Assessing the Competency and Acceptability of Community Health Worker Provision of Standard Days Method® in Family Planning Services in Gisagara District, Rwanda

VanEnk, Lauren; Shelus, Victoria; Mugeni, Catherine; Mukabatsinda, Marie; Cachan, Jeannette

doi:10.1111/sifp.12059

Cited by 2 publications

(2 citation statements)

References 33 publications

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“…Family planning (FP) studies have explored the acceptability of specific MCMs such as intrauterine devices (IUDs) [ 5 ], female condom [ 6 ], male condom shape [ 7 ], self-injections [ 8 ], and contraceptive vaginal rings [ 9 , 10 ] as well as behaviour change methods to increase FP uptake including mobile FP decision aids [ 11 ] and mobile phone behavioural interventions [ 12 ]. FP studies have also investigated the delivery of interventions by different cadres of facility- and community-based health workers such as community health workers (CHWs) delivering the standard days method [ 13 ] and community extension workers delivering subdermal implants [ 14 ]. However, acceptability is rarely defined in these studies despite commonly being implied through the measurement of quantitative outcomes or through the interrogation of qualitative themes.…”

Section: Introductionmentioning

confidence: 99%

Context-acceptability theories: example of family planning interventions in five African countries

et al. 2021

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Background Family planning (FP) can lengthen birth intervals and potentially reduce the risk of foetal death, low birthweight, prematurity, and being small for gestational age. Effective FP is most easily achieved through access to and acceptability of modern contraceptive methods (MCMs). This study aimed to identify mechanisms of acceptability and the contexts in which they are triggered and to generate theories to improve the selection and implementation of effective interventions by studying an intervention integrating FP with childhood immunisation services. Methods Qualitative interpretative synthesis of findings from realist evaluations of FP interventions in five African countries was guided by an analytical framework. Empirical mechanisms of acceptability were identified from semi-structured interviews and focus group discussions with key stakeholders (N = 253). The context in which these mechanisms were triggered was also defined. Empirical mechanisms of acceptability were matched to constructs of a theoretical framework of acceptability. Context-acceptability theories (CATs) were developed, which summarised constructs of acceptability triggered for specific actors in specified contexts. Examples of interventions that may be used to trigger acceptability for these actors were described. Results Seven CATs were developed for contexts with strong beliefs in religious values and with powerful religious leaders, a traditional desire for large families, stigmatisation of MCM use, male partners who are non-accepting of FP, and rumours or experiences of MCM side effects. Acceptability mechanisms included alignment with values and beliefs without requiring compromise, actors’ certainty about their ability to avoid harm and make the intervention work, and understanding the intervention and how it works. Additionally, acceptability by one group of actors was found to alter the context, triggering acceptability mechanisms amongst others. Conclusions This study demonstrated the value of embedding realist approaches within implementation research. CATs are transferable theories that answer the question: given the context, what construct of acceptability does an intervention need to trigger, or more simply, what intervention do we need to apply here to achieve our outcomes? CATs facilitate transfer of interventions across geographies within defined contexts.

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Section: Introductionmentioning

confidence: 99%

Context-acceptability theories: example of family planning interventions in five African countries

et al. 2021

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“…Further, 89% of clients reported knowledge of all key steps in the SDM after being counseled by the community health worker. 40 There was some evidence that improved job aids could have overcome clinical providers' oversight of community health worker SDM provision and counseling, 40 while task shifting or sharing were important and effective tools to disseminate the SDM.…”

Section: Pilot Introductions Of the Sdmmentioning

confidence: 99%

Implementation and Scale-Up of the Standard Days Method of Family Planning: A Landscape Analysis

Weis¹,

Festin

2020

Glob Health Sci Pract

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Pilot introductions of the Standard Days Method (SDM) of family planning demonstrated its potential to meet unmet contraceptive needs in key populations, strengthen male involvement, and increase overall contraceptive uptake. Few countries had implemented national scale-up due to barriers, such as competing resource priorities and uneven stakeholder engagement. Demand-side user barriers, including insufficient fertility awareness knowledge, were also constraints. Policy makers should determine the SDM's added value to the contraceptive method mix and identify potential barriers to its implementation. ABSTRACTThe Standard Days Method (SDM), a modern fertility awareness-based family planning method, has been introduced in 30 countries since its development in 2001. It is still unclear to what extent the SDM was mainstreamed within the family planning method mix, particularly in low-and middle-income country (LMIC) settings, where the SDM had been introduced by donors and implementing partners. This review of implementation science publications on the SDM in LMICs first looked at community pilot studies of the SDM to determine the acceptability of the method; correct use and efficacy rates; demographics of users; and changes to contraceptive prevalence rates and family planning behaviors, especially among men and couples. Then, we examined the status of the SDM in the 16 countries that had attempted to scale up the method within national family planning protocols, training, and service delivery. At the community level, evidence demonstrated a high level of acceptability of the method; efficacy rates comparable to the initial clinical trials; diversity in demographic characteristics of users, including first-time or recently discontinued users of family planning; increased male engagement in family planning; and improved couple's communication. Nationally, few countries had scaled up the SDM due to uneven stakeholder engagement, lackluster political will, and competing resource priorities. Results of this review could help policy makers determine the added value of the SDM in the contraceptive method mix and identify potential barriers to its implementation moving forward.

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Assessing the Competency and Acceptability of Community Health Worker Provision of Standard Days Method® in Family Planning Services in Gisagara District, Rwanda

Cited by 2 publications

References 33 publications

Context-acceptability theories: example of family planning interventions in five African countries

Context-acceptability theories: example of family planning interventions in five African countries

Implementation and Scale-Up of the Standard Days Method of Family Planning: A Landscape Analysis

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