Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, USA.
Population Services International, C-445, Bipin Chandra Pal Marg, Block C, Chittaranjan, New Delhi, Delhi, 110019, India.
BMC Health Serv Res. 2020 Dec 11;20(1):1139. doi: 10.1186/s12913-020-05995-9.
Person-centered quality for family planning has been gaining increased attention, yet few interventions have focused on this, or measured associations between person-centered quality for family planning and family planning outcomes (uptake, continuation, etc.). In India, the first point of contact for family planning is often the community health care worker, in this case, Accredited Social Health Activists (ASHAs).
In this study, we evaluate a training on person-centered family planning as an add-on to a training on family planning provision for urban ASHAs in Varanasi, India in 2019 using mixed methods. We first validate a scale to measure person-centered family planning in a community health worker population and find it to be valid. Higher person-centered family planning scores are associated with family planning uptake.
Comparing women who saw intervention compared to control ASHAs, we find that the intervention had no impact on overall person-centered family planning scores. Women in the intervention arm were more likely to report that their ASHA had a strong preference about what method they choose, suggesting that the training increased provider pressure. However, qualitative interviews with ASHAs suggest that they value person-centered care for their interactions and absorbed the messages from the intervention.
More research is needed on how to intervene to change behaviors related to person-centered family planning.
This study received IRB approval from the University of California, San Francisco (IRB # 15-25,950) and was retrospectively registered at clinicaltrials.gov ( NCT04206527 ).
计划生育以人为中心的质量越来越受到关注，但很少有干预措施关注这一点，也很少有干预措施衡量计划生育以人为中心的质量与计划生育结果（使用率、持续率等）之间的关联。在印度，计划生育的第一个接触点通常是社区卫生工作者，在这种情况下，是合格的社会卫生活动家（ASHAs）。
在这项研究中，我们使用混合方法评估了 2019 年在印度瓦拉纳西对城市 ASHAs 进行计划生育提供培训的基础上增加计划生育以人为中心培训的效果。我们首先验证了一个适用于社区卫生工作者人群的衡量计划生育以人为中心的量表，发现其具有有效性。更高的计划生育以人为中心的分数与计划生育的使用呈正相关。
与对照组 ASHAs 的妇女相比，我们发现干预措施对整体计划生育以人为中心的分数没有影响。干预组的妇女更有可能报告说，她们的 ASHA 对她们选择的方法有强烈的偏好，这表明培训增加了提供者的压力。然而，对 ASHAs 的定性访谈表明，他们重视以人为中心的护理，以促进他们的互动，并吸收了干预措施的信息。
需要进一步研究如何干预以改变与计划生育以人为中心相关的行为。
这项研究得到了加州大学旧金山分校（IRB # 15-25,950）的伦理委员会的批准，并在 clinicaltrials.gov 上进行了回顾性注册（NCT04206527）。
