REACHING PROVIDERS IS NOT ENOUGH TO INCREASE IUD USE: A FACTORIAL EXPERIMENT OF ‘ACADEMIC DETAILING’ IN KENYA
REACHING PROVIDERS IS NOT ENOUGH TO INCREASE IUD USE: A FACTORIAL EXPERIMENT OF ‘ACADEMIC DETAILING’ IN KENYA
复制标题
接触医疗服务提供者并不足以增加宫内节育器的使用：肯尼亚“学术细节”的因素实验
DOI：
--
复制
发表时间：
2008
影响因子：
1.5
通讯作者：
B. Janowitz
中科院分区：
文献类型：
--
作者：
J. Wesson;A. Olawo;V. Bukusi;M. Solomon;B. Pierre;J. Stanback;B. Janowitz
虽然宫内节育器是一种非常有效和低成本的避孕方法，但在过去20年中，它的使用在肯尼亚急剧下降。一项研究测试了对计划生育提供者和社区分发（CBD）代理商进行外展干预以促进肯尼亚西部使用宫内节育器的有效性。45家公共卫生诊所被随机分配接受干预，仅针对提供者，仅针对CBD代理商，针对提供者和CBD代理商，或者根本没有详细说明。干预措施以制药公司的“详细”模式为基础，包括对供应商和生物多样性公约方案进行教育/激励访问，以及提供教育和宣传材料。向地区卫生监督员提供了避孕药具，包括宫内节育器的最新情况，并在进行详细访问之前接受了沟通和信息开发方面的培训。详细说明只适度增加了宫内节育器的提供，只有当供应商和CBD代理商都是目标。两次详细的访问似乎不足以维持干预措施的效果，也不足以解决提供者态度差和缺乏技术技能的问题。每3.5年的妊娠保护成本为49.57美元，用于详细干预，包括宫内节育器的成本，而目前标准护理的商品成本为15.19美元-提供注射避孕药醋酸甲羟孕酮（DMPA）。当同时进行需求创造活动时，以提供者为基础的活动的有效性得到放大。然而，与插入的少量宫内节育器相比，详细说明的成本表明这种干预措施不符合成本效益。
Summary Although the IUD is an extremely effective and low-cost contraceptive method, its use has declined sharply in Kenya in the past 20 years. A study tested the effectiveness of an outreach intervention to family planning providers and community-based distribution (CBD) agents in promoting use of the IUD in western Kenya. Forty-five public health clinics were randomized to receive the intervention for providers only, for CBD agents only, for both providers and CBD agents, or no detailing at all. The intervention is based on pharmaceutical companies’ ‘detailing’ models and included education/motivation visits to providers and CBD programmes, as well as provision of educational and promotional materials. District health supervisors were given updates on contraceptives, including the IUD, and were trained in communication and message development prior to making their detailing visits. Detailing only modestly increased the provision of IUDs, and only when both providers and CBD agents were targeted. The two detailing visits do not appear sufficient to sustain the effect of the intervention or to address poor provider attitudes and lack of technical skills. The cost per 3·5 years of pregnancy protection was US$49·57 for the detailing intervention including the cost of the IUD, compared with US$15·19 for the commodity costs of the current standard of care – provision of the injectable contraceptive depot-medroxyprogesterone acetate (DMPA). The effectiveness of provider-based activities is amplified when concurrent demand creation activities are carried out. However, the cost of the detailing in comparison to the small number of IUDs inserted indicates that this intervention is not cost-effective.