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

Abstract

Objective We investigated whether use of the World Health Organization's (WHO's) DecisionMaking Tool (DMT) for Family Planning Clients and Providers would improve the process and outcome quality indicators of family planning (FP) services in Iran. Methods The DMT was adapted for the Iranian setting. The study evaluated 24 FP quality key indicators grouped into two main areas, namely process and outcome. The tool was implemented in 52 urban and rural public health facilities in four selected and representative provinces of Iran. A pre-post methodology was undertaken to examine whether use of the tool improved the quality of FP services and client satisfaction with the services. Quantitative data were collected through observations of counselling and exit interviews with clients using structured questionnaires. Results Different numbers of FP clients were recruited during the baseline and the postintervention rounds (n=448 vs 547, respectively). The DMT improved many client-provider interaction indicators, including verbal and nonverbal communication ( p<0.05). The tool also impacted positively on the client's choice of contraceptive method, providers' technical competence, and quality of information provided to clients ( p<0.05). Use of the tool improved the clients' satisfaction with FP services (from 72% to 99%; p<0.05). Conclusions The adapted WHO's DMT has the potential to improve the quality of FP services.

Interventions to improve participation in health‐care decisions in non‐Western countries: A systematic review and narrative synthesis

“…The use of this tool was initiated by the health‐care providers during client encounters, which may have created an environment where clients felt safe and encouraged to play an active role. The more recent study from Iran also reinforced the positive effects of the DMT and provider training on patient participation in decision making …”

“…Of the nine included studies of PDAs, three were RCTs . We note that none of the RCTs included training as part of their intervention and that the studies which did were all of a weaker study design as uncontrolled before‐and‐after studies (n = 6) . Nevertheless, amongst these nine studies evaluating patient decision aids, there was a consistent improvement in the patient and provider participatory behaviours in those studies which included provider and/or patient training as part of the intervention …”

“…Patient decision aids (PDAs) were utilized in nine of the 17 included studies and the PDAs were either paper‐based or computer‐delivered . Five of these studies (5/9), all from East Asian countries, used the International Patient Decision Aids Standards (IPDAS) Collaboration checklist to guide the development of their decision aids .…”

“…Amongst the remaining six uncontrolled before‐and‐after studies, three studies using the WHO family planning decision‐making tool (DMT) reported positive changes in provider and client participatory behaviours (see Table ) . The other two studies from China (PDA in POAG) and Japan (PDA in birth choices) reported a reduction in decisional conflict after patients were given PDAs with a short briefing and decisional support .…”

“…A patient decision aid, the WHO family planning Decision‐Making Tool (DMT), began to be evaluated next in Mexico (2005), Nicaragua (2007) and Iran (2014) . The DMT tool was developed by WHO in 2001 to promote client‐centred counselling and client active participation in decision making .…”