39 results on '"Joanna Paula Cordero"'
Search Results
2. A continuum of individual-level factors that influence modern contraceptive uptake and use: perspectives from community members and healthcare providers in Durban, South Africa
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Yolandie Kriel, Cecilia Milford, Joanna Paula Cordero, Fatima Suleman, Petrus S. Steyn, and Jennifer Ann Smit
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Contraception ,South Africa ,Continuum of use ,Individual-level factors ,Family planning ,Gynecology and obstetrics ,RG1-991 - Abstract
Abstract Background South Africa faces numerous sexual and reproductive health challenges that can be mitigated with contraceptive use. Contraceptive use is defined and measured as use, non-use, or discontinued use. Research has shown that there are expanded definitions of use beyond these categories. Identifying such categories may assist in a better understanding of factors that influence contraceptive use. Setting and methodology This qualitative study was conducted in the eThekwini Municipality in KwaZulu-Natal, South Africa. The aim was to explore the factors influencing the uptake and use of modern contraception. One hundred and twenty-seven participants were enrolled in this study. One hundred and three of those were community members, and twenty-five were healthcare providers. Focus group discussions and in-depth interviews were conducted to gather the data. Data analysis was facilitated using NVivo 10 software. Results The data show that numerous factors influence contraceptive uptake and use. From these factors, a continuum of use that captures a variety of states of use emerged. Five different states of use were uncovered: no-use, vulnerable use, compelled use, conditional use, and autonomous use. The development of the model illustrates the complexity of contraceptive needs and that it extends beyond definitions found in policies and large-scale surveys. Expanding conceptions of use can aid in developing counselling and information support tools that can improve the uptake and continued use of modern contraception.
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- 2023
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3. The role of social accountability in changing service users’ values, attitudes, and interactions with the health services: a pre-post study
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Victoria Boydell, Petrus S. Steyn, Joanna Paula Cordero, Ndema Habib, My Huong Nguyen, Dela Nai, Donat Shamba, Kamil Fuseini, Sigilbert Mrema, and James Kiarie
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Contraception ,Social accountability ,Attitudes ,Ghana ,Tanzania ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract This study evaluated the effects of community engagement through social accountability on service users’ values, attitudes and interactions. We conducted a pre–post study of the community and provider driven social accountability intervention (CaPSAI) over a 12-month period among 1,500 service users in 8 health facilites in Ghana and in Tanzania (n = 3,000). In both countries, there were significant improvements in women’s participation in household decision-making and in how service users’ perceive their treatment by health workers. In both settings, however, there was a decline in women’s knowledge of rights, perception of service quality, awareness of accountability mechanisms and collective efficacy in the community. Though CaPSAI intervention set out to change the values, attitudes, and interactions between community members and those providing contraceptive services, there were changes in different directions that require closer examination.
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- 2023
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4. The impact of community and provider-driven social accountability interventions on contraceptive use: findings from a cohort study of new users in Ghana and Tanzania
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Petrus S. Steyn, Joanna Paula Cordero, Dela Nai, Donat Shamba, Kamil Fuseini, Sigilbert Mrema, Ndema Habib, My Huong Nguyen, and James Kiarie
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Social accountability ,Contraception / family planning ,Contraceptive use ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Although contraceptive use has increased over 15 years, discontinuation rates remain high. Contraceptive use is becoming more important when addressing unmet need for family planning. Social accountability, defined here as collective processes for holding duty bearers to account for their actions, is a rights-based participatory process that supports service provision and person-centred care, as well as, informed decision-making among community members regarding their health. A study implemented in Ghana and Tanzania was designed to understand and evaluate how social accountability and participatory processes influences quality of care and client satisfaction and whether this results in increased contraceptive uptake and use. We report here on the relationship between social accountability and the use of modern contraceptives, i.e., contraceptive method discontinuation, contraceptive method switching, and contraceptive discontinuation. Methods As part of Community and Provider driven Social Accountability Intervention (CaPSAI) Project, a cohort of women aged 15 to 49 years who were new users of contraception and accessing family planning and contraceptives services at the study facilities across both intervention and control groups were followed-up over a 12-month period to measure changes contraceptive use. Results In this cohort study over a one-year duration, we did not find a statistically significant difference in Ghana and Tanzania in overall method discontinuation, switching, and contraceptive discontinuation after exposure to a social accountability intervention. In Ghana but not in Tanzania, when stratified by the type of facility (district level vs. health centre), there were significantly less method and contraceptive discontinuation in the district level facility and significantly more method and contraceptive discontinuation in the health centres in the intervention group. In Ghana, the most important reasons reported for stopping a method were fear of side-effects, health concerns and wanting to become pregnant in the control group and fear of side-effects wanting a more effective method and infrequent sex in the intervention group. In Tanzania, the most important reasons reported for stopping a method were fear of side-effects, wanting a more effective method, and method not available in the control group compared to wanting a more effective method, fear of side-effects and health concerns in the intervention group. Conclusions We did not demonstrate a statistically significant impact of a six-month CaPSAI intervention on contraceptives use among new users in Tanzania and Ghana. However, since social accountability have important impacts beyond contraceptive use it is important consider results of the intermediate outcomes, cases of change, and process evaluation to fully understand the impact of this intervention. Trial registration The CaPSAI Project has been registered at Australian New Zealand Clinical Trials Registry (ACTRN12619000378123, 11/03/2019).
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- 2023
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5. Research and implementation interactions in a social accountability study: utilizing guidance for conducting process evaluations of complex interventions
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Joanna Paula Cordero, Vernon Mochache, Victoria Boydell, Mary Awelana Addah, Heather McMullen, Alice Monyo, Sigilbert Mrema, Dela Nai, Donat Shamba, and Petrus S. Steyn
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Social accountability ,Complex intervention ,Research ,Practice ,Methodology ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background In recent years, researchers and evaluators have made efforts to identify and use appropriate and innovative research designs that account for the complexity in studying social accountability. The relationship between the researchers and those implementing the activities and how this impacts the study have received little attention. In this paper, we reflect on how we managed the relationship between researchers and implementers using the United Kingdom Medical Research Council (MRC) guidance on process evaluation of a complex intervention. Main body The MRC guidance focuses on three areas of interaction between researchers and stakeholders involved in developing and delivering the intervention: (i) working with program developers and implementers; (ii) communication of emerging findings between researchers/evaluators and implementers; and (iii) overlapping roles of the intervention and research/evaluation. We summarize how the recommendations for each of the three areas were operationalized in the Community and Provider driven Social Accountability Intervention (CaPSAI) Project and provide reflections based on experience. We co-developed various tools, including standard operating procedures, contact lists, and manuals. Activities such as training sessions, regular calls, and meetings were also conducted to enable a good working relationship between the different partners. Conclusions Studying social accountability requires the collaboration of multiple partners that need to be planned to ensure a good working relationship while safeguarding both the research and intervention implementation. The MRC guidance is a useful tool for making interaction issues explicit and establishing procedures. Planning procedures for dealing with research and implementers’ interactions could be more comprehensive and better adapted to social accountability interventions if both researchers and implementers are involved. There is a need for social accountability research to include clear statements explaining the nature and types of relationships between researchers and implementers involved in the intervention.
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- 2022
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6. Impact of community and provider-driven social accountability interventions on contraceptive uptake in Ghana and Tanzania
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Petrus S. Steyn, Joanna Paula Cordero, Dela Nai, Donat Shamba, Kamil Fuseini, Sigilbert Mrema, Ndema Habib, My Huong Nguyen, and James Kiarie
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Social accountability ,Contraception/ family planning ,Uptake of contraception ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Social accountability, which is defined as a collective process for holding duty bearers and service providers to account for their actions, has shown positive outcomes in addressing the interrelated barriers to quality sexual and reproductive health services. The Community and Provider driven Social Accountability Intervention (CaPSAI) Project contributes to the evidence on the effects of social accountability processes in the context of a family planning and contraceptive programme. Methods A quasi-experimental study utilizing an interrupted time series design with a control group (ITS-CG) was conducted to determine the actual number of new users of contraception amongst women 15–49 years old in eight intervention and eight control facilities per country in Ghana and Tanzania. A standardized facility audit questionnaire was used to collect facility data and completed every year in both intervention and control groups in each country from 2018–2020. Results In Ghana, the two-segmented Poisson Generalized Estimating Equation (GEE) model demonstrated no statistically significant difference at post-intervention, between the intervention and control facilities, in the level of uptake of contraceptives (excess level) (p-value = 0.07) or in the rate of change (excess rate) in uptake (p-value = 0.07) after adjusting for baseline differences. Similarly, in Tanzania, there was no statistical difference between intervention and control facilities, in the level of uptake of contraceptives (excess level) (p-value = 0.20), with the rate of change in uptake (p-value = 0.05) after adjusting for the baseline differences. There was no statistical difference in the level of or rate of change in uptake in the two groups in a sensitivity analysis excluding new users recruited in outreach activities in Tanzania. Conclusions The CAPSAI project intervention did not result in a statistically significant increase in uptake of contraceptives as measured by the number of or increase in new users. In evaluating the impact of the intervention on the intermediate outcomes such as self-efficacy among service users, trust and countervailing power among social groups/networks, and responsiveness of service providers, cases of change and process evaluation should be considered. Trial registration The CaPSAI Project has been registered at the Australian New Zealand Clinical Trials Registry (ACTRN12619000378123, 11/03/2019).
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- 2022
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7. Access to public sector family planning services and modern contraceptive methods in South Africa: A qualitative evaluation from community and health care provider perspectives.
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Yolandie Kriel, Cecilia Milford, Joanna Paula Cordero, Fatima Suleman, Petrus S Steyn, and Jennifer Ann Smit
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Medicine ,Science - Abstract
Progress has been made to improve access to family planning services and contraceptive methods, yet many women still struggle to access contraception, increasing their risk for unintended pregnancy. This is also true for South Africa, where over fifty per cent of pregnancies are reported as unintended, even though contraception is freely available. There is also stagnation in the fertility rate indicators and contraceptive use data, indicating that there may be challenges to accessing contraception. This paper explores the evaluation of access to contraception from community and health care provider perspectives. This qualitative study explored factors affecting the uptake and use of contraception through focus group discussions (n = 14), in-depth interviews (n = 8), and drawings. Participants included male and female community members (n = 103) between 15 and 49 years of age, health care providers (n = 16), and key stakeholder informants (n = 8), with a total number of 127 participants. Thematic content analysis was used to explore the data using NVivo 10. Emergent themes were elucidated and thematically categorised. The results were categorised according to a priori access components. Overall, the results showed that the greatest obstacle to accessing contraception was the accommodation component. This included the effects of integrated care, long waiting times, and limited operational hours-all of which contributed to the discontinuation of contraception. Community members reported being satisfied with the accessibility and affordability components but less satisfied with the availability of trained providers and a variety of contraceptive methods. The accessibility and affordability themes also revealed the important role that individual agency and choice in service provider plays in accessing contraception. Data from the illustrations showed that adolescent males experienced the most geographic barriers. This study illustrated the importance of examining access as a holistic concept and to assess each component's influence on contraceptive uptake and use.
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- 2023
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8. Quality of care in public sector family planning services in KwaZulu-Natal, South Africa: a qualitative evaluation from community and health care provider perspectives
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Yolandie Kriel, Cecilia Milford, Joanna Paula Cordero, Fatima Suleman, Petrus S. Steyn, and Jennifer Ann Smit
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Quality of care ,Family planning services ,Contraception ,South Africa ,Qualitative research ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Quality of care is a multidimensional concept that forms an integral part of the uptake and use of modern contraceptive methods. Satisfaction with services is a significant factor in the continued use of services. While much is known about quality of care in the general public health care service, little is known about family planning specific quality of care in South Africa. This paper aims to fill the gap in the research by using the Bruce-Jain family planning quality of care framework. Methods This formative qualitative study was conducted in South Africa, Zambia, and Kenya to explore the uptake of family planning and contraception. The results presented in this paper are from the South African data. Fourteen focus group discussions, twelve with community members and two with health care providers, were conducted along with eight in-depth interviews with key informants. Thematic content analysis using the Bruce-Jain Quality of Care framework was conducted to analyse this data using NVIVO 10. Results Family planning quality of care was defined by participants as the quality of contraceptive methods, attitudes of health care providers, and outcomes of contraceptive use. The data showed that women have limited autonomy in their choice to either use contraception or the method that they might prefer. Important elements that relate to quality of care were identified and described by participants and grouped according to the structural or process components of the framework. Structure-related sub-themes identified included the lack of technically trained providers; integration of services that contributed to long waiting times and mixing of a variety of clients; and poor infrastructure. Sub-themes raised under the process category included poor interpersonal relations; lack of counselling/information exchange, fear; and time constraints. Neither providers nor users discussed follow up mechanisms which is a key aspect to ensure continuity of contraceptive use. Conclusion Using a qualitative methodology and applying the Bruce-Jain Quality of Care framework provided key insights into perceptions and challenges about family planning quality of care. Identifying which components are specific to family planning is important for improving contraceptive outcomes. In particular, autonomy in user choice of contraceptive method, integration of services, and the acceptability of overall family planning care was raised as areas of concern.
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- 2021
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9. Accounting for complexity – Intervention design in the context of studying social accountability for reproductive health [version 2; peer review: 1 approved, 2 approved with reservations]
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James Kiarie, Petrus S. Steyn, Alice Monyo, Patrick Kinemo, Jacob Tetteh Ahuno, Mary Awelana Addah, Joanna Paula Cordero, Osei-Bonsu Gyamfi, Victoria Boydell, and Heather McMullen
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Social Accountability ,Reproductive Health ,Complex Interventions ,eng ,Medicine - Abstract
Background: Social accountability interventions aim to propel change by raising community voices and holding duty bearers accountable for delivering on rights and entitlements. Evidence on the role of such interventions for improving community health outcomes is steadily emerging, including for sexual and reproductive health and rights (SRHR). However, these interventions are complex social processes with numerous actors, multiple components, and a highly influential local context. Unsurprisingly, determining the mechanisms of change and what outcomes may be transferable to other similar settings can be a challenge. We report our methodological considerations to account for complexity in a social accountability intervention exploring contraceptive uptake and use in Ghana and Tanzania. Main Body: The Community and Provider driven Social Accountability Intervention (CaPSAI) study explores the relationship between a health facility-focused social accountability intervention and contraceptive service provision in two countries. This 24-month mixed-method quasi-experimental study, using an interrupted time series with a parallel control group, is being undertaken in 16 sites across Ghana and Tanzania in collaboration with local research and implementation partners. The primary outcomes include changes in contraceptive uptake and use. We also measure outcomes related to current social accountability theories of change and undertake a process evaluation. We present three design components: aspects of co-design, ‘conceptual’ fidelity, and how we aim to track the intervention as ‘intended vs. implemented’ to explore how the intervention could be responsive to the embedded routines, local contextual realities, and the processual nature of the social accountability intervention. Conclusions: Through a discussion of these design components and their rationale, we conclude by suggesting approaches to intervention design that may go some way in responding to recent challenges in accounting for social accountability interventions, bearing relevance for evaluating health system interventions.
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- 2022
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10. Community and health provider perspectives on the quality of family planning and contraceptive services in Kabwe District, Zambia
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Theresa Nkole, Adam Silumbwe, Margarate N. Munakampe, Joanna Paula Cordero, Cecilia Milford, Joseph Mumba Zulu, and Petrus S. Steyn
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community ,contraceptives ,family planning ,health providers ,quality ,services ,zambia ,Diseases of the genitourinary system. Urology ,RC870-923 ,The family. Marriage. Woman ,HQ1-2044 - Abstract
Quality family planning and contraceptive (FP/C) services result in positive outcomes such as client satisfaction and sustained use of contraceptives. While most assessments of quality in FP/C services are based on measurable reproductive health outcomes, there is limited consideration of the perspectives and experiences of health providers and community members. This study aimed to address this knowledge gap, by exploring health providers’ and community perspectives on the elements of quality FP/C services in Kabwe district, Zambia. Fourteen focus group discussions and 10 in-depth interviews were conducted in October–December 2016, involving community members, key community stakeholders such as religious and political leaders, health committee members and frontline and managerial healthcare providers. Data were analysed using a thematic approach. According to study participants, quality FP/C services would include provision by skilled personnel with positive attitudes towards clients, availability of preferred methods and affordable products. Additional factors included appropriate infrastructure, especially counselling services spaces and adequate consultation time. Participants stressed the need for reduced waiting time and opportunity for self-expression. The efficiency and effectiveness of service delivery factors, such as information dissemination and community engagement, were also considered important elements of quality FP/C. This study underscores the value of considering both community and health provider perspectives in efforts to improve the quality of FP/C services, with the overall aim of increasing client satisfaction and sustained utilisation. However, service delivery processes must also be addressed in addition to providing for community participation, if quality is to be achieved in FP/C services.
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- 2021
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11. Adaptation and validation of social accountability measures in the context of contraceptive services in Ghana and Tanzania
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Victoria Boydell, Petrus S. Steyn, Joanna Paula Cordero, Ndema Habib, My Huong Nguyen, Dela Nai, and Donat Shamba
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Social accountability ,Measurement ,Contraception ,Tanzania ,Ghana ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Changes in the values, attitudes, and interactions of both service users and health care providers are central to social accountability processes in reproductive health. However, there is little consensus on how best to measure these latent changes. This paper reports on the adaptation and validation of measures that capture these changes in Tanzania and Ghana. Methods The CaPSAI theory of change determined the dimensions of the measure, and we adapted existing items for the survey items. Trained data collectors used a survey to collect data from 752 women in Tanzania and 750 women in Ghana attending contraceptive services. We used reliability analysis, exploratory, and confirmatory factor analysis to assess the validity and reliability of these measures in each country. Results The measure has high construct validity and reliability in both countries. We identified several subscales in both countries, 10 subscales in Tanzania, and 11 subscales in Ghana. Many of the domains and items were shared across both settings. Conclusion The study suggests that the multi-dimensional scales have high construct validity and reliability in both countries. Though there were differences in the two country contexts and in items and scales, there was convergence in the analysis that suggests that this measure may be relevant in different settings and should be validated in new settings. Trial registration ACTRN12619000378123 .
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- 2020
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12. Facilitating community participation in family planning and contraceptive services provision and uptake: community and health provider perspectives
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Adam Silumbwe, Theresa Nkole, Margarate N. Munakampe, Joanna Paula Cordero, Cecilia Milford, Joseph Mumba Zulu, and Petrus S. Steyn
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Community ,Participation ,Family planning ,Contraceptives ,Programs ,Accountability ,Gynecology and obstetrics ,RG1-991 - Abstract
Abstract Background Although community participation has been identified as being important for improved and sustained health outcomes, designing and successfully implementing it in large scale public health programmes, including family planning and contraceptive (FP/C) service provision, remains challenging. Zambian participants in a multi-country project (the UPTAKE project) took part in the development of an intervention involving community and healthcare provider participation in FP/C services provision and uptake. This study reports key thematic areas identified by the study participants as critical to facilitating community participation in this intervention. Methods This was an exploratory qualitative research study, conducted in Kabwe District, Central Province, in 2017. Twelve focus group discussions were conducted with community members (n = 114), two with healthcare providers (n = 19), and ten in-depth interviews with key community and health sector stakeholders. Data were analyzed using a thematic analysis approach. Results Four thematic categories were identified by the participants as critical to facilitating community participation in FP/C services. Firstly, accountability in the recruitment of community participants and incorporation of community feedback in FP/C. programming. Secondly, engagement of existing community resources and structures in FP/C services provision. Thirdly, building trust in FP/C methods/services through credible community-based distributors and promotion of appropriate FP/C methods/services. Fourthly, promoting strategies that address structural failures, such as the feminisation of FP/C services and the lack FP/C services that are responsive to adolescent needs. Conclusions Understanding and considering community members’ and healthcare providers’ views regarding contextualized and locally relevant participatory approaches, facilitators and challenges to participation, could improve the design, implementation and success of participatory public health programmes, including FP/C.
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- 2020
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13. Feasibility testing of a community dialogue approach for promoting the uptake of family planning and contraceptive services in Zambia
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Margarate Nzala Munakampe, Theresa Nkole, Adam Silumbwe, Joseph Mumba Zulu, Joanna Paula Cordero, and Petrus S. Steyn
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Family planning and contraception ,Community participation ,Contraception ,Community dialogue ,Zambia ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Community dialogues have been used in participatory approaches in various health prevention and awareness programs, including family planning interventions, to increase understanding and alignment of particular issues from different peoples’ perspectives. The main objective of this paper is to document the feasibility of a community dialogue approach, which aimed to promote dialogue between healthcare providers and community members. The feasibility testing was part of formative-phase research needed to design an intervention, with the ultimate goal of increasing the uptake of family planning and contraception. The community dialogue intervention generated discussions on key approaches to improve family planning and contraception provision and uptake. Methods Key stages of the community dialogue were undertaken, with representation from healthcare providers and community members. Participants included frontline and managerial health care providers, community health workers, family planning and contraception users, the youth, other stakeholders from the education sector, and civil society. How the dialogue was implemented (operational feasibility) as well as the cultural feasibility of the community dialogue content was evaluated through participant observations during the dialogue, using a standardised feasibility testing tick-list, and through focus group discussions with the stakeholders who participated in the community dialogue. Results Overall, 21 of the 30 invited participants attended the meeting- 70% attendance. The approach facilitated discussions on how quality care could be achieved in family planning and contraception provision, guided by the ground rules that were agreed upon by the different stakeholders. A need for more time for the discussion was noted. Participants also noted the need for more balanced representation from adolescents as well as other family planning stakeholders, such as community members, especially in comparison to healthcare providers. Some participants were not comfortable with the language used. Young people felt older participants used complicated terminologies while community members felt the health care providers outnumbered them, in terms of representation. Conclusion Generally, the community dialogue was well received by the community members and the healthcare providers, as was observed from the sentiments expressed by both categories. Some key considerations for refining the approach included soliciting maximum participation from otherwise marginalized groups like the youth would provide stronger representation.
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- 2020
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14. ‘Leaving no one behind’: a scoping review on the provision of sexual and reproductive health care to nomadic populations
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Moazzam Ali, Joanna Paula Cordero, Faria Khan, and Rachel Folz
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Nomad ,Pastoralist ,Sexual and reproductive health ,Family planning ,Health services ,Gynecology and obstetrics ,RG1-991 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Backgrund Marginalized groups, such as nomadic populations across the world, have perhaps the least access to modern reproductive health (RH) services. This scoping review aims to identify barriers to access to RH services faced by nomadic populations from the existing literature and to highlight possible opportunities to address them. Methods Key databases, including PubMed, Popline, Google Scholar, and Google Advanced were searched for relevant articles published between 2002 and 2019. A total 344 articles were identified through database online searches, and 31 were included in the review. Results Nomadic people face complex barriers to healthcare access that can be broadly categorized as external (geographic isolation, socio-cultural dynamics, logistical and political factors) and internal (lifestyle, norms and practices, perceptions) factors. To effectively address the needs of nomadic populations, RH services must be available, accessible and acceptable through tailored and culturally sensitive approaches. A combination of fixed and mobile services has proven effective among mobile populations. Low awareness of modern RH services and their benefits is a major barrier to utilization. Partnership with communities through leveraging existing structures, networks and decision-making patterns can ensure that the programmes are effectively implemented. Conclusion Further research is needed to better understand and address the RH needs of nomadic populations. Though existing evidence is limited, opportunities do exist and should be explored. Raising awareness and sensitization training among health providers about the specific needs of nomads is important. Improved education and access to information about the benefits of modern RH care among nomadic communities is needed. Ensuring community participation through involvement of nomadic women and girls, community leaders, male partners, and trained traditional birth attendants are key facilitators in reaching nomads. However, participatory programmes also need to be recognized and supported by governments and existing health systems.
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- 2019
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15. 'As we have gathered with a common problem, so we seek a solution': exploring the dynamics of a community dialogue process to encourage community participation in family planning/contraceptive programmes
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Tamaryn L. Crankshaw, Yolandie Kriel, Cecilia Milford, Joanna Paula Cordero, Nzwakie Mosery, Petrus S. Steyn, and Jennifer Smit
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Community participation ,Health provider ,Family planning ,Contraception ,Unmet need ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Community dialogues have been widely used as a method for community engagement and participation to cover a broad range of areas. However, there has been limited documentation and evaluation of the process, particularly as a method towards achieving family planning and contraception (FP/C) programme goals. As part of the development of an intervention package aimed at increasing community and health care provider (HCP) participation in the provision of FP/C, feasibility testing of the intervention approach (a community dialogue between communities and health facilities) was carried out. Our findings offer a systematic description and evaluation of the community dialogue process, with key recommendations towards future implementation. Methods The dialogue was evaluated in three ways: 1) through participant observation during the community dialogue, 2) via a standardised feasibility testing tick-list for all observers of the dialogue, and 3) through three focus group discussions (FGDs) consisting of different groups of stakeholders who participated in the community dialogue. In total, 28 community members, HCPs, and key stakeholders attended the community dialogue (22 females, 6 males). Twenty-seven of the community dialogue participants participated in one of 3 FGDs held after the dialogue. Six evaluators assessed feasibility of the dialogue process. Results There was good attendance, representation and participation amongst community and provider sectors based on the participant observations using the standardized feasibility check-list. The community dialogue process received positive feedback in the FGDs and was demonstrated to be feasible and acceptable. Key factors contributing to the success of the community dialogue included a skilled facilitator, good representation of participants, establishing ground rules, good timekeeping, and using a Theory of Change to facilitate goal identification and dialogue. Issues to consider are the underlying power differentials related to age, profession and gender which caused initial feelings of anxiety amongst some participants. Conclusions Our formative findings offer a systematic description and evaluation of a community dialogue process with key recommendations that may be considered when constituting similar community dialogues in the future.
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- 2019
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16. Rationale and design of a complex intervention measuring the impact and processes of social accountability applied to contraceptive programming: CaPSAI Project [version 2; peer review: 2 approved]
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Petrus S Steyn, Victoria Boydell, Joanna Paula Cordero, Heather McMullen, Ndema Habib, Thi My Huong Nguyen, Dela Nai, Donat Shamba, James Kiarie, and CaPSAI Project
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Medicine - Abstract
Background: There are numerous barriers leading to a high unmet need for family planning and contraceptives (FP/C). These include limited knowledge and information, poor access to quality services, structural inefficiencies in service provision and inadequately trained and supervised health professionals. Recently, social accountability programs have shown promising results in addressing barriers to accessing sexual and reproductive health services. As a highly complex participatory process with multiple and interrelated components, steps and actors, studying social accountability poses methodological challenges. The Community and Provider driven Social Accountability Intervention (CaPSAI) Project study protocol was developed to measure the impact of a social accountability intervention on contraceptive uptake and use and to understand the mechanisms and contextual factors that influence and generate these effects (with emphasis on health services actors and community members). Methods: CaPSAI Project is implementing a social accountability intervention where service users and providers assess the quality of local FP/C services and jointly identify ways to improve the delivery and quality of such services. In the project, a quasi-experimental study utilizing an interrupted time series design with a control group is conducted in eight intervention and eight control facilities in each study country, which are Ghana and Tanzania. A cross-sectional survey of service users and health care providers is used to measure social accountability outcomes, and a cohort of women who are new users of FP/C is followed up after the completion of the intervention to measure contraceptive use and continuation. The process evaluation utilizes a range of methods and data sources to enable a fuller description of how the findings were produced. Conclusion: This complex study design could provide researchers and implementers with the means to better measure and understand the mechanisms and contextual factors that influence social accountability processes in reproductive health, adding important findings to the evidence base.
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- 2020
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17. Rationale and design of a complex intervention measuring the impact and processes of social accountability applied to contraceptive programming: CaPSAI Project [version 1; peer review: 2 approved]
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Petrus S Steyn, Victoria Boydell, Joanna Paula Cordero, Heather McMullen, Ndema Habib, Thi My Huong Nguyen, Dela Nai, Donat Shamba, James Kiarie, and CaPSAI Project
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Medicine - Abstract
Background: There are numerous barriers leading to a high unmet need for family planning and contraceptives (FP/C). These include limited knowledge and information, poor access to quality services, structural inefficiencies in service provision and inadequately trained and supervised health professionals. Recently, social accountability programs have shown promising results in addressing barriers to accessing sexual and reproductive health services. As a highly complex participatory process with multiple and interrelated components, steps and actors, studying social accountability poses methodological challenges. The Community and Provider driven Social Accountability Intervention (CaPSAI) Project study protocol was developed to measure the impact of a social accountability process on contraceptive uptake and use and to understand the mechanisms and contextual factors that influence and generate these effects (with emphasis on health services actors and community members). Methods: CaPSAI Project is implementing a social accountability intervention where service users and providers assess the quality of local FP/C services and jointly identify ways to improve the delivery and quality of such services. In the project, a quasi-experimental study utilizing an interrupted time series design with a control group is conducted in eight intervention and eight control facilities in each study country, which are Ghana and Tanzania. A cross-sectional survey of service users and health care providers is used to measure social accountability outcomes, and a cohort of women who are new users of FP/C is followed up after the completion of the intervention to measure contraceptive use and continuation. The process evaluation utilizes a range of methods and data sources to enable a fuller description of how the findings were produced. Conclusion: This complex study design could provide researchers and implementers with the means to better measure and understand the mechanisms and contextual factors that influence social accountability processes in reproductive health, adding important findings to the evidence base.
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- 2020
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18. Social accountability for reproductive, maternal, newborn, child and adolescent health: A review of reviews.
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Frances Squires, Adriane Martin Hilber, Joanna Paula Cordero, Victoria Boydell, Anayda Portela, Miriam Lewis Sabin, and Petrus Steyn
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Medicine ,Science - Abstract
Globally, increasing efforts have been made to hold duty-bearers to account for their commitments to improve reproductive, maternal, newborn, child and adolescent health (RMNCAH) over the past two decades, including via social accountability approaches: citizen-led, collective processes for holding duty-bearers to account. There have been many individual studies and several reviews of social accountability approaches but the implications of their findings to inform future accountability efforts are not clear. We addressed this gap by conducting a review of reviews in order to summarise the current evidence on social accountability for RMNCAH, identify factors contributing to intermediary outcomes and health impacts, and identify future research and implementation priorities. The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42019134340). We searched eight databases and systematic review repositories and sought expert recommendations for published and unpublished reviews, with no date or language restrictions. Six reviews were analysed using narrative synthesis: four on accountability or social accountability approaches for RMNCAH, and two specifically examining perinatal mortality audits, from which we extracted information relating to community involvement in audits. Our findings confirmed that there is extensive and growing evidence for social accountability approaches, particularly community monitoring interventions. Few documented social accountability approaches to RMNCAH achieve transformational change by going beyond information-gathering and awareness-raising, and attention to marginalised and vulnerable groups, including adolescents, has not been well documented. Drawing generalisable conclusions about results was difficult, due to inconsistent nomenclature and gaps in reporting, particularly regarding objectives, contexts, and health impacts. Promising approaches for successful social accountability initiatives include careful tailoring to the social and political context, strategic planning, and multi-sectoral/multi-stakeholder approaches. Future primary research could advance the evidence by describing interventions and their results in detail and in their contexts, focusing on factors and processes affecting acceptability, adoption, and effectiveness.
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- 2020
- Full Text
- View/download PDF
19. Community and health systems barriers and enablers to family planning and contraceptive services provision and use in Kabwe District, Zambia
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Adam Silumbwe, Theresa Nkole, Margarate Nzala Munakampe, Cecilia Milford, Joanna Paula Cordero, Yolandie Kriel, Joseph Mumba Zulu, and Petrus S. Steyn
- Subjects
Barriers ,Community ,Contraception ,Enablers ,Family planning ,Health system ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Unmet need for contraception results in several health challenges such as unintended pregnancies, unwanted births and unsafe abortions. Most interventions have been unable to successfully address this unmet need due to various community and health system level factors. Identifying these inhibiting and enabling factors prior to implementation of interventions forms the basis for planning efforts to increase met needs. This qualitative study was part of the formative phase of a larger research project that aimed to develop an intervention to increase met needs for contraception through community and health system participation. The specific study component reported here explores barriers and enablers to family planning and contraceptive services provision and utilisation at community and health systems levels. Methods Twelve focus group discussions were conducted with community members (n = 114) and two with healthcare providers (n = 19). Ten in-depth interviews were held with key stakeholders. The study was conducted in Kabwe district, Zambia. Interviews/discussions were translated and transcribed verbatim. Data were coded and organised using NVivo 10 (QSR international), and were analysed using thematic analysis. Results Health systems barriers include long distances to healthcare facilities, stock-outs of preferred methods, lack of policies facilitating contraceptive provision in schools, and undesirable provider attitudes. Community level barriers comprise women’s experience with contraceptive side effects, myths, rumours and misconceptions, societal stigma, and negative traditional and religious beliefs. On the other hand, health systems enablers consist of political will from government to expand contraceptive services access, integration of contraceptive services, provision of couples counselling, and availability of personnel to offer basic methods mix. Functional community health system structures, community desire to delay pregnancy, and knowledge of contraceptive services are enablers at a community level. Conclusions These study findings highlight key community and health systems factors that should be considered by policy, program planners and implementers in the design and implementation of family planning and contraceptive services programmes, to ensure sustained uptake and increased met needs for contraceptive methods and services.
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- 2018
- Full Text
- View/download PDF
20. Teamwork in Qualitative Research
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Cecilia Milford, Yolandie Kriel, Irene Njau, Theresa Nkole, Peter Gichangi, Joanna Paula Cordero, Jennifer A. Smit, and Petrus S. Steyn
- Subjects
Social sciences (General) ,H1-99 - Abstract
Multicountry teamwork in qualitative research is receiving increased recognition in an attempt to address global health problems. We report our experience of teamwork implementing a multicountry study (Zambia, South Africa, and Kenya), employing qualitative research to gain insight into met needs of contraception. Using this study example, we demonstrate the innovative development of a multicountry, south–south relationship (i.e., collaboration and sharing of knowledge between developing countries located in the Global South) within the health-care research setting. In addition, strategies employed for a collaborative research process and approaches used for data collection and analysis are described. We also describe the parallel but interlinked processes of developing a collaborative relationship, rigorous data collection, and the process of teamwork in data analysis. We discuss how we collaboratively developed and tested codes and themes and the use of a shared codebook in a team. The end result was country-specific data analyses reports using a single shared codebook, allowing for analyses that were appropriate to the region yet comparable across countries. The success of this project can be attributed to the methodological rigor, facilitated by intense communications, and support processes in this south–south collaboration.
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- 2017
- Full Text
- View/download PDF
21. Quality of care in public sector family planning services in KwaZulu-Natal, South Africa: a qualitative evaluation from community and health care provider perspectives
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Joanna Paula Cordero, Yolandie Kriel, Jennifer A. Smit, Petrus S. Steyn, Cecilia Milford, and Fatima Suleman
- Subjects
Counseling ,Health Personnel ,Health informatics ,Health administration ,South Africa ,Family planning services ,Nursing ,Qualitative research ,Health care ,Humans ,Medicine ,Quality of Health Care ,Public Sector ,business.industry ,Research ,Health Policy ,Nursing research ,Public sector ,Quality of care ,Focus Groups ,Focus group ,Contraception ,Family planning ,Female ,Thematic analysis ,Public aspects of medicine ,RA1-1270 ,business - Abstract
Background Quality of care is a multidimensional concept that forms an integral part of the uptake and use of modern contraceptive methods. Satisfaction with services is a significant factor in the continued use of services. While much is known about quality of care in the general public health care service, little is known about family planning specific quality of care in South Africa. This paper aims to fill the gap in the research by using the Bruce-Jain family planning quality of care framework. Methods This formative qualitative study was conducted in South Africa, Zambia, and Kenya to explore the uptake of family planning and contraception. The results presented in this paper are from the South African data. Fourteen focus group discussions, twelve with community members and two with health care providers, were conducted along with eight in-depth interviews with key informants. Thematic content analysis using the Bruce-Jain Quality of Care framework was conducted to analyse this data using NVIVO 10. Results Family planning quality of care was defined by participants as the quality of contraceptive methods, attitudes of health care providers, and outcomes of contraceptive use. The data showed that women have limited autonomy in their choice to either use contraception or the method that they might prefer. Important elements that relate to quality of care were identified and described by participants and grouped according to the structural or process components of the framework. Structure-related sub-themes identified included the lack of technically trained providers; integration of services that contributed to long waiting times and mixing of a variety of clients; and poor infrastructure. Sub-themes raised under the process category included poor interpersonal relations; lack of counselling/information exchange, fear; and time constraints. Neither providers nor users discussed follow up mechanisms which is a key aspect to ensure continuity of contraceptive use. Conclusion Using a qualitative methodology and applying the Bruce-Jain Quality of Care framework provided key insights into perceptions and challenges about family planning quality of care. Identifying which components are specific to family planning is important for improving contraceptive outcomes. In particular, autonomy in user choice of contraceptive method, integration of services, and the acceptability of overall family planning care was raised as areas of concern.
- Published
- 2021
22. A continuum of individual-level factors that influence modern contraceptive uptake and use: perspectives from community members and healthcare providers in Durban, South Africa
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Yolandie Kriel, Cecilia Milford, Joanna Paula Cordero, Fatima Suleman, Petrus S Steyn, and Jennifer Ann Smit
- Abstract
Background South Africa faces numerous sexual and reproductive health challenges that can be mitigated with contraceptive use. Contraceptive use is defined and measured as use, non-use, or discontinued use. Research has shown that there are expanded definitions of use beyond these categories. Identifying such categories may assist in a better understanding of factors that influence contraceptive use. Setting and methodology This qualitative study was conducted in the eThekwini Municipality in KwaZulu-Natal, South Africa. The aim was to explore the factors influencing the uptake and use of modern contraception. One hundred and twenty-seven participants were enrolled in this study. One hundred and three of those were community members, and twenty-five were healthcare providers. Focus group discussions and in-depth interviews were conducted to gather the data. Data analysis was facilitated using NVivo 10 software. Results The data show that numerous factors influence contraceptive uptake and use. From these factors, a continuum of use that captures a variety of states of use emerged. Five different states of use were uncovered: no-use, vulnerable use, compelled use, conditional use, and autonomous use. The development of the model illustrates the complexity of contraceptive needs and that it extends beyond definitions found in policies and large-scale surveys. Expanding conceptions of use can aid in developing counselling and information support tools that can improve the uptake and continued use of modern contraception.
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- 2022
23. Community and health provider perspectives on the quality of family planning and contraceptive services in Kabwe District, Zambia
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Margarate Nzala Munakampe, Petrus S. Steyn, Joseph Mumba Zulu, Theresa Nkole, Adam Silumbwe, Joanna Paula Cordero, and Cecilia Milford
- Subjects
Counseling ,services ,Service delivery framework ,media_common.quotation_subject ,Information Dissemination ,family planning ,health providers ,zambia ,Nursing ,Contraceptive Agents ,Humans ,Quality (business) ,media_common ,Reproductive health ,HQ1-2044 ,Community engagement ,business.industry ,Community Participation ,Obstetrics and Gynecology ,Focus group ,Diseases of the genitourinary system. Urology ,Reproductive Medicine ,Family planning ,quality ,Family Planning Services ,contraceptives ,community ,The family. Marriage. Woman ,Customer satisfaction ,RC870-923 ,business ,Research Article - Abstract
Quality family planning and contraceptive (FP/C) services result in positive outcomes such as client satisfaction and sustained use of contraceptives. While most assessments of quality in FP/C services are based on measurable reproductive health outcomes, there is limited consideration of the perspectives and experiences of health providers and community members. This study aimed to address this knowledge gap, by exploring health providers’ and community perspectives on the elements of quality FP/C services in Kabwe district, Zambia. Fourteen focus group discussions and 10 in-depth interviews were conducted in October–December 2016, involving community members, key community stakeholders such as religious and political leaders, health committee members and frontline and managerial healthcare providers. Data were analysed using a thematic approach. According to study participants, quality FP/C services would include provision by skilled personnel with positive attitudes towards clients, availability of preferred methods and affordable products. Additional factors included appropriate infrastructure, especially counselling services spaces and adequate consultation time. Participants stressed the need for reduced waiting time and opportunity for self-expression. The efficiency and effectiveness of service delivery factors, such as information dissemination and community engagement, were also considered important elements of quality FP/C. This study underscores the value of considering both community and health provider perspectives in efforts to improve the quality of FP/C services, with the overall aim of increasing client satisfaction and sustained utilisation. However, service delivery processes must also be addressed in addition to providing for community participation, if quality is to be achieved in FP/C services.
- Published
- 2021
24. The use of segmented regression for evaluation of an interrupted time series study involving complex intervention: the CaPSAI project experience
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James Kiarie, My Huong Nguyen, Soe Soe Thwin, Victoria Boydell, Joanna Paula Cordero, Donat Shamba, Dela Nai, Petrus S. Steyn, and Ndema Habib
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Computer science ,Quasi-experiment ,Interrupted time series ,Poisson distribution ,01 natural sciences ,Gee ,Article ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Complex intervention ,Intervention (counseling) ,Statistics ,030212 general & internal medicine ,Poisson regression ,0101 mathematics ,Segmented regression ,Modern contraception uptake ,Generalized estimating equation ,Health Policy ,010102 general mathematics ,Community-driven intervention ,Public Health, Environmental and Occupational Health ,Regression ,symbols - Abstract
An interrupted time series with a parallel control group (ITS-CG) design is a powerful quasi-experimental design commonly used to evaluate the effectiveness of an intervention, on accelerating uptake of useful public health products, and can be used in the presence of regularly collected data. This paper illustrates how a segmented Poisson model that utilizes general estimating equations (GEE) can be used for the ITS-CG study design to evaluate the effectiveness of a complex social accountability intervention on the level and rate of uptake of modern contraception. The intervention was gradually rolled-out over time to targeted intervention communities in Ghana and Tanzania, with control communities receiving standard of care, as per national guidelines. Two ITS GEE segmented regression models are proposed for evaluating of the uptake. The first, a two-segmented model, fits the data collected during pre-intervention and post-intervention excluding that collected during intervention roll-out. The second, a three-segmented model, fits all data including that collected during the roll-out. A much simpler difference-in-difference (DID) GEE Poisson regression model is also illustrated. Mathematical formulation of both ITS-segmented Poisson models and that of the DID Poisson model, interpretation and significance of resulting regression parameters, and accounting for different sources of variation and lags in intervention effect are respectively discussed. Strengths and limitations of these models are highlighted. Segmented ITS modelling remains valuable for studying the effect of intervention interruptions whether gradual changes, over time, in the level or trend in uptake of public health practices are attributed by the introduced intervention.Trial Registration: The Australian New Zealand Clinical Trials registry.Trial registration number: ACTRN12619000378123.Trial Registration date: 11-March-2019.
- Published
- 2020
25. Adaptation and validation of social accountability measures in the context of contraceptive services in Ghana and Tanzania
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Joanna Paula Cordero, Victoria Boydell, Donat Shamba, Dela Nai, My Huong Nguyen, Petrus S. Steyn, and Ndema Habib
- Subjects
Adult ,Adolescent ,Applied psychology ,Validity ,Context (language use) ,Tanzania ,Ghana ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,Health care ,Humans ,030212 general & internal medicine ,Social accountability ,Reproductive health ,Social Responsibility ,Measurement ,biology ,business.industry ,Research ,030503 health policy & services ,Health Policy ,lcsh:Public aspects of medicine ,Public Health, Environmental and Occupational Health ,Health services research ,Reproducibility of Results ,Construct validity ,lcsh:RA1-1270 ,Middle Aged ,biology.organism_classification ,Confirmatory factor analysis ,Contraception ,Female ,Reproductive Health Services ,Factor Analysis, Statistical ,0305 other medical science ,business ,Psychology - Abstract
BackgroundChanges in the values, attitudes, and interactions of both service users and health care providers are central to social accountability processes in reproductive health. However, there is little consensus on how best to measure these latent changes. This paper reports on the adaptation and validation of measures that capture these changes in Tanzania and Ghana.MethodsThe CaPSAI theory of change determined the dimensions of the measure, and we adapted existing items for the survey items. Trained data collectors used a survey to collect data from 752 women in Tanzania and 750 women in Ghana attending contraceptive services. We used reliability analysis, exploratory, and confirmatory factor analysis to assess the validity and reliability of these measures in each country.ResultsThe measure has high construct validity and reliability in both countries. We identified several subscales in both countries, 10 subscales in Tanzania, and 11 subscales in Ghana. Many of the domains and items were shared across both settings.ConclusionThe study suggests that the multi-dimensional scales have high construct validity and reliability in both countries. Though there were differences in the two country contexts and in items and scales, there was convergence in the analysis that suggests that this measure may be relevant in different settings and should be validated in new settings.Trial registrationACTRN12619000378123.
- Published
- 2020
26. Accounting for complexity - Intervention design in the context of studying social accountability for reproductive health
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Petrus S. Steyn, James Kiarie, Heather McMullen, Jacob Tetteh Ahuno, Osei-Bonsu Gyamfi, Victoria Boydell, Alice Monyo, Patrick Kinemo, Mary Awelana Addah, and Joanna Paula Cordero
- Subjects
Social accounting ,030219 obstetrics & reproductive medicine ,business.industry ,Health Policy ,Sexual and reproductive health and rights ,Psychological intervention ,Public Health, Environmental and Occupational Health ,Medicine (miscellaneous) ,Context (language use) ,Accounting ,Theory of change ,Biochemistry, Genetics and Molecular Biology (miscellaneous) ,03 medical and health sciences ,0302 clinical medicine ,Immunology and Microbiology (miscellaneous) ,Intervention (counseling) ,Community health ,030212 general & internal medicine ,Psychology ,business ,Reproductive health - Abstract
Background: Social accountability interventions aim to propel change by raising community voices and holding duty bearers accountable for delivering on rights and entitlements. Evidence on the role of such interventions for improving community health outcomes is steadily emerging, including for sexual and reproductive health and rights (SRHR). However, these interventions are complex social processes with numerous actors, multiple components, and a highly influential local context. Unsurprisingly, determining the mechanisms of change and what outcomes may be transferable to other similar settings can be a challenge. We report our methodological considerations to account for complexity in a social accountability intervention exploring contraceptive uptake and use in Ghana and Tanzania. Main Body: The Community and Provider driven Social Accountability Intervention (CaPSAI) study explores the relationship between a health facility-focused social accountability intervention and contraceptive service provision in two countries. This 24-month mixed-method quasi-experimental study, using an interrupted time series with a parallel control group, is being undertaken in 16 sites across Ghana and Tanzania in collaboration with local research and implementation partners. The primary outcomes include changes in contraceptive uptake and use. We also measure outcomes related to current social accountability theories of change and undertake a process evaluation. We present three design components: aspects of co-design, ‘conceptual’ fidelity, and how we aim to track the intervention as ‘intended vs. implemented’ to explore how the intervention could be responsive to the embedded routines, local contextual realities, and the processual nature of the social accountability intervention. Conclusions: Through a discussion of these design components and their rationale, we conclude by suggesting approaches to intervention design that may go some way in responding to recent challenges in accounting for social accountability interventions, bearing relevance for evaluating health system interventions.
- Published
- 2021
27. Male partner influence on family planning and contraceptive use: perspectives from community members and healthcare providers in KwaZulu-Natal, South Africa
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Fatima Suleman, Joanna Paula Cordero, Mags Beksinska, Cecilia Milford, Petrus S. Steyn, Jennifer A. Smit, and Yolandie Kriel
- Subjects
Adult ,Male ,Health Knowledge, Attitudes, Practice ,medicine.medical_specialty ,Facilitators ,Adolescent ,Service delivery framework ,Health Personnel ,Sex Education ,Male partners ,lcsh:Gynecology and obstetrics ,Young Adult ,03 medical and health sciences ,South Africa ,0302 clinical medicine ,Pregnancy ,Health care ,medicine ,Humans ,030212 general & internal medicine ,Family planning ,Contraception Behavior ,Qualitative Research ,lcsh:RG1-991 ,Family planning policy ,Reproductive health ,030219 obstetrics & reproductive medicine ,Influencers ,business.industry ,Research ,Community Participation ,Obstetrics and Gynecology ,Men ,Middle Aged ,Focus group ,Sexual Partners ,Contraception ,Reproductive Medicine ,Family Planning Services ,Family medicine ,Female ,Thematic analysis ,business ,Psychology ,Barriers ,Qualitative research - Abstract
Background South Africa faces numerous reproductive challenges that include high rates of unplanned and adolescent pregnancies. The uptake and utilization of family planning services and modern contraception methods depend on numerous factors. The male partner plays a key role in reproductive health but data on this topic are outdated or have a predominant HIV prevention focus. The purpose of this paper is to explore the influence of male partners on family planning and contraceptive (FP/C) uptake and use within the contemporary South African setting, and to identify further areas of exploration. Methods This qualitative study was conducted in a community and healthcare provision setting in the eThekwini District in KwaZulu-Natal province, South Africa. Data were collected from twelve community-based focus group discussions (n = 103), two healthcare providers focus group discussions (n = 16), and eight key informant individual in-depth interviews. Following a constructionist paradigm and using the health utilization behaviour model, data were analysed using thematic analysis, allowing a robust and holistic exploration of the data. Results The data from this study revealed the complex and evolving role that male partners play in FP/C uptake and use within this setting. Key themes from the data elucidated the dual nature of male involvement in FP/C use. Culturally influenced gender dynamics and adequate understanding of FP/C information were highlighted as key factors that influenced male attitudes and perceptions about contraceptive use, whether positively or negatively. Male opposition was attributed to limited understanding; misunderstandings about side-effects; male dominance in relationships; and physical abuse. These factors contributed to covert or discontinued use by female partners. Pathways identified through which male partners positively influenced FP/C uptake and access include: social support, adequate information, and shared responsibility. Conclusions Understanding the role that male partners play in FP/C uptake and use is important in preventing unintended pregnancies and improving family planning policy and service delivery programmes. By identifying the barriers that male partners present, appropriate strategies can be implemented. Equally important is identifying how male partners facilitate and promote adherence and use, and how these positive strategies can be incorporated into policy to improve the uptake and use of FP/C.
- Published
- 2019
28. Unpacking power dynamics in research and evaluation on social accountability for sexual and reproductive health and rights
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Cicely Marston, Marta Schaaf, Sana Qais Contractor, Joanna Paula Cordero, Etobssie Wako, and Suzanne Cant
- Subjects
Sexual Behavior ,Sexual and reproductive health and rights ,Participatory action research ,03 medical and health sciences ,0302 clinical medicine ,Community of practice ,Right to Health ,Process tracing ,Humans ,030212 general & internal medicine ,Sociology ,Social accountability ,Health policy ,Reproductive health ,Social accounting ,Social Responsibility ,Measurement ,Reproductive Rights ,business.industry ,lcsh:Public aspects of medicine ,Research ,030503 health policy & services ,Health Policy ,Public Health, Environmental and Occupational Health ,Health services research ,lcsh:RA1-1270 ,Public relations ,Research Personnel ,Reproductive Health ,Power ,Commentary ,Power, Psychological ,Sexual Health ,0305 other medical science ,business - Abstract
Over the past decade, social accountability for health has coalesced into a distinct field of research and practice. Whether explicitly stated or not, changed power relations are at the heart of what social accountability practitioners seek, particularly in the context of sexual and reproductive health. Yet, evaluations of social accountability programs frequently fail to assess important power dynamics. In this commentary, we argue that we must include an examination of power in research and evaluation of social accountability in sexual and reproductive health, and suggest ways to do this. The authors are part of a community of practice on measuring social accountability and health outcomes. We share key lessons from our efforts to conduct power sensitive research using different approaches and methods.First, participatory research and evaluation approaches create space for program participants to engage actively in evaluations by defining success. Participation is also one of the key elements of feminist evaluation, which centers power relations rooted in gender. Participatory approaches can strengthen ‘traditional’ health evaluation approaches by ensuring that the changes assessed are meaningful to communities.Fields from outside health offer approaches that help to describe and assess changes in power dynamics. For example, realist evaluation analyses the causal processes, or mechanisms, grounded in the interactions between social, political and other structures and human agency; programs try to influence these structures and/or human agency. Process tracing requires describing the mechanisms underlying change in power dymanics in a very detailed way, promoting insight into how changes in power relationships are related to the broader program.Finally, case aggregation and comparison entail the aggregation of data from multiple cases to refine theories about when and how programs work. Case aggregation can allow for nuanced attention to context while still producing lessons that are applicable to inform programming more broadly.We hope this brief discussion encourages other researchers and evaluators to share experiences of analysing power relations as part of evaluation of social accountability interventions for sexual and reproductive health so that together, we improve methodology in this crucial area.
- Published
- 2021
29. Social accountability for reproductive, maternal, newborn, child and adolescent health: A review of reviews
- Author
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Miriam Lewis Sabin, Victoria Boydell, Frances Squires, Joanna Paula Cordero, Petrus S. Steyn, Adriane Martin Hilber, and Anayda Portela
- Subjects
Male ,Economics ,Maternal Health ,Social Sciences ,Adolescents ,Pediatrics ,Families ,Database and Informatics Methods ,0302 clinical medicine ,Pregnancy ,Medicine and Health Sciences ,Public and Occupational Health ,030212 general & internal medicine ,Database Searching ,Health Systems Strengthening ,Child ,Children ,Reproductive health ,Social Responsibility ,030219 obstetrics & reproductive medicine ,Multidisciplinary ,Child Health ,Public relations ,Research Assessment ,Systematic review ,Reproductive Health ,Health ,Accountability ,Needs assessment ,Medicine ,Female ,Psychology ,Behavioral and Social Aspects of Health ,Needs Assessment ,Adolescent health ,Research Article ,Systematic Reviews ,Adolescent ,Science ,Adolescent Health ,Context (language use) ,Research and Analysis Methods ,03 medical and health sciences ,Health Economics ,Humans ,Infant Health ,Perinatal Mortality ,Social accounting ,Health Care Policy ,business.industry ,Community Participation ,Infant, Newborn ,Health Care ,Age Groups ,People and Places ,Population Groupings ,business ,Social responsibility - Abstract
Globally, increasing efforts have been made to hold duty-bearers to account for their commitments to improve reproductive, maternal, newborn, child and adolescent health (RMNCAH) over the past two decades, including via social accountability approaches: citizen-led, collective processes for holding duty-bearers to account. There have been many individual studies and several reviews of social accountability approaches but the implications of their findings to inform future accountability efforts are not clear. We addressed this gap by conducting a review of reviews in order to summarise the current evidence on social accountability for RMNCAH, identify factors contributing to intermediary outcomes and health impacts, and identify future research and implementation priorities. The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42019134340). We searched eight databases and systematic review repositories and sought expert recommendations for published and unpublished reviews, with no date or language restrictions. Six reviews were analysed using narrative synthesis: four on accountability or social accountability approaches for RMNCAH, and two specifically examining perinatal mortality audits, from which we extracted information relating to community involvement in audits. Our findings confirmed that there is extensive and growing evidence for social accountability approaches, particularly community monitoring interventions. Few documented social accountability approaches to RMNCAH achieve transformational change by going beyond information-gathering and awareness-raising, and attention to marginalised and vulnerable groups, including adolescents, has not been well documented. Drawing generalisable conclusions about results was difficult, due to inconsistent nomenclature and gaps in reporting, particularly regarding objectives, contexts, and health impacts. Promising approaches for successful social accountability initiatives include careful tailoring to the social and political context, strategic planning, and multi-sectoral/multi-stakeholder approaches. Future primary research could advance the evidence by describing interventions and their results in detail and in their contexts, focusing on factors and processes affecting acceptability, adoption, and effectiveness.
- Published
- 2020
30. Feasibility testing of a community dialogue approach for promoting the uptake of family planning and contraceptive services in Zambia
- Author
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Theresa Nkole, Joanna Paula Cordero, Margarate Nzala Munakampe, Joseph Mumba Zulu, Petrus S. Steyn, and Adam Silumbwe
- Subjects
Male ,Adolescent ,Psychological intervention ,Zambia ,Health Promotion ,Community dialogue ,Health informatics ,Health administration ,03 medical and health sciences ,0302 clinical medicine ,Health care ,Humans ,Medicine ,Community Health Services ,030212 general & internal medicine ,Medical education ,030219 obstetrics & reproductive medicine ,Family planning and contraception ,business.industry ,lcsh:Public aspects of medicine ,Health Policy ,Nursing research ,Community participation ,Attendance ,lcsh:RA1-1270 ,Focus Groups ,Focus group ,Contraception ,Family planning ,Family Planning Services ,Feasibility Studies ,Female ,business ,Research Article - Abstract
Background Community dialogues have been used in participatory approaches in various health prevention and awareness programs, including family planning interventions, to increase understanding and alignment of particular issues from different peoples’ perspectives. The main objective of this paper is to document the feasibility of a community dialogue approach, which aimed to promote dialogue between healthcare providers and community members. The feasibility testing was part of formative-phase research needed to design an intervention, with the ultimate goal of increasing the uptake of family planning and contraception. The community dialogue intervention generated discussions on key approaches to improve family planning and contraception provision and uptake. Methods Key stages of the community dialogue were undertaken, with representation from healthcare providers and community members. Participants included frontline and managerial health care providers, community health workers, family planning and contraception users, the youth, other stakeholders from the education sector, and civil society. How the dialogue was implemented (operational feasibility) as well as the cultural feasibility of the community dialogue content was evaluated through participant observations during the dialogue, using a standardised feasibility testing tick-list, and through focus group discussions with the stakeholders who participated in the community dialogue. Results Overall, 21 of the 30 invited participants attended the meeting- 70% attendance. The approach facilitated discussions on how quality care could be achieved in family planning and contraception provision, guided by the ground rules that were agreed upon by the different stakeholders. A need for more time for the discussion was noted. Participants also noted the need for more balanced representation from adolescents as well as other family planning stakeholders, such as community members, especially in comparison to healthcare providers. Some participants were not comfortable with the language used. Young people felt older participants used complicated terminologies while community members felt the health care providers outnumbered them, in terms of representation. Conclusion Generally, the community dialogue was well received by the community members and the healthcare providers, as was observed from the sentiments expressed by both categories. Some key considerations for refining the approach included soliciting maximum participation from otherwise marginalized groups like the youth would provide stronger representation.
- Published
- 2020
31. Facilitating community participation in family planning and contraceptive services provision and uptake: community and health provider perspectives
- Author
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Joanna Paula Cordero, Theresa Nkole, Joseph Mumba Zulu, Margarate Nzala Munakampe, Petrus S. Steyn, Adam Silumbwe, and Cecilia Milford
- Subjects
Male ,Sex Education ,Community ,Health Services Accessibility ,0302 clinical medicine ,Promotion (rank) ,Accountability ,030212 general & internal medicine ,Qualitative Research ,media_common ,Social Responsibility ,030219 obstetrics & reproductive medicine ,Participation ,Obstetrics and Gynecology ,Contraceptives ,Focus Groups ,Middle Aged ,Contraception ,Family planning ,Family Planning Services ,Scale (social sciences) ,Female ,Strategies ,Thematic analysis ,Adult ,medicine.medical_specialty ,Adolescent ,media_common.quotation_subject ,Trust ,lcsh:Gynecology and obstetrics ,Interviews as Topic ,Young Adult ,03 medical and health sciences ,Contraceptive Agents ,Nursing ,Stakeholder Participation ,medicine ,Humans ,lcsh:RG1-991 ,Motivation ,Research ,Public health ,Community Participation ,Focus group ,Reproductive Medicine ,Programs ,Business ,Qualitative research - Abstract
Background Although community participation has been identified as being important for improved and sustained health outcomes, designing and successfully implementing it in large scale public health programmes, including family planning and contraceptive (FP/C) service provision, remains challenging. Zambian participants in a multi-country project (the UPTAKE project) took part in the development of an intervention involving community and healthcare provider participation in FP/C services provision and uptake. This study reports key thematic areas identified by the study participants as critical to facilitating community participation in this intervention. Methods This was an exploratory qualitative research study, conducted in Kabwe District, Central Province, in 2017. Twelve focus group discussions were conducted with community members (n = 114), two with healthcare providers (n = 19), and ten in-depth interviews with key community and health sector stakeholders. Data were analyzed using a thematic analysis approach. Results Four thematic categories were identified by the participants as critical to facilitating community participation in FP/C services. Firstly, accountability in the recruitment of community participants and incorporation of community feedback in FP/C. programming. Secondly, engagement of existing community resources and structures in FP/C services provision. Thirdly, building trust in FP/C methods/services through credible community-based distributors and promotion of appropriate FP/C methods/services. Fourthly, promoting strategies that address structural failures, such as the feminisation of FP/C services and the lack FP/C services that are responsive to adolescent needs. Conclusions Understanding and considering community members’ and healthcare providers’ views regarding contextualized and locally relevant participatory approaches, facilitators and challenges to participation, could improve the design, implementation and success of participatory public health programmes, including FP/C.
- Published
- 2020
32. Studying social accountability in the context of health system strengthening: innovations and considerations for future work
- Author
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Joanna Paula Cordero, Victoria Boydell, James Kiare, Petrus S. Steyn, and Heather McMullen
- Subjects
Context (language use) ,maternal health ,sexual and reproductive health ,03 medical and health sciences ,study design ,0302 clinical medicine ,Political science ,Health care ,Humans ,030212 general & internal medicine ,Social accountability ,Health policy ,Quality of Health Care ,Social accounting ,Social Responsibility ,business.industry ,lcsh:Public aspects of medicine ,030503 health policy & services ,Health Policy ,Politics ,Community Participation ,Health services research ,Public institution ,methodology ,lcsh:RA1-1270 ,Public relations ,Public good ,Community-Institutional Relations ,Research Personnel ,Research Design ,Accountability ,Commentary ,Power, Psychological ,0305 other medical science ,business - Abstract
There is a growing body of research on the role of social accountability in bringing about more accessible and better-quality healthcare. Here, we refer to social accountability as “citizens’ efforts at ongoing meaningful collective engagement with public institutions for accountability in the provision of public goods” (Joshi, World Dev 99:160–172, 2017). These processes have multiple interrelated components and sub-processes and engage a range of actors in community-driven, often unpredictable and context-dependent actions, which pose many methodological challenges for researchers. In June 2017, scientists and implementers working in this area came together to share experiences, discuss approaches, identify research gaps and consider directions for future studies. This paper shares learnings from this discussion. In particular, participants considered (1) how best to define and measure the complex processual nature of social accountability; (2) the study of social accountability as an inherently political process; and (3) the challenges of generalising unpredictable, community-driven and context-dependent processes. Key among a range of consensus areas was the need for researchers to capture a broader range of outcomes and better understand the nuances of implementation processes in order to effectively test theories and assumptions. Furthermore, power relationships are inherent in social accountability and the research process itself. In presenting details on these deliberations, we hope to prompt a wider discussion on the study of social accountability in health programming.
- Published
- 2019
33. 'Leaving no one behind': a scoping review on the provision of sexual and reproductive health care to nomadic populations
- Author
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Rachel Folz, Joanna Paula Cordero, Faria Khan, and Moazzam Ali
- Subjects
Male ,medicine.medical_specialty ,Sexual and reproductive health ,Pastoralism ,Reproductive medicine ,Nomad ,Pastoralist ,lcsh:Gynecology and obstetrics ,Health Services Accessibility ,03 medical and health sciences ,Politics ,0302 clinical medicine ,Health care ,medicine ,Humans ,030212 general & internal medicine ,Family planning ,lcsh:RG1-991 ,Reproductive health ,Transients and Migrants ,030219 obstetrics & reproductive medicine ,business.industry ,lcsh:Public aspects of medicine ,Community Participation ,Obstetrics and Gynecology ,Citizen journalism ,lcsh:RA1-1270 ,General Medicine ,Public relations ,Health services ,Reproductive Health ,Reproductive Medicine ,General partnership ,Female ,Reproductive Health Services ,Sexual Health ,business ,Research Article - Abstract
Backgrund Marginalized groups, such as nomadic populations across the world, have perhaps the least access to modern reproductive health (RH) services. This scoping review aims to identify barriers to access to RH services faced by nomadic populations from the existing literature and to highlight possible opportunities to address them. Methods Key databases, including PubMed, Popline, Google Scholar, and Google Advanced were searched for relevant articles published between 2002 and 2019. A total 344 articles were identified through database online searches, and 31 were included in the review. Results Nomadic people face complex barriers to healthcare access that can be broadly categorized as external (geographic isolation, socio-cultural dynamics, logistical and political factors) and internal (lifestyle, norms and practices, perceptions) factors. To effectively address the needs of nomadic populations, RH services must be available, accessible and acceptable through tailored and culturally sensitive approaches. A combination of fixed and mobile services has proven effective among mobile populations. Low awareness of modern RH services and their benefits is a major barrier to utilization. Partnership with communities through leveraging existing structures, networks and decision-making patterns can ensure that the programmes are effectively implemented. Conclusion Further research is needed to better understand and address the RH needs of nomadic populations. Though existing evidence is limited, opportunities do exist and should be explored. Raising awareness and sensitization training among health providers about the specific needs of nomads is important. Improved education and access to information about the benefits of modern RH care among nomadic communities is needed. Ensuring community participation through involvement of nomadic women and girls, community leaders, male partners, and trained traditional birth attendants are key facilitators in reaching nomads. However, participatory programmes also need to be recognized and supported by governments and existing health systems.
- Published
- 2019
34. 'As we have gathered with a common problem, so we seek a solution': exploring the dynamics of a community dialogue process to encourage community participation in family planning/contraceptive programmes
- Author
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Jennifer A. Smit, Yolandie Kriel, Joanna Paula Cordero, Tamaryn L. Crankshaw, Nzwakie Mosery, Cecilia Milford, and Petrus S. Steyn
- Subjects
Male ,Participant observation ,Health provider ,Formative assessment ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Humans ,030212 general & internal medicine ,Family planning ,Medical education ,Community engagement ,business.industry ,030503 health policy & services ,Health Policy ,Nursing research ,lcsh:Public aspects of medicine ,Community participation ,Attendance ,lcsh:RA1-1270 ,Theory of change ,Focus Groups ,Focus group ,Contraception ,Facilitator ,Family Planning Services ,Feasibility Studies ,Female ,0305 other medical science ,business ,Program Evaluation ,Research Article ,Unmet need - Abstract
Background Community dialogues have been widely used as a method for community engagement and participation to cover a broad range of areas. However, there has been limited documentation and evaluation of the process, particularly as a method towards achieving family planning and contraception (FP/C) programme goals. As part of the development of an intervention package aimed at increasing community and health care provider (HCP) participation in the provision of FP/C, feasibility testing of the intervention approach (a community dialogue between communities and health facilities) was carried out. Our findings offer a systematic description and evaluation of the community dialogue process, with key recommendations towards future implementation. Methods The dialogue was evaluated in three ways: 1) through participant observation during the community dialogue, 2) via a standardised feasibility testing tick-list for all observers of the dialogue, and 3) through three focus group discussions (FGDs) consisting of different groups of stakeholders who participated in the community dialogue. In total, 28 community members, HCPs, and key stakeholders attended the community dialogue (22 females, 6 males). Twenty-seven of the community dialogue participants participated in one of 3 FGDs held after the dialogue. Six evaluators assessed feasibility of the dialogue process. Results There was good attendance, representation and participation amongst community and provider sectors based on the participant observations using the standardized feasibility check-list. The community dialogue process received positive feedback in the FGDs and was demonstrated to be feasible and acceptable. Key factors contributing to the success of the community dialogue included a skilled facilitator, good representation of participants, establishing ground rules, good timekeeping, and using a Theory of Change to facilitate goal identification and dialogue. Issues to consider are the underlying power differentials related to age, profession and gender which caused initial feelings of anxiety amongst some participants. Conclusions Our formative findings offer a systematic description and evaluation of a community dialogue process with key recommendations that may be considered when constituting similar community dialogues in the future.
- Published
- 2018
35. Rationale and design of a complex intervention measuring the impact and processes of social accountability applied to contraceptive programming: CaPSAI Project
- Author
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James Kiarie, CaPSAI, Thi My Huong Nguyen, Ndema Habib, Heather McMullen, Victoria Boydell, Donat Shamba, Joanna Paula Cordero, Petrus S. Steyn, and Dela Nai
- Subjects
media_common.quotation_subject ,050204 development studies ,Control (management) ,Medicine (miscellaneous) ,Biochemistry, Genetics and Molecular Biology (miscellaneous) ,complex intervention ,Study Protocol ,03 medical and health sciences ,0302 clinical medicine ,Immunology and Microbiology (miscellaneous) ,Intervention (counseling) ,community monitoring ,Health care ,0502 economics and business ,Protocol ,Quality (business) ,030212 general & internal medicine ,social accountability ,Reproductive health ,media_common ,Social accounting ,business.industry ,Health Policy ,05 social sciences ,Public Health, Environmental and Occupational Health ,Citizen journalism ,Articles ,Public relations ,contraception ,Family planning ,Business - Abstract
Background: There are numerous barriers leading to a high unmet need for family planning and contraceptives (FP/C). These include limited knowledge and information, poor access to quality services, structural inefficiencies in service provision and inadequately trained and supervised health professionals. Recently, social accountability programs have shown promising results in addressing barriers to accessing sexual and reproductive health services. As a highly complex participatory process with multiple and interrelated components, steps and actors, studying social accountability poses methodological challenges. The Community and Provider driven Social Accountability Intervention (CaPSAI) Project study protocol was developed to measure the impact of a social accountability intervention on contraceptive uptake and use and to understand the mechanisms and contextual factors that influence and generate these effects (with emphasis on health services actors and community members). Methods: CaPSAI Project is implementing a social accountability intervention where service users and providers assess the quality of local FP/C services and jointly identify ways to improve the delivery and quality of such services. In the project, a quasi-experimental study utilizing an interrupted time series design with a control group is conducted in eight intervention and eight control facilities in each study country, which are Ghana and Tanzania. A cross-sectional survey of service users and health care providers is used to measure social accountability outcomes, and a cohort of women who are new users of FP/C is followed up after the completion of the intervention to measure contraceptive use and continuation. The process evaluation utilizes a range of methods and data sources to enable a fuller description of how the findings were produced. Conclusion: This complex study design could provide researchers and implementers with the means to better measure and understand the mechanisms and contextual factors that influence social accountability processes in reproductive health, adding important findings to the evidence base.
- Published
- 2020
36. Community and health systems barriers and enablers to family planning and contraceptive services provision and use in Kabwe District, Zambia
- Author
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Margarate Nzala Munakampe, Petrus S. Steyn, Joseph Mumba Zulu, Adam Silumbwe, Joanna Paula Cordero, Theresa Nkole, Yolandie Kriel, and Cecilia Milford
- Subjects
Adult ,Counseling ,Male ,Enablers ,medicine.medical_specialty ,Health Knowledge, Attitudes, Practice ,Health Personnel ,Population ,Zambia ,Community ,Health informatics ,Health administration ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Contraceptive Agents ,Pregnancy ,Health care ,medicine ,Humans ,Health system ,030212 general & internal medicine ,Community Health Services ,Family planning ,education ,Qualitative Research ,education.field_of_study ,030219 obstetrics & reproductive medicine ,Medical Assistance ,business.industry ,lcsh:Public aspects of medicine ,Health Policy ,Public health ,lcsh:RA1-1270 ,Abortion, Induced ,Focus Groups ,Focus group ,Government Programs ,Contraception ,Family Planning Services ,Community health ,Female ,business ,Delivery of Health Care ,Barriers ,Research Article - Abstract
Background Unmet need for contraception results in several health challenges such as unintended pregnancies, unwanted births and unsafe abortions. Most interventions have been unable to successfully address this unmet need due to various community and health system level factors. Identifying these inhibiting and enabling factors prior to implementation of interventions forms the basis for planning efforts to increase met needs. This qualitative study was part of the formative phase of a larger research project that aimed to develop an intervention to increase met needs for contraception through community and health system participation. The specific study component reported here explores barriers and enablers to family planning and contraceptive services provision and utilisation at community and health systems levels. Methods Twelve focus group discussions were conducted with community members (n = 114) and two with healthcare providers (n = 19). Ten in-depth interviews were held with key stakeholders. The study was conducted in Kabwe district, Zambia. Interviews/discussions were translated and transcribed verbatim. Data were coded and organised using NVivo 10 (QSR international), and were analysed using thematic analysis. Results Health systems barriers include long distances to healthcare facilities, stock-outs of preferred methods, lack of policies facilitating contraceptive provision in schools, and undesirable provider attitudes. Community level barriers comprise women’s experience with contraceptive side effects, myths, rumours and misconceptions, societal stigma, and negative traditional and religious beliefs. On the other hand, health systems enablers consist of political will from government to expand contraceptive services access, integration of contraceptive services, provision of couples counselling, and availability of personnel to offer basic methods mix. Functional community health system structures, community desire to delay pregnancy, and knowledge of contraceptive services are enablers at a community level. Conclusions These study findings highlight key community and health systems factors that should be considered by policy, program planners and implementers in the design and implementation of family planning and contraceptive services programmes, to ensure sustained uptake and increased met needs for contraceptive methods and services. Electronic supplementary material The online version of this article (10.1186/s12913-018-3136-4) contains supplementary material, which is available to authorized users.
- Published
- 2017
37. Advancing prevention of sexually transmitted infections through point-of-care testing: target product profiles and landscape analysis
- Author
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Maurine Murtagh, James Kiarie, Rosanna W. Peeling, Joanna Paula Cordero, Karel Blondeel, and Igor Toskin
- Subjects
0301 basic medicine ,Adult ,Male ,medicine.medical_specialty ,CERVICAL-CANCER ,Point-of-care testing ,030106 microbiology ,Dermatology ,medicine.disease_cause ,03 medical and health sciences ,Gonorrhea ,0302 clinical medicine ,Epidemiology ,medicine ,Global health ,Medicine and Health Sciences ,Humans ,030212 general & internal medicine ,Syphilis ,CLINICAL-EVALUATION ,Reproductive health ,TRICHOMONAS-VAGINALIS ,Cervical cancer ,business.industry ,Diagnostic Tests, Routine ,Public health ,Papillomavirus Infections ,Reproducibility of Results ,XPERT HPV ASSAY ,Chlamydia Infections ,medicine.disease ,RAPID TESTS ,SYPHILIS ,Infectious Diseases ,Reproductive Health ,CHLAMYDIA-TRACHOMATIS ,Point-of-Care Testing ,Family medicine ,MICROFLUIDIC DEVICES ,Female ,NEISSERIA-GONORRHOEAE ,Public Health ,business ,Chlamydia trachomatis ,Trichomonas Vaginitis ,TREPONEMAL ANTIBODIES - Abstract
Objectives Advancing the field of point-of-care testing (POCT) for STIs can rapidly and substantially improve STI control and prevention by providing targeted, essential STI services (case detection and screening). POCT enables definitive diagnosis and appropriate treatment in a single visit and home and community-based testing. Methods Since 2014, the WHO Department of Reproductive Health and Research, in collaboration with technical partners, has completed four landscape analyses of promising diagnostics for use at or near the point of patient care to detect syphilis, Neisseria gonorrhoeae , Chlamydia trachomatis , Trichomonas vaginalis and the human papillomavirus. The analyses comprised a literature review and interviews. Two International Technical Consultations on STI POCTs (2014 and 2015) resulted in the development of target product profiles (TPP). Experts in STI microbiology, laboratory diagnostics, clinical management, public health and epidemiology participated in the consultations with representation from all WHO regions. Results The landscape analysis identified diagnostic tests that are either available on the market, to be released in the near future or in the pipeline. The TPPs specify 28 analytical and operational characteristics of POCTs for use in different populations for surveillance, screening and case management. None of the tests that were identified in the landscape analysis met all of the targets of the TPPs. Conclusion More efforts of the global health community are needed to accelerate access to affordable quality-assured STI POCTs, particularly in low- and middle-income countries, by supporting the development of new diagnostic platforms as well as strengthening the validation and implementation of existing diagnostics according to internationally endorsed standards and the best available evidence.
- Published
- 2017
38. Participatory approaches involving community and healthcare providers in family planning/contraceptive information and service provision : a scoping review
- Author
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Jennifer A. Smit, Marleen Temmerman, Petrus S. Steyn, Theresa Nkole, James Kiarie, Joanna Paula Cordero, and Peter Gichangi
- Subjects
Program evaluation ,medicine.medical_specialty ,Quality management ,Health Personnel ,Psychological intervention ,Review ,Professional Staff Committees ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Obstetrics and Gynaecology ,medicine ,Medicine and Health Sciences ,PROGRAM ,Humans ,Family ,030212 general & internal medicine ,Family planning ,Reproductive health ,Operationalization ,business.industry ,030503 health policy & services ,Public health ,Community participation ,Obstetrics and Gynecology ,Monitoring and evaluation ,Contraception ,Reproductive Medicine ,Family Planning Services ,planning ,0305 other medical science ,business ,KENYA ,Social Welfare ,Program Evaluation ,Healthcare provider ,Unmet need - Abstract
As efforts to address unmet need for family planning and contraception (FP/C) accelerate, voluntary use, informed choice and quality must remain at the fore. Active involvement of affected populations has been recognized as one of the key principles in ensuring human rights in the provision of FP/C and in improving quality of care. However, community participation continues to be inadequately addressed in large-scale FP/C programmes. Community and healthcare providers’ unequal relationship can be a barrier to successful participation. This scoping review identifies participatory approaches involving both community and healthcare providers for FP/C services and analyzes relevant evidence. The detailed analysis of 25 articles provided information on 28 specific programmes and identified three types of approaches for community and healthcare provider participation in FP/C programmes. The three approaches were: (i) establishment of new groups either health committees to link the health service providers and users or implementation teams to conduct specific activities to improve or extend available health services, (ii) identification of and collaboration with existing community structures to optimise use of health services and (iii) operationalization of tools to facilitate community and healthcare provider collaboration for quality improvement. Integration of community and healthcare provider participation in FP/C provision were conducted through FP/C-only programmes, FP/C-focused programmes and/or as part of a health service package. The rationales behind the interventions varied and may be multiple. Examples include researcher-, NGO- or health service-initiated programmes with clear objectives of improving FP/C service provision or increasing demand for services; facilitating the involvement of community members or service users and, in some cases, may combine socio-economic development and increasing self-reliance or control over sexual and reproductive health. Although a number of studies reported increase in FP/C knowledge and uptake, the lack of robust monitoring and evaluation mechanisms and quantitative and comparable data resulted in difficulties in generating clear recommendations. It is imperative that programmes are systematically designed, evaluated and reported.
- Published
- 2016
39. Teamwork in Qualitative Research
- Author
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Irene Njau, Joanna Paula Cordero, Petrus S. Steyn, Peter Gichangi, Cecilia Milford, Jennifer A. Smit, Theresa Nkole, and Yolandie Kriel
- Subjects
Teamwork ,Knowledge management ,business.industry ,030503 health policy & services ,media_common.quotation_subject ,Education ,03 medical and health sciences ,0302 clinical medicine ,Global health ,030212 general & internal medicine ,0305 other medical science ,business ,Psychology ,media_common ,Qualitative research - Abstract
Multicountry teamwork in qualitative research is receiving increased recognition in an attempt to address global health problems. We report our experience of teamwork implementing a multicountry st...
- Published
- 2017
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