What Have We Learned from Studying Changes in Service Guidelines and Practices?

Hardee, Karen; Janowitz, Barbara; Stanback, John; Villinski, Michele T.

doi:10.2307/2991931

Cited by 8 publications

(7 citation statements)

References 8 publications

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“…The few studies that have looked at provider attitudes and practices towards contraceptive provision have found that providers tend to impose restrictions related to client safety based on outdated medical information or based on moral concerns related to client behavior [5]. …”

Section: Introductionmentioning

confidence: 99%

Clinical training alone is not sufficient for reducing barriers to IUD provision among private providers in Pakistan

Agha

Fareed²,

Keating

2011

Reprod Health

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BackgroundIUD uptake remains low in Pakistan, in spite of three major efforts to introduce the IUD since the 1960s, the most recent of these being through the private sector. This study examines barriers to IUD recommendation and provision among private providers in Pakistan.MethodsA facility-based survey was conducted among randomly selected private providers who were members of the Greenstar network and among similar providers located within 2 Kilometers. In total, 566 providers were interviewed in 54 districts of Pakistan.Logistic regression analysis was conducted to determine whether correct knowledge regarding the IUD, self-confidence in being able to insert the IUD, attitudes towards suitability of candidates for the IUD and medical safety concerns were influenced by provider type (physician vs. Lady Health Visitor), whether the provider had received clinical training in IUD insertion in the last three years, membership of the Greenstar network and experience in IUD insertion. OLS regression was used to identify predictors of provider productivity (measured by IUD insertions conducted in the month before the survey).ResultsPrivate providers consider women with children and in their peak reproductive years to be ideal candidates for the IUD. Women below age 19, above age 40 and nulliparous women are not considered suitable IUD candidates. Provider concerns about medical safety, side-effects and client satisfaction associated with the IUD are substantial. Providers' experience in terms of the number of IUDs inserted in their careers, appears to improve knowledge, self-confidence in the ability provide the IUD and to lower age-related attitudinal barriers towards IUD recommendation. Physicians have greater medical safety concerns about the IUD than Lady Health Visitors. Clinical training does not have a consistent positive effect on lowering barriers to IUD recommendation. Membership of the Greenstar network also has little effect on lowering these barriers. Providers' barriers to IUD recommendation significantly lower their monthly IUD insertions.ConclusionsTechnical training interventions do not reduce providers' attitudinal barriers towards IUD provision. Formative research is needed to better understand reasons for the high levels of provider barriers to IUD provision. "Non-training" interventions should be designed to lower these barriers.

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Section: Introductionmentioning

confidence: 99%

Clinical training alone is not sufficient for reducing barriers to IUD provision among private providers in Pakistan

Agha

Fareed²,

Keating

2011

Reprod Health

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“…Their answers give the impression that they were not seeking to provide answers consistent with the objectives of the intervention. The degree of correspondence between their answers and their daily practice cannot be assessed by interviews alone, but it is unlikely that they perform better than their self‐assessment (Hardee et al. 1995, 1998).…”

Section: Discussionmentioning

confidence: 99%

Can a comprehensive voucher programme prompt changes in doctors’ knowledge, attitudes and practices related to sexual and reproductive health care for adolescents? A case study from Latin America

Meuwissen

Gorter

Kester

et al. 2006

Tropical Med Int Health

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Summaryobjectives To evaluate whether participation in a competitive voucher programme designed to improve access to and quality of sexual and reproductive health care (SRH-care), prompted changes in doctors' knowledge, attitudes and practices.methods The voucher programme provided free access to SRH-care for adolescents. Doctors received training and guidelines on how to deal with adolescents, a treatment protocol, and financial incentives for each adolescent attended. To evaluate the impact of the intervention on doctors, nearly all participating doctors (n ¼ 37) were interviewed before the intervention and 23 were interviewed after the intervention. Answers were grouped in subthemes and scores compared using nonparametric methods.results The initial interviews disclosed deficiencies in doctors' knowledge, attitudes and practices relating to adolescent SRH-issues. Gender and age of the doctor were not associated with the initial scores. Comparing scores from before and after the intervention revealed significant increases in doctors' knowledge of contraceptives (P ¼ 0.003) and sexually transmittable infections (P < 0.001); barriers to contraceptive use significantly diminished (P < 0.001 and P ¼ 0.003); and some attitudinal changes were observed (0 ¼ 0.046 and P ¼ 0.11). Doctors became more aware of the need to improve their communication skills and were positive about the programme.conclusions This study confirmed provider related barriers that adolescents in Nicaragua may face and reinforces the importance of focusing on the quality of care and strengthening doctors' training. Participation in the voucher programme resulted in increased knowledge, improved practices and, to a lesser extent, in changed attitudes. A competitive voucher programme with technical support for the participating doctors can be a promising strategy to prompt change.keywords adolescents, doctors' knowledge attitudes practices, nicaragua, quality of care, reproductive health care, voucher programme

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“…13 A recent review of changes in service guidelines and practices argues that revising guidelines is only one of several ways to improve practices, and recommends a variety of actions to disseminate and institutionalize new policies and practices within service delivery programs. 14 In Bangladesh, the widespread perception that family planning services are offered as part of a national fertility re-veedores les han suministrado un método anticonceptivo, ellos tienen cierta responsabilidad por el tratamiento de problemas de…”

Section: Discussionmentioning

confidence: 99%

The Persistence of a Service Delivery 'Culture': Findings from a Qualitative Study in Bangladesh

Schuler¹,

Bates²,

Islam³

2001

International Family Planning Perspectives

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What Have We Learned from Studying Changes in Service Guidelines and Practices?

Cited by 8 publications

References 8 publications

Clinical training alone is not sufficient for reducing barriers to IUD provision among private providers in Pakistan

Clinical training alone is not sufficient for reducing barriers to IUD provision among private providers in Pakistan

Can a comprehensive voucher programme prompt changes in doctors’ knowledge, attitudes and practices related to sexual and reproductive health care for adolescents? A case study from Latin America

The Persistence of a Service Delivery 'Culture': Findings from a Qualitative Study in Bangladesh

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