PAFP Provider Feedback Trial in Nepal
- Conditions
- Health Behavior
- Interventions
- Behavioral: Monthly PAFP rates displayed at clinics.
- Registration Number
- NCT03071029
- Lead Sponsor
- Marie Stopes International
- Brief Summary
A six-month RCT conducted within 36 health centres throughout urban and rural Nepal. The purpose of the RCT is to test the effectiveness of a peer comparison intervention at increasing uptake of long-acting reversible contraceptives (LARCs) as a percentage of PAFP uptake among clients who receive a safe abortion at a Marie Stopes International Nepal. The total sample size will be \~12,000 safe abortion clients. The primary outcome of interest is LARCs among safe abortion clients at Marie Stopes Centres in Nepal. The secondary outcome is to evaluate the impact of behaviorally designed intervention on the service providers' engagement in discussing measures to increase PAFP LARC uptake among women.
- Detailed Description
The overall goal of the proposed research project is to increase uptake of long-acting reversible contraceptives (LARCs) among clients who receive a safe abortion at a Marie Stopes International - Nepal (MSI-N)/ Sunaulo Parivar Nepal (SPN) centre using a behaviourally-informed intervention: monthly feedback to service providers comparing their LARC uptake as a percentage of PAFP uptake performance to other centres. The impact of the intervention will be evaluated using a clustered, stepped wedge randomized controlled trial (RCT). The intervention will be implemented and data will be collected regularly from 36 centres over a period of 6 months. The RCT study design is stepped wedge, meaning that all health centres will begin in the control group and will be randomly assigned to begin receiving the treatment in 4 "steps". Each step will be 1 month in duration. The primary outcome of interest is LARC uptake as a percentage of PAFP uptake. The secondary outcome is type of method selected. The intervention consists of a monthly poster that centres will receive which shows service providers the PAFP LARC % performance at their centre as compared to 3 similar centres. The intervention was developed using a behavioral science methodology, including interviews with clients and service providers at 9 health centres and user-testing of the intervention with service providers at 4 health centres. Data used for this study will consist of daily PAFP LARC uptake data that is already being collected and consolidated at centres. The data will be securely shared between centres and the MSI-N central support office in Kathmandu on a weekly basis. Data will be securely shared between MSI-N and ideas monthly. Monitoring will consist of mystery client visits at each centre two times during the study period. At least one interview will be conducted with each service provider through the study period. The investigators will manually check 5% of all medical records to confirm that electronic data is accurate. Service providers will undergo written consent in order that they may choose to participate, or choose not to participate, in the study. Individual clients will be opted in to having their data shared for the purpose of the study. Clients will be notified about data sharing through posters and interactions with service providers and can choose not to have their data shared. All safe abortion clients, aged 18 and older, are eligible to have their data shared. Data from approximately 12,000 safe abortion clients will be required for the study. Strict confidentiality procedures in line with Marie Stopes International's best practices will be put into place to ensure that information made public or otherwise distributed outside the PIs and other key personnel cannot be linked to any individual client records. Results from the study will be published in a report, among other outputs, and the outcomes will be shared within MSI as well as with the wider sexual and reproductive health (SRH) community.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Female
- Target Recruitment
- 12000
- All women over the age of 18 who receive safe abortion services at the 36 centres are eligible to participate in the study. Women will be opted in to the study.
- Women <18
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Intervention (receive data updates) Monthly PAFP rates displayed at clinics. Intervention clinics will receive a monthly poster that centres will receive which informs service providers of the PAFP LARC uptake rate at their centre. This is a step-wedged randomised controlled trial where all the clinics will eventually receive an intervention by the end of the study.
- Primary Outcome Measures
Name Time Method Long term reversible contraceptives uptake as a percentage of post-abortion family planning uptake among safe abortion clients within 2 weeks 2 weeks post-abortion The study aims to observe a minimum 4% difference in PAFP LARC rates at two weeks post-abortion between intervention and control participants.
- Secondary Outcome Measures
Name Time Method Types of family planning method used after safe abortion procedure 2 weeks post abortion % of participants using different types of family planning methods at two weeks post-abortion, including % using short-acting vs long-acting contraceptives.
Trial Locations
- Locations (36)
Marie Stopes Parbat
🇳🇵Parbat, Dhaulagiri, Nepal
Marie Stopes Gorkha
🇳🇵Gorkha, Gandaki, Nepal
Marie Stopes Chandrauta
🇳🇵Kapilbastu, Lumbini, Nepal
Marie Stopes Gongabu
🇳🇵Kathmandu, Bagati, Nepal
Marie Stopes Satdobato
🇳🇵Kathmandu, Bagmati, Nepal
Marie Stopes Pyuthan
🇳🇵Pyuthan, Rapti, Nepal
Marie Stopes Birgunj
🇳🇵Parsa, Narayani, Nepal
Marie Stopes Chuchchepati
🇳🇵Kathmandu, Bagati, Nepal
Marie Stopes Putalisadak
🇳🇵Kathmandu, Bagmati, Nepal
Marie Stopes Surkhet
🇳🇵Surkhet, Bheri, Nepal
Marie Stopes Itahari
🇳🇵Sunsari, Koshi, Nepal
Marie Stopes Birtamod
🇳🇵Jhapa, Mechi, Nepal
Marie Stopes Dang
🇳🇵Dang, Rapti, Nepal
Marie Stopes Banepa
🇳🇵Kavre, Bagmati, Nepal
Marie Stopes Kohalpur
🇳🇵Banke, Bheri, Nepal
Marie Stopes Dumre
🇳🇵Tanahun, Gandaki, Nepal
Marie Stopes Janakpur
🇳🇵Dhanusa, Janakpur, Nepal
Marie Stopes Taulihawa
🇳🇵Kapilbastu, Lumbini, Nepal
Marie Stopes Hetauda
🇳🇵Makwanpur, Narayani, Nepal
Marie Stopes Lahan
🇳🇵Siraha, Sagarmatha, Nepal
Marie Stopes Attariya clinic
🇳🇵Kailali, Seti, Nepal
Marie Stopes Hile
🇳🇵Dhankuta, Koshi, Nepal
Marie Stopes Biratnagar
🇳🇵Morang, Koshi, Nepal
Marie Stopes Bhairahawa
🇳🇵Rupandehi, Lumbini, Nepal
Marie Stopes Nuwakot
🇳🇵Nuwakot, Bagmati, Nepal
Marie Stopes Bardibas
🇳🇵Mahottari, Janakpur, Nepal
Marie Stopes Lalbandi
🇳🇵Sarlahi, Janakpur, Nepal
Marie Stopes Jumla
🇳🇵Jumla, Karnali, Nepal
Marie Stopes Gulmi
🇳🇵Gulmi, Lumbini, Nepal
Marie Stopes Butwal
🇳🇵Rupandehi, Lumbini, Nepal
Marie Stopes Pokhara
🇳🇵Kaski, Gandaki, Nepal
Marie stopes Arghakhachi
🇳🇵Arghakhachi, Lumbini, Nepal
Marie Stopes Bardghat
🇳🇵Nawalparasi, Lumbini, Nepal
Marie Stopes Narayanghat
🇳🇵Chitwan, Narayani, Nepal
Marie Stopes Dadheldhura
🇳🇵Dadheldhura, Mahakali, Nepal
Marie Stopes Ilam
🇳🇵Ilam, Mechi, Nepal