Ethical Foundations of Client-Centered Care in Family Planning

Abstract Background Person-centered quality for family planning has been gaining increased attention, yet few interventions have focused on this, or measured associations between person-centered quality for family planning and family planning outcomes (uptake, continuation, etc.). In India, the first point of contact for family planning is often the community health care worker, in this case, Accredited Social Health Activists (ASHAs). Methods In this study, we evaluate a training on person-centered family planning as an add-on to a training on family planning provision for urban ASHAs in Varanasi, India in 2019 using mixed methods. We first validate a scale to measure person-centered family planning in a community health worker population and find it to be valid. Higher person-centered family planning scores are associated with family planning uptake. Results Comparing women who saw intervention compared to control ASHAs, we find that the intervention had no impact on overall person-centered family planning scores. Women in the intervention arm were more likely to report that their ASHA had a strong preference about what method they choose, suggesting that the training increased provider pressure. However, qualitative interviews with ASHAs suggest that they value person-centered care for their interactions and absorbed the messages from the intervention. Conclusions More research is needed on how to intervene to change behaviors related to person-centered family planning. Trial registration This study received IRB approval from the University of California, San Francisco (IRB # 15–25,950) and was retrospectively registered at clinicaltrials.gov (NCT04206527).

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A mixed-methods evaluation of the impact of a person-centered family planning intervention for community health workers on family planning outcomes in India

10.21203/rs.3.rs-29183/v4 ◽

2020 ◽

Author(s):

Nadia Diamond-Smith ◽

Claire McDonell ◽

Ananta Basudev Sahu ◽

Kali Prasad Roy ◽

Katie Giessler

Keyword(s):

Mixed Methods ◽

Family Planning ◽

Community Health ◽

San Francisco ◽

Health Workers ◽

Qualitative Interviews ◽

Centered Care ◽

The University ◽

Care Worker ◽

The Impact

Abstract Background: Person-centered quality for family planning has been gaining increased attention, yet few interventions have focused on this, or measured associations between person-centered quality for family planning and family planning outcomes (uptake, continuation, etc.). In India, the first point of contact for family planning is often the community health care worker, in this case, Accredited Social Health Activists (ASHAs). Methods: In this study, we evaluate a training on person-centered family planning as an add-on to a training on family planning provision for urban ASHAs in Varanasi, India in 2019 using mixed methods. We first validate a scale to measure person-centered family planning in a community health worker population and find it to be valid. Higher person-centered family planning scores are associated with family planning uptake. Results: Comparing women who saw intervention compared to control ASHAs, we find that the intervention had no impact on overall person-centered family planning scores. Women in the intervention arm were more likely to report that their ASHA had a strong preference about what method they choose, suggesting that the training increased provider pressure. However, qualitative interviews with ASHAs suggest that they value person-centered care for their interactions and absorbed the messages from the intervention.Conclusions: More research is needed on how to intervene to change behaviors related to person-centered family planning. This study received IRB approval from the University of California, San Francisco (IRB # 15-25950) and was retrospectively registered at clinicaltrials.gov (NCT04206527)

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Understanding Women Veterans’ Family Planning Counseling Experiences and Preferences to Inform Patient-Centered Care

Women s Health Issues ◽

10.1016/j.whi.2019.03.002 ◽

2019 ◽

Vol 29 (3) ◽

pp. 283-289 ◽

Cited By ~ 3

Author(s):

Lisa S. Callegari ◽

Erica V. Tartaglione ◽

Sara L. Magnusson ◽

Karin M. Nelson ◽

David E. Arteburn ◽

...

Keyword(s):

Family Planning ◽

Women Veterans ◽

Patient Centered Care ◽

Patient Centered ◽

Family Planning Counseling ◽

Centered Care

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A mixed-methods evaluation of the impact of a person-centered family planning intervention for community health workers on family planning outcomes in India

10.21203/rs.3.rs-29183/v3 ◽

2020 ◽

Author(s):

Nadia Diamond-Smith ◽

Claire McDonell ◽

Ananta Basudev Sahu ◽

Kali Prasad Roy ◽

Katie Giessler

Keyword(s):

Mixed Methods ◽

Family Planning ◽

Community Health ◽

San Francisco ◽

Health Workers ◽

Qualitative Interviews ◽

Centered Care ◽

The University ◽

Care Worker ◽

The Impact

Abstract Background: Person-centered quality for family planning has been gaining increased attention, yet few interventions have focused on this, or measured associations between person-centered quality for family planning and family planning outcomes (uptake, continuation, etc.). In India, the first point of contact for family planning is often the community health care worker, in this case, Accredited Social Health Activists (ASHAs). Methods: In this study, we evaluate a training on person-centered family planning as an add-on to a training on family planning provision for urban ASHAs in Varanasi, India in 2019 using mixed methods. We first validate a scale to measure person-centered family planning in a community health worker population and find it to be valid. Higher person-centered family planning scores are associated with family planning uptake. Results: Comparing women who saw intervention compared to control ASHAs, we find that the intervention had no impact on overall person-centered family planning scores. Women in the intervention arm were more likely to report that their ASHA had a strong preference about what method they choose, suggesting that the training increased provider pressure. However, qualitative interviews with ASHAs suggest that they value person-centered care for their interactions and absorbed the messages from the intervention.Conclusions: More research is needed on how to intervene to change behaviors related to person-centered family planning. This study received IRB approval from the University of California, San Francisco (IRB # 15-25950) and was retrospectively registered at clinicaltrials.gov (NCT04206527)

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Person-centred Quality, Provider Involvement and Family Planning Continuation in India

10.21203/rs.3.rs-49054/v1 ◽

2020 ◽

Author(s):

Nadia Diamond-Smith ◽

Beth Phillips ◽

Patience Afulani ◽

Aradhana Srivast ◽

Ginger Golub ◽

...

Keyword(s):

Quality Of Care ◽

Family Planning ◽

Quality Measures ◽

Power Dynamics ◽

Care Experience ◽

Person Centered Care ◽

Centered Care ◽

And Gender ◽

The Impact

Abstract Background: Quality of care of family planning provision has many dimensions, and measuring and understanding these different components is challenging. Furthermore, understanding which components are most important for women’s experiences and method continuation is essential for improving the quality of care provision. Methods: We use longitudinal data from India to explore the impact of different measures of quality (provider preference, provider involvement, and a newly developed scale of person-centered care experiences) on method continuation. We also look at associations between the quality measures and discuss why different measures may be more salient in different contexts. Results: We find that a woman’s person-centered care experience is not associated with continuation in India. Providers having a strong preference is associated with continuation. Conclusions: Certain measures of person-centered quality appear to impact family planning continuation, but the validated person-centered care measure is not. Socio-cultural factors such as power dynamics and gender norms likely impact expectations, and need to be considered in interpreting and choosing quality measures.

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Do quality improvement interventions for person-centered family planning work? Evidence from Kenya

Gates Open Research ◽

10.12688/gatesopenres.13120.1 ◽

2020 ◽

Vol 4 ◽

pp. 44

Author(s):

Nadia Diamond-Smith ◽

Katie Giessler ◽

Meghan Munson ◽

Cathy Green

Keyword(s):

Quality Improvement ◽

Family Planning ◽

Lessons Learned ◽

Cross Sectional ◽

Middle Income ◽

Health And Human Rights ◽

Centered Care ◽

Improvement Interventions ◽

Quality Improvement Interventions ◽

The Impact

Background: Quality of care for family planning, especially person-centered care, is important from a health and human-rights standpoint. Few interventions have aimed to improve person-centered family planning (PCFP) in low and middle-income countries. In this study, we tested the impact of a quality improvement (QI) intervention in Kenya on aspects of PCFP included in a validated measure of PCFP and on the overall PCFP scale. Methods: We conducted QI cycles in three facilities providing family planning in Nairobi and Kiambu Counties, Kenya, with three facilities serving as controls. Cross-sectional baseline data was collected from 478 women receiving family planning in 2016 and end line data was collected from 640 in 2017-18. We analysed the impact of the QI intervention on PCFP using difference-in-difference models. Results: We found no impact of the QI intervention on either PCFP or the overall PCFP scale. Conclusions: We take away key lessons learned from the null findings of the intervention that are important for future interventions. Lessons learned include the need to be flexible in light of external factors that prolonged the study and probably led to burnout; and simplifying measurement and procedures.

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Modern contraceptive use among women in need of family planning in India: an analysis of the inequalities related to the mix of methods used

Reproductive Health ◽

10.1186/s12978-021-01220-w ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Fernanda Ewerling ◽

Lotus McDougal ◽

Anita Raj ◽

Leonardo Z. Ferreira ◽

Cauane Blumenberg ◽

...

Keyword(s):

Family Planning ◽

Contraceptive Use ◽

Wealth Quintile ◽

Modern Method ◽

Modern Contraceptive ◽

Contraceptive Methods ◽

Modern Methods ◽

Centered Care ◽

Using Data ◽

Long Acting

Abstract Objective To evaluate the type of contraceptives used by women in need of family planning in India and the inequalities associated with that use according to women's age, education, wealth, subnational region of residence and empowerment level. Methods Using data from the Indian National Family and Health Survey-4 (2015–2016), we evaluated the proportion of partnered women aged 15–49 years with demand for family planning satisfied (DFPS) with modern contraceptive methods. We also explored the share of each type of contraception [short- (e.g., condom, pill) and long-acting (i.e., IUD) reversible contraceptives and permanent methods] and related inequalities. Results The majority (71.8%; 95% CI 71.4–72.2) of women in need of contraception were using a modern method, most (76.1%) in the form of female sterilization. Condom and contraceptive pill were the second and third most frequently used methods (11.8% and 8.5%, respectively); only 3.2% reported IUD. There was a nearly linear exchange from short-acting to permanent contraceptive methods as women aged. Women in the poorest wealth quintile had DFPS with modern methods at least 10 percentage points lower than other women. We observed wide geographic variation in DFPS with modern contraceptives, ranging from 23.6% (95% CI 22.1–25.2) in Manipur to 93.6% (95% CI 92.8–94.3) in Andhra Pradesh. Women with more accepting attitudes towards domestic violence and lower levels of social independence had higher DFPS with modern methods but also had higher reliance on permanent methods. Among sterilized women, 43.2% (95% CI 42.7–43.7) were sterilized before age 25, 61.5% (95% CI 61.0–62.1) received monetary compensation for sterilization, and 20.8% (95% CI 20.3–21.3) were not informed that sterilization prevented future pregnancies. Conclusion Indian family planning policy should prioritize women-centered care, making reversible contraceptive methods widely available and promoted.

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A mixed-methods evaluation of the impact of a person-centered family planning intervention for community health workers on family planning outcomes in India

10.21203/rs.3.rs-29183/v2 ◽

2020 ◽

Author(s):

Nadia Diamond-Smith ◽

Claire McDonell ◽

Ananta Basudev Sahu ◽

Kali Prasad Roy ◽

Katie Giessler

Keyword(s):

Mixed Methods ◽

Family Planning ◽

Community Health ◽

San Francisco ◽

Health Workers ◽

Qualitative Interviews ◽

Centered Care ◽

The University ◽

Care Worker ◽

The Impact

Abstract Background: Person-centered quality for family planning has been gaining increased attention, yet few interventions have focused on this, or measured associations between person-centered quality for family planning and family planning outcomes (uptake, continuation, etc.). In India, the first point of contact for family planning is often the community health care worker, in this case, Accredited Social Health Activists (ASHAs). Methods: In this study, we evaluate a training on person-centered family planning as an add-on to a training on family planning provision for urban ASHAs in Varanasi, India in 2019 using mixed methods. We first validate a scale to measure person-centered family planning in a community health worker population and find it to be valid. Higher person-centered family planning scores are associated with family planning uptake. Results: Comparing women who saw intervention compared to control ASHAs, we find that the intervention had no impact on overall person-centered family planning scores. Women in the intervention arm were more likely to report that their ASHA had a strong preference about what method they choose, suggesting that the training increased provider pressure. However, qualitative interviews with ASHAs suggest that they value person-centered care for their interactions and absorbed the messages from the intervention.Conclusions: More research is needed on how to intervene to change behaviors related to person-centered family planning. This study received IRB approval from the University of California, San Francisco (IRB # 15-25950) and was retrospectively registered at clinicaltrials.gov (NCT04206527)

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Person-Centred Quality, Provider Involvement and Family Planning Continuation in India

10.21203/rs.3.rs-124362/v1 ◽

2020 ◽

Author(s):

Nadia Diamond-Smith ◽

Beth Phillips ◽

Patience Afulani ◽

Aradhana Srivast ◽

Ginger Golub ◽

...

Keyword(s):

Quality Of Care ◽

Family Planning ◽

Uttar Pradesh ◽

Power Dynamics ◽

Care Experience ◽

Person Centered Care ◽

Centered Care ◽

Secondary Objective ◽

And Gender

Abstract Background: Quality of care of family planning provision has many dimensions, including those related to a woman’s experience, or person-centered care, and measuring and understanding these different components is challenging. Understanding which components are most important for women’s experiences and method continuation is essential for improving the quality of care provision. The objective of this paper is to explore weather a recently developed scale to measure person-centered family planning experiences is associated with method continuation in India. The secondary objective is to compare this scale to other commonly used measures of quality, and if other measures are more associated with continuation. Methods: We use longitudinal data collected from women in Uttar Pradesh, India (N=225 at baseline, N=179 6 weeks later) to explore the association between different measures of quality (provider preference, provider involvement, and a newly developed scale of person-centered care experiences) and method continuation. Results: We find that a woman’s person-centered care experience is not associated with continuation in this population in India. Providers having a strong method preference is associated with continuation. Conclusion: Certain measures of person-centered quality appear to impact family planning continuation, but the validated person-centered care measure is not. Socio-cultural factors such as power dynamics and gender norms likely impact expectations, and need to be considered in interpreting and choosing quality measures.

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