DECISION-MAKING

Decision-Making



Decision-Making

One of the many challenges in realizing informed choice in family planning is that people often find it difficult to make a decision when presented with a variety of health care options. They may not understand the options, they may have trouble weighing the pros and cons, and they may not have clarified in their own minds which attributes of the various family planning methods are most important to them. In such cases, people may need support to negotiate the decision-making process.

Yet, this kind of support has been lacking in many family planning programs. Dissemination of information is one well-documented area of weakness: Often, providers do not tailor information to clients' individual situations, and the information they do give—especially about clients' chosen methods—may be inaccurate and incomplete. Another weakness is providers' and clients' lack of understanding of their roles in the decision-making process. In some cases, for example, providers may believe that they know what is best for clients and that they should make all the decisions; in other cases, they may accept that family planning is the client's choice, but incorrectly believe that that means they should relinquish all involvement in the decision-making process.

The challenge is to find a balance between the client's and the provider's input into decision making.4 The client is ultimately responsible for choosing which method (if any) to use, but the provider should inform and support the client's efforts to make a decision.

Developing a Decision-Making Tool

To help improve the quality of family planning services, the Department of Reproductive Health and Research at the World Health Organization (WHO) is leading the development of four evidence-based guidelines and tools. One of these is the Decision-Making Tool for Family Planning Clients and Providers, a two-sided flipchart with one side designed to function as a decision aid for clients and the other side to act as a job aid for providers.

Decision aids guide patients through a series of steps, giving them personalized information and helping them clarify their values regarding benefits and risks, ultimately aiding their choice of health care options.8 The WHO flipchart uses clients' pages with simple language and illustrations to raise key issues in an orderly decision-making process; providers expand on these messages during consultations and tailor the information to the needs of the client.

Job aids improve worker performance and make performance more consistent, by reducing guesswork, minimizing reliance on memory and promoting compliance with standards. The WHO flipchart functions as a job aid by supplying providers with directions, technical information, sample questions and statements, and counseling tips.

Unlike other family planning flipcharts, the WHO flipchart uses a decision-making algorithm to systematically guide clients and providers through the counseling process.10 First, it categorizes clients on the basis of the reason for their visit: for example, to adopt a method that he or she is already interested in, to seek help for a problem that he or she is experiencing with a method, or to get emergency ...