Advani Raina, Manu Adom, Kploanyi Emma Edinam, Morhe Emmanuel, Maya Ernest, Compton Sarah D
Department of Obstetrics and Gynecology, Emory University, Atlanta, GA (Dr Advani).
Department of Population Health, School of Public Health, University of Ghana, Accra, Ghana (Drs Manu and Maya, and Ms Kploanyi).
AJOG Glob Rep. 2023 May 8;3(2):100216. doi: 10.1016/j.xagr.2023.100216. eCollection 2023 May.
Increased use of contraception is associated with reduced maternal mortality worldwide; however, an unmet need remains high in many places, including Ghana. The quality of care provided by family planning practitioners influences contraceptive use; one way to improve the quality of care is to adopt a client-centered approach to counseling, including engaging in shared decision-making In Ghana, little is currently known about the extent of shared decision-making between clients and providers in contraceptive counseling encounters.
The purpose of this study was to explore the extent of shared decision-making during contraceptive counseling in 2 cities in Ghana.
This was a cross-sectional study across 6 urban family planning clinics in Accra and Kumasi, Ghana. We recorded, transcribed, and analyzed 20 family planning patient-provider interactions using the "Observing PatienT InvOlvemeNt" (OPTION) scale. This scale has 12 domains, which are scored on a 5-point scale, from 0 ("the behavior is not observed") to 4 ("the behavior is observed and executed at a high standard"); the scores of each domain are summed up for a total score ranging from 0 to 48.
In these encounters, the mean total scores for each interaction ranged from a low of 9.25/48 to a high of 21.5/48. Although providers were thorough in sharing medical information with clients, they did not actively involve clients in the decision-making process and did not generally elicit client preferences. Across the 12 domains, the mean total score was 34.7%, which is below the 50% that would correspond with a "baseline skill level," suggesting there are very low levels of shared decision-making currently occurring.
In these 20 patient-provider encounters, counseling was mainly a sharing of medical information from the provider with the client, without the provider eliciting information from the client about her preferences for method characteristics, side effects, or method preference. Family planning counseling in these settings would benefit from increased shared decision-making to engage patients in their contraceptive choice.
在全球范围内，避孕措施使用的增加与孕产妇死亡率的降低相关；然而，包括加纳在内的许多地方，未满足的需求仍然很高。计划生育从业者提供的护理质量会影响避孕措施的使用；提高护理质量的一种方法是采用以客户为中心的咨询方法，包括参与共同决策。目前在加纳，对于避孕咨询过程中客户与提供者之间共同决策的程度了解甚少。
本研究的目的是探讨加纳两个城市在避孕咨询过程中共同决策的程度。
这是一项针对加纳阿克拉和库马西6家城市计划生育诊所的横断面研究。我们使用“观察患者参与度”（OPTION）量表记录、转录并分析了20次计划生育患者与提供者之间的互动。该量表有12个领域，采用5分制评分，从0分（“未观察到该行为”）到4分（“观察到该行为并高标准执行”）；每个领域的得分相加得出总分，范围从0到48分。
在这些互动中，每次互动的平均总分从低至9.25/48分到高至21.5/48分不等。尽管提供者在与客户分享医疗信息方面很全面，但他们没有积极让客户参与决策过程，也没有普遍征求客户的偏好。在这12个领域中，平均总分是34.7%，低于与“基线技能水平”相对应的50%，这表明目前共同决策的水平非常低。
在这20次患者与提供者的互动中，咨询主要是提供者向客户分享医疗信息，而提供者没有从客户那里获取关于她对方法特征、副作用或方法偏好的信息。在这些环境中进行计划生育咨询将受益于增加共同决策，以使患者参与到他们的避孕选择中。
