Search results for: codebook

Authors: Yong-Jun Kim, Jae-Hyun Ro, Chang-Bin Ha, Hyoung-Kyu Song

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Because current wireless communication requires high reliability in a limited bandwidth environment, this paper proposes the variable modulation scheme based on the codebook. The variable modulation scheme adjusts transmission power using the codebook in accordance with hannel state. Also, if the codebook is composed of many bits, the reliability is more improved by the proposed scheme. The simulation results show that the performance of proposed scheme has better reliability than the the performance of conventional scheme.

Keywords: MIMO-OFDM, variable modulation, codebook, channel state

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Authors: Biji Jacob

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Vector quantization algorithm which uses minimum distance calculation for codebook generation, a time consuming calculation performed on each pixel values leads to computation complexity. The codebook is updated by comparing the distance of each vector to their centroid vector and measure for their closeness. In this paper vector quantization is modified based on vector difference algorithm for image enhancement purpose. In the proposed scheme, vector differences between the vectors are considered as the new generation vectors or new codebook vectors. The codebook is updated by comparing the new generation vector with a threshold value having minimum error with the parent vector. The minimum error decides the fitness of each newly generated vector. Thus the codebook is generated in an adaptive manner and the fitness value is determined for the suppression of the degraded portion of the image and thereby leads to the enhancement of the image through the adaptive searching capability of the vector quantization through vector difference algorithm. Experimental results shows that the vector difference scheme efficiently modifies the vector quantization algorithm for enhancing the image with peak signal to noise ratio (PSNR), mean square error (MSE), Euclidean distance (E_dist) as the performance parameters.

Keywords: codebook, image enhancement, vector difference, vector quantization

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Authors: Yun-Tao Zhang, Jong-Yeop Bae, Whoi-Yul Kim

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Background modeling and subtraction in video analysis has been widely proved to be an effective method for moving objects detection in many computer vision applications. Over the past years, a large number of approaches have been developed to tackle different types of challenges in this field. However, the dynamic background and illumination variations are two of the most frequently occurring issues in the practical situation. This paper presents a new two-layer model based on codebook algorithm incorporated with local binary pattern (LBP) texture measure, targeted for handling dynamic background and illumination variation problems. More specifically, the first layer is designed by block-based codebook combining with LBP histogram and mean values of RGB color channels. Because of the invariance of the LBP features with respect to monotonic gray-scale changes, this layer can produce block-wise detection results with considerable tolerance of illumination variations. The pixel-based codebook is employed to reinforce the precision from the outputs of the first layer which is to eliminate false positives further. As a result, the proposed approach can greatly promote the accuracy under the circumstances of dynamic background and illumination changes. Experimental results on several popular background subtraction datasets demonstrate a very competitive performance compared to previous models.

Keywords: background subtraction, codebook model, local binary pattern, dynamic background, illumination change

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Authors: Ahmed Abdullah Ahmed

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The task of recognizing the writer of a handwritten text has been an attractive research problem in the document analysis and recognition community with applications in handwriting forensics, paleography, document examination and handwriting recognition. This research presents an automatic method for writer recognition from digitized images of unconstrained writings. Although a great effort has been made by previous studies to come out with various methods, their performances, especially in terms of accuracy, are fallen short, and room for improvements is still wide open. The proposed technique employs optimal codebook based writer characterization where each writing sample is represented by a set of features computed from two codebooks, beginning and ending. Unlike most of the classical codebook based approaches which segment the writing into graphemes, this study is based on fragmenting a particular area of writing which are beginning and ending strokes. The proposed method starting with contour detection to extract significant information from the handwriting and the curve fragmentation is then employed to categorize the handwriting into Beginning and Ending zones into small fragments. The similar fragments of beginning strokes are grouped together to create Beginning cluster, and similarly, the ending strokes are grouped to create the ending cluster. These two clusters lead to the development of two codebooks (beginning and ending) by choosing the center of every similar fragments group. Writings under study are then represented by computing the probability of occurrence of codebook patterns. The probability distribution is used to characterize each writer. Two writings are then compared by computing distances between their respective probability distribution. The evaluations carried out on ICFHR standard dataset of 206 writers using Beginning and Ending codebooks separately. Finally, the Ending codebook achieved the highest identification rate of 98.23%, which is the best result so far on ICFHR dataset.

Keywords: off-line text-independent writer identification, feature extraction, codebook, fragments

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Authors: Mohammed Salem Atoum

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The success of audio steganography is to ensure imperceptibility of the embedded message in stego file and withstand any form of intentional or un-intentional degradation of message (robustness). Audio steganographic that utilized LSB of audio stream to embed message gain a lot of popularity over the years in meeting the perceptual transparency, robustness and capacity. This research proposes an XLSB technique in order to circumvent the weakness observed in LSB technique. Scrambling technique is introduce in two steps; partitioning the message into blocks followed by permutation each blocks in order to confuse the contents of the message. The message is embedded in the MP3 audio sample. After extracting the message, the permutation codebook is used to re-order it into its original form. Md5sum and SHA-256 are used to verify whether the message is altered or not during transmission. Experimental result shows that the XLSB performs better than LSB.

Keywords: XLSB, scrambling, audio steganography, security

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Authors: Munaf Rashid

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For content-based human action retrieval systems, search accuracy is often inferior because of the following two reasons 1) global information pertaining to videos is totally ignored, only low level motion descriptors are considered as a significant feature to match the similarity between query and database videos, and 2) the semantic gap between the high level user concept and low level visual features. Hence, in this paper, we propose a method that will address these two issues and in doing so, this paper contributes in two ways. Firstly, we introduce a method that uses both global and local information in one framework for an action retrieval task. Secondly, to minimize the semantic gap, a user concept is involved by incorporating features weight updating (FWU) Relevance Feedback (RF) approach. We use statistical characteristics to dynamically update weights of the feature descriptors so that after every RF iteration feature space is modified accordingly. For testing and validation purpose two human action recognition datasets have been utilized, namely Weizmann and UCF. Results show that even with a number of visual challenges the proposed approach performs well.

Keywords: relevance feedback (RF), action retrieval, semantic gap, feature descriptor, codebook

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Authors: Rong-Terng Juang

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Autonomous vehicles offer the possibility of significant benefits to social welfare. However, fully automated cars might not be going to happen in the near further. To speed the adoption of the self-driving technologies, many governments worldwide are passing laws requiring data recorders for the testing of autonomous vehicles. Currently, the self-driving vehicle, (e.g., shuttle bus) has to be monitored from a remote control center. When an autonomous vehicle encounters an unexpected driving environment, such as road construction or an obstruction, it should request assistance from a remote operator. Nevertheless, large amounts of data, including images, radar and lidar data, etc., have to be transmitted from the vehicle to the remote center. Therefore, this paper proposes a data compression method of in-vehicle networks for remote monitoring of autonomous vehicles. Firstly, the time-series data are rearranged into a multi-dimensional signal space. Upon the arrival, for controller area networks (CAN), the new data are mapped onto a time-data two-dimensional space associated with the specific CAN identity. Secondly, the data are sampled based on differential sampling. Finally, the whole set of data are encoded using existing algorithms such as Huffman, arithmetic and codebook encoding methods. To evaluate system performance, the proposed method was deployed on an in-house built autonomous vehicle. The testing results show that the amount of data can be reduced as much as 1/7 compared to the raw data.

Keywords: autonomous vehicle, data compression, remote monitoring, controller area networks (CAN), Lidar

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Authors: Estephanie S. López Contreras, Vicente Aranda Palacios, Daniela Flores Silva, Felipe Oliveros Olivares, Romina Riquelme Escobedo, Iñaki Westerhout Usabiaga

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This research explored whether the context of online instruction has influenced the development of first-year English-teaching students' communication skills, being these speaking and listening. The theoretical basis finds its niche in the need to bridge the gap in knowledge about the Chilean online educational context and the development of English communicative skills. An interpretative paradigm and a phenomenological design were implemented in this study. Twenty- two first-year students and two teachers from an English teaching training program participated in the study. The students' ages ranged from 18 to 26 years of age, and the teachers' years of experience ranged from 5 to 13 years in the program. For data collection purposes, semi- structured interviews were applied to both students and teachers. Interview questions were based on the initial conceptualization of the central phenomenon. Observations, field notes, and focus groups with the students are also part of the data collection process. Data analysis considered two-cycle methods. The first included descriptive coding for field notes, initial coding for interviews, and creating a codebook. The second cycle included axial coding for both field notes and interviews. After data analysis, the findings show that students perceived online classes as instances in which active communication cannot always occur. In addition, changes made to the curricula as a consequence of the COVID-19 pandemic have affected students' speaking and listening skills.

Keywords: attitudes, communicative skills, EFL teaching training program, online instruction, and perceptions

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Authors: Chi-Hsuan Cheng

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This research aims to evaluate public-private partnerships against cyberattacks by comparing the UK and Taiwan. First, the study analyses major cyberattacks and factors influencing cybersecurity in both countries. Second, it assesses the effectiveness of current cyber defence strategies in combating cyberattacks by comparing the approaches taken in the UK and Taiwan, while also evaluating the cyber resilience of both nations. Lastly, the research evaluates existing public-private partnerships by comparing those in the UK and Taiwan, and proposes recommendations for enhancing cooperation and collaboration mechanisms in tackling cyberattacks. Grounded theory serves as the core research method. Theoretical sampling is used to recruit participants in both the UK and Taiwan, including investigators, police officers, and professionals from cybersecurity firms. Semi-structured interviews are conducted in English in the UK and Mandarin in Taiwan, recorded with consent, and pseudonymised for privacy. Data analysis involves open coding, grouping excerpts into codes, and categorising codes. Axial coding connects codes into categories, leading to the development of a codebook. The process continues iteratively until theoretical saturation is reached. Finally, selective coding identifies the core topic, evaluating public-private cooperation against cyberattacks and its implications for social and policing strategies in the UK and Taiwan, which highlights the current status of the cybersecurity industry, governmental plans for cybersecurity, and contributions to cybersecurity from both government sectors and cybersecurity firms, with a particular focus on public-private partnerships. In summary, this research aims to offer practical recommendations to law enforcement, private sectors, and academia for reflecting on current strategies and tailoring future approaches in cybersecurity

Keywords: cybersecurity, cybercrime, public private partnerships, cyberattack

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Authors: A. Sainvil, J. Mallela, L. M. Pereira

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Adolescents and young adults (AYA) diagnosed with cancer are tasked with managing their health through treatment, a time when reliance on and independence from parents may change in unexpected ways. Resilience allows patients to cope and manage their own health through treatment, promoting motivation and a healthier lifestyle. The film acts as a source of reflection through the cancer journey, which may have an impact on how patients cope. The current research investigated relationships between resilient linguistic qualities of the video narratives and attitudes toward personal health management. N=24 patients diagnosed between ages 11-18 were recruited. First, participants provided demographic information, then made a video testimonial about their cancer experience. After filming, participants then completed a questionnaire on the perceived benefits for themselves and others for making the video. Videos were transcribed and analyzed for thematic content via codebook and for linguistic qualities, indicating resilience with the use of the Linguistic Inquiry and Word Count Analysis Program (LIWC). Linear regressions were then calculated to explore relationships between resilient qualities, thematic content, and participants’ perceptions of their medical team and willingness to care for themselves. Participants who spoke with greater narrator connectedness were more likely to change their view of their medical team (β=.628 p=.034). When a participant believed that providers were likely to view their video, they were marginally more likely to want to take better care of themselves (β=.367, p=.078). Participants who spoke in depth about their health reported higher intention to take better care of themselves (β=.785, p=.033). AYAs with cancer who showcased certain resilient qualities within their narrative were more likely to consider taking better care of themselves. Additionally, the more patients reflected on their health, the more they wanted to take better care of themselves. These relationships were stronger when a patient believed that a provider would watch their video. Study findings highlight the utility of film in uncovering aspects of resilience and coping that may lead to healthier behaviors in AYAs with cancer.

Keywords: adolescents, cancer, resilience, health management

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Authors: Sunha Ahn

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Intimate relationships have constructed our embodied experiences and emotional memories, which can become grounded as practical knowledge to some extent and play a critical role in social medicine, particularly, in our well-being and mental health. In South Africa, such relational factors are significant for young women and girls in their emotional development period of time, especially, working as the existence of social and relational pressures over feminine sexual health and choices. This, in turn, brings about the absence/lack of communication in intimate relationships, especially with their parents, which leads to a vicious cycle in sexual health behaviour choices. Drawing upon sociological and socio-anthropological understandings of HIV-related issues, this study provides narrative threads of evidence about South African teenage mothers from early-dating debuted to HIV infection. Their stories consist of a visualised figure in chronicle order, illustrating embodied journeys of sexual health choices surrounding uncommunicative relationships and socially-suppressive environments. Methodologically, this qualitative study explored data from mixed online methods: 1) a case study analysing online comments (N = 12,763) on the South African Springster's website, run by the UK-based NGO, namely, Girl Effect; and 2) In-depth online interviews (N = 21) were conducted with young SA women and girls (16-28 ages) recruited in Cape Town, Pretoria, and Johannesburg, SA. Participants consist of both those living with HIV and without. Ethical approval was gained via the College of Social Sciences Ethical Committee at the University of Glasgow, and informed consent was obtained verbally and in writing from participants in due course. Data were thematically applied to an iteratively developed codebook and analysed. There are three kinds of typical pressures as relational factors for them, including peer pressure, partners or boyfriends, and parents’ reactions. Under the patriarchal and religious-devoted social atmospheres, these relationships work as a source of scaredness among young women and girls who could not talk about their sexual health concerns and rights. Such an inability to communicate with intimate relationships, eventually, emerges as a perpetuated or taken-for-granted social environment in South Africa, insistently leading to an increase in unwanted pregnancies or new HIV infections in young South African women and girls. In this sense, this study reveals the pressing need for open communication between generations with accurate information about HIV/AIDS. This also implies that the sociological feminist praxes in South Africa would help eliminate HIV-related stigma as well as construct open space to reduce gender-based violence and sexually-transmitted infection. Ultimately, this will be a road for supporting sexually healthy decisions and well-being across South African generations.

Keywords: HIV, young women, South Africa, intimate relationships, communication, social medicine

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Authors: Leen Al Kassab, Sarah Johns, Helen Noble, Nawal Nour, Elizabeth Janiak, Sarrah Shahawy

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Introduction: Immigrant and refugee women experience disparities in sexual and reproductive health (SRH) outcomes, partially as a result of barriers to SRH literacy and to regular healthcare access and engagement. Despite the existing data highlighting growing needs for culturally relevant and structurally competent care, interventions are scarce and not well-documented. Methods: In this IRB-approved study, we used a community-based participatory research approach, with the assistance of a community advisory board, to conduct a qualitative needs assessment of SRH knowledge and service engagement with immigrant and refugee women from Africa or the Middle East and currently residing in Boston. We conducted a total of nine focus group discussions (FGDs) in partnership with medical, community, and religious centers, in six languages: Arabic, English, French, Somali, Pashtu, and Dari. A total of 44 individuals participated. We explored migrant and refugee women’s current and evolving SRH care needs and gaps, specifically related to the development of interventions and clinical best practices targeting SRH literacy, healthcare engagement, and informed decision-making. Recordings of the FGDs were transcribed verbatim and translated by interpreter services. We used open coding with multiple coders who resolved discrepancies through consensus and iteratively refined our codebook while coding data in batches using Dedoose software. Results: Participants reported immigrant adaptation experiences, discrimination, and feelings of trust, autonomy, privacy, and connectedness to family, community, and the healthcare system as factors surrounding SRH knowledge and needs. The context of previously learned SRH knowledge was commonly noted to be in schools, at menstruation, before marriage, from family members, partners, friends, and online search engines. Common themes included empowering strength drawn from religious and cultural communities, difficulties bridging educational gaps with their US- born daughters, and a desire for more SRH education from multiple sources, including family, health care providers, and religious experts & communities. Regarding further SRH education, participants’ preferences varied regarding ideal platform (virtual vs. in-person), location (in religious and community centers or not), smaller group sizes, and the involvement of men. Conclusions: Based on these results, empowering SRH initiatives should include both community and religious center-based, as well as clinic-based, interventions. Interventions should be composed of frequent educational workshops in small groups involving age-grouped women, daughters, and (sometimes) men, tailored SRH messaging, and the promotion of culturally, religiously, and linguistically competent care.

Keywords: community, immigrant, religion, sexual & reproductive health, women's health

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Authors: Oluwaseun Adeleke, Samuel Ikan, Anthony Nwala, Mopelola Raji, Fidelis Edet

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Background: The risks associated with each pregnancy is carried almost entirely by a woman; however, the decision about whether and when to get pregnant is a subject that several others contend with her to make. The self-care concept offers women of reproductive age the opportunity to take control of their health and its determinants with or without the influence of a healthcare provider, family, and friends. DMPA-SC Self-injection (SI) is becoming the cornerstone of contraceptive self-care and has the potential to expand access and create opportunities for women to take control of their reproductive health. Methodology: To obtain insight into the influences that interfere with a woman’s capacity to make contraceptive choices independently, the Delivering Innovations in Selfcare (DISC) project conducted two intensive rounds of qualitative data collection and triangulation that included provider, client, and community mobilizer interviews, facility observations, and routine program data collection. Respondents were sampled according to a convenience sampling approach and data collected analyzed using a codebook and Atlas-TI. The research team members came together for participatory analysis workshop to explore and interpret emergent themes. Findings: Insights indicate that women are increasingly finding their voice and independently seek services to prevent a deterioration of their economic situation and achieve personal ambitions. Women who hold independent decision-making power still prefer to share decision making power with their male partners. Male partners’ influence on women’s use of family planning and self-inject was most dominant. There were examples of men’s support for women’s use of contraception to prevent unintended pregnancy, as well as men withholding support. Other men outrightly deny their partners from obtaining contraceptive services and their partners cede this sexual and reproductive health right without objection. A woman’s decision to initiate family planning is affected by myths and misconceptions, many of which have cultural and religious origins. Some tribes are known for their reluctance to use contraception and often associate stigma with the pursuit of family planning (FP) services. Information given by the provider is accepted, and, in many cases, clients cede power to providers to shape their SI user journey. A provider’s influence on a client’s decision to self-inject is reinforced by their biases and concerns. Clients are inhibited by the presence of peers during group education at the health facility. Others are motivated to seek FP services by the interest expressed by peers. There is also a growing trend in the influence of social media on FP uptake, particularly Facebook fora. Conclusion: The convenience of self-administration at home is a benefit for those that contend with various forms of social influences as well as covert users. Beyond increasing choice and reducing barriers to accessing Sexual and Reproductive Health (SRH) services, it can initiate the process of self-discovery and agency in the contraceptive user journey.

Keywords: selfcare, self-empowerment, agency, DMPA-SC, contraception, family planning, influences

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Authors: Vaiddehi Bansal, Ridhi Sahai, Kareem Kysia

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Overseas labor migration is currently one of the most important contributors to the economy of Bangladesh and is a highly profitable form of labor for Gulf Cooperative Council (GCC) countries. In 2019, 700,159 migrant workers from Bangladeshtraveled abroad for employment. GCC countries are a major destination for Bangladeshi migrant workers, with Saudi Arabia being the most common destination for Bangladeshi migrant workers since 2016. Despite the high rate of migration between these countries every year, the OLR industry remains complex and often leaves migrants susceptible to human trafficking, forced labor, and modern slavery. While the prevalence of forced labor among Bangladeshi migrants in GCC countries is still unknown, the IOM estimates international migrant workers comprise one fourth of the victims of forced labor. Moreover, the onset of the global COVID-19 pandemic has exposed migrant workers to additional adverse situations, making them even more vulnerable to forced labor and health risks. This paper presents findings from a rapid assessment of the impacts of COVID-19 on OLR in Bangladesh, with an emphasis on the increased risk of forced labor among vulnerable migrant worker populations, particularly women.Rapid reviews are a useful approach to swiftly provide actionable evidence for informed decision-making during emergencies, such as the COVID-19 pandemic. The research team conducted semi-structured key information interviews (KIIs) with a range of stakeholders, including government officials, local NGOs, international organizations, migration researchers, and formal and informal recruiting agencies, to obtain insights on the multi-facted impacts of COVID-19 on the OLR sector. The research team also conducted a comprehensive review of available resources, including media articles, blogs, policy briefs, reports, white papers, and other online content, to triangulate findings from the KIIs. After screening for inclusion criteria, a total of 110 grey literature documents were included in the review. A total of 31 KIIs were conducted, data from which was transcribed and translated from Bangla to English, andanalyzed using a detailed codebook. Findings indicate that there was limited reintegration support for returnee migrants. Facing increasing amounts of debt, financial insecurity, and social discrimination, returnee migrants, were extremely vulnerable to forced labor and exploitation. Growing financial debt and limited job opportunities in their home country will likely push migrants to resort to unsafe migration channels. Evidence suggests that women, who are primarily domestic works in GCC countries, were exposed to increased risk of forced labor and workplace violence. Due to stay-at-home measures, women migrant workers were tasked with additional housekeeping working and subjected to longer work hours, wage withholding, and physical abuse. In Bangladesh, returnee women migrant workers also faced an increased risk of domestic violence.

Keywords: forced labor, migration, gender, human trafficking

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Authors: Nicki Mohammadi, Emma Reford, Natalia Romano Spica, Laura Tabacof, Jenna Tosto-Mancuso, David Putrino, Christopher P. Kellner

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Introductory Statement: The onset of the COVID-19 pandemic demanded an unprecedented need for the rapid development, dispersal, and application of infection testing. However, despite the impressive mobilization of resources, individuals were incredibly limited in their access to tests, particularly during the initial months of the pandemic (March-April 2020) in New York City (NYC). Access to COVID-19 testing is crucial in understanding patients’ illness experiences and integral to the development of COVID-19 standard-of-care protocols, especially in the context of overall access to healthcare resources. Succinct Description of basic methodologies: 18 Patients in a COVID-19 Remote Patient Monitoring Program (Precision Recovery within the Mount Sinai Health System) were interviewed regarding their experience with COVID-19 during the first wave (March-May 2020) of the COVID-19 pandemic in New York City. Patients were asked about their experiences navigating COVID-19 diagnoses, the health care system, and their recovery process. Transcribed interviews were analyzed for thematic codes, using grounded theory to guide the identification of emergent themes and codebook development through an iterative process. Data coding was performed using NVivo12. References for the domain “testing” were then extracted and analyzed for themes and statistical patterns. Clear Indication of Major Findings of the study: 100% of participants (18/18) referenced COVID-19 testing in their interviews, with a total of 79 references across the 18 transcripts (average: 4.4 references/interview; 2.7% interview coverage). 89% of participants (16/18) discussed the difficulty of access to testing, including denial of testing without high severity of symptoms, geographical distance to the testing site, and lack of testing resources at healthcare centers. Participants shared varying perspectives on how the lack of certainty regarding their COVID-19 status affected their course of recovery. One participant shared that because she never tested positive she was shielded from her anxiety and fear, given the death toll in NYC. Another group of participants shared that not having a concrete status to share with family, friends and professionals affected how seriously onlookers took their symptoms. Furthermore, the absence of a positive test barred some individuals from access to treatment programs and employment support. Concluding Statement: Lack of access to COVID-19 testing in the first wave of the pandemic in NYC was a prominent element of patients’ illness experience, particularly during their recovery phase. While for some the lack of concrete results was protective, most emphasized the invalidating effect this had on the perception of illness for both self and others. COVID-19 testing is now widely accessible; however, those who are unable to demonstrate a positive test result but who are still presumed to have had COVID-19 in the first wave must continue to adapt to and live with the effects of this gap in knowledge and care on their recovery. Future efforts are required to ensure that patients do not face barriers to care due to the lack of testing and are reassured regarding their access to healthcare. Affiliations- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 2Abilities Research Center, Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY

Keywords: accessibility, COVID-19, recovery, testing

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Authors: Oluwaseun Adeleke, Samuel O. Ikani, Simeon Christian Chukwu, Fidelis Edet, Anthony Nwala, Mopelola Raji, Simeon Christian Chukwu

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Background: Health service providers are offered in-service training periodically to strengthen their ability to deliver services that are ethical, quality, timely and safe. Not all capacity-building courses have successfully resulted in intended service delivery outcomes because of poor training content, design, approach, and ambiance. The Delivering Innovations in Selfcare (DISC) project developed a Moment of Truth innovation, which is a proven training model focused on improving consumer/provider interaction that leads to an increase in the voluntary uptake of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) self-injection among women who opt for injectable contraception. Methodology: Six months after training on a moment of truth (MoT) training manual, the project conducted two intensive rounds of qualitative data collection and triangulation that included provider, client, and community mobilizer interviews, facility observations, and routine program data collection. Respondents were sampled according to a convenience sampling approach, and data collected was analyzed using a codebook and Atlas-TI. Providers and clients were interviewed to understand their experience, perspective, attitude, and awareness about the DMPA-SC self-inject. Data were collected from 12 health facilities in three states – eight directly trained and four cascades trained. The research team members came together for a participatory analysis workshop to explore and interpret emergent themes. Findings: Quality-of-service delivery and performance outcomes were observed to be significantly better in facilities whose providers were trained directly trained by the DISC project than in sites that received indirect training through master trainers. Facilities that were directly trained recorded SI proportions that were twice more than in cascade-trained sites. Direct training comprised of full-day and standalone didactic and interactive sessions constructed to evoke commitment, passion and conviction as well as eliminate provider bias and misconceptions in providers by utilizing human interest stories and values clarification exercises. Sessions also created compelling arguments using evidence and national guidelines. The training also prioritized demonstration sessions, utilized job aids, particularly videos, strengthened empathetic counseling – allaying client fears and concerns about SI, trained on positioning self-inject first and side effects management. Role plays and practicum was particularly useful to enable providers to retain and internalize new knowledge. These sessions provided experiential learning and the opportunity to apply one's expertise in a supervised environment where supportive feedback is provided in real-time. Cascade Training was often a shorter and abridged form of MoT training that leveraged existing training already planned by master trainers. This training was held over a four-hour period and was less emotive, focusing more on foundational DMPA-SC knowledge such as a reorientation to DMPA-SC, comparison of DMPA-SC variants, counseling framework and skills, data reporting and commodity tracking/requisition – no facility practicums. Training on self-injection was not as robust, presumably because they were not directed at methods in the contraceptive mix that align with state/organizational sponsored objectives – in this instance, fostering LARC services. Conclusion: To achieve better performance outcomes, consideration should be given to providing training that prioritizes practice-based and emotive content. Furthermore, a firm understanding and conviction about the value training offers improve motivation and commitment to accomplish and surpass service-related performance outcomes.

Keywords: training, performance outcomes, innovation, family planning, contraception, DMPA-SC, self-care, self-injection.

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