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

Dwyer, Sara Chace; Jain, Aparna; Ishaku, Salisu Mohammed; Okunade, Faizah; Uzomba, Chiamaka; Adebayo, Adedamola; Tobey, Elizabeth

doi:10.1186/s12889-019-7668-2

Cited by 6 publications

(6 citation statements)

References 14 publications

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“…Failure to inform women about potential side effects of contraceptive methods during the counseling encounter, and how such can be managed has been shown to be associated with higher rates of discontinuation ( 13 ). The findings from the present study suggest that providers might benefit from job aids or cue cards that remind them of aspects of quality family planning services that they can use while counseling family planning clients ( 30 , 31 ).…”

Section: Discussionmentioning

confidence: 80%

Changes in clients' perceptions of family planning quality of care in Kaduna and Lagos States, Nigeria: A mixed methods study

Akomolafe

OlaOlorun

Okafor

et al. 2022

Front. Glob. Womens Health

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Community Pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs) are crucial to improving access to family planning (FP) services in Nigeria. Although the private sector is preferred for convenience, availability of commodity, privacy, and timeliness, less well known is the quality of care received by clients who obtain FP services from CPs and PPMVs. This paper seeks to explore the use of validated quality of care measures for programming in Kaduna and Lagos States and to assess how these measures worked in capturing changes in quality of care using client exit interviews implemented at two time points. Using validated measures of quality of care, 598 and 236 exit interviews in rounds 1 and 2 were conducted with FP clients aged 18–49 years old. The quality of care domains were assessed using 22 questions. A weighted additive quality score was created, and scores were grouped into three: low, medium, and high quality. Changes in quality of care received were examined using χ2 test. A subset of 53 clients were selected for in-depth interviews. Deductive and inductive approaches were used for coding, and data analysis was thematic. In Lagos, we observed increases in 16 out of 22 items while in Kaduna increases were only observed in 8 items. For instance, increases were observed in the proportion of women who experienced visual privacy between rounds 1 and 2 in Lagos (74%–89%) and Kaduna (66%–82%). The quality of care received by clients changed over time. Women who reported high quality care in Lagos increased from 42% to 63%, whereas women who reported high quality care in Kaduna decreased from 35% to 21%. In both states, in-depth interviews revealed that women felt they were treated respectfully, that their sessions with providers were visually private, that they could ask questions, and that they were asked about their preferred method. This study demonstrates that clients received high quality of care services from providers (CPs and PPMVs) especially in Lagos, and such services can be improved over time. Continuous support may be required to maintain and prevent reduction in quality of FP counseling and services, particularly in Kaduna.

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Section: Discussionmentioning

confidence: 80%

Changes in clients' perceptions of family planning quality of care in Kaduna and Lagos States, Nigeria: A mixed methods study

Akomolafe

OlaOlorun

Okafor

et al. 2022

Front. Glob. Womens Health

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“…This issue requires further investigation. Nevertheless, future interventions must continue to emphasise the importance of use of aids to produce better outcomes [ 23 ]. In addition to training on the use of the job aids and the provision and distribution of different types/ranges [ 23 ], another strategy which may be explored in this population is the use of mobile phone job aids [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…The UK Medical Research Council framework posits that the outcome of a complex intervention is influenced by the interactions between the implementation processes, context, and mechanisms. We applied a theory of change articulating the project ’ s hypothesised pathways to intervention outcomes and utilised both quantitative and qualitative primary and secondary data from a wide range of sources [ 15 , 20 , 23 ] to assess implementation, and understand causal mechanisms. This approach was aimed at triangulation of data which enriched the interpretation of the results.…”

Section: Methodsmentioning

confidence: 99%

Process evaluation of an intervention to improve access to injectable contraceptive services through patent medicine vendors in Nigeria: a mixed methods study

Oluwasanu

Adebayo

Okunade³

et al. 2021

J of Pharm Policy and Pract

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Background The low utilisation of modern contraceptives in many low- and middle-income countries remains a challenge. Patent medicine vendors (PMVs) that operate in the informal health sector, have the potential to address this challenge. Between 2015 and 2018, the Population Council, in collaboration with the Federal and State Ministries of Health and the Pharmacy Council of Nigeria, trained PMVs in six states to deliver injectable contraceptive services. Outcome evaluation demonstrated increased client uptake of injectable contraceptive services; however, there is limited information on how and why the intervention influenced outcomes. This study was conducted to elucidate the processes and mechanism through which the previous intervention influenced women’s utilisation of injectable contraceptive services. Methods The study utilised a mixed methods, convergent parallel design guided by the UK Medical Research Council framework. Quantitative data were obtained from 140 trained PMVs and 145 of their clients in three states and 27 in-depth interviews were conducted among relevant stakeholders. The quantitative data were analysed descriptively, while the qualitative data were analysed thematically. Results The results revealed that even after the completion of the PMV study which had a time-bound government waiver for injectable contraceptive service provision by PMVs, they continued to stock and provide injectables in response to the needs of their clients contrary to the current legislation which prohibits this. The causal mechanism that influenced women’s utilisation of injectable contraceptives were the initial training that the PMV received; the favourable regulatory environment as demonstrated in the approval provided by government for PMVs to provide injectable contraceptives for the duration of the study; and the satisfaction and the confidence the female clients had developed in the ability of the PMVs to serve them. However, there were gaps with regards to the consistent supply of quality injectable contraceptive commodities and in PMVs use of job aids. Referral and linkages to government or private-owned facilities were also sub-optimal. Conclusion PMVs continue to play important roles in family planning service provision; this underscores the need to formalize and scale-up this intervention to aid their integral roles coupled with multi-faceted initiatives to enhance the quality of their services.

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“…Phase one of the project was carried out in Oyo and Nasarawa States, both in South-West and North-Central regions respectively, between November 2015 and December 2016 [ 4 ]. The second phase was conducted in four states of the remaining four regions of North-East (Bauchi), North-West (Kaduna), South-East (Ebonyi) and South-South (Cross Rivers) between May 2017 and September 2018 [ 7 ]. A total of 381 PMVs participated in the two phases with 156 participants selected from 4 (2 urban and 2 rural) Local Government Areas (LGAs) in phase one [ 4 , 7 ] and 225 recruited in phase two [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…The PMVs attended a five-day training on family planning counselling, sale, referral, and administration of progestin-only injectable contraceptives. The training modules consisted of screening and counselling clients who are interested in the injectables; intramuscular and subcutaneous injectable contraceptives and their administration; safe storage and proper disposal of sharps; reinjection procedures, record keeping, procedures for handling adverse events; and referral [ 4 , 7 ]. The intervention entailed the monitoring of the activities of trained PMVs as well as interviewing of clients who got injectable contraceptives at the third, sixth and ninth months in-order to determine factors affecting the continuation or discontinuation of use of injectables from the same PMVs or others.…”

Section: Introductionmentioning

confidence: 99%

Contextual factors influencing the roles of patent medicine vendors in the provision of injectable contraception services in Nigeria

Adebayo

Oluwasanu

Okunade³

et al. 2023

Reprod Health

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Background Patent medicine vendors (PMVs) play vital roles in the delivery of family planning services in Nigeria and other developing countries. There is a growing recognition of the need to integrate them into the formal health care system as a strategy to increase the contraceptive prevalence rate and achieve universal health coverage. Though promising, the success of this proposition is largely dependent on a critical analysis of the factors which influence their operations. This study was designed to identify the contextual factors influencing the provision of injectable contraceptive services by PMVs and the broader effects of their activities on the health system to inform similar interventions in Nigeria. Methods This was a qualitative study guided by the UK Medical Research Council’s Framework for Complex Interventions. Twenty-seven in-depth interviews were conducted among officials of the association of PMVs, health workers, government regulatory officers and programme implementers who participated in a phased 3-year (2015–2018) intervention designed to enhance the capacity of PMVs to deliver injectable contraceptive services. The data were transcribed and analyzed thematically using NVIVO software. Results The contextual factors which had implications on the roles of PMVs were socio-cultural and religious, the failing Nigerian health system coupled with government regulatory policies. Other factors were interprofessional tensions and rivalry between the PMVs and some categories of health care workers and increasing donors’ interest in exploring the potentials of PMVs for expanded healthcare service provision. According to the respondents, the PMVs bridged the Nigerian health system service delivery gaps serving as the first point of contact for injectable contraceptive services and this increased contraceptive uptake in the study sites. A negative effect of their operation is the tendency to exceed their service provision limits, which has spurred a planned tiered PMV accreditation system. Conclusions This study has highlighted the contextual factors which define the roles and scope of practice of PMVs involved in injectable contraceptive service provision. Strategies and interventions aimed at expanding the healthcare delivery roles of PMVs must be encompassing to address the broader contextual factors which underpin their capacities and functions.

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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

Cited by 6 publications

References 14 publications

Changes in clients' perceptions of family planning quality of care in Kaduna and Lagos States, Nigeria: A mixed methods study

Changes in clients' perceptions of family planning quality of care in Kaduna and Lagos States, Nigeria: A mixed methods study

Process evaluation of an intervention to improve access to injectable contraceptive services through patent medicine vendors in Nigeria: a mixed methods study

Contextual factors influencing the roles of patent medicine vendors in the provision of injectable contraception services in Nigeria

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