Development of a multi-level family planning intervention for couples in rural Uganda: key findings & adaptations made from community engaged research methods.
Development of a multi-level family planning intervention for couples in rural Uganda: key findings & adaptations made from community engaged research methods.
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DOI：
10.1186/s12905-023-02667-8
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发表时间：
2023-10-21
影响因子：
2.5
通讯作者：
Kiene, Susan M.
中科院分区：
文献类型：
--
作者：
Muhumuza, Christine;Sileo, Katelyn M.;Wanyenze, Rhoda K.;Kershaw, Trace S.;Lule, Haruna;Sekamatte, Samuel;Kiene, Susan M.
乌干达是世界上生育率最高的国家之一，多层次的障碍导致避孕药具使用率低。本研究的目的是通过社区参与的研究方法，开发一种与文化和社会相关的社区干预措施，以增加乌干达农村夫妇的避孕药具使用。本研究报告了社区参与的研究，这些研究为干预的内容和结构以及干预的最终内容提供了信息；试点干预措施的评估将在完成后报告。由社区利益相关者组成的干预指导委员会审查了最初提出的干预内容和方法。对26名未满足计划生育需求的男性和女性进行了四(4)个性别隔离的焦点小组。与社区领导人和计划生育利益攸关方进行了15次关键信息提供者访谈。最后，对一组夫妇（N = 7）进行了4期干预试验的试点测试，这些夫妇在人口统计学上与未来试点干预试验的目标样本相似。对定性数据进行专题分析。研究结果包括确定需要重塑的社区信念，以提高对计划生育的接受程度，以及吸引男性参与的策略，社区领导人参与支持计划生育的干预的可接受方法，以及管理性别动态和最小化参与意外负面后果风险的方法。研究结果被用来为干预的理想结构和形式提供信息，包括在小组会议期间直接分发避孕药具，并确定需要加强卫生工作者的能力，以提供长效可逆避孕药具（LARCs），作为干预的一部分。这些发现被用于在对其可行性、可接受性和潜在疗效进行更大规模的试点试验之前，对干预措施进行改进。它们可以为类似环境下的其他多层次计划生育干预提供信息，其他人可以采用这些方法，以提高干预措施的可行性、可接受性和文化相关性。
Uganda has among the highest fertility rates in the world and multi-level barriers contribute to the low contraceptive use. The objective of this study was to develop a culturally and socially relevant, community-based intervention to increase contraceptive use among couples in rural Uganda through community-engaged research methods. This study reports on the community-engaged research that informed the intervention’s content and structure and the final content of the intervention; the evaluation of the pilot intervention will be reported upon completion. An intervention steering committee of community stakeholders reviewed the initially proposed intervention content and approach. Four (4) gender-segregated focus groups were conducted with twenty-six (26) men and women who had an unmet need for family planning. Fifteen key-informant interviews were conducted with community leaders and family planning stakeholders. Finally, the 4-session intervention was pilot tested with a cohort of couples (N = 7) similar in demographics to the target sample of the future pilot intervention trial. Qualitative data were analyzed thematically. Findings included the identification of community beliefs to reshape in order to increase family planning acceptance, as well as strategies to engage men, acceptable approaches for community leader involvement in the intervention to endorse family planning, and methods for managing gender dynamics and minimizing risk of unintended negative consequences of participation. The findings were used to inform the ideal structure and format of the intervention, including the distribution of contraceptives directly during group sessions, and identified the need to strengthen health worker capacity to provide Long-Acting Reversable Contraceptives (LARCs) as part of the intervention. These findings were used to refine an intervention before a larger scale pilot test of its feasibility, acceptability, and potential efficacy. They can inform other multi-level family planning interventions in similar settings and the methods can be adopted by others to increase the feasibility, acceptability, and cultural relevance of interventions.
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