The feasibility of self-assessment with a pregnancy test after medical abortion in a low-resource setting in India
ESC Congress Library. Paul M. 05/28/14; 50419; A-001
Ms. Mandira Paul
Ms. Mandira Paul
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Abstract
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Objective
The aim of the adaptation phase was to establish the study protocol and to evaluate the feasibility of using a low-sensitivity pregnancy test and a checklist for self-assessment after medical abortion in Rajasthan, India.
Method
The randomized control trial will set out to evaluate the effectiveness and acceptability of self-assessment after medical abortion. To ensure feasibility of the intervention and study protocol an adaption phase took place. The pre-testing of the study procedures was conducted at the four clinics of Action Research & Training for Health, Udaipur. Their rural field area is characterized by poor road connections, poverty, and low literacy among women; while their urban clinic caters to a wider range of women from low socioeconomic strata. Throughout the adaptation phase qualitative interviews were conducted with women to assess acceptability of using the low-sensitivity test, and the means of follow-up: home, phone or clinic. A pictorial instruction sheet for how to use the low-sensitivity pregnancy test and a checklist showing danger signs after a medical abortion were developed accordingly. Eligibility criteria were established as follows: women opting for medical abortion with a gestational age not more than nine weeks and a hemoglobin value of >85 mg/l. Additionally, women, who agree to follow-up with a minimum age of 18 years will be included. Eligible women consenting to the study will be randomly allocated to a group. If allocated to the intervention group, the woman will be provided the instruction sheet and low-sensitivity pregnancy test along with an explanation. The woman will carry out the low-sensitivity pregnancy test 10-14 days post abortion at her home and will further be followed-up over phone or at home. The assessment of the abortion outcome will depend on the result of the low-sensitivity pregnancy test, as reported by the woman. Women in the control group will follow clinical protocol, where a provider will assess the abortion outcome two weeks post abortion. To ensure successful follow-up, travel reimbursements will be provided.
Results
Rural women enrolled in the study had neither education nor phone and thus an adaptation phase was needed. The intervention was adjusted accordingly, creating alternative means of follow-up, increased measures ensuring confidentiality and a tailor-made pictorial checklist with instructions on how to use the low-sensitivity pregnancy test.
Conclusions
Since this intervention has not been carried out in a similar low-resource setting an adaptation phase was crucial. The study protocol was also established and field-tested in conjunction with the adaptation phase.

Objective
The aim of the adaptation phase was to establish the study protocol and to evaluate the feasibility of using a low-sensitivity pregnancy test and a checklist for self-assessment after medical abortion in Rajasthan, India.
Method
The randomized control trial will set out to evaluate the effectiveness and acceptability of self-assessment after medical abortion. To ensure feasibility of the intervention and study protocol an adaption phase took place. The pre-testing of the study procedures was conducted at the four clinics of Action Research & Training for Health, Udaipur. Their rural field area is characterized by poor road connections, poverty, and low literacy among women; while their urban clinic caters to a wider range of women from low socioeconomic strata. Throughout the adaptation phase qualitative interviews were conducted with women to assess acceptability of using the low-sensitivity test, and the means of follow-up: home, phone or clinic. A pictorial instruction sheet for how to use the low-sensitivity pregnancy test and a checklist showing danger signs after a medical abortion were developed accordingly. Eligibility criteria were established as follows: women opting for medical abortion with a gestational age not more than nine weeks and a hemoglobin value of >85 mg/l. Additionally, women, who agree to follow-up with a minimum age of 18 years will be included. Eligible women consenting to the study will be randomly allocated to a group. If allocated to the intervention group, the woman will be provided the instruction sheet and low-sensitivity pregnancy test along with an explanation. The woman will carry out the low-sensitivity pregnancy test 10-14 days post abortion at her home and will further be followed-up over phone or at home. The assessment of the abortion outcome will depend on the result of the low-sensitivity pregnancy test, as reported by the woman. Women in the control group will follow clinical protocol, where a provider will assess the abortion outcome two weeks post abortion. To ensure successful follow-up, travel reimbursements will be provided.
Results
Rural women enrolled in the study had neither education nor phone and thus an adaptation phase was needed. The intervention was adjusted accordingly, creating alternative means of follow-up, increased measures ensuring confidentiality and a tailor-made pictorial checklist with instructions on how to use the low-sensitivity pregnancy test.
Conclusions
Since this intervention has not been carried out in a similar low-resource setting an adaptation phase was crucial. The study protocol was also established and field-tested in conjunction with the adaptation phase.

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