Effects of a prosocial intervention among sellers of HIV and reproductive health supplies on young women’s health

艾滋病毒和生殖健康用品销售者的亲社会干预对年轻女性健康的影响

• 批准号: 10706507
• 负责人: Jenny Xin Liu
• 金额: $ 8.08万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-20 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10706507
• 关键词: AIDS prevention; Africa South of the Sahara; Age; Area; Automobile Driving; Award; Baseline Surveys; Behavior; Businesses; Caring; Characteristics; Cluster randomized trial; Community Health; Community Services; Complement; Contraceptive Agents; Contraceptive Distributions; Contraceptive methods; Diagnostic Reagent Kits; Effectiveness; Electronics; Enrollment; Ensure; Equipment and supply inventories; Exclusion; Face; Failure; Feedback; Female Adolescents; Friends; Future; Goals; Gold; HIV; Health; Health system; Heterogeneity; Human immunodeficiency virus test; Image; Intervention; Literature; Marketing; Measures; Methods; Motivation; Outcome; Parents; Performance; Persons; Pharmaceutical Preparations; Phase; Population Dynamics; Positioning Attribute; Preventive; Preventive Health Services; Price; Private Sector; Privatization; Provider; Public Health; Randomized; Randomized, Controlled Trials; Reporting; Reproductive Health; Reproductive Health Services; Research Infrastructure; Research Priority; Resources; Role; Sales; Sampling; Service provision; Services; Sexual Health; Side; Surveys; System; Tanzania; Testing; Time; Women' s Health; Work; arm; behavior change; behavioral economics; consumer demand; cost effective; design; experience; girls; innovation; insight; intervention program; novel; peer; pilot test; point of care; pregnancy prevention; prevention service; primary endpoint; primary outcome; programs; provider behavior; secondary endpoint; secondary outcome; self testing; service uptake; social; theories; trend; unintended pregnancy; uptake; willingness to pay; young woman

SUMMARY In sub-Saharan Africa, adolescent girls and young women (AGYW; ages 15-24) face the dual threats of unintended pregnancy and HIV, but struggle to access critical preventive health services, such as HIV testing and contraception. As discreet and convenient access points, private sector drug shops have the potential to amplify access among AGYW, as demonstrated by our R34 pilot of our Malkia Klabu (“Queen Club”) intervention in Tanzania, a loyalty program that creates AGYW-friendly drug shops where AGYW can access contraception and HIV prevention services. While our pilot showed great potential for Malkia Kalbu to increase AGYW demand for such services at drug shops, shopkeepers were reluctant to continue service provision to AGYW beyond the study period. AGYW products were perceived to yield low profits, despite shopkeepers recognizing the benefit of increased AGYW patronage and expressing desires to support broader community health in their role as first point of care. Thus, private providers need additional motivation to independently support service provision to AGYW, even when consumer demand is high. Building on our planned cluster-randomized control trial (CRCT) our Malkia Klabu AGYW program in Tanzania (R01MH12451601), we proposed to pilot-test 2 strategies that bolster shopkeepers’ motivations to distribute AGYW SRH products: (1) privately giving AGYW customer feedback to shopkeepers to leverage prosocial motivation, and; (2) publicly giving AGYW customer feedback with peer comparisons to leverage social image motivations. Based on insights from behavioral economics (BE) and the mixed-methods results from our pilot, our novel interventions aim to harness shopkeepers’ intrinsic prosocial motivation towards AGYW and tendency to compare themselves with their peers. We hypothesize that providing customer feedback from AGYW to socially-motivated shopkeepers will encourage distribution of contraception and HIVST, especially when feedback is publicly displayed. To that end, we have designed a mixed-methods R03 study that leverages the research infrastructure and implementation from our parent R01 CRCT. Our proposed study will assess the effect of these strategies on shopkeepers’ distribution of HIVST and contraceptives to AGYW (Aim 1), and use mixed-methods to understand shopkeepers’ experiences and assess to what extent treatment mechanisms through prosocial motivation and social image theory drive behavior change (Aim 2). Specifically, we will cross-randomize the initial condition (i.e., No Feedback, Private Feedback, and Public Feedback) across the parent R01 CRCT’s 120 enrolled drug shops, with progressive phase-in of additional intervention conditions for each group over 18 months. If feasible and with preliminary evidence of effectiveness, we will develop our enhanced Malkia Klabu program for a future R01 sustainability study. Our study’s focus on increasing AGYW’s access to contraception matches the Population Dynamics Branch’s research priorities.

摘要 在撒哈拉以南非洲，少女和年轻妇女(AGYW；15-24岁)面临双重威胁 意外怀孕和艾滋病毒，但难以获得关键的预防性保健服务，如艾滋病毒检测 和避孕措施。作为谨慎和方便的接入点，私营药店有可能 扩大AGYW之间的联系，正如我们马尔基亚克拉布(“女王俱乐部”)的R34飞行员所展示的那样 在坦桑尼亚的干预，一个忠诚度计划，创建AGYW友好的药店，AGYW可以进入 避孕和艾滋病毒预防服务。虽然我们的飞行员显示出马尔基亚卡尔布增加的巨大潜力 AGYW药店对此类服务的需求，店主不愿继续提供服务 超过研究期的AGYW。AGYW产品被认为利润很低，尽管店主 认识到增加AGYW赞助的好处，并表达了支持更广泛社区的愿望 健康在他们作为第一个护理点的作用中。因此，私营提供商需要额外的动力来独立 支持向AGYW提供服务，即使在消费者需求很高的情况下。 在我们计划的整群随机对照试验(CRCT)的基础上，我们在坦桑尼亚的Malkia KLabu AGYW计划 (R01MH12451601)，我们建议试行2种策略，以增强店主的分销动机 AGYW SRH产品：(1)私下向店主提供AGYW客户反馈，以利用亲社会 动机；以及；(2)公开向AGYW客户提供反馈，并进行同行比较，以利用社会形象 动机。基于行为经济学(BE)的见解和我们试点的混合方法结果， 我们的新干预措施旨在利用店主对AGYW和 倾向于将自己与同龄人比较。我们假设从客户那里提供反馈 向有社会动机的店主提供AGYW将鼓励分发避孕药具和HIVST，特别是 当反馈被公开展示时。 为此，我们设计了一项混合方法的R03研究，利用研究基础设施和 从我们的母公司R01 CRCT实施。我们建议的研究将评估这些策略对 店主向AGYW分发艾滋病毒/艾滋病和避孕药具(目标1)，并使用混合方法 了解店主的经历并评估通过亲社会的治疗机制在多大程度上 动机和社会形象理论推动行为改变(目标2)。具体地说，我们将交叉随机地 父R01 CRCT的初始条件(即无反馈、私有反馈和公共反馈) 120家登记的药店，分阶段为每组18岁以上的人提供额外的干预条件 月份。如果可行，并有初步的有效性证据，我们将开发增强的马尔基亚克拉布 未来R01可持续性研究的计划。我们的研究重点是增加AGYW获得避孕的机会 符合人口动力学分部的研究重点。