ArticleBMJ open2022
Acceptability of family planning in a changing context in Uganda: a realist evaluation at two time points.
Article in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Measuring social norms endorsement and normative influence on contraceptive use among youth (15-24) in northeastern Uganda.Frontiers in global women's health · 2026Article
- Barriers and facilitators to community-based, peer-led sexual and reproductive health intervention for adolescent girls and young women in northeastern Uganda: A qualitative study.PLOS global public health · 2026Article
- Determinants of contraceptive use and intention to use among youth 15-24 years from a remote pastoral community in Northeastern, Uganda.Frontiers in global women's health · 2025Article
- Using the 5C Vaccine Hesitancy Framework to Elucidate and Measure Contraceptive Acceptability in sub-Saharan Africa.Global health, science and practice · 2024Article
- Article
- Scoping review of qualitative studies on family planning in Uganda.PLOS global public health · 2024Article
- Family planning integration in Ethiopia's primary health care system: a qualitative study on opportunities, challenges and best practices.Reproductive health · 2023Article
- Gender norms and family planning amongst pastoralists in Kenya: a qualitative study in Wajir and Mandera.Sexual and reproductive health matters · 2022Article
- "It was my own decision": the transformational shift that influences a woman's decision to use contraceptives covertly.BMC women's health · 2022Article
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Authors and funding
8 authors.
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Abstract
objectivesThis study sought to understand, during an intervention which integrated family planning (FP) and immunisation, (1) if and how prevailing contextual factors influenced acceptability and use of modern contraceptive methods (MCMs) in a pastoral community in Uganda, (2) what mechanisms were triggered by these contextual factors (3) if these contextual factors changed between two time points 2 years apart and (4) the impact of contextual changes on mechanisms triggered and acceptability and use outcomes.
designQualitative realist evaluation over two time points.
settingGovernment health facilities in Moroto District, Karamoja, Uganda.
participants69 participants involved in the delivery and uptake of integrated FP and childhood immunisation services.
interventionIntegrated delivery of FP and childhood immunisation services offered to women accessing immunisation services in health facilities between January 2016 and December 2019.
resultsFour key themes were identified that encompassed context and mechanisms influencing acceptability of MCMs across both time points of the evaluation. These were: (1) fear of side effects of MCMs; (2) preference for natural FP methods; (3) pastoral lifestyles in the community and (4) food insecurity. The context of these themes changed over time leading to the triggering of mechanisms with an overall increase in acceptability of MCMs over time. Key mechanisms of acceptability triggered included: affective attitude, intervention coherence, self-efficacy, perceived effectiveness and opportunity cost, leading to the development of three context-acceptability theories.
conclusionsIn this study, social and cultural norms played a strong role in influencing acceptability of the intervention. The context combined with intervention components were found to trigger several mechanisms that mapped to constructs of diffusion of innovations and acted as catalysts for 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 MCM use.
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