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The determinants and outcomes of good provider communication: a cross-sectional study in seven African countries
  1. Elysia Larson,
  2. Hannah H Leslie,
  3. Margaret E Kruk
  1. Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Ms Elysia Larson; ell539{at}


Objectives To determine the extent of provider communication, predictors of good communication and the association between provider communication and patient outcomes, such as patient satisfaction, in seven sub-Saharan African countries.

Design Cross-sectional, multicountry study.

Setting Data from recent Service Provision Assessment (SPA) surveys from seven countries in sub-Saharan Africa. SPA surveys include assessment of facility inputs and processes as well as interviews with caretakers of sick children. These data included 3898 facilities and 4627 providers.

Participants 16 352 caregivers visiting the facility for their sick children.

Primary and secondary outcome measures We developed an index of four recommended provider communication items for a sick child assessment based on WHO guidelines. We assessed potential predictors of provider communication and considered whether better provider communication was associated with intent to return to the facility for care.

Results The average score of the composite indicator of provider communication was low, at 35% (SD 26.9). Fifty-four per cent of caregivers reported that they were told the child’s diagnosis, and only 10% reported that they were counselled on feeding for the child. Caregivers’ educational attainment and provider preservice education and training in integrated management of childhood illness were associated with better communication. Private facilities and facilities with better infrastructure received higher communication scores. Caretakers reporting better communication were significantly more likely to state intent to return to the facility (relative risk: 1.19, 95% CI 1.16 to 1.22).

Conclusions There are major deficiencies in communication during sick child visits. These are associated with lower provider education as well as less well-equipped facilities. Poor communication, in turn, is linked to lower satisfaction and intention to return to facility among caregivers of sick children. Countries should test strategies for enhancing quality of communication in their efforts to improve health outcomes and patient experience.

  • Health services research
  • Measurement of quality
  • Child health
  • Sub-Saharan Africa

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors EL and MEK developed the study question. EL conducted all analyses and drafted the manuscript. All authors contributed to the analysis plan, revised the manuscript and approved the final version for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data used in this analysis are publically available from the Demographic and Health Survey Program ( Statistical code can be obtained from the authors on request.