A systematic review of person-centered care interventions to improve quality of facility-based delivery.

INTRODUCTION: We conducted a systematic review to summarize the global evidence on person-centered care (PCC) interventions in delivery facilities in order to: (1) map the PCC objectives of past interventions (2) to explore the impact of PCC objectives on PCC and clinical outcomes. METHODS: We developed a search strategy based on a current definition of PCC. We searched for English-language, peer-reviewed and original research articles in multiple databases from 1990 to 2016 and conducted hand searches of the Cochrane library and gray literature. We used systematic review methodology that enabled us to extract and synthesize quantitative and qualitative data. We categorized interventions according to their primary and secondary PCC objectives. We categorized outcomes into person-centered and clinical (labor and delivery, perinatal, maternal mental health). RESULTS: Our initial search strategy yielded 9378 abstracts; we conducted full-text reviews of 32 quantitative, 6 qualitative, 2 mixed-methods studies, and 7 systematic reviews (N = 47). Past interventions pursued these primary PCC objectives: autonomy, supportive care, social support, the health facility environment, and dignity. An intervention's primary and secondary PCC objectives frequently did not align with the measured person-centered outcomes. Generally, PCC interventions either improved or made no difference to person-centered outcomes. There was no clear relationship between PCC objectives and clinical outcomes. CONCLUSIONS: This systematic review presents a comprehensive analysis of facility-based delivery interventions using a current definition of person-centered care. Current definitions of PCC propose new domains of inquiry but may leave out previous domains.

Interventions to improve the person-centered quality of family planning services: a narrative review.

Person-centered care, a key component of quality of care, is receiving increased attention for maternal and reproductive health. While many interventions have aimed to improve person-centered care for family planning, there is no known narrative review of person-centered-focused interventions in family planning and the outcomes of these interventions. This narrative review fills this gap by conducting a rigorous analysis of interventions that address person-centered care and measure family planning related outcomes, including quality, knowledge and use/continuation. The search of the published and grey literature, from 1990 to 2015 identified 5530 papers, of which 25 were ultimately included in the analysis (after exclusion criteria was applied). We grouped these interventions under seven domains of person-centered care: dignity, autonomy, privacy/confidentiality, communication, social support, supportive care, and trust. We find that person-centered interventions had high success in improving perceptions of quality and knowledge of family planning among clients; however, results were less consistent in improving family planning uptake and continuation. These findings will help program and policy makers develop interventions that incorporate person-centered components to have the highest likelihood for success in improving clients' experiences and family planning use.

Process evaluation of a mobile phone-based intervention to support post-abortion contraception in Cambodia.

BACKGROUND: The MObile Technology for Improved Family Planning (MOTIF) trial assessed a mobile phone-based intervention comprising voice messages and counsellor support to increase post-abortion contraception at four Marie Stopes International clinics in Cambodia. The aim of this process evaluation was to assess participants' interaction with the intervention from a service provider perspective. METHODS: (1) We conducted a descriptive analysis to assess participants' interaction with the intervention. (2) In order to explore how the intervention might work, we assessed associations between interaction with the intervention and contraception use using logistic regression analysis. (3) We undertook a logistic regression analysis to assess associations between baseline socio-demographic factors and ever requesting to speak to a counsellor (pressing '1'), a variable found to be associated with contraception use. RESULTS: Amongst 249 women that received six interactive voice messages +/- counsellor support for contraception, around half actively requested to speak to a counsellor (pressed '1') and over 90% spoke to a counsellor at some stage. Women who spoke to the counsellor having requested to (by pressing '1') were more than four times as likely to be using effective contraception at four months compared to women who didn't request or speak to the counsellor (Odds Ratio 4.39; 95% CI: 1.15-16.71). There was a small, non-statistically significant increase in contraception use amongst women that spoke to the counsellor without requesting a call. Increased parity, a history of >2 previous induced abortions, lower socio-economic status, and medical abortion (after adjusting for age, socio-economic status and residence) were associated with requesting to speak to a counsellor. CONCLUSIONS: The interactive message can identify a subgroup of women in whom counselling will be more effective and appears to be equitable in terms of engaging those most in-need. The intervention could be adapted based on the findings of this study.

Women's views and experiences of a mobile phone-based intervention to support post-abortion contraception in Cambodia.

BACKGROUND: The MObile Technology for Improved Family Planning (MOTIF) trial assessed a mobile phone-based intervention comprising voice messages and counsellor support to increase post-abortion contraception at four Marie Stopes International clinics in Cambodia. The aim of this process evaluation was to assess women's views and experiences of receiving the MOTIF intervention, gain insights into the mechanism of action of the intervention and seek recommendations for improvements. METHODS: We conducted a qualitative study comprising15 semi-structured interviews with women who had received the intervention and undertook a simple thematic analysis. RESULTS: We identified themes relating to communication via mobile phone, supporting contraception use, broader post-abortion care, interaction with family and friends and suggestions for improvement. The majority of women were positive about the mobile phone-based intervention to support contraception use and reported it to be a convenient way to ask questions or get advice without going to a health centre, although a few women found the voice messages intrusive. The intervention supported contraception use by provision of information, encouragement, reminders to return to clinic, reassurance and advice for problems and had a positive effect on contraceptive uptake and continuation. Women reported a sense of being cared for and received support for additional physical and emotional issues. Most women thought that the duration of the intervention and frequency of messages were acceptable. CONCLUSIONS: The majority of women were positive about the mobile phone-based intervention which provided support for contraception use as well as additional physical and emotional issues. The study provides some insights into how the intervention might have worked and considers how the intervention could be improved.

Effect of a mobile phone-based intervention on post-abortion contraception: a randomized controlled trial in Cambodia.

OBJECTIVE: To assess the effect of a mobile phone-based intervention (mHealth) on post-abortion contraception use by women in Cambodia. METHODS: The Mobile Technology for Improved Family Planning (MOTIF) study involved women who sought safe abortion services at four Marie Stopes International clinics in Cambodia. We randomly allocated 249 women to a mobile phone-based intervention, which comprised six automated, interactive voice messages with counsellor phone support, as required, whereas 251 women were allocated to a control group receiving standard care. The primary outcome was the self-reported use of an effective contraceptive method, 4 and 12 months after an abortion. FINDINGS: Data on effective contraceptive use were available for 431 (86%) participants at 4 months and 328 (66%) at 12 months. Significantly more women in the intervention than the control group reported effective contraception use at 4 months (64% versus 46%, respectively; relative risk, RR: 1.39; 95% confidence interval, CI: 1.17-1.66) but not at 12 months (50% versus 43%, respectively; RR: 1.16; 95% CI: 0.92-1.47). However, significantly more women in the intervention group reported using a long-acting contraceptive method at both follow-up times. There was no significant difference between the groups in repeat pregnancies or abortions at 4 or 12 months. CONCLUSION: Adding a mobile phone-based intervention to abortion care services in Cambodia had a short-term effect on the overall use of any effective contraception, while the use of long-acting contraceptive methods lasted throughout the study period.