Perspectives on DMPA-SC for self-injection among adolescents with unmet need for contraception in Malawi

Ali, Gracious; Erlank, Chelsey Porter; Birhanu, Frehiwot; Stanley, Melinda A.; Chirwa, Jessie; Kachale, Fannie; Gunda, Andrews

doi:10.3389/fgwh.2023.1059408

Cited by 3 publications

(1 citation statement)

References 26 publications

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“…This study was designed to include a specific objective to investigate best practices and potential gaps in providers’ approaches to integrating the SI option into their contraceptive counselling/training for injectable users in Malawi. Other specific objectives of the study included aspects such as understanding perspectives of adolescents with unmet need for contraception on DMPA-SC SI, the results of which are published elsewhere [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Health care provider and client experiences of counselling on depot medroxyprogesterone acetate subcutaneous (DMPA-SC) for self-injection in Malawi

Porter Erlank,

Ali,

Birhanu

et al. 2023

PLOS Glob Public Health

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Since the introduction of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) in 2018, Malawi has achieved national coverage of trained providers in the public sector and steady increases in uptake of DMPA-SC. However, the rate of clients opting to self-inject DMPA-SC has remained lower than early acceptability studies suggested. Providers play an instrumental role in building client confidence to self-inject through counselling/training. This cross-sectional qualitative study explored the perspectives of providers and injectable clients on the integration of self-injection into contraceptive counselling, to identify best practices and potential gaps. The study was conducted at public sector sites in three districts (Nkhotakota, Mzimba South, Zomba) in Malawi. In-depth interviews were conducted with provider-administered injectable clients, self-injecting clients, and DMPA-SC trained providers. All providers interviewed reported successfully integrating self-injection into their approach. During group health education sessions, some providers reported focusing on benefits of self-injection to spark interest in the method, and then follow that up with more in-depth information during individual counselling. Due to time pressures, a minority of providers reported replacing individual counselling with small-group counselling and limited use of elements such as visualizations and demonstrations. Most providers skipped client practice on inanimate objects, feeling this was either not necessary or inappropriate given stock constraints. Self-injection clients tended to credit their decision to take up SI to receiving lengthy, comprehensive counselling/training, often inclusive of reassuring messages, visualizations, demonstrations and sometimes repeated trainings over time. Provider-administered clients tended to credit their lack of uptake of self-injection to fear and lack of confidence, often blaming themselves instead of the quality of their counselling/training–even while many felt their counselling/training had been rushed or incomplete. Providers should be supported to overcome time- and resource-pressures to invest in counselling/training best practices, to ensure sufficient support is provided to clients interested in self-injection.

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Section: Introductionmentioning

confidence: 99%

Health care provider and client experiences of counselling on depot medroxyprogesterone acetate subcutaneous (DMPA-SC) for self-injection in Malawi

Porter Erlank,

Ali,

Birhanu

et al. 2023

PLOS Glob Public Health

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Self-care interventions for women’s health and well-being

Narasimhan,

Hargreaves,

Logie

et al. 2024

Nat Med

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Health care provider and client experiences of counselling on depot medroxyprogesterone acetate subcutaneous (DMPA-SC) for self-injection in Malawi

Erlank¹,

Ali

Birhanu

et al. 2023

Preprint

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Since the introduction of depot medroxyprogesterone acetate (DMPA-SC) in 2018, Malawi has achieved national coverage of trained providers in the public sector and steady increases in uptake of DMPA-SC. However, the rate of clients opting to self-inject DMPA-SC has remained lower than early acceptability studies suggested. Providers play an instrumental role in building client confidence to self-inject through counselling. This cross-sectional qualitative study explored the perspectives of providers and injectable clients on the integration of self-injection into contraceptive counselling, to identify best practices and gaps. The study was conducted at public sector sites in three districts (Nkhotakota, Mzimba South, Zomba) in Malawi. In-depth interviews were conducted with provider-administered injectable clients, self-injecting clients, and DMPA-SC trained providers. All providers interviewed reported successfully integrating self-injection into their approach. During health education sessions, providers tended to focus mainly on benefits of self-injection to spark interest in the method, and then follow that up with more in-depth information in individual counselling. Due to time pressures, a minority of providers reported replacing individual counselling with small-group counselling and limited their use of peer testimonials, visualizations, and demonstrations. Most providers skipped client practice on inanimate objects, feeling this was either not necessary or not appropriate given stock or resource constraints. Current self-injecting clients showed the best recall for self-injection steps and tended to report having received comprehensive, supportive counselling including aspects such as peer testimonials, visualizations, and demonstrations to build confidence. Injectable clients who had declined self-injection tended to demonstrate less detailed recall of key self-injection messages and report receiving incomplete information, and lack of peer testimonials, visualization, or demonstrations. Comprehensive counselling and training from supportive providers, including best practices identified in this study, are vital to improving client confidence to self-inject. Providers should be supported to overcome time- and resource-pressures to invest in these best practices.

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Perspectives on DMPA-SC for self-injection among adolescents with unmet need for contraception in Malawi

Cited by 3 publications

References 26 publications

Health care provider and client experiences of counselling on depot medroxyprogesterone acetate subcutaneous (DMPA-SC) for self-injection in Malawi

Health care provider and client experiences of counselling on depot medroxyprogesterone acetate subcutaneous (DMPA-SC) for self-injection in Malawi

Self-care interventions for women’s health and well-being

Health care provider and client experiences of counselling on depot medroxyprogesterone acetate subcutaneous (DMPA-SC) for self-injection in Malawi

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