ARTH undertook a research study to assess whether training doctors in counseling improves care-seeking behaviour in families with sick children. The study was implemented in 12 PHC areas of Udaipur district, 6 of which were intervention areas and 6 were control areas. Doctors in intervention centres were trained in counseling, communication, and clinical skills, using the integrated management of childhood illness approach.
The results of the study suggested that :
- Mothers’ appreciation of the need to seek prompt and appropriate care for severe episodes of childhood illness increased after counselling, but their care seeking behaviour did not improve significantly.
- For episodes of illness with at least one reported danger sign, 15% of intervention group mothers and 10% of control group mothers reported having sought care from an appropriate provider promptly. However this difference was not statistically significant.
- A greater proportion of mothers in the intervention group than in the control group recalled having had at least one danger sign explained.
- One month after training, intervention site doctors counseled more effectively than control group doctors, but at six months their performance had declined.
- Informal discussions with the intervention site physicians provided some cues: in face of several field and administrative duties, they are left with little time for clinical duties, affecting their ability to counsel. Some others reported that patients crowd around them in the OPD, making it difficult to counsel individual caretakers.
The intervention site physicians reported that following training, use of local terms for danger signs and pictorial cards for demonstrating these signs helped them in communicating more effectively with the families. Sustained improvement in counselling performance would probably require, in addition to training, addressing systemic factors such as crowd management and queuing, scheduling field duties and administrative work in a manner that does not affect the time-availability for OPD.