Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #106880

Rebecka Inga Lundgren, MPH¹, Federico R. León, PhD², and Caroline Blair, MBA¹. (1) Georgetown University Medical Center, Institute for Reproductive Health, 4301 Connecticut Ave., Suite 310, Washington, DC 20008, 202-687-7969, lundgrer@georgetown.edu, (2) Consultant, Los Libertadores 533, Of. 304, San Isidro, Lima, L-27, Peru

Standards of care require providers to offer appropriate, non-biased information to family planning clients. However, concerns with the quality of information exchange are persistent, and measurement is challenging. The simulated client methodology reliably measures quality of care in family planning. In this technique, trained clients enact a specific client profile, receive services, observe provider behavior and report their observations. This paper compares results from simulated client visits in three countries and discusses the lessons learned from application of this methodology in diverse settings. Specifically, the thoroughness and neutrality of providers offering DMPA, sterilization, the Standard Days Method and oral contraceptives are assessed to provide a reliable measurement of informed choice and quality of care. Results of simulated client interviews in India (81), Peru (62) and Rwanda (43), revealed that providers score high in interpersonal relations, but base counseling on medical issues, ignoring reproductive intentions and partner cooperation. Information exchanged on the method chosen, such as side effects, was scarce. Few discussed condom use, despite client need. In Peru, less than 5% of DMPA clients received condom information. Trends were similar across countries, although quality varied significantly. Peruvian providers scored significantly higher than Indian providers – with mean scores of 30 vs. 14 for pill clients. Counseling duration was longer in Peru, averaging 17 minutes vs. ten minutes in India. Providers obtained higher scores for the predominant program method, for example, sterilization in India. Implications for best practices for measuring and improving quality of care in diverse service settings will be discussed.

Learning Objectives: By the end of the session, participants will be able to

• describe the simulated client methodology as applied in diverse settings;
• compare quality of family planning counseling in three programs; and
• assess the potential contribution of this methodology for improving quality of care.

Keywords: Quality of Care, Family Planning

Related Web page: irh.org

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.