Development, Testing and Health Effects of a Multilevel Family Planning Intervention

摘要 2018年，乌干达32.6%的育龄妇女的计划生育需求未得到满足，这意味着她们 想避免怀孕，但没有使用现代避孕方法。满足未满足的需求 计划生育具有重要的公共卫生影响，包括减少与怀孕有关的健康风险 死亡率和婴儿死亡率。虽然乌干达正在加大努力，减少农村地区的供应方障碍， 在社区发放避孕药具等方面，夫妻双方仍面临多层次的需求方 使用避孕药具的障碍。除了错误的信息和对避孕副作用的恐惧， 动态、同龄人和家庭的影响以及更广泛的社区规范， 性别角色影响计划生育。我们建议发展和试行一个多层次、以社区为基础的 干预，利用变革性的社区对话来改变个人的态度和看法 社区规范阻碍了计划生育。社区对话是提供给团体的夫妇 加强4次以上的会议，以同时处理个人和人际一级的家庭决定因素 计划生育和将夫妇与计划生育服务联系起来。我们的项目的目标是：目标1）开发一个多- 一级干预，使夫妇参与变革性的社区对话，以减少意外的 增加现代避孕药具的使用。我们将通过定性研究来开发干预措施， 与需求未得到满足的妇女和男子以及社区利益攸关方进行研究， 一个社区干预指导委员会;目标2）进行一项试验性准实验性对照试验， 夫妻（干预组n = 35，对照组n = 35），随机抽取一个村进行多级干预（n = 35 对照组（n = 35对夫妇，注意力匹配对照干预）。我们将 评估试验程序（目标2a）和干预内容（目标2b）的可接受性和可行性， 探索性目标（2c），评估干预措施对避孕药具使用和持续使用的潜在功效 和中间成果（知识、态度、感知的社区规范、伙伴沟通和 6个月随访期间。

Abstract In 2018, 32.6% of women of reproductive age had an unmet need for family planning in Uganda, meaning they wanted to avoid pregnancy but were not using a modern contraceptive method. Filling the unmet need for family planning has important public health implications, including reductions in pregnancy-related health risks and deaths, and infant mortality. While Uganda is scaling up efforts to reduce supply-side barriers in rural areas, such as community distribution of contraceptives, couples are still faced with multi-level demand-side barriers to contraceptive use. In addition to misinformation and fear of contraceptive side-effects, relationship dynamics, peer and family influence, and broader community norms promoting large family size and traditional gender roles influence family planning. We propose to develop and pilot test a multi-level, community-based intervention, which employs transformative community dialogues to alter individual attitudes and the perception of community norms that discourage family planning. Community dialogues are delivered to groups of couples over 4-sessions enhanced to simultaneously address individual and interpersonal-level determinants of family planning and link couples to family planning services. The aims of our project are to: Aim 1) Develop a multi- level intervention that engages couples in transformative community dialogues to reduce unintended pregnancy by increasing modern contraceptive use. We will develop the intervention through qualitative research with women and men with an unmet need and community stakeholders and through the formation of a community intervention steering committee; Aim 2) Conduct a pilot quasi-experimental controlled trial with 70 couples (intervention n=35, control n=35), randomizing one village to the multi-level intervention (n=35 couples) and one village to the control condition (n=35 couples, attention-matched control intervention). We will assess acceptability and feasibility of the trial procedures (Aim 2a) and intervention content (Aim 2b), with the exploratory aim (2c) of assessing the intervention's potential efficacy on contraceptive uptake and continuation and intermediate outcomes (knowledge, attitudes, perceived community norms, partner communication and equity) through 6-month follow up.