OBJECTIVE: The World Health Organization has led the development of a Decision-Making Tool for Family Planning Clients and Providers (DMT) to improve the quality of family planning counseling. This study investigates the DMT's impact on health communication in Nicaragua. METHODS: Fifty nine service providers in Nicaragua were videotaped with 426 family planning clients 3 months before and 4 months after attending a training workshop on the DMT. The videotapes were coded for both provider and client communication. RESULTS: After the intervention providers increased their efforts to identify and respond to client needs, involve clients in the decision-making process, and screen for and educate new clients about the chosen method. While the DMT had a smaller impact on clients than providers, in general clients did become more forthcoming about their situation and their wishes. The DMT had a greater impact on sessions in which clients chose a new contraceptive method, as compared with visits by returning clients for a check-up or resupply. CONCLUSION: The DMT proved effective both as a job aid for providers and a decision-making aid for clients, regardless of the client's level of education. PRACTICE IMPLICATIONS: Job and decision-making aids have the potential to improve health communication, even or especially when clients have limited education and providers have limited training and supervision.
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