Mixed-methods study on pharmacies as contraception providers to Kenyan young people: who uses them and why?

Gonsalves, Lianne; Wyss, Kaspar; Cresswell, Jenny A.; Waithaka, Michael; Gichangi, Peter; Hilber, Adriane Martin

doi:10.1136/bmjopen-2019-034769

Cited by 15 publications

(8 citation statements)

References 18 publications

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“…Private sector community pharmacies are a critical point of contraceptive access among AGYW in Kenya, often for reasons of privacy and convenience ( 45 , 46 ). Our findings, consistent with a recent study by Calhoun et al on young Kenyan women's contraceptive decision-making ( 47 ), suggest a high demand for provider contraceptive counseling among AGYW, which steers many to public sector clinics—despite their co-existing needs for privacy and after-hours access.…”

Section: Discussionmentioning

confidence: 99%

Priorities for contraceptive method and service delivery attributes among adolescent girls and young women in Kenya: a qualitative study

Harrington,

Hauber,

Ouma

et al. 2024

Front. Reprod. Health

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IntroductionDespite increasing global commitment to meeting the family planning needs of adolescent girls and young women (AGYW), there is limited research on how they prioritize contraceptive method and service delivery characteristics. In this qualitative study, we examine the specific elements that drive the contraceptive choices of Kenyan AGYW, and apply our findings to the development of attributes and levels for a discrete choice experiment (DCE).MethodsOur four-stage approach included data collection, data reduction, removing inappropriate attributes, and optimizing wording. Between June-October 2021, we conducted in-depth interviews with 30 sexually-active 15–24 year-old AGYW in Kisumu county, Kenya who were non-pregnant and desired to delay pregnancy. Interviews focused on priorities for contraceptive attributes, how AGYW make trade-offs between among these attributes, and the influences of preferences on contraceptive choice. Translated transcripts were qualitatively coded and analyzed with a constant comparative approach to identify key concepts. We developed and iteratively revised a list of attributes and levels, and pre-tested draft DCE choice tasks using cognitive interviews with an additional 15 AGYW to optimize comprehension and relevance.ResultsIn-depth interview participants' median age was 18, 70% were current students, and 93% had a primary sexual partner. AGYW named a variety of priorities and preferences related to choosing and accessing contraceptive methods, which we distilled into six key themes: side effects; effectiveness; user control; privacy; source of services; and cost. Bleeding pattern was top of mind for participants; amenorrhea was generally considered an intolerable side effect. Many participants felt more strongly about privacy than effectiveness, though some prioritized duration of use and minimizing chance of pregnancy above other contraceptive characteristics. Most AGYW preferred a clinic setting for access, as they desired contraceptive counseling from a provider, but pharmacies were considered preferable for reasons of privacy. We selected, refined, and pre-tested 7 DCE attributes, each with 2–4 levels.ConclusionsIdentifying AGYW preferences for contraceptive method and service delivery characteristics is essential to developing innovative strategies to meet their unique SRH needs. DCE methods may provide valuable quantitative perspectives to guide and tailor contraceptive counseling and service delivery interventions for AGYW who want to use contraception.

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Section: Discussionmentioning

confidence: 99%

Priorities for contraceptive method and service delivery attributes among adolescent girls and young women in Kenya: a qualitative study

Harrington,

Hauber,

Ouma

et al. 2024

Front. Reprod. Health

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“…We also acknowledge that our study population comprised women who attended government-run antenatal care clinics in Homa Bay and Siaya, were relatively older (the youngest participant was 21 years old), and were more likely to be in stable partnerships. Therefore, the perspectives shared might not necessarily represent the views of the broader population in the region and, in particular, younger, single women, who are likely to have different care-seeking behaviors and attitudes toward pharmacies and pregnancy testing ( 34 , 35 ). Despite these limitations, this is one of the first studies to qualitatively explore barriers to pregnancy testing in the Kenyan region.…”

Section: Discussionmentioning

confidence: 99%

Understanding factors influencing home pregnancy test use among women in western Kenya: A qualitative analysis

Mazumder

Dollah

Ouda³

et al. 2023

Front. Reprod. Health

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BackgroundThere are limited data on home pregnancy test use among women in low-and-middle-income countries. A prior survey found that only 20% of women in western Kenya used a home pregnancy test to confirm their pregnancies before going to antenatal care. This qualitative study aims to understand why women do not use home pregnancy tests in early pregnancy.MethodsFrom April 2021 to July 2021, we interviewed women from four antenatal care clinics in Homa Bay and Siaya counties. We recruited women previously enrolled in the PrEP Implementation for Mothers in Antenatal care (PrIMA) study, a cluster-randomized trial that evaluated the best approaches to implementing PrEP in maternal and child health clinics in Western Kenya (NCT03070600). Interviews were conducted via phone, audio recorded, translated, and transcribed verbatim. We coded and analyzed the transcripts to capture factors influencing women's capability, opportunity, and motivation to use home pregnancy tests.ResultsWe conducted 48 semistructured interviews with women aged 21–42 years. Twenty-seven women did not use a home pregnancy test in their most recent pregnancy. Seventeen of these women reported not using a home pregnancy test before. Lack of knowledge, mistrust in the accuracy of tests, preferring to rely on signs and symptoms of pregnancy or get a test from the health facility, cost, and accessibility were key barriers to home pregnancy test use.ConclusionImproving the uptake of home pregnancy testing during early pregnancy will require efforts to enhance community knowledge of test use and associated benefits and reduce cost burdens by making tests more affordable and accessible.

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“…Targeted messaging about STI and HIV appears to have reached young people, as concerns about STI and HIV transmission were high among the sample of Nairobi youth with 55.8% of unmarried, sexually active young men and 28.8% of unmarried, sexually active young women who said they always use a condom [15]. In addition, young people may face fewer barriers to accessing condoms over other modern methods due to providers restricting access to hormonal methods and a wider range of sources for condoms, including pharmacies and shops, which are frequently more accessible, more convenient, and provide privacy and confidentiality [12,[51][52][53]. These factors contribute to condoms frequently being an entry point to contraceptive use for young people and may further contribute to normalizing condom use amongst this population [54].…”

Section: All Other Modern Methods B Vs Non-user Of Modern Methodsmentioning

confidence: 99%

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

Calhoun

Mirzoyants²,

Thuku³

et al. 2022

Reprod Health

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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.

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Mixed-methods study on pharmacies as contraception providers to Kenyan young people: who uses them and why?

Cited by 15 publications

References 18 publications

Priorities for contraceptive method and service delivery attributes among adolescent girls and young women in Kenya: a qualitative study

Priorities for contraceptive method and service delivery attributes among adolescent girls and young women in Kenya: a qualitative study

Understanding factors influencing home pregnancy test use among women in western Kenya: A qualitative analysis

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

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