A Field Test of the NORMAL Job Aid With Community Health Workers in Kenya to Address Contraceptive-Induced Menstrual Changes

External Resource

01/02/2023 12:00 am

Global Health: Science and Practise

Key Findings

  • An adapted, 2-page job aid for counseling clients on contraceptive-induced menstrual changes was found to be highly acceptable among a small sample of community health volunteers in 2 subcounties in Kenya.

  • According to the community health volunteers, the job aid increased the effectiveness of their counseling and supported diffusion of information in the community.

Key Implication

  • Improved counseling on contraceptive-induced menstrual changes may increase uptake and continued use of family planning methods. Policymakers and managers should consider introducing the NORMAL job aid after additional evaluation with the intended audiences.



Concerns about contraceptive-induced menstrual changes (CIMCs) contribute to nonuse and discontinuation of family planning (FP). Current counseling materials inadequately address these concerns. After obtaining initial feedback, we field-tested an adapted version of the NORMAL job aid that guides community health workers on how to counsel women about CIMCs. The field test aimed to help understand how the job aid was used, the challenges faced in using it, and recommendations to improve the job aid.


Sixteen community health volunteers (CHVs) from 2 subcounties in Kenya were trained on the 2-page job aid and given copies of the job aid to use with clients. Six to 8 weeks after the training, we interviewed the CHVs about their experiences using the job aid. The interviews were audio-recorded, transcribed, and analyzed to identify qualitative themes.


All 16 CHVs reported using the job aid each time they counseled. All liked it and said they used it because it gave them new information and made counseling easier. All reported offering the job aid to most clients and that most clients accepted a copy. CHVs noted clients referred their friends and family to them after counseling using the job aid. CHVs said the job aid reduced clients’ and their male partners’ concerns about CIMCs and helped clients select or switch FP methods. Most CHVs did not have suggestions for improving the job aid.


The job aid was highly acceptable to the CHVs who participated in this small assessment. According to the CHVs, it increased counseling effectiveness and may help increase uptake and continued use of FP methods directly through counseling or indirectly through diffusion in the community. Though further research is needed in other settings and to quantify its impact, we recommend this promising job aid be adapted for wider use.

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