Improving Client Provider Interaction
Online Discussion Forum
March 8, 2007
Daily Digest
Thank you to everyone who has participated in the discussion so far. Today, we have received Dr. Moodley’s response to the question posed by Yvonne Golley-Morgan from Sierra Leone. Dr. Stan Yoder from ORC Macro also asks Dr. Moodley some questions about her presentation at the March 1 videoconference. Dr. Heidi Reynolds from FHI also describes the Kenyan Ministry of Health’s approach in integrating FP into VCT and asks for people’s thoughts on this approach.
To view the archived webcast of the March 1 videoconference, go to http://www.jhuccp.org/cpconference/
Dr. Jennifer Moodley’s response to a question asked yesterday:
Hello Forum Members
In response to the question about about the 15 year client engaging in unprotected anal intercourse with an older man...
Anal intercourse without condoms is risky sexual behaviour. The 15 year old girl that you describe is at risk of acquiring a sexually transmitted infection, notably HIV. As reproductive health workers we should be advising people engaged in anal intercourse(heterosexual or homosexual) to use condoms. We need to explain to our clients that unprotected intercourse - vaginal or anal puts them at risk of HIV.
Dr Jennifer Moodley
Director Women's Health Research Unit
School of Public Health and Family Medicine Faculty of Health Sciences University of Cape Town Observatory 7925 South Africa
Dr. Stan Yoder’s questions for Dr. Moodley:
I watched the video conference last week from Baltimore and I have two questions for Dr. Moodley. First, what kind of questionnaire was used to interview the 89 respondents in the study? I assume the questions were printed and the answers pre-coded, but no information on this was offered. Second, from what you know of the way respondents were interviewed, how should we interpret the declarations of respondents that they will use one kind of family planning or another in the future?
I find it difficult to know how to interpret responses to hypothetical questions in surveys or studies I have worked on, for statements of intent may not match subsequent actions. Therefore, it is helpful to know more about the interviewing process to be able to interpret answers to hypothetical questions. Thank you. Stan Yoder
P. Stanley Yoder PhD, MPH
Senior Qualitative Research Specialist
Macro International, USA
Dr. Heidi Reynolds on Kenyan Ministry of Health’s approach in integrating FP into VCT
I have appreciated reading everyone's contributions so far, but I wanted to take this opportunity to follow up with Dr. Amenyah's observation that providers (in ART) have very little time to deliver FP services and Dr. Mulugeta's point for discussion about provider initiated counseling in the context of FP/RH. The approach that the Kenyan Ministry of Health is implementing in the integration of FP into VCT is one where the VCT provider first screens the client for risk of unintended pregnancy. In other words, is the client using a method of contraception and does the client want to get pregnant soon? If the answer to these questions is 'no,' then the provider will proceed by offering the client more information about contraceptive methods (among his/her other VCT duties). And, if the client wants, the provider will provide additional guidance to assist the client in choosing safe and appropriate contraceptive options and provide that method (or referral). The expectation is that with this approach, providers save time by only offering family planning services to those clients who need and want them, and the discussions about risk of unintended pregnancy can be integrated with discussions about risky sexual behaviors for HIV. I am interested to know what people think about this approach. Could it help busy HIV providers target their family planning messages to those clients who really need them? Is the approach sufficient to reach those clients who want to prevent pregnancy? What do people see may be some of the limitations or barriers to such an approach?
Heidi W. Reynolds, PhD, MPH
Health Services Research Scientist
Family Health International, USA