Evidence map›Paper›PMID 40538667›Full record

ArticleWomen's health reports (New Rochelle, N.Y.)2025

Behavioral Drivers Influencing Women's Decision to Use Self-Injectable Contraception Provided by Community Health Surveillance Assistants in Rural Malawi.

Martha Kamanga, Dilys Walker, Address Malata, Mandaachepa Nyando, Jessie Salamba, Alaizi Nkhoma, Innocencia Mtalimanja, Tamanda Jumbe, Emas Potolani, Alfred Maluwa and 9 more

Abstract read
In one paragraph

Article in Women's health reports (New Rochelle, N.Y.), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors.

Martha KamangaDepartment of Midwifery, School of Maternal, Neonatal and Reproductive Health, Kamuzu University of Health Sciences, Lilongwe, Malawi.
Dilys WalkerDepartment of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, UCSF, San Francisco, California, USA.
Address MalataMalawi University of Science and Technology, Academy of Medical Sciences, Limbe, Malawi.
Mandaachepa NyandoSchool of Nursing, Kamuzu University of Health Sciences, Lilongwe, Malawi.
Jessie SalambaReproductive Health Directorate, Government of Malawi Ministry of Health, Lilongwe, Malawi.
Alaizi NkhomaNursing and Midwifery Department, Government of Malawi Ministry of Health, Lilongwe, Malawi.
Innocencia MtalimanjaMalawi University of Science and Technology, Academy of Medical Sciences, Limbe, Malawi.
Tamanda JumbeMalawi University of Science and Technology, Academy of Medical Sciences, Limbe, Malawi.
Emas PotolaniMalawi University of Science and Technology, Academy of Medical Sciences, Limbe, Malawi.
Alfred MaluwaMalawi University of Science and Technology, Academy of Medical Sciences, Limbe, Malawi.
Chifundo ZimbaMalawi University of Science and Technology, Academy of Medical Sciences, Limbe, Malawi.
Josophine ChangoleMalawi University of Science and Technology, Academy of Medical Sciences, Limbe, Malawi.
Rabecca BikaMalawi University of Science and Technology, Academy of Medical Sciences, Limbe, Malawi.
Emily HimesDepartment of Family and Community Medicine, School of Medicine, UCSF, San Francisco, California, USA.
Lauren SuchmanDepartment of Social and Behavioral Sciences, Institute for Health and Aging, School of Nursing, UCSF, San Francisco, California, USA.
Janelli VallinInstitute for Health and Aging, School of Nursing, UCSF, San Francisco, California, USA.
Beth PhillipsDepartment of Family and Community Medicine, School of Medicine, UCSF, San Francisco, California, USA.
Jenny LiuDepartment of Social and Behavioral Sciences, Institute for Health and Aging, School of Nursing, UCSF, San Francisco, California, USA.
Kelsey HoltDepartment of Family and Community Medicine, School of Medicine, UCSF, San Francisco, California, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Introduction: Self-injection (SI) for contraceptive use is recommended for its proven ability to empower women and overcome barriers to contraceptive access. The World Health Organization endorsed SI as a self-care approach in 2019. Despite the increase in Malawi's modern contraceptive prevalence rate from 38.1% in 2012 to 48.9% in 2020, it remains below the government's 60% target. Injectable contraceptives, including depot medroxyprogesterone acetate subcutaneous (DMPA-SC), introduced in 2018, are the most popular contraceptive method in Malawi, particularly among adolescents, representing 49.8% of the contraceptive method mix. However, utilization of SI remains limited, especially in rural areas where access challenges persist. This study explores the behavioral drivers influencing women's decision to use self-injectable contraception provided by community health surveillance assistants (CHSA) in rural Malawi. Methods: Using the capability, opportunity, motivation-behavior model, the study analyzed drivers of DMPA-SC SI adoption among 60 women aged 15-45 years in two rural districts, Mulanje and Ntchisi. Data were collected through in-depth interviews on women's experiences with contraceptives, including SI. Results: Women's capability was strengthened as CHSAs addressed initial hesitation through practical demonstrations. Opportunity improved through enhanced access, trust, and privacy. Motivation increased with counseling, reduced travel costs, and CHSAs' support, encouraging women to adopt self-injection confidently and consistently. Discussion: Women's decisions to adopt SI were shaped by capability, motivation, and opportunity, with CHSAs playing a pivotal role. Future family planning programs should prioritize CHSAs' training and deployment to improve SI uptake, fostering autonomy and accessibility for rural women.

Indexed as

behavioral driverscommunity health surveillance assistantsuse self-injectable contraceptionwomen’s decision making

Identifiers

PMID40538667
PMCPMC12177317

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.