The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #67429

Michelle Heerey, MPH¹, Young Mi Kim, EdD¹, Adrienne Kols, MA², and Fitri Putjuk, MS³. (1) Center for Communication Programs, The Johns Hopkins University, 111 Market Place, Suite 310, Baltimore, MD 21202, 410-659-6367, mheerey@jhuccp.org, (2) Consultant, 11101 Falls Road, Lutherville, MD 21093, (3) JHU/CCP Indonesia Field Office, TIFA Building, 5th Floor, Suite 502, J1. Kuningan Barat 26, Jarkarta, 12710, Indonesia

Client-provider communication is a cornerstone of quality health care. While most agree on the characteristics of quality interpersonal communication and counseling (IPC/C) in service delivery, many programs have yet to achieve the behavior change needed for quality IPC/C. Barriers in low resource settings are often exacerbated by social distance between clients and providers due to differences in ethnicity, education and social class. A previous study of family planning counseling in Indonesia demonstrated the role that clients play in determining the quality of ICP/C. This study investigates that experience further using positive deviance inquiry to identify the factors that contributed most to empowering client communication.

Of 768 clients included in the study, investigators identified positive deviants (PDs) by the degree of active communication observed via interaction analysis of audiotaped consultations using RIAS and Cegala coding. Facility audit and survey data allowed comparison of PD clients with non-PDs. Client in-depth-interviews and FGDs examined a range of factors related to enabling communication. While PDs resemble other clients in age, income, and assertiveness, they are more educated and more likely to be new contraceptive users. Qualitative data suggest that the factors most instrumental in empowering client communication are: 1)self-efficacy; 2)provider feedback ; 3)role expectations; and 4) IEC materials. Programs to improve IPC/C must move beyond provider-focused interventions and enhance client communication skills. Strategies to empower clients should: 1) increase self-efficacy; 2) strengthen providers’ ability to reinforce active client communication; 3) promote norms of clients’ rights AND responsibilities for quality; and 4) ensure IEC materials.

Learning Objectives:

At the conclusion of the presentation, session participants will be able to:
• describe the importance of client communication behavior in improving quality of care;
• identify critical environmental and social factors that empower effective client communication;
• design more effective interventions for improving quality of interpersonal communication and enabling informed choice.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.