1. Association of provider’s family planning ideation and skills on clients’ perspectives about the quality of CPI in Nigeria Stella Babalola 1, Lisa Cobb 1, Emily Holman 1, Moji Odeku 2, John Ayankola 2 Paper presented at the 2016 SBCC Summit, Addis Ababa, February 8 – 10. 2016 1 Johns Hopkins Center for Communication Programs, Baltimore, USA 2 Nigeria Urban Reproductive Health Initiative, Abuja, Nigeria

2. Context Population: 182.5 million Poor reproductive health outcomes Low contraceptive prevalence Influence of supply and demand factors on contraceptive prevalence

3. Supply-side factors include: Availability of services Range of methods Cost of services Provider skills and attitudes

4. Traditionally … Efforts to address provider weaknesses have generally focused on strengthening technical and interpersonal skills. Need for a more comprehensive approach that includes ideation

5. Ideation Defined as: “views and ideas that people hold individually” – van de Kaa 1996 “New ways of thinking and the diffusion of those ways of thinking by means of exposure to mass media and social interactions in local, culturally homogeneous communities” – Kincaid, 2000

6. Importance of provider ideation Documented influence of ideation or ways of thinking on behaviors. Providers are members of specific geographic communities and may share the same ideational characteristics as other community members. Provider ideation can affect performance and mediate effects of technical and interpersonal skills on client outcomes.

7. ENVIRONMENTAL SUPPORTS & CONSTRAINTS enabling INTENTION BEHAVIOR Source: Adapted from Kincaid (2000) IDEATION MODEL SKILLS & KNOWLEDGE reinforcement confirmation COMMUNICATIONCOMMUNICATION INTEGRATION/C OUNSELING ADVOCACY MASS MEDIA QUALITY IMPROVEMENT /PPP COMM. MOBILIZ IDEATION COGNITIVE Beliefs Values Knowledge Perceived Risk Norms EMOTIONAL Self-Efficacy SOCIAL Spousal Communication Perceived Social Support Personal Advocacy Attitudes

8. Presentation Objectives Assess the association of provider ideation on client’s perceived quality of client- provider interactions.

9. Data Data Source: Longitudinal, multi-component facility-based study in 2014/2015 Conducted by NURHI with funding from the Bill and Melinda Gates Foundation. Data came from baseline interviews with 597 clients and 42 providers.

10. Measures of provider ideation 1.Provider rejection of myths and rumors related to contraceptives; 2.Perceived contraceptive prescribing behaviors and attitudes of professional peers; 3.Perceived FP social approval index; 4.Provider counseling attitudes and beliefs; 5.Provider contraceptive prescription attitudes

11. Outcome Considered Score on perceived client-provider interactions: Derived from: –Perceived comprehensiveness of general contraceptive information obtained; –Perceived provider responsiveness; –Perceived comprehensiveness of explanation of chosen method; –Client’s perspective on how the provider planned for adequate follow-up at the end of the consultation.

12. Findings

13. Results of the regression of client’s score for perceived CPI quality on provider ideation and other variables VariableCoefficientStd. Error City of Residence Ibadan (RC) Kaduna 0.00 2.422**0.863 Provider FP-related Ideation0.101***0.036 Provider Professional Cadre CHEW or others (RC) Nurse/Nurse-Midwife 0.00 6.441***0.951 Provider Reported Overwork No (RC) Yes 0.00 -1.864*0.783 Provider Competence Score Lower (RC) Higher 0.00 7.419***1.128 Provider Score for Rejection of Non-medical Barriers0.799***0.159 Notes * p<0.05; ** p<0.01; *** p<0.001. R 2 = 14.4%

14. Unpacking the Ideation Construct VariableCoefficientStd. Error VariableCoefficientStd. Error FP Counseling Attitudes0.777**0.276 FP Prescription Attitudes0.262***0.078 Perceived Peer Prescription and Counseling Behaviors-0.0380.058 Rejection of Myths and Rumors-0.0810.099 Perceived Social Support-0.0030.006

15. Conclusion Provider ideation matters Programs should consider providers as an audience for behavior change communication Focus should be on changing provider counseling and prescription attitudes

16. Thank You!