Title: Development of a Multi-Level Family Planning Intervention for Couples in Rural
Uganda: Key Findings & Adaptations Made from Community Engaged Research Methods
Version: 3 Date: 05 Jul 2023
Reviewer's report:
I commend the authors for their dedication to engaging multilevel stakeholders in the
development of an important theory-informed intervention designed to increase the uptake and
sustained use of modern contraception. I do, however, have some suggestions I hope the authors
find useful for strengthening their paper.
• It could be helpful to further define or specify where the definition for unmet need comes from,
as the literature has multiple ways of calculating it (e.g., the inclusion or exclusion of condoms
as an effective method). I see that you have cited a national document for it – perhaps just state
that in the text. You do provide a definition later, but I’m still left wondering if condoms are
considered effective in this instance.
• The third box under Immediate Outcomes of Figure 1 could be re-worded so that the bullet
points all start with action words like they do in the rest of the outcomes. Also, should the primary
outcome be contraceptive use or increased contraceptive use? For that matter, should it not be
increased use of effective (or modern) contraceptives?
• There is some more detail that I would have liked to see in the following section. At a minimum,
who is delivering the activities? Some include the actors while most do not.
o “…relationship-building through communication skills training, shared decision-making
activities, modeling of gender equitable couples, economic skills training (to engage men’s
interest, while increasing equity and shared decision-making within the couple), family planning
and program endorsement by local leaders, and the development of “Family Action Plans” and
“Community Action Plans.””
• Page 7 includes a typo – there is a c that is written as subscript.
o “The study was conducted in selected rural and peri-urban communities of Butambala
District ,central Uganda located approximately two hours from the capital city of Kampala.”
• Was there any qualitative software that was used for coding? Were there regularly held
meetings to review coding or emerging themes? Did the coders or interviewers write memos
or field notes?
• How and by whom were the small pilot participants recruited? What were their demographics?
• I may have missed it, but I see Table 1 has a diverse sample. Can you please provide context
as to whether that diversity reflects the population of the area in which the intervention will be
conducted? And the ever use of contraception – is that modern contraception or condoms or any
method such as the standard days method, etc.?
• Table 3 is already quite long but I liked where you included a quote to back up the thematic
finding. I found it a bit odd, though, that not all findings included a quote. I would suggest being
more consistent with your use of quotes – particularly when describing qualitative findings as
the quotes are the basis of your data.
• I believe there is a type in Table 3: ‘cater for’ should either be ‘cater to’ or ‘care for’.
• On page 12, I believe there may be a typo for the table number. The sentence does not accurately
describe Table 1.
# Table 1 highlights a selection of key community beliefs identified through the formative
work included in the final intervention package to be reshaped to align with family planning
acceptance.
• Table 4 could be enhanced by specifying who will be leading each activity.
• I am left wondering about the potential unintended consequences and what you plan to do if
they arise.
• I was also wondering about the limitations of this approach and future intervention. That section
seemed missing from the paper.