Design and impact evaluation of a digital reproductive health program in Rwanda using a cluster randomized design: study protocol
Abstract Background Rwandan adolescents have limited access to high-quality family planning and reproductive health (FP/RH) information and care to prevent unplanned pregnancy and HIV/STIs. In addition to the immediate implications for health and well-being, teenage pregnancy is a significant cause...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-11-01
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| Series: | BMC Public Health |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12889-020-09746-7 |
| _version_ | 1819007603057885184 |
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| author | Cara Nolan Laura Packel Rebecca Hope Jordan Levine Laura Baringer Emmyson Gatare Aline Umubyeyi Felix Sayinzoga Michael Mugisha Janepher Turatsinze Aimee Naganza Laiah Idelson Stefano Bertozzi Sandra McCoy |
| author_facet | Cara Nolan Laura Packel Rebecca Hope Jordan Levine Laura Baringer Emmyson Gatare Aline Umubyeyi Felix Sayinzoga Michael Mugisha Janepher Turatsinze Aimee Naganza Laiah Idelson Stefano Bertozzi Sandra McCoy |
| author_sort | Cara Nolan |
| collection | DOAJ |
| description | Abstract Background Rwandan adolescents have limited access to high-quality family planning and reproductive health (FP/RH) information and care to prevent unplanned pregnancy and HIV/STIs. In addition to the immediate implications for health and well-being, teenage pregnancy is a significant cause of school drop-out, limiting girls’ future potential and employment opportunities. This study introduces a direct-to-consumer digital education program that uses storytelling to deliver age-appropriate FP/RH information and economic empowerment training to adolescents. It also facilitates access to high-quality, youth-friendly FP/RH care and products. We evaluate two different school-based models of its implementation to understand how to optimize the uptake of contraception and HIV testing among adolescents. Methods The study consists of two distinct phases. The first formative intervention design phase, conducted from 2016 to 2019, used a human-centered design methodology to develop the intervention alongside over 600 Rwandan adolescents, their parents, teachers, and healthcare providers. Through this methodology, we sought to maximize the fit between evidence-based practices (uptake of modern contraception and HIV testing) and the implementation context of adolescents in Rwanda. The second phase is an impact evaluation, in which we will use a Hybrid Trial Type 2 Effectiveness-Implementation study design to determine the overall effectiveness of this digital intervention as well as the relative effectiveness of the two different school-based implementation models. This takes the form of a 3-arm cluster-randomized non-inferiority trial, with a sample of 6000 youth aged 12–19 in 60 schools across 8 districts in Rwanda. Primary outcome measures include use of modern contraception, delayed initiation of childbearing, and uptake of HIV testing. Discussion This study will yield insights into not only whether this digital intervention is successful in achieving the intended sexual and reproductive health outcomes, but also which mechanisms are likely to drive this effectiveness. The methodologies used are broadly applicable to the design, implementation, and evaluation of other behavior-based health programs in low and middle-income countries. Trial registration ClinicalTrials.gov Identifier: NCT04198272 . Prospectively registered 13 December 2019. |
| first_indexed | 2024-12-21T00:27:12Z |
| format | Article |
| id | doaj.art-bec70fa4c0514237b05d6990e5240bfa |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-12-21T00:27:12Z |
| publishDate | 2020-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-bec70fa4c0514237b05d6990e5240bfa2022-12-21T19:21:58ZengBMCBMC Public Health1471-24582020-11-0120111510.1186/s12889-020-09746-7Design and impact evaluation of a digital reproductive health program in Rwanda using a cluster randomized design: study protocolCara Nolan0Laura Packel1Rebecca Hope2Jordan Levine3Laura Baringer4Emmyson Gatare5Aline Umubyeyi6Felix Sayinzoga7Michael Mugisha8Janepher Turatsinze9Aimee Naganza10Laiah Idelson11Stefano Bertozzi12Sandra McCoy13School of Public Health, University of CaliforniaSchool of Public Health, University of CaliforniaYLabsYLabsYLabsYLabsDepartment of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, University of RwandaRwanda Biomedical CenterDepartment of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, University of RwandaSociety for Family Health, RwandaSociety for Family Health, RwandaYTH Initiative, ETRSchool of Public Health, University of CaliforniaSchool of Public Health, University of CaliforniaAbstract Background Rwandan adolescents have limited access to high-quality family planning and reproductive health (FP/RH) information and care to prevent unplanned pregnancy and HIV/STIs. In addition to the immediate implications for health and well-being, teenage pregnancy is a significant cause of school drop-out, limiting girls’ future potential and employment opportunities. This study introduces a direct-to-consumer digital education program that uses storytelling to deliver age-appropriate FP/RH information and economic empowerment training to adolescents. It also facilitates access to high-quality, youth-friendly FP/RH care and products. We evaluate two different school-based models of its implementation to understand how to optimize the uptake of contraception and HIV testing among adolescents. Methods The study consists of two distinct phases. The first formative intervention design phase, conducted from 2016 to 2019, used a human-centered design methodology to develop the intervention alongside over 600 Rwandan adolescents, their parents, teachers, and healthcare providers. Through this methodology, we sought to maximize the fit between evidence-based practices (uptake of modern contraception and HIV testing) and the implementation context of adolescents in Rwanda. The second phase is an impact evaluation, in which we will use a Hybrid Trial Type 2 Effectiveness-Implementation study design to determine the overall effectiveness of this digital intervention as well as the relative effectiveness of the two different school-based implementation models. This takes the form of a 3-arm cluster-randomized non-inferiority trial, with a sample of 6000 youth aged 12–19 in 60 schools across 8 districts in Rwanda. Primary outcome measures include use of modern contraception, delayed initiation of childbearing, and uptake of HIV testing. Discussion This study will yield insights into not only whether this digital intervention is successful in achieving the intended sexual and reproductive health outcomes, but also which mechanisms are likely to drive this effectiveness. The methodologies used are broadly applicable to the design, implementation, and evaluation of other behavior-based health programs in low and middle-income countries. Trial registration ClinicalTrials.gov Identifier: NCT04198272 . Prospectively registered 13 December 2019.http://link.springer.com/article/10.1186/s12889-020-09746-7Human-centered designCluster randomized controlled trialAdolescent sexual and reproductive healthFamily planning and reproductive healthRwandaDigital health |
| spellingShingle | Cara Nolan Laura Packel Rebecca Hope Jordan Levine Laura Baringer Emmyson Gatare Aline Umubyeyi Felix Sayinzoga Michael Mugisha Janepher Turatsinze Aimee Naganza Laiah Idelson Stefano Bertozzi Sandra McCoy Design and impact evaluation of a digital reproductive health program in Rwanda using a cluster randomized design: study protocol BMC Public Health Human-centered design Cluster randomized controlled trial Adolescent sexual and reproductive health Family planning and reproductive health Rwanda Digital health |
| title | Design and impact evaluation of a digital reproductive health program in Rwanda using a cluster randomized design: study protocol |
| title_full | Design and impact evaluation of a digital reproductive health program in Rwanda using a cluster randomized design: study protocol |
| title_fullStr | Design and impact evaluation of a digital reproductive health program in Rwanda using a cluster randomized design: study protocol |
| title_full_unstemmed | Design and impact evaluation of a digital reproductive health program in Rwanda using a cluster randomized design: study protocol |
| title_short | Design and impact evaluation of a digital reproductive health program in Rwanda using a cluster randomized design: study protocol |
| title_sort | design and impact evaluation of a digital reproductive health program in rwanda using a cluster randomized design study protocol |
| topic | Human-centered design Cluster randomized controlled trial Adolescent sexual and reproductive health Family planning and reproductive health Rwanda Digital health |
| url | http://link.springer.com/article/10.1186/s12889-020-09746-7 |
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