A systematic review of the use of adolescent mystery clients in assessing the adolescent friendliness of health services in high, middle, and low-income countries

Abstract

Background: Mystery client methodology is a form of participatory research that provides a unique opportunity to monitor and evaluate the performance of health care providers or health facilities from the perspective of the service user. However, there are no systematic reviews that analyse the use of mystery clients in adolescent sexual and reproductive health (ASRH) research and monitoring and evaluation of programmes. Objective: To assess the use of adolescent mystery clients in examining health care provider and facility performance in providing ASRH services in high, middle, and low-income countries. Methods: We carried out a systematic review of published journal articles and reports from the grey literature on this topic from 2000 to 2017 (inclusive). Thirty research evaluations/studies were identified and included in the analysis. We identified common themes through thematic analysis. Results: The findings reveal that researchers and evaluators used mystery client methodology to observe client-provider relationships, and to reduce observation bias, in government or private health facilities, NGOs, and pharmacies. The mystery clients in the evaluations/studies were young people who played varying roles; in most cases, they were trained for these roles. Most reported good experiences and friendly providers; however, some reported lack of privacy and confidentiality, lack of sufficient written/verbal information, and unfavourable experiences such as sexual harassment and judgmental comments. Female mystery clients were more likely than males to report unfavourable experiences. Generally, the methodology was considered useful in monitoring and evaluating the attitudes of health service providers and ASRH service provision. Conclusions: The research evaluations/studies in this review highlight the usefulness of mystery clients as a method to gain insight, from an adolescent perspective, on the quality of ASRH services for research and monitoring and evaluation of programmes.

Pharmacists’ Preparedness to Patients Education at the Time of Pandemic—A Cross-Sectional Study with an Example of SARS-CoV-2 Outbreak in Poland

“…The study was conducted in March 2020 using the “mystery shopper” (MS) methodology that allows evaluating the performance of healthcare providers [ 22 ]. The roles of patients were portrayed by the first and second researchers, both female in their mid-thirties and with previous experience in interviewing pharmacists, telephone interviewing, and the MS method.…”

Quality of youth friendly sexual and reproductive health Services in West Gojjam Zone, north West Ethiopia: with special reference to the application of the Donabedian model

“…Besides, it removed issues of privacy and confidentiality that may occur with direct observation of the researcher [29][30][31]. However, difficulties in recruitment and training of simulated clients, and the limitations to the type of information that can be collected by them were reported as significant limitations of simulated clients study [32].…”

Forward, Together: A Collaborative Path to Comprehensive Adolescent Sexual and Reproductive Health and Rights in Our Time

“…In doing so, we must account for the fact that such approaches are hugely dependent on the organizational context in which they are meant to occur and require a fundamental behavior shift in management and decision-making dynamics [130]. Finally, we must couple such approaches with participatory assessments (e.g., mystery client methods and client feedback mechanisms) that collect data from the perspectives of adolescents themselves to ensure their voices inform decision-making and promote real accountability to the beneficiaries we seek to serve [131]. Throughout these efforts, we must recognize that perfect cannot be the enemy of the good, and that the path to scale-up will be messy and nonlinear.…”