Population Council, Dhaka, Bangladesh.
Population Council, Washington, D.C., USA.
J Glob Health. 2021 Mar 10;11:07007. doi: 10.7189/jogh.11.07007.
Low rates of contraceptive continuation in Bangladesh are a symptom of poor quality family planning (FP) counseling. Improving family planning counseling by the country's community health care workers (CHWs) could improve contraceptive continuation. This study explores client experiences of care from CHWs, as measured by the method information index plus (MII+) and communication quality metric.
Conducted in a peri-urban sub-district with low contraceptive use rates, this mixed methods study explores FP client experiences with community-based counseling and referrals by Family Welfare Assistants (FWAs), a CHW cadre providing FP services. Client- and patient-reported experience with community FP services was measured by the MII+ and communication quality metric. A quantitative post-service exit survey was coupled with observations of the interactions between 62 FWAs and 692 female clients to measure FWA and client FP knowledge, FWA capacities, attitudes, quality of FP communication, FP referrals, and contraceptive uptake.
Summary MII+ scores suggest that only 20% of clients reported adequate provision of information for informed decisions. Observations and self-reporting alike suggest moderate to high quality of communication during FWA and client interactions. Despite FWAs' theoretical knowledge of long-acting reversible and permanent FP methods, few clients were referred to facilities for them; 81% of clients who preferred a pill received it, while only 34% of clients seeking long-acting methods received needed referrals.
Quality community-based FP counseling could help address rising contraceptive discontinuation rates in Bangladesh. While MII and MII+ scores in this study were low, and FWA evinced numerous misconceptions, FWAs demonstrated strong communication skills that facilitate rapport and trust with their clients and communities. Bangladesh's policy and programs should capitalize upon these relationships and enhance CHWs' knowledge of all method types, and side effects management, with updated job aids, refresher training, and supervision.
孟加拉国的避孕续用率较低，这是计划生育（FP）咨询质量差的表现。提高该国社区卫生工作者（CHW）的计划生育咨询水平可以改善避孕续用率。本研究通过方法信息指数加（MII+）和沟通质量指标，探索了 CHW 提供的客户护理体验。
该混合方法研究在一个避孕使用率较低的城市郊区进行，探索了家庭福利助理（FWAs）提供的基于社区的咨询和转介服务对 FP 客户的影响，FWAs 是提供 FP 服务的 CHW 干部。通过 MII+和沟通质量指标测量了社区 FP 服务的客户和患者体验。在提供服务后的出口调查中，对 62 名 FWAs 和 692 名女性客户之间的互动进行了观察，以衡量 FWA 和客户 FP 知识、FWA 能力、态度、FP 沟通质量、FP 转介和避孕措施的采用情况。
总结 MII+评分表明，只有 20%的客户报告说获得了充分的信息以做出知情决策。观察和自我报告都表明，FWAs 和客户互动期间的沟通质量处于中等至较高水平。尽管 FWAs 对长效可逆和永久性 FP 方法有理论上的了解，但很少有客户被转介到相关设施；81%的希望服用避孕药的客户获得了该药物，而只有 34%寻求长效方法的客户获得了所需的转介。
基于社区的高质量 FP 咨询可以帮助解决孟加拉国不断上升的避孕中断率问题。虽然本研究中的 MII 和 MII+评分较低，且 FWAs 存在许多误解，但 FWAs 表现出了强大的沟通技巧，这有助于与他们的客户和社区建立融洽的关系和信任。孟加拉国的政策和项目应利用这些关系，增强 CHW 对所有方法类型的了解，并加强副作用管理，更新工作辅助工具、定期培训和监督。
