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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

基本信息

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
项目类别：
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

项目摘要

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.

摘要