Increasing client participation in family planning consultations: "Smart Patient" coaching in Indonesia

The opinions expressed herein are those of the author and do not necessarily reflect the view of USAID. SUMMARY Context: Paternalistic models of health care, social distance between clients and service providers, and cultural norms discourage family planning clients from playing an active role in consultations. Interventions are needed to encourage clients to communicate more openly and more vigorously with providers. Methods: While waiting to see a service provider, 384 family planning clients in Indonesia received individual coaching on their right to speak out and on three basic communication skills: asking questions, expressing concerns, and seeking clarification. An equal number of clients in the control group received an HIV/AIDS booklet to read while waiting. The consultations were audiotaped and analyzed, and both the educators and clients were interviewed. Home visits with clients were made eight months later to measure contraceptive continuation. Results: Compared with clients in the control group, those who received Smart Patient coaching raised significantly more questions (6.3 vs 4.9) and concerns (6.7 vs 5.4) during the consultations, but they did not seek clarification or volunteer information more often. Smart Patient coaching narrowed differentials in active communication by client type, age, and assertiveness, but it widened differentials by client education and socioeconomic class. Coaching was associated with more tailored information-giving by providers (24.9 vs. 21.1). However, the intervention did not make a significant impact on contraceptive continuation rates at eight months. Conclusion: Educational interventions directed to family planning clients can complement and reinforce provider Interpersonal Communication and Counseling (IPC/C) training by giving clients the confidence and the communication skills to take advantage of increased opportunities for participation.