Protocol Assignment Forum: Defining the Quality & Outcome Gaps

A. What evidence are you proposing to translate into practice? There is new evidence that shows mobile health initiatives improve clinic attendance and family planning knowledge. I would like to use this as base to implement a mhealth program promoting continuation of family planning method chosen during the first postpartum year. The intervention will include a series of messages sent after a patient has chosen and used a specific method. The messages will contian information about side effects and a mechanism to reach out healthcare providers to ask more questions. 1. Justify that this evidence is “ready for translation.” We have piloted a series of mobile messages about postpartum family planning, which was well received by our clients. There are also multiple other RCTs which shows that mobile health is a promising intervention for behavior change. 2. Identify a single, key behavior change target for your translational activity. A common reason for discontinuation of family planning is the unexpected side effects. Patients say that they do not consult a healthcare provider because they were not told what to expect and imagine that their is something wrong with their reaction to the new method. With this intervention, we would like our patients to contact health care providers about side effects instead of discontinuing without consultation. 3. Conduct a “gap analysis” of your target behavior. Look to diverse sources for “best guess” estimates if specific measures are not available. There isn't any evidence that shows how often a women returns for information about side effects, but other indicators could include return for follow-up visit or continuation of method at 1 month, 3 month and 6 months. B. What is the quality (performance) gap? The leading quality framework for family planning programs identifies proper information and education and good interpersonal relations as two key factors in providing high quality care. Communication about side effects is the most important piece of counseling that seems to be falling through the cracks. A recent study at UCSF showed that less than 50% of healthcare providers discussed side effects while counseling women about starting method. C. What is the outcome gap? As estimate of about 19% of women with an unmet need were users who discontinued used. About 30%worldwide of women discontinue their method due to side effects. D. Is there evidence that changing performance will improve health (clinical outcomes)? There is substantial evidence that shows improvement in quality of family planning decreases discontinuation after choosing and starting a method. A recent analysis showed that nearly 35% of unmet need for family planning can be met by providing support to women who have already started a method (Askew 2013). Furthermore, counseling about side effects decreases discontinuation by nearly 30% (Lei 1996).