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Completed

NCT Number: NCT04802304

Beyond Bias - Reducing Provider Bias Towards Adolescents to Increase Contraception Take-Up in Tanzania, Burkina Faso, and Pakistan

Beyond Bias will evaluate the impact of an intervention designed to reduce family planning provider bias towards young, unmarried, and nulliparous women in Tanzania, Burkina Faso, and Pakistan. The intervention has three components: 1) a summit that includes impactful stories told to and by family planning providers that highlight the consequences of provider bias, 2) a forum for continued communication between providers, and 3) a rewards program where clinics in which providers exhibit less biased client interactions or who have improved the most towards this end will be rewarded with social recognition and a ceremony.

Half of the eligible clinics in each country (233 in total) are randomly assigned to receive the intervention, while the remaining half serves as control. The objective of the evaluation is to estimate the impact of the intervention on a range of outcomes related to quality of family planning care among young, unmarried, and nulliparous women. The investigators hypothesize that the intervention will increase the share of young, unmarried, and nulliparous women who received counseling on a range of methods, counseling on long acting methods, and who received their preferred method.

The investigators will collect four types of data to evaluate the intervention: 1) provider surveys, 2) mystery clients' visits, 3) direct observations of client-provider interactions, and 4) qualitative interviews with clients, providers, and implementors.

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Key information

Conditions

Family Planning Services

Age range

Up to 24 year

Sex eligibility

Female

Study type

Interventional

Phase

Not applicable

Primary location

RAND

Santa Monica, California, 90401, United States

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

for Providers:

  • All providers that are part of Pathfinder Internal's supported clinic network in Burkina Faso, Tanzania, and Pakistan.

Exclusion criteria

for Providers:

  • None

Inclusion criteria

for Clients:

  • All clients aged 24 or under that visit a clinic that is enrolled in the study

Exclusion criteria

for Providers:

  • Clients over 24
  • Clients who do not visit the clinic for family planning services

Treatment and study plan

Beyond Bias Treatment

Other

The intervention has three components: 1) a summit that includes impactful stories told to and by family planning providers that highlight the consequences of provider bias, 2) a forum for continued communication between providers, and 3) a rewards program where clinics in which providers exhibit less biased client interactions or who have improved the most towards this end will be rewarded with social recognition and a ceremony.

Primary outcomes

  1. Whether client was able to receive services

    Time frame: 12 months after the intervention starts

    This is a measure of whether the client received family planning services on the day they came into the clinic. This will be measured from real clients using client exit surveys and using mystery clients.

  2. Optimal Counseling

    Time frame: 12 months after the intervention starts

    This is a measure of whether the client was counseled on all methods that were good options for the client given her background and preferences. This will be coded as 1 if client was counseled on the full set of optimal family planning methods and zero if the client was not counseled on the full set of optimal family planning methods. This will be collected in the client exit survey and in by mystery clients.

  3. Received modern method

    Time frame: 12 months after the intervention starts

    This is a measure of whether the client received a modern family planning method during her visit. This will be collected in the client exit survey only.

  4. Perceived patient centeredness

    Time frame: 12 months after the intervention starts

    This is a composite scale (ranging from 0 to 1) that measures the extent to which the client perceived the her interaction with family provider as patient centered. The questions included in the scale will be chosen based on data driven factor analysis methods. Higher scores will indicate better patient centeredness. This will be collected in the client exit survey and in by mystery clients.

Secondary outcomes

  1. Provider biased attitudes

    Time frame: 12 months after the intervention starts

    This is a composite scale (ranging from 0 to 1) that measures the extent to which providers have biased attitudes towards young, unmarried, and adolescent women. The questions included in the scale will be chosen based on data driven factor analysis methods. Higher scores will indicate better patient centeredness. This will be collected through a provider survey.

Sponsors and collaborators

Lead sponsor

RAND

Other

Collaborators

  • Bill and Melinda Gates Foundation
  • Pathfinder International
  • University of California, Los Angeles

Registry information

Important dates

Study start
2020
Primary completion
2021
Study completion
2022
First posted
Mar 17, 2021
Registry last updated
Oct 17, 2022

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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