The simulated client method: evaluating client-provider interactions in family planning clinics

Stud Fam Plann. May-Jun 1993;24(3):187-93.

Abstract

The "simulated client" method was first detailed in the family planning literature in 1985, but it has not been extensively covered since. As used by the authors to study client-provider interactions in family planning programs, this method essentially consists of sending women to a family planning service provider to request information, and interviewing them after the encounter. The women do not reveal to service providers they are participating in the study. This report describes the method; reviews some of the theoretical, ethical, and methodological issues related to it; and underlines its usefulness as a tool for examining quality-of-care issues in family planning programs.

PIP: The simulated client method is a way to study client-provider interactions in family planning (FP) programs. It consists of sending women who do not reveal their identity to a FP service provider to request information and interviewing them after the encounter. A theoretical framework for interpreting client/patient interactions; a description of the method based on the authors' experiences with it; different versions of the simulated client method; and some of the theoretical, ethical, and methodological issues related to it are presented. In a 1985 study in Nepal, simulated clients of different ages and socioeconomic backgrounds were used to investigate the possibility that different types of clients would receive different treatment at FP clinical. In 1990 and 1991 in Ghana and Senegal, simulated clients of different ages and marital status were sent to the clinics with the objective of assessing the quality of services for problematic client types (lower-class and low-caste women in Nepal and younger women in Ghana). During a simulated client study in Nepal in 1985, a transcript was produced for each of the 33 clinic visits by the simulated clients. A scale was developed for assigning a score to each interview transcript to assess the accuracy of the information that the client received and the providers' attitudes and biases. This approach indicated that clients at a higher socioeconomic level received better treatment. Ethics in social science research, particularly in applied field studies mandate adequate safeguards to ensure that participants are protected from undue physical or psychological harm, and fully informed consent of participants must be obtained. The simulated client method can assist program managers in assessing and improving the quality of care provided in FP clinics, especially if an experienced social anthropologist or psychologist is involved.

MeSH terms

  • Developing Countries*
  • Family Planning Services*
  • Ghana
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Patient Simulation*
  • Professional-Patient Relations*
  • Quality Assurance, Health Care
  • Referral and Consultation