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Reimagining how social-behavioral research can be integrated into contraceptive R&D

Post written by Amelia Mackenzie, PhD ScM, FHI 360, and @AmesMack on Twitter

Contraceptive product developers and funders alike have a growing appreciation for the importance of incorporating research on the preferences of users—as well as other key influencers at the interpersonal, community, and broader levels—into contraceptive research and development (R&D). This social-behavioral research is often called “acceptability research”, “market research”, or “end-user research”, among other terms. And methodologies can range from traditional, thorough qualitative and mixed methods approaches from the social and behavioral sciences to more rapid and iterative approaches like human- or user-centered design, growing out of the private and business sectors.

As an early-career scientist working at the intersections of contraceptive product development and social-behavioral research, I often wonder how we might better integrate these two worlds in meaningful ways to ensure the products we develop truly meet the needs of users. In this blog, I pose four “what if” questions, imagining what that improved integration of social-behavioral research could look like and pondering how we could better “begin with the end in mind” in contraceptive R&D.

1. What if we actively aligned target product profiles with product user profiles?

Product developers often create target product profiles (TPPs) that detail target characteristics for a product, generally including preferred or ideal product attributes, as well as those deemed to be minimally acceptable. For example, for a novel contraceptive product, this can include the duration of pregnancy prevention, route of administration, expected side effects or contraindications, etc. So, what if we used social-behavioral research to similarly develop and refine product user profiles for communities and populations of interest, especially including those often marginalized or systemically left out of research? These product user profiles could then be actively paired with developer TPPs, possibly at key decision-points, to optimize product features for market segments most likely to use them. Also through this profile pairing and alignment process, developers and social-behavioral researchers could both learn from one another, which leads to my next question….

2. What if all teams developing new contraceptives included social-behavioral scientists?

Groups working in contraceptive product development often include expertise in areas such as pharmaceutical development, preclinical and clinical research, and regulatory strategies. Social-behavioral scientists may not be a part of the R&D team or may be involved only in limited ways. But what if social-behavioral scientists were fully engaged and integrated members of all R&D teams? This integration, however, can be challenging. Product developers and social-behavioral scientists typically have very different training, lexicons, and approaches. Fostering collaboration and communication by developing a shared language and encouraging an environment of mutual learning is a key part of building these types of interdisciplinary teams.

3. What if user preferences were considered from the very beginning of the contraceptive R&D process?

The question of when to include social-behavioral research during the lengthy contraceptive development process can sometimes be an issue of contention. Although to some, “beginning with the end in mind” is intuitively important from the very early R&D stages, other product developers may not see a use for social-behavioral research until products are heading towards the marketing and introduction stages. So, what if teams took advantage of more opportunities for engagement and integration early and often by not waiting until this late stage to consider the preferences of users in contraceptive R&D? An ideal development process would include an ongoing partnership between basic and clinical scientists and social-behavioral scientists (preferably within a single team, per question number two above), where there’s iterative feedback between the two from the very beginning, or at the very least during key touchpoints in the product development process. For example, this engagement can include early development and preclinical research to define and refine the TPP so it aligns with product user profiles (a la question number one above). And it can continue with integrating user research and social-behavioral approaches into recruitment for clinical trials and developing participant education materials, especially for novel products that may require trial participants to understand a completely new mechanism of action or delivery system. There are also opportunities to collect new user experience and perceptibility data during clinical trials, as well as other social-behavioral research in conjunction or alongside trials.

4. What if contraceptive R&D teams looked more like the users and communities for whom they sought to develop products?

Reflecting over the more than 60 years since the FDA’s approval of the first oral contraceptive pill, I’ve often wondered how the current method mix and contraceptive R&D landscape might be different if, historically, the perspectives and experiences of users were better reflected by greater diversity within R&D teams. Building on this thinking, what if those working in R&D now and in the future—including individuals in leadership positions and among those making funding decisions—were more representative of the users and wider communities for whom they sought to develop products? And, importantly, what steps can we take to ensure this improved diversity? These questions seem particularly relevant for the development of new contraceptive products for use in low- and middle-income countries and for communities and couples not well-served by current methods, often due to marginalization and exclusion. An important first step is a process of reckoning with the history and legacies that have led to this lack of diversity and equity, because research on contraception does not happen in a vacuum, devoid of the larger systems and structures of power and privilege that surround it. Out of that improved understanding and reflection, efforts to redress such power imbalances can be essential next steps, including improving training and professional development opportunities, building partnership and capacity-bridging work, and changes in funding structures.

I’ll finish with one concluding question: How do we make this reimagined contraceptive development process a reality? There are certainly groups whose work in contraceptive R&D begin to answer the questions above by already putting into action many of these ideas. Building on this innovative work, what might the future of contraceptive R&D look like if these four questions became reality? My hope is we can take the lessons learned from these successful strategies to integrate social-behavioral research into R&D—in contraceptive and other sexual and reproductive health product development—to establish “best-practices” that can be widely shared and implemented by all groups working in the future. Those funding contraceptive development can also lead the way, and it is important to advocate for such funding innovation.

As a first step, share your ideas! How can we build better partnerships between product developers and social-behavioral scientists? And in what other ways can we reimagine integrating socio-behavioral research into contraceptive R&D? Post your ideas on Twitter and LinkedIn, tag @ctiexchange, and use the hashtag #NextGenFP.