Abstract
BackgroundMaintaining quality of care in family planning (FP) counselling in low-resource settings is challenging. Job aids can help providers give more accurate and client-specific advice but require a provider to use them effectively and consistently. Marie Stopes International (MSI) have designed the tablet-computer based Digital Counselling Application (DCA), which prompts structured, supportive, client-specific and unbiased FP counselling. We hypothesise that a systematic exploration of clients’ fertility intentions, medical eligibility and preferences will increase their uptake of long acting and permanent methods of contraception (LAPMs).Methods/designWe will conduct a two-armed, parallel, cluster randomised control trial across all MSI clinics (clusters) in Ethiopia (24) and Vietnam (11), randomising 18 clinics to the intervention group and 17 to the control group. Intervention providers will attend a two-day DCA-use training programme, and use DCA in their FP counselling sessions. Usual care providers will counsel clients as before. We aim to recruit 75 clients who have had FP counselling per clinic (2625 total), following them up via two telephone interviews, initially within 2 days and then at 4 months. The primary outcome is defined as the proportion of clients who report choosing a LAPM following FP counselling and will include switchers (FP counselling clients who switch from using any other FP method) and adopters (FP counselling clients who adopt any FP method having not previously been using one). We will also collect secondary outcomes at the initial follow-up (including the proportion of clients reporting being recommended a LAPM by a provider and a range of measures of client experience and satisfaction) and at the 4-month follow-up (including a range of measures of continuation rates for different FP method types). In the intervention arm, we will also conduct mixed-methods sampling to assess how providers use DCA (using an observational survey of provider–client interactions), and understand users’ experiences of receiving and giving DCA-based FP counselling (through in-depth interviews).DiscussionThis trial will provide novel information on the feasibility and acceptability of health worker delivered FP counselling using DCA, with robust evidence on its effectiveness at increasing the uptake of LAPMs in low-resource settings.Trial registrationISRCTN, ISRCTN11040557. Registered on 2 March 2017 (retrospectively registered).
Highlights
Maintaining quality of care in family planning (FP) counselling in low-resource settings is challenging
Estimate that we will have 80% power to detect an absolute increase in Long-acting and permanent method of contraception (LAPM) uptake from 40% to 50.5% at a 5% level of statistical significance, assuming a between-cluster coefficient of variation of 0.2, with 18 clinics in the intervention arm and 17 in the control arm, and 75 clients recruited per clinic [20]
Marie Stopes International (MSI) Ethiopia and Vietnam recognise the need for FP, which empowers women, men and young people to achieve their sexual and reproductive health rights, and reduces maternal mortality and morbidity
Summary
Maintaining quality of care in family planning (FP) counselling in low-resource settings is challenging. A greater methods mix, or range of available family planning (FP) services, to address an unmet need is promoted by the World Health Organisation (WHO) [2, 3] and the United Nations [4]. FP service providers inform clients about available methods in different ways across the private and public sectors, ranging from group information sessions introducing all methods, to individual screening of a client’s needs and wants and supporting a client’s selection of methods. Information leaflets and posters, reproductive anatomy models and displays of contraceptive methods support provider–client consultations, and the WHO eligibility wheel is widely used in low-income countries to support providers in giving guidance on medically appropriate methods [6]. The application of these job aids varies across the private and public sectors, as well as between providers within the same organisation
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