{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T06:54:08Z","timestamp":1762325648298,"version":"3.37.3"},"reference-count":33,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,6,22]],"date-time":"2023-06-22T00:00:00Z","timestamp":1687392000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Rationale<\/jats:title><jats:p>Kilifi County, Kenya, has a modern contraceptive prevalence of 44%, compared to the national prevalence of 61%. In 2018, the Government of Kenya and Population Services Kenya implemented a pilot project in Kilifi to improve contraceptive awareness and access.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims and Objectives<\/jats:title><jats:p>The Riziki Demonstration Project task shifted contraceptive injectable and implant provision to community health extension workers (CHEWs) and supported community engagement led by community health volunteers (CHVs). This mixed methods evaluation examined the effect of Riziki on contraceptive service provision and identified drivers of the intervention's success in increasing public sector contraceptive uptake.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>We obtained monthly contraceptive service provision data from DHIS2 for intervention and comparison facilities from June 2018 to July 2020. Controlled interrupted time series analyses were used to assess difference\u2010in\u2010differences effects on the levels and trends in service provision. Qualitative data included key informant interviews with health workers, community\u2010based focus group discussions\u00a0and contraceptive journey mapping. Topics included contraception\u2010related shifts in the health system and social environment and changes to contraceptive accessibility and demand.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We found positive difference\u2010in\u2010differences effects for levels of provision for implant (adj. <jats:italic>\u03b2<\/jats:italic>\u2009\u2009=\u2009\u20097.4 per month, per facility, 95% confidence interval [CI]: 2.8\u201312.0) and all methods combined (adj. <jats:italic>\u03b2<\/jats:italic>\u2009\u2009=\u2009\u200912.2, 95% CI: 3.0\u201321.3). The health system provided a legal framework and management support for the pilot. Community engagement by CHVs and CHEWs, including with men and religious leaders, bolstered supportive social norms by emphasizing birth spacing and family wellbeing. Awareness and supportive social norms were strengthened among women and their husbands through counselling that leveraged CHEW and CHV community embeddedness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Findings demonstrate the potential for task sharing combined with community engagement efforts to improve contraceptive awareness, knowledge\u00a0and supply. Community engagement should include men, traditional leaders\u00a0and other influencers to strengthen norms that position family planning in alignment with community values.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jep.13889","type":"journal-article","created":{"date-parts":[[2023,6,24]],"date-time":"2023-06-24T21:28:51Z","timestamp":1687642131000},"page":"1380-1394","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Task shifting and community engagement as the keys to increasing access to modern contraception: Findings from mixed methods operational research in coastal Kenya"],"prefix":"10.1111","volume":"29","author":[{"given":"Hildah","family":"Essendi","sequence":"first","affiliation":[{"name":"Population Services Kenya Nairobi Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kerry","family":"Scott","sequence":"additional","affiliation":[{"name":"Independent Research Consultant Toronto Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorina","family":"McAdam","sequence":"additional","affiliation":[{"name":"Independent Research Consultant Auradou France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harmon","family":"Momanyi","sequence":"additional","affiliation":[{"name":"Population Services Kenya Nairobi Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Mutuku","sequence":"additional","affiliation":[{"name":"Population Services International Washington District of Columbia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Mwangome","sequence":"additional","affiliation":[{"name":"Kilifi County Department of Health Kilifi Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2419-9881","authenticated-orcid":false,"given":"Claire W.","family":"Rothschild","sequence":"additional","affiliation":[{"name":"Population Services International Washington District of Columbia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Were","sequence":"additional","affiliation":[{"name":"Population Services Kenya Nairobi Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8263-1903","authenticated-orcid":false,"given":"Brett","family":"Keller","sequence":"additional","affiliation":[{"name":"Population Services International Washington District of Columbia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susannah","family":"Gibbs","sequence":"additional","affiliation":[{"name":"Population Services International Washington District of Columbia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hambulle","family":"Mohammed","sequence":"additional","affiliation":[{"name":"Division of Reproductive and Maternal Health Ministry of Health Nairobi Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,6,22]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0248393"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.3389\/fgwh.2021.669760"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-021-01094-y"},{"key":"e_1_2_10_5_1","unstructured":"Kenya National Bureau of Statistics Ministry of Health\/Kenya National AIDS Control Council\/Kenya Kenya Medical Research Institute National Council for Population and Development\/Kenya ICF International Kenya Demographic and Health Survey 2014.\u00a02015. 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