Impact of a provider job aid intervention on injectable contraceptive continuation in South Africa

Stud Fam Plann. 2012 Dec;43(4):305-14. doi: 10.1111/j.1728-4465.2012.00328.x.


Arriving late for scheduled contraceptive reinjections is common in many countries and contributes to discontinuation when providers are unsure how to manage such clients. A clinic-randomized cohort and cross-sectional study with more than 5,000 clients using injectable contraceptives was conducted in the Eastern Cape province of South Africa to test the effectiveness of a provider job aid for managing late-returning clients and promoting continued use of the method. A marginally significant difference in reinjection rates between intervention and control groups was found for those up to two weeks late, and reanalysis excluding one clinic that experienced stockout issues revealed a significant difference. The difference in reinjection rates for those 2-12 weeks late was also found to be significant. The one-reinjection cycle continuation rate for the intervention group was higher than that for the control group, but the difference was not statistically significant. Appropriate management of late-returning clients is critical, and this study illustrates that reinjection rates can be significantly increased with a low-resource provider job aid.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Ambulatory Care Facilities / organization & administration*
  • Clinical Protocols*
  • Contraceptive Agents, Female / administration & dosage
  • Contraceptive Agents, Female / adverse effects
  • Contraceptive Agents, Female / therapeutic use*
  • Counseling / organization & administration
  • Cross-Sectional Studies
  • Health Promotion / organization & administration*
  • Humans
  • Injections, Intramuscular
  • Inservice Training / organization & administration
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Practice Guidelines as Topic
  • Public Sector
  • Socioeconomic Factors
  • South Africa
  • Time Factors


  • Contraceptive Agents, Female