User's perspective of counseling training in Ghana: the "mystery client" trial

Evaluating counseling training programs from the client's perspective has posed a methodological challenge for family planning researchers. This report describes an evaluation method that combines clinic observation with an exit interview methodology. Eighteen women posing as clients were requested to visit three clinics with trained and three clinics with untrained family planning counselors. These clients (called "mystery clients" in Ghana) were later interviewed to uncover any perceived differences between the consultations. The effect of training was evident. Trained counselors consistently provided more complete information about all available contraceptives. However, both trained and untrained counselors often treated younger clients with disrespect or refused to give them the information they requested. This behavior indicated the need to strengthen the values clarification section of the counselors' training sessions, which has now been done.