The Net Promoter Score (NPS) for Insight Into Client Experiences in Sexual and Reproductive Health Clinics

Area of Science:

• Public Health
• Health Services Research
• Social Science Research Methods

Background:

• The Net Promoter Score (NPS) is a widely used metric for customer experience in for-profit sectors.
• Its adoption in the social sector, particularly for sexual and reproductive health (SRH) services, is limited due to concerns about applicability and acceptability among low-literacy populations.
• Adapting NPS for non-profit settings requires testing various implementation strategies and response scales.

Purpose of the Study:

• To evaluate the feasibility and effectiveness of adapting the Net Promoter Score (NPS) in low-resource sexual and reproductive health (SRH) clinics.
• To compare different implementation methods (e.g., interviews, drop boxes, online surveys) and response scales (numerical vs. emoji) for NPS data collection.
• To assess the utility of NPS in identifying client satisfaction and areas for service improvement in non-profit healthcare settings.

Main Methods:

• Conducted small-scale pilots in El Salvador, India, Kenya, and Nigeria, testing NPS in SRH clinics.
• Implemented various data collection approaches: face-to-face interviews, guided drop boxes, integrated exit interviews, and tablet-based online surveys (self-administered and volunteer-assisted).
• Compared the traditional 0-10 numerical scale with an emoji-face scale for the NPS question.

Main Results:

• The NPS, using the numerical scale, was effectively adapted for low-resource clinics and low-literacy clients.
• No significant difference in NPS scores was found between numerical and emoji scales in India.
• Significant differences in NPS were observed between guided drop box and face-to-face interview methods.
• NPS, when combined with demographic data, provided insights into client groups' likelihood to recommend services.
• Tablet-based online surveys showed efficiency, but self-administration posed literacy and technology barriers.
• Qualitative feedback is recommended for populations with lower NPS to identify improvement actions.

Conclusions:

• The Net Promoter Score (NPS) is a viable and promising metric for assessing client experience in non-profit SRH clinics, even in diverse, low-resource settings.
• Adaptations in implementation methods and scales can enhance its applicability across different populations.
• Integrating NPS with qualitative feedback mechanisms is crucial for actionable insights and service enhancement.