Increasing access to contraceptive choice through targeted incentives: a cluster randomized controlled trial

Last registered on March 24, 2022

Pre-Trial

Trial Information

General Information

Title
Increasing access to contraceptive choice through targeted incentives: a cluster randomized controlled trial
RCT ID
AEARCTR-0009020
Initial registration date
March 22, 2022

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
March 24, 2022, 4:39 PM EDT

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

Locations

Region

Primary Investigator

Affiliation
University of California, Berkeley

Other Primary Investigator(s)

PI Affiliation
UC Berkeley
PI Affiliation
UC Berkeley

Additional Trial Information

Status
In development
Start date
2022-04-04
End date
2022-09-30
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
We investigate how targeted subsidies and information campaigns for long-acting injectable contraception (Sayana Press) and provider incentives impact initial uptake of Sayana Press, sustained adoption, pricing and stocking decisions for contraceptive products in local markets, sales, and user health outcomes. Following prior work on the effectiveness of subsidies to promote the adoption of new technologies and experience goods, we aim to test if subsidies lead to sustained adoption of Sayana Press as well as to study possible mechanisms for short-term and continued usage (or lack of) such as learning, price anchoring, and information effects. We use a cluster randomized controlled trial in a network of independent pharmacies. Patient subsidies and pharmacist incentives will be cross-randomized and compared against the status quo to evaluate their effectiveness in promoting sustained adoption. Information treatments will be combined with the subsidies, and an information-only arm will allow us to test the effect of this channel when compared to a pure control.
External Link(s)

Registration Citation

Citation
Dieci, Maria, Paul Gertler and Carlos Paramo. 2022. "Increasing access to contraceptive choice through targeted incentives: a cluster randomized controlled trial." AEA RCT Registry. March 24. https://doi.org/10.1257/rct.9020-1.0
Sponsors & Partners

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Experimental Details

Interventions

Intervention(s)
There will be 5 arms that will be randomized at the pharmacy (site) level. All sites will be users of a digital point-of-sale inventory management platform. Total subsidy and incentive amounts will be constant across arms that have either/both a patient subsidy or pharmacy incentive (there is no financial incentive in the pure control or information-only arms).

(1) Pure control arm: pharmacy is an active user of the basic sales and inventory management digital platform, and pharmacy manages own stock of contraceptives.
(2) Information-only arm: pharmacy is an active user of the basic sales and inventory management digital platform, and pharmacy manages own stock of contraceptives. Visual information about Sayana Press will be displayed in these pharmacies, and pharmacists will receive an information treatment and training.
(3) Information and patient subsidy arm: The price of Sayana Press will be subsidized for the patient (50-80% subsidy). Same information treatment as the information-only arm.
(4) Information and provider incentive arm: Providers will receive an incentive for each Sayana Press sale made, while being able to set their own prices. Same information treatment as the information-only arm.
(5) Information and patient subsidy with provider incentive arm: Total subsidy amount will be evenly split between the provider (as an incentive) and the patient (as a price-subsidy). Same information treatment as the information-only arm.
Intervention Start Date
2022-04-29
Intervention End Date
2022-09-23

Primary Outcomes

Primary Outcomes (end points)
The primary outcome is the uptake of Sayana Press.
Primary Outcomes (explanation)
Indicator for Family-Planning transaction including a Sayana Press sale.

Secondary Outcomes

Secondary Outcomes (end points)
Sales and prices of other contraceptive products, markups charged by pharmacies, and stocking of Sayana Press in study sites.
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
A sample of approximately 192 eligible independent pharmacies in Western Kenya will be randomized into 5 study arms: (1) Pure control arm (2) Information-only arm (3) Information and patient subsidy arm (4) Information and provider incentive arm, and (5) Information and patient subsidy with provider incentive arm
Experimental Design Details
Randomization Method
Stratified randomization. Random seed will be set to equal the UC Berkeley IRB protocol number for the trial.
Randomization Unit
Cluster-level randomization at the pharmacy level stratified by current stocks of Sayana Press, Family Planning sale volumes and urbanicity.
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
192 Pharmacies
Sample size: planned number of observations
21,600 family planning product-transactions.
Sample size (or number of clusters) by treatment arms
64 pure control sites, 32 information only sites, 32 patient subsidy sites, 32 pharmacy incentive sites, 32 pharmacy patient subsidy with provider incentive sites.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
With 192 pharmacies, and 120 eligible family planning clients per site, and assuming an intra-class correlation (ICC) of 0.09 for SP uptake, we will be able to detect a minimum of a 5-percentage point increase in our main outcome between each group. This corresponds to a 62% of 1 SD change (SD = 0.08).
IRB

Institutional Review Boards (IRBs)

IRB Name
Committee for Protection of Human Subjects - 2, UC Berkeley
IRB Approval Date
2022-02-18
IRB Approval Number
CPHS #2021-11-14823
IRB Name
Strathmore University Institutional Ethics Review
IRB Approval Date
2022-01-28
IRB Approval Number
SU-IERC1233/21

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
No
Data Collection Complete
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials