Academic journal article International Perspectives on Sexual and Reproductive Health

Evaluation of a Communication Campaign to Improve Continuation among First-Time Injectable Contraceptive Users in Nyando District, Kenya

Academic journal article International Perspectives on Sexual and Reproductive Health

Evaluation of a Communication Campaign to Improve Continuation among First-Time Injectable Contraceptive Users in Nyando District, Kenya

Article excerpt

Consistent and correct contraceptive use is necessary for women who want to limit their family size. Unfortunately, many women who wish to space or stop childbearing discontinue contraceptive use. Variables consistently associated with contraceptive discontinuation include method type, side effects, age, number of living children, fertility intentions and change in marital status. (1) Other measures linked to discontinuation--although not consistently across studies--include number of methods available, (2) socioeconomic factors, (1,3,4) urban-rural residence, (3) husband's disapproval of contraceptive use (5) and cost of or access to methods. (2,4) Studies have shown that quality of family planning services affects discontinuation, although such results have not been strong or consistent. (2,6-8)

Sustained method use is particularly problematic among users of the injectable contraceptive. (9) In Kenya, the injectable is the most popular method--used by 22% of married women in 2009; however, 29% discontinued use within 12 months of starting. Issues related to side effects are a major reason for women's discontinuation of the injectable.

To date, few interventions aimed at reducing contraceptive discontinuation have been evaluated; those that have have focused on improving counseling, and their assessments have yielded mixed results. (10-15) Communication campaigns, which deliver messages repetitively, have been associated with increased adoption of contraceptive use; (16-21) in these studies, radio was an important channel of message delivery. Such campaigns may be a viable means of improving method continuation.

In this study, we developed and evaluated a communication campaign to increase contraceptive continuation rates among first-time injectable users in Nyando District, Kenya.

Theoretical Model

Our model for predicting contraceptive continuation expands on the Bruce-Jain framework (22) and has been described elsewhere. (23) The Bruce-Jain framework links quality of family planning services to fertility through contraceptive prevalence, acceptance and continuation. It outlines six elements of service quality: choice of methods, information given to clients, provider competence, client-provider relations, follow-up and continuity mechanisms, and appropriate constellation of services. Quality of services is primarily considered a supply factor. Demand factors, including fertility motivations, also influence continuation. Couples' desire or motivation to regulate their fertility is considered the most important factor affecting demand for contraception.

We expanded on the Bruce-Jain framework by adding constructs from the theories of reasoned action and planned behavior. (24,25) The theory of reasoned action was developed to understand the relationship between attitudes and behaviors. (24) According to this theory, the most important predictor of behavior is intention, which is influenced by attitudes and subjective norms associated with the behavior. Subjective norms are influenced by an individual's perception of the attitudes of important referents toward the behavior and motivation to comply with those referents. In this study, the salient referents are those influencing women's contraceptive behavior (i.e., family members, service providers).

The theory of planned behavior contributed the construct of perceived behavioral control to reasoned action, to account for factors outside the individual's control that may influence intention and behavior. In the context of this study, contraceptive users' beliefs about continuing method use should be determined and addressed for behavior change to occur. Specifically, beliefs that inhibit the desired behavior should be countered and those that encourage the behavior should be supported.

On this theoretical basis, we included in our model perceived side effects and health concerns held by contraceptive users and salient referents. …

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