Introduction: This study examines experiences with a family planning segmentation counseling tool that is used during the provision of family planning services. Based on answers to a series of questions, women are segmented into one of five categories of family planning users and counseled based on their identified segment. This study aimed to qualitatively assess provider perspectives on implementation of the tool.
Methods: Semi-structured in-depth interviews took place in the Dosso region of Niger among 16 family planning providers who had been trained in segmentation and were currently using the segmentation tool. The facilities chosen for interviews were part of a larger mixed methods study assessing the impact of using the segmentation approach. Interview questions focused on training, supervision, how segmentation occurs at the health facility, how segmentation changes provider-client interactions, and any difficulties faced with implementation. Interviews were translated and transcribed into French and data were coded and thematically analyzed.
Results: All providers in the study reported positive outcomes associated with segmentation. While providers acknowledged that the segmentation approach added time to the clinic visit, they did see the benefit of this extra time in providing more meaningful interactions between clients and providers, leaving clients with a deeper understanding of family planning and of the different methods available. The implementation of the tool did not change other aspects of service delivery, except that a segmentation sheet was required to be filled in and kept in each patient's file. Difficulties reported included translating the segmentation tool questions into local languages, training enough health care providers and avoiding stock outs of the segmentation sheets.
Conclusion: The segmentation process is of benefit to family planning clients in Niger and the scale-up of the strategy could bring higher quality services to women. If this approach is brought to scale the implementation challenges uncovered need to be addressed, especially adequate training. Further research is needed to determine if segmentation leads to changes in family planning use outcomes.
RéSUMé: INTRODUCTION: Cette étude examine les expériences d’un outil de conseil de segmentation en planification familiale utilisé lors des prestations de services de planification familiale. Sur la base des réponses données à une série de questions, les femmes sont réparties dans l’une des cinq catégories d’utilisatrices de planification familiale (segment) et conseillées en fonction de leur segment identifié. Cette étude vise à évaluer qualitativement les perceptions des prestataires sur l’utilisation de l’outil de conseil de segmentation. MéTHODES: Des entretiens approfondis semi-structurés ont été effectués dans la région de Dosso au Niger auprès de 16 prestataires de planification familiale formés à l’utilisation de l’outil et l’utilisant au moment de la collecte des données. Les structures de santé sélectionnés pour les entretiens figurent dans une étude plus vaste à méthodes mixtes évaluant l’impact de l’utilisation de l’approche de segmentation. Les questions d’entretien portaient sur la formation, la supervision, la façon dont la segmentation se produit dans l’établissement de santé, comment la segmentation modifie les interactions prestataire-client et toutes les difficultés rencontrées lors de la mise en œuvre. Les entretiens ont été traduits et transcrits en français et les données ont été codées et analysées par thématique. RéSULTATS: Tous les prestataires de l’étude ont rapporté des résultats positifs associés à la segmentation. Bien que les prestataires aient reconnu que l’approche de segmentation a ajouté du temps à la visite au centre de santé, ils ont vu l’avantage de ce temps supplémentaire en fournissant des interactions plus significatives entre les clients et les prestataires, laissant aux clients une meilleure compréhension de la planification familiale et des différentes méthodes disponibles. La mise en place de l’outil n’a pas changé les autres aspects de la prestation de services, si ce n’est qu’une fiche de segmentation devait être remplie et conservée dans le dossier de chaque patient. Les difficultés signalées comprenaient la traduction des questions de l’outil de segmentation dans les langues locales, la formation d’un nombre suffisant de prestataires de soins de santé et la prévention des ruptures de stock de fiches de segmentation. CONCLUSION: Le processus de segmentation profite aux clientes de la planification familiale au Niger et la mise à l’échelle de la stratégie pourrait apporter des services de meilleure qualité aux femmes. Si cette approche est portée à grande échelle, les défis de mise en œuvre découverts doivent être relevés, en particulier une formation sur l’utilisation de l’outil adéquate. Des recherches supplémentaires sont nécessaires pour déterminer si la segmentation entraîne des changements dans les résultats de l’utilisation de la planification familiale.
Keywords: Family planning; Niger; Program scale-up; Quality of counseling; Reproductive health services; Segmentation; Sub-Saharan Africa.
This is a study about what nurses and other health care staff in Niger think about a segmentation counseling tool that is used during family planning services. Segmentation means that during counseling each woman is asked a series of questions and, depending on her answers, she is segmented into one of five ‘client type’ categories and counseled based on that ‘client type’ or segment. Face-to-face interviews with health care staff took place in the Dosso region of Niger among 16 staff who were using the tool with their patients. The facilities chosen for interviews were part of a larger study assessing how well segmentation was working. Staff were asked about training, supervision, how segmentation occurs at the facility, how segmentation changes how they interact with patients, and any difficulties faced with implementation. All the interviews were then analyzed. All providers in the study had positive things to say about segmentation, including the benefit of spending extra time with each client. This extra time results in more meaningful interactions between clients and providers, leaving clients with a deeper understanding of family planning and of the different methods available. Difficulties reported included translating the segmentation tool questions into local languages, training enough health care providers and avoiding stock outs of the segmentation sheets. The segmentation process is of benefit to family planning clients in Niger and can contribute to higher quality family planning services for women. The challenges that were found need to be addressed, especially adequate training.
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