Increasing coverage and uptake of voluntary family planning in urban areas of central-eastern Uganda: an implementation research study protocol

Abstract

Introduction While urban areas are often perceived and reported as better off due to the wide availability of and apparent proximity to services, family planning (FP) access among the marginalized communities such as slums might be worse. Although evidence on access to FP in urban space is illusive, just like rural poor, the urban poor residents are characterized by multidimensional challenges that not only limit the population from accessing voluntary FP (VFP) services but also expose them to unplanned sexual intercourse and ultimately unplanned pregnancies and other related consequences. In this study we seek to augment and strengthen existing efforts towards increasing coverage and uptake of VFP in Jinja city and Iganga Municipality, central eastern Uganda. Our primary question is “what interventions can effectively be packaged and delivered to increase uptake of VFP and promote urban thriving. Methods We propose to use the Human-Centered Design (HCD) approach to understand the needs, capabilities and challenges of users and ensure stakeholder engagement in the development or adaptation of solutions and design of programs through co-creation. As such, we shall implement in three faceted phases: formative assessment, design and implementation, implementation monitoring and evaluation. Monitoring, learning, and adaptation are embedded within the implementation process with the focus of using the information to guide implementation design and learning. Building on implementation research framework such as RE-AIM (reach, effectiveness, adoption, implementation, maintenance) and Fidelity frameworks, we shall apply process monitoring and evaluation approach to address questions related to what package of FP interventions work, for whom, under what circumstances and why. Discussion Guided by a strong learning and implementation flexibility, we hypothesize that our implementation will provide the segmentation specific high impact interventions in an urban context. We also hypothesize that the use human-centred approach will enable us to develop a tailored package of FP interventions that match different segments in an urban setting of developing countries.

How a co-design process led to more contextually relevant family planning interventions in emerging urban settings in Eastern Uganda

“…Several activities were proposed a priori at the start of the project under each of the three action areas ( Table 1 ). More details about the Urban Thrive Project are presented in the study protocol [ 28 ].…”

“…This phase includes all the efforts to gain an empathic understanding of the problem and the people involved within their context. For this study, this was achieved through a concurrent mixed methods study involving a household survey and qualitative study, as part of the Urban Thrive Project’s baseline assessment [ 28 ]. The household survey collected information on fertility (birth and pregnancy history), family planning use experience, sexuality (age at first sex, recent time of having sex, protected sex), knowledge of family planning methods, fertility, and family planning intention.…”

“…A total of 17 focus group discussions, 24 in-depth interviews, and 20 key informant interviews were done. Details of the data collection procedures are presented elsewhere [ 28 ].…”

Intra-urban inequalities in modern family planning use in Uganda’s urban settings: the role of place of residence, socio-economic, family, and individual factors

“…The study not only excluded women who refused to consent but also those who had severe illness at the time of the survey. Details on the study design and sampling are indicated in the study protocol [17].…”