Improving access to family planning for women with disabilities in Kaduna city, Nigeria: study protocol for a pragmatic cluster-randomized controlled trial with integrated process evaluation
Abstract Background Globally, women with disabilities are less likely to have access to family planning services compared to their peers without disabilities. However, evidence of effective interventions for promoting their sexual and reproductive health and rights remains limited, particularly in l...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | Trials |
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| Online Access: | https://doi.org/10.1186/s13063-023-07892-y |
| _version_ | 1827388113700257792 |
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| author | Sarah Marks Ekundayo Arogundade Mark T. Carew Shanquan Chen Lena Morgon Banks Hannah Kuper Femi Adegoke Calum Davey |
| author_facet | Sarah Marks Ekundayo Arogundade Mark T. Carew Shanquan Chen Lena Morgon Banks Hannah Kuper Femi Adegoke Calum Davey |
| author_sort | Sarah Marks |
| collection | DOAJ |
| description | Abstract Background Globally, women with disabilities are less likely to have access to family planning services compared to their peers without disabilities. However, evidence of effective interventions for promoting their sexual and reproductive health and rights remains limited, particularly in low- and middle-income settings. To help address disparities, an inclusive sexual and reproductive health project was developed to increase access to modern contraceptive methods and reduce unmet need for family planning for women of reproductive age with disabilities in Kaduna city, Nigeria. The project uses demand-side, supply-side and contextual interventions, with an adaptive management approach. This protocol presents a study to evaluate the project’s impact. Methods A pragmatic cluster-randomized controlled trial design with surveys at baseline and endline will be used to evaluate interventions delivered for at least 1 year at health facility and community levels in comparison to ‘standard’ state provision of family planning services, in the context of state-wide and national broadcast media and advocacy. Randomization will be conducted based on the health facility catchment area, with 19 clusters in the intervention arm and 18 in the control arm. The primary outcome measure will be access to family planning. It was calculated that at least 950 women aged 18 to 49 years with disabilities (475 in each arm) will be recruited to detect a 50% increase in access compared to the control arm. For each woman with disabilities enrolled, a neighbouring woman without disabilities in the same cluster and age group will be recruited to assess whether the intervention has a specific effect amongst women with disabilities. The trial will be complemented by an integrated process evaluation. Ethical approval for the study has been given by the National Health Research Ethics Committee of Nigeria and London School of Hygiene & Tropical Medicine. Discussion Defining access to services is complex, as it is not a single variable that can be measured directly and need for family planning is subjectively defined. Consequently, we have conceptualized ‘access to family planning’ based on a composite of beliefs about using services if needed. Trial registration ISRCTN registry ISRCTN12671153. Retrospectively registered on 17/04/2023. |
| first_indexed | 2024-03-08T16:12:59Z |
| format | Article |
| id | doaj.art-0e27198017284ff689840a87b18c90ee |
| institution | Directory Open Access Journal |
| issn | 1745-6215 |
| language | English |
| last_indexed | 2024-03-08T16:12:59Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Trials |
| spelling | doaj.art-0e27198017284ff689840a87b18c90ee2024-01-07T12:43:33ZengBMCTrials1745-62152024-01-0125111510.1186/s13063-023-07892-yImproving access to family planning for women with disabilities in Kaduna city, Nigeria: study protocol for a pragmatic cluster-randomized controlled trial with integrated process evaluationSarah Marks0Ekundayo Arogundade1Mark T. Carew2Shanquan Chen3Lena Morgon Banks4Hannah Kuper5Femi Adegoke6Calum Davey7International Centre for Evidence in Disability, London School of Hygiene & Tropical MedicineOxford Policy ManagementInternational Centre for Evidence in Disability, London School of Hygiene & Tropical MedicineInternational Centre for Evidence in Disability, London School of Hygiene & Tropical MedicineInternational Centre for Evidence in Disability, London School of Hygiene & Tropical MedicineInternational Centre for Evidence in Disability, London School of Hygiene & Tropical MedicineOxford Policy ManagementInternational Centre for Evidence in Disability, London School of Hygiene & Tropical MedicineAbstract Background Globally, women with disabilities are less likely to have access to family planning services compared to their peers without disabilities. However, evidence of effective interventions for promoting their sexual and reproductive health and rights remains limited, particularly in low- and middle-income settings. To help address disparities, an inclusive sexual and reproductive health project was developed to increase access to modern contraceptive methods and reduce unmet need for family planning for women of reproductive age with disabilities in Kaduna city, Nigeria. The project uses demand-side, supply-side and contextual interventions, with an adaptive management approach. This protocol presents a study to evaluate the project’s impact. Methods A pragmatic cluster-randomized controlled trial design with surveys at baseline and endline will be used to evaluate interventions delivered for at least 1 year at health facility and community levels in comparison to ‘standard’ state provision of family planning services, in the context of state-wide and national broadcast media and advocacy. Randomization will be conducted based on the health facility catchment area, with 19 clusters in the intervention arm and 18 in the control arm. The primary outcome measure will be access to family planning. It was calculated that at least 950 women aged 18 to 49 years with disabilities (475 in each arm) will be recruited to detect a 50% increase in access compared to the control arm. For each woman with disabilities enrolled, a neighbouring woman without disabilities in the same cluster and age group will be recruited to assess whether the intervention has a specific effect amongst women with disabilities. The trial will be complemented by an integrated process evaluation. Ethical approval for the study has been given by the National Health Research Ethics Committee of Nigeria and London School of Hygiene & Tropical Medicine. Discussion Defining access to services is complex, as it is not a single variable that can be measured directly and need for family planning is subjectively defined. Consequently, we have conceptualized ‘access to family planning’ based on a composite of beliefs about using services if needed. Trial registration ISRCTN registry ISRCTN12671153. Retrospectively registered on 17/04/2023.https://doi.org/10.1186/s13063-023-07892-yFamily planningSexual and reproductive health and rightsDisabilityRandomized controlled trial |
| spellingShingle | Sarah Marks Ekundayo Arogundade Mark T. Carew Shanquan Chen Lena Morgon Banks Hannah Kuper Femi Adegoke Calum Davey Improving access to family planning for women with disabilities in Kaduna city, Nigeria: study protocol for a pragmatic cluster-randomized controlled trial with integrated process evaluation Trials Family planning Sexual and reproductive health and rights Disability Randomized controlled trial |
| title | Improving access to family planning for women with disabilities in Kaduna city, Nigeria: study protocol for a pragmatic cluster-randomized controlled trial with integrated process evaluation |
| title_full | Improving access to family planning for women with disabilities in Kaduna city, Nigeria: study protocol for a pragmatic cluster-randomized controlled trial with integrated process evaluation |
| title_fullStr | Improving access to family planning for women with disabilities in Kaduna city, Nigeria: study protocol for a pragmatic cluster-randomized controlled trial with integrated process evaluation |
| title_full_unstemmed | Improving access to family planning for women with disabilities in Kaduna city, Nigeria: study protocol for a pragmatic cluster-randomized controlled trial with integrated process evaluation |
| title_short | Improving access to family planning for women with disabilities in Kaduna city, Nigeria: study protocol for a pragmatic cluster-randomized controlled trial with integrated process evaluation |
| title_sort | improving access to family planning for women with disabilities in kaduna city nigeria study protocol for a pragmatic cluster randomized controlled trial with integrated process evaluation |
| topic | Family planning Sexual and reproductive health and rights Disability Randomized controlled trial |
| url | https://doi.org/10.1186/s13063-023-07892-y |
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