The effect of job aids on knowledge retention among Patent and Proprietary Medicine Vendors trained to administer injectable contraceptives: Longitudinal results from implementation science in Nigeria.
Abstract Background: To increase access to voluntary family planning (FP) services, policymakers in Nigeria are debating how to task share the provision of injectable contraceptives to drug shop owners known as Patent and Proprietary Medicine Vendors (PPMVs). Globally, task sharing FP services to drug shops is a promising practice, but more information is needed on how to support PPMVs in providing high quality FP, including injectable services. Methods: 194 PPMVs were trained to provide FP counseling and administration of injectable contraceptive services in Bauchi, Cross River, Ebonyi and Kaduna states. PPMVs were interviewed immediately before, immediately after, and 9 months after the training. Three variables were used to assess injectable contraceptive knowledge: 1) intramuscular depot-medroxyprogesterone acetate (DMPA-IM) knowledge: a combination of three questions related to device type, injection location, and reinjection frequency; 2) subcutaneous DMPA (DMPA-SC) knowledge: a combination of the same three questions but for DMPA-SC; and 3) knowledge of at least 4 of the 7 common side effects of progestin-only injectables. Three separate adjusted logistic regression models were conducted to determine the factors that influence PPMV knowledge of injectable contraceptives 9 months after the training. Results: A little over half of PPMVs (56%) reported using at least two job aids at 9 months. PPMVs’ knowledge of DMPA-IM, DMPA-SC and side effects were low before the training but increased immediately after. Nine months later, knowledge levels remained higher than pre-test levels but generally reduced compared to post-test levels. PPMVs who reported using at least 2 FP job aids were 2.6 (95% CI: 1.4-5.1) times more likely to have complete DMPA-IM knowledge 9 months after the training compared to those who did not use job aids or only used one, while adjusting for PPMV characteristics. Similar results were observed for knowledge of DMPA-SC (AOR: 2.5; 95% CI: 1.2-4.6) and side effects (AOR: 2.5; 95% CI: 1.3-4.8). Conclusion: Training PPMVs to use proven FP job aids should be incorporated into routine trainings, as they reinforce knowledge months after a training and can help PPMVs to retain information. When designing scale-up programs, jobs aids are a good investment for larger capacity-building strategies.