Women’s (15-49 years) choices, challenges and everyday realities in dual protection utilization, a cross-sectional study at Mbale Regional Referral Hospital

Abstract Background Dual protection, defined as the use of condoms together with an effective contraceptive method, provides protection against both unintended pregnancy and sexually transmitted infections (STIs), including HIV. Despite the availability of modern contraceptive methods, the use of dual protection remains suboptimal among women of reproductive age. Evidence on knowledge, attitudes, perceptions, and utilization of dual protection among women accessing family planning services in Eastern Uganda is limited. This study assessed knowledge, attitudes, perceptions, and factors associated with dual protection utilization among women aged 15–49 years accessing modern contraceptive services at Mbale Regional Referral Hospital, Eastern Uganda. Methods A descriptive cross-sectional study was conducted among women aged 15–49 years attending the family planning clinic at Mbale Regional Referral Hospital. A sample of 312 participants was determined using the Kish-Leslie formula, and participants were recruited using consecutive sampling. Data were collected using a structured questionnaire and analyzed using Stata version 15. Descriptive statistics were used to summarize participants' characteristics and levels of knowledge, attitudes, perceptions, and dual protection utilization. Associations between independent variables and dual protection utilization were assessed using chi-square tests and logistic regression. Statistical significance was assessed at p  < 0.05. Results Of the 312 participants targeted, 311 were included in the reported analysis of age and outcome measures. Overall, 73.31% (n = 228) of participants had good knowledge of dual protection, while 62.70% (n = 195) had a positive attitude. However, 52.90% (n = 164) had poor perceptions regarding dual protection. More than half of the participants (53.05%, n = 165) reported that they had never used a condom in addition to their current modern contraceptive method. Among participants who reported never using dual protection, partner refusal (45.83%, n = 77), fear of side effects from using two methods (28.57%, n = 48), and reduced sexual pleasure (19.05%, n = 32) were the most frequently reported reasons. In multivariable analysis, HIV testing history, awareness of dual protection, positive attitude towards dual protection, and number of sexual partners were associated with utilization. Women who had never tested for HIV, had never heard of dual protection, or had two sexual partners had lower odds of dual protection utilization, while women with a positive attitude had higher odds of utilization. Conclusion Although most participants demonstrated good knowledge and positive attitudes towards dual protection, reported utilization was low and perceptions were frequently unfavorable. Partner-related barriers, concerns about side effects and sexual pleasure, and limited provider discussion of condom use may contribute to low utilization. Integrating dual protection counselling into family planning and HIV services, together with strengthening condom negotiation and partner communication, may help address these barriers.