Quasi-experimentation - design and analysis issues for field settings - cook,td, campbell,dt

Aim The aim of this systematic review was to synthesise the evidence on the comparative effectiveness of different counselling strategies for modern contraception on contraceptive behaviour and satisfaction, and to examine their advantages and disadvantages. Methods Six electronic databases (Medline, Embase, Global Health, Popline, CINAHL Plus, and Cochrane Library) were searched to identify publications comparing two or more contraceptive counselling strategies and reporting quantitative results on contraceptive use, uptake, continuation or switching, or client satisfaction. Studies of women or couples from any country, published in English since 1990 were considered. Results A total of 63 publications corresponding to 61 studies met the inclusion criteria. There was substantial heterogeneity in study settings, interventions and outcome measures. Interventions targeting women initiating a method (including structured counselling on side effects) tended to show positive effects on contraceptive continuation. In contrast, the majority of studies of provider training and decision-making tools for method choice did not find evidence of an effect. Additional antenatal or postpartum counselling sessions were associated with increased postpartum contraceptive use, regardless of their timing in pregnancy or postpartum. Dedicated pre-abortion contraceptive counselling was associated with increased use only when accompanied by broader contraceptive method provision. Male partner or couples counselling was effective at increasing contraceptive use in two of five studies targeting non-users, women initiating implants or seeking abortion. High-quality evidence is lacking for the majority of intervention types. Conclusions The evidence base and quality of studies are limited, and further research is needed to determine the effectiveness of many counselling interventions in different settings.

https://srh.bmj.com/content/familyplanning/46/4/254.full.pdf

A systematic review of the effectiveness of counselling strategies for modern contraceptive methods: what works and what doesn't?

Medication counseling is a critical component of pharmaceutical care to promote the safe and effective use of medications and to maximize therapeutic outcomes. The assessment of patients’ and pharmacists’ satisfaction with medication counseling services could be one of the vital parameters for predicting the quality of pharmacy services. No study has measured and compared both patients’ and pharmacists’ satisfaction with medication counseling. The objectives of this study were to describe and compare patients’ and pharmacists’ levels of satisfaction with medication counseling services offered by community pharmacists in South Korea. This was a descriptive, cross-sectional survey. The online survey was distributed to patients and community pharmacists using a structured questionnaire. The questionnaires consisted of 4 main areas: (1) responders’ characteristics (2) current state of medication counseling methods provided by community pharmacies (3) overall satisfaction with medication counseling (4) demand for the development of medication counseling standards. A comparison between patients and pharmacists was made using either a chi-square test or a Fisher’s exact test. Between June 13, 2014 and July 15, 2014, a total of 252 patients and 620 pharmacists completed the survey. It was found that 47.3 % of pharmacists and 34.0 % of patients were satisfied with the current medication counseling service. Pharmacists showed a higher degree of satisfaction with the medication counseling service compared to patients (p <0.05). A major reason for patients not being satisfied with the medication counseling from community pharmacists was the insufficient time spent on counseling (51.2 %). The pharmacists’ perception of a major barrier to providing appropriate medication counseling for patients was the lack of time (24.3 %). Moreover, a substantial number of patients (88 %) and pharmacists (73 %) supported the development of medication counseling standards to improve community pharmacist counseling services (p < 0.001). This study showed that both patients and pharmacists have low levels of satisfaction with the current medication counseling service offered by community pharmacists. This study provides baseline data for the development of national guidelines for medication counseling by pharmacists.

/pdf/a-comparison-of-patients-and-pharmacists-satisfaction-with-4gm15ghpib.pdf

A comparison of patients' and pharmacists' satisfaction with medication counseling provided by community pharmacies: a cross-sectional survey.

Quality of family planning counseling is likely associated with whether or not women continue to use the same contraceptive method over time. The Method Information Index (MII) is a widely available measure of contraceptive counseling quality but little is known about its association with rates of method continuation. The index ranges from 0 to 3 based on a client's answer to whether she was told about other methods, potential side effects with her chosen method, and what to do if she experienced side effects. Using data from a prospective cohort study of 1,998 social franchise clients in Pakistan and Uganda, we investigated the relationship between reported baseline MII and the risk of method continuation over 12 months using survival analysis and Cox proportional hazard models. At baseline, about 65% of women in Pakistan and 73% of women in Uganda reported receiving information about all 3 MII aspects. In Pakistan, 59.4% of the 165 women who stopped using their modern method did so while still in need of contraception. In Uganda, of the 77 women who stopped modern method use, 64.9% discontinued while in need. Despite important differences in the demographics and method mix between the 2 countries, we found similar associations between baseline MII and discontinuation: in both countries as the MII score increased, the risk of discontinuation while in need decreased. In Pakistan, the risk of contraceptive discontinuation was 64% lower (crude hazard ratio [HRcrude]=0.36; P=.03), and 72% lower (HRcrude=0.28; P=.007), among women who were told about any 2, or any 3 aspects of MII, respectively. After adjusting for additional covariates, only the difference in the risk of contraceptive discontinuation between MII=3 and MII=0 remained statistically significant (HRadj=0.35; P=0.04). In Uganda, women who reported being informed about all aspects of MII were 80% less likely to discontinue while in need (HRadj=0.20; P<.001), women informed about any 2 aspects of MII were 90% less likely (HRadj=0.10; P<.001), and women who were informed about any 1 aspect of MII were 68% less likely (HRadj=0.32; P<.02) to discontinue contraceptive use while in need as compared to women who reported not being informed about any aspect of MII. Baseline MII scores were positively associated with method continuation rates in our sample of clients from social franchises in both Pakistan and Uganda and could potentially be used as an indicator of contraceptive counseling quality.

Association Between the Quality of Contraceptive Counseling and Method Continuation: Findings From a Prospective Cohort Study in Social Franchise Clinics in Pakistan and Uganda.

This policy brief uses the framework developed by the U.S. Agency for International Developments Maximizing Access and Quality (MAQ) Initiative to illuminate key issues about the quality of reproductive health care for young adults. The quality of care framework is multidimensional and depends on the priori ties of various stakeholders. For instance clients are usually concerned with the human aspects of care whereas providers tend to focus on technical aspects (see the first three briefs in this series). This brief focuses on facility-based services for young adults with some discussion of youth-friendly services that are offered outside of clinics. (excerpt)

https://pdf.usaid.gov/pdf_docs/PNACT319.pdf

Improving the quality of reproductive health care for young people.

Time constraints have been implicated in family planning providers inability to offer comprehensive counseling to their clients. It is important for providers to know whether lengthening counseling sessions increases the amount of relevant information imparted to clients. 28 women were trained to pretend to solicit an effective method and to opt for the injectable contraceptive at 19 clinics in urban areas from a national sample of Ministry of Health facilities in Peru. Each clinic was visited on different days by 6 of these ‘simulated clients’ for a total of 114 cases. For each visit the woman recorded on a 46-item checklist the topics discussed by the provider and estimated the duration of the counseling session. Providers dedicated anywhere from 2-45 minutes to counseling. The amount of information given that was relevant to the clients choice significantly increased by 43% when the session length went from 2-8 minutes to 9-14 minutes. However further improvements in the amount of useful information exchanged were trivial and nonsignificant when session lengths extended beyond 14 minutes. At any duration many pieces of information that should have been exchanged had not been. Offering a wide range of contraceptive options took up most of the consultation time and was highly correlated with session length. Discussion of the chosen method’s side effects and screening for contraindications did not vary by session length. Counseling sessions longer than 14 minutes confer little advantage in terms of effective counseling for women who choose the injectable. It is important that providers use the available time more efficiently; that they be more practical in assessing clients’ needs; and that they avoid providing too much information about irrelevant methods. They should focus on the method chosen by the client and address that specific method in greater depth. (authors)

/pdf/length-of-counseling-sessions-and-the-amount-of-relevant-4hepzuzl9u.pdf

Length of counseling sessions and the amount of relevant information exchanged: A study in peruvian clinics

This study investigated the effects of introducing a family planning counseling model at clinics of Peru’s Ministry of Health. Providers trained in the model presented greater quality of care and longer counseling sessions than did controls. The main effects, however, were misleading. Nearly all of the quality improvements were contributed by 37% of the trained providers; they had already been better performers at the pretest and complied with the new counseling model’s requirement of job aid use at the posttest. The recognition that a majority of trained providers did not profit from training posed a challenge that led to improvements in the model. Training Trainee Interactions should be explored in evaluations.

Training trainee interactions in a family planning intervention

This study was funded by the U.S. Agency for International Development (USAID) under the terms of Cooperative Agreement Number HRN-A-00-98-00012-00 and In-house project number 8002 13052. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID. Context. Very short counseling sessions, counseling not focused on clients' needs, redundancy in the role of physicians and social workers as providers, skewed method mix, and low client return rate for method re-supply prevailed at the main maternity hospital of the Social Security Institute (IGSS) in Guatemala. A need to improve the quality of care was identified. Methodology. The IGSS adapted the job aids-assisted Balanced Counseling Strategy and developed two service algorithms, one for the social worker and one for the physician. Method cards and method pamphlets were made available to providers. All the providers were trained and received reinforcing revisits during two months. The effects of the intervention were assessed by means of client exit interviews, home follow-up of client cohorts, analysis of service statistics, and a time-motion study. Results. The intervention changed the counseling behavior of physicians and social workers and enhanced the quality of family planning care. Client choices did not support the hypothesis that improvements in the quality of care would cause a decreased share of the injectable in the method mix. Three decreasing trends in the 19-week pre-intervention (choice of the injectable, client's reception of her desired method, client knowledge concerning the method chosen) presented reversals in the 19-week post-intervention. However, these changes could be attributed to either the intervention, trends in the provider workload, and/or instrumentation bias. Continuation in the use of family planning diminished from month one to month six, particularly in the case of the pill, but the behavior of pre-and post-intervention client cohorts were undistinguishable. Conclusions. The IGSS should continue using the job aids-assisted Balanced Counseling Algorithms, yet adjustments in instructions concerning post-choice counseling could be introduced and tested to improve client outcomes. The skewed method mix at the IGSS reflects clients' perception of the benefits of the injectable rather than provider bias; hence, the IGSS must adapt to this situation rather than attempting to change it. The six-month post-choice contraceptive behavior on the part of an overwhelming majority of Balanced Counseling Algorithms at the IGSS i clients (users of the injectable or the IUD) is satisfactory and may not be amenable to further improvement. Users of …

/pdf/effects-of-igss-job-aids-assisted-balanced-counseling-4ihg86ms3w.pdf

Effects of IGSS' job aids-assisted Balanced Counseling Algorithms on quality of care and client outcomes

A study with 24 health directorates of the Peru MOH as units of experimentation and analysis that was conducted in 2000-2001 showed that two-day provider training plus one-day re-training on the job aids-assisted Balanced Counseling Strategy resulted in significant enhancement of the quality of care an increase of four minutes in session length and improved client knowledge of the method chosen when this was an IUD or hormonal method. This study presents results of a one-year follow-up. New-event family planning clients were recruited as they exited counseling sessions at treated and control clinics. The clients had chosen a contraceptive method and stated intentions to use contraception for at least one year. A questionnaire that included the calendar module of DHS was applied twice in home interviews to tap six and 12-month outcomes. Twelve-month data from 215 clients were analyzed in depth. Knowledge of the method chosen when this was the IUD or a hormonal method was greater in the treated cohort (p < .05 one-tailed df = 18) at the end of the follow-up period. Mean monthly (k = 12) family planning use rates over health-directorates (n = 12) were obtained for each cohort. The latter months showed less use of needed contraception (p < .01 df = 1111) and the treated cohort greater use (.81) than the control cohort (.78 p < .01 df = 111) when contemporaneous perceptions of need were considered. Cumulative continuation rates from life tables did not differ significantly between cohorts according to the Wilcoxon (Gehan) statistic. Proportions of method shifting were similar in both cohorts. Attainment of contemporaneous reproductive goal was significantly greater in the treated cohort (.96) than the control cohort (.95 p < .01 df = 111). The intervention caused consistent yet small improvements in client outcomes. Correlational findings suggested that better impacts can be achieved in provincial primary health facilities than in larger settings like clinics or hospitals in capital cities. The results are important because: 1) other studies have failed to show significant impacts of controlled quality-of-care improvements on the use of contraception; and 2) the Balanced Counseling Strategy was not implemented to its full extent. Greater impacts can be expected when the Strategy’s potential is fully realized. (excerpt)

/pdf/one-year-client-impacts-of-quality-of-care-improvements-2mdottpqa7.pdf

One-year client impacts of quality of care improvements achieved in Peru.

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Length of counseling sessions and the amount of relevant information exchanged: A study in peruvian clinics

Training trainee interactions in a family planning intervention

Effects of IGSS' job aids-assisted Balanced Counseling Algorithms on quality of care and client outcomes

One-year client impacts of quality of care improvements achieved in Peru.