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Undercover careseekers: Simulated clients in the study of health provider behavior in developing countries

Author

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  • Madden, J. M.
  • Quick, J. D.
  • Ross-Degnan, D.
  • Kafle, K. K.

Abstract

The simulated client method (SCM) has been used for over 20 years to study health care provider behavior in a first-hand way while minimizing observation bias. In developing countries, it has proven useful in the study of physicians, drug retailers, and family planning services. In SCM, research assistants with fictitious case scenarios (or with stable conditions or a genuine interest in the services) visit providers and request their assistance. Providers are not aware that these clients are involved in research. Simulated clients later report on the events of their visit and these data are analyzed. This paper reviews 23 developing country studies of physician, drug retail, and family planning services in order to draw conclusions about (1) the advantages and limitations of the method; (2) considerations for design and implementation of a simulated client study; (3) validity and reliability; and (4) ethical concerns. Examples are also drawn from industrialized countries, related methodologies, and non-health fields to illustrate the issues surrounding SCM. Based on this review, we conclude that the information gathered through the use of simulated clients is unique and valuable for managers, intervention planners and evaluators, social scientist, regulators, and others. Areas that need to be explored in future work with this method include: ways to ensure data validity and reliability; research on additional types of providers and health care needs; and adaptation of the technique for routine use.

Suggested Citation

  • Madden, J. M. & Quick, J. D. & Ross-Degnan, D. & Kafle, K. K., 1997. "Undercover careseekers: Simulated clients in the study of health provider behavior in developing countries," Social Science & Medicine, Elsevier, vol. 45(10), pages 1465-1482, November.
    • Handle: RePEc:eee:socmed:v:45:y:1997:i:10:p:1465-1482
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    Cited by:

    1. Merhawi Bahta & Sirak Tesfamariam & Dawit G Weldemariam & Hermella Yemane & Eyasu H Tesfamariam & Tesfamariam Alem & Mulugeta Russom, 2020. "Dispensing of antibiotics without prescription and associated factors in drug retail outlets of Eritrea: A simulated client method," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-10, January.
    2. Leonard, Kenneth & Masatu, Melkiory C., 2006. "Outpatient process quality evaluation and the Hawthorne Effect," Social Science & Medicine, Elsevier, vol. 63(9), pages 2330-2340, November.
    3. Timothy O Abuya & Greg Fegan & Abdinasir A Amin & Willis S Akhwale & Abdisalan M Noor & Robert W Snow & Vicki Marsh, 2010. "Evaluating Different Dimensions of Programme Effectiveness for Private Medicine Retailer Malaria Control Interventions in Kenya," PLOS ONE, Public Library of Science, vol. 5(1), pages 1-9, January.
    4. Roland Cheo & Ge Ge & Geir Godager & Rugang Liu & Jian Wang & Qiqi Wang, 2020. "The effect of a mystery shopper scheme on prescribing behavior in primary care: Results from a field experiment," Health Economics Review, Springer, vol. 10(1), pages 1-19, December.
    5. Andia, Tatiana & Mantilla, César & Morales, Álvaro & Ortiz, Santiago & Rodríguez-Lesmes, Paul, 2022. "Does price-cap regulation work for increasing access to contraceptives? Aggregate- and pharmacy-level evidence from Colombia," Social Science & Medicine, Elsevier, vol. 311(C).
    6. Nordyke, Robert J., 2002. "Determinants of PHC productivity and resource utilization: a comparison of public and private physicians in Macedonia," Health Policy, Elsevier, vol. 60(1), pages 67-96, April.
    7. Timothy Powell-Jackson & Rajib Acharya & Veronique Filippi & Carine Ronsmans, 2015. "Delivering Medical Abortion at Scale: A Study of the Retail Market for Medical Abortion in Madhya Pradesh, India," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-14, March.
    8. Martha Embrey & Catherine Vialle-Valentin & Angel Dillip & Bernard Kihiyo & Romuald Mbwasi & Innocent A Semali & John C Chalker & Jafary Liana & Rachel Lieber & Keith Johnson & Edmund Rutta & Suleiman, 2016. "Understanding the Role of Accredited Drug Dispensing Outlets in Tanzania’s Health System," PLOS ONE, Public Library of Science, vol. 11(11), pages 1-16, November.
    9. Ottar Mæstad & Gaute Torsvik & Arild Aakvik, 2009. "Overworked? The relationship between workload and health worker performance in rural Tanzania," CMI Working Papers 2, CMI (Chr. Michelsen Institute), Bergen, Norway.
    10. Mæstad, Ottar & Torsvik, Gaute & Aakvik, Arild, 2010. "Overworked? On the relationship between workload and health worker performance," Journal of Health Economics, Elsevier, vol. 29(5), pages 686-698, September.
    11. Carmen S. Christian & Ulf-G. Gerdtham & Dumisani Hompashe & Anja Smith & Ronelle Burger, 2018. "Measuring Quality Gaps in TB Screening in South Africa Using Standardised Patient Analysis," IJERPH, MDPI, vol. 15(4), pages 1-10, April.
    12. Cheo, Roland & Ge, Ge & Godager, Geir & Liu, Rugang & Wang, Qiqi & Wang, Jian, 2018. "The effect of a mystery shopper scheme on prescriptions in primary care," HERO Online Working Paper Series 2018:1, University of Oslo, Health Economics Research Programme.
    13. Andia, Tatiana & Mantilla, Cesar & Rodriguez-Lesmes, Paul & Criado, Leonel & Gomez, Juan Sebastian & Ortiz, Santiago & Quintero, Andrea & Rincón, Heiner & Romero, Steffanny, 2020. "Mentioning anosmia improves how community pharmacies handle phone call requests during the COVID-19 pandemic: An audit study in Colombia," SocArXiv s2z47, Center for Open Science.

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