From: Context-acceptability theories: example of family planning interventions in five African countries
Context | Intervention components | Actor, empirical mechanism of acceptability, and outcome | Acceptability construct |
---|---|---|---|
CIAMO 1: Strong belief in religious values | Analysis of religious text together with religious leaders (I) | Religious leaders (A) recognise and agree that FP fits with their religious values (M) and accept FP (O) | Dominant: Ethicality Additional: Opportunity costs |
CIAMO 2: Traditional desire for large family | Focus FP messages on birth spacing rather than limitation (I) | Community (A) recognise and agree that spacing births does not have to compromise their family size aspirations (M) and accept FP (O) | Dominant: Ethicality Additional: Opportunity costs, intervention coherence |
CIAMO 3 and 4: MCM use stigmatised | Referral cards from childhood immunisations to FP services (I) | Women (A) fear the visibility of accessing FP services due to referral cards (M) and do not accept MCMs (O) | Dominant: Unintended consequences |
Provide access to MCMs in private (I) | Women (A) feel confident to accept MCMs when these MCMs are not visible to their peers (M) and accept MCMs (O) | Dominant: Self-efficacy and unintended consequences Additional: Opportunity costs | |
CIAMO 5, 6, and 7: Male partners non-accepting of FP or MCM use | Male role models promote financial, educational, and health benefits of FP/birth spacing (I) | Male partners (A) relate to and trust male role models and their messages (M) and therefore believe the messages (M) and accept birth spacing with MCMs (O) | Dominant: Intervention coherence Additional: Perceived effectiveness |
Religious leaders promote the alignment of FP with religious values (I) | Male partners (A) respect and trust religious leaders (M) and therefore believe in alignment of FP with religious values (M) and accept FP (O) | Dominant: Ethicality Additional: Opportunity costs | |
Integrated FP and childhood immunisation services (I) | Women (A) feel that they are able to hide their use of FP services and have autonomous decision-making (M) and accept MCMs (O) | Dominant: Self-efficacy Additional: Opportunity costs | |
CIAMO 8 and 9: Experience of or rumours of side effects of MCMs | Train HCWs and expert clients in the community to discuss side effects (I) | Women (A) feel they can talk to HCWs about side effects and seek advice on their management (M) and accept MCMs (O) | Dominant: Self-efficacy Additional: Unintended consequences |
Message layering (I) | Women (A) are convinced by messages having received them multiple times via multiple HCWs and CHWs (M) and accept MCMs (O) | Dominant: Self-efficacy Additional: Intervention coherence |