Patient participation in healthcare consultations can improve the quality of decision making and increase patients' commitment to the treatment plan. This study examines client participation, operationally defined as client active communication, during family planning consultations in Indonesia. Data were collected on 1,203 consultations in the provinces of East Java and Lampung. Sessions were audiotaped and the conversation coded using an adaptation of the Roter Interaction Analysis System (RIAS). Culturally acceptable ways for Indonesian clients to participate in consultations include asking questions, requesting clarification, stating opinions, and expressing concerns. Factors significantly associated with client active communication were, in order of importance, providers' information giving, providers' facilitative communication, providers' expressing negative emotion, client educational level, and province. The last suggests the influence of culture on client participation. The results suggest that a combination of provider training and client education on key communication skills could increase client participation in healthcare consultations. (author's)

To improve the quality of reproductive health care in Indonesia, refresher training in interpersonal communication and counseling (IPC/C) has been offered to clinic-based family planning service providers who attend to family planning clients. This study tested the effectiveness and feasibility of two low-cost alternatives to supervision self-assessment and peer review that may reinforce providers' skills after training. The performance of three groups of providers from East Java and Lampung Provinces who attended an IPC/C training were compared. Providers in self-assessment only group conducted self-assessment exercises for 16 weeks after the training. Providers in the peer review with self-assessment group attended peer review meetings as well as conducted self-assessment exercises over the 16-week period. The control group received no reinforcement after training. Reinforcement activities improved provider-client interaction, although self-assessment and peer review did not have a similar positive impact on information giving. Both types of reinforcements proved feasible for low-resource settings. Cost analysis shows that money spent on training alone, without reinforcement, had minimal impact on provider performance. Adding peer review to self-assessment proved cost-effective despite its relative higher cost. The impact of the reinforcement strategies on providers, as well as on client behaviors is discussed. This study points to simple, affordable strategies to maximize the impact of costly training courses.