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.

抽象的意外怀孕是低收入国家（LIC）的母亲和婴儿死亡率的主要贡献者。由于并发症分娩和怀孕。每年在LIC中发生的2亿次怀孕中，近一半是意想不到的。大量意外怀孕主要是不使用避孕的结果。不使用在提供较差的提供者护理的潜在用户中，避孕更有可能发生。提供者经常不存在，从客户那里征求非正式付款，并拒绝未婚或无生气的方法妇女是寻求计划生育的妇女的主要障碍。但是，由于资源不足的公共设施中的低监督和问责制。这样的发现突出了需要通过替代机制来提高护理质量的干预措施。社交问责方法征求公民反馈，目的是改善提供商的绩效和服务送货。迄今为止，关于社会问责干预措施有效性的严格证据有限增加避孕药的使用以及成功和可持续规模所必需的条件干预措施。此外，在普遍的环境中，没有先前的研究严格评估社会问责制健康覆盖范围（UHC）已经运行。基于这些知识差距，我们建议评估使用严格的方法对两种社会责任干预的影响。我们在肯尼亚提出了这项研究，该公司于2018年底推出了UHC，每42名女性中，每42位女性中有一个会死于与之相关的并发症怀孕和分娩。这项研究寻求a）实施社区计分卡和公民报告卡，b）评估这些干预措施对避孕药的影响，护理质量和肯尼亚基苏木县社区内的社区参与和c）评估潜力使用实施科学方法，肯尼亚其他县的可持续性。评估社区计分卡和关于我们感兴趣的结果的公民报告卡，这是一个三臂集群随机对照试验将在肯尼亚的Kisumu进行，并随机所有公共部门设施分配给三个研究臂之一：1。社区评分卡干预，2。公民报告卡干预，或3。控制站点。结局将通过干预前后的调查评估个体（n = 2268）和设施水平（n = 129）。实施科学方法将用于评估社区计分卡和公民报告卡的质量，可伸缩性和可复制性由公共部门的医疗系统。具体而言，将与社区进行深入的访谈会员和服务提供商（n = 30）和焦点小组（n = 4）将在关键干预下进行促进者评估实施挑战。该研究项目将建立证据基础，实施策略，用于有效地监控LIC的公共资助医疗机构。