Interventions
confusion
The interventions are centered around the use of a tablet-based app, developed as a job-support tool for nurse counselors providing FP services (see Supplemental Text section D for a detailed description of the app and its main features). All nurse counselors at HGOPY were given state-of-the art FP training, designed by professors of obstetrics and gynecology and other reproductive health experts in Cameroon, before conducting counseling sessions with HGOPY clients using the app.Formative qualitative work in Cameroon before the development of the app and the design of the trial suggested that concern and confusion about side effects—both among clients and providers—were some of the main barriers to the take-up of modern contraceptives. Discussion of possible side effects during counseling may be particularly important: For example, Hubacher Our formative qualitative work also suggested that many providers were reluctant to discuss certain methods, especially long-acting ones, with certain subgroups of clients, such as adolescent, unmarried, or nulliparous clients. Hence, the job-support tool aimed to reduce provider bias by structuring the discussion around a given ranking of methods. As the app records all actions with time stamps, it is difficult for counselors to deviate from the structure of the counseling session in its algorithm, as metadata and paradata (regularly uploaded to the cloud from each session) would quickly identify providers with unusual activity. In both its purpose as a tool that accommodates shared decision-making by providing individually tailored recommendations based on elicited client goals and preferences and as a tool that can enhance a better discussion by empowering the client, the app is not dissimilar to the My Birth Control app, designed for use by clients before contraceptive counseling (For the purposes of our study, the app served as both the platform through which the counseling approach and prices of contraceptive methods were randomly assigned to each client and the data collection tool to assess the impacts of these interventions. Every client enrolled in the study was counseled by a trained provider using the app.