Positive deviance for dual-method promotion among women in Uganda: study protocol for a cluster randomized controlled trial

Abstract

Background: Dual-method use is known as the most reliable protection against unintended pregnancies and sexually transmitted infections, including HIV. However, it is not commonly used in sub-Sharan Africa, especially among women using highly effective contraceptives. This article describes a protocol to evaluate the effect of an intervention formulated under the positive deviance approach for promoting dual-method use in Uganda. Methods: A total of 150 women will be interviewed using a structured questionnaire to find those practicing dualmethod use. In-depth interviews will then be conducted with all women using the dual method and 10 women using only highly effective contraceptives to identify their unique practice. Then, a cluster randomized controlled trial will be conducted to examine the effect of an intervention formulated under the positive deviance approach on dual-method uptake and adherence. Twenty health facilities will be randomized to an intervention or control arm and 480 women will be enrolled in each group. The participants will be followed up for 8 months.Discussion: This trial focuses on women who already adapted dual-method use and identifies their unique solutions to promote dual-method use. This trial could tackle barriers for dual-method use, which expert outsiders may fail to recognize, by analyzing and promulgating their unique behaviors. This study could provide evidence that the positive deviance approach can address unintended pregnancies and sexually transmitted infections as well as other health problems which usual approaches have failed to address.

Positive Deviance for Dual-Method Promotion among Women in Uganda: A Qualitative Study

“…Moreover, this study did not fully explore why PDs had a higher level of perceived threat for the dual risk, which might be a factor underlying their unique behaviors. In Phase II of our study, we will examine the effectiveness of an intervention that we are developing based on the unique practices found in the interviews through a randomized controlled trial with a larger sample of women using HECs [9]. Finally, this study focused exclusively on women, although condom use is not an individual action that a woman alone can choose to undertake [32].…”

“…It will be followed by Phase II, which is a clustered randomized controlled trial (C-RCT) to test the effectiveness of a positive deviance intervention. We developed the intervention to promote dual-method use among women using HECs based on the findings of the current study [9]. The intervention consists of a combination of clinic-and phone-based counselling and a participatory workshop which are delivered by PDs.…”

“…We excluded pregnant women and women who were infertile for other reasons, healthcare workers, political and religious leaders, and teachers, because they might not be representative of their communities as they could be influenced by their occupation and social status. The sample size was calculated based on the assumption that at least 7% of women would practice dual-method use and approximately 10 women considered PDs would be identified and invited for an in-depth interview [9]. We also randomly invited 10 women out of those who were not practicing dual-method use, or non-PDs, to an in-depth interview for comparison.…”

“…These are effective contraceptive methods but cannot prevent HIV and other STIs [8]. Therefore, it is crucial for sexually active women to protect themselves from infections, regardless of whether they are using HECs [9].…”

Positive deviance for promoting dual-method contraceptive use among women in Uganda: a cluster randomised controlled trial

“…The protocol of the trial has been previously published. 21 The population of Mbarara District is 472 629 (female=50.6%; male=49.4%), and about a half of the female population (45.7%) are estimated within the reproductive ages (15–49 years). 22…”