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Duby Z, Bergh K, Bunce B, Jonas K, Slingers N, Mathews C, Abdullah F. "I will find the best method that will work for me": navigating contraceptive journeys amongst South African adolescent girls and young women. Contracept Reprod Med 2024; 9:39. [PMID: 39090752 PMCID: PMC11295340 DOI: 10.1186/s40834-024-00298-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 07/20/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Given that South Africa has one of the highest rates of pregnancy amongst adolescent girls and young women (AGYW) globally, the provision of contraceptives to this group has been a key focus in recent years. Pregnancy prevention involves an on-going continuum of decision-making around contraceptive method choice, uptake, use, experience, continuation, and discontinuation. METHODS This paper presents analysis of data from a cross-sectional survey with 2376 AGYW, as well as qualitative in-depth interviews (IDIs) with 54 AGYW, inclusive of contraceptive journey narratives. We examine the preferences, valued characteristics, choices, beliefs, understandings and experiences of choosing and using contraceptives amongst AGYW in two South African communities characterised by high rates of pregnancy. RESULTS These findings shed light on the preferences towards, beliefs about, and experiences of choosing, using and discontinuing contraceptive methods amongst this population, with survey data suggesting that the most popular methods were the injection, followed by the implant, and then the oral pill. Findings illustrate the complexity and dynamic nature of contraceptive decision-making and the varied embodied and lived experiences of contraceptive use, and how these are impacted by contraception service provision. CONCLUSIONS Our findings show that contraception experiences of each individual are cumulative, and comprise a continuum of method initiation, use, discontinuation, method switching and on-going circular decision-making influenced by multiple social, structural, contextual and interpersonal factors, combined with shifting preferences, values and needs. To maximise the use of contraceptives amongst South African AGYW, it is necessary to provide responsive contraception service provision to reflect the changing contexts and preferences of users, in order to ensure that pregnancy prevention needs are catered for throughout their reproductive life course.
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Affiliation(s)
- Zoe Duby
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
- School of Public Health, University of Cape Town, Cape Town, South Africa.
| | - Kate Bergh
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | | | - Kim Jonas
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Nevilene Slingers
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Fareed Abdullah
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
- Department of Public Health Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Division of Infectious Diseases, Department of Internal Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Buser JM, Pebolo PF, August E, Rana GK, Gray R, Jacobson-Davies FE, Kumakech E, Endale T, Auma AG, Smith YR. Scoping review of qualitative studies on family planning in Uganda. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003313. [PMID: 38959214 PMCID: PMC11221757 DOI: 10.1371/journal.pgph.0003313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/11/2024] [Indexed: 07/05/2024]
Abstract
Family planning (FP) is an essential component of public health programs and significantly impacts maternal and child health outcomes. In Uganda, there is a need for a comprehensive review of the existing literature on FP to inform future research and programmatic efforts. This scoping review aims to identify factors shaping the use of FP in Uganda. We conducted a systematic search of eight scholarly databases, for qualitative studies on FP in Uganda. We screened the titles and abstracts of identified articles published between 2002-2023 and assessed their eligibility based on predefined criteria. We extracted data from the 71 eligible studies and synthesized the findings using thematic analysis and the Ecological Systems Theory (EST) individual, interpersonal, community, institutional, and policy-level determinants. Findings reveal the interplay of factors at different socio-ecological levels influencing family planning decisions. At the individual level, the most common determinants related to the EST were knowledge and attitudes of FP. Interpersonal dynamics, including partner communication and social support networks, played pivotal roles. Community-level factors, such as cultural norms and accessibility of services, significantly influenced family planning practices. Institutional and policy-level factors, particularly a healthcare system's quality and policies, also shaped use. Other themes included the intersection of HIV/AIDS on FP practice and Ugandan views of comprehensive abortion care. This scoping review underscores the intricate socio-ecological fabric shaping FP in Uganda. The findings highlight the need for targeted interventions to increase knowledge and awareness of FP, improve access to services, and address social and cultural norms that discourage contraceptive use. Policymakers and program implementers should also consider gender dynamics and power imbalances in FP programs to ensure they are equitable and effective.
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Affiliation(s)
- Julie M. Buser
- Center for International Reproductive Health Training (CIRHT), University of Michigan, Ann Arbor, Michigan, United States of America
| | - Pebalo F. Pebolo
- Department Reproductive Health, Gulu University Faculty of Medicine, Gulu, Uganda
| | - Ella August
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
- PREPSS (Pre-Publication Support Service), University of Michigan, Ann Arbor, Michigan, United States of America
| | - Gurpreet K. Rana
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Rachel Gray
- Center for International Reproductive Health Training (CIRHT), University of Michigan, Ann Arbor, Michigan, United States of America
| | - Faelan E. Jacobson-Davies
- Center for International Reproductive Health Training (CIRHT), University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Edward Kumakech
- Department of Nursing and Midwifery, Lira University, Lira, Uganda
| | - Tamrat Endale
- Center for International Reproductive Health Training (CIRHT), University of Michigan, Ann Arbor, Michigan, United States of America
| | - Anna Grace Auma
- Department of Nursing and Midwifery, Lira University, Lira, Uganda
| | - Yolanda R. Smith
- Center for International Reproductive Health Training (CIRHT), University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States of America
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Soehnchen C, Burmann A, Henningsen M, Meister S. A Digital Sexual Health Education Web Application for Resource-Poor Regions in Kenya: Implementation-Oriented Case Study Using the Intercultural Research Model. JMIR Form Res 2024; 8:e58549. [PMID: 38959047 PMCID: PMC11255522 DOI: 10.2196/58549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/19/2024] [Accepted: 05/22/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Developing a digital educational application focused on sexual health education necessitates a framework that integrates cultural considerations effectively. Drawing from previous research, we identified the problem and essential requirements to incorporate cultural insights into the development of a solution. OBJECTIVE This study aims to explore the Solution Room of the self-established Intercultural Research Model, with a focus on creating a reusable framework for developing and implementing a widely accessible digital educational tool for sexual health. The study centers on advancing from a low-fidelity prototype (She!Masomo) to a high-fidelity prototype (We!Masomo), while evaluating its system usability through differentiation. This research contributes to the pursuit of Sustainable Development Goals 3, 4, and 5. METHODS The research methodology is anchored in the Solution Room of the self-expanded Intercultural Research Model, which integrates cultural considerations. It uses a multimethod, user-centered design thinking approach, focusing on extensive human involvement for the open web-based application. This includes gathering self-assessed textual user feedback, conducting a System Usability Scale (SUS) analysis, and conducting 4 face-to-face semistructured expert interviews, following COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines. RESULTS Based on the identified limitations of the low-fidelity prototype, She!Masomo (SUS score 67), which were highlighted through textual user feedback (63/77) and prototype feature comparisons, iterative development and improvement were implemented. This process led to the creation of an enhanced high-fidelity prototype (We!Masomo). The improved effectiveness of the enhanced prototype was evaluated using the qualitative SUS analysis (82/90), resulting in a favorable score of 77.3, compared with the previous SUS score of 67 for the low-fidelity prototype. Highlighting the importance of accessible digital educational tools, this study conducted 4 expert interviews (4/4) and reported e-survey results following the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) guideline. The digital educational platform, We!Masomo, is specifically designed to promote universal and inclusive free access to information. Therefore, the developed high-fidelity prototype was implemented in Kenya. CONCLUSIONS The primary outcome of this research provides a comprehensive exploration of utilizing a case study methodology to advance the development of digital educational web tools, particularly focusing on cultural sensitivity and sensitive educational subjects. It offers critical insights for effectively introducing such tools in regions with limited resources. Nonetheless, it is crucial to emphasize that the findings underscore the importance of integrating culture-specific components during the design phase. This highlights the necessity of conducting a thorough requirement engineering analysis and developing a low-fidelity prototype, followed by an SUS analysis. These measures are particularly critical when disseminating sensitive information, such as sexual health, through digital platforms. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12905-023-02839-6.
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Affiliation(s)
- Clarissa Soehnchen
- Health Informatics, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Anja Burmann
- Department Healthcare, Fraunhofer Institute for Software and Systems Engineering, Dortmund, Germany
| | - Maike Henningsen
- School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Sven Meister
- Health Informatics, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
- Department Healthcare, Fraunhofer Institute for Software and Systems Engineering, Dortmund, Germany
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Soehnchen C, Weirauch V, Schmook R, Henningsen M, Meister S. An acceptance analysis of a sexual health education digital tool in resource-poor regions of Kenya: an UTAUT based survey study. BMC Womens Health 2023; 23:676. [PMID: 38114976 PMCID: PMC10729446 DOI: 10.1186/s12905-023-02839-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Unplanned pregnancies and sexually transmitted diseases are a concern in Sub-Saharan Africa, particularly in low-income areas. Access to sexual health information is limited, partly due to the absence of comprehensive sex education in the national school curriculum and social taboos. In response to these challenges, this study introduces a web-based prototype, designed to provide essential sexual health information, targeting 18 to 35-year-old Kenyans, focusing on contraception, menstruation, and female genital mutilation. METHOD Aiming to investigate young adults' behavioral intention to use a digital tool for sexuality education, by analyzing factors affecting acceptance and usability in low-income and resource-poor regions in Kenya. To explore the acceptability and use of the developed digital tool, this study used a modified version of the Unified Theory of Acceptance and Use of Technology (UTAUT), complemented by the System Usability Scale (SUS) questionnaire. For statistical analysis, a Structural Equation Model (SEM) including Confirmatory Factor Analysis (CFA) and Linear Regression was used. Regarding the reporting of the E-survey results, the Checklist for Reporting Results of Internet E-surveys (CHERRIES), was considered. RESULTS Survey information from 77 persons (69 female, 7 male, 1 diverse) were collected. A modified UTAUT appears as an appropriate model for measuring the constructs and integrating evidence-based approaches to advanced and safe sexual healthcare information. Results from the SEM showed perceived usefulness, attitude towards healthcare integrated evidence technology, and usability as well as having a significant positive impact on the acceptance, the intention to use as well as wellbeing. Having the resources and knowledge necessary for the usage of a digital tool turns out to have a significant negative impact. A SUS score of 67.3 indicates the usability of the tool for sexual health information, assessed as okay. CONCLUSIONS The study adopts validated methods to assess the acceptability and usability of a digital sexual health education tool in Kenya. Emphasizing its potential effectiveness and highlighting the influence of cultural and contextual factors on technology adoption.
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Affiliation(s)
- Clarissa Soehnchen
- Faculty of Health Informatics / School of Medicine, Witten/Herdecke University, Witten/Herdecke, Deutschland.
- Department Health Care, Fraunhofer Institute for Software and Systems Engineering ISST, Dortmund, Germany.
| | - Vera Weirauch
- Department Health Care, Fraunhofer Institute for Software and Systems Engineering ISST, Dortmund, Germany
| | - Rebecca Schmook
- Department Health Care, Fraunhofer Institute for Software and Systems Engineering ISST, Dortmund, Germany
| | - Maike Henningsen
- Faculty of Health Informatics / School of Medicine, Witten/Herdecke University, Witten/Herdecke, Deutschland
| | - Sven Meister
- Faculty of Health Informatics / School of Medicine, Witten/Herdecke University, Witten/Herdecke, Deutschland
- Department Health Care, Fraunhofer Institute for Software and Systems Engineering ISST, Dortmund, Germany
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Soehnchen C, Rietz A, Weirauch V, Meister S, Henningsen M. Creating an Intercultural User-Centric Design for a Digital Sexual Health Education App for Young Women in Resource-Poor Regions of Kenya: Qualitative Self-Extended Double Diamond Model for Requirements Engineering Analysis. JMIR Form Res 2023; 7:e50304. [PMID: 37921860 PMCID: PMC10656664 DOI: 10.2196/50304] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/08/2023] [Accepted: 09/22/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND The stigmatization around sexual health due to culture, religious traditions, and norms leads to myths and a lack of available information and resources related to universal access to sexual and reproductive health services. Additional sexual health education not being part of the Kenya school curriculum leads to insufficient access to knowledge about safe contraception, menstruation, and female genital mutilation. A digital app could support and provide education and information for universal equal access, addressing United Nations Sustainable Development Goals 3, 4, and 5. OBJECTIVE The study targeted the requirements for establishing a reusable framework to develop a successful accessible web-based sexual health education app and the behavioral intention to use it to obtain sexual health information by mainly young women in Kenya. METHODS The double diamond model, with a problem room including the discover and define phases, enriched with cultural aspects and modeled to a self-expanded intercultural research model was used in a user-centered design thinking approach to develop a framework for requirements engineering analysis. For problem identification, semistructured pilot phase interviews based on Consolidated Criteria for Reporting Qualitative Research guidelines were conducted, followed by expert interviews for qualitative content analysis. A sample size of 12 pilot phase interviews and 5 expert interviews was determined using data saturation. The responses were coded and analyzed according to the affinity mapping method. RESULTS The requirements engineering analysis showed potential enablers of and barriers to the use of a digital sexual health education app. Through this qualitative study, a conservative cultural background, classic text communication, and the influence of social affiliation within society were identified as barriers, which should be enhanced through visual and auditory channels as well as a fictional character in the app. CONCLUSIONS The developed intercultural research model provides an impetus to providing digital sexual health education, integrating culture-specific aspects in the design process, while focusing on cultural and religious stigmata. The reusable framework enables identifying and overcoming hurdles in providing information about taboo and intimate topics. The overall use of online education tools focusing on intimate topics is correlated with accessibility and understanding specific cultural needs while delivering content on a basic and comprehensive level. It helps the target user from a social conservative background and in resource-poor circumstances to benefit from a digital educational solution.
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Affiliation(s)
- Clarissa Soehnchen
- HealthCare Department, Fraunhofer Institute for Software and System Engineering, Dortmund, Germany
- Health Care Informatics, Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Annika Rietz
- HealthCare Department, Fraunhofer Institute for Software and System Engineering, Dortmund, Germany
| | - Vera Weirauch
- HealthCare Department, Fraunhofer Institute for Software and System Engineering, Dortmund, Germany
| | - Sven Meister
- HealthCare Department, Fraunhofer Institute for Software and System Engineering, Dortmund, Germany
- Health Care Informatics, Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Maike Henningsen
- Health Care Informatics, Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
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Calhoun LM, Mandal M, Onyango B, Waga E, McGuire C, van den Akker T, Beňová L, Delvaux T, Zulu EM, Speizer IS. "So let me give you money, you give me what I want": decision-making priorities around contraceptive method and source choice among young women in Kenya. Reprod Health 2023; 20:96. [PMID: 37365630 PMCID: PMC10294346 DOI: 10.1186/s12978-023-01641-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 06/19/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Many factors influence young women's choice of contraceptive methods and where to source them, yet less is known about whether one of these choices (method or source) is prioritized and the relationship between these choices. This study qualitatively explored decision-making around contraceptive method and source choice among young women in Kenya. METHODS In August-September 2019, 30 in-depth interviews were conducted with women ages 18-24 who had used two or more contraceptive methods and resided in three counties: Nairobi, Mombasa or Migori. Participants were recruited from public and private health facilities and pharmacies. Interview guides captured information about decision-making processes for each contraceptive method the respondent had ever used. Responses were audio-recorded, transcribed, translated into English, coded, and analyzed thematically. RESULTS The majority of respondents knew which method they wanted to use prior to seeking it from a source. This was true for all types of methods that women ever used. Of the small number of respondents who selected their source first, most were in the post-partum period or experiencing side effects and sought counseling at a source before choosing a method. CONCLUSIONS This study highlights the importance of providing young women with high quality counseling that provides full information about contraceptive options and addresses that young women's needs vary along the reproductive health continuum of care. This will ensure that young women have information to inform future contraceptive decision-making prior to seeking care.
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Affiliation(s)
- Lisa M. Calhoun
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 West Franklin Street, Suite 210, NC 27516 Chapel Hill, USA
- Athena Institute, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Mahua Mandal
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 West Franklin Street, Suite 210, NC 27516 Chapel Hill, USA
| | | | - Erick Waga
- African Institute for Development Policy, Nairobi, Kenya
| | - Courtney McGuire
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 West Franklin Street, Suite 210, NC 27516 Chapel Hill, USA
| | - Thomas van den Akker
- Athena Institute, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Eliya M. Zulu
- African Institute for Development Policy, Nairobi, Kenya
| | - Ilene S. Speizer
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 West Franklin Street, Suite 210, NC 27516 Chapel Hill, USA
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
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Kamuyango A, Yu T, Ao CK, Hu SC, Salim LA, Sulistyorini Y, Li CY. Associations of Urban Residence and Wealth Index With Various Sources of Contraceptives Among Young Women Aged 15-24 Years in 25 Sub-Saharan African Countries. J Adolesc Health 2023; 72:599-606. [PMID: 36599761 DOI: 10.1016/j.jadohealth.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Appreciating user differences in contraceptive sources is essential for improving contraceptive access and safeguarding an equitable and sustainable future. Therefore, this study explored whether urban residence and individual wealth are associated with where women access contraception (e.g., government, private, or nongovernmental organization provider) and assessed whether these associations are modified by the income level in the respondents' country of residence. METHODS We analyzed the cross-sectional data of Demographic Health Surveys conducted between 2009 and 2020 in 25 countries. The final data set included 25,081 young women aged between 15 and 24 years who are using contraceptives. Multinomial logistic regression models were established to assess the associations of our outcome variable, namely, various contraceptive sources, with our main independent variables, namely, urban residence and wealth index. We also assessed the potential effect modification by country income level on the above associations. RESULTS We observed obvious urban-rural and rich-poor disparities in odds of using contraceptive sources. Generally, living in urban residences and being wealthy were positively associated with all sources of contraceptives. However, these associations were mostly modified by country income level. People living in urban residences utilized more private sources, especially in low-income (beta coefficient, B = 0.973) and upper-middle-income countries (B = 1.361). Young women in urban areas across all analyzed countries were also more likely to use contraceptives from other sources (B = 0.267). In addition, women from poor households were less likely to use private sources (B = -1.166) and other sources (B = -0.547). DISCUSSION Even though young women may prefer private sources of contraceptives due to their confidentiality and flexible hours, these sources carry more benefits for rich and urban young women than for poor and rural women. The differential accessibility and affordability may account for the observed urban-rural and rich-poor disparities in using contraceptive sources, respectively, and the income level of a country is likely to modify such disparities.
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Affiliation(s)
- Asantesana Kamuyango
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsung Yu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chon-Kit Ao
- Department of Economics, College of Social Sciences, National Cheng Kung University, Tainan, Taiwan
| | - Susan C Hu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Healthy Cities Research Center, Research and Services Headquarter, National Cheng Kung University, Tainan, Taiwan
| | - Lutfi Agus Salim
- Division of Biostatistics and Demography, Department of Epidemiology, Biostatistics, Population Studies and Health Promotion, Faculty of Public Health, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Yuly Sulistyorini
- Division of Biostatistics and Demography, Department of Epidemiology, Biostatistics, Population Studies and Health Promotion, Faculty of Public Health, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of Biostatistics and Demography, Department of Epidemiology, Biostatistics, Population Studies and Health Promotion, Faculty of Public Health, Universitas Airlangga, Surabaya, East Java, Indonesia; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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Winston J, Calhoun LM, Guilkey D, Macharia PM, Speizer IS. Choice of a family planning outlet in urban areas: The role of distance and quality of services in Kenya and Uganda. Front Glob Womens Health 2023; 4:1117849. [PMID: 37066040 PMCID: PMC10099502 DOI: 10.3389/fgwh.2023.1117849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/13/2023] [Indexed: 04/01/2023] Open
Abstract
IntroductionQuality of care and physical access to health facilities affect facility choice for family planning (FP). These factors may disproportionately impact young contraceptive users. Understanding which components of service quality drive facility choice among contraceptive users of all ages can inform strategies to strengthen FP programming for all potential users of FP.MethodsThis study uses data from Population Services International's Consumer's Market for Family Planning (CM4FP) project, to examine drivers of facility choice among female FP users. The data collected from female contraceptive users, the outlet where they obtained their contraceptive method, and the complete set of alternative outlets in select urban areas of Kenya and Uganda were used. We use a mixed logit model, with inverse probability weights to correct for selection into categories of nonuse and missing facility data. We consider results separately for youth (18–24) and women aged 25–49 in both countries.ResultsWe find that in both countries and across age groups, users were willing to travel further to public outlets and to outlets offering more methods. Other outlet attributes, including signage, pharmacy, stockouts, and provider training, were important to women in certain age groups or country.DiscussionThese results shed light on what components of service quality drive outlet choice among young and older users and can inform strategies to strengthen FP programming for all potential users of FP in urban settings.
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Affiliation(s)
- Jennifer Winston
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Correspondence: Jennifer Winston
| | - Lisa M. Calhoun
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - David Guilkey
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Economics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Peter M. Macharia
- Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
- Population Health Unit, Kenya Medical Research Institute – Wellcome Trust Research Programme, Nairobi, Kenya
| | - Ilene S. Speizer
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Maternal and Child Health, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Wood SN, Milkovich R, Thiongo M, Gichangi P, Byrne ME, Devoto B, Anglewicz P, Decker MR. Disruptions to youth contraceptive use during COVID-19: Mixed-methods results from Nairobi, Kenya. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001005. [PMID: 36962989 PMCID: PMC10021138 DOI: 10.1371/journal.pgph.0001005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/16/2023] [Indexed: 02/25/2023]
Abstract
Ensuring access to sexual and reproductive health (SRH) services for adolescents is a global priority, given the detrimental health and economic impact of unintended pregnancies. To examine whether and how COVID-19 affected access to SRH services, we use mixed-methods data from young men and women in Nairobi, Kenya to identify those at greatest risk of contraceptive disruptions during COVID-19 restrictions. Analyses utilize cross-sectional data collected from August to October 2020 from an existing cohort of youth aged 16-26. Unadjusted and adjusted logistic regression examined sociodemographic, contraceptive, and COVID-19-related correlates of contraceptive disruption among users of contraception. Qualitative data were collected concurrently via focus group discussions (n = 64, 8 groups) and in-depth interviews (n = 20), with matrices synthesizing emergent challenges to obtaining contraception by gender. Among those using contraception, both young men (40.4%) and young women (34.6%) faced difficulties obtaining contraception during COVID-19. Among young men, difficulty was observed particularly for those unable to meet their basic needs (aOR = 1.60; p = 0.05). Among young women, risk centered around those with multiple partners (aOR = 1.91; p = 0.01), or who procured their method from a hospital (aOR = 1.71; p = 0.04) or clinic (aOR = 2.14; p = 0.03). Qualitative data highlight economic barriers to obtaining contraceptives, namely job loss and limited supply of free methods previously available. Universal access to a variety of contraceptive methods during global health emergencies, including long-acting reversible methods, is an essential priority to help youth avert unintended pregnancies and withstand periods of disruptions to services. Non-judgmental, youth-friendly services must remain accessible throughout the pandemic into the post-COVID-19 period.
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Affiliation(s)
- Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Rachel Milkovich
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Mary Thiongo
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
| | - Peter Gichangi
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
- Department of Public Health and Primary Care, Technical University of Mombasa, Mombasa, Kenya
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Meagan E Byrne
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Bianca Devoto
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Philip Anglewicz
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States of America
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10
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Williams CR, Britton LE, Bullington BW, Wambua DM, Onyango DO, Tumlinson K. Frequency and impact of long wait times for family planning in public-sector healthcare facilities in Western Kenya. Glob Health Action 2022; 15:2128305. [PMID: 36190697 PMCID: PMC9543147 DOI: 10.1080/16549716.2022.2128305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Long wait times for family planning services are a barrier to high quality care and client satisfaction. Existing literature examining family planning wait times has methodological limitations, as most studies use data collected during exit interviews, which are subject to recall, courtesy, and selection bias. OBJECTIVE We sought to employ a mixed methods approach to capture the prevalence, length, causes, and impacts of wait times for family planning services in Western Kenya. METHODS We used mystery clients, focus groups, key informant interviews, and journey mapping workshops to measure and describe family planning wait times. Fifteen mystery clients visited 60 public-sector facilities to quantitatively capture wait times. We conducted eight focus group discussions with 55 current or former family planning clients and 19 key informant interviews to understand facility-level barriers to family planning and feasible solutions. Finally, we visualized the process of seeking and providing family planning with journey mapping workshops with nine clients and 12 providers. RESULTS Mystery clients waited, on average, 74 minutes to be seen for family planning services. In focus group discussions and key informant interviews, three themes emerged: the nature of wait times, the impact of wait times, and how to address wait times. Clients characterized long wait times as a barrier to achieving their reproductive desires. Key informants perceived provider shortages to cause long wait times, which reduced quality of family planning services. Both providers and family planning clients suggested increasing staffing or offering specialization to decrease wait times and increase quality of care. CONCLUSION Our mixed methods approach revealed that wait times for family planning services were common, could be extensive, and were viewed as a barrier to high quality of care by clients, providers, and key informants. Across the board, participants felt that addressing workforce shortages would enhance service delivery and thus promote reproductive autonomy among women in Kenya.
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Affiliation(s)
- Caitlin R. Williams
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Brooke W. Bullington
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,CONTACT Brooke W. Bullington Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill135 Dauer Drive, 2101 McGavran-Greenberg Hall, Chapel Hill, NC27599-7445, USA
| | | | - Dickens Otieno Onyango
- Kisumu County Department of Health, Kisumu, Kenya,Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, Netherlands
| | - Katherine Tumlinson
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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11
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Acre VN, Dijkerman S, Calhoun LM, Speizer IS, Poss C, Nyamato E. The association of quality contraceptive counseling measures with postabortion contraceptive method acceptance and choice: results from client exit interviews across eight countries. BMC Health Serv Res 2022; 22:1519. [PMID: 36514040 PMCID: PMC9749205 DOI: 10.1186/s12913-022-08851-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 11/17/2022] [Indexed: 12/15/2022] Open
Abstract
The availability of a variety of modern contraceptive methods is necessary but insufficient to provide a high-quality contraceptive service to postabortion clients. Women, especially young women, must be empowered to make informed choices about which methods they receive, including whether to use contraception following an abortion service. In this study, we conducted 2,488 client exit interviews with abortion clients after their induced abortion service or postabortion care visit in Ipas-supported health facilities in eight countries: Argentina, Bolivia, Ethiopia, Kenya, Mexico, Nepal, Nigeria, and Uganda. We evaluated the quality of postabortion contraceptive counseling across two domains of contraceptive counseling: information exchange and interpersonal communication. We measured the association between these quality elements and two outcomes: 1) client-perceived choice of contraceptive method and 2) whether or not the client received a modern contraceptive method. We examined these relationships while adjusting for sociodemographic and confounding variables, such as the client feeling pressure from the provider to accept a particular method. Finally, we determined whether associations identified differ by age group: under 25 and 25+. Information exchange and interpersonal communication both emerged as important counseling domains for ensuring that clients felt they had the ability to choose a contraceptive method. The domain of information exchange was associated with having received a contraceptive method for all abortion clients, including young abortion clients under 25. Nearly 14% of clients interviewed reported pressure from the provider to accept a particular contraceptive method; and pressure from the provider was significantly associated with a client's perception of not having a choice in selecting and receiving a contraceptive method during her visit to the facility. Improving interpersonal communication, strengthening contraceptive information exchange, and ensuring clients are not pressured by a provider to accept a contraceptive method, must all be prioritized in postabortion contraceptive counseling in health facilities to ensure postabortion contraceptive services are woman-centered and rights-based for abortion clients.
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Affiliation(s)
| | | | - Lisa M Calhoun
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ilene S Speizer
- Department of Maternal and Child Health and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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12
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Calhoun LM, Mandal M, Onyango B, Waga E, McGuire C, Zulu EM, van den Akker T, Benova L, Delvaux T, Speizer IS. Contraceptive method use trajectories among young women in Kenya: A qualitative study. Front Glob Womens Health 2022; 3:973971. [PMID: 36177336 PMCID: PMC9513027 DOI: 10.3389/fgwh.2022.973971] [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: 06/20/2022] [Accepted: 08/15/2022] [Indexed: 12/15/2022] Open
Abstract
Background Many young women experience important key life transitions during adolescence and early adulthood, such as initiation of sexual activity, first use of contraceptives, marriage, and childbirth. For young women to be able to plan and manage their lives, it is critical to understand how these life events intersect and shape their contraceptive decision-making. This study aims to explore young women's contraceptive method use trajectories, including the factors that influence contraceptive decision-making throughout adolescence and youth. Methodology In 2019, the Full Access, Full Choice project (FAFC), implemented by the University of North Carolina at Chapel Hill and the African Institute for Development Policy, conducted 30 in-depth interviews with young women aged 18-24 years in three counties in Kenya (Nairobi, Mombasa and Migori). Eligible respondents had used two or more modern contraceptive methods. Interview guides utilized a modified life history approach to capture details about respondents' contraceptive use and life experiences from the time they first used contraception until the time of interview. Results We identified five separate contraceptive use trajectories based on the occurrence and timing of marriage, childbirth, and contraceptive method choice as well as various influences on contraceptive decision-making. The majority of respondents began their contraceptive journey by using male condoms or emergency contraception, but subsequent contraceptive decisions were varied across trajectories and influenced by different factors. For many women, the initiation of a non-coitally dependent method occurred after the birth of a child; for some, this was the first method used. Once women transitioned to using a non-coitally dependent method such as injectables or implants, many cycled through different methods to find one that had fewer side effects or provided the desired duration of protection. Discussion This study highlights the nuanced needs of young women throughout their adolescent and youth years in Kenya. This suggests that programs and policies need to encompass young women's diversity of experiences and motivations to best serve them.
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Affiliation(s)
- Lisa M. Calhoun
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States,Athena Institute, Vrije Universiteit, Amsterdam, Netherlands,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium,*Correspondence: Lisa M. Calhoun
| | - Mahua Mandal
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Erick Waga
- African Institute for Development Policy, Nairobi, Kenya
| | - Courtney McGuire
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Eliya M. Zulu
- African Institute for Development Policy, Nairobi, Kenya
| | - Thomas van den Akker
- Athena Institute, Vrije Universiteit, Amsterdam, Netherlands,Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, Netherlands
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ilene S. Speizer
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States,Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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13
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Perceptions of peer contraceptive use and its influence on contraceptive method use and choice among young women and men in Kenya: a quantitative cross-sectional study. Reprod Health 2022; 19:16. [PMID: 35062970 PMCID: PMC8777431 DOI: 10.1186/s12978-022-01331-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 12/27/2021] [Indexed: 11/18/2022] Open
Abstract
Background Prior research has established that an individual’s social environment may influence his or her reproductive behaviors, yet less is known about peer influence on contraceptive use among young people (ages 15–24). In Kenya, the site of this study, 15% of adolescents ages 15–19 have begun childbearing and 45% of sexually active young women report current use of a modern contraceptive method. This highlights the need to better understand what factors influence young people to use contraception. The objective of this study is to explore the relationship between the perception of peers’ use of contraceptives and contraceptive use and method choice among young men and women in Kenya. Methods This study utilizes a nationally representative sample of women and men aged 15–24 years from the 2018 and 2019 cross sectional Shujaaz State of the Kenyan Youth annual surveys. Among the sample of sexually experienced young people (59%), multivariable multinomial logistic regression was used to explore the association between the perception of peers’ use of contraceptives and the respondent’s contraceptive method choice: non-user, condom use or use of any other modern method. Results are presented separately for young men and young women. Results Our results show that sexually experienced young men and women who perceive that their peers are using contraceptives are more likely to report current use of condoms compared to being a nonuser (RRR = 2.12, p < 0.001, RRR = 2.59, p < 0.001, respectively); they are also more likely to use condoms than another modern method of contraception (RRR = 2.13, p = 0.034, RRR = 1.71, p = 0.014, respectively). Young women are more likely to use another modern method (not including condoms) than be a nonuser when they perceive that their peers’ use contraceptives (RRR = 1.51, p = 0.020). Conclusions The results of this study highlight the important role of peer influence on young people’s contraceptive choices. These findings can be used to develop programs that encourage behavior change communication activities in Kenya that focus on normalizing use of a full range of contraceptive methods among peer groups of sexually experienced young people. In Kenya, about 15% of women age 15–19 have already had a birth and approximately one third of these women did not want to have a child at that time. Yet about 45% of sexually active women ages 15–24 report that they currently use family planning (FP). Among young people, friends and peers are an important influence on behaviors. This study focused on a representative sample from Kenya of female and male youth (ages 15–24) who ever had sex. Men and women were asked questions about use of FP, if they think their peers use FP and about characteristics such as age and education. The results showed that young women and men who believed their peers use FP were more likely to use FP themselves. Also, young men and women who believed that peers use FP were more likely to use condoms than not use any FP and more likely to use condoms than to use another modern method of FP. Young women who thought their peers use were more likely to use another modern method (not including condoms) than to be a nonuser of FP. Programs targeting young people should include information on a range of FP methods and aim to include groups of peers and encourage open discussion.
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