Comparing Effectiveness of Active and Passive Client Follow-Up Approaches in Sustaining the Continued Use of Long Acting Reversible Contraceptives (LARC) in Rural Punjab: A Multicentre, Non-Inferiority Trial
- PMID: 27584088
- PMCID: PMC5008757
- DOI: 10.1371/journal.pone.0160683
Comparing Effectiveness of Active and Passive Client Follow-Up Approaches in Sustaining the Continued Use of Long Acting Reversible Contraceptives (LARC) in Rural Punjab: A Multicentre, Non-Inferiority Trial
Abstract
Background: The use of long-acting reversible contraceptive (LARC) methods is very low in Pakistan with high discontinuation rates mainly attributed to method-related side effects. Mixed evidence is available on the effectiveness of different client follow-up approaches used to ensure method continuation. We compared the effectiveness of active and passive follow-up approaches in sustaining the use of LARC-and within 'active' follow-up, we further compared a telephone versus home-based approach in rural Punjab, Pakistan.
Methods: This was a 12-month multicentre non-inferiority trial conducted in twenty-two (16 rural- and 6 urban-based) franchised reproductive healthcare facilities in district Chakwal of Punjab province, between November 2013 and December 2014. The study comprised of three groups of LARC clients: a) home-based follow-up, b) telephone-based follow-up, and c) passive or needs-based follow-up. Participants in the first two study groups received counselling on scheduled follow-up from the field workers at 1, 3, 6, 9, and 12 month post-insertion whereas participants in the third group were asked to contact the health facility if in need of medical assistance relating to LARC method use. Study participants were recruited with equal allocation to each study group, but participants were not randomized. The analyses are based on 1,246 LARC (intra-uterine contraceptive device and implant) users that completed approximately 12-months of follow-up. The non-inferiority margin was kept at five percentage points for the comparison of active and passive follow-up and six percentage points for telephone and home-based approach. The primary outcome was cumulative probability of method continuation at 12-month among LARC users.
Results: Women recruited in home-based, telephone-based, and passive groups were 400, 419 and 427, respectively. The cumulative probability of LARC continuation at 12 month was 87.6% (95% CI 83.8 to 90.6) among women who received home-based follow-up; 89.1% (95% CI 85.7, 91.8) who received telephone-based follow-up; and 83.8% (95% CI 79.8 to 87.1) who were in the passive or needs-based follow-up group. The probability of continuation among women who were actively followed-up by field health educators-either through home-based visit or telephone-based follow-up was, 88.3% (95% CI 85.9 to 90.0). An adjusted risk difference of -4.1 (95% CI -7.8 to -0.28; p-value = 0.035) was estimated between active and passive follow-up. Whereas, within the active client follow-up, the telephone-based follow-up was found to be as effective as the home-based follow-up with an adjusted risk difference of 1.8 (95% CI -2.7 to 6.4; p-value = 0.431).
Conclusion: A passive follow-up approach was 5% inferior to an active follow-up approach; whereas telephone-based follow-up was as effective as the home-based visits in sustaining the use of LARC, and was far more resource efficient. Therefore, active follow-up could improve method continuation especially in the critical post-insertion period.
Conflict of interest statement
The authors WH, MI, GM, WHS, OFK though are affiliated with the implementing organization; however, they neither come under nor are part of program team. The study was conceptualized and conducted by them independently without any consultation with the implementing field team.
Similar articles
-
Comparing effectiveness of two client follow-up approaches in sustaining the use of Long Acting Reversible Contraceptives (LARC) among the underserved in rural Punjab, Pakistan: a study protocol and participants' profile.Reprod Health. 2015 Mar 18;12:9. doi: 10.1186/1742-4755-12-9. Reprod Health. 2015. PMID: 25971781 Free PMC article.
-
Not seeking yet trying long-acting reversible contraception: a 24-month randomized trial on continuation, unintended pregnancy and satisfaction.Contraception. 2018 Jun;97(6):524-532. doi: 10.1016/j.contraception.2018.02.001. Epub 2018 Feb 19. Contraception. 2018. PMID: 29470950 Free PMC article. Clinical Trial.
-
Long-acting reversible contraceptive acceptability and unintended pregnancy among women presenting for short-acting methods: a randomized patient preference trial.Am J Obstet Gynecol. 2017 Feb;216(2):101-109. doi: 10.1016/j.ajog.2016.08.033. Epub 2016 Sep 20. Am J Obstet Gynecol. 2017. PMID: 27662799 Free PMC article. Clinical Trial.
-
Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas.Cochrane Database Syst Rev. 2022 Feb 1;2(2022):CD014217. doi: 10.1002/14651858.CD014217. Cochrane Database Syst Rev. 2022. PMID: 36321557 Free PMC article.
-
Strategies to improve adherence and continuation of shorter-term hormonal methods of contraception.Cochrane Database Syst Rev. 2019 Apr 23;4(4):CD004317. doi: 10.1002/14651858.CD004317.pub5. Cochrane Database Syst Rev. 2019. PMID: 31013349 Free PMC article.
Cited by
-
Factors associated with early long-acting reversible contraceptives discontinuation in Ethiopia: evidence from the 2016 Ethiopian demographic and health survey.Arch Public Health. 2020 Jul 1;78:36. doi: 10.1186/s13690-020-00419-w. eCollection 2020. Arch Public Health. 2020. PMID: 32626577 Free PMC article.
-
Are family planning vouchers effective in increasing use, improving equity and reaching the underserved? An evaluation of a voucher program in Pakistan.BMC Health Serv Res. 2019 Mar 29;19(1):200. doi: 10.1186/s12913-019-4027-z. BMC Health Serv Res. 2019. PMID: 30922318 Free PMC article.
-
Assessing the sustainability of two independent voucher-based family planning programs in Pakistan: a 24-months post-intervention evaluation.Contracept Reprod Med. 2023 Aug 22;8(1):43. doi: 10.1186/s40834-023-00244-w. Contracept Reprod Med. 2023. PMID: 37608333 Free PMC article.
-
Counseling Supporting HIV Self-Testing and Linkage to Care Among Men Who Have Sex With Men: Systematic Review and Meta-Analysis.JMIR Public Health Surveill. 2024 Jan 24;10:e45647. doi: 10.2196/45647. JMIR Public Health Surveill. 2024. PMID: 38265866 Free PMC article.
-
The logistics of voucher management: the underreported component in family planning voucher discussions.J Multidiscip Healthc. 2018 Nov 22;11:683-690. doi: 10.2147/JMDH.S155205. eCollection 2018. J Multidiscip Healthc. 2018. PMID: 30538489 Free PMC article. Review.
References
-
- United Nations Department of Economic and Social Affairs Population Division. World Contraceptive Use 2011. 2011. Available: http://www.un.org/esa/population/publications/contraceptive2011/contrace...
-
- Alkema L, Kantorova V, Menozzi C, Biddlecom A. National, regional, and global rates and trends in contraceptive prevalence and unmet need for family planning between 1990 and 2015: a systematic and comprehensive analysis. Lancet 2013. May 11;381(9878):1642–52. 10.1016/S0140-6736(12)62204-1 - DOI - PubMed
-
- Cleland J, Shah IH. Causes and consequences of contraceptive discontinuation: evidence from 60 demographic and health surveys Geneva, Switzerland: World Health Organization; 2012. Available: http://apps.who.int/iris/bitstream/10665/75429/1/9789241504058_eng.pdf
-
- Marston C, Cleland J. Do unintended pregnancies carried to term lead to adverse outcomes for mother and child? An assessment in five developing countries. Popul Stud (Camb) 2003;57(1):77–93. - PubMed
-
- Staveteig S, Mallick L, Winter R. Uptake and Discontinuation of Long-Acting Reversible Contraceptives (LARCs) in Low-Income Countries DHS Analytical Studies 54 Rockville, Maryland, USA: ICF International; 2015. September Available: https://dhsprogram.com/pubs/pdf/AS54/AS54.pdf
Publication types
MeSH terms
Substances
Grants and funding
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical