Randomized Controlled Trial to Address Unintended Pregnancy Rates in Low Resource Settings

解决资源匮乏环境中意外怀孕率的随机对照试验

• 批准号: 10617389
• 负责人: KATHERINE M TUMLINSON
• 金额: $ 64.43万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-19 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10617389
• 关键词: Abbreviations; Absenteeism; Accountability; Address; Age; Area; Award; Behavior; Childbirth; Client; Collaborations; Communities; Contraceptive Agents; Contraceptive Usage; Contraceptive methods; Counseling; Country; County; Cross-Sectional Studies; Data; Effectiveness; Family Planning; Feedback; Fees; Focus Groups; Funding; Goals; Health; Health Personnel; Health care facility; Healthcare Systems; Individual; Infant Mortality; Intervention; Interview; Job Satisfaction; Kenya; Knowledge; Maternal Mortality; Measures; Methods; Modeling; Modernization; Monitor; National Institute of Child Health and Human Development; Newborn Infant; Nulliparity; Outcome; Pathway interactions; Patient Rights; Perception; Performance; Pregnancy; Pregnancy Rate; Prevalence; Provider; Public Facilities; Public Health; Public Sector; Quality of Care; Randomized; Randomized, Controlled Trials; Reporting; Research; Research Design; Research Project Grants; Resource-limited setting; Resources; Sampling; Site; Social Accountability; Supervision; Surveys; Time; Unmarried; Wait Time; Woman; Work; arm; care providers; community engagement; empowerment; evidence base; experience; experimental study; follow-up; implementation barriers; implementation evaluation; implementation science; implementation strategy; improved; interest; low income country; member; payment; post intervention; reinforced behavior; reproductive; scale up; service delivery; service providers; service utilization; therapy design; three-arm study; unintended pregnancy; uptake

ABSTRACT Unintended pregnancy is a major contributor to maternal and infant mortality in low-income countries (LICs). More than 300,000 women and 2.7 million newborns die every year in LICs due to complications from childbirth and pregnancy. Nearly half of the 200 million pregnancies occurring annually in LICs are unintended. High numbers of unintended pregnancy are primarily the result of non-use of contraception. Non-use of contraception is more likely to occur among potential users who experience poor provider care. Providers who are frequently absent, solicit informal payments from clients, and deny methods to unmarried or nulliparous women are a major barrier to women seeking family planning. Yet, removing these barriers is difficult due to low supervision and accountability in under-resourced public facilities. Such findings highlight the need for interventions that increase quality of care via alternative mechanisms for monitoring providers. The social accountability approach solicits citizen feedback with the goal of improving provider performance and service delivery. To date, there is limited rigorous evidence on the effectiveness of social accountability interventions to increase contraceptive use and on the conditions necessary for successful and sustainable scale-up of these interventions. Further, no prior study has rigorously assessed social accountability in a setting where Universal Health Coverage (UHC) is already operating. Based on these knowledge gaps, we propose to evaluate the impact of two social accountability interventions using rigorous methods. We propose this study in Kenya, which rolled out UHC in late 2018 and where one out of every 42 women will die from complications related to pregnancy and childbirth. This study seeks a) to implement the Community Score Card and the Citizen Report Card, b) to evaluate the impact of each of these interventions on contraceptive use, quality of care, and community engagement within communities in Kisumu County, Kenya, and c) to assess the potential for sustainability in additional counties in Kenya, using implementation science methods. To evaluate the impact of the Community Score Card and the Citizen Report Card on our outcomes of interest, a three-armed cluster randomized controlled trial will be conducted in Kisumu, Kenya, with all public-sector facilities randomly assigned to one of three study arms: 1. Community Score Card intervention, 2. Citizen Report Card intervention, or 3. control sites. Outcomes will be assessed via pre- and post-intervention surveys at the individual (n=2268) and facility levels (n=129). Implementation science methods will be used to assess the quality, scalability, and replicability of both the Community Score Card and the Citizen Report Card for uptake by the public-sector healthcare system. Specifically, in-depth interviews will be conducted with community members and service providers (n=30), and focus groups (n=4) will be conducted with key intervention facilitators to assess implementation challenges. This research project will develop an evidence base and implementation strategy for effective community monitoring of publicly funded healthcare facilities in LICs.

抽象的 意外怀孕是低收入国家 (LIC) 孕产妇和婴儿死亡的主要原因。 每年有超过 300,000 名妇女和 270 万新生儿死于低收入国家的并发症 分娩和怀孕。低收入国家每年发生的 2 亿例怀孕中，近一半是意外怀孕。 大量意外怀孕的主要原因是不采取避孕措施。不使用 在提供者护理较差的潜在使用者中更有可能采取避孕措施。提供者 经常缺席，向客户索取非正式付款，并拒绝向未婚或未婚人士提供服务 妇女是妇女寻求计划生育的主要障碍。然而，消除这些障碍很困难，因为 资源不足的公共设施的监督和问责制较低。这些发现凸显了需要 通过监测提供者的替代机制来提高护理质量的干预措施。社会 问责方法征求公民反馈，以提高提供商的绩效和服务 送货。迄今为止，关于社会责任干预措施有效性的严格证据有限。 增加避孕药具的使用以及成功和可持续扩大避孕药具的必要条件 干预措施。此外，之前没有任何研究严格评估过普遍存在的环境中的社会责任。 健康保险 (UHC) 已经投入运行。基于这些知识差距，我们建议评估 使用严格方法进行的两项社会责任干预措施的影响。我们建议在肯尼亚进行这项研究， 该组织于 2018 年底推出了全民健康覆盖，每 42 名女性中就有 1 人死于与以下相关的并发症 怀孕和分娩。本研究旨在 a) 实施社区记分卡和公民报告 卡，b) 评估每项干预措施对避孕药具使用、护理质量和的影响 肯尼亚基苏木县社区内的社区参与，以及 c) 评估 使用实施科学方法在肯尼亚其他县实现可持续性。评估影响 关于我们感兴趣的结果的社区记分卡和公民报告卡，三臂集群 随机对照试验将在肯尼亚基苏木进行，所有公共部门设施均随机进行 分配给三个研究组之一：1. 社区记分卡干预，2. 公民报告卡 干预，或3.控制部位。将通过干预前和干预后调查来评估结果 个人（n = 2268）和设施级别（n = 129）。将使用实施科学方法来评估 社区记分卡和公民报告卡的质量、可扩展性和可复制性以供采用 由公共部门医疗保健系统提供。具体来说，将与社区进行深度访谈 成员和服务提供者（n=30）和焦点小组（n=4）将进行重点干预 协调员评估实施挑战。该研究项目将建立一个证据基础并 对低收入国家公共资助的医疗机构进行有效社区监测的实施战略。