the baseline and the post-intervention rounds (n=448 vs 547, respectively). The DMT improved many client-provider interaction indicators, including verbal and non-verbal communication (p<0.05). The tool also impacted positively on the client's choice of contraceptive method, providers' technical competence, and quality of information provided to clients (p<0.05). Use of the tool improved the clients' satisfaction with FP services (from 72% to 99%; p<0.05).


CONCLUSIONS
The adapted WHO's DMT has the potential to improve the quality of FP services.
Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia and Reproductive Health Research Center, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran.
Hamidreza
H
Farrokh-Eslamlou
Siamak
S
Aghlmand
Mohammad
M
Eslami
Caroline S E
CS
Homer
D002983:Clinical Competence; D003142:Communication; D003267:Contraception / Q000379:methods*; D003376:Counseling / Q000379:methods; D003657:Decision Making; D003662:Decision Theory; D005193:Family Planning Services / Q000458:organization & administration*; D007492:Iran; D011369:Professional-Patient Relations; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000458:organization & administration*; D019035:Rural Health Services / Q000458:organization & administration; D012959:Socioeconomic Factors; D019037:Urban Health Services / Q000458:organization & administration; D014944:World Health Organization
education and training; family planning service provision