Length of counseling sessions and the amount of relevant information exchanged:: A study in Peruvian clinics

Context: Time constraints have been implicated in family planning providers' inability to offer comprehensive counseling to their clients. It is important for providers to know whether lengthening counseling sessions increases the amount of relevant information imparted to clients. Methods: Twenty-eight women were trained to pretend to solicit an effective method and to opt for the injectable contraceptive at 19 clinics in urban areas from a national sample of Ministry of Health facilities in Peru. Each clinic was visited on different days by six of these "simulated clients," fora total of 114 cases. For each visit, the woman recorded on a 46-item checklist the topics discussed by the provider and estimated the duration of the counseling session. Results: Providers dedicated anywhere from two to 45 minutes to counseling. The amount of information given that was relevant to the client's choice significantly increased, by 43%, when the session length went from 2-8 minutes to 9-14 minutes. However, further improvements in the amount of useful information exchanged were trivial and nonsignificant when session lengths extended beyond 14 minutes. At any duration, many pieces of information that should have been exchanged had not been. Offering a wide range of contraceptive options took up most of the consultation time and was highly correlated with session length. Discussion of the chosen method's side effects and screening for contraindications did not vary by session length. Conclusions: Counseling sessions longer than 14 minutes confer little advantage in terms of effective counseling for women who choose the injectable. It is important that providers use the available time more efficiently; that they be more practical in assessing clients' needs; and that they avoid providing too much information about irrelevant methods. They should focus on the method chosen by the client and address that specific method in greater depth.