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Table 4 Context-acceptability theories

From: Context-acceptability theories: example of family planning interventions in five African countries

Theory 1 In contexts of strong belief in religious values and powerful religious leaders
Religious leaders’ recognition that FP aligns with these values and they do not need to compromise on their values will lead to their acceptability of FP.
An example of an intervention is the examination of religious text to identify passages aligning with FP.
Mechanisms of acceptability: ethicality and opportunity costs
Theory 2 In contexts of strong belief in religious values and of powerful religious leaders
Men’s trust in religious leaders’ belief that there is alignment between FP and religious values will lead to acceptability of FP by men.
An example intervention is religious leaders promoting the alignment of religious text with FP.
Mechanism of acceptability: ethicality
Theory 3 In contexts of traditional desire for a large family
The community’s recognition that FP does not require a compromise of their family size aspirations will lead to their acceptability of FP.
An example intervention is the focussing of messages and trainings on birth spacing.
Mechanisms of acceptability: ethicality and opportunity costs
Theory 4 In contexts where MCMs are stigmatised
Providing the potential for women to feel that they can access MCMs discretely will lead to their acceptability.
Example interventions are providing access to FP services outside of clinic hours and avoiding presenting women with written notification of their attendance, such as referral cards.
Mechanism of acceptability: self-efficacy and opportunity costs
Theory 5 In contexts where male partners are non-accepting of FP or MCM use
Providing the potential for women to feel that they can access MCMs discretely will lead to their acceptability.
An example intervention is the co-delivery of immunisation and FP services.
Mechanism of acceptability: self-efficacy
Theory 6 In contexts where male partners are non-accepting of FP or MCM use
Men’s recognition of the financial, educational, and health benefits of using MCMs for birth spacing will lead to the acceptability of MCM use when they trust those delivering the messages.
An example intervention is using male role models to deliver messages on the financial, educational, and health benefits of MCMs.
Mechanism of acceptability: intervention coherence and self-efficacy
Theory 7 In contexts where there are rumours or experience of MCM side effects
Women need to feel that they can manage potential side effects. Ensuring that there are trained HCWs and community health workers that women can talk to about potential side effects will lead to women’s acceptability of MCMs.
An example intervention is the training of expert clients and satisfied family planning users from the community.
Mechanism of acceptability: self-efficacy