Positive deviance for promoting dual-method contraceptive use among women in Uganda: a cluster randomized controlled trial

Abstract

Background Dual-method contraceptive use, or using condoms with highly effective contraceptives, is effective at preventing both unintended pregnancies and HIV infections. Although it remains uncommon among women in long-term relationships in sub-Saharan Africa, some do practice it. The positive deviance approach aims to promulgate practices of such individuals to other members in the community. We examined the effects of a positive deviance intervention on the dual-method use among married or in-union women. Methods We conducted a cluster randomized controlled trial in 20 health facilities in Mbarara District, Uganda, with 960 women aged 18-49 years. The intervention was a combination of clinic- and phone-based counseling and a participatory workshop, which was developed based on the qualitative study of women practicing the dual-method use in the study area. The control group received regular clinic-based counseling and health-related messages via phone. We assessed dual-method contraceptive use at the last sexual intercourse and its consistent use at two, four, six, and eight months after enrollment. Findings More women in the intervention group reported dual-method contraceptive use at the last sexual intercourse at two months (AOR = 4.29; 95% CI: 2.12-8.69; p < 0.001) and at eight months (AOR = 2.19; 95% CI: 1.07-4.48; p = 0.032) than in the control group. Consistent dual-method contraceptive use was also more prevalent in the intervention group at two months (AOR = 13.71; 95% CI: 3.59-52.43; p < 0.001), and the intervention effect remained at four, six, and eight months. Conclusion Dual-method contraceptive use increased significantly among women in the intervention group. The positive deviance intervention can be a potential option for promoting the dual-method use among women in long-term relationships in Uganda.