PDF(Pubmed)
Abstract：
BACKGROUND: Although long-acting reversible contraception (LARC) is more effective and longer lasting than short-acting methods, uptake remains low among post-abortion clients. Using a stepped-wedge, cluster-randomized trial, we evaluate the impact of a provider-level peer-comparison intervention to encourage choice of LARC in Nepal among post-abortion clients.
METHODS: The intervention used prominently displayed monthly posters comparing the health clinic\'s previous month performance on LARC uptake against peer clinics. To understand how the intervention affected behavior, while ensuring voluntarism and informed choice, we used mystery client visits, in-depth provider interviews, and client exit survey data. The trial examined 17,680 post-abortion clients in 36 clinics in Nepal from July 2016 to January 2017. The primary outcome was the proportion of clients receiving LARCs. Statistical analysis used ordinary least squares (OLS) regression with ANCOVA estimation to assess the intervention\'s impact on LARC uptake while controlling for client- and clinic-level characteristics.
RESULTS: The intervention increased LARC use among post-abortion clients by 6.6% points [95% CI: 0.85 to 12.3, p-value < 0.05], a 29.5% increase in LARC use compared to control clinics. This effect persisted after the formal experiment ended. Analysis of provider and client experiences showed that the behavioral intervention generated significant change in providers\' counseling practices, motivated the sharing of best practices. Quality of care indicators either remained stable or improved.
CONCLUSIONS: We find that a provider-level behavioral intervention increases LARC uptake among post-abortion clients. This type of intervention represents a low-cost option to contribute to reducing unmet need for contraception through provider behavior change.
METHODS: The intervention used prominently displayed monthly posters comparing the health clinic\'s previous month performance on LARC uptake against peer clinics. To understand how the intervention affected behavior, while ensuring voluntarism and informed choice, we used mystery client visits, in-depth provider interviews, and client exit survey data. The trial examined 17,680 post-abortion clients in 36 clinics in Nepal from July 2016 to January 2017. The primary outcome was the proportion of clients receiving LARCs. Statistical analysis used ordinary least squares (OLS) regression with ANCOVA estimation to assess the intervention\'s impact on LARC uptake while controlling for client- and clinic-level characteristics.
RESULTS: The intervention increased LARC use among post-abortion clients by 6.6% points [95% CI: 0.85 to 12.3, p-value < 0.05], a 29.5% increase in LARC use compared to control clinics. This effect persisted after the formal experiment ended. Analysis of provider and client experiences showed that the behavioral intervention generated significant change in providers\' counseling practices, motivated the sharing of best practices. Quality of care indicators either remained stable or improved.
CONCLUSIONS: We find that a provider-level behavioral intervention increases LARC uptake among post-abortion clients. This type of intervention represents a low-cost option to contribute to reducing unmet need for contraception through provider behavior change.
摘要：
背景：尽管长效可逆避孕（LARC）比短效方法更有效，更持久，堕胎后客户的摄入量仍然很低。使用阶梯式楔形物，整群随机试验，我们评估了提供者级别的同行比较干预对鼓励堕胎后患者在尼泊尔选择LARC的影响.
方法：干预措施使用突出显示的每月海报，比较健康诊所上个月在LARC吸收方面的表现与同行诊所的对比。要了解干预措施如何影响行为，在确保自愿和知情选择的同时，我们使用了神秘的客户访问，深入的提供者访谈，和客户退出调查数据。该试验从2016年7月至2017年1月在尼泊尔的36家诊所检查了17680名堕胎后客户。主要结果是接受LARC的客户比例。统计分析使用普通最小二乘（OLS）回归与ANCOVA估计来评估干预对LARC摄取的影响，同时控制患者和临床水平的特征。
结果：干预措施使流产后客户的LARC使用增加了6.6个百分点[95％CI：0.85至12.3，p值<0.05]，与对照诊所相比，LARC使用量增加了29.5%。正式实验结束后，这种效果仍然存在。对提供者和客户经验的分析表明，行为干预在提供者的咨询实践中产生了显著的变化，鼓励分享最佳实践。护理质量指标要么保持稳定，要么有所改善。
结论：我们发现提供者级别的行为干预可增加流产后患者对LARC的摄取。这种类型的干预是一种低成本的选择，可以通过改变提供者的行为来减少未满足的避孕需求。
方法：干预措施使用突出显示的每月海报，比较健康诊所上个月在LARC吸收方面的表现与同行诊所的对比。要了解干预措施如何影响行为，在确保自愿和知情选择的同时，我们使用了神秘的客户访问，深入的提供者访谈，和客户退出调查数据。该试验从2016年7月至2017年1月在尼泊尔的36家诊所检查了17680名堕胎后客户。主要结果是接受LARC的客户比例。统计分析使用普通最小二乘（OLS）回归与ANCOVA估计来评估干预对LARC摄取的影响，同时控制患者和临床水平的特征。
结果：干预措施使流产后客户的LARC使用增加了6.6个百分点[95％CI：0.85至12.3，p值<0.05]，与对照诊所相比，LARC使用量增加了29.5%。正式实验结束后，这种效果仍然存在。对提供者和客户经验的分析表明，行为干预在提供者的咨询实践中产生了显著的变化，鼓励分享最佳实践。护理质量指标要么保持稳定，要么有所改善。
结论：我们发现提供者级别的行为干预可增加流产后患者对LARC的摄取。这种类型的干预是一种低成本的选择，可以通过改变提供者的行为来减少未满足的避孕需求。
