Protocol for a prospective mixed-methods longitudinal study to evaluate the dynamics of contraceptive use, discontinuation, and switching in Kenya
Abstract Background More women are accessing modern contraceptive use in Kenya, however, contraceptive discontinuation has stagnated over the decades. Any further increase in contraceptive use will most likely be from past users, hence understanding the dynamics of discontinuation while addressing q...
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doaj-3049c4dbda4f4be6ab60b0bfba619cee2020-11-25T02:43:12ZengBMCReproductive Health1742-47552019-09-011611810.1186/s12978-019-0797-3Protocol for a prospective mixed-methods longitudinal study to evaluate the dynamics of contraceptive use, discontinuation, and switching in KenyaSusan Ontiri0Lilian Mutea1Maxwell Muganda2Peter Mutanda3Carolyne Ajema4Stephen Okoth5Solomon Orero6Ruth Odhiambo7Regien Biesma8Jelle Stekelenburg9Mark Kabue10Jhpiego Corporation, An affiliate of Johns Hopkins UniversityUSAID Kenya and East AfricaJhpiego Corporation, An affiliate of Johns Hopkins UniversityJhpiego Corporation, An affiliate of Johns Hopkins UniversityJhpiego Corporation, An affiliate of Johns Hopkins UniversityJhpiego Corporation, An affiliate of Johns Hopkins UniversityJhpiego Corporation, An affiliate of Johns Hopkins UniversityJhpiego Corporation, An affiliate of Johns Hopkins UniversityDepartment of Health Sciences, Global Health, University Medical Centre Groningen/University of GroningenDepartment of Health Sciences, Global Health, University Medical Centre Groningen/University of GroningenJhpiego Corporation, An affiliate of Johns Hopkins UniversityAbstract Background More women are accessing modern contraceptive use in Kenya, however, contraceptive discontinuation has stagnated over the decades. Any further increase in contraceptive use will most likely be from past users, hence understanding the dynamics of discontinuation while addressing quality of family planning services offered at health facilities and communities is critical for increasing the contraceptive prevalence rate and reducing the unmet need of family planning. The paper presents a study protocol that intends to evaluate the dynamics of contraceptive use, discontinuation, and switching among women of reproductive age initiating use of a contraceptive method. Methods This longitudinal mixed-methods study is being conducted in Migori and Kitui counties, Kenya. A formative assessment using Interviews with adolescents, older women, heterosexual couples, health care workers, and community health volunteers explored barriers to contraceptive continuation and perspectives on discontinuation utilizing a qualitative cross sectional study design. Following the formative assessment, a client-centered intervention focusing on improving quality of family planning services, including counseling, will be implemented in 10 health facilities. A 24-month prospective cohort study among women of reproductive age initiating contraception with follow-up at 3, 6, 12, and 24 months will then be undertaken to assess the discontinuation rates, examine the dynamics of contraceptive use, discontinuation and switching, and further explore barriers and enablers for contraceptive continuation and switching among the study population. Discussion In sub-Saharan Africa, contraceptive discontinuation studies have mainly been based on survey data that is collected retrospectively. By implementing a longitudinal mixed-methods study, we gain deeper insights into the contraceptive dynamics influencing the decision to continue, discontinue, and even switch following implementation of a client-centered intervention that enhances quality of care. Additionally, the study will shed more light on the profile of women discontinuing contractive use and further explore individual and couple-level dynamics influencing decision-making on continuation and discontinuation. The findings of this study will provide information that can be used to develop and implement human-centered interventions that focus on improving quality of family planning services and consequently improved continuation rates and overall satisfaction with method. Trial registration The study is registered with the Clinical Trials Registry, NCT03973593.http://link.springer.com/article/10.1186/s12978-019-0797-3ContraceptionDiscontinuationSwitchingInterventionsSide effectsCounseling |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Susan Ontiri Lilian Mutea Maxwell Muganda Peter Mutanda Carolyne Ajema Stephen Okoth Solomon Orero Ruth Odhiambo Regien Biesma Jelle Stekelenburg Mark Kabue |
spellingShingle |
Susan Ontiri Lilian Mutea Maxwell Muganda Peter Mutanda Carolyne Ajema Stephen Okoth Solomon Orero Ruth Odhiambo Regien Biesma Jelle Stekelenburg Mark Kabue Protocol for a prospective mixed-methods longitudinal study to evaluate the dynamics of contraceptive use, discontinuation, and switching in Kenya Reproductive Health Contraception Discontinuation Switching Interventions Side effects Counseling |
author_facet |
Susan Ontiri Lilian Mutea Maxwell Muganda Peter Mutanda Carolyne Ajema Stephen Okoth Solomon Orero Ruth Odhiambo Regien Biesma Jelle Stekelenburg Mark Kabue |
author_sort |
Susan Ontiri |
title |
Protocol for a prospective mixed-methods longitudinal study to evaluate the dynamics of contraceptive use, discontinuation, and switching in Kenya |
title_short |
Protocol for a prospective mixed-methods longitudinal study to evaluate the dynamics of contraceptive use, discontinuation, and switching in Kenya |
title_full |
Protocol for a prospective mixed-methods longitudinal study to evaluate the dynamics of contraceptive use, discontinuation, and switching in Kenya |
title_fullStr |
Protocol for a prospective mixed-methods longitudinal study to evaluate the dynamics of contraceptive use, discontinuation, and switching in Kenya |
title_full_unstemmed |
Protocol for a prospective mixed-methods longitudinal study to evaluate the dynamics of contraceptive use, discontinuation, and switching in Kenya |
title_sort |
protocol for a prospective mixed-methods longitudinal study to evaluate the dynamics of contraceptive use, discontinuation, and switching in kenya |
publisher |
BMC |
series |
Reproductive Health |
issn |
1742-4755 |
publishDate |
2019-09-01 |
description |
Abstract Background More women are accessing modern contraceptive use in Kenya, however, contraceptive discontinuation has stagnated over the decades. Any further increase in contraceptive use will most likely be from past users, hence understanding the dynamics of discontinuation while addressing quality of family planning services offered at health facilities and communities is critical for increasing the contraceptive prevalence rate and reducing the unmet need of family planning. The paper presents a study protocol that intends to evaluate the dynamics of contraceptive use, discontinuation, and switching among women of reproductive age initiating use of a contraceptive method. Methods This longitudinal mixed-methods study is being conducted in Migori and Kitui counties, Kenya. A formative assessment using Interviews with adolescents, older women, heterosexual couples, health care workers, and community health volunteers explored barriers to contraceptive continuation and perspectives on discontinuation utilizing a qualitative cross sectional study design. Following the formative assessment, a client-centered intervention focusing on improving quality of family planning services, including counseling, will be implemented in 10 health facilities. A 24-month prospective cohort study among women of reproductive age initiating contraception with follow-up at 3, 6, 12, and 24 months will then be undertaken to assess the discontinuation rates, examine the dynamics of contraceptive use, discontinuation and switching, and further explore barriers and enablers for contraceptive continuation and switching among the study population. Discussion In sub-Saharan Africa, contraceptive discontinuation studies have mainly been based on survey data that is collected retrospectively. By implementing a longitudinal mixed-methods study, we gain deeper insights into the contraceptive dynamics influencing the decision to continue, discontinue, and even switch following implementation of a client-centered intervention that enhances quality of care. Additionally, the study will shed more light on the profile of women discontinuing contractive use and further explore individual and couple-level dynamics influencing decision-making on continuation and discontinuation. The findings of this study will provide information that can be used to develop and implement human-centered interventions that focus on improving quality of family planning services and consequently improved continuation rates and overall satisfaction with method. Trial registration The study is registered with the Clinical Trials Registry, NCT03973593. |
topic |
Contraception Discontinuation Switching Interventions Side effects Counseling |
url |
http://link.springer.com/article/10.1186/s12978-019-0797-3 |
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