BACKGROUND More women are accessing modern contraceptive use in Kenya, however, contraceptive discontinuation has stagnated over the decades. Any further increase in contraceptive use will most likely be from past users, hence understanding the dynamics of discontinuation while addressing quality of family planning services offered at health facilities and communities is critical for increasing the contraceptive prevalence rate and reducing the unmet need of family planning. The paper presents a study protocol that intends to evaluate the dynamics of contraceptive use, discontinuation, and switching among women of reproductive age initiating use of a contraceptive method. METHODS This longitudinal mixed-methods study is being conducted in Migori and Kitui counties, Kenya. A formative assessment using Interviews with adolescents, older women, heterosexual couples, health care workers, and community health volunteers explored barriers to contraceptive continuation and perspectives on discontinuation utilizing a qualitative cross sectional study design. Following the formative assessment, a client-centered intervention focusing on improving quality of family planning services, including counseling, will be implemented in 10 health facilities. A 24-month prospective cohort study among women of reproductive age initiating contraception with follow-up at 3, 6, 12, and 24 months will then be undertaken to assess the discontinuation rates, examine the dynamics of contraceptive use, discontinuation and switching, and further explore barriers and enablers for contraceptive continuation and switching among the study population. DISCUSSION In sub-Saharan Africa, contraceptive discontinuation studies have mainly been based on survey data that is collected retrospectively. By implementing a longitudinal mixed-methods study, we gain deeper insights into the contraceptive dynamics influencing the decision to continue, discontinue, and even switch following implementation of a client-centered intervention that enhances quality of care. Additionally, the study will shed more light on the profile of women discontinuing contractive use and further explore individual and couple-level dynamics influencing decision-making on continuation and discontinuation. The findings of this study will provide information that can be used to develop and implement human-centered interventions that focus on improving quality of family planning services and consequently improved continuation rates and overall satisfaction with method. TRIAL REGISTRATION The study is registered with the Clinical Trials Registry, NCT03973593 .

中文翻译：

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一项前瞻性混合方法纵向研究的协议，以评估肯尼亚避孕药具使用，停用和转换的动态。

背景技术在肯尼亚，越来越多的妇女正在使用现代避孕方法，然而，几十年来避孕药的停产一直停滞不前。避孕药具使用的任何进一步增加很有可能来自过去的使用者，因此，在解决卫生机构和社区提供的计划生育服务质量时，了解停药的动态对于提高避孕药具的普及率和减少计划生育的未满足需求至关重要。本文提出了一项研究方案，旨在评估在开始使用避孕方法的育龄妇女中避孕药使用，中止和转换的动态。方法这项纵向混合方法研究正在肯尼亚的Migori和Kitui县进行。使用对青少年，老年妇女的访谈进行的形成性评估，异性恋夫妇，医护人员和社区卫生志愿者利用定性的横断面研究设计，探索了避孕药具持续发展的障碍以及对避孕药具的看法。在形成性评估之后，将在10个医疗机构中实施以客户为中心的干预措施，着重提高计划生育服务的质量，包括提供咨询服务。然后将对开始生育的育龄妇女进行为期24个月的前瞻性队列研究，并在3、6、12和24个月进行随访，以评估停用率，检查避孕药使用，停用和转换的动态，以及进一步探讨在研究人群中继续避孕和进行避孕的障碍和促成因素。讨论在撒哈拉以南非洲，避孕药终止研究主要基于回顾性收集的调查数据。通过实施纵向混合方法研究，我们获得了关于避孕动态的更深刻见解，这些动态影响了实施以客户为中心的干预措施以提高护理质量后决定继续，终止，甚至转换的决定。此外，该研究将进一步阐明终止合同使用的妇女的特征，并进一步探讨影响继续和终止决策的个人和夫妻层面的动态。这项研究的结果将提供可用于开发和实施以人为中心的干预措施的信息，这些干预措施的重点是提高计划生育服务的质量，从而提高持续率和对方法的总体满意度。试验注册本研究已在临床试验注册中心（NCT03973593）中注册。