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Full-Text Articles in Medicine and Health Sciences
Ndola Demonstration Project: A Midterm Analysis Of Lessons Learned, Horizons Program
Ndola Demonstration Project: A Midterm Analysis Of Lessons Learned, Horizons Program
HIV and AIDS
This report summarizes baseline and midterm findings of an intervention pilot study conducted by Horizons, LINKAGES, National Food and Nutrition Commission, District Health Management Team, Hope Humana, and the Zambia Integrated Health Program in Ndola District, Zambia. The aim of the research is to investigate how integrating services for the prevention of mother-to-child transmission (PMCT) of HIV into low-resource maternal and child health (MCH) and antenatal care (ANC) settings influences women’s ability to make and implement informed decisions about HIV. The intervention strengthened routine services and introduced HIV voluntary counseling and testing and PMCT counseling and services into the MCH/ANC …
Training Service Providers On Emergency Contraception: Lessons Learned From An Or Study, M.E. Khan, Sharif M.I. Hossain
Training Service Providers On Emergency Contraception: Lessons Learned From An Or Study, M.E. Khan, Sharif M.I. Hossain
Reproductive Health
The Bangladesh Directorate of Family Planning in collaboration with the Population Council, Pathfinder International, and John Snow, Inc. is conducting an operations research project to test the feasibility of introducing emergency contraceptive pills (ECP) in the national family planning (FP) program and to answer operational questions on implementing the use of ECP efficiently. In Bangladesh, 1.2 million births are unplanned and the number of menstrual regulation/abortions is increasing. ECP could be a good reproductive health intervention for women since it gives them a chance to avoid unwanted pregnancy. ECP does not induce abortion. In fact, it helps in reducing the …
Peer Education As A Strategy To Increase Contraceptive Prevalence And Reduce The Rate Of Stis/Hiv Among Adolescents In Cameroon, Institut De Recherche Et Des Etudes Des Comportements (Iresco)
Peer Education As A Strategy To Increase Contraceptive Prevalence And Reduce The Rate Of Stis/Hiv Among Adolescents In Cameroon, Institut De Recherche Et Des Etudes Des Comportements (Iresco)
Reproductive Health
The Institute for Behavioral Studies and Research completed an operations research project entitled “Among Youth” targeting adolescents in the Mokolo neighborhood of Yaoundé, Cameroon. The results presented in this report show that adolescents in Mokolo, more often than their counterparts in the control site, adopted behavioral changes to prevent STI/HIV transmission and unwanted pregnancies as a result of the intervention. The report concludes that peer education combined with mass media campaigns form an important strategy for targeting youth with reproductive health and family planning messages and can help adolescents translate knowledge into healthy lifestyles. Integration of reproductive health messages into …
Upgrading The Capacity And Skills Of Service Providers Of The West Bank/Gaza Pilot Health Project, Nancy Ali, Laila Nawar, Dale Huntington, Tawhida Khalil
Upgrading The Capacity And Skills Of Service Providers Of The West Bank/Gaza Pilot Health Project, Nancy Ali, Laila Nawar, Dale Huntington, Tawhida Khalil
Reproductive Health
The Center for Development in Primary Health Care (CDPHC), in collaboration with the Population Council’s FRONTIERS program, developed a 19-month training program to strengthen and improve existing maternal and children’s health and family planning services and to promote the establishment of the standardized basic package of services at Pilot Health Project (PHP) clinic sites in the West Bank and Gaza. There were four key start-up activities, including: 1) an assessment of standards of care provided at PHP clinics; 2) a review of formative research; 3) the development of clinical training manuals and curricula; and 4) the development of behavior change …
Hiv/Aids Prevention Guidance For Reproductive Health Professionals In Developing-Country Settings, Helen Epstein, Daniel Whelan, Janneke Van De Wijgert, Purnima Mane, Suman Mehta
Hiv/Aids Prevention Guidance For Reproductive Health Professionals In Developing-Country Settings, Helen Epstein, Daniel Whelan, Janneke Van De Wijgert, Purnima Mane, Suman Mehta
HIV and AIDS
While the integration of information, technologies, and services to respond to HIV/AIDS may seem closely related, there are a variety of issues that continue to create obstacles to integration. Among these are the stigmatizing nature of HIV infection and AIDS and discrimination faced by those who are infected or perceived to be infected; sexual practices and identities that remain socially unacceptable; gender roles and relations that make it difficult for women and men to access information, services, and technologies on HIV prevention; reluctance to recognize the special needs of young people; and barriers to service delivery created by broader economic, …
Meeting The Sexual Health Needs Of Men Who Have Sex With Men In Senegal, Horizons Program
Meeting The Sexual Health Needs Of Men Who Have Sex With Men In Senegal, Horizons Program
HIV and AIDS
Research conducted in many countries has highlighted the vulnerability of men who have sex with men (MSM) to HIV and other STIs. Yet in Africa, they receive little attention in HIV/AIDS programming and service delivery because of widespread denial and stigmatization of homosexual behavior. In Senegal, a study conducted by researchers from the National AIDS Control Program, Cheikh Anta Diop University, and the Horizons Program has provided valuable information about the needs, behaviors, knowledge, and attitudes of MSM that has important implications for program managers and policymakers working to stem the spread of HIV/AIDS. The researchers used ethnographic and survey …
Best Practices In Cbd Programs In Sub-Saharan Africa: Lessons Learned From Research And Evaluation, Frontiers In Reproductive Health, Family Health International, Advance Africa
Best Practices In Cbd Programs In Sub-Saharan Africa: Lessons Learned From Research And Evaluation, Frontiers In Reproductive Health, Family Health International, Advance Africa
Reproductive Health
Community-based distribution (CBD) is the use of nonprofessional local distributors or agents to provide family planning (FP) methods—typically condoms, pills, and spermicides—and referral for other services. FP programs in Africa, Asia, and Latin America have implemented CBD programs for the past 30 years. There is a large body of evidence on the effectiveness, cost, and sustainability of CBD models. Most evidence supports using CBD where appropriate conditions exist. However, major changes have taken place in the context in which programs operate, including the onset of the HIV/AIDS pandemic, enhanced access to FP services, and increased demand for related reproductive health …
Men In Maternity Study: A Summary Of The Findings From Pre-Intervention Interviews With Women And Their Husbands Attending Antenatal Clinics At Esic Facilities In Delhi, Anurag Mishra, Leila Caleb-Varkey, Anjana Das, Emma Ottolenghi, Dale Huntington, Susan E. Adamchak, Shahina Begum
Men In Maternity Study: A Summary Of The Findings From Pre-Intervention Interviews With Women And Their Husbands Attending Antenatal Clinics At Esic Facilities In Delhi, Anurag Mishra, Leila Caleb-Varkey, Anjana Das, Emma Ottolenghi, Dale Huntington, Susan E. Adamchak, Shahina Begum
Reproductive Health
The Frontiers in Reproductive Health program, a USAID-funded project of the Population Council is conducting an operations research (OR) study that investigates the effects of male participation in a new model of maternity care that is gender sensitive and provided at the primary-care level. The immediate objectives are to increase the use of family planning methods in the postpartum period and to promote STI primary preventive practices in men and women. The three-year study called Men in Maternity (MiM) is being conducted in South Africa and India. In India, the project is collaborating with the Employees State Insurance Corporation (ESIC). …
Using Men As Community-Based Distributors Of Condoms, Cynthia P. Green, Stephanie Joyce, James R. Foreit
Using Men As Community-Based Distributors Of Condoms, Cynthia P. Green, Stephanie Joyce, James R. Foreit
Reproductive Health
The HIV/AIDS epidemic has led program managers to seek approaches to family planning (FP) that will also help combat HIV/AIDS and other sexually transmitted infections (STIs). These approaches include use of simplified STI diagnosis and treatment protocols and promotion of male and female condoms. One aspect of condom promotion that is receiving increased attention is the idea of adding men to community-based distribution (CBD) programs. The male latex condom is the only contraceptive method that, when used correctly and consistently, provides protection against STIs, including HIV/AIDS. Currently, an estimated 6 to 9 billion male condoms are used worldwide annually. However, …
Baseline Survey Results: Integrating Adolescent Livelihood Activities Within A Reproductive Health Program For Urban Slum Dwellers In India, Mary Philip Sebastian, Dale Huntington, Wesley H. Clark, Barbara Mensch, Bela Patel Uttekar
Baseline Survey Results: Integrating Adolescent Livelihood Activities Within A Reproductive Health Program For Urban Slum Dwellers In India, Mary Philip Sebastian, Dale Huntington, Wesley H. Clark, Barbara Mensch, Bela Patel Uttekar
Reproductive Health
The Population Council’s Frontiers in Reproductive Health Program and Policy Research Division, in collaboration with CARE India, is conducting an operations research study of an intervention designed to improve the lives and prospects of young women in several urban slum areas of Allahabad, Uttar Pradesh. The project aims to take a preexisting reproductive health program for adolescents and test the feasibility and impact of adding four additional components to it: 1) counseling about savings formation and livelihoods, 2) training in vocational skills, 3) assistance in opening savings accounts, and 4) follow-up support. CARE India is managing the larger adolescent reproductive …
Men In Maternity Study: Results From The Pre-Intervention Survey Of Pregnant Women And Their Husbands At The Three Interventions, And Of Only Women At Three Control Employees' State Insurance Corporation Dispensaries In Delhi, India: Preliminary Findings, Anurag Mishra, Leila Caleb-Varkey, Emma Ottolenghi, Anjana Das, Dale Huntington, Susan E. Adamchak
Men In Maternity Study: Results From The Pre-Intervention Survey Of Pregnant Women And Their Husbands At The Three Interventions, And Of Only Women At Three Control Employees' State Insurance Corporation Dispensaries In Delhi, India: Preliminary Findings, Anurag Mishra, Leila Caleb-Varkey, Emma Ottolenghi, Anjana Das, Dale Huntington, Susan E. Adamchak
Reproductive Health
The Frontiers in Reproductive Health program, a USAID-funded project of the Population Council, is conducting an operations research (OR) study that investigates the effects of male participation in a new model of maternity care that is gender sensitive and provided at the primary-care level. The immediate objectives are to increase the use of family planning methods in the postpartum period and to promote STI primary preventive practices in men and women. The three-year study called Men in Maternity (MiM) is being conducted in South Africa and India. In India, the project is collaborating with the Employees State Insurance Corporation (ESIC). …
Anti-Trafficking Programs In South Asia: Appropriate Activities, Indicators And Evaluation Methodologies, Dale Huntington
Anti-Trafficking Programs In South Asia: Appropriate Activities, Indicators And Evaluation Methodologies, Dale Huntington
Reproductive Health
Throughout South Asia, men, women, boys, and girls are trafficked within their own countries and across international borders against their wills in what is essentially a clandestine slave trade. The Congressional Research Service and the U.S. State Department estimate that between 1 to 2 million people are trafficked each year worldwide with the majority originating in Asia. Root causes include extreme disparities of wealth, increased awareness of job opportunities far from home, pervasive inequality due to caste, class, and gender bias, lack of transparency in regulations governing labor migration, poor enforcement of internationally agreed-upon human rights standards, and the enormous …
Philippines And Senegal: Services Improve Quality Of Care But Fail To Increase Fp Continuation, Frontiers In Reproductive Health
Philippines And Senegal: Services Improve Quality Of Care But Fail To Increase Fp Continuation, Frontiers In Reproductive Health
Reproductive Health
In 1999, Frontiers in Reproductive Health collaborated on studies on the impact of interventions to improve quality of care in the Philippines and Senegal. The two interventions were part of a multicountry Population Council study (also undertaken in Pakistan and Zambia) to test whether improving quality affects women’s contraceptive continuation. The Philippines study focused on training in family planning (FP), supportive supervision, and refresher courses to improve client-provider interaction. The Senegal study compared the impact of improved quality of care at five newly established “reference centers” with five clinics that served as controls. Data were gathered through analyses of quality …
Reproductive Health Care In The Postnatal Period In Guatemala, Erika Jacobs, Carlos Brambila, Ricardo Vernon
Reproductive Health Care In The Postnatal Period In Guatemala, Erika Jacobs, Carlos Brambila, Ricardo Vernon
Reproductive Health
This operations research study aimed to develop and test a job aid to provide comprehensive care to mothers and children during the first year postpartum; to train physicians, nurses, auxiliary nurses, and social workers in its use; and to develop and test strategies and materials for training community health agents to promote services for new mothers during the first year postpartum. It also collected data to establish if these strategies were effective in improving the quality and comprehensiveness of the care received by mothers and children less than one year of age. Drawing from exit interviews, the intervention appeared to …
Social Organization And Reproductive Behavior In Southern Ghana, Dominic K. Agyeman, John B. Casterline
Social Organization And Reproductive Behavior In Southern Ghana, Dominic K. Agyeman, John B. Casterline
Poverty, Gender, and Youth
The objective of this research is to examine the association between social organization and reproductive behavior in one setting in sub-Saharan Africa. The particular focus is on the effects of social organization on the diffusion of innovative reproductive ideas and behaviors. Social diffusion is assumed to be strongly affected by patterns of informal social interaction, and these in turn are assumed to be determined in part by the social organization of local communities (gender relations, employment activity, voluntary organizations). The research draws on data collected in six communities in southern Ghana. The analysis reveals a weaker than expected association between …
Changes In Functional Limitations And Survival Among The Elderly In Taiwan: 1993, 1996, And 1999, Zachary Zimmer, Linda G. Martin, Ming-Cheng Chang
Changes In Functional Limitations And Survival Among The Elderly In Taiwan: 1993, 1996, And 1999, Zachary Zimmer, Linda G. Martin, Ming-Cheng Chang
Poverty, Gender, and Youth
This paper focuses on changes in the prevalence of functional limitations among nationally representative samples of adults aged 65 and older in Taiwan as measured in 1993, 1996, and 1999. Using data from the Survey of Health and Living Status of the Elderly in Taiwan, we investigate changes in difficulties walking and climbing stairs, two tasks that represent basic lower body movements that are less likely to be influenced by changes in living environments and social roles than are activities of daily living and instrumental activities of daily living. Results are shown for both unadjusted prevalence rates and rates adjusted …
The Effect Of Gender Differences In Primary School Access, Type, And Quality On The Decision To Enroll In Rural Pakistan, Cynthia B. Lloyd, Cem Mete, Zeba Sathar
The Effect Of Gender Differences In Primary School Access, Type, And Quality On The Decision To Enroll In Rural Pakistan, Cynthia B. Lloyd, Cem Mete, Zeba Sathar
Poverty, Gender, and Youth
The paper explores the effect of primary school access, type, and quality on the decision to enroll in rural Pakistan using a 1997 survey especially designed for this purpose. A unique contribution of the paper is the construction of gender-specific dimensions of school accessibility and school quality according to school type (i.e., public vs. private). Within the same village, girls and boys often face starkly different options for schooling in terms of distance, type, and quality. Public primary schools are segregated by sex; private schools, whose numbers have grown rapidly in recent years in response to rising demand and the …
Universal Sexuality Education In Mongolia: Educating Today To Protect Tomorrow, Delia Barcelona, Laura Laski, Caitlin Gerdts
Universal Sexuality Education In Mongolia: Educating Today To Protect Tomorrow, Delia Barcelona, Laura Laski, Caitlin Gerdts
Poverty, Gender, and Youth
This issue of Quality/Calidad/Qualité demonstrates how Mongolia developed a national plan to a provide a comprehensive sexual and reproductive health curriculum and media for adolescents. Among the lessons learned from the Mongolian experience were the following: 1) questions about unwanted sexual relations and sexual roles were the most pressing among adolescents, especially girls; 2) printed media are efficient and inexpensive; and 3) parental opposition was almost nonexistent in certain settings—often they expressed gratitude for this education.
How Long Do We Live?, John Bongaarts, Griffith Feeney
How Long Do We Live?, John Bongaarts, Griffith Feeney
Poverty, Gender, and Youth
Period life expectancy is calculated from age-specific death rates using life table methods that are among the oldest and most fundamental tools of demography. These methods are rarely questioned, much less criticized. Yet changing age patterns of adult mortality in contemporary countries with high life expectancy provide a basis for questioning the conventional use of age-specific death rates and life tables. This paper argues that when the mean age at death is rising, period life expectancy at birth as conventionally calculated overestimates life expectancy. Estimates of this upward bias, ranging from 1.6 years for the United States and Sweden to …
How Community Structures Of Time And Opportunity Shape Adolescent Sexual Behavior In South Africa, Carol E. Kaufman, Shelley Clark, Ntsiki Manzini, Julian May
How Community Structures Of Time And Opportunity Shape Adolescent Sexual Behavior In South Africa, Carol E. Kaufman, Shelley Clark, Ntsiki Manzini, Julian May
Poverty, Gender, and Youth
Recently, South Africa has led the world in rates of HIV/AIDS infection. Particularly among young adults, the prevalence of HIV has soared, now reaching 25 percent. The statistics suggest a high level of unprotected sex and risky sexual behavior even in the midst of high levels of knowledge. Research has focused on the dynamics of individuals’ and partners’ sexual decisionmaking. Little is known, however, about the larger context in which those decisions are made. What are the everyday experiences that influence risk-taking? Are young people with little to do more likely to engage in risky behavior? Do community opportunities of …
The Elderly And Aids: Coping Strategies And Health Consequences In Rural Tanzania, Julia Dayton, Martha Ainsworth
The Elderly And Aids: Coping Strategies And Health Consequences In Rural Tanzania, Julia Dayton, Martha Ainsworth
Poverty, Gender, and Youth
The elderly are often especially likely to be adversely affected by the death from AIDS of prime-aged adults. The authors use a longitudinal survey of households from northwestern Tanzania in 1991-94 to compare the activities and wellbeing of the elderly in households before and after the death of a prime-aged adult with those of the elderly in households that did not experience the death of an adult. A significant proportion of adults suffering from AIDS return to their parents’ home shortly before death. Time spent by the elderly performing household chores rises following an adult’s death, and their participation in …
Pregnant Or Positive: Adolescent Childbearing And Hiv Risk In South Africa, Naomi Rutenberg, Carol E. Kaufman, Kate Macintyre, Lisanne Brown, Ali Mehyrar Karim
Pregnant Or Positive: Adolescent Childbearing And Hiv Risk In South Africa, Naomi Rutenberg, Carol E. Kaufman, Kate Macintyre, Lisanne Brown, Ali Mehyrar Karim
Poverty, Gender, and Youth
In communities where early age of childbearing is common and HIV prevalence is high, adolescent boys and girls may place themselves at risk of HIV to realize their childbearing preferences. In this paper, we analyze survey data from Kwa-Zulu-Natal province that explores whether an association exists between pregnancy preferences and behavioral and perceptual measures of HIV risk among adolescents in South Africa. Our analysis is based on data from 1,426 sexually active respondents aged 14-22 who participated in wave 1 of the “Transitions to Adulthood in the Context of AIDS in South Africa” study. We use logistic regression to model …
Living Arrangements And Socio-Demographic Conditions Of Older Adults In Cambodia, Zachary Zimmer, Sovan Kiry Kim
Living Arrangements And Socio-Demographic Conditions Of Older Adults In Cambodia, Zachary Zimmer, Sovan Kiry Kim
Poverty, Gender, and Youth
Since the takeover of Cambodia by the Khmer Rouge in 1975, analysis of social conditions in the country has been lacking. Only recently has dependable socio-demographic data become available. We use some of these data to examine living arrangements and other socio-demographic conditions among Cambodia’s older population and compare results to those recently found in Thailand and Vietnam. On balance, living arrangements in Cambodia are similar to those in neighboring countries. Older adults are likely to be living with a grown child and in a variety of arrangements involving different family members. To determine gender preference for coresident children we …
Premarital Sex In Vietnam: Is The Current Concern With Adolescent Reproductive Health Warranted?, Barbara Mensch, Wesley H. Clark, Dang Nguyen Anh
Premarital Sex In Vietnam: Is The Current Concern With Adolescent Reproductive Health Warranted?, Barbara Mensch, Wesley H. Clark, Dang Nguyen Anh
Poverty, Gender, and Youth
To the extent that research on Vietnamese adolescents has been conducted, it has been concerned with unprotected and unsanctioned sexual activity and its health consequences, namely abortion and sexually transmitted diseases, especially HIV. The question we pose is whether this concern is warranted. Is the population community justified in focusing its attention on early sexual activity and HIV risk? Even if the sexual behavior of young people can be considered problematic, are there perhaps other aspects of young people’s lives that should give us greater pause? The paper reviews the literature on adolescent sexual behavior in Vietnam and analyzes data …
'Bus Fare, Please': The Economics Of Sex And Gifts Among Adolescents In Urban South Africa, Carol E. Kaufman, Stavros E. Stavrou
'Bus Fare, Please': The Economics Of Sex And Gifts Among Adolescents In Urban South Africa, Carol E. Kaufman, Stavros E. Stavrou
Poverty, Gender, and Youth
Force or coercion are often a part of sexual relationships in South Africa, especially among adolescents. This coercion is also often pinioned by an economic exchange: gifts or favours for sex. Studies have pointed out the negative consequences of the exchanges which are often characterised by large age differences (‘sugar daddies’) or power imbalances. Perhaps more pervasive but largely ignored, gift-giving in same-age relationships also may be associated with sexual leverage, an exchange which somehow entitles one partner physical and sexual rights to the other’s body. The circumstances surrounding gifts and favours may shape young women’s and men’s sexual experiences, …
Are We Not Peasants Too? Land Rights And Women's Claims In India, Bina Agarwal
Are We Not Peasants Too? Land Rights And Women's Claims In India, Bina Agarwal
Poverty, Gender, and Youth
This edition of SEEDS explores the critical elements in securing effective and independent land rights for women in South Asia. The author presents a range of cooperative strategies for enabling women to retain and cultivate the land and shows how micro-credit and other programs can be redirected to increase the amount and productivity of land women control. Recognizing that new policies and political will are required to foster and sustain such experiments, the author ends with a summary of how women are organizing to place women’s access to land at the center of national and global agendas.
What About Us? Bringing Infertility Into Reproductive Health Care, Okonofua Friday, Bishakha Datta
What About Us? Bringing Infertility Into Reproductive Health Care, Okonofua Friday, Bishakha Datta
Poverty, Gender, and Youth
Infertility is a major reproductive health problem throughout much of the world. Despite the prevalence and seriousness of infertility, the population and reproductive health field has largely neglected this problem. National policies and international donor organizations have been one-sided in their focus on programs designed to prevent unwanted pregnancies. This issue of Quality/Calidad/Qualité, with clinic-based narratives and case reports from India and Nigeria, illustrates what is involved in trying to address the problem of infertility in developing countries. A possible framework for incorporating limited infertility care into a family planning or reproductive health program includes providing education and counseling, preliminary …
Frontiers Capacity Building: An Overview, James R. Foreit
Frontiers Capacity Building: An Overview, James R. Foreit
Reproductive Health
The Population Council’s Frontiers in Reproductive Health Program is a cooperative agreement with USAID to improve family planning and reproductive health service delivery through operations research (OR). Frontiers builds on more than 20 years of research to improve family planning service delivery programs. A major goal of Frontiers is to transfer skills in OR so that public and private agencies in developing countries can conduct OR and apply research findings to reproductive health programs and policies. OR addresses problems in operational effectiveness, access, quality, and efficiency by investigating facets of programs that managers can control and change. As concluded in …
Kenya: Community Sensitization Must Precede Alternative Coming-Of-Age Rite, Frontiers In Reproductive Health
Kenya: Community Sensitization Must Precede Alternative Coming-Of-Age Rite, Frontiers In Reproductive Health
Reproductive Health
Female genital cutting (FGC) is practiced as a rite of passage in over half of Kenya’s districts. Kenyan nongovernmental agency Maendeleo Ya Wanawake (MYWO) has long conducted community sensitization focused on discouraging this practice. In 1996, MYWO began implementing the “alternative rite” (AR) intervention in sensitized communities. Girls participating in AR receive family life education in seclusion, followed by a public graduation ceremony recognizing them as adults. They are not cut as part of the ceremony. In 2000, the Population Council carried out an assessment of the AR program that sought to identify the impact of MYWO’s activities on knowledge …
Increasing Client Participation In Family Planning Consultations: "Smart Patient" Coaching In Indonesia, Young Mi Ki, Fitri Putjuk, Endang Basuki, Adrienne Kols
Increasing Client Participation In Family Planning Consultations: "Smart Patient" Coaching In Indonesia, Young Mi Ki, Fitri Putjuk, Endang Basuki, Adrienne Kols
Reproductive Health
In Indonesia, paternalistic models of health care, social distance between clients and service providers, and cultural norms discourage family planning clients from playing an active role in consultations. This report discusses the interventions needed to encourage clients to communicate more openly and more vigorously with providers. The study confirmed that educational interventions directed to family planning clients can help them become effective partners in their own care, assuming they meet with receptive providers. Communication interventions like Smart Patient complement and reinforce provider interpersonal communication and counseling training by giving clients the confidence and the skills to take advantage of increased …