Client-provider Interactions Research Articles

Access and use of interventions to prevent and treat malaria among pregnant women in Kenya and Mali: a qualitative study.

BackgroundCoverage of malaria in pregnancy interventions in sub-Saharan Africa is suboptimal. We undertook a systematic examination of the operational, socio-economic and cultural constraints to pregnant women’s access to intermittent preventive treatment (IPTp), long-lasting insecticide-treated nets (LLINs) and case management in Kenya and Mali to provide empirical evidence for strategies to improve coverage.MethodsFocus group discussions (FGDs) were held as part of a programme of research to explore the delivery, access and use of interventions to control malaria in pregnancy. FGDs were held with four sub-groups: non-pregnant women of child bearing age (aged 15–49 years), pregnant women or mothers of children aged <1 year, adolescent women, and men. Content analysis was used to develop themes and sub-themes from the data.ResultsWomen and men’s perceptions of the benefits of antenatal care were generally positive; motivation among women consisted of maintaining a healthy pregnancy, disease prevention in mother and foetus, checking the position of the baby in preparation for delivery, and ensuring admission to a facility in case of complications. Barriers to accessing care related to the quality of the health provider-client interaction, perceived health provider skills and malpractice, drug availability, and cost of services. Pregnant women perceived themselves and their babies at particular risk from malaria, and valued diagnosis and treatment from a health professional, but cost of treatment at health facilities drove women to use herbal remedies or drugs bought from shops. Women lacked information on the safety, efficacy and side effects of antimalarial use in pregnancy.ConclusionWomen in these settings appreciated the benefits of antenatal care and yet health services in both countries are losing women to follow-up due to factors that can be improved with greater political will. Antenatal services need to be patient-centred, free-of-charge or highly affordable and accountable to the women they serve.

Modularity in KIBS: The Case of Third-Party Logistics Service Providers

This paper investigates service modularity and inter-organizational coupling in knowledge-intensive business services (KIBS). While KIBS literature traditionally emphasizes tight client–provider interactions with service customization, modularity literature emphasizes inter-organizational decoupling with service standardization. We disentangle this tension by exploring how KIBS firms utilize service modularity and shape their client–provider relationships in terms of information and knowledge sharing. Conducting two in-depth case studies of third-party logistics (TPLs), we show that TPLs extensively rely on service modularity with standard procedures as their constitutive element. We also demonstrate that service modularity and inter-organizational decoupling are aligned for knowledge sharing but not for information sharing, which remains high regardless of the service architecture. Overall, we suggest that modularity in KIBS differs in many aspects from modularity in products and that these differences significantly impact the organizational design consequences of service modularity. Theoretical and managerial implications are drawn.

Assessment of Quality of Antenatal Care (ANC) Service Provision Among Pregnant Women in Ambo Town Public Health Institution, Ambo, Ethiopia, 2013

Introduction: Antenatal care refers to care given to pregnant women so that they have safe pregnancy and healthy baby. Improving the quality of ANC and other reproductive health services has been shown to increase uptake of services and reduce the number of adverse maternal health outcomes. There is a limited attempt to measure the quality of ANC services in Ethiopia. Although, the coverage of ANC services has improved in the last few years, the quality of the services has remained comparatively low. The objective of the study is to assess quality of antenatal care services provision in governmental health institution. Methods: Institutional based descriptive cross-sectional study design was employed from October 23, 2013 to December 30, 2013. A pretested and semi structured questionnaire via interview was used to collect quantitative data from 288 pregnant women and in-depth interview of focal person at facility level to collect the qualitative data. The collected data was entered a only small number of participants had information on how to recognize serious problems occurring during pregnancy. Even if, as a principle all pregnant women should properly involved in decision making process, in this study almost half (44.5%) had not properly involved in decision making process during ANC service provision. Giving greater emphasis on the delivering information on how to recognize serious problems (danger sign) occurring during pregnancy and securing privacy of clients in order to improve quality of care was recommended. Pregnant women should be encouraged to reach at decision during client provider interaction by health care provider.

Accuracy of standard measures of family planning service quality: findings from the simulated client method.

In the field of international family planning, quality of care as a reproductive right is widely endorsed, yet we lack validated data-collection instruments that can accurately assess quality in terms of its public health importance. This study, conducted within 19 public and private facilities in Kisumu, Kenya, used the simulated client method to test the validity of three standard data-collection instruments used in large-scale facility surveys: provider interviews, client interviews, and observation of client-provider interactions. Results found low specificity and low positive predictive values in each of the three instruments for a number of quality indicators, suggesting that the quality of care provided may be overestimated by traditional methods of measurement. Revised approaches to measuring family planning service quality may be needed to ensure accurate assessment of programs and to better inform quality-improvement interventions.

Parental perceptions of information needs and service provision for children with developmental disabilities in rural Australia

Purpose: Rural Australians comprise a third of the population. However, there are relatively few research studies that have focused on issues for children with developmental disabilities in rural regions. In particular, there is very limited research that gives voice to parents regarding challenges faced by them due to their location in rural regions. Methods: This article is based on the qualitative component of a mixed-methods study undertaken in rural settings. In-depth, face-to-face interviews were conducted with 17 parents yielding 30 h of information rich taped data. Thematic analysis techniques were used to identify major issues. Results: Three core themes emerged from analysis of the qualitative data regarding information and support needs: an ongoing lack of timely and relevant information about disabilities and support services; inadequacies in interactions with service providers particularly doctors and allied health staff; and considerable challenges and barriers to access and use of health services. Conclusions: Within the constraints of limited rural service provision, there are still opportunities for considerable improvements, through focussed in-service training to narrow the information gap, improve provider-client interaction around attitudinal issues and uptake of tele-health to minimise the long waiting times and the need to regularly travel long distances to access services and setting up online support groups.Implications for RehabilitationThere is limited information on challenges faced by parents of children with developmental disabilities in rural Australia.The challenges around lack of information about support systems available add to parental stress as does limited experience, frequent staff turnover and poor attitude of many service providers.There is a need to improve rural service provision. Feasible options within resource constraints include focussed in-service training to narrow the information gap, improve provider-client interaction around attitudinal issues, and uptake of tele-health services.Setting up of parent-professional support groups as well peer support groups using digital technologies will help reduce the sense of isolation for rural carers and minimise impediments related to travelling long distances.

Family planning counselling and use among clients seeking abortion services in private health facilities in Kenya

This paper examines family planning service provision and use among clients seeking abortion services in private health facilities in Kenya. Data are from observations of client-provider interactions and exit interviews conducted in May-June 2013 with 125 clients from 30 private clinics in Kisumu, Nairobi, and Mombasa counties. Analysis entails simple frequencies, cross-tabulations with Chi-square tests, and estimation of multivariate logistic regression models. The results show that: (1) although 78% of the clients had used family planning before, it was mostly short-acting methods such as condoms (44%), injectables (35%), oral (40%) and emergency (26%) pills; (2) providers did not counsel clients on family planning in 20% of the consultations while clients were offered a method in 47% of the consultations; and (3) among clients who had ever used family planning and accepted a method during the visit, 60% chose a different method with the shift being from short-acting to long-term methods.

"I pray that they accept me without scolding:" experiences with disengagement and re-engagement in HIV care and treatment services in Tanzania.

HIV care and treatment programs in sub-Saharan Africa have been remarkably successful, but disengagement from care by people living with HIV (PLHIV) remains high. The goal of this study was to explore the experiences of PLHIV who disengaged from HIV care in Iringa, Tanzania. We conducted a series of three longitudinal, semi-structured interviews with 14 PLHIV who had disengaged from ART programs for a total of 37 interviews. Narrative analysis was used to identify key themes. Our findings indicate that an individual's decision to disengage from care often resulted from harsh and disrespectful treatment from providers following missed appointments. Once disengaged, participants reported a strong desire to re-engage in care but also reluctance to return due to fear of further mistreatment. Participants who successfully re-engaged in care during the course of this study leveraged social support networks to facilitate this process, but often felt guilt and shame for breaking clinic rules and believed themselves to be at fault for disengagement. Developing strategies to minimize disengagement and facilitate re-engagement through more flexible attendance policies, improved client-provider interactions, and outreach and support for disengaged clients could increase retention and re-engagement in HIV care and treatment programs.

A theory led narrative review of one-to-one health interventions: the influence of attachment style and client-provider relationship on client adherence.

A theory-led narrative approach was used to unpack the complexities of the factors that enable successful client adherence following one-to-one health interventions. Understanding this could prepare the provider to anticipate different adherence behaviours by clients, allowing them to tailor their interventions to increase the likelihood of adherence. The review was done in two stages. A theoretical formulation was proposed to explore factors which influence the effectiveness of one-to-one interventions to result in client adherence. The second stage tested this theory using a narrative synthesis approach. Eleven studies across the health care arena were included in the synthesis and explored the interplay between client attachment style, client-provider interaction and client adherence with health interventions. It emerged that adherence results substantially because of the relationship that the client has with the provider, which is amplified or diminished by the client's own attachment style. This occurs because the client's attachment style shapes how they perceive and behave in relationships with the health-care providers, who become the 'secure base' from which the client accepts, assimilates and adheres with the recommended health intervention. The pathway from one-to-one interventions to adherence is explained using moderated mediation and mediated moderation models.

Traditional birthspacing practices and uptake of family planning during the postpartum period in Ouagadougou: qualitative results.

In many low-income countries, postpartum women typically start contraception after the resumption of sexual intercourse or menstruation. Postpartum breast-feeding and abstinence delay these events. Information is needed on women's motivations to rely on these traditional birthspacing practices and their difficulties in starting a contraceptive method after a birth in urban West Africa. In 2012, provider-client interactions and service delivery were observed for a week in seven health facilities in Ouagadougou, Burkina Faso, and semistructured interviews were conducted with 33 women and 12 men with infants younger than 24 months. Existing postpartum family planning services and women's transition from traditional practices to a family planning method are described. Family planning is scheduled to be delivered at the six-week postpartum checkup, which women rarely attend. No women viewed amenorrhea as protective against pregnancy, and all had started or planned to start a method just before or when they resumed sexual activity. Half of the women abstained for six or more months, and some then either adopted a method they used incorrectly or did not adopt one at all. The main difficulties included providers' requirements for amenorrheic women seeking contraceptives and husbands' refusal to refrain from unprotected sex. The initial postpartum family planning visit should occur right after delivery. Integration of family planning into immunization programs would provide opportunities to reach women who did not adopt a method early in the postpartum period. Provider barriers for amenorrheic women should be ended. Men should be involved in the postpartum family planning consultation.

The practice of essential nutrition actions in healthcare deliveries of Shebedino District, South Ethiopia

The essential nutrition actions explain nutrition through life cycle approach addressing women’s nutrition during pregnancy and lactation, optimal infant and young children feeding, nutritional care for sick children and control of anemia, iodine and vitamin A deficiencies. Essential nutrition action has been implemented and resulted in positive outcome in less developed countries. However, the status of practice and associated factors were not studied in Ethiopia. Thus, institution-based cross-sectional study was conducted to assess the practice of essential nutrition actions in healthcare deliveries of Shebedino District, South Ethiopia. Quantitative data were collected though face-to-face interview with health workers and triangulated with data obtained through in-depth interview with health managers in the district and non-participatory observation of client-provider interaction in health facilities. Data were analyzed using SPSS16.0 software. Descriptive and logistic regression analyses were undertaken. The study revealed that 61 (56.0%) health workers practiced essential nutrition actions. Seventy one (65.1%) health workers were trained on essential nutrition actions. The practice of essential nutrition actions was associated with career structure of the health workers (AOR = 6.79, 95%CI: 2.31, 19.98), essential nutrition actions knowledge of health workers (AOR = 6.87, 95%CI: 2.11, 21.51) and availability of monthly nutrition related report form (AOR = 4.95, 95%CI: 1.46, 16.81). The practice of essential nutrition actions was low. The factors affecting the practice were inadequate training and knowledge of essential nutrition actions, career structure of the health workers and availability of monthly report form. Training should be provided for health workers on essential nutrition actions; moreover, essential nutrition actions indicators should be included in monthly report forms of the health institutions.

Client-provider interactions in provider-initiated and voluntary HIV counseling and testing services in Uganda

BackgroundProvider-initiated HIV testing and counselling (PITC) is based on information-giving while voluntary counselling and testing (VCT) includes individualised client-centered counseling. It is not known if the provider-client experiences, perceptions and client satisfaction with the information provided differs in the two approaches.MethodsIn 2008, we conducted structured interviews with 627 individuals in Uganda; 301 tested through PITC and 326 through voluntary counselling and testing (VCT). We compared client experiences and perceptions based on the essential elements of consent, confidentiality, counseling, and referral for follow-up care. We conducted multivariate analysis for predictors of reporting information or counselling as sufficient.ResultsIn VCT, 96.6% (282) said they were asked for consent compared to 91.3% (198) in PITC (P = 0.01). About the information provided, 92.0% (286) in VCT found it sufficient compared to 78.7% (221) in PITC (P = <0.01). In VCT 79.9% (246) thought their results were kept confidential compared to 71.7% (200) in PITC (P = 0.02). Eighty percent (64) of HIV infected VCT clients said they were referred for follow-up care versus 87.3% (48) in PITC (p = 0.2). Predictors of perceived adequacy of information in PITC included an opportunity to ask questions (adj.RR 1.76, CI 1.41, 2.18) and expecting the test results received (adj.RR 1.18, CI 1.06, 1.33). For VCT significant factors included being given an opportunity to ask questions (adj.RR 1.62, CI 1.00, 2.60) and 3+ prior times tested, (adj.RR 1.05, CI 1.00, 1.09).ConclusionsThis study demonstrates good practices in the essential elements of HIV testing for both VCT and PITC. However, further quality enhancement is required in both testing approaches in relation to referral to HIV care post-test, client confidence in relation to confidentiality, and providing an opportunity to ask questions to address client-specific information needs.

Postpartum Family Planning Service Provision in Durban, South Africa: Client and Provider Perspectives

Researchers in Sub-Saharan Africa have found that health facility factors influence client contraceptive use. We sought to understand how client-provider interactions, discussions of side effects, and HIV status influence women's contraceptive use postpartum. We conducted in-depth interviews with eight HIV negative clients and six HIV positive clients in Zulu, and with five nurses in English. Interviews were translated and transcribed into English. We created a codebook and coded all transcripts. Nurses and clients reported limited time to discuss contraception, side effects, and HIV. Nurses did not comply with national contraceptive policies and created unnecessary barriers to contraceptive use.

Impact of the World Health Organization's Decision-Making Tool for Family Planning Clients and Providers on the quality of family planning services in Iran

ObjectiveWe investigated whether use of the World Health Organization's (WHO's) Decision-Making Tool (DMT) for Family Planning Clients and Providers would improve the process and outcome quality indicators of family planning...

An intervention targeting service providers and clients for methadone maintenance treatment in China: a cluster‐randomized trial

This study examines the preliminary outcomes of an intervention targeting service providers in methadone maintenance therapy (MMT) clinics in China. The intervention effects on both service providers and clients are reported. The MMT CARE intervention pilot was developed and implemented collaboratively with local health educators. After three group intervention sessions, trained providers in intervention clinics delivered two individual motivational interviewing sessions with their clients. Six clinics in Sichuan, China, were randomized to either the MMT CARE intervention condition or a standard care condition. A total of 41 providers and 179 clients were sampled from the six clinics. At baseline and three-, six-, and nine-month assessments, providers completed self-administrated paper/pencil questionnaires regarding provider-client interaction, MMT knowledge, perceived job-related stigma and clinic support. Clients completed a face-to-face survey about their concurrent drug use and drug avoidance self-efficacy. Mixed-effects regression models with clinic-level random effect were used to assess the intervention effects. Significant intervention effects for providers were found in improved MMT knowledge, provider-client interaction and perceived clinic support. For clients, better improvements in drug avoidance self-efficacy and reduced concurrent drug use were observed for the intervention compared with the standard care group. The MMT CARE intervention targeting providers in methadone maintenance clinics can improve providers' treatment knowledge and their interaction with clients. The intervention can also reduce clients' drug-using behavior through motivational interviewing sessions conducted by trained providers.

A Rural—Urban Comparison of Client-Provider Interactions in Patent Medicine Shops in South West Nigeria

The increasing prominence of patent medicine vendors (PMVs) in healthcare provision makes information about how they operate of interest. This study assessed consumers' behavior and PMVs' performance in the treatment of childhood illnesses in rural and urban communities in South West Nigeria. Non-participatory observations were carried out in 163 licensed patent medicine stores in Oyo State, Nigeria. Many PMV shops (70.6% rural and 61.9% urban; p = 0.141); stocked non proprietary drugs. Clients often requested for drugs by name (75.4% urban versus 62.2% rural; p = 0.002) and PMVs mostly sold drugs as requested without questions (65.3% urban 57.8% rural; p = 0.07). Inappropriate treatment practices and invasive procedures were observed more often in urban PMVs shops (p < 0.001). PMVs functioned mostly as sales persons supplying clients' drug requests. Strategies to improve PMV treatment practices should include caregiver education to be effective.

Provider–Client Interaction in Methadone Treatment Clinics in China

This study examines provider-client interactions in the context of methadone maintenance treatment (MMT) in China. Service providers were recruited from six methadone clinics. A total of 41 providers were enrolled in the study and participated in an assessment from February to March 2010. Descriptive and multiple regression analyses were performed. Providers with a higher level of negative attitude toward drug users were less likely than others to interact with clients. Female providers were less likely to have negative attitudes toward drug users as compared with their male counterparts. Doctors were more likely than others to have negative attitudes toward drug users. Knowledge of MMT was not related to either negative attitude toward drug users or to provider-client interaction. The findings indicate an urgent need to address the issue of provider attitudes, which can impact interactions with clients and influence efforts to maintain treatment retention and outcomes for drug users.

Linking women who test HIV‐positive in pregnancy‐related services to long‐term HIV care and treatment services: a systematic review

To quantify attrition between women testing HIV-positive in pregnancy-related services and accessing long-term HIV care and treatment services in low- or middle-income countries and to explore the reasons underlying client drop-out by synthesising current literature on this topic. A systematic search in Medline, EMBASE, Global Health and the International Bibliography of the Social Sciences of literature published 2000-2010. Only studies meeting pre-defined quality criteria were included. Of 2543 articles retrieved, 20 met the inclusion criteria. Sixteen (80%) drew on data from sub-Saharan Africa. The pathway between testing HIV-positive in pregnancy-related services and accessing long-term HIV-related services is complex, and attrition was usually high. There was a failure to initiate highly active antiretroviral therapy (HAART) among 38-88% of known-eligible women. Providing 'family-focused care', and integrating CD4 testing and HAART provision into prevention of mother-to-child HIV transmission services appear promising for increasing women's uptake of HIV-related services. Individual-level factors that need to be addressed include financial constraints and fear of stigma. Too few women negotiate the many steps between testing HIV-positive in pregnancy-related services and accessing HIV-related services for themselves. Recent efforts to stem patient drop-out, such as the MTCT-Plus Initiative, hold promise. Addressing barriers and enabling factors both within health facilities and at the levels of the individual woman, her family and society will be essential to improve the uptake of services.

Trust in knowledge exchanges between service providers and clients: a multiple case study of KIBS

For some sectors, the management of client–provider knowledge exchanges is the core element of the business. This is especially the case for knowledge-intensive business services (KIBS) whose delivery entails intensive supplier–client cognitive interactions: KIBS firms supply clients with precious elements of technical and applicative knowledge, while clients give KIBS companies the knowledge items needed for designing a successful solution. Although trust has proved to be an essential ingredient of knowledge exchanges, empirical studies about its role are still scarce, especially as regards KIBS. The paper contributes to this topic by discussing the results of a multiple case study of computer services. Particularly, it (a) offers a knowledge-oriented description of client–provider interactions; (b) investigates the main mechanisms that govern such interactions; (c) analyses the role played by trust as antecedent and consequence of the interaction; (d) discusses the issue of development of trustworthy interactions between KIBS and clients.

Interpersonal complementarity in the mental health intake: A mixed-methods study.

The study examined which socio-demographic differences between clients and providers influenced interpersonal complementarity during an initial intake session; that is, behaviors that facilitate harmonious interactions between client and provider. Complementarity was assessed using blinded ratings of 114 videotaped intake sessions by trained observers. Hierarchical linear models were used to examine how match between client and provider in race/ethnicity, sex, and age were associated with levels of complementarity. A qualitative analysis investigated potential mechanisms that accounted for overall complementarity beyond match by examining client-provider dyads in the top and bottom quartiles of the complementarity measure. Results indicated significant interactions between client's race/ethnicity (Black) and provider's race/ethnicity (Latino) (p = .036) and client's age and provider's age (p = .044) on the Affiliation axis. The qualitative investigation revealed that client-provider interactions in the upper quartile of complementarity were characterized by consistent descriptions between the client and provider of concerns and expectations as well as depictions of what was important during the meeting. Results suggest that differences in social identities, although important, may be overcome by interpersonal variables early in the therapeutic relationship. Implications for both clinical practice and future research are discussed, as are factors relevant to working across cultures.

O5-S2.03 Effect of improving the STI services in seven provinces of China

BackgroundThe STI services can reduce HIV transmission and have been the important component of HIV control programmes. In China, the STI services remain weak. Under the framework of AIDS control programme of the Global Funds Round 4, we conducted the sub-programme to improve STI services in 21 counties of 7 provinces in China from 2007 to 2009, including one-week training workshops for all STI care providers, two-month field training for key STI clinicians at STD Clinic of National Center for STD Control, STI drug assurance, and quality services offering for STI patients. Annually the effect of STI services was assessed according to the guideline of WHO/UNAIDS in the 21 counties.MethodsThe assessment of STI services was through health facility survey, including three indicators: (1)STI service indicator 1 (SI1) is defined as the per cent of patients with STIs at observed health care facilities who are appropriately diagnosed and treated according to the national guidelines on STI treatment in China; (2) STI service indicator 2 (SI2) is defined as the per cent of patients with STIs who are given advice on condom use and partner notification and referral for HIV testing in term of national standards; (3)Standardised STI service indicator (SSI) means the comprehensive case management including SI1 and SI2. The sample size of STI patients between provider and client interactions observed was 40 per county according to the recommendation of national experts. Data were collected in observations of provider-client interaction at the health-care facilities offering STI services by trained professionals. The software of EpiData3.1 and SPSS 11.5 was used to data entry and analysis.ResultsFrom 2007 to 2009, the SI1 was 46.16% (397/860) (95% CI 42.83% to 49.49%), 62.94% (603/958) (95% CI 59.88% to 66.00%), 81.96% (686/837) (95%CI 79.35% to 84.57%) on average in 21 counties, respectively, and there was significantly increased trends (χ2is 234.30, p=0.000); the SI2 was 28.32% (243/858) (95%CI 25.31% to 31.33%), 45.04% (431/957) (95% CI 41.89% to 48.19%), 80.33% (678/844) (95% CI 77.65% to 83.01%) on average for these counties, respectively, and there was also significantly increased trends (χ2is 459.37, p=0.000). For overall STI service quality, SSI was 20.98% (180/858) (95% CI 18.26% to 23.70%), 40.02% (383/957) (95% CI 36.92% to 43.12%), 67.26% (563/837) (95% CI 64.08% to 70.44%), respectively in 2007–2009, and there was significantly increased trends (χ2is 370.81, p=0.000). The STI service indicators in rich areas were higher than in poor counties.ConclusionsThe quality of STI services was significantly improved through the Global Funds Round 4 in 21 counties of seven provinces in China, and should be scaled up to other areas in the country.