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Published on August 4, 2007

Author: Malbern

Source: authorstream.com

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Empowering Client Communication: Smart Patient and Community Interventions:  Empowering Client Communication: Smart Patient and Community Interventions Young-Mi Kim JHU/CCP MAQ Mini-University Washington, D.C. - July , 2002 Client-provider communication CPC is key to high quality services:  Client-provider communication CPC is key to high quality services Informed Choice Client Satisfaction Compliance Effectiveness Job Satisfaction Quality Questions for Discussions :  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? Agenda:  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' “Smart Patient” coaching intervention in Indonesia:  '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 Client educators:  Client educators Slide7:  Smart Patient Coaching to FP Consultation “Smart Patient” Learning Model: Four step process:  'Smart Patient' Learning Model: Four step process Step 1: (Re) Assess needs and skills Step 2: Motivation Step 3: Prepare and rehearse Step 4: Take action Continue the cycle Study objectives are to investigate whether “Smart Patient” coaching:  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 Study methods:Sample:  Study methods: Sample 64 clinics In 2 districts of East Java 64 providers 768 clients Study methods:Design:  Study methods: Design True experimental design Latin square design 6 control clients and 6 intervention clients per provider Study methods:Data collection and analysis:  Study methods: Data collection and analysis Audio taping consultations Coding tapes using Roter’s and Cegala’s analysis systems Client interviews Qualitative evaluation (FGDs, observation, in-depth interviews) Follow-up home visit Clients’ characteristics:  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 Process evaluation:Findings :  Process evaluation: Findings 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 Slide15:  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 N=768, *pandlt;.05, **pandlt;.01 Slide16:  Client questions by type (Cegala’s 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 N=768, *pandlt;.05, **pandlt;.01 Slide17:  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' N=768, pandlt;.01 Slide18:  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 andamp; side effects (53%) The duration of method use before discontinuation was about 3.3 months. N=256 new clients percent Conclusion:“Smart Patient” coaching:  Conclusion: 'Smart Patient' coaching Empowers clients to speak out Improves client participation Improves provider tailored information giving Impact on short-term continuation is debatable Conclusion:Three critical elements for success :  Conclusion: Three 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 SMART Project in Indonesia “Sahabat (Special Friend)”:  SMART Project in Indonesia 'Sahabat (Special Friend)' Push/Pull strategies Multiple interventions Client communication empowerment Community empowerment Quality improvement Changing norms and behaviors Integrated activities (1)Indonesia:  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) Integrated activities (2)Indonesia:  Integrated activities (2) Indonesia Client Coaching at clinics Quality improvement, including provider training and self-assessment, peer group review, and certification Where do we begin?: Client, provider and community:  Where do we begin?: Client, provider and 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 Client Provider Community Slide25:  Client Client Client Client Client Provider Provider Provider Provider Provider push/pull interaction Slide26:  FP successful for client Improved quality of life Client committed to FP Client makes informed choice Fruitful interaction Smart client Smart provider Increased confidence What is the 'Smart Interaction'? Slide27:  Client: Want to be active but don’t know how Making poor informed choice Low self esteem.‘Nrimo’ in receiving low-quality service -Unfulfilled psychological expectation andamp; technical needs Provider: Emphasize their authority andamp; technical skill Know how , but lack motivation Perception / Attitude: From present to future Client’s response: Empowered -Take decisions based on informed choices Provider’s response: Motivated to give respect Motivated to improve their their quality of service Communication Message: Berani Memegang Kendali (Take charge of your life) Smart Interaction Quality andamp; Recognition Future Slide28:  'Sahabat' TV spots Indonesia 'Don’t worry, be happy, we have a sahabat (special friend)' Empowering Client and Provider in Peru: “Cultural Dialogue” project:  Empowering Client and Provider in Peru: 'Cultural Dialogue' project Puno 'Puentes' project sites “Cultural Dialogue” project Strategies in Peru (1):  '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 Slide31:  A draft poster for clients Peru 'Our rights and responsibility' Slide32:  A draft poster for provider Peru 'Five steps for quality attention' “Cultural Dialogue” project Strategies in Peru (2):  '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 Providers’ meeting by watching their own consultations on video:  Providers’ meeting by watching their own consultations on video Clients’ meeting by watching their own consultations on video:  Clients’ meeting by watching their own consultations on video A client on horse to come to the meeting, it took her 2 hours:  A client on horse to come to the meeting, it took her 2 hours Interactive CD-rom for providers:  Interactive CD-rom for providers

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