Clinical trial NCT05725278: Impact Evaluation of Triggerise's Tiko Platform
Official title: Health Impact Evaluation of Triggerise's Tiko Platform
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Contraception
Iron Deficiency Anemia of Pregnancy
Antenatal Care
Postnatal Care
Keywords: mHealth
Social Franchising
Social Marketing
Impact Evaluation
Market-Driven
Family Planning
Antenatal Care
Community Health Workers
Lead sponsor: Network for Engineering and Economics Research and Management
Sponsor class: OTHER
First posted: 2023-02-13
Enrollment: 1708
Sex: FEMALE
Minimum age (years): 18
Maximum age (years): 50
Standard ages: ADULT
Accepts healthy volunteers: yes
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Intervention model description: The study compares family planning, antenatal care and postnatal care related outcomes (multiple) for women who had registered on Tiko Platform between those who used the platform and those who did not access any services on the platform. The comparison is done ex-post with a single cross sectional survey in March-April 2021. Model uses fixed effects at Pro-Agent level who is a local health promoter of a small geographical area and recruits and serves women in that area so that confounders at agent and levels beyond are controlled. For women/household level confounder control, a few socio-economic and demographic variables at the woman level were included in the model, and sensitivity of the results with and without adjusting for these control variables was investigated.
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: Triggerise designed web and phone based Tiko platform to connect young girls and women to the health products, services and information. The platform uses principles of behaviour economics to motivate positive choices-including rewards, promotions, discounts, coupons, reminders, alerts etc. The platform was implemented in several cities from seven states of India to provide Sexual Reproductive Health (SRH) and maternal and child health (MCH) products and services. The consumers (called Rafikis) use Tiko card to get discounts and to earn 'Tiko miles' rewards at Tiko franchised healthcare providers and pharmacies. Tiko miles are redeemable towards lifestyle products or services (e.g., beauty salons). The local Tiko health promoter (celled Pro agent) can also buy health and hygiene products at bulk discounts and sell them at profit.

Triggerise appointed Network for Engineering, Economics Research and Management (NEERMAN) to conduct an independent impact assessment of the Tiko platform with multiple research objectives include health impact evaluation at the Rafiki level.

NEERMAN used an ex-post observational design to compare usage of SRH and MCH services and family planning (FP), antenatal care (ANC) and postnatal care (PNC) practices by comparing Users and Non-Users of Tiko platform, and accounting for the selection bias statistically. The structured questionnaire collected data on knowledge, practices, barriers, enablers for SRH and MCH services, exposure o Tiko platform, and how it helped or did not help. The survey participants were approx. 1200 users and 600 non-users being served by approx. 350 pro-agents in their respective operations area.

The association between use of Tiko platform and various outcomes were identified using a generalized linear model with fixed effects at pro-agent level and including a set of covariates. To evaluate the effect modification by type of pro agent - government community health worker (CHW) versus others - an interaction model was used. The standard errors were automatically clustered at pro-agent level due to fixed effects. Primary outcomes are proportion of married Rafikis currently using any contraceptives, currently using modern short-term contraceptives, proportion of Rafikis who delivered a child post Jan 2019 and received at least 4 ANC check-ups, consumed at least 100 iron folic acid (IFA( during pregnancy, and received a PNC check-up within 6 weeks of birth.

Detailed description: See subsequent sections

Eligibility criteria: Inclusion Criteria:

* Women who are registered on Tiko Platform with Pro-agents active in 2020-21
* Age 18-50
* Address and contacts details are found with help of Pro-agent

Exclusion Criteria:

* Does not consent to participation
* Does not agree or confirm registering on Tiko Platform
* If a woman is never married, she is excluded from survey on family planning but surveyed for use of Tiko platform
* If a married woman does not have a child born on/after 1 January 2019, then she is excluded from the survey on antenatal care, delivery and postnatal care but surveyed for use of Tiko platform

Primary outcomes:
measure: Proportion of women currently using any contraceptives
timeFrame: Through survey completion, an average of 1 month
measure: Proportion of women currently using modern short-term contraceptives
timeFrame: Through survey completion, an average of 1 month
measure: Proportion of women who consumed 100 or more Iron Folic Acid (IFA) tablets during last pregnancy
timeFrame: 9 months during pregnancy with the youngest child
measure: Proportion of women who received 4 or more antenatal check-ups during last pregnancy
timeFrame: 9 months during pregnancy with the youngest child
measure: Proportion of women who received a postnatal check-up within 6 week of the delivery from a healthcare provider
timeFrame: Within 6 weeks after delivery of the youngest child
Secondary outcomes:
measure: Out of pocket expenditure on antenatal care, iron folic acid tablets, delivery, and postnatal check-ups
timeFrame: 9 months during pregnancy with the youngest child
measure: Out of pocket expenditure on Family planning services and products
timeFrame: Past 24 months (from survey date)
measure: Proportion of women receiving Antenatal check-ups at (a) Tiko franchisee doctors, (b) other private doctors, or (c) government healthcare provider
timeFrame: 9 months during pregnancy with the youngest child
measure: Proportion of women receiving postnatal check-ups at (a) Tiko franchisee doctors, (b) other private doctors, or (c) government healthcare provider
timeFrame: Within 6 weeks after delivery of the youngest child
Other outcomes:
Locations:
city: Mumbai
country: India
facility: NEERMAN
state: Maharashtra
Study officials:
affiliation: Network for Engineering and Economics Research and Management
name: Sumeet Patil, PhD
role: PRINCIPAL_INVESTIGATOR
References: