Patient-centered care is a critical approach to meeting the sexual and reproductive health (SRH) needs of individuals, especially for those who have been historically excluded and marginalized. Patient-centered care (also referred to as person-centered care) focuses on patients’ values and preferences, is a key aspect of high-quality family planning care, and has been associated with positive reproductive health outcomes. Factors central to patient-centered care are whether staff are helpful and treat clients with courtesy, whether clients’ privacy is respected, and whether clients receive the contraceptive method that is acceptable to them. This brief explores the care experiences of family planning clients accessing clinics in rural areas. Previous research has shown unique barriers to accessing SRH services in rural communities and disparities in SRH outcomes between urban and rural women.

Child Trends conducted interviews with 12 clients from two publicly funded Title X family planning clinics serving rural communities to better understand the unique challenges clients in this setting encounter when accessing family planning care and their experiences receiving family planning services. Clients mostly described positive experiences. However, descriptions of negative experiences were vivid and tended to focus on disrespectful or uncomfortable interactions with providers. This brief assesses patient-centered care by describing clients’ positive and negative experiences. Documenting both positive and negative client experiences around provider interactions, contraceptive counseling, and contraceptive choice can help family planning clinics improve and shift toward a more patient-centered approach to service provision.


Key findings

  • Family planning clients’ interactions with providers and clinic staff when receiving services were a key determinant of having a positive, negative, or neutral overall experience. Clients’ positive experiences highlight central components of patient-centered care, while their negative experiences point to key areas where providers can improve service provision.
  • Clients viewed their interactions with providers as positive when providers were warm, non-judgmental, and knowledgeable. Clients described their interactions as negative when providers were rough during an examination, discussed in detail a specific method of contraception that the client was not interested in, and did not listen to client contraceptive preferences.
  • Negative experiences usually led clients to change providers or clinics rather than discontinue using family planning services.
  • While most clients felt that their providers listened to their contraceptive preferences, a few clients felt providers pushed them towards a specific method.

Methodology and Data

This brief is part of a larger research study on trends in publicly-funded family planning services. From February 2020 to January 2021, Child Trends conducted 46 interviews with clinic staff—of which 21 were located in rural communities. From March to May 2022, we conducted semi-structured interviews with 12 clients who accessed family planning services at two of these rural Title X clinics.

Table 1 presents demographic data on the clients interviewed. In total, we interviewed 12 family planning clients who had recently received services in one of two rural clinics. Eight clients received services in one clinic located in the Southeast region of the United States and four clients received services in the second clinic located in the Pacific Northwest. The majority (10 out of 12 clients) were between 20 and 40 years old. About half identified as Black or African American, three participants identified as White, and one participant each identified as Hispanic, Asian, American Indian or Alaska Native, and multiracial.


Table 1. Client Demographics

Table 1. Client Demographics

To reach clients that recently accessed family planning services, we partnered with two clinics that had participated in our provider interviews. Clinic staff integrated the recruitment process into their visit check-in and check-out procedures and posted flyers both in their clinic spaces and on their social media accounts. We also solicited referrals from interviewees. We asked clients about their awareness of family planning services; their experiences trying to access family planning services; their experiences with family planning services that they accessed, including how they were treated by their provider, how they felt about the contraceptive counseling they received, their experience choosing a contraceptive method during their visit, and whether they were satisfied with the care received; and suggestions for improving client access and experiences.

Interviews were transcribed and then coded in Dedoose using a blended approach of combining codes developed from the interview protocol and were responsive to the data. To ensure inter-rater reliability, we double coded multiple interviews and then reconciled differences through a consensus-building process. We coded experiences as either positive or negative based on client descriptions. Positive experiences were defined as those described as “good,” “great,” “friendly,” “caring,” “welcoming,” “organized,” or something similar, and negative experiences were defined as those described as “not good,” “not great,” “horrible,” “unsatisfactory,” or something similar. We thematically analyzed coded excerpts to understand the reported client experiences and identify the patterns and frequency of positive, negative, and neutral experiences during various aspects of the family planning visit. We defined neutral experiences as those that were described as “okay,” “alright,” or “so-so,” or as those with an absence of positive or negative descriptors. Then, we identified factors that significantly impact clients’ experiences during their family planning visit, which include interactions with the provider, contraceptive counseling, and choosing a preferred contraceptive method. The findings in this brief are focused on the extreme ends of positive and negative client experiences.


Presentation of Findings

We found that clients’ interactions with providers and clinic staff were a key determinant of having a positive, negative, or neutral experience. In particular, the extent to which clients felt respected, heard, and listened to by their provider shaped their experience. For example, one client recalled, “The people make a difference…. because of that doctor, I decided to stay away from that clinic altogether.” Another client noted that their experience changed when “the people (they were) dealing with” changed. Most clients we interviewed received services over a period of years and were able to compare multiple experiences at one or more clinics. The length of time clients attended their clinic ranged from 5 months to over 30 years, with half of the clients receiving services at their clinic for at least eight years. Most clients described a combination of positive, negative, and/or neutral experiences over time. Given that clients described a combination of experiences, all clients reported positive experiences and most clients also reported negative experiences.

Positive experiences

All clients interviewed reported having at least some positive experiences accessing services at clinics. The types of positive experiences recalled by participants, and the way these experiences were described, were relatively similar across participants. There were many more reports of positive experiences than negative experiences. However, clients seldom provided as much detail about their positive experiences.

Client-provider interactions

When clients described positive experiences, they focused on their interactions with providers. In particular, clients described providers who were knowledgeable, friendly, acted “like they actually enjoyed what they were doing,” didn’t make clients feel “weird” or “judged,” talked to them like they were a “normal person,” and created a space where clients felt like they were “making [their] own choices and were supportive of whatever that would be.” When discussing contraceptive counseling, a client shared how important it felt to them that the provider listened to their needs and preferences and provided options based on that information:

And she took in my concerns about not wanting to be on something that would make me gain more weight. Because I’m trying to lose weight. She didn’t just discount anything I said. She took it all in and gave me options and told me what the other options were.”

Other provider characteristics that clients described positively were being caring, professional, and time efficient. One client recalled that practitioners had gone above and beyond by calling the client multiple times after their exam to see how they were doing, ask if they needed anything, and ensure that they could talk to someone if they needed to.

Contraceptive counseling

All clients said that providers gave thorough explanations of the contraceptive method options available to them, and many clients felt like they received an appropriate amount of information. During counseling sessions, providers discussed method side effects, improvements to current methods, and new methods, while taking into consideration clients’ preferences and family planning goals. One client said that although contraceptive counseling did not change their mind about which method they preferred, they were “glad they were informing me about it, because if I did want to switch up the one that I was going to get, then I would know about it.”

Contraceptive method choice

Clients said that providers were responsive when clients expressed wanting to switch methods. Most clients felt comfortable expressing when a specific method of contraception was or was not working effectively for them and their goals. One client recalled that the clinic staff were always respectful and supportive of their contraceptive method choice. This client also said that switching from an IUD to another type of contraceptive methods was easy:

They were real easy with taking it out and then just putting me on a birth control pill. I’ve had issues with the birth control pill in the past. And so, they were really good with giving me information about different birth control pills that I could try that wouldn’t affect me the way that the ones that I have already tried.”

Negative experiences


Resources


Acknowledgments

The authors would like to extend their gratitude to the Office of Population Affairs for supporting this research under grant FPRPA006070. We would especially like to thank our project officer, Roshni Menon, for her leadership.

We additionally thank Asari Offiong, Lisa Kim, and Brent Franklin for their reviews and Catherine Nichols for her design work. Finally, the authors are deeply grateful to the patients who offered their time and critical perspectives to this research.

Suggested citation

Faccio, B., Logan, D., Shelton, R., Briggs, S., Solomon, B., & Manlove, J. (2023). Family planning clients’ experiences with providers can inform patient-centered care. Child Trends. https://doi.org/10.56417/6691k6666e