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Understanding quality of contraceptive counseling in the CHARM2 gender-equity focused family planning intervention: Findings from a cluster randomized controlled trial among couples in rural India.
Averbach, Sarah; Johns, Nicole E; Ghule, Mohan; Dixit, Anvita; Begum, Shahina; Battala, Madhusudana; Saggurti, Niranjan; Silverman, Jay; Raj, Anita.
Afiliação
  • Averbach S; Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, United States; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego School of Medicine, La Jolla, CA, United States. Electronic address: saverbach@h
  • Johns NE; Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, United States.
  • Ghule M; Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, United States.
  • Dixit A; Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, United States.
  • Begum S; Department of Biostatistics, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, India.
  • Battala M; Population Council, Zone 5A, India Habitat Center, New Delhi, India.
  • Saggurti N; Population Council, Zone 5A, India Habitat Center, New Delhi, India.
  • Silverman J; Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, United States.
  • Raj A; Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, United States; Department of Education Studies, Division of Social Sciences, University of California San Diego School of Medicine, La Jolla, CA, United States.
Contraception ; 118: 109907, 2023 02.
Article em En | MEDLINE | ID: mdl-36328094
OBJECTIVES: The CHARM2 (Counseling Husbands and wives to Achieve Reproductive Health and Marital Equity) intervention engages health care providers to deliver gender-equity and family planning sessions to couples using a person-centered shared decision-making approach for contraception counseling. We previously showed that the intervention improved contraceptive use at 9-month follow-up. We sought to assess whether the intervention was further associated with the quality of care reported by participants and whether the quality of care reported mediated the effect of the intervention on contraceptive use. STUDY DESIGN: This is a planned secondary analysis of the effect of the CHARM2 intervention on 1201 married couples in rural Maharashtra, India in a cluster randomized controlled trial completed between 2018 and 2020. We assessed the effect of CHARM2 on perceived quality of care as measured by the Interpersonal Quality of Family Planning (IQFP) scale using a difference-in-differences linear regression approach including a mixed-effects model with nested random effects to account for clustering. We assessed whether the association between CHARM2 and modern contraceptive use was mediated by quality of family planning care. RESULTS: Intervention participants had higher mean IQFP scores than control participants at 9-month follow-up (intervention 3.2, SD 0.6 vs. control 2.3 mean, SD 0.9, p < 0.001). The quality of care reported mediated the effect of the intervention on contraceptive use (indirect effect coefficient 0.29, 95% CI 0.07-0.50). CONCLUSION: Family planning interventions such as CHARM2, which utilize person-centered shared decision-making contraceptive counseling approaches improve women's perceived quality of care. Effects on quality of care mediate observed effects of the intervention on contraceptive use. IMPLICATIONS: Contraceptive interventions should focus on improving person-centered outcomes, such as quality of care, rather than contraceptive use targets. By focusing on improving person-centered care, interventions will improve contraceptive use among those who desire a method while meeting the holistic reproductive health needs of clients and couples.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Anticoncepção / Serviços de Planejamento Familiar Tipo de estudo: Clinical_trials / Diagnostic_studies / Prognostic_studies Aspecto: Determinantes_sociais_saude / Equity_inequality Limite: Female / Humans País/Região como assunto: Asia Idioma: En Revista: Contraception Ano de publicação: 2023 Tipo de documento: Article País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Anticoncepção / Serviços de Planejamento Familiar Tipo de estudo: Clinical_trials / Diagnostic_studies / Prognostic_studies Aspecto: Determinantes_sociais_saude / Equity_inequality Limite: Female / Humans País/Região como assunto: Asia Idioma: En Revista: Contraception Ano de publicação: 2023 Tipo de documento: Article País de publicação: Estados Unidos