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Purpose: Gaslighting a form of abusive manipulation both emotional and psychological is a growing phenomenon in recent times. However, as of yet, there is a scarcity of a valid and reliable instrument which can measure the severity of gaslighting in victims of interpersonal relationships abuse. The purpose of this study is the development of an instrument which can effectively measure gaslighting in victims and is psychometrically reliable and valid. Design/methodology/approach: Since the aim of the study was the development of a scale first a sample of eight women who were victims of domestic abuse was taken for the focus group. Afterwards using purposive sampling a sample of 20 women for the pilot study and a sample of 150 women for the main study was taken with age range 18–40 (M = 23.38, S.D = 4.03). For the development of scale theoretical basis along with a focus group was conducted to establish an item pool. Afterwards, subject matter experts helped in establishing contend validity followed by Velicer's minimum average partial (MAP) method and maximum likelihood factor analysis (FA) was performed for the establishment of the factorial structure of the instrument. Findings: Velicer's MAP method and Maximum Likelihood FA suggested two factor structures including peer disagreement and loss of self-trust. Instrument displayed high alpha reliability of α = 0.934, with α = 0.927 and α = 0.854, for the subscale, respectively. Research limitations/implications: Though all necessary steps were taken to minimize the limitations of the present study, however, some limitations do exist which needs to be addressed. The foremost limitation of the present scale is that it is being developed with only a female sample, however, the inclusion of a male sample in future studies can help in identifying whether men also are victims of gaslighting from peers and other family members or not. The second limitation is of validity though necessary validities have been established future studies should study on establishing further validities to further refine the instrument. Additionally, the scale has only been validated and tested on female samples future studies should be conducted on other specific groups or samples to develop norms. Moreover, testing the scale on other cultures could also help in establishing cross cultural validation of the instrument. Finally, though the scale assumes a higher level of scores suggests a higher level of victimization, a proper cutoff score can help in further identifying proper victims from the normal level of gaslighting. Practical implications: The present instrument has its applicability in several domains the most important being in the criminal justice system as gaslighting comes under gaslighting and even in the UK is considered as a criminal offense. This instrument can help in determining the severity of gaslighting in victims. Likewise, it can be used in clinical settings for psychologists to identify possible cases of gaslighting victims which can enable them to provide specific help and treatment for them. Moreover, researchers can also benefit from the instrument as it can enable them to explore gaslighting with other possible variables which can help them explore the concept of gaslighting even further. Originality/value: This paper is a novel study and has been completed with the purpose of evaluating the effects of gaslighting in victims of interpersonal relationships abuse as the earlier measures are either not psychometrically valid or cannot be generalized to a wider population. The present established scale is an effort to construct an instrument that can be used worldwide. [ABSTRACT FROM AUTHOR]

This paper examines the issue of quality assurance (QA) in library and information science (LIS) education in Pakistan. It identifies the practices of quality assessment prevalent in Pakistani LIS schools and examines the perceptions of faculty members concerning the accreditation of LIS programs. A questionnaire sent to heads of departments and semi-structured interviews with faculty were employed to collect data. The findings of the study identify human, physical, procedural, and behavioral hindrances to imparting quality education. The study revealed a need for developing and implementing robust internal and external quality assurance mechanisms. The findings may lead to the development of policy guidelines for quality assurance in Pakistan and other countries with a similar context. [ABSTRACT FROM AUTHOR]

Background: Because of diverse topographical habitats, the Chenab River wetland harbors a wealth of medicinal and food plant species. This paper presents first quantitative assessment on the ethnobotanical use of plants by the local peoples residing in the Chenab riverine area. Methods: The ethnobotanical data were collected from six parts of the Chenab River wetland: Mandi Bahuddin, Gujranwala, Gujrat, Sargodha, and Sialkot during 2014 to 2015, using semi-structured interviews. Quantitative indices including informant consensus factor (FCI), relative frequency of citation (RFC), relative importance level (RIL), use value (UV), fidelity level (FL), and corrected fidelity level (CFL) were used to analyze the data. Results: On the whole, 129 medicinal plant species belonging to 112 genera of 59 families were reported, with herbs as dominant life forms (51%). Poaceae was the leading family with 13 species, and leaves were the most frequently utilized plant parts (28%). Herbal medicines were mostly used in the form of powder or decoction, and were mainly taken orally. Withania somnifera, Solanum surattense, Solanum nigrum, Azadirachta indica, Ficus benghalensis, Morus nigra, Morus alba, Polygonum plebeium, and Tribulus terrestris were among the highly utilized plant species, with highest UV, RFC, RIL, FL, and CFL values. The reported ailments were grouped into 11 categories based on FCI values, whereas highest FIC was recorded for gastrointestinal diseases and glandular diseases (0.41 and 0.34, respectively). The use report (UR) and frequency of citation (FC) depicted strong positive correlation (r = 0.973; p = 0.01). The value of determination (r2 = 0.95) indicating 95% variation in UR can be explained in terms of the FC. Conclusion: The significant traditional knowledge possessed by local communities depicts their strong relation with phytodiversity. Reported data could be helpful in sustainable use and protection of plant species in the Chenab wetland, with special emphasis on medicinal plants. Furthermore, screening of plant-borne active ingredients and in vivo/in vitro pharmacological activities could be of interest for novel drug synthesis. [ABSTRACT FROM AUTHOR]

Background: Although Pakistan was one of the first countries in Asia to launch national family planning programs, current modern contraceptive use stands at only 26% with a method mix skewed toward short-acting and permanent methods. As part of a multiyear operational research study, a baseline survey was conducted to understand the predictors of contraceptive use and demand for family planning services in underserved areas of Punjab province in Pakistan. This paper presents the baseline survey results; the outcomes of the intervention will be presented in a separate paper after the study has been completed. Method: A cross-sectional baseline household survey was conducted with randomly selected 3,998 married women of reproductive age (MWRA) in the Chakwal, Mianwali, and Bhakkar districts of Punjab. The data were analyzed on SPSS 17.0 using simple descriptive and logistic regression. Results: Most of the women had low socio-economic status and were younger than 30 years of age. Four-fifths of the women consulted private sector health facilities for reproductive health services; proximity, availability of services, and good reputation of the provider were the main predicators for choosing the facilities. Husbands were reported as the key decision maker regarding health-seeking and family planning uptake. Overall, the current contraceptive use ranged from 17% to 21% across the districts: condoms and female sterilization were widely used methods. Woman's age, husband's education, wealth quintiles, spousal communication, location of last delivery, and favorable attitude toward contraception have an association with current contraceptive use. Unmet need for contraception was 40.6%, 36.6%, and 31.9% in Chakwal, Mianwali, and Bhakkar, respectively. Notably, more than one fifth of the women across the districts expressed willingness to use quality, affordable long-term family planning services in the future. Conclusion: The baseline results highlight the need for quality, affordable long-term family planning services close to women's homes. Furthermore, targeted community mobilization and behavior change efforts can lead to increased awareness, acceptability, and use of family planning and birth spacing services. [ABSTRACT FROM AUTHOR]

Background: Temporomandibular joint disorders (TMDs) are a variety of conditions that affect different parts of the temporomandibular joints (TMJ) and can cause orofacial pain and functional impairment. This study aims to investigate dental practitioners' knowledge and management of Temporomandibular Joint Disorders (TMDs), particularly their knowledge of the role physical therapy plays in TMD treatment. Methods: A mixed-methods approach was adopted to provide a comprehensive view of current knowledge, management practices, and attitudes toward collaboration among dental practitioners in treating TMD. Data were collected from a convenience sample of 335 dentists in Karachi using a detailed questionnaire to assess their knowledge of the role of physical therapy in the treatment of TMD. Twenty dentists were chosen for face-to-face, in-depth interviews to explore their experiences and challenges in managing TMDs based on their responses to the administered questionnaire. Results: The cumulative quantitative and qualitative findings of the study revealed a landscape marked by individualized approaches to referral practices and significant gaps in interdisciplinary collaboration. Most practitioners holding a bachelor's degree predominantly used medication (65.2%) and cause-specific treatment (65.3%) for TMD treatment. Thematic analysis of clinical efficacy and practitioner challenges in managing TMD revealed significant issues faced by dental professionals. Conclusions: The study successfully validated a questionnaire to understand dental practitioners' knowledge regarding physical therapy in TMD treatment. The study identified significant gaps in knowledge and a lack of collaboration between dentists and physiotherapists. The limited referral practices highlighted in the study, along with insights from dentist interviews, emphasize the need for improved interdisciplinary approaches to managing TMDs within dental practice. [ABSTRACT FROM AUTHOR]

Background This paper represents the first ethnobotanical study in Chail valley of district Swat-Pakistan and provides significant information on medicinal plants use among the tribal people of the area. The aim of this study was to document the medicinal uses of local plants and to develop an ethnobotanical inventory of the species diversity. Methods In present study, semi-structured interviews with 142 inhabitants (age range between 31-75 years) were conducted. Ethnobotanical data was analyzed using relative frequency of citation (RFC) to determine the well-known and most useful species in the area. Results Current research work reports total of 50 plant species belonging to 48 genera of 35 families from Chail valley. Origanum vulgare, Geranium wallichianum and Skimmia laureola have the highest values of relative frequency of citation (RFC) and are widely known by the inhabitants of the valley. The majority of the documented plants were herbs (58%) followed by shrubs (28%), trees (12%) and then climbers (2%). The part of the plant most frequently used was the leaves (33%) followed by roots (17%), fruits (14%), whole plant (12%), rhizomes (9%), stems (6%), barks (5%) and seeds (4%). Decoction was the most common preparation method use in herbal recipes. The most frequently treated diseases in the valley were urinary disorders, skin infections, digestive disorders, asthma, jaundice, angina, chronic dysentery and diarrhea. Conclusion This study contributes an ethnobotanical inventory of medicinal plants with their frequency of citations together with the part used, disease treated and methods of application among the tribal communities of Chail valley. The present survey has documented from this valley considerable indigenous knowledge about the local medicinal plants for treating number of common diseases that is ready to be further investigated for biological, pharmacological and toxicological screening. This study also provides some socio-economic aspects which are associated to the local tribal communities. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Children and adults involved in carpet weaving are prone to a number of health and safety problems. This paper describes initial impact of an ergonomically designed loom and work place modifications, to encourage young and adult workers to weave carpets and reduce the hazardous child labor in carpet weaving in the province of Punjab, Pakistan. METHODS: A new carpet loom with improved ergonomic and safety features suitable for adult carpet weavers was designed. Model carpet weaving worksites based on the new loom and better work environment were created in 30 villages. The impact of new loom compared with the traditional looms was assessed through structured questionnaires and health examinations after 24 months. RESULTS: Adolescent (15-17 years) and adult (> 17 years) participants included 75 respondents (males 10.7%, n=8; females 89.3%, n=67) operating under the new conditions and 92 respondents (males 12%, n=11; females 88%, n=81) operating under traditional conditions. Results indicated an improvement of health related complaints among those working in the new conditions, most notable were the differences in joint pain (p=0.002) and respiratory health (p=0.02). Improvement of income was also reported by workers at model workplaces. Also, no children below the age of 14 were found to be working at the new looms. CONCLUSIONS: The results indicate that individuals who adopted new looms and workplace interventions reported less joint pain and better respiratory health than those working with traditional looms in a traditional work environment. By reducing the risks in the workplace, this ergonomic intervention has the potential to reduce or eliminate hazardous child labor from carpet weaving. [ABSTRACT FROM AUTHOR]

Women's satisfaction with the quality of care during pregnancy and childbirth can impact their access to and utilization of healthcare services. Since many women live in rural regions in developing nations, it is crucial to secure their access to and use of basic healthcare services to reduce maternal and newborn morbidity and mortality. This cross-sectional study is part of a first-time, sizeable, mixed-method study involving women and midwives' quantitative and qualitative perspectives on the quality of midwifery care in rural Pakistan. The aim was to describe women's satisfaction with the quality of midwifery care during labor and delivery at basic health units in rural Punjab, Pakistan. Simple random sampling was used to select 328 women from 96 basic health units. Data were collected between December 2020-March 2021. The Labor and Delivery Satisfaction Index measured women's satisfaction with childbirth. Data were analyzed using descriptive statistics and presented in frequencies and percentages. Results indicated that the majority, 277 (84.5%), were satisfied with the quality of midwifery care during labor and delivery, whereas the remaining 51 (15.5%) were unsatisfied. Appropriate tools to monitor labor and delivery and non-pharmacological pain management during labor need much improvement. The women must also be treated with respect, given accurate information about their labor status, and given control over it. Midwives and other health service providers and administrators can use the findings of this study to improve services available to rural women. [ABSTRACT FROM AUTHOR]

Introduction: Imposter Syndrome (IS) is loosely defined as doubting your abilities and feeling like a fraud. It disproportionately affects high-achieving people, who find it difficult to accept their accomplishments. This research was conducted in order to predict the IS in gifted students based on ego development, self-efficacy, and self-awareness. Method: The research was descriptive and correlational. All gifted students studying in middle schools in central Islamabad in the academic year 2020-2021 formed the statistical population of this research. For this purpose, 202 students were selected using the cluster sampling method and used the IS Questionnaire (Clans and Ames, 1978), the Ego Development Questionnaire (Markstrom et al., 1997), the Psychological Capital Questionnaire (Luthans et al., 2007), and the Spirituality Questionnaire (Donning and Parsian, 2009). The collected data were analyzed by SPSS version 26 and the significance level was considered 0.05. Results: The results of Pearson's correlation coefficient showed that there was a negative and significant relationship between self-efficacy and spiritual-health scores with IS in female students at the level of 0.05. Moreover, the regression analysis with the simultaneous entry method showed that the predictor variables together explained 43% of the variance of the IS scores among female students. Conclusion: The findings of the present study suggest that the psychological structures under investigation can predict and explain IS in female students. The aim of developing and assembling educational programs is to improve students' self-efficacy. Therefore, school officials, community health officials, and mental health officials are encouraged to improve students' self-efficacy. [ABSTRACT FROM AUTHOR]

Background: The mountainous territory of Kohistan shelters diverse food plant species and is considered one of the important hotspots of local plant knowledge. In the era of globalization and food commodification, wild food plants (WFPs) play an important role in supporting local food systems and related local knowledge is one of the important pillars of food sustainability across the region. Since the area is populated by different cultural groups and each culture has retained particular knowledge on the local plant species, therefore, to make a cross-culturally comparison, the study was planned to record and compare the local plants knowledge among three linguistic groups viz Gujjar, Kohistani and Shina in order to not only protect the local knowledge but to determine the food cultural adaptations among these groups looking through the lens of their food ethnobotanies. Methods: Field ethnobotanical survey was carried out in 2020–2021 to gather the data on wild food plants. We used semi-structured interviews. Use reports were counted, and the results were visualized through Venn diagrams. Results: In total, 64 plant species belonging to 45 botanical families were documented. Among these Ajuga integrifolia, Barbarea verna, Clematis grata, Impatiens edgeworthii, Ranunculus laetus (vegetables), Parrotiopsis jacquemontiana (fruit), Indigofera tinctoria (flower), Juniperus excelsa, Primula elliptica, P. macrophylla (flavoring agent), Leontopodium himalayanum (Chewing gum), and Juniperus excelsa (snuff) were reported for the first time. The highest use reports (≥ 90) were recorded for Mentha longifolia, Amaranthus hybridus, Quercus semecarpifolia, Solanum miniatum, Oxalis corniculata, Ficus palmata, and Urtica dioica. Maximum number of wild food plant species (WFPs) were reported by Kohistani, followed by Shinaki and Gujjari linguistic groups. The percentage overlap of traditional knowledge on WFPs was highest among Kohistani and Shinaki (56.0%), followed by Shinaki and Gujjars (17.0%), and Kohistani and Gujjars (15.0%). Kohistani and Shinaki groups exhibited maximum homogeneity in traditional knowledge. However, Gujjars had more knowledge on WFPs compared to Kohistani and Shinaki. In addition, some dairy products viz. Bhorus, Bagora, Bak, Cholam, Kacha, Gurloo and Poyeen were reported also reported that are consumed orally and used in traditional cuisines. Conclusions: The study indicates that Kohistan is one of the important spots of biocultural diversity and could be recognized as biocultural refugia. WFPs have been an integral part of the traditional food systems among the studied groups, particularly the Gujjars have reported more distinct plant uses which could be referred to their distinctive ecological experiences among others. However, social change is one of the challenges that might lead to the erosion of local plant knowledge. Moreover, intercultural negotiations among the studied groups are also a matter of concern which could homogenize the local knowledge among them. Therefore, we suggest solid policy measures to protect the local knowledge and celebrate diversity across this mountain territory. [ABSTRACT FROM AUTHOR]

The present study aims to translate and adapt the WHO-Five Wellbeing Index (WHO-5) into the Urdu language and then determine its psychometric properties. Male participants (N = 201) between 18 and 45 years old (M = 29.56 years, SD = 7.80) were recruited from substance use disorder treatment centers and hospitals in Karachi... Participants completed a Personal Information Form, The WHO-5, Self-Esteem Scale, and the Depression, Anxiety, and Stress Scale in Urdu. The Cronbach's alpha for the WHO Wellbeing Index (Cronbach's alpha =.80) is adequate. Similarly, both the Self Esteem (Cronbach's alpha =.86) and the Depression, Anxiety and Stress Scale total (Cronbach's alpha =.94) had adequate internal consistency. Further, Cronbach's alpha for subscales (depression =.88, anxiety =.91, stress =.82) was also adequate. A higher level of well-being is significantly positively associated with self-esteem (r =.275, p <.001) and negatively associated with depression, anxiety, and stress (r = −.307, p <.001). The Urdu version of WHO-5 has is a reliable measure for investigating well-being in male patients receiving treatment for substance use disorders in Pakistan who speak Urdu. [ABSTRACT FROM AUTHOR]

Aging people in Pakistan are a growing population who face a shortage of old age home facilities. There is critical need to develop state-run old age homes for poor older people but to plan them while identifying protective factors for life satisfaction in currently housed residents. Our sample consists of 139 aging residents from six public sector old age homes across four cities. The qualitative results highlight barriers to life satisfaction and coping strategies of the aging population. Bivariate regression results show that aging residents have higher odds for life satisfaction when they are content with: (i) quality of life overall (AOR 5.99; 95% CI: 2.38–7.06); (ii) health (AOR 2.50; 95% CI: 1.02–4.14); (iii) finances (AOR 1.98; 95% CI: 0.67–3.72); (iv) religious and spiritual associations (AOR 1.90; 95% CI: 0.81–2.45); and (v) opportunities for learning (AOR 1.02; 95% CI: 0.42–2.41). We conclude with four salient social policy recommendations to improve life satisfaction for older populations living in old age homes. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the challenges and patterns of seeking primary health care services in slums of Karachi, where about 60% of the population lives in various informal settlements. We surveyed 8 largest slums of the metropolitan, and analyzed the data both descriptively and inferentially to evaluate the factors associated with health care seeking behavior. Significantly positive association of quality health care seeking behavior and various socioeconomic indicators were found. In addition, substantial insights about the conditions of slum dwellers and health challenges of the population, such as low immunization and low vaccinations, among others, were reported. Thus, the role of policymakers is emphasized to strategize for the inclusion of these people in national health plans and to develop health infrastructure near these communities. Furthermore, there is a strong need to increase awareness of the population about hygiene practices, importance of immunization, and importance of utilizing appropriate health care services. [ABSTRACT FROM AUTHOR]

Background: Psychiatric illnesses have recently escalated in numbers, with patients resorting to various forms of healthcare providers, including faith healers. This delays early psychiatric treatment, resulting in further mental health deterioration of the patient. Various factors impact the mode of treatment preferred by psychiatric patients. Aims: To determine the frequency of psychiatric patients visiting faith healers, presenting at the outpatient department of Liaquat National Hospital, Karachi, Pakistan, and to explore the predictors that direct them toward visiting faith healers. Methods: This cross-sectional survey was conducted using a semi-structured pre-tested questionnaire, employing a total of 219 male and female psychiatric patients. Patients were recruited through non-random consecutive sampling technique. SPSS 18 was used for statistical analysis. Results: About 32% of the patients had visited a faith healer in their lifetime. Frequency of current visitors declined; the most frequent reason being stated was no relief from their treatment. Students, patients of upper middle class and those coming for initial visit to a psychiatrist were more likely to visit a faith healer. Patients who knew of someone previously visiting a faith healer were less likely to have visited a faith healer. Conclusion: This study highlights the importance of a multisectoral approach to dealing with psychiatric patients to help in bridging the treatment gap in mental health. [ABSTRACT FROM AUTHOR]

Purpose: The risk behaviors of Hong Kong ethnic minority students are understudied. This exploratory qualitative study aimed to explore culturally nuanced factors for the development and prevention of risk behaviors among Pakistani and Indian students in Hong Kong. Method: Twenty-three students participated in four focus groups. All interviews were transcribed verbatim and analyzed using thematic analysis. Results: The participants reported bullying, delinquency, gambling, alcohol, cigarette, and drug uses as risk behaviors. Four themes emerged in the development and prevention of risk behaviors: (a) Parental and peer influence, (b) An unsafe community environment were perceived by the participants as essential factors for the development of risk behaviors, (c) Parental monitoring, and (d) Strong religious beliefs were believed as protective factors for the prevention of risk behaviors. Conclusion: Further research and practice may investigate and focus on the factors embedded in the Hong Kong ethnic minorities’ sociocultural contexts to prevent risk behaviors. [ABSTRACT FROM AUTHOR]

Background: Traditional knowledge of indigenous plants is pivotal in developing strategies to feed livestock sustainably in low input systems. Likewise, in Pakistan the indigenous people of Central Punjab have been using their regional grasses as a ruminant fodder for centuries. This study evaluated the indigenous traditional knowledge to ascertain the value of various fodder grasses to optimise their use to feed livestock in Central Punjab. Methods: The snowball technique was employed to identify key informants who had relevant knowledge about different grasses in the study area. Semi-structured questionnaires, face-to-face interviews and site visits were used for describing the fodder grasses. The data were then analysed by using relative frequency citation and pairwise comparison methods to determine the order of priority among the listed fodder grasses. Furthermore, SPSS 22 software was used for descriptive statistics and interpretation of associations among studied parameters. Microsoft Excel was used to present data as % values and graphs. Results: Overall, 53 grasses were described with ethnobotanical information regarding their uses for fodder, ethnoveterinary and other purposes. All these grasses belonged to the family Poaceae where the subfamily Panicoideae had the maximum number of 30 grasses. We categorized these grasses into high (A), medium (B) and low priority (C) groups where the group A grasses were reported as not only the most abundant but also the most palatable forages to all ruminants. Their higher demand was reflected by the feeding systems of both ad libitum grazing and feeding after cutting and mixing with other feeds. The study also revealed 37 previously unreported ethnoveterinary uses of these grasses. Conclusions: The results have reinforced the value of conserving ethnobotanical knowledge, being poorly documented previously, in developing strategies to feed livestock. It indicated the preferred fodder grasses as well as the possible reasons of their preference. The reported data need to be validated for nutritional and health benefits. This information could help the smallholder farmers in association with regional governments to propagate suitable fodder grasses for their use in sustainable livestock feeding to produce safe and healthy food for indigenous communities. [ABSTRACT FROM AUTHOR]

Background: Globally, pre-eclampsia and eclampsia are major contributors to maternal and perinatal mortality; of which the vast majority of deaths occur in less developed countries. In addition, a disproportionate number of morbidities and mortalities occur due to delayed access to health services. The Community Level Interventions for Pre-eclampsia (CLIP) Trial aims to task-shift to community health workers the identification and emergency management of pre-eclampsia and eclampsia to improve access and timely care. Literature revealed paucity of published feasibility assessments prior to initiating large-scale community-based interventions. Arguably, well-conducted feasibility studies can provide valuable information about the potential success of clinical trials prior to implementation. Failure to fully understand the study context risks the effective implementation of the intervention and limits the likelihood of post-trial scale-up. Therefore, it was imperative to conduct community-level feasibility assessments for a trial of this magnitude. Methods: A mixed methods design guided by normalization process theory was used for this study in Nigeria, Mozambique, Pakistan, and India to explore enabling and impeding factors for the CLIP Trial implementation. Qualitative data were collected through participant observation, document review, focus group discussion and in-depth interviews with diverse groups of community members, key informants at community level, healthcare providers, and policy makers. Quantitative data were collected through health facility assessments, self-administered community health worker surveys, and household demographic and health surveillance. Results: Refer to CLIP Trial feasibility publications in the current and/or forthcoming supplement. Conclusions: Feasibility assessments for community level interventions, particularly those involving task-shifting across diverse regions, require an appropriate theoretical framework and careful selection of research methods. The use of qualitative and quantitative methods increased the data richness to better understand the community contexts. [ABSTRACT FROM AUTHOR]

Background: Family planning (FP) interventions aimed at reducing population growth have negligible during the last two decades in Pakistan. Innovative FP interventions that help reduce the growing population burden are the need of the hour. Marie Stopes Society - Pakistan implemented an operational research project - 'Evidence for Innovating to Save Lives', to explore effective and viable intervention models that can promote healthy timing and spacing of pregnancy in rural and under-served communities of Sindh, Punjab and Khyber Pakhtunkhwa provinces of Pakistan. Methods: We conducted a quasi-experimental (pre - and post-intervention with control arm) study to assess the effectiveness of each of the two intervention models, 1) Suraj model (meaning 'Sun' in English), which uses social franchises (SF) along with a demand-side financing (DSF) approach using free vouchers, and 2) Community Midwife (CMW) model, in promoting the use of modern contraceptive methods compared to respective controls. Baseline and endline cross-sectional household surveys were conducted, 24 months apart, by recruiting 5566 and 6316 married women of reproductive age (MWRA) respectively. We used Stata® version 8 to report the net effect of interventions on outcome indicators using difference-in-differences analysis. Multivariate Cox proportional hazard regression analysis was used to assess the net effect of the intervention on current contraceptive use, keeping time constant and adjusting for other variables in the model. Results: The Suraj model was effective in significantly increasing awareness about FP methods among MWRA by 14 % percentage points, current contraceptive use by 5 % percentage points and long term modern method - intrauterine device (IUD) use by 6 % percentage points. The CMW model significantly increased contraceptive awareness by 28 % percentage points, ever use of contraceptives by 7 % percentage points and, IUD use by 3 % percentage points. Additionally the Suraj intervention led to a 35 % greater prevalence (prevalence ratio: 1.35, 95 % CI: 1.22-1.50) of contraceptive use among MWRA. Conclusion: Suraj intervention highlights the importance of embedding subsidized FP services within the communities of the beneficiaries. The outcomes of the CMW intervention also improved the use of long-term contraceptives. These findings indicate the necessity of designing and implementing FP initiatives involving local mid-level providers to expand contraceptive coverage in under-served areas. [ABSTRACT FROM AUTHOR]