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Triton quarterly analysis of FOF [Family of the Future] plans, fiscal report and funding request for September-November 1981 (Quarter 3).
Washington, D.C., Triton, 1981. 28 p. (Contract No. NEB-0029-C-1037-00, Egypt)The report details plans for the activities and expenditures related to the promotion and sale of contraceptive devices in Egypt for the 3rd quarter of 1981. Family of the Future (FOF) is a nongovernmental agency which operates on a US Agency for International Development grant of $27,200. Major activities from the previous quarter are summarized and plans for each of the 6 FOF departments are provided. The Medical Promotion and Distribution department will develop distribution strategies including locating new cities and establishing sales targets for IUDs, condoms, and spermicides; prepare information booklets for doctors and pharmacists on devices as they are added to the product line; and oversee warehousing details and sponsor conferences for pharmacists and doctors. These activities are expected to consume 25.6% of the proposed budget. The advertising and art department will determine communication strategies for all products. Copy and time slots will be suggested for mass media promotion of FOF and of available family planning methods to be aired on television stations and 6 radio stations. Inserts for 6 newspapers, 7 weekly magazines, 5 bi-monthly or monthly magazines, and 4 special audience publications will be prepared. This department will operate on 31.3% of the budget. Other promotional activities will include the design and production of multi-product countertop displays and of giveaway items. The medical and scientific department will sponsor a symposium for influential university affiliated obstetricians and gynecologists from 4 cities to stimulate interest in family planning and in FOF and its products. Training programs on IUD insertions will be provided. Volunteers and social affairs departments will use 25 volunteers to organize 110 rallies reaching 2500 people each that are gathered in crowded places or through door-to-door contact. Volunteers will also continue to collect interview data. Volunteer training is planned to target seasonal vacation areas. Samples of condoms and spermicides, booklets, and pamphlets will be distributed during upcoming festivals. A central location will be established from which volunteers can answer questions. The market research department plans to conduct 19 group sessions and continue data collection for the pharmacy intercept study. Market research training in the US is arranged for an FOF employee. No changes are planned which would affect the administration department. A detailed financial analysis of quarterly projections and expenditures is provided. Revenues from sales of contraceptive devices are also included in the report. An evaluation of the planned activities and recommendations for additional activities are detailed.
Silver Spring, Maryland, 1979.. 5.As a result of both FDA's review of IUD labelling in the United States and a public hearing on IUD use conducted by an Ad Hoc Obstetric-Gynecology Advisory Committee, FDA announced effective November 7, 1977 new patient and physician labelling requirements for IUDs. The information contained in a patient brochure developed by IUD manufacturers includes both pre- and postinsertion facts describing the effectiveness of IUDs, in addition to directions for use, side effects and contraindications. Warnings are also listed particularly cautioning about pregnancy with an IUD in situ. Physicians received similar detailed information including use-effectiveness data along with communication stressing the need for patient counseling and evaluation. The new requirements are intended to aid both physicians and patients in making informed decisions and choices concerning IUD use.
Family Planning Perspectives. 1992 May-Jun; 24(3):111-5.The patient package inserts (PPIs) for 56 brands of combined and triphasic oral contraceptives made by 9 U.S. Manufacturers were analyzed for content, completeness, consistency, format and readability. PPIs for oral contraceptives are required by the Food and Drug Administration (FDA) to be standardized and to include instructions on how to take pills properly and what to do if pills are missed. Most manufacturers used the same PPI for all their brands, so that users must scan the pamphlet to find start directions for their brand. Most makers offered at least 2 choices for start day, Day 1, 5, and/or Sunday. Directions for 1 missed pill were fairly consistent. Directions for missing 2 pills, and especially 3 or more missed, varied widely, and were even omitted in some cases, but generally posed no added risk of pregnancy. Instructions for using a back-up contraceptive method when starting or when pills were missed also varied greatly. There was potential for confusion because of the number of options, and potential for contraceptive failure because of the long periods, up to 3 weeks, during which the user would be expected to use an additional method. A more serious criticism was the format of the PPIs. Most were printed in extremely small type, often in pale colors, without headings or paragraphing, so the user would need to scan the whole insert, and in many cases the directions for physicians also, to find needed information. When the text was analyzed for readability the PPIs were found to be at 10th grade level, and the physician's section at 12th grade level. Family Health International recommended that all pill PPIs be standardized to avoid confusion for women switching brands, and that format, type size, and readability be improved for use by those with lower reading skills. Furthermore it was suggested that diagrams be included showing what direction to take pills from the package, and that a summary card be provided in the packet.
[Unpublished] 1991 Nov.  p.The sales of Sathi brand condoms in Pakistan remained low in November 1991. In fact, a warehouse in Karachi only sold 138,240 condoms. Nonavailability of packaging material and price stickers prevented higher sales at the wholesale level. Yet the percentage of retail outlets carrying Sathi condoms climbed from 47-53% between August-September 1991. Only 11-19% of retail outlets carried other condom brands. Further only 17% of stores that sell Sathi and Durex condoms did not have Sathi condoms in stock in September compared to 18-24% of stores did not have other condoms brands in stock. Moreover the market share for Sathi condoms climbed to 69%. At the same time, the market share for the public sector brand Sultan and Durex fell from 14-10% and to 7% respectively. Rough Rider condoms held 8% of the market share. Other brands claimed 6%. A new marketing plan for Sathi revealed that PSi would hold off introducing oral contraceptives (OCs) and a premium condom. PSI and other nongovernmental organizations conducted market research of married women with 2-4 years of education to test instructions for OCs. The study indicated that they better grasped instructions when they included a lifelike pointing hand instead of an arrowhead and all arrows pointed from left to right rather than zig zag. The test marketers also improved instructions in Urdu so the women could discern other aspects of OC use. A staff member from Family Health International evaluated storage conditions of condoms in karachi and lahore. He also obtained samples of USAID procured condoms for testing in the U.S. Family planning specialists observed distribution of Sathi condoms in several villages in the Punjab and in working class areas of Lahore.
[Unpublished] 1989 Nov.  p.The foundations of a contraceptive social marketing project aimed at increasing the availability and use of condoms among urban, married, low-income men in Morocco are described. Aiming to sell the condom through commercial retail outlets with the goal of increasing overall prevalence of condom use, the Moroccan Social Marketing Project (MSMP) is the 1st major contribution by the commercial sector in the national effort to increase participation in family planning. 18 months of research on the Moroccan condom market and promotion strategy served as initial groundwork for the project. Specifically, pre-campaign surveys on contraceptive usage, attitude, and pharmacies; product name and pack development research; and advertising positioning research and message testing were conducted. Low condom usage was found in Morocco, with <5% of urban, married, male contraceptors using condoms; nationwide, <1% of women and their partners used condoms. Using radio and point of purchase advertising in urban and peri-urban pharmacies, a marketing strategy was developed urging non-contracepting men to choose condoms once they decided to begin using a contraceptive method. Focus was placed upon shifting the image of the condom away from its association with illicit relationships, encouraging the continued strong male support of and role in family planning, and choosing an appropriate product name, advertising positioning, and price through the assistance of focus groups' suggestions.
[Washington, D.C.], Futures Group, SOMARC, . iv, 147 p.This training manual in social marketing of contraceptives (CSM) in text format presents the elements of a program, summarizes marketing theory, and describes practical examples. It is based primarily on written material by marketing professionals and population communication experts. The elements of social marketing, elaborated in 10 chapters, include: marketing, products selection, pricing, promotion, distribution, market research, marketing plan, organization, management, and management information systems. CSM use commercial marketing techniques to expand availability of contraceptive products, information and services by existing or newly created outlets, thereby complementing private and public services. While commercial and social marketing share the same management process and the same activities planned around product, price, promotion and distribution, they differ in that the goal of commerce is profit, while that of social marketing is maximizing sales and contraceptive usage. Contraceptive products supplied by USAID are described. Types of promotion used in CSMs are advertising, point-of-purchase, personal selling, and sampling: local conditions determine which is most effective. Distribution may be by commercial distributors or by program distributors if needed. The section on market research is particularly detailed and broken down into types and steps, preparing for the annual marketing plan, itself divided into 15 sub-sections. 2 methods of forecasting contraceptive demand are given, a matrix projection model and logit analysis. Types of marketing organization suggested are by functional and product specialties, the latter modeled after pharmaceutical firm management and most commonly used in CSM. Suggestions on minimal software requirements for marketing information systems, covering commodity tracking, finances, and donor agency data requirements are briefly outlined, and a monthly report form is shown.
Jakarta, Indonesia, Survey Research Indonesia, 1988 Sep. 40,  p. (SRI - 737)This report of a survey of awareness, usage and attitudes of 2106 men from Jakarta, Surabaya, Medan and Bandung, Indonesia, featuring condoms and the Duo Lima condom in particular, by Survey Research Indonesia, comparing 1988 to 1987, consists of 27 tables and 2 conceptual maps. Many of the data compare location or economic class. Unaided awareness of condoms had decreased from 20 to 16% overall between 1987-1988, while knowledge of vasectomy and Norplant had increased. Use of condoms as the main method fell from 7 to 5%. 10% have ever tried condoms. The main source of purchase was the Apotik (50%), drug store (195) and puskesmas (12%). The most common condom pack size purchased was 12, followed by 3 and 6. Men described condoms' "messiness" as their worst drawback. Most users tried condoms for <1 year, indicating falling off of use. Awareness of the Duo Lima brand has increased to 48%, up from 43% in 1987. It was the 1st brand mentioned by all men; 69% recalled Duo Lima advertising, primarily on radio, on billboards, and in newspapers. Duo Lima was the leading brand with 39% of subjects using it. Perceptual maps placed Duo Lima as an attractive, modestly priced, well advertised brand, the right size, and best suited for family planning.
Research Triangle Park, North Carolina, FHI, 1991 Feb 8.  p.A special notebook for use at a U.S. Food and Drug Administration meeting held February 8, 1991, for the Advisory Committee on Fertility and Maternal Health Drugs, contains draft instructions for oral contraceptive users to be included in the Patient's Package Insert (PPI). There are 9 manufacturers of 56 types of oral contraceptives in the U.S., as well as 26 family planning organizations, with many different sets of directions for use. Particular discrepancies exist in start date, what to do if 1, 2 or more pills are missed, and in related factors such as the design of the package. The suggested instructions are readable by a person with 5-6th grade reading level, are the same for all pills, and resemble those issued by the IPPF and WHO. THe only exception is the difference between 21- and 28-day pill packages. This draft has been pre-tested on a limited basis on 70 users. The rest of the notebook contains sections on advantages and disadvantages of the proposed instructions, a review of relevant biomedical and social literature on pill-taking with excerpted readings, list of manufacturers, types of instructions by manufacturer, bibliography, and contributors. With a 1st-year failure rate as high as 10%, leading to a 10-year failure rate of 40%, it is assumed that if compliance could be improved, the current estimated 250,000 pill failures annually in the U.S. would decrease.
IMAGE - THE JOURNAL OF NURSING SCHOLARSHIP. 1990 Spring; 22(2):96-100.The readability of contraceptive package inserts appears to be a critical factors in ensuring proper use of the method. The patient package inserts prepared by commercial manufacturing generally require a reading level above 8th grade to be adequately comprehended, which places functionally illiterate and poorly educated acceptors at high risk of noncompliance. To remedy this situation, family planning service providers in many areas have developed their own generic instructions geared to the populations they serve. In this study, readability levels were analyzed for 26 sets of patient package inserts included with commercially distributed contraceptives and 24 sets of generic instructions prepared by health care agencies in Northern California. 6 standardized readability formulas were applied to data on 4 types of contraceptives: jellies, foams, creams, and vaginal sponge; diaphragms; oral contraceptives (OCs); and condoms. The mean readability of the 4 groups of contraceptive patient package inserts was grade 10.21, while that for the generic inserts was grade 8.17. There was a significant difference between the readability scores of commercially and locally prepared inserts for 3 (diaphragm, OCs, and condoms) of the 4 product categories studied. The lowest readability score (grade 5.5) was found in a generic leaflet accompanying OC, while the highest score (grade 13.6) was obtained for a condom package insert. These findings indicate that the commercial patient package inserts, whose mean readability score is always beyond the 10th grade level, may be too difficult to comprehend for most individuals at risk of unwanted pregnancies. Continued development of generic inserts is urged, as is research on the use of pictures, posters, audio and videotapes, anatomical models, and computer-assisted instruction for those with low literacy skills.
ASBURY PARK PRESS. 1986 Jun 26;  p.US condom manufacturers have begun marketing their product directly to the people they most protect--women. "With the spread of sexually transmitted diseases and the growing number of unplanned pregnancies, women aren't just assuming that their partners will take the responsibility for birth control and disease prevention," said Stuart Gold, president of National Sanitary Laboratories Inc. in suburban Lincolnwood. Women account for over 40% of condom sales in this country, he said. The company's "Lady Protex" line of condoms--packaged in silver foil boxes with fuchsia or turquoise trim--is designed to be sold at the feminine hygiene sections of drug stores and supermarkets, spokesman Kevin Foley said yesterday. 7 months ago, a Minneapolis-based medical supply manufacturer, Mentor Corp. entered the condom market with the "Mentor Contraceptive" designed with the female buyer in mind. Mentor spokeswoman Jane O'Meara said the company would begin a national advertising campaign in September women's magazines. (full text)
DEVELOPMENT COMMUNICATION REPORT. 1980 Jul; (31):3-4.The success in social marketing of the PROFAM brand of subsidized contraceptives, by a nonprofit private institution that supports the Mexican government program, is related here. PROFAM began in 1978, when half of contraceptives were purchased commercially from drugstores: they were neither economical, consistently distributed, nor advertised. Comprehensive market research revealed that a great demand existed. It generated information for choice of items to market, package design, and instructions. In 1979, pills, condoms, foam, cream and vaginal suppositories, all locally produced were distributed. A serious problem initially was the impropriety of using the word "contraceptive" in the media. The first phase of advertising targeted newspapers. After 3 months, 40% of Mexico's drugstores carried PROFAM. The second phase of advertising, in radio, magazines and newspapers, approached consumers with information tailored to the specific socioeconomic group involved. The third phase, geared to rural areas and general stores, concentrates on advantages of each method. Other aggressive aspects of the campaign include house to house sampling and a mail-in question and answer service. Evidence of success in broadcasting the PROFAM message is the frequent reference to PROFAM in jokes in the media and even in graffiti. The government's goal is to reduce the growth rate form 2.9 percent annually to 1 percent by 2000.
Advances in Contraceptive Delivery Systems. 1986 Feb; 2(1):84-103.This pamphlet, edited by an ad hoc committee of several consultants, scientists, theologians, public health and family planning directors, and an international attorney, covers the following topics: contra-conception; choices of contraceptives; contraceptive package information; copper IUDs; pelvic inflammatory disease (PID); sexually transmitted diseases; and acquired immunodeficiency syndrome. It includes a questionnaire for sexually transmitted diseases (STDs). Professor Joseph Goldzieher describes the "Contra-Conception" database as "a synthesis of up-to-date literature and contemporary guidelines, designed to provide ready access for practicing physicians and medical students." It contains data on several types of hormonal contraception. "Contra-Conceptions" is designed to allow the physician to set his or her own pace when working with the computer, and no previous computer experience is required. 1 of the program's many innovative features is the patient-profiling/decisionmaking section which can be used in the doctor's office to help decide what type of hormonal contraceptive is appropriate for a particular patient. The program permits the doctor to evaluate the significance of patient variables such as parity, smoking, menstrual difficulties and helps the doctor to identify the risks and benefits of the various methods and, ultimately, to make a balanced decision in the context of the most recent data. Contraceptive drugs and devices should include detailed information on the following: description of formula or device; indication, usage, and contraindications, clinical pharmacology and toxicology; dose-related risk; pregnancies per 100 women year; and detailed warning. The sequence of major pathophysiological reactions associated with copper IUDs is identified as are special problems of pelvic infections in users of copper IUDs. Those women who use oral contraceptives (OCs) or a barrier method of contraception or whose partners use a condom have a lower frequency of PID than women not employing any protection. It is well established that copper IUDs cause different types and different degrees of PID. Women using copper IUDs are more at risk for pelvic infection. There is a higher frequency of salpingitis and PID when copper IUDs are employed especially when the population is nulligravidas under the age of 25. The pamphlet lists criteria for the diagnosis of salpingo-oophoritis and actue salpingitis.
Magazine versus physicians: the influence of information source on intentions to use oral contraceptives.
Women and Health. 1985 Spring; 10(1):9-23.An experiment was conducted among a group of college students to assess the relative influence of various information sources on the subjects' intentions to either use or recommend the use of oral contraceptives (OCs) to others. 162 females and 90 male students at the University of California were presented with a questionnaire concerning the subjects' background characteristics, their attitudes about OCs. The subjects were then asked to read 600-word passages containing information on OCs. All of the passages contained identical statistical information; but 1/2 of the students were given passages in which the statistical information was used to support the use of OCs, and the remaining students were given passages in which the data was used to discourage OC usage. The students were told that the passage was a summary of a published article and that the article was attributable either to a traditional physician, a nontraditional physician, a traditional women's magazine, or a nontraditional (feminist) women's magazine. After reading the passages, the students were presented with another questionnaire concerning their attitudes toward OCs. The subjects' attitudes both before and after reading the passage were evaluated using a 9-point Likert scale, and analysis of variance was used to determine if the students significantly altered their attitudes toward OCs after reading the passages. Students who read supporting passages had more positive attitudes toward OCs than they had before reading the passages, and students who read opposing passages had more negative attitudes toward OCs than they had before the experiment. Students who read opposing passages attributed to physicians made greater negative shifts in their attitudes than students who read opposing passages attributed to magazines. Students who read supporting passages attributed to physicians made greater positive shifts than students who read supporting passages attributed to magazines. Opposing passages had a greater impact than supporting passages. No significant differences were observed in reference to the traditional and nontraditional variable. These findings indicate that despite the growing discontentment with the medical professions, especially among women who are concerned with the negative side effects of OCs, physician are still more influential in shaping attitudes than womenHs magazines, even feminist magazines. Males were included in the study because women are often influenced by their male partners in the choice of a contraceptive. Male subjects were much more likely to be influenced by the passages than females. Previous studies have found that individuals who are less involved in an issue can more easily be persuaded to alter their attitudes than individuals with a strong involvement in the issue. The statistical information presented in the passages was similar to the type of information contained on OC packages. The fact that this information could be interpreted both negatively and positively and the fact that these interpretations were accepted by the subjects, raises many questions about how the information provided by the manufacturers is interpreted by the women who read the information.
American Journal of Public Health. October 1972; 62(10):1328-1330.A new approach to the task of patient education that recognized the emotional components of human behavior and used appropriate advertising principles was established in a magazine called True to Life. The goal was to design literature aimed at problems of contraceptive continuation rather than problems of initial acceptance; the objective was to help a woman contracept effectively. True to Life contains 6 stories, 3 feature columns, 1 graphic feature, and 2 public service ads. Stories are about characters with whom readers can have healthy identification. Postpartum interviews have indicated that the magazine has been successful.
Washington Post. 1969 Dec 22; A1, A10.Dr. Herbert L. Ley, Jr., until three weeks ago, Food and Drug Administration Commissioner, said yesterday the government must consider action to see that the 8.5 million American women taking birth control pills get "much greater information" on their possible ill effects. This could mean giving women several hundreds of words of information on how the pill may cause blood clots, strokes and skin discoloration, and how they may be involved in liver, thyroid, urinary and vaginal problems; changes in pituitary, ovarian and other hormone functions; eye trouble; depression and suicidal urges. He said: "Speaking as a private citizen and as a concerned physician, I feel a need for greater information for the patient. Also, Ley said, his new feeling "is the crystallization of some thinking for a long period of time" about "the whole category of drugs to prevent something, given to healthy people" compounds like birth control pills, anticholesterol drugs and preventive vaccines, all of which sometimes have undesirable effects". "I think the patient has to be involved and involved very deeply in information on this new category of drugs. I think he needs to be involved in the decision on when to use them". Here, he said, he has been impressed by some arguments in a recent book, "The Doctors' Case Against the Pill" by Barbara Seaman, and its case for a patients' package insert explaining the pill's advantages and disadvantages. An announcement by Sen. Gaylord Nelson (D-Wis.) said that on Jan. 14 his Senate Monopoly Subcommittee will begin hearings to learn whether women "are being adequately informed of the pills' known hazards". "It appears evident," Nelson charges, "that a substantial number are not advised of any of the health hazards or side effects". For his part, Ley said he still stands by the September finding of an FDA advisory committee that the pill is "safe" as defined by law, and that the pills' "significant" benefits outweigh their risks. "That was a highly dependable report", he said yesterday, but "it's dated, as any report is", and "we absolutely have to look now at any new British data. Until I see hard data, however, I'm hard pressed to draw different conclusions. I may wish to revise my opinion as a private physician after I see the British data but not until".(AUTHOR'S MODIFIED)
Acceptability and use of oral rehydration salts: the development of user pamphlets and improved packaging.
[Unpublished] 1982 Feb 23. 8 p.A major problem facing diarrhea disease control programs is to train mothers of children under 5 in the correct use of oral rehydration salts. The authors have approached this problem in 4 Asian countries: Bangladesh, Indonesia, Philippines, and Thailand. The work was performed by indigenous groups in each country: Social Marketing Project (Bangladesh), Yayasan Kusuma Buana (Indonesia), Kabalikat Ng Pamilyang Pilipino (Philippines), and Population and Community Development Association (Thailand). The authors methodology has been to use the technique of focus group discussions to develop instructional pamphlets and improved labeling for oral rehydration salts. The pamphlets and packages that have been developed are now in field testing and should be introduced into wide scale distribution in the near future. In addition to developing pamphlets and packages that have high levels of comprehension, the focus group discussions have also yielded important insights about the devliery of oral rehydration therapy. The authors have been able to identify widely available, uniform volume containers that mothers can use to prepare ORS. The authors have identified a simple 3 diagram illustration for ORS preparation that is highly effective. The authors have determined that dosage is the most difficult message to transmit. Materials for service providers should be developed next, since many providers are uniformed, apathetic or antagonistic to the use of ORS. (author's, modified)