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External Evaluation of the In Their Hands Programme (Kenya)., Round 1

Kenya, 2018
Health and Well-Being (HaW)
African Population and Health Research Centre
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Identification

IDNO
APHRC-ITH-2019-1.0
Title
External Evaluation of the In Their Hands Programme (Kenya)., Round 1
Subtitle
Round 1
Country
Name Country code
Kenya KEN
Abstract
Background:
Adolescent girls in Kenya are disproportionately affected by early and unintended pregnancies, unsafe abortion and HIV infection. The In Their Hands (ITH) programme in Kenya aims to increase adolescents' use of high-quality sexual and reproductive health (SRH) services through targeted interventions. ITH Programme aims to promote use of contraception and testing for sexually transmitted infections (STIs) including HIV or pregnancy, for sexually active adolescent girls, 2) provide information, products and services on the adolescent girl's terms; and 3) promote communities support for girls and boys to access SRH services.

Objectives:
The objectives of the evaluation are to assess: a) to what extent and how the new Adolescent Reproductive Health (ARH) partnership model and integrated system of delivery is working to meet its intended objectives and the needs of adolescents; b) adolescent user experiences across key quality dimensions and outcomes; c) how ITH programme has influenced adolescent voice, decision-making autonomy, power dynamics and provider accountability; d) how community support for adolescent reproductive and sexual health initiatives has changed as a result of this programme.

Methodology
ITH programme is being implemented in two phases, a formative planning and experimentation in the first year from April 2017 to March 2018, and a national roll out and implementation from April 2018 to March 2020. This second phase is informed by an Annual Programme Review and thorough benchmarking and assessment which informed critical changes to performance and capacity so that ITH is fit for scale. It is expected that ITH will cover approximately 250,000 adolescent girls aged 15-19 in Kenya by April 2020. The programme is implemented by a consortium of Marie Stopes Kenya (MSK), Well Told Story, and Triggerise. ITH's key implementation strategies seek to increase adolescent motivation for service use, create a user-defined ecosystem and platform to provide girls with a network of accessible subsidized and discreet SRH services; and launch and sustain a national discourse campaign around adolescent sexuality and rights. The 3-year study will employ a mixed-methods approach with multiple data sources including secondary data, and qualitative and quantitative primary data with various stakeholders to explore their perceptions and attitudes towards adolescents SRH services. Quantitative data analysis will be done using STATA to provide descriptive statistics and statistical associations / correlations on key variables. All qualitative data will be analyzed using NVIVO software.

Study Duration:
36 months - between 2018 and 2020.

Version

Version Date
2019-01-29
Version Notes
N/A

Scope

Keywords
Keyword Vocabulary
according to the WHO, adolescents refers to any person between the ages of 10 and 19 years. This study focuses on adolescents of age 15-19 years only. Adolescents:
is measured by examining adolescent involvement in different aspects of the project. In the literature on adolescent SRH, adolescent voice is defined through the following elements: space, expression, audience and influence Adolescent voice
is measured by gathering adolescent views on decisions about the future (future goals), decision about having children – if and when, decisions about sex and decisions about contraceptives Decision making autonomy
is examined by interrogating the extent to which the adolescent – provider relationship is influenced by age related power differences i.e. adult – adolescent, position and the effect of such power dynamics on adolescent’s choice of contraceptives. Power dynamics
is defined as the extent to which health services provided to adolescents improve desired health outcomes among adolescents. We focus on users experience, availability, accessibility, affordability, appropriateness and acceptability of services. Quality of care

Coverage

Geographic Coverage
Narok and Homabay counties
Unit of Analysis
Households
Universe
All adolescent girls aged 15-19 years resident in the household.

Producers and sponsors

Authoring entity/Primary investigators
Agency Name Affiliation
African Population and Health Research Centre African Population and Health Research Centre
Producers
Name Affiliation Role
Yohannes Dibaba Wado, PhD African Population and Health Research Centre PI
Damazo Kadengye, PhD African Population and Health Research Centre PI
Estelle M. Sidze, PhD African Population and Health Research Centre Associate Research Scientist
Tizta Tilahun, PhD African Population and Health Research Centre Post-doctoral Research Scientist
Joan Njagi, MSC African Population and Health Research Centre Research Officer
Clement Oduor, M.A African Population and Health Research Centre Research Officer
Funding Agency/Sponsor
Name Abbreviation Role
Child Investment Fund Foundation CIFF Funder
Other Identifications/Acknowledgments
Name Role
Narok and Homabay residents Study subjects
Community leaders - chiefs and village elders Support to field teams
MSK Kenya
Triggeress
Shujaaz

Sampling

Sampling Procedure
The sampling of adolescents for the household survey was based on expected changes in adolescent's intention to use contraception in future. According to the Kenya Demographic and Health Survey 2014, 23.8% of adolescents and young women reported not intending to use contraception in future. This was used as a baseline proportion for the intervention as it aimed to increase demand and reduce the proportion of sexually active adolescents who did not intend to use contraception in the future. Assuming that the project was to achieve an impact of at least 2.4 percentage points in the intervention counties (i.e. a reduction by 10%), a design effect of 1.5 and a non- response rate of 10%, a sample size of 1885 was estimated using Cochran's sample size formula for categorical data was adequate to detect this difference between baseline and end line time points. Based on data from the 2009 Kenya census, there were approximately 0.46 adolescents girls per a household, which meant that the study was to include approximately 4876 households from the two counties at both baseline and end line surveys.

We collected data among a representative sample of adolescent girls living in both urban and rural ITH areas to understand adolescents' access to information, use of SRH services and SRH-related decision making autonomy before the implementation of the intervention. Depending on the number of ITH health facilities in the two study counties, Homa Bay and Narok that, we sampled 3 sub-Counties in Homa Bay: West Kasipul, Ndhiwa and Kasipul; and 3 sub-Counties in Narok, Narok Town, Narok South and Narok East purposively. In each of the ITH intervention counties, there were sub-counties that had been prioritized for the project and our data collection focused on these sub-counties selected for intervention. A stratified sampling procedure was used to select wards with in the sub-counties and villages from the wards. Then households were selected from each village after all households in the villages were listed. The purposive selection of sub-counties closer to ITH intervention facilities meant that urban and semi-urban areas were oversampled due to the concentration of health facilities in urban areas.

Qualitative Sampling

Focus Group Discussion participants were recruited from the villages where the ITH adolescent household survey was conducted in both counties. A convenience sample of consenting adults living in the villages were invited to participate in the FGDS. The discussion was conducted in local languages. A facilitator and note-taker trained on how to use the focus group guide, how to facilitate the group to elicit the information sought, and how to take detailed notes. All focus group discussions took place in the local language and were tape-recorded, and the consent process included permission to tape-record the session. Participants were identified only by their first names and participants were asked not to share what was discussed outside of the focus group. Participants were read an informed consent form and asked to give written consent.
In-depth interviews were conducted with purposively selected sample of consenting adolescent girls who participated in the adolescent survey. We conducted a total of 45 In-depth interviews with adolescent girls (20 in Homa Bay County and 25 in Narok County respectively). In addition, 8 FGDs (4 each per county) were conducted with mothers of adolescent girls who are usual residents of the villages which had been identified for the interviews and another 4 FGDs (2 each per county) with CHVs.
Deviations from the Sample Design
N/A
Response Rate
A total of 1897 households with eligible respondents were identified through the household listed done in all the sampled villages (46). However, only 1840 adolescent girls were successfully interviewed for the study with the remaining 57 not being consented mostly due to non-availability of the sampled girls for consenting. We sampled only one eligible girl per household. This represents an overall response rate of 97%. The non-response cases were due to absence by the adolescent girls after repeated visits, callbacks which were not concluded by the close of data collection and refusal to participate.
Weighting
N/A

Data Collection

Dates of Data Collection (YYYY/MM/DD)
Start date End date Cycle
2018-09-01 2018-10-12 Round 1
Mode of data collection
Face-to-face [f2f] for quantitative data collection and Focus Group Discussions and In Depth Interviews for qualitative data collection
Supervision
Several data quality control approaches were used during data collection.
These included:
i. Review of each questionnaire by the field interviewers before leaving the household to be sure that every applicable question has been asked and that responses recorded are clear and reasonable.
ii. Team leaders and supervisors conducted sit-in interviews per week with their team members to randomly observe each interviewer at least once per week during the survey implementation. This helped to verify that field interviewers were following all the procedures outlined in the training and ensuring that interviews were being conducted to the highest standards.
iii. The team leaders also conducted spot checks on randomly selected interviews to verify that the field interviewers went to the right households and asked the right questions.
iv. All completed interviews were reviewed by the team leaders to ensure their internal consistency and completeness.
v. In-built internal consistency checks were embedded in the SurveyCTO platform, and error messages and caution notices were triggered when out of range data were entered to alert field interviewers to correct the errors.
vi. Data inconsistency checks report based on pre-designed data quality checks script were generated daily by the data manager for the study and a daily feedback was provided to the field teams for validation and correction as was necessary.
Type of Research Instrument
The questionnaire covered; socio-demographic and household information, SRH knowledge and sources of information, sexual activity and relationships, family planning knowledge, access, choice and use when needed, exposure to family planning messages and voice and decision making autonomy and quality of care for those who visited health facilities in the 12 months before the survey. The questionnaire was piloted before the data collection and the questions reviewed for appropriateness, comprehension and flow. The questionnaire was piloted among a sample of 42 adolescent girls (two each per field interviewer) 15-19 from a community outside the study counties.

The questionnaire was originally developed in English and later translated into Kiswahili. The questionnaire was programmed using ODK-based Survey CTO platform for data collection and management and was administered through face-to-face interview.

Data Processing

Cleaning Operations
The survey tools were programmed using the ODK-based SurveyCTO platform for data collection and management. During programming, consistency checks were in-built into the data capture software which ensured that there were no cases of missing or implausible information/values entered into the database by the field interviewers. For example, the application included controls for variables ranges, skip patterns, duplicated individuals, and intra- and inter-module consistency checks. This reduced or eliminated errors usually introduced at the data capture stage. Once programmed, the survey tools were tested by the programming team who in conjunction with the project team conducted further testing on the application's usability, in-built consistency checks (skips, variable ranges, duplicating individuals etc.), and inter-module consistency checks. Any issues raised were documented and tracked on the Issue Tracker and followed up to full and timely resolution. After internal testing was done, the tools were availed to the project and field teams to perform user acceptance testing (UAT) so as to verify and validate that the electronic platform worked exactly as expected, in terms of usability, questions design, checks and skips etc.

Data cleaning was performed to ensure that data were free of errors and that indicators generated from these data were accurate and consistent. This process begun on the first day of data collection as the first records were uploaded into the database. The data manager used data collected during pilot testing to begin writing scripts in Stata 14 to check the variables in the data in 'real-time'. This ensured the resolutions of any inconsistencies that could be addressed by the data collection teams during the fieldwork activities. The Stata 14 scripts that perform real-time checks and clean data also wrote to a .rtf file that detailed every check performed against each variable, any inconsistencies encountered, and all steps that were taken to address these inconsistencies. The .rtf files also reported when a variable was found not to have any inconsistencies. The data manager performed all checks according to the flow of the survey tools, instructions in the survey tools and instructions to data collectors in both the survey tools and the data collection manual. The .rtf file that was generated as a result of the real-time checks was sent to the field coordinator for reconciliation of inconsistent data in the field. Audios from qualitative interviews were transcribed and saved in MS Word format.
Other Processing
na

Data Appraisal

Estimates of Sampling Error
N/A

Data access

Contact
Name Affiliation Email URI
Director of research APHRC info@aphrc.org www.aphrc.org
Conditions
N/A
Citation requirement
Use of the dataset must be acknowledged using a citation which would include:
- the Identification of the Primary Investigator
- the title of the survey (including country, acronym and year of implementation)
- the survey reference number
- the source and date of download

Metadata production

Document ID
APHRC-ITH-2019-1.0
Producers
Name Abbreviation Role
African Population and Health Research Center APHRC Documentation of the study
Date of Production
2019-01-25
Document version
Version 1.0 (January 2019)