Do improvements in client-provider interaction increase contraceptive continuation? Unraveling the puzzle

Objective: Evidence on the association between client-provider interaction (CPI) and contraceptive continuation has been mixed. This paper attempts to unravel the puzzle by examining various factors that may have contributed to the mixed results. Methods: This paper critically reviews key studies that examined the association between CPI and contraceptive continuation. A scan of peer reviewed publications and project reports was undertaken with a focus on CPI and contraceptive continuation. In addition, a review of key studies that examined the impact of interventions to improve CPI in compliance with medical regimens was carried out. Results: The inconsistency of results may be attributed to methodological factors, characteristics of interventions to improve CPI, or conceptual factors related to the complexity of the issue of contraceptive continuation. Conclusion: More rigorous research is needed to understand the role played by CPI in contraceptive continuation as well as socio-demographic, behavioral and contextual factors that moderate the relationship between CPI and contraceptive continuation. Practice implications: Counseling services should be expanded to address physical, social and emotional needs of continuing clients. Moreover, interventions to improve CPI should also address contextual and health system factors that prevent clients from using family planning consistently and effectively. (C) 2010 Elsevier Ireland Ltd. All rights reserved.