PSI ELEVATE
An insight-driven
Research digest

In this inaugural issue of PSI Elevate, our insight-driven research digest, we highlight recent peer-reviewed journal publications and conference presentations with contributions from PSI-affiliated authors. The recent publications cited below highlight research findings across evidence priorities: integration of client experience into healthcare delivery, identifying innovative channels to reach consumers with products and services, and expansion of self-care interventions. 

Key findings from these publications include: 

• The process of integrating client voice into healthcare interventions is important but challenging; focusing on the client experience can result in important improvements in clinical quality. 
• Innovative strategies, such as the use of peer counselor support to address barriers to HIV care-seeking and school-based delivery of water, sanitation, and hygiene interventions, help us reach the right consumers with the right healthcare products and services. 
• The knowledge base for self-care is expanding, with evidence emerging on how to reach different population groups, including HIV self-testing for older adults and self-care for sexual and reproductive health in humanitarian settings.

Client experience: Integrating client voice and experience into healthcare interventions

A publication in  Health Promotion Practice  documents the youth-led participatory approach to design used by A360 (Adolescents 360) through the lenses of community-based participatory action research and human-centered design. A360 key partners—PSI, IDEO.org, and Itad—joined with consultant and lead author Ibidun Fakoya of King’s College London to critically analyze A360’s youth-participatory design approach. The authors note the importance and challenges of meaningfully engaging with youth throughout the design and implementation process to understand and respond to youth experiences with resulting sexual and reproductive health interventions. Key challenges included the need for strategies to ensure continued and consistent levels of youth participation from design through implementation and the required investment of resources to sufficiently prepare youth and adult team members to successfully participate in project phases as partners. 

Multiple recent publications that include PSI India co-authors describe the evaluation and scale up of a locally designed person-centered maternity care intervention in public facilities in Uttar Pradesh. These studies use an innovative validated scale for person-centered maternity care to measure and understand client experience of care. Findings indicate that scaling up the quality improvement intervention was associated with improvements in clinical quality and in the client experience of maternity care. Other publications involving PSI India coauthors examine a person-centered family planning intervention and behavior related to essential birth practices among nurses and other birth coaches.
 

Channel Innovation: Bringing products and services closer to consumers

CommLink was a PSI-implemented case-management program in Eswatini that leveraged peer counselors to connect community-diagnosed people living with HIV to care. Led by Duncan MacKellar of the Centers for Disease Control and Prevention, a publication on CommLink in AIDS and Behavior reports that peer counselors successfully resolved a range of key barriers to HIV care seeking behavior, including concerns about stigma, cost and quality of care. This research supports PSI’s priority to understand ways to efficiently and effectively reach prioritized populations with HIV treatment services. 

James Bell of Ipsos, along with PSI co-authors Shawn Malone, Project Director, Kristen Little, Senior Technical Advisor for Strategic Research, and Nina Hasen, Director of HIV/TB, conducted a psycho-behavioral segmentation of men at high risk of acquiring HIV in South Africa. This work was done as part of the PSI-led Break the Cycle project, funded by the Bill and Melinda Gates Foundation. This segmentation informed a human-centered design process that resulted in a range of optimally targeted HIV testing and treatment interventions for men. 

A publication led by James Tidwell of the Harvard Kennedy School of Government highlights PSI’s contribution to understanding which channels are most effective for delivering water, sanitation and hygiene interventions to various consumer segments. Addressing the evidence gap for school-based handwashing interventions in low- and middle-income countries, this evaluation of an intervention implemented by PSI in Bihar, India, found positive effects on handwashing before eating. The authors reflect on the benefits of school-based programs as a complement to community-based programs to achieve handwashing behavior change.
 

Self-care: Catalyzing self-care options for consumers

One of PSI’s research priorities for self-care is to identify and understand approaches for driving demand for quality assured self-care products, including HIV self-testing. A publication describing a qualitative study that examined HIV risk and self-testing among midlife-older adults in Malawi was part of the HIV Self-Testing Africa (STAR) Initiative and included as a co-author Karin Hatzold, PSI’s Associate Director and project Director for HIV. The authors conclude that although HIV self-testing has often been oriented toward young people, it may be a valuable and acceptable tool for reaching older adults who might not otherwise uptake conventional HIV testing.  

A study conducted in two urban areas of Kenya used an experimental economic method to elicit willingness to pay for HIV self-testing in a sample of adults attending clinics and pharmacies. Authors included Patrick Aylward, former Senior Market Dynamics Advisor, and Kristen Little, Senior Technical Advisor for Strategic Research, from PSI and Hildah Essendi, Director of Research and Metrics for Population Services Kenya. Findings indicated high demand for HIV self-testing at low prices but possible challenges achieving testing targets at current market prices. 

A commentary on SRH self-care in humanitarian settings in Conflict and Health includes PSI’s Pierre Moon, Director of MOMENTUM Private Healthcare Delivery, as a co-author and acknowledges the support of the Self-Care Trailblazer Group. They describe the important role that self-care can play in the broader sexual and reproductive health continuum of care in fragile settings. Also noted is the potential for digital technologies to advance the delivery of SRH self-care.

PSI’s Presence at Recent Conferences

PSI’s digital health team presented on remote stewardship during the Global Digital Development Summit. Daniel Messer, Vice President for Technology Integration and Chief Information Officer, Wycliffe Waweru, Deputy Director of Monitoring, and Rodrigo Gramajo, Deputy Director of Global Business Systems, shared learnings from activities in Kenya and Angola that leveraged mobile phones in the hands of healthcare providers to drive continuous remote engagement during the COVID-19 pandemic. The presentation underscored the importance of engaging healthcare providers to optimize the user experience and highlighted the potential cost-effectiveness of delivering remote capacity building activities at scale. 

The Population Association of America Annual Meeting included a presentation on the Consumer Markets for Family Planning (CM4FP) study that linked contraceptive users to service delivery points to better understand family planning markets in Kenya, Nigeria and Uganda.  

Members of PSI’s global WASH team presented at the Sixth International Faecal Sludge Management conference. Sanjay Singh, Director of Programs for PSI India, presented on practical experiences formalizing fecal sludge management service providers to create opportunities for improved service delivery in India. Bernard Elegbe, Director of Hygiene, Sanitation and Child Survival for PSI’s network member l’Association Béninoise pour le Marketing Social, presented on a partnership model between government, private sector and civil society organization to improve safe sanitation in urban areas of Benin. The presentations highlighted the importance of private sector and government engagement and partnership for the delivery of sustainable fecal sludge management services. 

As part of the Research for Scalable Solutions (R4S) project, PSI helped organize a session on adapting family planning service provision during the COVID-19 pandemic at the Global Health Science and Practice Technical Exchange (GHTechX). The session featured panelist Joy Otsanya Ede, Design and Adaptations Lead at the Society for Family Health Nigeria, who presented lessons from A360 on digital adaptations during the pandemic to reach youth in Nigeria with sexual and reproductive health messaging.

Other presentations with PSI contributions at GHTechX featured the following:  

• R4S country consultations to develop locally driven country research and learning agendas for family planning 
• The Utkrisht development impact bond to improve private sector maternal and neonatal care in India through innovative financing 
• Work from the Kampala Slum Maternal and Newborn Health (MaNe) Project to strengthen referral linkages between health facilities for maternal and newborn health care in Uganda 
• A session on contraceptive product introduction that included strategies and examples from PSI Madagascar’s work on the Expanding Effective Contraceptive Options (EECO) project 

Presentations from the Global Health Science and Practice Technical Exchange are freely available online.