Multilevel Family Planning Intervention
Condition: Contraceptive Usage
Study type: Interventional

Summary: 
      This study seeks to develop and evaluate a multi-level intervention to satisfy couples' unmet
      need for family planning in rural Uganda. The study will evaluate the acceptability,
      feasibility, and preliminary efficacy of the intervention at increasing contraceptive uptake
      and continuation and improving intermediate outcomes of knowledge, attitudes, perceived
      community norms, partner communication and equity among couples in rural Uganda.
    

Detailed description: 
      In 2018, 32.6% of women of reproductive age had an unmet need for family planning in Uganda,
      meaning they wanted to avoid pregnancy but were not using a modern contraceptive method.
      Filling the unmet need for family planning has important public health implications,
      including reductions in pregnancy-related health risks and deaths, and infant mortality.
      While Uganda is scaling up efforts to reduce supply-side barriers in rural areas, such as
      community distribution of contraceptives, couples are still faced with multi-level
      demand-side barriers to contraceptive use. In addition to misinformation and fear of
      contraceptive side-effects, relationship dynamics, peer and family influence, and broader
      community norms promoting large family size and traditional gender roles influence family
      planning. This study will pilot test a multi-level, community-based intervention, which
      employs transformative community dialogues to alter individual attitudes and the perception
      of community norms that discourage family planning. Community dialogues are delivered to
      groups of couples enhanced to simultaneously address individual and interpersonal-level
      determinants of family planning and link couples to family planning services. The aims of
      this project are to conduct a pilot quasi-experimental controlled trial to: 1) assess
      acceptability and feasibility of the trial procedures and intervention content; 2) the
      intervention's potential efficacy on contraceptive uptake and continuation and intermediate
      outcomes (knowledge, attitudes, perceived community norms, partner communication and equity)
      through 6-month follow up.

      One village will be randomized to the multi-level intervention and one village to the control
      condition (attention-matched control intervention). Participation in the full study will last
      6 months. Participants will first complete a questionnaire after enrollment, and female
      participants will take a pregnancy test at baseline. Participants in both study arms will
      participate in interviewer administered questionnaires at 3 months and 6 months follow-up,
      pregnancy testing at 6-months follow-up for women, and will permit the research team to
      access their medical records to extract information about their contraceptive use and use of
      family planning services. Participants in the intervention arm will participate in a series
      of group sessions with other couples from the community. Group sessions will last
      approximately 90 minutes, including community dialogues to reconstruct group norms that
      discourage contraceptive use enhanced with activities to improve knowledge, motivation,
      couple dynamics, and link couples to services.
    

Intervention name(s): Multilevel Family Planning Intervention; Time and attention matched control
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The intervention is comprised of community dialogues, or facilitated discussions, aimed to reshape community norms around gender roles, equity, and family size, and critically analyze the social and community influences of "family-wealth" and poverty with the overall goal of reconstructing individual attitudes and group norms on paths to/definitions of a "successful family" inclusive of family planning. Dialogues are enhanced to address knowledge, motivation, self-efficacy, and relationship dynamics, tailored to men and women. Sessions include both gender segregated and integrated groups with couples in the community.; This intervention serves as the attention-matched control. The format and delivery will mirror that of the "Family Health = Family Wealth" intervention (i.e., number, timing, and duration of sessions). The focus of the intervention is on community sanitation and at-home hygiene (hand-washing, food preparation) following an intervention manual that was developed for community groups in Uganda.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Prevention