Expanding access to modern contraceptives, particularly long-acting reversible contraceptives (LARCs), is crucial for reducing unmet need, unintended pregn

Background: Despite active national initiatives, the low prevalence of modern contraception in Pakistan remains unchanged, leading to high rates of unintended pregnancies and poor maternal and neonatal outcomes. Conventional directive counseling does not sufficiently cater to women’s needs, whereas structured client-centered strategies like GATHER (greet, ask, tell, help, explain, return) and the balanced counseling strategy (BCS) may improve outcomes. Existing literature assessing the comparative effectiveness of these strategies in the Pakistani population lacks evidence. Objective: The study aim is to compare the effectiveness of routine counseling, GATHER, and the BCS in improving client satisfaction with, and uptake of, modern contraceptives. Methods: This is a pilot, 3-arm, single-blinded, parallel, cluster-randomized trial conducted in tertiary care hospital–affiliated family health centers in Rawalpindi, Pakistan. It is a 3-phased trial, first assessing baseline data on contraceptive uptake and discontinuation determinants among 333 women of reproductive age. The second phase will provide structured training to service providers based on either GATHER or the BCS in each arm. After training, assessments will be performed at 3- and 6-month intervals to evaluate contraceptive uptake and counseling quality improvements. In the last phase, a qualitative analysis will be done through focus group discussions and in-depth interviews to identify barriers to implementation and to assess scalability. Analyses will be done using SPSS (version 26; IBM Corp). Analyses of quantitative and qualitative data will be done using mixed effects models and thematic analysis, accounting for clustering, to evaluate the interventions’ effects on contraceptive uptake and client satisfaction. Results: Delivery of the intervention is underway, and baseline data from the 333 participants have been collected. The first follow-up assessments are planned at intervals of 3 and 6 months. However, no outcome data have been obtained or analyses performed at this stage. Conclusions: This pilot trial is expected to generate evidence on the effectiveness of structured, client-centered counseling strategies in comparison to conventional routine practices, showing improved uptake of contraceptive use and satisfaction in Pakistan. The findings are expected to facilitate the design of comprehensive and scaled-up trials and guide national family planning programs and the integration of rights-based counseling strategies.

Background/Objectives: Adolescence is the phase of life when an individual develops habits that lead to their health outcomes in later life stages; yet, comprehensive evidence from low- and middle-income countries (LMICs) like Pakistan remains limited. This study examined the lifestyle behaviors of school-going adolescents in Rawalpindi and their correlation with key sociodemographic factors. Methods: A descriptive cross-sectional study was conducted in four (public and private) schools, using multistage cluster sampling (n = 675). Lifestyle behaviors were examined within seven predefined domains. K-means cluster analysis was used for the identification of distinct behavioral profiles. Associations with age, gender, and school type were examined using Chi-square tests. Correlations within clusters were analyzed using Pearson’s correlation test. Results: The majority of adolescents demonstrated positive life perspectives (88.3%) and strong interpersonal relationships (83.8%), while nutrition (16.2%), physical activity (31.7%), and health responsibility (15.0%) were weaker domains. Cluster analysis revealed three groups: poor (n = 129), moderate (n = 334), and good (n = 212) lifestyle behaviors. Statistically significant associations were found between lifestyle profiles and both age group (p = 0.037) and school type (p = 0.007), with private school students being more likely to exhibit healthier behaviors. Gender differences were notable in physical activity, but not significant in other domains. Conclusions: Interventions targeting low-performing domains, especially physical activity and nutrition, are needed—particularly for females and public school students. These findings highlight the importance of targeted, school-based lifestyle interventions in resource-limited settings.

Background/Objectives: School-based nutrition education provides a platform that could help in the promotion of healthy eating habits among adolescents. Nonetheless, information about the factors influencing the success of these interventions in low- and middle- income countries is still lacking. The objective of the study was to identify facilitators and barriers to effective implementation of school-based nutrition education by applying the Consolidated Framework for Implementation Research (CFIR) and interpreting findings across levels of the Social Ecological Model (SEM). Methods: A qualitative study was conducted after eight to ten weeks of nutrition education intervention in an urban school setting. Data were collected through two focus group discussions with sixteen students (eight students in each group), in-depth interviews with four teachers, six parents and key informant interviews with two school administrators. A semi-structured, CFIR- and SEM-based guide was used to conduct the data collection. Thematic analysis was conducted following Braun and Clarke’s six-phase approach, with deductive and inductive coding conducted independently by two researchers and reconciled through consensus. Results: Five themes were aligned with CFIR domains, including intervention characteristics, outer setting, inner setting, character of individuals, and implementation process. In general, the stakeholders agreed to the importance of relevance and contextualization of the intervention and the use of multi-mediums (classroom-based and online) to deliver the intervention, which they perceived to support improved knowledge of nutrition among adolescents. Implementation of the programme faced challenges arising from the incongruence between messages delivered in classrooms and those served in the school canteens, economic hurdles from home, cultural practices related to food consumption, social influence on peers and media, lack of time among staff, and largely passive parent participation. Conclusions: Nutrition education was perceived as inadequate on its own to support sustainable behaviour related dietary change. Factors that may influence whether nutrition messages can be translated into practice were identified by the study participants and include the school food environment (canteen), the development of the curriculum, policy integration, and shift in parental participation from passive learning to active collaboration.