Knowledge, confidence and social support: Kenyan women's priority needs for contraceptive self-injection learning through a social cognitive theory lens.

backgroundSelf-injectable contraceptives provide individuals the opportunity to prevent pregnancy with a self-controlled method that helps enhance self-care. Kenya is in the process of making self-injectable subcutaneous depot medroxyprogesterone acetate (DMPA-SC) widely available. We know little about what would make women in Kenya feel that contraceptive self-injection (SI) is feasible. Applying the social cognitive theory, we sought to understand what SI-naïve reproductive-aged women wanted to learn about SI, how they desired to learn it, and with whom.

methodsWe conducted sixty-one in-depth interviews with women aged 15-45 years, residing in Nairobi and Kisumu, Kenya. Participants were purposively sampled to ensure diverse representation by age, contraceptive use or non-use, and previous experience with SI of DMPA-SC. Audio recordings of the in-depth interviews were transcribed and translated into English as necessary. Transcripts were coded in Dedoose qualitative analysis software, data was analyzed thematically, and insights were drawn from the emerging themes.

resultsParticipants' SI learning perceptions were influenced by their perceived ability to self-inject, shaped by an interplay of their knowledge of SI (cognitive factors), vis-à-vis their confidence to self-inject (behavioral factors), and their perceived value of social reinforcements to enable the behavior (environmental factors). Participants had low knowledge and skills in SI resulting in low self-efficacy; thus, they preferred direct observational learning from a knowledgeable healthcare provider and practical demonstrations to enhance confidence in their SI skills. In addition, participants desired to learn with someone familiar or close to them who would provide support to navigate the complexities of SI beyond the initial training session.

conclusionOur study highlights Kenyan women's desire for a contraceptive SI learning experience that imparts knowledge through comprehensive counseling and instills confidence through observational learning from healthcare providers and ample practice opportunities until the users feel ready to self-inject at home. By aligning with the WHO self-care guidelines and leveraging the social cognitive theory, client training programs can equip women to adopt SI confidently should they so choose.