Context-acceptability theories: example of family planning interventions in five African countries
Abstract Background Family planning (FP) can lengthen birth intervals and potentially reduce the risk of foetal death, low birthweight, prematurity, and being small for gestational age. Effective FP is most easily achieved through access to and acceptability of modern contraceptive methods (MCMs). T...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-01-01
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| Series: | Implementation Science |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13012-020-01074-z |
| _version_ | 1811270973715906560 |
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| author | Jayne Webster Shari Krishnaratne Jenna Hoyt Shiferaw Dechasa Demissie Nathaly Spilotros Justine Landegger Misozi Kambanje Shannon Pryor Easterlina Moseti Seth Marcus Marius Gnintoungbe Dora Curry Jessie K. Hamon |
| author_facet | Jayne Webster Shari Krishnaratne Jenna Hoyt Shiferaw Dechasa Demissie Nathaly Spilotros Justine Landegger Misozi Kambanje Shannon Pryor Easterlina Moseti Seth Marcus Marius Gnintoungbe Dora Curry Jessie K. Hamon |
| author_sort | Jayne Webster |
| collection | DOAJ |
| description | Abstract Background Family planning (FP) can lengthen birth intervals and potentially reduce the risk of foetal death, low birthweight, prematurity, and being small for gestational age. Effective FP is most easily achieved through access to and acceptability of modern contraceptive methods (MCMs). This study aimed to identify mechanisms of acceptability and the contexts in which they are triggered and to generate theories to improve the selection and implementation of effective interventions by studying an intervention integrating FP with childhood immunisation services. Methods Qualitative interpretative synthesis of findings from realist evaluations of FP interventions in five African countries was guided by an analytical framework. Empirical mechanisms of acceptability were identified from semi-structured interviews and focus group discussions with key stakeholders (N = 253). The context in which these mechanisms were triggered was also defined. Empirical mechanisms of acceptability were matched to constructs of a theoretical framework of acceptability. Context-acceptability theories (CATs) were developed, which summarised constructs of acceptability triggered for specific actors in specified contexts. Examples of interventions that may be used to trigger acceptability for these actors were described. Results Seven CATs were developed for contexts with strong beliefs in religious values and with powerful religious leaders, a traditional desire for large families, stigmatisation of MCM use, male partners who are non-accepting of FP, and rumours or experiences of MCM side effects. Acceptability mechanisms included alignment with values and beliefs without requiring compromise, actors’ certainty about their ability to avoid harm and make the intervention work, and understanding the intervention and how it works. Additionally, acceptability by one group of actors was found to alter the context, triggering acceptability mechanisms amongst others. Conclusions This study demonstrated the value of embedding realist approaches within implementation research. CATs are transferable theories that answer the question: given the context, what construct of acceptability does an intervention need to trigger, or more simply, what intervention do we need to apply here to achieve our outcomes? CATs facilitate transfer of interventions across geographies within defined contexts. |
| first_indexed | 2024-04-12T22:12:54Z |
| format | Article |
| id | doaj.art-502cb72f67b14a7f8b8e349b0b628fef |
| institution | Directory Open Access Journal |
| issn | 1748-5908 |
| language | English |
| last_indexed | 2024-04-12T22:12:54Z |
| publishDate | 2021-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science |
| spelling | doaj.art-502cb72f67b14a7f8b8e349b0b628fef2022-12-22T03:14:40ZengBMCImplementation Science1748-59082021-01-0116111410.1186/s13012-020-01074-zContext-acceptability theories: example of family planning interventions in five African countriesJayne Webster0Shari Krishnaratne1Jenna Hoyt2Shiferaw Dechasa Demissie3Nathaly Spilotros4Justine Landegger5Misozi Kambanje6Shannon Pryor7Easterlina Moseti8Seth Marcus9Marius Gnintoungbe10Dora Curry11Jessie K. Hamon12Disease Control Department, London School of Hygiene and Tropical MedicineDisease Control Department, London School of Hygiene and Tropical MedicineDisease Control Department, London School of Hygiene and Tropical MedicineInternational Rescue Committee Ethiopia ProgrammeInternational Rescue Committee USInternational Rescue Committee USSave the Children Malawi Country OfficeSave the Children USWorld Vision InternationalWorld Vision USCARE BeninCARE USADisease Control Department, London School of Hygiene and Tropical MedicineAbstract Background Family planning (FP) can lengthen birth intervals and potentially reduce the risk of foetal death, low birthweight, prematurity, and being small for gestational age. Effective FP is most easily achieved through access to and acceptability of modern contraceptive methods (MCMs). This study aimed to identify mechanisms of acceptability and the contexts in which they are triggered and to generate theories to improve the selection and implementation of effective interventions by studying an intervention integrating FP with childhood immunisation services. Methods Qualitative interpretative synthesis of findings from realist evaluations of FP interventions in five African countries was guided by an analytical framework. Empirical mechanisms of acceptability were identified from semi-structured interviews and focus group discussions with key stakeholders (N = 253). The context in which these mechanisms were triggered was also defined. Empirical mechanisms of acceptability were matched to constructs of a theoretical framework of acceptability. Context-acceptability theories (CATs) were developed, which summarised constructs of acceptability triggered for specific actors in specified contexts. Examples of interventions that may be used to trigger acceptability for these actors were described. Results Seven CATs were developed for contexts with strong beliefs in religious values and with powerful religious leaders, a traditional desire for large families, stigmatisation of MCM use, male partners who are non-accepting of FP, and rumours or experiences of MCM side effects. Acceptability mechanisms included alignment with values and beliefs without requiring compromise, actors’ certainty about their ability to avoid harm and make the intervention work, and understanding the intervention and how it works. Additionally, acceptability by one group of actors was found to alter the context, triggering acceptability mechanisms amongst others. Conclusions This study demonstrated the value of embedding realist approaches within implementation research. CATs are transferable theories that answer the question: given the context, what construct of acceptability does an intervention need to trigger, or more simply, what intervention do we need to apply here to achieve our outcomes? CATs facilitate transfer of interventions across geographies within defined contexts.https://doi.org/10.1186/s13012-020-01074-zContext-acceptability theoryRealist evaluationFamily planning |
| spellingShingle | Jayne Webster Shari Krishnaratne Jenna Hoyt Shiferaw Dechasa Demissie Nathaly Spilotros Justine Landegger Misozi Kambanje Shannon Pryor Easterlina Moseti Seth Marcus Marius Gnintoungbe Dora Curry Jessie K. Hamon Context-acceptability theories: example of family planning interventions in five African countries Implementation Science Context-acceptability theory Realist evaluation Family planning |
| title | Context-acceptability theories: example of family planning interventions in five African countries |
| title_full | Context-acceptability theories: example of family planning interventions in five African countries |
| title_fullStr | Context-acceptability theories: example of family planning interventions in five African countries |
| title_full_unstemmed | Context-acceptability theories: example of family planning interventions in five African countries |
| title_short | Context-acceptability theories: example of family planning interventions in five African countries |
| title_sort | context acceptability theories example of family planning interventions in five african countries |
| topic | Context-acceptability theory Realist evaluation Family planning |
| url | https://doi.org/10.1186/s13012-020-01074-z |
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