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Table 3 Contexts, interventions, actors, mechanisms, and constructs of acceptability

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