Adolescent girls in Burkina Faso face unintended pregnancy risk due to a lack of contraceptive use. The (re)solve project was designed to address contraceptive misperceptions and increase girls' perceptions of their pregnancy risk, primarily through a participatory game and a health passport aimed at easing health facility access. The intervention components were implemented for girls in private and public school in grades 4ème and 3ème (grades 9 and 10) in Ouagadougou and Bobo Dioulasso, Burkina Faso. We conducted an impact evaluation using a mixed-methods cluster randomized control trial design to evaluate (re)solve's impact on girls' intentions to use contraception, among other outcomes. Thirty-two schools were randomly allocated intervention or control. The evaluation included quantitative longitudinal surveys at baseline (N = 2,372) and endline (N = 2,072), qualitative in-depth interviews with girls in the intervention group at baseline (N = 41) and endline (N = 48) and with implementation staff (N = 35) and experts (N = 14) at endline. We used generalized estimating equations (GEE) analysis for the main analysis. Girls receiving the intervention had more positive attitudes related to contraception at endline compared to girls at control schools. (re)solve had a positive effect on girls' intention to use contraception (aOR = 1.59, 95% CI 0.97-2.61), though this did not reach statistical significance. The impact was particularly large among girls who had never had sex, girls who attended public schools, and girls in 3ème. Qualitative findings suggest the intervention was well received and positively shifted attitudes and facility-seeking behaviors for many girls, but that myths and misconceptions related to contraceptive use persist in this mostly young, sexually naïve population. That the (re)solve intervention appears to have shifted adolescent girls' attitudes toward using contraception, coupled with positive trends in intention to use contraception, indicates that interventions like (re)solve may 'prime the pump' for behavior change and increasing girls' use of contraception. Trial registration number and date: https://www.isrctn.com/ISRCTN15387847 Registered on June 15th 2021.
Through the collection and utilization of timely data, program implementers can review feedback and make rapid adjustments and adaptations to interventions while they are in progress.Responsive feedback mechanisms (RFMs), which emphasize flexibility and iterative adaptation, provide opportunities for improving the fit and feasibility of a program, as well as its effectiveness. The (re)solve project-a 5-year, multicountry project testing new, context-specific solutions to address unmet need for family planning-used responsive feedback to ensure products and services designed and implemented were responsive to the context and preferences of health care workers, women, and girls. The adaptive learning meeting (ALM) cycle was designed as an RFM during implementation. This frequent series of rapid, actionable, cross-team meetings builds on several existing frameworks and practices. The ALM cycle used rapid, close to real-time data and observations from a wide range of stakeholders; routine monitoring data; and a structured, facilitated process to examine and act on feedback. Each cycle was repeated every 2 weeks for 3 months in Burkina Faso. During each cycle, the team interpreted data and feedback from multiple sources; assessed pragmatic, actionable options to address the feedback; and identified and agreed upon short- and long-loop adaptations that could improve the implementation process, coordination, efficiency, and outputs of the project. The ALM cycle proved helpful in engendering practices of surfacing and checking assumptions, careful interpretation of data, options analysis, and decision-making. The emphasis was on actionable feedback for improvement of the intervention rather than rigor of results and findings. The (re)solve project's experience with designing, structuring, and implementing the ALM cycle to address challenges and gaps in implementation can be informative for similar programs seeking to implement RFMs in complex and dynamic settings, especially where technology-based RFMs are not an option.
Learning , Humans , Female , Burkina Faso
