The relevance of client-centered communication to family planning settings in developing countries: lessons from the Egyptian experience

Soc Sci Med. 2002 May;54(9):1357-68. doi: 10.1016/s0277-9536(01)00101-0.

Abstract

Concern for client's rights in the provision of reproductive health services in the developing world has prompted intense efforts by international experts to promote client-centered models of communication as a replacement for more provider-centered approaches. Nonetheless, the usefulness or feasibility of cross-cultural transplantation of client-centered models of communication has not been examined. The present study examines the feasibility, acceptability, and effectiveness of client-centered models of communication in 31 family planning clinics in Egypt. Consultations between 34 physicians and 112 clients requesting family planning methods were audio-taped and analyzed for physician communication style. Client satisfaction was measured through exit interviews. Method continuation was determined through home interviews at 3 and 7 months from the index visit. Based on audio-tape analysis, two-thirds of physician consultations were characterized as physician-centered and one-third as client-centered. Client-centered consultations were only one minute longer than physician-centered consultations. A client-centered consultation was associated with a three-fold increase in the likelihood of client satisfaction and method continuation at 7 months. A high proportion of solidarity statements (positive talk) by the physician was predictive of client satisfaction whereas a high proportion of disagreement statements and directive instructions by the physician were predictive of method discontinuation. The study findings suggest that in Egypt, as in more developed countries, client-centered models of communication are likely to produce better client outcomes than provider-centered models, with no substantial changes in the structure of services.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Communication
  • Contraceptive Agents, Female / therapeutic use
  • Counseling / methods
  • Developing Countries
  • Egypt
  • Family Planning Services / methods*
  • Family Planning Services / statistics & numerical data
  • Female
  • Humans
  • Intrauterine Devices / statistics & numerical data
  • Patient Satisfaction
  • Patient-Centered Care*
  • Physician-Patient Relations*
  • Prospective Studies

Substances

  • Contraceptive Agents, Female