Keesara Protocol

Keesara Protocol

by Sirina Keesara -
  1. Identify a patient or community group that contributes to or is involved in the principal behavior you are attempting to improve with your intervention.

My intervention is meant to support women who have chosen a method of contraception and have started to use a method. 

2. Using any of the individual explanatory theories in “Theory at a Glance”, develop an explanatory model for the target behavior (above) that you will be attempting to influence with your intervention.  This can be an extension/based on expected findings (or previously published literature) from your answers to Homework #3.  Figures are always very useful... keep it simple.

  1. I can apply many of the other models of health behavior to the process leading up to choosing a method. For example, the elements of theory of planned behavior and diffusion of innovations theory contain concepts such as subjective norm and observability that can lead to the decision to use contraception and selection of a particular method. However, after choosing method, the stages of behavior change model fits the best because most women are in the action --> maintenance stage of behavior change. Please see figure attached. 

3. Identify how one or more of your specific interventions will target one or more of these key factors contributing to the behavior of interest.

Interventions are written in red. The intervention that I propose to improve maintenance of new behavior is a text messaging system in which patients are supported with messages that come directly to their phone about common side effects. This intervention will support women with the most common reason for discontinuation. Another intervention could include better counseling about expected side effects during administration of choose method. 

4. Create a framework that draws upon a socio-ecological framework to orient your target behavior within a larger context.  ie, what are some of broader, external forces that influence the individual behavior of interest...see Figure 2 of “Theory at a Glance.”

Pathophysiological pathways- Hormonal effects on mood, bleeding, appetite, nausea

Individual risk factors- Does not know what to expect about side effects of methods, not literate or able to read brochures or patient education given about methods, young and not able to talk about contraceptives with friends and family due to social stigma

Social Relationships- Women hear rumors about side effects and consequences for body, not enough reliable information about side effects, not able to talk openly about contraceptives

Institutions- Nurses are not trained to counsel about side effects, nurses and other health workers have their own preconceptions about side effects and effects of contraceptives on the body. 

 

 

Re: Keesara Protocol

by JESSICA COHAN -

This is a really well thought out framework!  I like the idea of text messaging as a prophylactic intervention, however, I think the most important aspect will be making sure that women have access to specific information about the difficulties they are experiencing.  The hotline will be particularly helpful for women who are having difficulty but do not have an upcoming appointment.  This will be useful for minor side effects, but ultimately I suppose the goal is to get women on a method that will work for them, and therefore follow up with a care provider who can help them navigate the options will be very important.  This is a very useful idea to patch some of the areas of the system that are allowing some patients to fall through.

Re: Keesara Protocol

by Matt Hickey -

Nice work Sirina!  I really like your application of the stages of change model and use of the figure.  This might be beyond the scope of your specific intervention, but I'm curious what the clinic you work with does to support re-entry at the pre-contemplation phase for women who stop using their chosen method all together.  This may be particularly relevant for women who stop because they had a bad experience with their chosen method.  Is there a mechanism for capturing information about the particular adverse experiences that women have and using this to work on re-engaging women in the process (perhaps even just getting them to come back to the clinic)?

Re: Keesara Protocol

by Sirina Keesara -

Hi Matt, 

Thanks for the comments! IN our procedures, nurses have to check in about family planning during every visit. This integrates FP counseling with postnatal care and immunization visits for their children. We have documentation in clinic to capture the side effects and reasons for discontinuation for particular method that a woman might be using. The nurses are directed to re-start the balanced counseling strategy (population council developed FP counseling method) if a woman is not using a method of contraception. However, we do not capture women who have discontinued methods and do not return to the clinic! This is probably a major gap, and we have to figure out what to do with clients who are participating in the text message program and may never come back to us!