Addressing Reproductive Coercion in HEalth Settings - Kenya
Condition: Unintended Pregnancy; Family Planning; Intimate Partner Violence (IPV)
Study type: Interventional

Summary: 
      The primary purpose of this research is to conduct a small matched cluster control trial of
      an intervention designed to address reproductive coercion and unintended pregnancy (ARCHES -
      Addressing Reproductive Coercion within Healthcare Settings) adapted to the Kenyan cultural
      and family planning healthcare context (ARCHES Kenya) so as to provide initial data regarding
      acceptability, feasibility and efficacy in this high-need LMIC context.
    

Detailed description: 
      The project consortium will implement the ARCHES Kenya model across 6 Family Health Options
      Kenya clinics in Nairobi, Kenya. A matched-pair cluster control design including 600 female
      family planning (FP) clients ages 15-49 years (inclusive of 360 clients age 15-24 years) will
      be utilized to evaluate this intervention. Baseline data will be collected prior to routine
      FP service delivery, with a short exit survey conducted immediately following the clients' FP
      appointment (ARCHES or standard FP counseling will be provided during this visit). Follow-up
      data will be collected at 3 and 6-months post-intervention. Qualitative data will be
      collected from intervention providers (n=12) regarding implementation via weekly technical
      assistance sessions during the first three months, and then monthly, regarding acceptability
      and feasibility of integrating ARCHES into routine FP counseling, including barriers and
      facilitators to implementation, and any issues with maintaining fidelity to the ARCHES model.
      Structured interviews with select providers (n=12) will also be conducted at 3-months
      post-training to delve further into these issues. Structured interviews with intervention
      participants reporting experience of RC in the past 3 months on the baseline survey (20
      participants ages 15-24, 15 ages 25-49; total n=35) will be conducted at 3-months follow-up
      to assess their experience of the intervention; perceived utility of the messages, care and
      materials; barriers to utilizing messaging and materials; and suggestions for improvement.
      Analyses specific to participants ages 15-24 will provide findings to guide consideration of
      ARCHES as an effective strategy to improve reproductive health and reduce GBV among
      adolescents in the region. The project consortium will engage Government of Kenya officials,
      IPPF executive directors and IPPF member associations across the federation to pave the way
      for the future roll out of this approach in other low and middle-income country (LMIC)
      contexts.
    

Intervention name(s): ARCHES Kenya
Intervention type(s): Behavioral
Intervention description(s): ARCHES: Contraceptive counselors in intervention clinics will receiving training to ) provide counseling and education regarding risk of partner detection of contraceptive methods, and women's and girls' strategies to use contraceptive methods to minimize partner detection risk integrated into standard contraceptive counseling, b) make brief inquiries to allow clients the opportunity to disclose experiences of RC and IPV (i.e., screening), c) provide method-specific counseling based on this information and the method chosen by the client, d) provide supported linkage of IPV survivors to local IPV support services (i.e. warm referral), and e) offer palm-sized educational materials on RC and IPV, as well as IPV services to all clients.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The ARCHES Kenya study will take place in six IPPF-affiliated Family Health Options Kenya (FHOK) clinics in Nairobi, Kenya or surrounding smaller cities for all clients receiving voluntary FP counseling. The intervention study will involve a matched cluster control trial. Three clinics will serve as the intervention sites and three other clinics matched on client volume and demographics, clinic structure and staffing will serve as matched comparison sites and will not receive the intervention.
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Reproductive Coercion; Gender-based violence; Contraception; Clinic-based screening for IPV; Clinic-based counseling