Behavioural and contextual factors influencing intention to shift from short- to long-acting reversible contraceptive methods among women in central Ethiopia: a theory of planned behaviour-guided study.

Background: Understanding women's intention to shift from short-acting methods to long-acting reversible contraceptive methods (LARCMs) in diverse settings, including socioeconomic, behavioural and multicultural contexts, is crucial for improving contraceptive utilization. While short-acting methods are widely used, shifting to LARCMs remains a challenge in resource-limited settings like Ethiopia. Previous studies in Ethiopia either lack theoretical framework or focus on intention spanning a year with theoretical incoherence. Objective: Guided by the theory of planned behaviour, this study aims to assess the intention to shift from short- to long-acting methods in 6 months and identify associated factors among women attending public health facilities in Hossana Town, Central Ethiopia. Design: A facility-based cross-sectional study was conducted in public health facilities of Hossana town, Central Ethiopia Region. Methods: The 336 reproductive-age women who were using short-acting contraceptive methods were included. The data were collected through face-to-face interviews using a pre-tested structured questionnaire. A generalized linear model (GLM) with a Gamma distribution and log link function was applied to model the positively skewed intention scores. Adjusted exponentiated beta coefficients (Exp(β)) and their corresponding 95% confidence intervals were used to quantify associations and declared statistically significant at Results: The proportion of women who intended to shift from short-acting contraceptives to LARCMs was only 42.3%. In the multivariable GLM, primary education (Exp(β) = 1.10; 95% CI: 1.033-1.170), secondary education (Exp(β) = 1.15; 95% CI: 1.078-1.227), and tertiary education (Exp(β) = 1.19; 95% CI: 1.061-1.329) were significantly associated to shift from short- to LARCMs. Additionally, attitude (Exp(β) = 1.011; 95% CI: 1.007-1.015), subjective norm (Exp(β) = 1.007; 95% CI: 1.001-1.013), and perceived behavioural control (Exp(β) = 1.012; 95% CI: 1.004-1.020) were also positively and significantly associated with the intention to shift. Conclusion: These findings suggest that enhancing educational access, improving service delivery through informed decision-making support, addressing social influences and strengthening psychosocial factors such as attitude and self-confidence could improve the intention for uptake of long-acting contraceptive methods.