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) Decision-
Making 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