Task shifting and community engagement as the keys to increasing access to modern contraception: Findings from mixed methods operational research in coastal Kenya

Abstract

RationaleKilifi County, Kenya, has a modern contraceptive prevalence of 44%, compared to the national prevalence of 61%. In 2018, the Government of Kenya and Population Services Kenya implemented a pilot project in Kilifi to improve contraceptive awareness and access.Aims and ObjectivesThe Riziki Demonstration Project task shifted contraceptive injectable and implant provision to community health extension workers (CHEWs) and supported community engagement led by community health volunteers (CHVs). This mixed methods evaluation examined the effect of Riziki on contraceptive service provision and identified drivers of the intervention's success in increasing public sector contraceptive uptake.MethodWe obtained monthly contraceptive service provision data from DHIS2 for intervention and comparison facilities from June 2018 to July 2020. Controlled interrupted time series analyses were used to assess difference‐in‐differences effects on the levels and trends in service provision. Qualitative data included key informant interviews with health workers, community‐based focus group discussions and contraceptive journey mapping. Topics included contraception‐related shifts in the health system and social environment and changes to contraceptive accessibility and demand.ResultsWe found positive difference‐in‐differences effects for levels of provision for implant (adj. β = 7.4 per month, per facility, 95% confidence interval [CI]: 2.8–12.0) and all methods combined (adj. β = 12.2, 95% CI: 3.0–21.3). The health system provided a legal framework and management support for the pilot. Community engagement by CHVs and CHEWs, including with men and religious leaders, bolstered supportive social norms by emphasizing birth spacing and family wellbeing. Awareness and supportive social norms were strengthened among women and their husbands through counselling that leveraged CHEW and CHV community embeddedness.ConclusionFindings demonstrate the potential for task sharing combined with community engagement efforts to improve contraceptive awareness, knowledge and supply. Community engagement should include men, traditional leaders and other influencers to strengthen norms that position family planning in alignment with community values.

Explaining barriers to childbearing using the risk communication and community engagement (RCCE) strategy: Based on action research

“…According to studies, factors such as economic problems, women's employment, children's educational problems, and other factors are effective in parents' desire for childbearing 7 . Community engagement and the desire to follow health measures are the most powerful weapons for implementing health intervention 8,9 . The analysis of social behaviors indicates that even though people have adequate information about the importance of childbearing and the problems of single children, there are oversimplification and low‐risk perceptions in the majority 10 .…”

“… 7 Community engagement and the desire to follow health measures are the most powerful weapons for implementing health intervention. 8 , 9 The analysis of social behaviors indicates that even though people have adequate information about the importance of childbearing and the problems of single children, there are oversimplification and low‐risk perceptions in the majority. 10 Furthermore, the people's belief about what they can do is not enough; in other words, people do not believe in their ability to improve their lifestyles and consider the public sector as the guardian and responsible for public health.…”

Shaping Brand Loyalty through Social Media Influencers: The Mediating Role of Follower Engagement and Social Attractiveness

“…The study predicts that SMIs’ homophily may significantly influence social attractiveness. Past research investigations have indicated a positive association between homophily and social acceptability (Essendi et al, 2023). Demonstrating similar characteristics by SMIs may cultivate a perception of relatability and familiarity within their followers.…”