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

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...

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Autores principales: Kosugi, Hodaka, Shibanuma, Akira, Kiriya, Junko, Ong, Ken Ing Cherng, Mucunguzi, Stephen, Muzoora, Conrad, Jimba, Masamine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400262/
https://www.ncbi.nlm.nih.gov/pubmed/32664646
http://dx.doi.org/10.3390/ijerph17145009
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author Kosugi, Hodaka
Shibanuma, Akira
Kiriya, Junko
Ong, Ken Ing Cherng
Mucunguzi, Stephen
Muzoora, Conrad
Jimba, Masamine
author_facet Kosugi, Hodaka
Shibanuma, Akira
Kiriya, Junko
Ong, Ken Ing Cherng
Mucunguzi, Stephen
Muzoora, Conrad
Jimba, Masamine
author_sort Kosugi, Hodaka
collection PubMed
description 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.
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spelling pubmed-74002622020-08-23 Positive Deviance for Dual-Method Promotion among Women in Uganda: A Qualitative Study Kosugi, Hodaka Shibanuma, Akira Kiriya, Junko Ong, Ken Ing Cherng Mucunguzi, Stephen Muzoora, Conrad Jimba, Masamine Int J Environ Res Public Health Article 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. MDPI 2020-07-12 2020-07 /pmc/articles/PMC7400262/ /pubmed/32664646 http://dx.doi.org/10.3390/ijerph17145009 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Kosugi, Hodaka
Shibanuma, Akira
Kiriya, Junko
Ong, Ken Ing Cherng
Mucunguzi, Stephen
Muzoora, Conrad
Jimba, Masamine
Positive Deviance for Dual-Method Promotion among Women in Uganda: A Qualitative Study
title Positive Deviance for Dual-Method Promotion among Women in Uganda: A Qualitative Study
title_full Positive Deviance for Dual-Method Promotion among Women in Uganda: A Qualitative Study
title_fullStr Positive Deviance for Dual-Method Promotion among Women in Uganda: A Qualitative Study
title_full_unstemmed Positive Deviance for Dual-Method Promotion among Women in Uganda: A Qualitative Study
title_short Positive Deviance for Dual-Method Promotion among Women in Uganda: A Qualitative Study
title_sort positive deviance for dual-method promotion among women in uganda: a qualitative study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400262/
https://www.ncbi.nlm.nih.gov/pubmed/32664646
http://dx.doi.org/10.3390/ijerph17145009
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