title: Young People's Preferences for Family Planning Service Providers in Rural Malawi: A Discrete Choice Experiment.
abstract: OBJECTIVE
  To quantify the impact of service provider characteristics on young people's choice of family planning (FP) service provider in rural Malawi in order to identify strategies for increasing access and uptake of FP among youth.
  
  
  RESULTS
  A discrete choice experiment was developed to assess the relative impact of service characteristics on preferences for FP service providers among young people (aged 15-24). Four alternative providers were included (government facility, private facility, outreach and community based distribution of FP) and described by six attributes (the distance between participants' home and the service delivery point, frequency of service delivery, waiting time at the facility, service providers' attitude, availability of FP commodities and price). A random parameters logit model was used to estimate preferences for service providers and the likely uptake of services following the expansion of outreach and community based distribution (CBDA) services. In the choice experiment young people were twice as likely to choose a friendly provider (government service odds ratio [OR] = 2.45, p<0.01; private service OR = 1.99, p<0.01; CBDA OR = 1.88, p<0.01) and more than two to three times more likely to choose a provider with an adequate supply of FP commodities (government service OR = 2.48, p<0.01; private service OR = 2.33, p<0.01; CBDA = 3.85, p<0.01). Uptake of community based services was greater than facility based services across a variety of simulated service scenarios indicating that such services may be an effective means of expanding access for youth in rural areas and an important tool for increasing service uptake among youth.
  
  
  CONCLUSIONS
  Ensuring that services are acceptable to young people may require additional training for service providers in order to ensure that all providers are friendly and non-judgemental when dealing with younger clients and to ensure that supplies are consistently available.
authors.affiliation: London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, Department of Global Health and Development, London, United Kingdom.
authors.forename: Christine
authors.initials: C
authors.lastname: Michaels-Igbokwe
authors.affiliation: London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, Department of Global Health and Development, London, United Kingdom.
authors.forename: Fern
authors.initials: F
authors.lastname: Terris-Prestholt
authors.affiliation: London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, Department of Global Health and Development, London, United Kingdom.|London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, Department of Health Services Research and Policy, London, United Kingdom.
authors.forename: Mylene
authors.initials: M
authors.lastname: Lagarde
authors.affiliation: University of Malawi, College of Medicine, Blantyre, Malawi.
authors.forename: Effie
authors.initials: E
authors.lastname: Chipeta
authors.affiliation: London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, Department of Health Services Research and Policy, London, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Cairns
mesh_terms: D000293:Adolescent; D000328:Adult; D002755:Choice Behavior / Q000502:physiology*; D003695:Delivery of Health Care / Q000379:methods; D005193:Family Planning Services; D005260:Female; D006282:Health Personnel; D006801:Humans; D008295:Malawi; D008297:Male; D057240:Patient Preference / Q000523:psychology*; D019035:Rural Health Services; D055815:Young Adult