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Tag: counseling


DMPA-SC self-injection: Advancing contraceptive access and use for women and girls

This DMPA-SC Advocacy Pack brief details the strong body of evidence and experience with self-injection of DMPA-SC, including how the practice can reduce access-related barriers, improve contraceptive continuation, and enhance women’s autonomy.

Institutional author(s): PATH, Clinton Health Access Initiative (CHAI), inSupply Health, Jhpiego, JSI
Publication date: 2023

Informed choice counseling in the context of new product or service delivery innovations

An in-depth look at DMPA-SC and self-injection introduction in Zambia

The DMPA-SC Access Collaborative (AC) hosted this virtual discussion on February 16, 2023 to explore the challenges of introducing new contraceptive methods in the context of informed choice programming. This webinar focused on findings from a recent study conducted in Zambia which aimed to determine:

  • The barriers to clients’ ability to exercise autonomy in their choice of family planning methods and modes of administration.
  • The extent to which provider perceptions and method bias affect access to self-injection as a new contraceptive option.

This research was conducted as part of the AC’s broader learning agenda and focused on the potential risks to informed choice that could arise as new products or service innovations are integrated in family planning programs. While a new intervention is intended to expand contraceptive access and options, its introduction may inadvertently convey to providers that it is inherently better than existing products or practices. In the case of DMPA-SC, providers may promote self-injection over provider administration. Alternatively, providers may feel hesitant about a new method and withhold information. In either case, the client’s right to receive accurate information about a variety of methods and to make an informed choice about her reproductive health care is compromised. To explore these questions, the AC conducted a literature review and study interviewing both clients and providers to understand how DMPA-SC and self-injection are being offered in Zambia’s Copperbelt Province.

Institutional author(s): PATH, JSI
Publication date: February, 2023

Webinar recording

Family Planning: A Global Handbook for Providers

The global family planning handbook provides high-quality, up-to-date guidance for health care professionals working in low- and middle-income countries. “Chapter 4: Progestin-Only Injectables” includes information and guidance for DMPA-SC administration and self-injection.

Institutional author(s): World Health Organization (WHO), Johns Hopkins Center for Communication Programs (JHU CCP)
Publication date: 2022

DMPA-SC supportive supervision toolkit

Supportive supervision plays a critical role to ensure high-performing health workers have the appropriate knowledge, skills, and motivation in order to deliver quality family planning (FP) services and informed choice counseling. This package includes three supportive supervision tools that can be used by regional or district health teams when conducting supervision visits at health facilities that offer FP services:

  1. Supportive supervision checklist to assess provision of family planning counseling
  2. Observation checklist to assess health workers counseling clients on DMPA-SC self-injection
  3. Remote supervision of family planning providers (includes family planning and self-injection)

Tools #1 and #2 can be used together or separately, depending on whether or not the supervision visits include follow-up with providers recently trained to counsel clients on DMPA-SC self-injection.

Tool #3 is intended for use in situations where in-person supervision is not possible; the supervision exercise can be conducted through phone or video. This tool includes guidance and instructions for supervisors who plan to conduct supervision remotely.

The tools are intended to serve as guides and can be adapted for specific settings as needed. For more information, contact FPoptions@path.org.

Institutional author(s): PATH, JSI
Publication date: July, 2021

Resources: A list of references about subcutaneous DMPA

This brief lists key references and resources from the evidence base on DMPA-SC. Pair this with the Evidence at-a-glance brief if your target decision-maker would like to have access to the data in that handout.

Institutional author(s): PATH
Publication date: October, 2019

GATHER Guide to Counseling

This 32-page publication outlines the GATHER model of family planning counseling, which has been successfully used for nearly two decades and is based on the elements described including tips, illustrations, techniques, technical information, and charts.

Institutional author(s): Johns Hopkins Center for Communication Programs (JHU CCP)
Publication date: December, 1998

Testing a counseling message for increasing uptake of self-injectable contraception in southern Malawi

A mixed-methods, clustered randomized controlled study

Objective: While self-injection of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) has well-documented benefits, uptake may be improved by addressing client concerns such as fear of self-injury and low self-efficacy. However, current training materials for family planning providers do not address these concerns. We used an iterative process with family planning providers and clients, male community leaders and partners, and stakeholders in Malawi to develop a counseling message addressing user-centered concerns about self-injection. We report on our testing of the effectiveness of this evidence-based message for increasing self-injection uptake in the context of full method choice.

Methods: We randomized 60 public facilities across two districts in southern Malawi to orient their providers to the message (treatment) or not (control). After strengthening data quality, we extracted routine service delivery data from the facilities six months before and after introducing the message. We compared pre- and post-orientation trends for the treatment and control groups using generalized linear mixed models. We conducted eight focus group discussions with a sample of providers oriented to the message.

Results: The message was feasible to implement and highly acceptable to providers. During June 2020–June 2021, 16,593 new clients used injectables in Mangochi district (52% DMPA-SC; 15% self-injected). In Thyolo district, 7,761 new clients used injectables during July 2020–July 2021 (29% DMPA-SC; 14% self-injected). We observed high variability in number of clients and self-injection uptake across facilities and over time, indicating inconsistent offering of self-injection. In both districts, we found significant increases in self-injection in treatment facilities after message introduction. However, this increase was not sustained, especially when DMPA-SC was unavailable or about to expire.

Conclusion: Based on the study findings, we recommend the evidence-based message be used in programs offering DMPA-SC self-injection services. However, effective use of the message is contingent upon a consistent supply of DMPA-SC.

Institutional author(s): FHI 360, Centre for Health, Agriculture Development Research and Consulting
Individual author(s): Holly M Burke, Catherine Packer, Akuzike Zingani, Philemon Moses, Alissa Bernholc, Lucy W Ruderman, Andres Martinez, Mario Chen
Publication date: October, 2022

Journal article PLoS ONE

Counseling for Choice

Counseling for Choice (C4C) is an evidence-based approach to contraceptive counseling that supports clients to decide which method is right for them. By addressing many of the root causes of unmet need for contraception and discontinuation, C4C aims to change how providers and clients participate in voluntary family planning (FP) counseling discussions. The approach comprises a thorough training in C4C techniques and the use of the Choice Book for Providers, a job aid and visual tool providers use with clients during counseling sessions.

Institutional author(s): Population Services International (PSI)
Publication date: 2021

Guide Counseling for Choice website

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

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. 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. Higher scores on the 3-question Method Information Index (MII)—measuring client-reported receipt of contraceptive information—was associated with continued use of family planning over 12 months. We recommend incorporating use of the MII in routine assessments of family planning service quality.

Global Health: Science and Practice. March 2019, 7(1):87-102. https://doi.org/10.9745/GHSP-D-18-00407

 

Institutional author(s): Metrics for Management, Population Council, Wilfrid Laurier University, Population Services International (PSI), MSI Reproductive Choices, Makerere University
Individual author(s): Nirali M. Chakraborty, Karen Chang, Benjamin Bellows, Karen A. Grépin, Waqas Hameed, Amanda Kalamar, Xaher Gul, Lynn Atuyambe, Dominic Montagu
Publication date: March, 2019

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

Self-Injection Feasibility and Acceptability

This brief provides an overview of PATH’s research studies assessing the feasibility and acceptability of self-injection in Uganda and Senegal.

Institutional author(s): PATH
Publication date: January, 2018

Brief Self-Injection Feasibility and Acceptability