Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Programme Section, UNICEF Uganda Country Office, Kampala, Uganda.
BMJ Open. 2021 Aug 18;11(8):e046536. doi: 10.1136/bmjopen-2020-046536.
To examine the effects of a positive deviance intervention on dual-method contraceptive use among married or in-union women.
Open-label cluster randomised controlled trial.
20 health facilities in Mbarara District, Uganda.
960 married or in-union women aged 18-49 years using a non-barrier modern contraceptive method.
A combination of clinic-based and telephone-based counselling and a 1-day participatory workshop, which were developed based on a preliminary qualitative study of women practising dual-method contraception.
Dual-method contraceptive use at the last sexual intercourse and its consistent use in the 2 months prior to each follow-up. These outcomes were measured based on participants' self-reports, and the effect of intervention was assessed using a mixed-effects logistic regression model.
More women in the intervention group used dual-method contraception at the last sexual intercourse at 2 months (adjusted OR (AOR)=4.12; 95% CI 2.02 to 8.39) and 8 months (AOR=2.16; 95% CI 1.06 to 4.41) than in the control group. At 4 and 6 months, however, the proportion of dual-method contraceptive users was not significantly different between the two groups. Its consistent use was more prevalent in the intervention group than in the control group at 2 months (AOR=14.53; 95% CI 3.63 to 58.13), and this intervention effect lasted throughout the follow-up period.
The positive deviance intervention increased dual-method contraceptive use among women, and could be effective at reducing the dual risk of unintended pregnancies and HIV infections. This study demonstrated that the intervention targeting only women can change behaviours of couples to practise dual-method contraception. Because women using non-barrier modern contraceptives may be more reachable than men, interventions targeting such women should be recommended.
UMIN000037065.
研究正向偏离干预对已婚或同居妇女双重避孕方法使用的影响。
开放标签群组随机对照试验。
乌干达姆巴拉拉区的 20 个卫生机构。
960 名年龄在 18-49 岁之间、使用非屏障现代避孕方法的已婚或同居妇女。
以基于对实践双重避孕方法的妇女的初步定性研究为基础，结合诊所和电话咨询以及为期 1 天的参与式讲习班。
上次性接触时的双重避孕方法使用及其在每次随访前 2 个月内的持续使用。这些结果是基于参与者的自我报告来衡量的，干预效果使用混合效应逻辑回归模型进行评估。
在 2 个月（调整后的比值比（AOR）=4.12；95%置信区间 2.02 至 8.39）和 8 个月（AOR=2.16；95%置信区间 1.06 至 4.41）时，干预组中更多的妇女在上次性接触时使用双重避孕方法，而对照组中则较少。然而，在 4 个月和 6 个月时，两组之间使用双重避孕方法的比例没有显著差异。在 2 个月时，干预组中持续使用双重避孕方法的比例高于对照组（AOR=14.53；95%置信区间 3.63 至 58.13），这种干预效果持续到整个随访期。
正向偏离干预增加了妇女双重避孕方法的使用，并可能有效降低意外怀孕和 HIV 感染的双重风险。这项研究表明，仅针对妇女的干预措施可以改变夫妻实践双重避孕方法的行为。由于使用非屏障现代避孕方法的妇女可能比男性更容易接触到，因此应该推荐针对这些妇女的干预措施。
UMIN000037065。
