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. 2021 Apr 5;10(4):e24884.
doi: 10.2196/24884.

User-Centered Counseling and Male Involvement in Contraceptive Decision Making: Protocol for a Randomized Controlled Trial

Mahesh Karra  1 , Kexin Zhang  2
Affiliations

User-Centered Counseling and Male Involvement in Contraceptive Decision Making: Protocol for a Randomized Controlled Trial

Mahesh Karra et al. JMIR Res Protoc. .

Abstract

Background: To achieve informed choice within the framework of reproductive autonomy, family planning programs have begun to adopt user-centered approaches to service provision, which highlight the individual client as the focal point of interaction and key decision maker. However, little is known about how user-centered approaches to family planning, particularly family planning counseling, shape contraceptive preferences and choices.

Objective: We conducted a multiarmed randomized controlled trial to identify the causal impact of user-centered approaches to family planning counseling on women's contraceptive decision making in urban Malawi. This study aims to determine how a tailored, preference-driven approach to family planning counseling and the involvement of male partners during the counseling process may contribute to shaping women's contraceptive preferences and choices.

Methods: Married women aged 18-35 years were recruited and randomly assigned to 1 of the 3 intervention arms or a control arm characterized by the following two interventions: an intervention arm in which women were encouraged to invite their husbands to family planning counseling (husband invitation arm) and an intervention arm in which women received targeted, tailored counseling on up to five contraceptive methods (as opposed to up to 13 contraceptive methods) that reflected women's stated preferences for contraceptive methods. Women were randomized into a control arm, T0 (no husband invitation, standard counseling); T1 (husband invitation, standard counseling); T2 (no husband invitation, targeted counseling); and T3 (husband invitation, targeted counseling). Following counseling, all women received a package of family planning services, which included free transportation to a local family planning clinic and financial reimbursement for family planning services. Follow-up surveys were conducted with women 1 month after counseling.

Results: A total of 785 women completed the baseline survey, and 782 eligible respondents were randomized to 1 of the 3 intervention groups or the control group (T1, n=223; T2, n=225; T3, n=228; T0, n=108). Furthermore, 98.1% (767/782) of women were contacted for follow-up. Among the 767 women who were contacted, 95.3% (731/767) completed the follow-up survey. The analysis of the primary outcomes is ongoing and is expected to be completed by the end of 2021.

Conclusions: The results from this trial will fill knowledge gaps on the effectiveness of tailored family planning counseling and male involvement in family planning on women's stated and realized contraceptive preferences. More generally, the study will provide evidence on how user-centered counseling may affect women's willingness to use and continue contraception to realize their contraceptive preferences.

Trial registration: American Economics Association's Registry for Randomized Controlled Trials AEARCTR-0004194; https://www.socialscienceregistry.org/trials/4194/history/46808. Registry for International Development Impact Evaluations RIDIE-STUDY-ID-5ce4f42bbc2bf; https://ridie.3ieimpact.org/index.php?r=search/detailView&id=823.

International registered report identifier (irrid): DERR1-10.2196/24884.

Keywords: Malawi; Sub-Saharan Africa; contraceptive use; family planning; male involvement; randomized controlled trial; user-centered counseling.

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Conflict of interest statement

Conflicts of Interest: External funding for the study was provided through two grants from the William and Flora Hewlett Foundation, Menlo Park, California, United States. The funder had no role in the design and implementation of this study and will have no role in the data analyses, interpretation of results, or dissemination of findings. In addition, the study protocol did not undergo peer review by the funding body. Finally, all study investigators have read and understood the BU IRB and NHSRC policies on the declaration of competing interests. The authors declare that they have no conflict of interest, financial or otherwise, other than the normal scholarly gains from taking part in this study.

Figures

Figure 1
Figure 1
Experimental framework and flowchart.
See this image and copyright information in PMC

References

    1. Kim YM, Kols A, Mucheke S. Informed choice and decision-making in family planning counseling in Kenya. Int Fam Plann Persp. 1998 Mar;24(1):4–11, 42. - PubMed
    1. Johnson-Hanks J, Hamory-Hicks J, Miguel E, Mueller MW. Reflecting on major life decisions: changing your mind and not recalling it. [2021-03-02]. https://pacdev.ucdavis.edu/files/conference-schedule/session/papers/2E/J....
    1. Debpuur C, Bawah AA. Are reproductive preferences stable? Evidence from rural northern Ghana. 2002. [2021-03-02]. https://www.jstor.org/stable/29788727?seq=1.
    1. Sennott C, Yeatman S. Stability and change in fertility preferences among young women in Malawi. [2021-03-02]. - DOI - PMC - PubMed
    1. Hensher DA. How do respondents process stated choice experiments? Attribute consideration under varying information load. J Appl Econ. 2006 Sep;21(6):861–78. doi: 10.1002/jae.877. doi: 10.1002/jae.877. - DOI - DOI

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