PSI | INDIA

Abstract

Effect of Communication Campaigns on Sexually Transmitted Infections Treatment Seeking Behaviour among Male Clients of Female Sex Workers in India

Increasing access to Post-Partum Intrauterine Device (PPIUD) through private sector providers in India

Increasing contraceptive use: Campaign to increase spousal communication and knowledge in Bihar, India

'Individualized IPC' as a highly productive and cost effective model to promote family planning in India

An Effective Communication Mix: A strategy to promote informed use of IUDs among women of reproductive age in three Indian states.

Impact assessment of a communication campaign to increase knowledge for early detection and treatment seeking of tuberculosis among general population In India

Title

Effect of Communication Campaigns on Sexually Transmitted Infections Treatment Seeking Behaviour among Male Clients of Female Sex Workers in India

Author

Deepti Bajaj, Kali Prosad, Amit Bhanot, Atul Kapoor, Dana Ward

Date of Publishing

22-27 July 2012

Conference Name

XIX International AIDS Conference (AIDS 2012)

Background

This paper describes programme-based communication campaigns and their association with treatment seeking behaviour of sexually transmitted infections (STI) from project-funded clinics [called key clinics (KCs)] by male clients of female sex workers (FSWs) in India.

Methodology

Data are drawn from two rounds of cross-sectional behavioral surveys conducted in 2006 (N=1031) and 2007 (N=1018) among men who had, sex with FSWs, and experience of STI-related symptoms in 12 months preceding survey. Individuals consenting prior to interview were surveyed on demographic characteristics, experience of STI symptoms, treatment seeking behavior from KCs, and exposure to different communication activities .The survey assessment followed communication campaigns, comprising of street plays, inter-personal communication (IPC) and mid-media, which promoted KC services. Both univariate and multivariate analyses were conducted.

Result

Exposure to any communication activity increased from 39% in 2006 to 83% in 2007 [Adjusted Odds Ratio (AOR):8.5, p<0.001]. Treatment seeking behavior from KCs increased six-fold over this period (8% vs. 36%, AOR: 6.5, p<0.001). Males exposed to at least one communication activity were more likely to seek treatment from KCs than those not exposed (43% vs. 5%, AOR: 12.8, p<0.001). The odds of seeking treatment from KCs is greater, if men were exposed to street plays (54% vs. 21%, AOR: 3.0, p<0.001), or mid-media (43% vs. 9%, AOR: 4.9, p<0.001) or IPC (57% vs. 29%, AOR: 2.0, p<0.001) as compared to those not exposed. Individuals exposed to all three communication activities were three times more likely to seek treatment from KCs than others (58% vs. 31%, P<0.001).

Conclusion

Increase in treatment seeking for STI from KCs may be attributed to augmented exposure to communication campaigns. These results suggest that, communication campaigns play vital role in changing the behavior of individuals, like male clients of FSWs, at risk of HIV in India and elsewhere.

Presentation

Report

Quantitative Study to Measure Recommending Behavior and Quality Parameters Related to IUD among Providers

Synopsis
India is amongst the first country to adopt family planning. Family Planning in India is largely based on Government sponsorship. The major focus of the family planning has been on permanent limiting methods like sterilization. In recent times, the focus has shifted to spacing methods like condoms, oral contraceptive pills, injections and IUD. IUD considering its effectiveness, longevity and reversibility is a very useful method of contraception. The PSI PEHEL program recognizes the utility of IUD as a contraceptive method and emphasizes on influencing the key factors that will increase its usage among the general population. Shaping demand and supply factors are a prerequisite for wider prevalence of a social product like IUD. Thus, one of the key aspects for the program was to train the PSI network providers who are practicing gynecologists or qualified gynecologists and obstetrician on IUD recommendation and the protocols that need to be adhered during consultation on IUD. Furthermore, under the program, Freedom 5 a brand of IUD was promoted by PSI International.

Featured Abstract

22-27 July 2012

Effect of Communication Campaigns on Sexually Transmitted Infections Treatment Seeking Behaviour among Male Clients of Female Sex Workers in India

Abstract

Title

Effect of Communication Campaigns on Sexually Transmitted Infections Treatment Seeking Behaviour among Male Clients of Female Sex Workers in India

Author

Deepti Bajaj, Kali Prosad, Amit Bhanot, Atul Kapoor, Dana Ward

Date of Publishing

22-27 July 2012

Conference Name

XIX International AIDS Conference (AIDS 2012)

Background

Methodology

Result

Conclusion

November 2014

Increasing access to Post-Partum Intrauterine Device (PPIUD) through private sector providers in India

Abstract

Title

Increasing access to Post-Partum Intrauterine Device (PPIUD) through private sector providers in India

Author

Dr.Shikha Srivastava, Dr. Jyoti Vajpayee, R.Jayashree Nair, Dr.Nayanjeet Chaudhury

Date of Publishing

November 2014

Conference Name

International conference on Family Planning, Addis Ababa, Ethiopia

Background

Despite known benefits as a Long Acting Reversible Contraceptive method (LARC), intrauterine device (IUD) use in India is low at 1.9% (DLHS-3, 2007-08), with a decline in urban prevalence from 3.7% (DLHS-2, 2002-04) to 2.9% (DLHS-3, 2007-08). The Government of India (GOI) has repositioned the IUD as a LARC and is promoting post-partum IUD (PPIUD) as an integral component of its National Family Planning Program. With increasing numbers of institutional deliveries, due to incentive schemes like Janani Suraksha Yojna in India, opportunities for providing safe and effective contraceptive via PPIUD has increased significantly. While 38.9% of deliveries in Uttar Pradesh (U.P.) and 20.7% in Rajasthan occur in the private sector, private sector providers are not motivated and trained to provide PPIUD services. This prompted PSI/India to intervene.

Methodology

PSI/India is currently implementing Project Pehel in 20 districts in three states (U.P., Rajasthan and Delhi). In 2011, PSI/India promoted PPIUD through its network of private providers with a built-in quality assurance system. Out of the 908 providers in the network, PSI/India identified approximately 100 who had more than 15 deliveries per month and were willing to insert IUDs during the immediate post-partum period. Paramedics were also identified and trained to provide counseling. PSI/India partnered with GOI-approved PPIUD training centers, and three such centers, one per program state, were targeted. Providers were trained in two phases: 1) classroom training using models and 2) hands-on practice on clients at training centers. PSI/India also worked with the federal and state governments to develop guidelines and quality protocols. In addition, PSI/India partnered with the Federation of Obstetrics and Gynecology Societies of India (FOGSI) to motivate private providers to provide PPIUD services and to share evidence-based best practices through national and district level conferences. PSI/India developed a campaign to support GOI's strategy to promote and reposition PPIUD, and increase PPIUD awareness among women of reproductive age. Client information was collected on a monthly basis through PPIUD record registers provided by PSI. The registers contain columns for details of PPIUD insertion, follow up and findings.

Result

PSI/India began with 10 providers in October, 2011 and increased to 95 providers by the end of December 2012. During this 15 month period, 119 paramedics and 14 PPIUD counselors were trained. Supportive supervision visits and documentation of insertions and follow-up were done to ensure quality. About 78% (74) of the trained providers were actively inserting PPIUD by December2012. Out of these providers, 43% were inserting at least three PPIUDs in a month. 'The data analysis shows that, out of 74 providers, providing PPIUD services, 45 (60%) providers motivated =>10% of their delivery and caesarean cases / clients for PPIUD insertion and out of these 15 (33%) motivated =>20% of their delivery and caesarean cases for PPIUD insertion.'

Conclusion

It was observed that both the client and providers were more comfortable with interval insertion. During the follow up made by technical team, it was ensured that providers are motivated for PPIUD insertion. Motivating providers for PPIUD services is difficult as they believe PPIUD is associated with high expulsion and infection rates. Sharing FOGSI PSI/India research result demonstrating that if PPIUD is inserted by a trained provider expulsion rate is less than 3%. Limited training centers exist for PPIUD in Pehel program states. Currently, there are only three training centers identified &strengthened by PSI and providers have to travel far distances for the training. To address this, four new training centers have been proposed. PPIUD clients are mostly walk-in antenatal care (ANC) clients. Doctors often lack time to counsel clients; therefore, paramedical staff has been trained to counsel woman in the ANC, during early labor and post-delivery for Post-Partum Family Planning. Record maintenance is a challenge. Constant capacity building of PPIUD counselors is required for supporting providers to keep records. Follow-up by phone needs to be considered. Non-monetary incentives such as recognition as champions do motivate the providers.

November 2013

Increasing contraceptive use: Campaign to increase spousal communication and knowledge in Bihar, India

Abstract

Title

Increasing contraceptive use: Campaign to increase spousal communication and knowledge in Bihar, India

Author

Kali Prosad Roy, Sanjeev Dham, Preena Loomba

Date of Publishing

November 2013

Conference Name

International conference on Family Planning, Addis Ababa, Ethiopia

Background

Indian women, particularly young women play a limited role in taking reproductive decisions. The decision-making process regarding contraception may be a joint endeavor in some cases, but typically does not involve the woman, especially if she is poor or less educated.2 Newly married women are expected to prove their fertility soon after marriage and childrearing is often perceived to be the duty of married women.3 A woman in Bihar and Jharkhand gives birth to 4.0 and 3.3 children in her reproductive years against the national average of 2.7 children per women.4 Contraceptive use among younger women is low and delaying or spacing births is often not a consideration among them, although the demand in this age group is high.5 In order to reduce unwanted fertility and improve reproductive health outcomes through increased use of birth spacing methods, Population Services International/India implemented a birth spacing communication program in eleven districts across rural and urban areas of Bihar and Jharkhand during 2008-2009. The purpose of this program is to increase demand and access to modern contraceptive methods for the healthy timing and spacing of pregnancies among married nonsterilized women in the age group of 15-29 years.

Methodology

Cross-sectional surveys among eligible6 female respondents were conducted in October 2008 and May 2010 from a sample of intervention units in the program districts. Stratified two stage cluster sampling was done wherein the district comprised the strata, and village/urban ward units were defined as the primary sampling units. The desired sample size (900) was calculated to allow comparison over time between independent samples: significance level was set at 0.05 and power was set at 80%. The baseline survey identified the key determinants of promoted behavior. Logistic regression was used to examine relationships between the determinants and current use of OCP or condom. Determinants related to behavior of interest were classified according to framework of opportunity, ability and motivation.7 During the end line survey adjusted proportions and means were generated to check whether the behavioral indicator and its determinants changed significantly from baseline, and whether such change was associated with program exposure as measured in end line.

Result

The baseline research identified knowledge about condom and OCP (odds ratio=2.92), selfefficacy to use contraceptives (odds ratio=1.86), spousal support for using spacing methods (odds ratio=3.49) and attitude towards use of family planning methods (odds ratio=1.43) as significant predictors of behaviour. Subsequently the program team prioritized the determinants, and communication activities were implemented on key message areas of spousal support and knowledge about contraceptives. Messages were communicated through interpersonal communicators and through culturally appropriate, community-based activities such as street theatre, folk dramas and small group contests and games that appeal to the target audience.

Conclusion

The benefits of contraceptive use by young couples in India are many, especially in states where the age at marriage is very low, and levels of fertility, population growth, infant and child mortality, and abortion are high.The research has opened up new perspectives in family planning that highlight the importance of husband-wife communication on family planning as one of the influencing variables for use of contraceptives. The results significantly indicate the necessity of a good spousal communication for the actual practice of contraception. Integrated communication campaigns using door-to-door communication and local community-based activities can be effectively used to underscore the importance of inter-spouse communication for joint decision-making to improve family planning acceptance.

November 2013

'Individualized IPC' as a highly productive and cost effective model to promote family planning in India

Abstract

Title

'Individualized IPC' as a highly productive and cost effective model to promote family planning in India

Author

K Laxmi Rao, Sr Communication Manager, WHP-India, Co Author: Bhaskar Pandya, Director Program, WHP-India

Date of Publishing

November 2013

Conference Name

International conference on Family Planning, Addis Ababa, Ethiopia

Background

In 2011-2012, PSI-India moved away from 'community' based IPC model and introduced an 'individualized' IPC model. Under the community model, an IPC contacted about 40-50 women of the reproductive age per day to deliver messages on modern family planning methods. Data showed that among the women contacted there was a high percentage of those who were consistent users of any modern family planning method and hence our efforts were resulting in method shift. A strategic change was made and an 'Individualized' IPC model was introduced in which the IPCs contacted only non-users of any modern family planning method; delivered messages on informed choice and motivated them to visit the nearby provider for consultation .

Methodology

Individualized IPC target groups (TG) were pre-identified through a census process and specific behavior change messaging was developed. Target group is defined as married women in the age group of 15-49 years old and not using any modern family planning method. Inconsistent method users as well as currently pregnant women were also included in the target group. Clusters with high density of less developed socio-economically population were identified in all the program districts. Analysis of secondary data of the identified clusters was conducted to arrive at an estimated universe of non-users and to calculate the number of interpersonal communicators required per cluster. An extensive house listing exercise in the selected clusters of the program districts was carried out to identify non-users. Physical maps of the clusters were drawn with distinct landmarks to facilitate the IPC day-to-day work. Approximately 900,000 households were visited and the family planning profiles of about 880,000 eligible women were collected. The data was fed into a specially designed MIS. The MIS established unique IDs for 450,000 exclusive, non-user women.

Result

The cost effectiveness study conducted for a 12 month period revealed that the cost per insertion came down from $26 in the community model to $20 in the individual model. The cost analysis is done by summing the expenditure made on various IPC activities like capacity building, tool development, salary, travel, IEC materials for a given period and dividing the total with number of TG motivated by IPCs during that period .

November 2013

An Effective Communication Mix: A strategy to promote informed use of IUDs among women of reproductive age in three Indian states.

Abstract

Title

An Effective Communication Mix: A strategy to promote informed use of IUDs among women of reproductive age in three Indian states.

Author

Priyanka Joshi, Dr. Nayanjeet Chaudhury, Atul Kapoor

Date of Publishing

November 2013

Conference Name

International conference on Family Planning, Addis Ababa, Ethiopia

Background

In India, the use of Intra-Uterine Device (IUD) among women of reproductive age has been stagnant for over a decade, despite the fact that it is one of the most effective and reversible methods of contraception. Increasingly, literature suggests that dissonance by consumers who had had an adverse experience following IUD insertion may demotivate new potential users by sharing of negative experiences. Research studies suggest that Health Care Providers believe that IUD counselling is time consuming, and client who face side effects due to IUD hamper provider's reputation in the community. These act as deterrents to use of IUDs.

Methodology

PSI has been working in selected districts of Rajasthan, Uttar Pradesh and Delhi since 2010 by enrolling obstetricians into a network to provide family planning, including IUDs. At the consumer level, an integrated communication campaign was rolled out using mass media (TV, radio, outdoor, print and cinema) to address myths surrounding traditional methods of contraception, raise awareness of PSI's IUD brand called 'Freedom5', and move women towards adoption of IUDs. Interpersonal communication was aimed to advance women from the awareness to the adoption/action stage. Interpersonal communicators (IPC)s conducted household visits, small group activities and special events like doctor-in-the community (where a doctor addresses a gathering of women on their family planning needs and modern contraceptives), couple meeting, counselling huts at the providers' clinic etc. These activities were reinforced through a reproductive health helpline that provided information to the callers on all contraceptives, pre-IUD insertion counselling, and referral to nearby network providers if required. Based on AIDAS model, the helpline was aimed at improved consumer value perception and communication. In addition, Helpline counsellors followed up with women who recently had an IUD insertion and provided them with post insertion counselling. Designed to be interactive, non-judgemental and non-threatening, it ensures confidentiality. This renders faith in the process and facilitates discussion on intimate concerns pertaining to IUD usage thus reducing dissonance. To improve provider perceptions of IUDs, medical detailing for provider behaviour change was introduced. The Medical Detailers (MDs), equivalent to medical representatives of a pharmaceutical company, were trained in the use of a thematic detailing kits based on the stimulus response approach. The stimulus response model of buyer behaviour assumes a prospect will respond to a pitch in some predictable manner, which is favourable for the sale. PSI India established a robust, formative, end line monitoring and evaluation system that included series of population based and provider based surveys to understand the impact of the communication campaign across different target groups. This supplemented the use of an electronically managed MIS for regular decision making.

Result

At the end of two phases of the project (2010-2012), there were 20 districts in which PSI was actively continuing its communication campaigns for promotion of IUD in women in reproductive age groups. In December 2012, there were 908 private providers who had enrolled into PSI's social franchise network.

Conclusion

Both mass media and interpersonal communication channels are equally important. Based on the stages of readiness, customer comprehension is primarily affected by advertising and interpersonal communications. Customer conviction is influenced mostly by interpersonal communications. Mass media not only increased the awareness of IUD among consumers, it also created a halo effect among providers to change their preference towards IUD-Freedom5.

Evidence-based programming forms an integral part of implementation and monitoring for successful delivery of outputs for all PSI Projects. PSI uses field-based evidence and new emerging data for critical interventions to address issues of duplication, gaps, and also program alterations.

Tracking Results Continuously (TRaC)

PSI collects quantitative data about our social marketing programs by conducting TRaC studies. TRaC is a multi-round survey-based research approach that PSI utilizes to gather information from a representative sample of our target populations. The data collected from TRaC studies allow us to understand characteristics of the groups we work with such as socio demographics, health behaviors, knowledge about health products, and much more. This information is very useful to understand how to best design our social marketing programs as well as to assess if they are effective.

Mapping Access and Performance (MAP)

PSI assesses its social marketing delivery systems using MAP (Measuring Access and Performance) studies. They are designed to gather evidence on the coverage, quality, equity of access, and efficiency of PSI's product and service delivery systems. PSI uses this evidence to continuously improve its social marketing interventions.
MAP surveys are derived from traditional private sector distribution surveys using Lot Quality Assurance Sampling (LQAS). The main outputs are indicators of: geographic coverage (i.e. availability), quality of coverage, outlet penetration, and access. In addition, MAP studies provide information on price levels, occurrence of stock-outs, reasons for not stocking a product, and other important information about a distribution network.

Framework for Qualitative Research in Social Marketing (FoQus)

PSI conducts qualitative research to provide rich, action-oriented evidence for program planners. This evidence helps program planners to develop interventions and health messages that will successfully reach target audiences.
PSI's "Project FoQus" is qualitative research that emphasizes audience-centered, qualitative methods such as photo narratives, collage-making and theatre presentations, as well as in-depth interviews and small group discussions. FoQus is conducted as a collaborative process between program planners, marketers, researchers and members of the target audience to inform intervention design.
FoQus most often serves as formative research to develop campaign strategies and messages, and is usually conducted when interventions are being designed or modified. FoQus studies provide insight into how target audience members make health decisions and which messages are likely to resonate to change health behaviors. In certain cases, FoQus is used during program implementation to clarify or redirect program and marketing strategy.
PSI began training researchers in the FoQus approach to qualitative research in 2008 and scaled up globally in 2009. By 2010, the FoQus approach to qualitative research was well established at PSI, and it continues to evolve.