title: Strengthening patient-centred communication in rural Ugandan health centres: A theory-driven evaluation within a cluster randomized trial.
abstract: This article describes a theory-driven evaluation of one component of an intervention to improve the quality of health care at Ugandan public health centres. Patient-centred services have been advocated widely, but such approaches have received little attention in Africa. A cluster randomized trial is evaluating population-level outcomes of an intervention with multiple components, including 'patient-centred services.' A process evaluation was designed within this trial to articulate and evaluate the implementation and programme theories of the intervention. This article evaluates one hypothesized mechanism of change within the programme theory: the impact of the Patient Centred Services component on health-worker communication. The theory-driven approach extended to evaluation of the outcome measures. The study found that the proximal outcome of patient-centred communication was rated 10 percent higher (p< 0.008) by care seekers consulting with the health workers who were at the intervention health centres compared with those at control health centres. This finding will strengthen interpretation of more distal trial outcomes.
authors.affiliation: Infectious Disease Research Collaboration, Uganda.
authors.forename: Susan
authors.initials: S
authors.lastname: Nayiga
authors.affiliation: London School of Hygiene & Tropical Medicine, UK.
authors.forename: Deborah
authors.initials: D
authors.lastname: DiLiberto
authors.affiliation: Infectious Disease Research Collaboration, Uganda.
authors.forename: Lilian
authors.initials: L
authors.lastname: Taaka
authors.affiliation: Infectious Disease Research Collaboration, Uganda.
authors.forename: Christine
authors.initials: C
authors.lastname: Nabirye
authors.affiliation: University of Oslo, Norway.
authors.forename: Ane
authors.initials: A
authors.lastname: Haaland
authors.affiliation: London School of Hygiene & Tropical Medicine, UK.
authors.forename: Sarah G
authors.initials: SG
authors.lastname: Staedke
authors.affiliation: London School of Hygiene & Tropical Medicine, UK.
authors.forename: Clare I R
authors.initials: CI
authors.lastname: Chandler
keywords: Africa; complex intervention; patient centred communication; quality of health care; theory-driven evaluation