Adapting, Expanding, and Evaluating ARCHES (Addressing Reproductive Coercion in Health Settings) in Kenya
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 3,928
- 试验地点
- 24
- 主要终点
- Incident unintended pregnancy
研究概览
简要总结
Document evidence, via cluster randomized controlled trial, of the effectiveness of the ARCHES intervention, a brief, clinic-based counselling intervention demonstrated to reduce intimate partner violence and reproductive coercion and promote women's reproductive health, as scaled in government health facilities in Kenya, to (1) decrease unintended pregnancy, (2) increase family planning uptake and use/continuation, (3) decrease experiences of reproductive coercion and intimate partner violence of women and girls aged 15 to 49 years seeking family planning services, and, to (4) improve quality of care, (5) increase gender equitable attitudes, and, (6) increase self-efficacy to provide comprehensive family planning counseling among providers trained in ARCHES.
详细描述
Background: In Kenya, 17% of women have unmet need for family planning (FP) and the modern contraceptive prevalence rate (mCPR) has plateaued around 45%, contributing to poor reproductive health outcomes. This includes the nearly 50% of women in Kenya who report their last pregnancy as unintended, with those experiencing gender-based violence (GBV), particularly in the forms of intimate partner violence (IPV) and reproductive coercion (RC; behaviors that reduce women's ability to use contraception or otherwise prevent pregnancy), at significantly greater risk. Similar to other LMIC settings, both RC and IPV are highly prevalent in Kenya, particularly among women seeking FP and other reproductive health services (>1/3 of female FP clients). Since 2013, the World Health Organization (WHO) has strongly recommended that IPV and RC be addressed within reproductive health services and, in 2018, the Lancet Commission on Sexual and Reproductive Health and Rights found that RC and IPV were a significant contributor to unmet need for FP and unintended pregnancy, with greatest impacts among women and girls in LMICs. Within Kenya, the Ministry of Health (MOH) has made reduction of unintended pregnancy and gender-based violence (GBV), especially among adolescents, a primary objective. Despite this need and guidance, no clinic-based intervention models outside of the U.S. (apart from one, ARCHES) have demonstrated efficacy to improve FP uptake/use and reduce IPV or RC thereby reducing unintended pregnancy.
Intervention Description: ARCHES (Addressing Reproductive Coercion in Health Settings) is a brief, clinic-based intervention delivered by family planning providers aiming to: 1) Increase women's and girls' ability to use family planning in the face of reproductive coercion, facilitating women's voluntary family planning uptake and continued use without interference, 2) Provide a safe and supportive environment for IPV disclosure and subsequent referral to support services, and 3) Educate and support providers to improve quality of care related to family planning counseling, including addressing reproductive coercion and intimate partner violence.
Objective
The objective of this study is to generate evidence and learnings on scaling integrated family planning services (including family planning, reproductive coercion, and intimate partner violence) in public sector health facilities in Uasin Gishu County, Kenya via adaptation and implementation of ARCHES, in partnership with the Kenya MOH.
Methodology: A cluster randomized controlled trial paired with concurrent implementation science assessments will test effectiveness of the ARCHES model that has been adapted for scale by the Kenya MOH. Female family planning clients aged 15-49 years at selected sites will complete baseline surveys (immediately prior to receiving care), immediately post-visit exit surveys, and 6-month follow-up surveys. Family planning providers trained in ARCHES will complete pre-training, post-training, and 3-month follow-up surveys to assess changes in gender-equitable attitudes and self-efficacy to address issues of violence among their clients. Costs associated with the scale-up strategy will be tracked and utilized in combination with results of the effectiveness trial to assess total cost and cost-effectiveness of ARCHES.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 15 Years 至 49 Years（Child, Adult）
- 性别
- Female
- 接受健康志愿者
- 否
入选标准
- •Seeking family planning services at a selected study facility
- •Aged 15-49 years old
- •Able to provide informed consent
- •Able to speak and understand English, Kiswahili, or Kalenjin
- •Able to provide a safe phone number at which they can be recontacted for follow-up
- •Not planning to move out of the area in the coming 6 months
排除标准
- •Sterilized at baseline
- •Pregnant at baseline
结局指标
主要结局
Incident unintended pregnancy
时间窗: 6-month follow-up
Difference in self-reported unintended pregnancy in the past 6 months at the 6-month follow-up in intervention compared to control group (single time point analysis)
次要结局
- Modern contraceptive use in the past 6 months(Baseline (at facility prior to receiving care) and 6-month follow-up)
- Emotional intimate partner violence in the past 6 months(Baseline (combined report at facility prior to receiving care and report at facility immediately after receiving care (post-visit); combined due to increased reporting post-visit) and 6-month follow-up)
- Contraceptive self-efficacy in the face of reproductive coercion(Baseline (at facility prior to receiving care), Post-visit (at facility immediately after receiving care), and 6-month follow-up)
- Use of intimate partner violence services(6-month follow-up)
- Awareness of intimate partner violence services(Baseline (at facility prior to receiving care), Post-visit (at facility immediately after receiving care), and 6-month follow-up)
- Sexual intimate partner violence in the past 6 months(Baseline (combined report at facility prior to receiving care and report at facility immediately after receiving care (post-visit); combined due to increased reporting post-visit) and 6-month follow-up)
- Covert use of contraception in the past 6 months(Baseline (at facility prior to receiving care) and 6-month follow-up)
- Quality of family planning care(Post-visit (at facility immediately after receiving care))
- Reproductive coercion from a male partner in the past 6 months(Baseline (combined report at facility prior to receiving care and report at facility immediately after receiving care (post-visit); combined due to increased reporting post-visit) and 6-month follow-up)
- Incident pregnancy(6-month follow-up)
- Self-efficacy to use intimate partner violence services(Baseline (at facility prior to receiving care), Post-visit (at facility immediately after receiving care), and 6-month follow-up)
- Attitudes accepting of reproductive coercion(Baseline (at facility prior to receiving care), Post-visit (at facility immediately after receiving care), and 6-month follow-up)
- Discontinuation of modern contraception(6-month follow-up)
- Physical intimate partner violence in the past 6 months(Baseline (combined report at facility prior to receiving care and report at facility immediately after receiving care (post-visit); combined due to increased reporting post-visit) and 6-month follow-up)
- Uptake of a modern contraceptive method(Post-visit (at facility immediately after receiving care))
研究者
Jay G. Silverman, PhD
Professor of Medicine
University of California, San Diego