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Bellow N, Dougherty L, Nai D, Kassegne S, Nagbe RHY, Babogou L, Guede KM, Silva M. Improving provider and client communication around family planning in Togo: Results from a cross-sectional survey. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001923. [PMID: 37289680 DOI: 10.1371/journal.pgph.0001923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/28/2023] [Indexed: 06/10/2023]
Abstract
Previous research has shown that clients are better able to achieve their reproductive intentions when family planning (FP) services meet their needs and they have satisfying client provider interactions. There are several areas of quality provider-client communication, including providers taking a complete reproductive history of their clients to best gauge their needs, communication around alternative FP methods and side effects captured in the method information index, and communication around sexually transmitted infections and HIV risk as it relates to FP choices. This study examines data from a clinic-based intervention in Togo that focuses on strengthening health provider counseling related to FP, including improving in these three areas of provider-client communication. A clustered sampling approach was used to select 650 FP clients from 23 intervention facilities and 235 clients from 17 control facilities in the Lomé and Kara districts of Togo. The FP clients' interactions with providers were observed and clients exit interviews were conducted in December 2021. For each communication area measured through client interviews and observations, principal components analysis and Cronbach's alpha scores were used to ensure that the individual components could be indexed. Outcomes variables based on an index of sub-questions were then created for those who had fulfilled each of the components within an index. Multivariate multilevel mixed-effects logit models accounted for clients nested within facilities and included independent variables capturing client demographic and facility variables. Multivariate results show that all three outcome variables representing the three provider-client communication areas were statistically significantly better for FP clients in intervention clinics versus control clinics (p<0.05). The results speak to the emphasis that the Togo Ministry of Health has placed on building the provider capacity to provide quality counseling and administration of FP methods and working to assist in achieving health programming goals through well-designed interventions.
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Affiliation(s)
- Nicole Bellow
- Avenir Health, Takoma Park, Maryland, United States of America
| | | | - Dela Nai
- Population Council, Accra, Ghana
| | | | | | | | | | - Martha Silva
- Department of International Health and Sustainable Development, Tulane University, New Orleans, Louisiana, United States of America
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Mbehero F, Momanyi R, Hesel K. Facilitating Uptake of Post-abortion Contraception for Young People in Kenya. Front Glob Womens Health 2022; 2:733957. [PMID: 35128527 PMCID: PMC8810546 DOI: 10.3389/fgwh.2021.733957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
Globally, maternal mortality is unacceptably high, and unsafe abortion is the most easily preventable cause of maternal death. Post-abortion contraception, recognized as a High Impact Practice in Family Planning, can reduce rates of unintended pregnancies and unsafe abortion and ultimately save lives. Implementation of this, however, is limited, especially for young people. This case study documents strategies, results, and lessons learned from Planned Parenthood Global's project in South West Kenya, which improved access to and provision of comprehensive abortion care, including safe abortion, post-abortion care and post-abortion contraception, at 80 public and private health facilities. By prioritizing training and mentorship of mid-level providers on both medical and surgical abortion care, post-abortion contraception and youth friendly services, in addition to community engagement and referrals, this intervention removes common barriers to care for women and young people. Eighty-five percent of abortion care clients served by the project accepted same-day contraception, with the vast majority-including 90% of clients aged 24 and under-choosing long-acting reversible contraception. The Closing the Gap project was funded by an anonymous donor.
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Affiliation(s)
- Faith Mbehero
- Clinical Quality of Care Consultant: Planned Parenthood Global, Nairobi, Kenya
| | - Ruth Momanyi
- Program Learning Officer, Planned Parenthood Global, Africa Regional Office, Nairobi, Kenya
| | - Kate Hesel
- Director of Program Learning and Impact, Planned Parenthood Global, New York, NY, United States
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Schwandt HM, Boulware A, Corey J, Herrera A, Hudler E, Imbabazi C, King I, Linus J, Manzi I, Merritt M, Mezier L, Miller A, Morris H, Musemakweli D, Musekura U, Mutuyimana D, Ntakarutimana C, Patel N, Scanteianu A, Shemeza BE, Sterling-Donaldson G, Umutoni C, Uwera L, Zeiler M, Feinberg S. "… the way we welcome them is how we will lead them to love family planning.": family planning providers in Rwanda foster compassionate relationships with clients despite workplace challenges. BMC Health Serv Res 2021; 21:293. [PMID: 33794871 PMCID: PMC8017655 DOI: 10.1186/s12913-021-06282-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rwanda has markedly increased the nation's contraceptive use in a short period of time, tripling contraceptive prevalence in just 5 years between 2005 and 2010. An integral aspect of family planning programs is the interactions between family planning providers and clients. This study aims to understand the client-provider relationship in the Rwandan family planning program and to also examine barriers to those relationships. METHODS This qualitative study in Rwanda utilized convenience sampling to include eight focus group discussions with family planning providers, both family planning nurses and community health workers, as well as in-depth interviews with 32 experienced modern contraceptive users. Study participants were drawn from the two districts in Rwanda with the highest and lowest modern contraceptive rates, Musanze and Nyamasheke, respectively Data analysis was guided by the thematic content approach, Atlas.ti 8 was utilized for coding the transcripts and collating the coding results, and Microsoft Excel for analyzing the data within code. RESULTS Data analysis revealed that, despite workplace related challenges - including inadequate staffing, training, and resources, relationships between providers and clients are strong. Family planning providers work hard to understand, learn from, and support clients in their initiation and sustained use of contraceptives. CONCLUSION Given the existing context of purposeful efforts on the part of family planning providers to build relationships with their clients, if the current level of government support for family planning service provision is enhanced, Rwanda will likely sustain many current users of contraception and engage even more Rwandans in contraceptive services in the future.
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Affiliation(s)
- Hilary M Schwandt
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA.
| | - Angel Boulware
- Spelman College, 350 Spelman Ln SW, Atlanta, GA, 30314, USA
| | - Julia Corey
- Wheaton College, 26 E Main St, Norton, MA, 02766, USA
| | - Ana Herrera
- Northwest Vista Community College, 3535 N Ellison Dr., San Antonio, TX, 78251, USA
| | - Ethan Hudler
- Whatcom Community College, 237 W Kellogg Rd, Bellingham, WA, 98226, USA
| | | | - Ilia King
- Xavier University, 1 Drexel Dr, New Orleans, LA, 70125, USA
| | | | | | - Madelyn Merritt
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
| | - Lyn Mezier
- SUNY Oswego, 7060 NY-104, Oswego, NY, 13126, USA
| | - Abigail Miller
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
| | - Haley Morris
- Western Oregon University, 345 Monmouth Ave N, Monmouth, OR, 97361, USA
| | | | - Uwase Musekura
- Eastern Oregon University, One University Blvd, La Grande, OR, 97850, USA
| | | | | | - Nirali Patel
- Arcadia University, 450 S Easton Rd, Glenside, PA, 19038, USA
| | | | | | | | | | | | - Madeleine Zeiler
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
| | - Seth Feinberg
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
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Fu TC, Herbenick D, Dodge BM, Beckmeyer JJ, Hensel DJ. Long-Acting Reversible Contraceptive Users' Knowledge, Conversations with Healthcare Providers, and Condom Use: Findings from a U.S. Nationally Representative Probability Survey. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2021; 33:163-174. [PMID: 38596749 PMCID: PMC10929580 DOI: 10.1080/19317611.2020.1870024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 04/11/2024]
Abstract
Objectives To describe long-acting reversible contraceptive (LARC) users' knowledge, patient-provider interactions, and condom use associated with LARC use. Methods: Data are from the 2018 National Survey of Sexual Health and Behavior, a probability survey of Americans aged 14-49. Results: Of 1,451 sexually active women, 11.2% used intrauterine devices, and 3.1% used implants. Approximately 19-26% of LARC users reported inaccurately on LARC longevity, and 30% reported relying on their provider to indicate the timing of intrauterine device removal. Consistent condom use among LARC users was rare (6.1%). Conclusions: Our findings have implications for how clinicians educate patients on LARC and condom use.
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Affiliation(s)
- Tsung-chieh Fu
- Center for Sexual Health Promotion, Indiana University, Bloomington, Indiana, USA
- Department of Applied Health Science, Indiana University, Bloomington, Indiana, USA
| | - Debby Herbenick
- Center for Sexual Health Promotion, Indiana University, Bloomington, Indiana, USA
- Department of Applied Health Science, Indiana University, Bloomington, Indiana, USA
| | - Brian M. Dodge
- Center for Sexual Health Promotion, Indiana University, Bloomington, Indiana, USA
- Department of Applied Health Science, Indiana University, Bloomington, Indiana, USA
| | - Jonathon J. Beckmeyer
- Center for Sexual Health Promotion, Indiana University, Bloomington, Indiana, USA
- Department of Applied Health Science, Indiana University, Bloomington, Indiana, USA
| | - Devon J. Hensel
- Department of Pediatrics, Indiana University School of Medicine, Bloomington, Indiana, USA
- Department of Sociology, Indiana University Purdue University-Indianapolis, Indianapolis, Indiana, USA
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