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. Key questions What is already known about this topic? Dual-method contraceptive use is incredible for preventing both unintended pregnancies and HIV infections but remains uncommon among women in long-term relationships in sub-Saharan Africa. The positive deviance approach aims to promulgate behaviors of individuals who have achieved rare success to other members in the community and has the potential to achieve sustainable behavioral change. What are the new findings? The proportion of women practicing dual-method contraception at the last sexual intercourse increased from 8.5% at baseline to 42.6% at two months after enrollment in the intervention group. Over 15% and 11% of women in the intervention group reported consistent dual-method contraceptive use at two and eight months, respectively. Between the intervention and control groups, the significant difference was detected for their consistent dual-method contraceptive use during the eight-month follow-up period. What do the new findings imply? The positive deviance intervention is effective in reducing the dual risk of unintended pregnancies and HIV infections through promoting dual-method contraceptive use among women in Mbarara District, Uganda. The positive deviance approach can help women to uptake and adhere to dual-method contraceptive use by disseminating the local solutions found among women already practicing it in the community.