The determinants and outcomes of good provider communication: a cross-sectional study in seven African countries.
OBJECTIVES
To determine the extent of provider communication, predictors of good communication and the association between provider communication and patient outcomes, such as patient satisfaction, in seven sub-Saharan African countries.


DESIGN
Cross-sectional, multicountry study.


SETTING
Data from recent Service Provision Assessment (SPA) surveys from seven countries in sub-Saharan Africa. SPA surveys include assessment of facility inputs and processes as well as interviews with caretakers of sick children. These data included 3898 facilities and 4627 providers.


PARTICIPANTS
16 352 caregivers visiting the facility for their sick children.


PRIMARY AND SECONDARY OUTCOME MEASURES
We developed an index of four recommended provider communication items for a sick child assessment based on WHO guidelines. We assessed potential predictors of provider communication and considered whether better provider communication was associated with intent to return to the facility for care.


RESULTS
The average score of the composite indicator of provider communication was low, at 35% (SD 26.9). Fifty-four per cent of caregivers reported that they were told the child's diagnosis, and only 10% reported that they were counselled on feeding for the child. Caregivers' educational attainment and provider preservice education and training in integrated management of childhood illness were associated with better communication. Private facilities and facilities with better infrastructure received higher communication scores. Caretakers reporting better communication were significantly more likely to state intent to return to the facility (relative risk: 1.19, 95% CI 1.16 to 1.22).


CONCLUSIONS
There are major deficiencies in communication during sick child visits. These are associated with lower provider education as well as less well-equipped facilities. Poor communication, in turn, is linked to lower satisfaction and intention to return to facility among caregivers of sick children. Countries should test strategies for enhancing quality of communication in their efforts to improve health outcomes and patient experience.
['Larson|Elysia|E|', 'Leslie|Hannah H|HH|', 'Kruk|Margaret E|ME|']
D000328:Adult D017954:Africa South of the Sahara D017028:Caregivers D003142:Communication D003430:Cross-Sectional Studies D003906:Developing Countries D005260:Female D006268:Health Facilities D006801:Humans D007223:Infant D008297:Male D010290:Parents D017060:Patient Satisfaction D011368:Professional-Family Relations D019984:Quality Indicators, Health Care D011795:Surveys and Questionnaires D055815:Young Adult
Sub-Saharan Africa Child health Health services research Measurement of quality