Experimental Design
1. Site selection (urban only)
The study was limited to urban areas only that are not currently an area targeted for family planning outreach activities by other agencies or previous home outreach locations by General Union of Voluntary Services and Circassian Charity Association (the project's current home implementing partners). This study area has not received outreach work by the predecessor project in the past three years.
2. Research firm recruitment and training
Interviewers were recruited through a research firm. Interviewers were fluent in Arabic and English and have experience conducting surveys. The interviewers participated in a week-long training which covered survey interviewing techniques, project goals, research ethics and confidentiality, and practice interviews.
3. Household screening, selection of eligible women
Within the selected study site(s), a screener visit was conducted by a research firm to determine which households contain eligible women. Women are eligible if they met the following criteria:
- Currently married
- Ages 15-49
- Not currently pregnant
- Not currently using modern family planning
- Resides with her husband
- Family does not intend on changing residence in the next year
During the screener visit basic information was collected that enabled us to determine eligibility, and locate the household again (i.e. names, phone numbers of key family members, house address). Screeners first asked any adult member of the household whether any married women between the ages of 15 and 49 currently lived in the household with their husbands. If there was more than one woman in the household who met those basic criteria, only one woman was be randomly chosen to be further screened for participation in the study. Note that all potentially eligible women in the household had an equal chance of being selected for further screening, even if they were not at home during the first visit.
For the second part of the screening, screeners met in a private location with the randomly selected woman who met the basic eligibility criteria to ask more sensitive screening questions about pregnancy intentions and use of family planning. Screeners also asked about whether the woman had ever used a modern family planning method (used for stratification). If the woman was eligible to participate according to all of the eligibility criteria, the screener sought her consent and proceeded with the baseline survey if the respondent was available. Otherwise, screeners would set up appointments for the baseline survey with the respondent who agreed to participate.
Each eligible woman was assigned an identification (ID) number, regardless of whether she consented to participate in the study. The research firm developed and assigned a unique ID number for each survey respondent.
4. Baseline survey
The baseline survey includes questions on demographic and socio-economic characteristics, communication with family members, fertility history and preferences, as well as family planning experiences. The husband, other family members, friends, or other people were not present during the survey. The only exception was children ages 5 and under. Only those who agreed to be surveyed and counseled completed a baseline survey.
5. Randomization to treatment arms (T1, T2, C)
Based on the data entered from the screening form, the research team randomized participant households into one of three counseling treatment arms:
- Treatment #1 (T1): Women counseled alone
- Treatment #2 (T2): Women counseled with their husbands
- Control (C): No counseling for women or their husbands
Randomization was stratified on previous use of modern methods and other explanatory variables to insure balanced groups. This variable was captured in the screening process.
Randomization was conducted in phases to avoid a long time window between the survey and counseling intervention and, thereby, reduce the likelihood of attrition. The research team had a 2 week window between the survey and counseling. This required close monitoring of the data collection and a data entry process that enabled quick entry of the screening and cover sheet data.
6. Counseling outreach visits
Only those who fully completed the baseline survey participated in the counseling.
Lists of names and contact information collected during the screener visits were given to the implementing partner to use for their health workers to conduct their visits. The CHWs were also handed data cards to record information on women or couples during the counseling visits. For households selected to participate in couple counseling, the CHW counseled the couple for at least the first household visit. Thereafter, the CHW may have counseled the woman alone if the husband was not available.
Vouchers were given to all women who were interviewed.
During follow-up outreach visits for each group (women alone or women and husbands), information about voucher redemption and use of FP services at private or public clinics/doctors were collected.
7. Follow-up survey
After completion of the outreach counseling cycle, endline surveys will be collected among all participant women and their husbands, separately.