Erratum to: Simple steps to develop trial follow-up procedures.

Unfortunately, the original version of this article [1] contained an error. There were errors in the reference numbers in Additional file 1. This has now been corrected and Additional file 1 is included here with the correct reference numbers

Simple steps to develop trial follow-up procedures.

BACKGROUND: Loss to follow-up in randomised controlled trials reduces statistical power and increases the potential for bias. Almost half of all trials fail to achieve their follow-up target. Statistical methods have been described for handling losses to follow-up and systematic reviews have identified interventions that increase follow-up. However, there is little guidance on how to develop practical follow-up procedures. This paper describes the development of follow-up procedures in a pilot randomised controlled trial of a sexual health intervention that required participants to provide and return questionnaires and chlamydia test samples in the post. We identified effective methods to increase follow-up from systematic reviews. We developed and tested prototype procedures to identify barriers to follow-up completion. We asked trial participants about their views on our follow-up procedures and revised the methods accordingly. RESULTS: We identified 17 strategies to increase follow-up and employed all but five. We found that some postal test kits do not fit through letterboxes and that that the test instructions were complicated. After identifying the appropriate sized test kit and simplifying the instructions, we obtained user opinions. Users wanted kits to be sent in coloured envelopes (so that they could identify them easily), with simple instructions and questionnaires and wanted to be notified before we sent the kits. We achieved 92 % (183/200) overall follow-up for the postal questionnaire at 1 month and 82 % (163/200) at 12 months. We achieved 86 % (171/200) overall follow-up for the postal chlamydia test at 3 months and 80 % (160/200) at 12 months. CONCLUSIONS: By using established methods to increase follow-up, testing prototype procedures and seeking user opinions, we achieved higher follow-up than previous sexual health trials. However, it is not possible to determine if the increase in response was due to our follow-up procedures. TRIAL REGISTRATION: Current Controlled Trials ISRCTN02304709 Date of registration: 27 March 2013

A randomised controlled trial of an intervention delivered by app instant messaging to increase the acceptability of effective contraception among young people in Tajikistan: study protocol.

INTRODUCTION: Women in lower income countries experience unintended pregnancies at a higher rate compared with women in higher income countries. Unintended pregnancy is associated with numerous poorer health outcomes for both women and their children. In Tajikistan, an estimated 26% of married individuals aged 15-24 years have an unmet need for contraception. The strong cultural value placed on childbearing and oppositional attitudes towards contraception are major barriers to contraceptive uptake in the country.Mobile phone ownership is widespread in Tajikistan. The option of receiving reproductive health support on your personal phone may be an appealing alternative to attending a clinic, particularly for young people. The London School of Hygiene & Tropical Medicine and the Tajik Family Planning Association have partnered to develop and evaluate a contraceptive behavioural intervention delivered by mobile phone. The intervention was developed in 2015-2016 guided by behavioural science. It consists of short instant messages sent through an app over 4 months, contains information about contraception and behaviour change methods. METHODS AND ANALYSIS: This randomised controlled trial is designed to evaluate the effect of the intervention on self-reported acceptability of effective contraception at 4 months. 570 men and women aged 16-24 years will be allocated with a ratio of 1:1 to receive the intervention messages or the control messages about trial participation. The messages will be sent through the Tajik Family Planning Association's 'healthy lifestyles' app, which contains basic information about contraception. ETHICS AND DISSEMINATION: The trial was granted ethical approval by the London School of Hygiene & Tropical Medicine Interventions Research Ethics Committee on 16 May 2016 and by the Tajik National Scientific and Research Centre on Paediatrics and Child Surgery on 15 April 2016. The results of the trial will be submitted for publication in peer-reviewed academic journals and disseminated to study stakeholders. TRIAL REGISTRATION NUMBER: Clinicaltrial.gov NCT02905513. DATE OF REGISTRATION: 14 September 2016. WHO TRIAL REGISTRATION DATASET: http://apps.who.int/trialsearch/Trial2.aspx?TrialID=NCT02905513

Texting Sexual Health Pilot - Interview Guide

A semi-structured topic guide used to discover participants’ views, experiences, and recommendations for improvements to behavioral intervention on sexual health. Questions cover tone and frequency of text messages, views regarding the message content, any concerns about others viewing texts, what (if anything) they had learned from text messages, sexual behavior since enrolment (such as condom use and partner notification), and suggested improvements to the intervention

An Intervention Delivered by App Instant Messaging to Increase Acceptability and Use of Effective Contraception Among Young Women in Bolivia: Protocol of a Randomized Controlled Trial.

BACKGROUND: Unintended pregnancy is associated with numerous poorer health outcomes for both women and their children. Fulfilling unmet need for contraception is essential in avoiding unintended pregnancies, yet millions of women in low- and middle-income countries continue to face obstacles in realizing their fertility desires. In Bolivia, family planning progress has improved in recent decades but lags behind other countries in the region. Unmet need for contraception among women aged 15 to 19 years is estimated to be 38%, with the adolescent fertility rate at 70 per 1000 women. Mobile phones are an established and popular mode in which to deliver health behavior support. The London School of Hygiene & Tropical Medicine and the Centro de Investigación, Educación y Servicios in Bolivia have partnered to develop and evaluate a contraceptive behavioral intervention for Bolivian young women delivered by mobile phone. The intervention was developed guided by behavioral science and consists of short instant messages sent through an app over 4 months. OBJECTIVE: The objective of this study is to evaluate the effect of the intervention on young women's use of and attitudes toward the most effective contraceptive methods. METHODS: We will allocate 1310 women aged 16 to 24 years with an unmet need for contraception in a 1:1 ratio to receive the intervention messages or the control messages about trial participation. The messages are sent through the Tú decides app, which contains standard family planning information. Coprimary outcomes are use and acceptability of at least one effective contraceptive method, both measured at 4 months. RESULTS: Recruitment commenced on March 1, 2017 and was completed on July 29, 2017. We estimate that the follow-up period will end in January 2018. CONCLUSIONS: This trial will evaluate the effect of the intervention on young women's use of and attitudes toward the (nonpermanent) effective contraception methods available in Bolivia. TRIAL REGISTRATION: ClinicalTrials.gov NCT02905526; https://clinicaltrials.gov/ct2/show/NCT02905526 (Archived by WebCite at http://www.webcitation.org/6vT0yIFfN)

A randomized controlled trial of an intervention delivered by mobile phone app instant messaging to increase the acceptability of effective contraception among young people in Tajikistan.

BACKGROUND: Unintended pregnancy is associated with poorer health outcomes for women and their families. In Tajikistan, around 26% of married 15-24 year old women have an unmet need for contraception. There is some evidence that interventions delivered by mobile phone can affect contraceptive-related behaviour and knowledge. We developed an intervention delivered by mobile phone app instant messaging to improve acceptability of effective contraceptive methods among young people in Tajikistan. METHODS: This was a randomized controlled trial among Tajik people aged 16-24. Participants allocated to the intervention arm had access to an app plus intervention messages. Participants allocated to the control arm had access to the app plus control messages. The primary outcome was acceptability of at least one method of effective contraception at 4 months. Secondary outcomes were use of effective contraception at 4 months and during the study, acceptability of individual methods, service uptake, unintended pregnancy and induced abortion. Process outcomes were knowledge, perceived norms, personal agency and intention. Outcomes were analysed using logistic and linear regression. We conducted a pre-specified subgroup analysis and a post-hoc analysis of change in acceptability from baseline to follow-up. RESULTS: Five hundred and seventy-three participants were enrolled. Intervention content was included on the app, causing contamination. Four hundred and seventy-two (82%) completed follow-up for the primary outcome. There was no evidence of a difference in acceptability of effective contraception between the groups (66% in the intervention arm vs 64% in the control arm, adjusted OR 1.21, 95% CI .80-1.83, p = 0.36). There were no differences in the secondary or process outcomes between groups. There was some evidence that the effect of the intervention was greater among women compared to men (interaction test p = 0.03). There was an increase in acceptability of effective contraception from baseline to follow-up (2% to 65%, p < 0.001). CONCLUSIONS: The whole intervention delivered by instant messaging provided no additional benefit over a portion of the intervention delivered by app pages. The important increase in contraceptive acceptability from baseline to follow-up suggests that the intervention content included on the app may influence attitudes. Further research is needed to establish the effect of the intervention on attitudes towards and use of effective contraception among married/sexually active young people. TRIAL REGISTRATION: Clinicaltrial.gov NCT02905513 . Date of registration: 14 September 2016

Strategiauudistuksen vaikutukset finanssialan myyntityön näkökulmasta

Tämän opinnäytetyön tarkoituksena on perehtyä finanssialan yrityksen strategiseen uudistumiseen ja uudistuksen aiheuttamiin muutoksiin yrityksen henkilöstön näkemyksissä. Työn tavoitteena on löytää mahdollisia eroja ja yhtäläisyyksiä työntekijäryhmien välillä sekä niiden sisällä. Opinnäytetyö koostuu teoriaosiosta ja empiirisestä osiosta. Teoriaosuus on jaettu kahteen osaan; ensimmäinen osa käsittelee strategian toimeenpanoa ja toinen osa strategian näkymistä myyntityössä. Teoriaosuuden on tarkoitus selventää strategian viemistä teoriasta käytäntöön sekä käsitellä strategian toimeenpanoa myyntityössä. Opinnäytetyön empiirinen osio toteutettiin kvalitatiivisena eli laadullisena tutkimuksena. Se käsittelee toimeksiantajayrityksen strategisesta uudistumisesta aiheutuvia mielipiteitä ja näkemyksiä. Empiirinen osio on jaettu kahteen osaan; teemahaastatteluina toteutettuihin esimiesten haastatteluihin sekä myyjien kyselyyn. Tutkimus osoittaa strategisen uudistumisen aiheuttavan erilaisia näkemyksiä niin eri työntekijäryhmien välillä kuin työntekijäryhmien sisällä. Yrityksen strateginen uudistus ei kuitenkaan tutkimuksen mukaan aiheuta äärimmäisiä reaktioita, vaikkakin hajontaa löytyy. Tutkimuksen mukaan yhdeksi merkittävimmäksi näkemyseroksi esimiesten ja myyjien välillä osoittautui strategialinjausten eroava tärkeysjärjestys. Esimiehet korostivat vahvasti yhtä linjausta, kun taas myyjien kesken mielipiteet motivoivimmasta linjauksesta hajautuivat.The purpose of this thesis is to analyse the renewal of a company’s strategy operating in the financial sector and to analyse the viewpoints of the personnel. The goal of this thesis is to find possible differences and similarities among members. This thesis is divided into theory and empirical sections. There are two theory parts; the first is about the implementation of strategy and the second is about strategy in sales work. The theoretical part clarifies how the often abstract strategy is implemented and how the strategy affects sales work. The empirical section of this thesis was carried out as a qualitative research. It is about company’s strategic renewal. There are two parts in this section; the interview with the supervisors and the enquiry of the sales personnel. The interviews with supervisors were conducted as theme interviews. The research shows that the strategic renewal divides the opinions of the personnel. However, the renewal doesn’t raise radical views. Nevertheless there is still dispersion among personnel groups. One of the most significant differences between supervisors and sales personnel was the prioritization of strategic alignments. Supervisors emphasized one of the four strategic alignments while the sales personnel’s opinions were divided into several views

Effect of a mobile phone-based intervention on post-abortion contraception: a randomized controlled trial in Cambodia.

OBJECTIVE: To assess the effect of a mobile phone-based intervention (mHealth) on post-abortion contraception use by women in Cambodia. METHODS: The Mobile Technology for Improved Family Planning (MOTIF) study involved women who sought safe abortion services at four Marie Stopes International clinics in Cambodia. We randomly allocated 249 women to a mobile phone-based intervention, which comprised six automated, interactive voice messages with counsellor phone support, as required, whereas 251 women were allocated to a control group receiving standard care. The primary outcome was the self-reported use of an effective contraceptive method, 4 and 12 months after an abortion. FINDINGS: Data on effective contraceptive use were available for 431 (86%) participants at 4 months and 328 (66%) at 12 months. Significantly more women in the intervention than the control group reported effective contraception use at 4 months (64% versus 46%, respectively; relative risk, RR: 1.39; 95% confidence interval, CI: 1.17-1.66) but not at 12 months (50% versus 43%, respectively; RR: 1.16; 95% CI: 0.92-1.47). However, significantly more women in the intervention group reported using a long-acting contraceptive method at both follow-up times. There was no significant difference between the groups in repeat pregnancies or abortions at 4 or 12 months. CONCLUSION: Adding a mobile phone-based intervention to abortion care services in Cambodia had a short-term effect on the overall use of any effective contraception, while the use of long-acting contraceptive methods lasted throughout the study period

Women’s Reproductive Health Survey 2023 Summary of Initial Findings

The Women’s Reproductive Health Survey is the largest survey of its kind to be undertaken in England to date, with a total of 59,332 responses. Painful or heavy periods were commonly reported and only a small proportion received professional help or advice for them in the last year. Of these, many experiences were negative. Most aged between 45-55 years did not report using hormone replacement therapy to help with symptoms of menopause. Of those who sought help or advice for menopause, experiences were generally positive. Common use of and good access to contraception were reported. Hormonal side effects were the most common reason for switching or stopping contraceptive methods. Of those who reported pregnancy in the last year, the majority were planned. A small percentage reported having had an abortion in the last year. Only a small percentage of those with reproductive health symptoms and conditions sought professional help or advice and experiences were mixed. Pain during or after sex was the most commonly reported symptom. Further survey analysis and collaboration will help to understand who are most affected and how support services can be improved

The Burden of Poor Reproductive Health in England: Results From a Cross-Sectional Survey.

Objective: To quantify the burden of poor reproductive health in England by age, ethnicity, and financial security. Design: Cross-sectional survey. Setting: England. Sample: 59 332 women and people assigned female at birth aged 16-55 years. Methods: The Reproductive Health Survey for England 2023 (RHSE2023) used an online convenience sampling strategy and a self-completion questionnaire. Main outcome measures: 13 indicators of reproductive health organised into three domains: reproductive morbidities (including endometriosis, fibroids); menstrual health (severely painful and/or heavy periods; menopausal symptoms); and pregnancy-related adverse experiences (pregnancy loss, infertility, unplanned pregnancy) in the last year. Results: Compared to the general population, our sample over-represented those with higher education levels and under-represented minority ethnic groups. 28.0% of participants reported at least one reproductive morbidity; 61.9% reported menstrual-related issue(s); and 5.5% reported pregnancy-related adverse experience(s) in the last year, with considerable variation by age. Compiling the three domains, 73.7% reported at least one indicator of poor reproductive health. Inequalities were observed: Black British, Caribbean, and African women had increased odds of reporting reproductive morbidity (aOR: 1.69); heavy and/or severely painful periods (aOR: 1.28); and pregnancy-related adverse experience (aOR: 1.50). Financial insecurity was also associated with poor reproductive health. Conclusions: As the first study to simultaneously examine this broad range of indicators of reproductive health within a single sample, we highlight the substantial burden of poor reproductive health in England, with evident ethnic and financial inequalities