Bellow Nicole, Dougherty Leanne, Nai Dela, Kassegne Sethson, Nagbe Robert Hugues Yaovi, Babogou Lorimpo, Guede Kossi Mawuko, Silva Martha
Avenir Health, Takoma Park, Maryland, United States of America.
Population Council, Washington, DC, United States of America.
PLOS Glob Public Health. 2023 Jun 8;3(6):e0001923. doi: 10.1371/journal.pgph.0001923. eCollection 2023.
Previous research has shown that clients are better able to achieve their reproductive intentions when family planning (FP) services meet their needs and they have satisfying client provider interactions. There are several areas of quality provider-client communication, including providers taking a complete reproductive history of their clients to best gauge their needs, communication around alternative FP methods and side effects captured in the method information index, and communication around sexually transmitted infections and HIV risk as it relates to FP choices. This study examines data from a clinic-based intervention in Togo that focuses on strengthening health provider counseling related to FP, including improving in these three areas of provider-client communication. A clustered sampling approach was used to select 650 FP clients from 23 intervention facilities and 235 clients from 17 control facilities in the Lomé and Kara districts of Togo. The FP clients' interactions with providers were observed and clients exit interviews were conducted in December 2021. For each communication area measured through client interviews and observations, principal components analysis and Cronbach's alpha scores were used to ensure that the individual components could be indexed. Outcomes variables based on an index of sub-questions were then created for those who had fulfilled each of the components within an index. Multivariate multilevel mixed-effects logit models accounted for clients nested within facilities and included independent variables capturing client demographic and facility variables. Multivariate results show that all three outcome variables representing the three provider-client communication areas were statistically significantly better for FP clients in intervention clinics versus control clinics (p<0.05). The results speak to the emphasis that the Togo Ministry of Health has placed on building the provider capacity to provide quality counseling and administration of FP methods and working to assist in achieving health programming goals through well-designed interventions.
先前的研究表明，当计划生育（FP）服务满足客户需求且他们与提供者有令人满意的互动时，客户能够更好地实现其生育意愿。优质的医患沟通有几个方面，包括提供者全面了解客户的生育史以更好地评估他们的需求，围绕替代FP方法以及方法信息指数中涵盖的副作用进行沟通，以及围绕性传播感染和与FP选择相关的HIV风险进行沟通。本研究考察了多哥一项基于诊所的干预措施的数据，该干预措施侧重于加强与FP相关的医疗提供者咨询，包括在这三个医患沟通领域进行改进。采用整群抽样方法从多哥洛美和卡拉地区的23个干预设施中选取了650名FP客户，并从17个对照设施中选取了235名客户。观察了FP客户与提供者的互动，并于2021年12月进行了客户离职访谈。对于通过客户访谈和观察测量的每个沟通领域，使用主成分分析和克朗巴哈系数得分来确保各个成分能够被索引。然后为那些在一个指数中完成了每个成分的人创建了基于子问题指数的结果变量。多变量多层次混合效应逻辑模型考虑了嵌套在设施内的客户，并纳入了反映客户人口统计学和设施变量的自变量。多变量结果表明，与对照诊所相比，干预诊所中代表三个医患沟通领域的所有三个结果变量在统计学上均显著更好（p<0.05）。这些结果说明了多哥卫生部对建设提供者提供优质咨询和实施FP方法的能力的重视，并致力于通过精心设计的干预措施协助实现健康规划目标。
