A Pilot Study to Estimate the Impact of a Screening and Referral Service on Contraceptive Use
Condition: Contraception Behavior
Study type: Interventional

Summary: 
      The specific aim of this pilot study is to estimate the impact of a new digital health
      service on the uptake of family planning among Kenyan women with an unmet need for
      contraception. Enrolled women will be randomized to a control arm or an encouragement arm
      that will receive a special invitation to try the new service.
    

Detailed description: 
      Based on global projections, meeting the unmet demand for contraceptives would prevent more
      than two-thirds of unintended pregnancies and more than two-thirds of maternal deaths.
      Voluntary family planning has also been shown to improve newborn health outcomes, advance
      women's empowerment, and bring socioeconomic benefits through reductions in fertility and
      population growth. Yet among the populations that would benefit the most from family
      planning, uptake remains too low.

      The specific aim of this pilot study is to estimate the impact of a new digital health
      service on the uptake of family planning among Kenyan women with an unmet need for
      contraception. This service promotes uptake by offering free screening and referral. Women
      text the service for free, complete a short automated screening over the phone, and receive a
      list of recommended methods and a referral to local family planning providers offering those
      methods. The main hypothesis is that the service will increase the uptake of family planning
      among these users.
    

Intervention name(s): digital family planning screening and referral service
Intervention type(s): Other
Intervention description(s): Clients text the service and receive a free call back to complete an automated family planning counseling session that results in a set of recommended methods that fit the client's preferences. The client is matched to family planning providers that offer these methods, and the service sends a referral code that the client can redeem at a facility. When someone receives a referral code, the service tracks them through their encounter with a provider to learn about their experience with the service, the provider, and their choice in contraception. The service also follows-up with clients who do not act on referrals to better understand their reasons and tries different behavioral nudges to promote uptake of contraception. The service does not pay costs the client may incur at a facility.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The service (intervention) is available to anyone living in the catchment area, so it is not possible to randomly assign access to the service and estimate impact through a traditional randomized controlled trial (RCT). Likewise, at this early stage it is not be feasible to randomize access at a higher level, such as counties or subcounties. In situations like this, a variation on the traditional randomized controlled trial called a randomized encouragement design can be very effective.
In a randomized encouragement design (RED), participants are randomized to receive an invitation or special encouragement to receive a treatment. Not everyone who is encouraged will take up the service, but as long as those randomly selected to receive the encouragement (the treatment group) use the service at a higher rate than the control group, the impact of the service can be estimated.
For more details, see http://bit.ly/RED17protocol (linked in this record).
Masking: Double (Care Provider, Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: Contraception; Family Planning; Digital Health; Kenya; Unmet Need