Positive Deviance for Dual-Method Promotion among Women in Uganda: A Qualitative Study
Abstract
:1. Introduction
2. Methods
2.1. Project Overview and Study Setting
2.2. Study Participants
2.3. Participant Enrolment
2.4. Data Collection
2.5. Data Analysis
2.6. Ethics
3. Results
3.1. Participant Characteristics
3.2. Barriers to Dual-Method Use for Women Using HECs in Stable Relationships
3.2.1. Low Perceived Need for Dual-Method Use
“I trust my husband, and he trusts me as well. We have always lived together for a long time. Why do we need to use a condom? I am using injection now, and I am no longer worried about being pregnant again.”(Non-PD, 36 years old, 1-025)
3.2.2. Difficulty Suggesting and Persuading Partners to Use Condoms
“My husband often travels for his work, so I do not know if he has slept with other women or not. I suggested that he use a condom. But he did not agree because I was using family planning. He said we should trust each other. I could not say anything. I am not sure if it is safe to sleep with him until I know the HIV result.”(Non-PD, 24 years old, 5-017)
3.3. Positive Deviant Behavior of Women Practicing Dual-Method Use in Stable Relationships
3.3.1. High Perceived Risk of Unintended Pregnancies and HIV/STIs
“My partner and I have been married for years, but I understand all human beings can make mistakes, especially men these days. I am not saying my husband is not trustworthy, but using condoms gives me a sense of relief when I have sexual intercourse with him.”(PD, 31 years old, 3-024)
“I got an STI shortly after my husband came back from his travel. I knew it came from him. I thought it was not only one time but would happen again. So, I decided to use condoms and discussed with him. That is how I started using condoms in our relationship.”(PD, 25 years old, 2-014)
“I have been using injectables, but I sometimes forget when it will be expired. To prevent pregnancy in such cases, I believe it is important to use both. I know some friends of mine have got pregnant somehow while using family planning methods. I do not know if it is true, but I heard injectables can expire before three months because they receive an insufficient dose. So, I believe condoms are necessary for women who want to avoid pregnancy.”(PD, 18 years old, 2-002)
“Condoms can prevent me from getting pregnant and infections from my partner. But I have experienced condoms slipping several times. I already have two children, so we do not want to have any more babies. That is why using two different methods is important to me.”(PD, 22 years old, 5-023)
3.3.2. Effective Communication about Dual-Method Use
“I often visited the health facility for postnatal care and family planning after delivering my child. I was given counseling on family planning and condom use. I got worried about HIV infection and told my partner about what I learned one day. He also got interested and started discussing condom use.”(PD, 27 years old, 2-004).
“I do not trust my partner as he often travels for work, and he avoids testing for HIV together. He did not agree to use condoms when I suggested it, so I avoided having sex with him several times, maybe for three months. He was not happy, but I thought it was important to protect myself.”(PD, 27 years old, 2-004).
“If I tell him to use a condom suddenly before having sex, he may get surprised and angry, thinking I am accusing him of infidelity. If he gets mad and tries to defend himself, it is difficult to keep discussing it. So, I brought up this sensitive topic when he first came back home from his travels, when he seemed to be in a good mood, in the same way that we talk about ordinary things.”(PD, 27 years old, 2-004).
“I always talked with him in a gentle manner, not accusing him of his sexual behavior. I talked about HIV and STI risk without condom use in a general setting, not between him and me, like a teacher. He likes discussions and tries to show off his knowledge. I think it helped him realize he did not use condoms although he explained the importance of condom use.”(PD, 31 years old, 3-024)
“I did not hide from him that I had got an infection before, which I might have got from my partner. I always mentioned how sad I was at that time when I suggested using condoms. But I did not accuse him of this, because it creates tension between us. I always tried to be calm when talking about condom use with him. Now he understands I am really serious about STIs and always uses condoms without me reminding him to do so.”(PD, 27 years old, 4-010)
“I did not tell him that I was using family planning. I had been using it before we got married, but I had never told him. I knew he would not agree to use condoms if he knew that I would not get pregnant because of injections.”(PD, 27 years old, 4-010).
“I avoid sex when my husband has been drinking. It is hard to discuss condom use rationally with him when he is drunk, and we may end up arguing. I just leave him until he falls asleep by himself.”(PD, 31 years old, 3-024).
3.3.3. Instructing Their Partners on How to Use A Condom
“I learned how to put on a male condom during family planning counseling. I even practiced with a model penis at that time. I returned home with a few condoms and showed him how it works. We had never used condoms before, but it went smoothly. I am sure I am handier than him.”(PD, 25 years old, 2-014)
“I taught him the right way to use condoms. It will help him avoid getting HIV and other STIs even if he is sleeping with another woman while he is away. This means that it can protect me and my children as well in the end.”(PD, 40 years old, 1-022)
3.3.4. Obtaining Condoms from A Variety of Sources
“My partner refused to use condoms when I suggested it, saying they smelled bad. I, actually, also hate the rubber smell of free condoms. So, I bought condoms from a pharmacy. They have nice smells such as chocolate and vanilla, and he said he wanted to try them. I think there are many types, so if people do not like the free condoms, they might consider trying purchased ones.”(PD, 21 years old, 5-021)
“It is difficult for him to buy condoms, so I receive condoms when I visit the health facility. I am not afraid because I am the one who is at risk, and it is my responsibility to protect myself. I keep them in my purse [showing condoms to the interviewer].”(PD, 40 years old, 1-022)
“When I cannot get condoms from the dispenser at the health center, I normally talk to the nurses because they have some stock and are willing to give them to patients.”(PD, 22 years old, 5-023)
“I feel embarrassed[receiving condoms in front of many people, but I can take condoms without feeling any shyness by going there when there are not so many people, like late afternoon and evening.”(PD, 31 years old, 3-024)
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variables | PDs (n = 9) | Non-PD (n = 10) | Total (n = 19) | |||
---|---|---|---|---|---|---|
n | % | n | % | n | % | |
Age, mean in years (SD) | 25.9 | (6.6) | 29.3 | (5.0) | 27.7 | (5.9) |
Education | ||||||
None | 2 | 22.2 | 1 | 10.0 | 3 | 15.8 |
Primary | 6 | 66.7 | 9 | 90.0 | 15 | 79.0 |
Secondary or more | 1 | 11.1 | 0 | 0.0 | 1 | 5.3 |
Religion | ||||||
Roman Catholic | 3 | 33.3 | 2 | 20.0 | 5 | 26.3 |
Protestant/Other Christian | 3 | 33.3 | 7 | 70.0 | 10 | 52.6 |
Muslim | 3 | 33.3 | 1 | 10.0 | 4 | 21.1 |
Ever given birth | ||||||
No | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 |
Yes | 9 | 100.0 | 10 | 100.0 | 19 | 100.0 |
No. of children, mean (SD) | 2.4 | (2.2) | 2.6 | (1.4) | 2.5 | (1.8) |
Type of HECs | ||||||
Injectables | 7 | 77.8 | 7 | 70.0 | 14 | 73.7 |
Implants | 1 | 11.1 | 3 | 30.0 | 4 | 21.1 |
OCPs | 1 | 11.1 | 0 | 0.0 | 1 | 5.3 |
Theme | Description |
---|---|
Low perceived need for dual-method use | Women had low perceived need of using condoms with their partners due to
|
Difficulty suggesting and persuading partners to use condoms when women are aware of the risk of HIV/STIs from their partners | Women had never discussed dual-method use with their partners due to
|
Limited access to condoms | Women had limited access to a condom when necessary due to
|
Concerns about condom use | Women had concerns about condom use, such as
|
Theme | Description |
---|---|
High perceived risk of unintended pregnancies and HIV/STIs | Women had high levels of risk perception of unintended pregnancy and HIV/STIs regardless of HEC use |
Effective communication about dual-method use | Women communicated with partners to practice dual-method use effectively through
|
Instructing partners on how to use a condom | Women instructed their partners on how to use condoms |
Obtaining condoms from a variety of sources | Women obtained condoms from several sources such as health facilities and pharmacies to preserve their access to a variety of condoms |
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Share and Cite
Kosugi, H.; Shibanuma, A.; Kiriya, J.; Ong, K.I.C.; Mucunguzi, S.; Muzoora, C.; Jimba, M. Positive Deviance for Dual-Method Promotion among Women in Uganda: A Qualitative Study. Int. J. Environ. Res. Public Health 2020, 17, 5009. https://doi.org/10.3390/ijerph17145009
Kosugi H, Shibanuma A, Kiriya J, Ong KIC, Mucunguzi S, Muzoora C, Jimba M. Positive Deviance for Dual-Method Promotion among Women in Uganda: A Qualitative Study. International Journal of Environmental Research and Public Health. 2020; 17(14):5009. https://doi.org/10.3390/ijerph17145009
Chicago/Turabian StyleKosugi, Hodaka, Akira Shibanuma, Junko Kiriya, Ken Ing Cherng Ong, Stephen Mucunguzi, Conrad Muzoora, and Masamine Jimba. 2020. "Positive Deviance for Dual-Method Promotion among Women in Uganda: A Qualitative Study" International Journal of Environmental Research and Public Health 17, no. 14: 5009. https://doi.org/10.3390/ijerph17145009