Beyond Bias - Reducing Provider Bias Towards Adolescents to Increase Contraception Take-Up in Tanzania, Burkina Faso, and Pakistan

NCT04802304 | Completed

• 1 other identifier: 2019-0387
• Study Type: interventional
• Target: 233
• Locations: 1 country
• Sites: 1

Brief Summary

Beyond Bias will evaluate the impact of an intervention designed to reduce family planning provider bias towards young, unmarried, and nulliparous women in Tanzania, Burkina Faso, and Pakistan. The intervention has three components: 1) a summit that includes impactful stories told to and by family planning providers that highlight the consequences of provider bias, 2) a forum for continued communication between providers, and 3) a rewards program where clinics in which providers exhibit less biased client interactions or who have improved the most towards this end will be rewarded with social recognition and a ceremony. Half of the eligible clinics in each country (233 in total) are randomly assigned to receive the intervention, while the remaining half serves as control. The objective of the evaluation is to estimate the impact of the intervention on a range of outcomes related to quality of family planning care among young, unmarried, and nulliparous women. The investigators hypothesize that the intervention will increase the share of young, unmarried, and nulliparous women who received counseling on a range of methods, counseling on long acting methods, and who received their preferred method. The investigators will collect four types of data to evaluate the intervention: 1) provider surveys, 2) mystery clients' visits, 3) direct observations of client-provider interactions, and 4) qualitative interviews with clients, providers, and implementors.

Conditions

Family Planning Services

Keywords

Human-centered design; Health provider bias

Outcome Measures

Primary Outcomes (4)

• Whether client was able to receive services

  This is a measure of whether the client received family planning services on the day they came into the clinic. This will be measured from real clients using client exit surveys and using mystery clients.

  12 months after the intervention starts

• Optimal Counseling

  This is a measure of whether the client was counseled on all methods that were good options for the client given her background and preferences. This will be coded as 1 if client was counseled on the full set of optimal family planning methods and zero if the client was not counseled on the full set of optimal family planning methods. This will be collected in the client exit survey and in by mystery clients.

  12 months after the intervention starts

• Received modern method

  This is a measure of whether the client received a modern family planning method during her visit. This will be collected in the client exit survey only.

  12 months after the intervention starts

• Perceived patient centeredness

  This is a composite scale (ranging from 0 to 1) that measures the extent to which the client perceived the her interaction with family provider as patient centered. The questions included in the scale will be chosen based on data driven factor analysis methods. Higher scores will indicate better patient centeredness. This will be collected in the client exit survey and in by mystery clients.

  12 months after the intervention starts

Secondary Outcomes (1)

• Provider biased attitudes

  12 months after the intervention starts

Study Arms (2)

Treatment

EXPERIMENTAL

Other: Beyond Bias Treatment

Control

NO INTERVENTION

Interventions

Beyond Bias Treatment OTHER

The intervention has three components: 1) a summit that includes impactful stories told to and by family planning providers that highlight the consequences of provider bias, 2) a forum for continued communication between providers, and 3) a rewards program where clinics in which providers exhibit less biased client interactions or who have improved the most towards this end will be rewarded with social recognition and a ceremony.

Treatment

Eligibility Criteria

• Age: Up to 24 Years
• Gender Eligibility Details: This study is about family planning for women so we do not incldude men in the study
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• All providers that are part of Pathfinder Internal's supported clinic network in Burkina Faso, Tanzania, and Pakistan.

You may not qualify if:

• None
• All clients aged 24 or under that visit a clinic that is enrolled in the study
• Clients over 24
• Clients who do not visit the clinic for family planning services

Sponsors & Collaborators

• RAND: lead
• University of California, Los Angeles: collaborator
• Bill and Melinda Gates Foundation: collaborator
• Pathfinder International: collaborator

Study Sites (1)

RAND

Santa Monica, California, 90401, United States

Location

Study Officials

• Zachary Wagner, Ph.D

  RAND

  PRINCIPAL INVESTIGATOR

• Corrina Moucheraud, Ph.D

  University of California, Los Angeles

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor of Policy Analysis

Model Details: Half of the eligible clinics in each country (233 in total) are randomly assigned to receive the intervention, while the remaining half serves as control.

Study Record Dates

• First Submitted: January 29, 2021
• First Posted: March 17, 2021
• Study Start: September 1, 2020
• Primary Completion: September 1, 2021
• Study Completion: October 14, 2022
• Last Updated: October 17, 2022

Record last verified: 2022-10

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, ANALYTIC CODE
• Time Frame: IPD will be made indefinitely available 6 months after publication.
• Access Criteria: IPD will be made public, without any need for prior request.

Locations

US (1)