Beyond Bias: Reducing Provider Bias Towards Adolescents to Increase Contraception Take-Up in Tanzania, Burkina Faso, and Pakistan

Last registered on June 02, 2023
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Pre-Trial

Trial Information

General Information

Title
Beyond Bias: Reducing Provider Bias Towards Adolescents to Increase Contraception Take-Up in Tanzania, Burkina Faso, and Pakistan
RCT ID
AEARCTR-0005354
Initial registration date
February 10, 2020

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
February 11, 2020, 1:46 PM EST

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Last updated
June 02, 2023, 1:38 PM EDT

Last updated is the most recent time when changes to the trial's registration were published.

Locations

Country
Burkina Faso
Region
Country
Pakistan
Region
Country
Tanzania, United Republic of
Region

Primary Investigator

Name
Zachary Wagner
Affiliation
RAND
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Other Primary Investigator(s)

PI Name
Corrina Moucheraud
PI Affiliation
University of California, Los Angeles
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PI Name
Allie Wollum
PI Affiliation
University of California, Los Angeles
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PI Name
Manisha Shah
PI Affiliation
UCLA
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PI Name
William Dow
PI Affiliation
UC Berkeley
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PI Name
Willa Friedman
PI Affiliation
University of Houston
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Additional Trial Information

Status
Completed
Start date
2019-09-01
End date
2021-09-30
Keywords
Health
Additional Keywords
Family planning, Provider bias
JEL code(s)
I1, I14, I12
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
We evaluate the impact of an intervention designed to reduce family planning provider bias towards young, unmarried, and nulliparous women in Tanzania, Burkina Faso, and Pakistan. The intervention has three components: 1) a summit that highlight the consequences of provider bias and instructions on how not to be biased, 2) a forum for continued communication between providers and implementation staff that reinforces the information from the summit, and 3) a rewards program where facilities in which providers exhibit less biased client interactions or who have improved the most towards this end are rewarded with social recognition and a ceremony. We randomized half of the eligible clinics in each country to receive the intervention and the other half to be a control group. We evaluate the impact of the intervention on a range of outcomes using four types of quantitative data: 1) provider surveys, 2) mystery client visits, 3) client exit surveys, and 4) service provision data routinely collected by the clinics. We report the impact of the intervention on providers’ biased attitudes and beliefs, family planning counseling, family planning methods dispensed, and client perceptions of family planning care. We contextualize our quantitative results with qualitative interviews with key stakeholders, managers, providers, and clients. The document outlines our general analysis plan. This document is in a “rough draft” format but nonetheless pre-specifies our main approach. Some of the writing will be included verbatim in the final paper and thus is written in the past tense (even though most of the work has yet to be performed).
External Link(s)

Registration Citation

Citation
Wagner, Zachary et al. 2023. "Beyond Bias: Reducing Provider Bias Towards Adolescents to Increase Contraception Take-Up in Tanzania, Burkina Faso, and Pakistan." AEA RCT Registry. June 02. https://doi.org/10.1257/rct.5354-2.3
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Experimental Details

Interventions

Intervention(s)
The intervention has three components: 1) a summit that includes impactful stories told to and by family planning providers that highlight the consequences of provider bias, 2) a forum for continued communication between providers, and 3) a rewards program where clinics in which providers exhibit less biased client interactions or who have improved the most towards this end will be rewarded with social recognition and a ceremony.

Intervention Start Date
2019-09-01
Intervention End Date
2021-08-31

Primary Outcomes

Primary Outcomes (end points)
We will have different primary outcomes for each domain of interest.

Provider Attitudes/Beliefs: Bias index (construction of index outlined in pre-analysis plan)
Patient Centered FP Care: Optimal method counseling
FP Method Received: Received modern method
Perceived Quality of Care: perceived patient centered care index (construction of index outlined in pre-analysis plan)




Primary Outcomes (explanation)
Provider Bias index: This is an index that combines pre-specified question related to bias into one measure. Index will be created using methods outline by Anderson (2008). A complete list of questions that will into the index can be found in the pre-analysis plan.

Optimal method counseling: For mystery clients, optimal counseling should include IUD, Implant, Injectable, and Pill. With real clients assessed using the exit survey, this will be set to 1 if counseled on all methods that fit with the clients preferences. Full set of methods includes IUD, Implant, Injectable, and Pill. If no preferences then they should be counseled on all 4 types. Each preference removed methods from the set. See pre-analysis plan for more details on construction of this measure.

Received modern method: Set to one if received IUD, Implant, Injectable, Pill, condom, emergency contraception, or permanent method

Perceived quality of care: we will aggregate all outcomes related to client perceptions (33 questions) into 1 index using the Anderson (2008) method. See pre-analysis plan for complete list of questions.

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
Among the eligible facilities in each country, half of the facilities will be randomly assigned to receive implementation of the “Beyond Bias” intervention, while the other facilities will serve as a control group—standard adolescent and youth sexual and reproductive health or family planning program interventions—to establish a counterfactual. Provider-level assignment is infeasible due to the nature of the interventions: all providers within a given facility will have the same assignment as the facility.
Experimental Design Details
Randomization Method
Randomization done in office using Stata
Randomization Unit
Clinic
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
235 clinics (Tanzania: 75; Burkina Faso: 78; Pakistan: 80)
Sample size: planned number of observations
91,000 exit surveys (Tanzania: 39,000; Burkina Faso: 39,000; Pakistan: 13,000) 692 provider surveys (Tanzania: 300; Burkina Faso: 312; Pakistan: 80) 366 mystery client visits (Tanzania: 150; Burkina Faso: 156; Pakistan: 160) 612 direct observation (Tanzania: 300; Burkina Faso: 312) 210 interviews with clients (70 per country) 90 interviews with providers (30 per country) 65 interviews with clinic administrators (Tanzania: 25; Burkina Faso: 20; Pakistan: 20)
Sample size (or number of clusters) by treatment arms
117 treatment clinics, 116 control clinics (Tanzania: 38 intervention, 37 control; Burkina Faso: 39 intervention, 39 control; Pakistan: 40 intervention, 40 control)
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
RAND Human Subject Protections Committee
IRB Approval Date
2019-07-15
IRB Approval Number
2019-0387
Analysis Plan

Analysis Plan Documents

Anslysis+Plan+For+Registration.pdf

MD5: b2dfccacbb809cfc9dc00fc7303e45d1

SHA1: 7b43ea94329a387e051ad54c40da0e585da92e12

Uploaded At: July 21, 2021

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
Yes
Intervention Completion Date
September 04, 2021, 12:00 +00:00
Data Collection Complete
Yes
Data Collection Completion Date
September 04, 2021, 12:00 +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
75 clinics in Tanzania, 78 clinics in Burkina Faso and 80 clinics in Pakistan
Was attrition correlated with treatment status?
No
Final Sample Size: Total Number of Observations
642 provider surveys
106,490 client exit surveys
756 mystery client visits
Final Sample Size (or Number of Clusters) by Treatment Arms
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials