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

Abstract

Dual-method use is the most reliable form of protection against unintended pregnancies and human immunodeficiency virus/sexually transmitted infections (HIV/STIs). Although dual-method use remains uncommon among women in stable relationships, some women do practice it. In this study, we explored the barriers that make dual-method use rare and the behaviors of women who practice dual-method use using a positive deviance framework in Uganda. We screened 150 women using highly effective contraceptives at five health facilities. We identified nine women who practiced dual-method use and 141 women who did not. In a qualitative study, we conducted in-depth interviews with all nine women practicing dual-method use and 10 women randomly selected out of the 141 who did not. We performed a thematic analysis using the positive deviance framework. Regardless of practicing dual-method use or not, women faced perceived barriers against dual-method use, such as partner’s objection, distrust, shyness about introducing condoms into marital relationships, and limited access to condoms. However, women practicing dual-method use had higher levels of risk perception about unintended pregnancies and HIV/STIs. They also engaged in unique behaviors, such as influencing their partners’ condom use by initiating discussions, educating their partners on sexual risks and condom use, and obtaining condoms by themselves. These findings will be useful in developing effective community-led and peer-based interventions promoting dual-method use to reduce the dual burden of unintended pregnancies and HIV/STIs among women in Uganda.

Scoping review of qualitative studies on family planning in Uganda

“…Nine articles discussed the intersection of HIV/AIDS in FP practice. Communication between partners is still important [ 62 , 89 , 90 ]. Kosugi et al [ 89 ] observed that those who perceived they were at a higher risk of HIV/AIDS were more likely to use dual-method contraceptives.…”

“…Communication between partners is still important [ 62 , 89 , 90 ]. Kosugi et al [ 89 ] observed that those who perceived they were at a higher risk of HIV/AIDS were more likely to use dual-method contraceptives. HIV prevention can be confusing, and people struggle to balance their perceptions of HIV risk with their desire to have children [ 91 – 93 ].…”

“…Moreover, some studies were geographically limited [ 96 ], conducted in small areas in Uganda, restricting the applicability of results to broader populations or other regions. Finally, a few studies relied on a limited number of interviews [ 62 , 89 ], possibly compromising the comprehensiveness and depth of insights obtained for the research topic. These weaknesses highlight areas for improvement in future research and call for careful interpretation of the findings.…”

Long-term retention and associated practices among Community Client Led Antiretroviral Distribution groups (CCLADs) in Uganda: A mixed methods study

“…To ensure sustained retention in CCLADs, treatment programs require adaptable, locally acceptable strategies that encourage behavior change. The positive deviance approach has effectively addressed persistent challenges in HIV prevention programs (24)(25)(26)(27), but few studies have utilized this approach to improve retention (23). The approach identi es behaviors and strategies that enable individuals and groups to solve problems more effectively than their peers, while making use of the same resources and facing similar or worse challenges (28,29).…”