Family Planning Acceptability in a Changing Context in Uganda: A Realistic Two-Moment Assessment

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BMJ open. 2022 Apr 8;12(4):e054277. doi: 10.1136/bmjopen-2021-054277.


OBJECTIVES: This study aimed to understand, during an intervention that integrated family planning (FP) and vaccination, (1) whether and how dominant contextual factors influenced the acceptability and use of modern contraceptive methods (MCMs) in a pastoral community in Uganda, (2) what mechanisms were triggered by these contextual factors (3) whether these contextual factors changed between two time points 2 years apart and (4) the impact of contextual changes on the mechanisms triggered and the results of acceptability and use.

DESIGN: Qualitative realistic assessment at two points in time.

SETTING: Government health facilities in Moroto District, Karamoja, Uganda.

PARTICIPANTS: 69 participants involved in the delivery and uptake of integrated FP and childhood immunization services.

INTERVENTION: Integrated delivery of FP and childhood immunization services offered to women accessing immunization services at health facilities between January 2016 and December 2019.

RESULTS: Four key themes were identified that encompassed the context and mechanisms influencing the acceptability of MCMs at both time points of the assessment. These were: (1) fear of MCM side effects; (2) preference for natural FP methods; (3) pastoral lifestyles in the community and (4) food insecurity. The context of these themes has evolved over time, triggering mechanisms with an overall increase in the acceptability of MCMs over time. The main mechanisms of acceptability triggered included: affective attitude, consistency of intervention, self-efficacy, perceived efficacy, and opportunity cost, leading to the development of three theories of contextual acceptability.

CONCLUSIONS: In this study, social and cultural norms played an important role in influencing the acceptability of the intervention. The context combined with the components of the intervention was found to trigger several mechanisms that corresponded to the concepts of diffusion of innovations and acted as catalysts for the mechanisms of acceptability. The context in which the intervention was implemented changed, leading to the triggering of mechanisms and an increase in the perceived value and acceptability of using MCMs.

PMID:35396286 | DO I:10.1136/bmjopen-2021-054277

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