Association Between the Quality of Contraceptive Counseling and Method Continuation: Findings From a Prospective Cohort Study in Social Franchise Clinics in Pakistan and Uganda

Chakraborty, Nirali M.; Chang, Karen; Bellows, Benjamin; Grépin, Karen A; Hameed, Waqas; Kalamar, Amanda; Gul, Xaher; Atuyambe, Lynn; Montagu, Dominic

doi:10.9745/ghsp-d-18-00407

Cited by 48 publications

(59 citation statements)

References 30 publications

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“…The highly significant association between a positive MII score and LARC adoption suggests the importance of information for decision-making and method use. Another recent study found a similar positive relationship between quality of information exchanged as measured by MII and method continuation; 22 however, the research using MII is still limited. It should also be noted that only 28% of women interviewed for this study answered "yes" to all three questions in the MII, suggesting more progress is needed in providing adequate information to women adopting a contraceptive method in Lomé.…”

Section: Discussionmentioning

confidence: 76%

“…There is a growing body of evidence to support the notion that improving the quality of care of FP services is key to increasing use and continuation of FP services, particularly in resource limited settings. 22,26,33 However, evidence on which factors are most important in determining quality of FP services is still sparse. 26 In this study, we set out to assess if the quality of FP service provision, both of program performance and program capacity, influenced LARC adoption in Lomé, Togo.…”

Section: Discussionmentioning

confidence: 99%

“…(3) Were you told what to do if you experienced side effects? 22,31 The index, ranging from 0-3, was used as a binary variable (three or less than three). These data were collected from the client exit interviews that were administered directly after the FP consultation by trained enumerators in a private location at the facility.…”

Section: Variable Definitionsmentioning

confidence: 99%

“…20 Two decades later, there is growing evidence on the association between quality of FP services and method uptake and continuation to substantiate Bruce's framework, [21][22][23][24] yet there is limited recent data to understand the specific aspects of quality associated with uptake and continuation, especially in low and middle-income countries (LMICs). 22,25 A systematic review of the evidence on factors determining the quality of care in FP services in Africa concluded that there was no strong evidence from which to make recommendations and called for future studies in this area. 26 The purpose of this paper is to assess whether quality of FP service provision affects LARC uptake among urban and peri-urban FP clients in Lomé, Togo.…”

Section: Introductionmentioning

confidence: 99%

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<p>Quality of Long-acting Reversible Contraception Provision in Lomé, Togo</p>

Weidert¹,

Tekou²,

Prata³

2020

OAJC

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Context: Provision of high-quality contraceptive counseling and services is essential to ensure family planning (FP) programs are rights-based and voluntary. Togo's modern contraceptive use has steadily increased with almost a quarter of the method mix attributed to longacting reversible contraceptives (LARC). The purpose of this study is to assess the quality of LARC provision in Togo. Methods: Data for this study were collected in 2016 as part of a larger research study conducted in Lomé, Togo to assess the effectiveness of the ongoing FP service delivery model. Quality of FP service was assessed in terms of program capacity and program performance. Program capacity was measured with five individual variables and program performance was measured with the Method Information Index (MII). Descriptive statistics and mixed effects models were used to assess likelihood of LARC uptake. Results: Of the 669 clients included in the study, 19.4% received a LARC method. Multivariable results show that LARC uptake is significantly associated with supervisory visit at the facility in the last three months (program capacity indicator) (OR 1.44; 95%CI 1.48-2.39) and is twice as likely for those with a positive MII score, even after controlling for provider and client characteristics (OR 2.1; 95%CI 1.61-2.51). Conclusion: This study identified supervisory visits and comprehensive contraceptive counseling as the key quality factors positively associated with uptake of LARC. Continued focus on quality of care and provider-client information exchange is necessary to ensure women's FP needs are met.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Variable Definitionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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<p>Quality of Long-acting Reversible Contraception Provision in Lomé, Togo</p>

Weidert¹,

Tekou²,

Prata³

2020

OAJC

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“…There are many tools to assess the quality of FP services, however, there is lack of agreement on their routine use (Sprockett 2017). Recent studies have validated quality measures appropriate for routine reporting in FP service delivery settings, finding that higher values on the FP quality measures were associated with increased contraceptive use and reduced discontinuation (Jain et al, 2013;Jain and Winfrey, 2017;Chakraborty et al, 2019;Jain et al, 2019;Holt et al, 2019). While the evidence and the validated metrics are promising, measurement of rights such as client autonomy in service delivery settings can be further improved (Bertrand et al, 2014;Cole et al, 2019).…”

mentioning

confidence: 99%

Positioning family planning quality within health financing for UHC: Connecting the discourse

Appleford¹,

RamaRao²,

Bellows³

et al. 2019

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This brief targets the 'bridge' constituency that is coalescing between the health financing and FP communities of practice around a shared interest in making access to health services universal. With this brief, we aim to identify opportunities for the FP community of practice to advocate for the inclusion of quality, voluntary, and equitable FP services within UHC and health financing discussions. METHODOLOGY AND OUTLINE This technical brief drew on selected published and grey literature on quality of care, FP and UHC. The technical brief is divided into four sections: • Section 1: outlines the quality and the UHC agenda, their grounding in rights, challenges with measurement, and how financing arrangements may affect quality • Section 2: outlines quality and FP, its client-oriented genesis, challenges with routine measurement, and efforts to analyze FP performance within financing arrangements • Section 3: outlines quality and strategic purchasing for FP, using the five Ps analytical framework to illustrate implications for the provision of quality FP services • Section 4: summarizes three important aspects of strategic purchasing for FP quality-the use of FP data and evidence to inform purchasing, FP quality by design and FP quality by implementation within purchasing schemes

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A risk scoring tool for predicting Kenyan women at high risk of contraceptive discontinuation

et al. 2020

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Objective We developed and validated a pragmatic risk assessment tool for identifying contraceptive discontinuation among Kenyan women who do not desire pregnancy. Study design Within a prospective cohort of contraceptive users, participants were randomly allocated to derivation ( n = 558) and validation ( n = 186) cohorts. Risk scores were developed by selecting the Cox proportional hazards model with the minimum Akaike information criterion. Predictive performance was evaluated using time-dependent receiver operating characteristic curves and area under the curve (AUC). Results The overall contraceptive discontinuation rate was 36.9 per 100 woman-years (95% confidence interval [CI] 30.3–44.9). The predictors of discontinuation selected for the risk score included use of a short-term method or copper intrauterine device (vs. injectable or implant), method continuation or switch (vs. initiation), < 9 years of completed education, not having a child aged < 6 months, and having no spouse or a spouse supportive of family planning (vs. having a spouse who has unsupportive or uncertain attitudes towards family planning). AUC at 24 weeks was 0.76 (95% CI 0.64–0.87) with 70.0% sensitivity and 78.6% specificity at the optimal cut point in the derivation cohort. Discontinuation was 3.8-fold higher among high- vs. low-risk women (95% CI 2.33–6.30). AUC was 0.68 (95% CI 0.47–0.90) in the validation cohort. A simplified score comprising routinely collected variables demonstrated similar performance (derivation-AUC: 0.73 [95% CI 0.60–0.85]; validation-AUC: 0.73 [95% CI 0.51–0.94]). Positive predictive value in the derivation cohort was 31.4% for the full and 28.1% for the simplified score. Conclusions The risk scores demonstrated moderate predictive ability but identified large proportions of women as high risk. Future research is needed to improve sensitivity and specificity of a clinical tool to identify women at high risk for experiencing method-related challenges. Implications Contraceptive discontinuation is a major driver of unmet contraceptive need globally. Few tools exist for identifying women who may benefit most from additional support in order to meet their contraceptive needs and preferences. This study developed and assessed the validity of a provider-focused risk prediction tool for contraceptive discontinuation among Kenyan women using modern contraception. High rates of early discontinuation observed in this study emphasize the necessity of investing in efforts to develop new contraceptive technologies and stronger delivery systems to better align with women's needs and preferences for voluntary family planning.

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Association Between the Quality of Contraceptive Counseling and Method Continuation: Findings From a Prospective Cohort Study in Social Franchise Clinics in Pakistan and Uganda

Cited by 48 publications

References 30 publications

<p>Quality of Long-acting Reversible Contraception Provision in Lomé, Togo</p>

<p>Quality of Long-acting Reversible Contraception Provision in Lomé, Togo</p>

Positioning family planning quality within health financing for UHC: Connecting the discourse

A risk scoring tool for predicting Kenyan women at high risk of contraceptive discontinuation

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