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Letter
Priority indicators for sexual and reproductive health self-care: recommendations from an expert working group
  1. Claire W Rothschild1,
  2. GIlda Sedgh2,
  3. Martha Brady3,
  4. Holly McClain Burke4,
  5. Jane Cover5,
  6. Andrea Cutherell6,
  7. Austen El-Osta7,
  8. Kelsey Holt8,
  9. Dinesh Kumar9,
  10. Fredrick Makumbi10
  1. 1 Department of Sexual and Reproductive Health, Population Services International, Washington, DC, USA
  2. 2 Independent Consultant, Philadelphia, Pennsylvania, USA
  3. 3 Independent Consultant, Washington, DC, USA
  4. 4 Reproductive, Maternal, Newborn, and Child Health Division, FHI 360, Durham, NC, USA
  5. 5 Department of Reproductive Health, PATH, Seattle, WA, USA
  6. 6 Impact for Health, Nairobi, Kenya
  7. 7 Self-Care Academic Research Unit, Imperial College London, London, UK
  8. 8 University of California San Francisco, San Francisco, CA, USA
  9. 9 Dr. R.P. Government Medical College, Himachal Pradesh, India
  10. 10 Department of Epidemiology & Biostatistics, Makerere University, Kampala, Uganda
  1. Correspondence to Dr Claire W Rothschild, Sexual and Reproductive Health, Population Services International, Washington, District of Columbia, USA; claire.w.rothschild{at}gmail.com

https://doi.org/10.1136/bmjsrh-2023-201909

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    Self-care has been lauded as a strategy to advance universal health coverage by placing users at the centre of health systems, supporting equitable access to health services, and improving health system resilience.1 Because self-care is by its nature often practised outside of the formal health system, self-care monitoring and evaluation (M&E) is challenging and requires novel approaches. The WHO has issued and updated global sexual and reproductive health (SRH) self-care guidance,1 but M&E standards have not yet been developed. As a result, routine M&E of self-care practice and programmes within national health systems is sparse and fragmented.2 Improving the validity, availability, and standardisation of SRH self-care data is critical for strengthening evidence-based self-care delivery models. The Self-Care Trailblazer Group (SCTG) is a global coalition that aims to advance evidence-based SRH self-care policies and programmes. The SCTG Evidence and Learning Working Group (ELWG) led the development of an SRH self-care measurement tool, with the goal of developing a practical and adaptable M&E resource including a set of priority indicators for SRH self-care.

    To develop this tool, ELWG recruited a measurement tool development committee comprising 15 members representing academic institutions, non-governmental organisations (NGOs), and clinical practitioners. The committee defined the scope, content, and target users of the tool, and led planning of an expert working group meeting to develop priority indicators. Drawing from extant self-care conceptual models,3 4 the committee identified three distinct measurement domains: the enabling regulatory and policy environment; individual knowledge, attitudes, practices, and preferences for SRH self-care; and healthcare service delivery and outcomes. The committee determined that the first edition of the tool would focus on three high-priority SRH self-care interventions that have been the focus of measurement attention and innovation: self-injection of the hormonal contraception subcutaneous depot medroxyprogesterone acetate (DMPA-SC), HIV self-testing, and self-managed abortion.

    The committee identified expert speakers, discussants, and participants to engage in a virtual expert working group meeting. Speakers recommended indicators specific to measurement domains and interventions in their areas of expertise, prioritised based on three criteria: usefulness for informing evidence-based decision-making; feasibility of collecting data on the indicator with reasonable and affordable effort; and demonstrated or expected validity of the indictor. More than 70 participants engaged in the 3-day virtual expert working group meeting, held in November 2022, including researchers, implementers, M&E experts, government representatives and donors. Proposed indicators were discussed and debated, with additional feedback from participants captured through online indicator rating polls. After the meeting, speakers convened with the committee to revise and finalise indicators. A consultation session with 13 Kenyan stakeholders representing NGOs, advocates, professional associations, and the Kenyan Ministry of Health was held in January 2023 to capture feedback on the tool’s design and content from target users.

    The first edition of the SCTG’s SRH Self-Care Measurement Tool was published online in February 2023 and includes a total of 69 priority indicators.5 Each indicator is accompanied by its definition and description of calculations, data sources, and relevant references. A set of illustrative indicators is presented in table 1.

    View this table:
    Table 1

    Illustrative indicators from the SRH Self-Care Measurement Tool, by intervention and measurement domain

    As self-care policies expand around the world, consensus on priority measures and measurement approaches for monitoring self-care is critical. To our knowledge, the SRH Self-Care Measurement Tool presents the first global good for measurement of SRH self-care, and can serve as a practical ‘user guide’ for M&E of SRH self-care for programme implementers and policymakers. It was developed through a replicable process for rapid consensus-driven indicator selection, which may serve as a reference for future efforts to develop standardised indicators across a broader range of self-care interventions.

    Ethics statements

    Patient consent for publication

    Ethics approval

    Not applicable.

    Acknowledgments

    We thank the efforts of the many people who made development of the SRH Self-Care Measurement Tool possible, including the tool development committee members: Martha Brady, Caila Brander, Aurélie Brunie, Holly Burke, Jane Cover, Austen El-Osta, Caitlin Gerdts, Kelsey Holt, Karin Hatzold, Dinesh Kumar, Kristen Little, Fredrick Makumbi, Saumya RamaRao, Claire Rothschild, Gilda Sedgh; experts who assisted in indicator selection, including our presenters, Phil Anglewicz, Helen Anyasi, Sarah Baum, Caitlin Corneliess, Ijeoma Egwuatu, Cheryl Johnson, Heidi Bart Johnston, Joseph Larmarange, Moses Muwonge, Allen Namagembe, Colleen Oakes, Funmilola OlaOlorun, Elizabeth Omoluabi, Olive Sentumbwe, and Arlette Simo Fotso. We also thank Impact for Health International (Andrea Cutherell, Justine Fisher, Tabitha Kibuka, and Jaitra Sathyandran) for strategic, logistic, and design support. We would also like to thank the over 70 participants who joined the 3-day expert working group meeting and provided invaluable contributions to refine and identify the final priority indicators.

    References

    1. ↵
      1. World Health Organization
      . WHO guideline on self-care interventions for health and well-being, 2022 revision. Geneva: World Health Organization, 2022.
    2. ↵
      2. Logie CH ,
      3. Berry I ,
      4. Ferguson L , et al
      . Uptake and provision of self-care interventions for sexual and reproductive health: findings from a global values and preferences survey. Sex Reprod Health Matters 2022;29. doi:10.1080/26410397.2021.2009104
    3. ↵
      Johns Hopkins Center for Communication Programs. Family planning high impact practices. Johns Hopkins University; 2023. Available: https://www.fphighimpactpractices.org
    4. ↵
      1. EngenderHealth
      . The SEED assessment guide for family planning programming. New York: EngenderHealth, 2011.
    5. ↵
      2. Rothschild CW ,
      3. Sedgh G ,
      4. Cover J , et al
      . Sexual and Reproductive Health Self-Care Measurement Tool 1 ed. Washington, DC: Self-Care Trailblazer Group, 2023.

    Footnotes

    • Twitter @austenelosta

    • Collaborators Evidence and Learning Working Group of the Self-Care Trailblazer Group.

    • Contributors Claire W Rothschild and Gilda Sedgh led the conceptualisation and planning of the work described and led the interpretation of findings and writing and editing of the manuscript. All other authors were involved in the planning and execution of the work described, contributed to the interpretation of results, and participated in writing and editing of the manuscript.

    • Funding This work was supported by the Children’s Investment Fund Foundation (CIFF) and the William and Flora Hewlett Foundation. The views and opinions expressed in this tool are those of the authors and not necessarily the views of the Foundations. Representatives from each of the donor foundations were invited to participate in the expert working group meeting but played no other role in the methodology or content included in the Sexual and Reproductive Health Measurement Tool.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.