Empowering Client Communication: Smart Patient and Community Interventions

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Empowering Client Communication Smart Patient
and Community Interventions
Young-Mi Kim JHU/CCP MAQ Mini-University
Washington, D.C. - July , 2002
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Client-provider communication CPC is key to high
quality services
Client Satisfaction
Effectiveness
Quality
Job Satisfaction
Compliance
Informed Choice
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Questions for Discussions

• Why do we direct interventions to clients to
  improve quality of client-provider communication?
  
• What are some example interventions for
  empowering client communication?

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Agenda

• Participants presentation (name, organization,
  interest)
• Smart patient coaching experience in Indonesia
• Sahabat (Special friend) project in Indonesia
• Dialogo cultural (Cultural dialogue) project in
  Peru
• Group discussion and pearls

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Smart Patient coaching intervention in Indonesia

• 20 minutes of client coaching on
• Right to seek information
• Asking questions
• Expressing concerns or opinions
• Asking for clarification

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Client educators
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Smart Patient Coaching to FP Consultation
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Smart Patient Learning Model Four step process
Step 1 (Re) Assess needs and skills
Step 2 Motivation
Continue the cycle
Step 3 Prepare and rehearse
Step 4 Take action
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Study objectives are to investigate whether
Smart Patient coaching

• Persuades clients that they have right to speak
• Enhances client participation
• Leads to improved provider information giving
• Increases contraceptive continuation

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Study methodsSample

• 64 clinics In 2 districts of East Java
• 64 providers
• 768 clients

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Study methodsDesign

• True experimental design
• Latin square design
• 6 control clients and 6 intervention clients per
  provider

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Study methodsData collection and analysis

• Audio taping consultations
• Coding tapes using Roters and Cegalas analysis
  systems
• Client interviews
• Qualitative evaluation (FGDs, observation,
  in-depth interviews)
• Follow-up home visit

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Clients characteristics

• All were married and have 2 children on average
• 98 were Moslem and Javanese
• 56 completed at least junior high school
• 72 were ages under 35
• Average monthly expenses per family member were
  72,000 Rp.
• 49 were currently breast - feeding a baby

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Process evaluationFindings

• Clients valued the coaching
• Intervention convinced clients of their right to
  ask providers questions
• Prepared 4 questions and concerns for provider
• Role play made the process more interactive and
  dynamic
• Response by providers was positive
• Coaching did not change length of consultation

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Smart Patient coaching encouraged client
questions and concerns, Indonesia

• Clients who had Smart Patient Coaching asked
  more questions
• Clients who had Smart Patient Coaching expressed
  more concerns or opinions

N768, plt.05, plt.01
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Client questions by type (Cegalas codes)
Indonesia

• Clients who had Smart Patient Coaching asked
  more direct and assertion questions
• Most frequently used strategy to solicit
  information was asking direct questions

N768, plt.05, plt.01
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Providers gave more tailored information in Smart
Patient intervention condition, Indonesia

• Provider tailored communication occurred more
  frequently among the intervention than control
  group, reflecting increase in both counseling
  and giving clients personalized information

N768, plt.01
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Contraceptive discontinuation (percent) at 8
months among new clients, Indonesia

• The contraceptive discontinuation rate in the
  intervention group was half that in the control
  group, but the difference was not statistically
  significant.
• The leading reason for discontinuation among new
  clients was health concerns side effects (53)
• The duration of method use before discontinuation
  was about 3.3 months.

percent
N256 new clients
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ConclusionSmart Patient coaching

• Empowers clients to speak out
• Improves client participation
• Improves provider tailored information giving
• Impact on short-term continuation is debatable

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ConclusionThree critical elements for success

• Informing clients of their right to speak
• Coaching clients on basic communication skills
• Ensuring warm response by providers to client
  participation

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SMART Project in Indonesia Sahabat (Special
Friend)

• Push/Pull strategies
• Multiple interventions
• Client communication empowerment
• Community empowerment
• Quality improvement
• Changing norms and behaviors

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Integrated activities (1)Indonesia

• TV (national)
• Radio and print materials (9 provinces, 15
  districts)
• Client coaching through community mobilization,
  mobile vans and group discussion (9 provinces,
  selected districts)

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Integrated activities (2)Indonesia

• Client Coaching at clinics
• Quality improvement, including provider training
  and self-assessment, peer group review, and
  certification

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Where do we begin? Client, provider and community
Client
Provider
Community
I N T E R ACTION
S E L F R E L I A N C E
T E C H N I C A L
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Client
Provider
Client
Provider
Client
Provider
Provider
Client
Client
Provider
push/pull interaction
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What is the Smart Interaction?
Smart client Smart provider
Fruitful interaction
Increased confidence
Client makes informed choice
Improved quality of life
Client committed to FP
FP successful for client
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Perception / Attitude From present to future

• Client
• Want to be active but dont know how
• Making poor informed choice
• Low self esteem.Nrimo in receiving
• low-quality service
• -Unfulfilled psychological expectation
• technical needs

• Provider
• Emphasize their authority technical skill
• Know how , but lack motivation

Communication Message Berani Memegang
Kendali (Take charge of your life)

Future

• Clients response
• Empowered
• -Take decisions based
• on informed choices

• Providers response
• Motivated to give respect
• Motivated to improve their
• their quality of service

Smart Interaction
Quality Recognition
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Sahabat TV spots Indonesia
Dont worry, be happy, we have a sahabat
(special friend)
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Empowering Client and Provider in Peru
Cultural Dialogue project

• Puno
• Puentes project sites

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Cultural Dialogue project Strategies in Peru
(1)

• Community meetings to share views on traditional
  and modern health practices to improve health
• Community radio programs for and clients and
  providers
• Posters for clients and providers

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A draft poster for clients Peru
Our rights and responsibility
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A draft poster for provider Peru
Five steps for quality attention
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Cultural Dialogue project Strategies in Peru
(2)

• IPC/C and intercultural relations training for
  providers using CD-rom
• Provider self-assessment and peer meetings
• Joint meetings with providers and clients

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Providers meeting by watching their own
consultations on video
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Clients meeting by watching their own
consultations on video
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A client on horse to come to the meeting, it
took her 2 hours
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Interactive CD-rom for providers