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

Abstract Background Family planning (FP) can lengthen birth intervals and potentially reduce the risk of foetal death, low birthweight, prematurity, and being small for gestational age. Effective FP is most easily achieved through access to and acceptability of modern contraceptive methods (MCMs). This study aimed to identify mechanisms of acceptability and the contexts in which they are triggered and to generate theories to improve the selection and implementation of effective interventions by studying an intervention integrating FP with childhood immunisation services. Methods Qualitative interpretative synthesis of findings from realist evaluations of FP interventions in five African countries was guided by an analytical framework. Empirical mechanisms of acceptability were identified from semi-structured interviews and focus group discussions with key stakeholders (N = 253). The context in which these mechanisms were triggered was also defined. Empirical mechanisms of acceptability were matched to constructs of a theoretical framework of acceptability. Context-acceptability theories (CATs) were developed, which summarised constructs of acceptability triggered for specific actors in specified contexts. Examples of interventions that may be used to trigger acceptability for these actors were described. Results Seven CATs were developed for contexts with strong beliefs in religious values and with powerful religious leaders, a traditional desire for large families, stigmatisation of MCM use, male partners who are non-accepting of FP, and rumours or experiences of MCM side effects. Acceptability mechanisms included alignment with values and beliefs without requiring compromise, actors’ certainty about their ability to avoid harm and make the intervention work, and understanding the intervention and how it works. Additionally, acceptability by one group of actors was found to alter the context, triggering acceptability mechanisms amongst others. Conclusions This study demonstrated the value of embedding realist approaches within implementation research. CATs are transferable theories that answer the question: given the context, what construct of acceptability does an intervention need to trigger, or more simply, what intervention do we need to apply here to achieve our outcomes? CATs facilitate transfer of interventions across geographies within defined contexts.

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Opportunities and Challenges in the Ethiopian Bamboo Sector: A Market Analysis of the Bamboo-Based Value Web

Sustainability ◽

10.3390/su11061644 ◽

2019 ◽

Vol 11 (6) ◽

pp. 1644 ◽

Cited By ~ 2

Author(s):

Jessie Lin ◽

Saurabh Gupta ◽

Tim Loos ◽

Regina Birner

Keyword(s):

Product Diversification ◽

Value Addition ◽

Structured Interviews ◽

Group Discussions ◽

Product Lines ◽

Potential Source ◽

Key Stakeholders ◽

Effective Training ◽

Challenges And Opportunities ◽

Collection Methods

Bamboo is one of the more important natural resources in Ethiopia and contributes to the bioeconomy as a potential source for high-value products. While the country is the largest producer of bamboo in Africa, the existing utilization of the bamboo sector in Ethiopia remains under-developed, with little value addition. This study identifies the current market challenges and opportunities for future developments of the northern Ethiopian bamboo sector, with a focus on the Injibara township. This research adopts the “value web” approach to assess the potentials of different product lines that create the bamboo biomass value web. We utilize qualitative data collection methods, in particular, semi-structured interviews and informal focus group discussions with key stakeholders. Our findings suggest that bamboo farmers in Injibara are constrained by a lack of local demand and market for bamboo products with high-value addition, leading to an absence of product diversification and innovation. Furthermore, there is an overreliance on foreign technology and methods that are poorly matched for local needs. We recommend that policymakers invest in targeted and effective training strategies on bamboo cultivation and processing. Furthermore, farmers can benefit from decreasing their reliance on middle men with cooperatives or contract arrangements.

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European influence in ITU-R: the end of an era of dominance?

Info ◽

10.1108/info-01-2014-0003 ◽

2014 ◽

Vol 16 (4) ◽

pp. 1-17 ◽

Cited By ~ 3

Author(s):

Mohamed Ali El-Moghazi ◽

Jason Whalley ◽

James Irvine

Keyword(s):

European Countries ◽

Current Debate ◽

Structured Interviews ◽

Allocation Mechanism ◽

African Countries ◽

Content Type ◽

Key Stakeholders ◽

The World ◽

Spectrum Policy

Purpose – The purpose of this paper is to examine the influence of the European countries in Region 1 of the Radio Sector of the International Telecommunications Union (ITU-R). More specifically, the focus is on the World Radiocommunication Conference 2012 meeting to explore whether European influence is in decline. Design/methodology/approach – This article adopts in-depth case study of the 700-MHz issue. Qualitative data are drawn from semi-structured interviews with key stakeholders who participated at the World Radiocommunication Conference 2012 meeting. Findings – This article concludes that the influence of European countries in the ITU-R in Region 1 has changed. The influence of Arab and African countries has increased, with that of European countries declining. However, European countries remain more influential than their African and Arab counterparts. Research limitations/implications – This article sheds light on an often overlooked but pivotal element of the international spectrum allocation mechanism. Originality/value – This article sheds light on important developments in the international spectrum policy that are largely overlooked in the current debate.

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The views of key stakeholders in Zimbabwe on the introduction of postgraduate family medicine training: A qualitative study

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v9i1.1469 ◽

2017 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Cherifa Sururu ◽

Robert Mash

Keyword(s):

Family Medicine ◽

Private Sector ◽

Government Support ◽

Economic Conditions ◽

Successful Implementation ◽

Structured Interviews ◽

African Countries ◽

District Health ◽

Primary Health ◽

Key Stakeholders

Background: Strengthening primary health care (PHC) is a priority for all effective health systems, and family physicians are seen as a key member of the PHC team. Zimbabwe has joined a number of African countries that are seriously considering the introduction of postgraduate family medicine training. Implementation of training, however, has not yet happened.Aim: To explore the views of key stakeholders on the introduction of postgraduate family medicine training.Setting: Key academic, governmental and professional stakeholders in Zimbabwean health and higher education systems.Method: Twelve semi-structured interviews were conducted with purposively selected key stakeholders. Data were recorded, transcribed and analysed using the framework method.Results: Anticipated benefits: More effective functioning of PHC and district health services with reduced referrals, improved access to more comprehensive services and improved clinical outcomes. Opportunities: International trend towards family medicine training, government support, availability of a small group of local trainers, need to revise PHC policy. Anticipated barriers: Family medicine is unattractive as a career choice because it is largely unknown to newly qualified doctors and may not be recognised in private sector. There is concern that advocacy is mainly coming from the private sector. Threats: Economic conditions, poor remuneration, lack of funding for resources and new initiatives, resistance from other specialists in private sector.Conclusion: Stakeholders anticipated significant benefits from the introduction of family medicine training and identified a number of opportunities that support this, but also recognised the existence of major barriers and threats to successful implementation.

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Family planning providers and contraceptive users in Rwanda employ strategies to prevent discontinuation

BMC Women s Health ◽

10.1186/s12905-021-01503-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hilary Schwandt ◽

Angel Boulware ◽

Julia Corey ◽

Ana Herrera ◽

Ethan Hudler ◽

...

Keyword(s):

Family Planning ◽

Side Effects ◽

Contraceptive Use ◽

First Year ◽

Modern Contraceptive ◽

Group Discussions ◽

Program Success ◽

Family Planning Programs ◽

Contraceptive Discontinuation

Abstract Background In Rwanda, nearly a third of contraceptive users discontinue within the first year of use. Family planning programs often focus more on recruitment of new users as opposed to maintaining use among current users. A focus on sustaining users and minimizing discontinuation is imperative for long-term family planning program success. This study explores the efforts providers and contraceptive users in Rwanda employ to prevent one of the greatest challenges to family planning programs: contraceptive discontinuation. Methods This was a qualitative study conducted in Rwanda between February and July 2018. It included eight focus group discussions with 88 family planning providers and 32 in-depth interviews with experienced modern contraceptive users. Data were collected in two districts with the highest (Musanze) and lowest (Nyamasheke) rates of contraceptive use. Data were analyzed using thematic content approach. Results Family planning providers in this study used the following strategies to prevent discontinuation: counseling new users on the potential for side effects and switching, reminding clients about appointments for resupply, as well as supporting dissatisfied users by providing counseling, medicine for side effects, and discussing options for switching methods. Users, on the other hand, employed the following strategies to prevent discontinuation: having an understanding that experiences of side effects vary by individuals, supporting peers to sustain use, persisting with use despite experiences of side effects, and switching methods. Conclusions The strategies used by family planning providers and users in Rwanda to prevent discontinuation suggest the possibility of long-term sustained use of contraception in the country. Harnessing and supporting such strategies could contribute to sustaining or improving further contraceptive use in the country.

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Tourism as a Career in Malaysia: Stakeholders' Perceptions

10.26686/wgtn.16959508.v1 ◽

2021 ◽

Author(s):

◽

Muhammad Rudy Khairudin Mohd Nor

Keyword(s):

Human Resource Development ◽

Work Experience ◽

Analytical Framework ◽

Structured Interviews ◽

Skilled Labour ◽

Tourism Management ◽

Key Stakeholders ◽

Overseas Travel ◽

Inclusive Approach ◽

The Government

<p>This thesis examines the perceptions of tourism as a graduate career from the view of key stakeholders of tourism - the government, industry, educators and students. It aims to understand what key tourism stakeholders in Malaysia do in promoting tourism as a graduate career, and how students perceive tourism as a career option. The literature suggests that the issue of perceptions of tourism as a career be investigated from the perspective of key stakeholders. Hence, a stakeholder-inclusive approach in tourism human resource development is suggested as a measure to address the skilled labour shortage in tourism and the needs of various stakeholders. An analytical framework has been developed in this thesis to illustrate the relationships and gaps amongst stakeholders and how they view tourism as a graduate career in Malaysia. A total of 11 semi-structured interviews were conducted with senior officials from relevant Ministries, industry bodies, a major employer, and directors of tourism management programs at two public universities and two polytechnics in Malaysia. In addition to that, a questionnaire survey was conducted with 193 final year students of tourism management programs at the same tertiary institutions. The qualitative data was coded into prominent themes while the quantitative data was analyzed using SPSS. This thesis found that the shortage of skilled labour is one of the issues faced by the stakeholders, due to the industry offering low level positions. The government believes that current policies in promoting tourism careers to students were adequate but the industry and educators feel that government does not provide adequate information about career paths in tourism for students. This thesis also discovered that students have generally positive perceptions of tourism as a career. Variables like level of education, willingness to choose a tourism program and overseas travel experience are significant, while the size of the employer, work experience in tourism, and the roles of family and friends working in tourism do not have an influence on students' career-related decisions. All stakeholders play a role in promoting tourism as a career to students but some measures have also been suggested to promote it more effectively.</p>

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Women Deprivation Index and Family Planning Utilisation in Urban Geography of West African Countries

Frontiers in Global Women's Health ◽

10.3389/fgwh.2021.656062 ◽

2021 ◽

Vol 2 ◽

Author(s):

Akanni Ibukun Akinyemi ◽

Jacob Wale Mobolaji ◽

John Olugbenga Abe ◽

Elhakim Ibrahim ◽

Olutoyin Ikuteyijo

Keyword(s):

Family Planning ◽

Secondary Analysis ◽

Binary Logistic Regression ◽

Health Care Utilisation ◽

West African ◽

Modern Contraceptive ◽

Binary Logistic Regression Model ◽

African Countries ◽

Log Odds ◽

Long Acting

Inequalities in health care utilisation and outcomes vary significantly across geographies. Though available evidence suggests disparity in contraceptive uptake in favour of urban compared with rural geographies, there are unassessed nuances among women in urban communities. This study examines some of these disparities within the context of socioeconomic deprivations and family planning utilisation among urban women in West Africa. A secondary analysis of the most recent Demographic and Health Survey dataset of five selected West African countries was conducted, using pooled data of 21,641 women aged 15–49 years. Associations between family planning utilisation and women's deprivation status were investigated using a binary logistic regression model. The findings show that more than one-quarter of the women were severely deprived across the countries except Senegal (17.4%), and the severely deprived consistently have relatively low contraceptive prevalence rates (CPR) (16.0–24.3%) compared with women with no/low deprivation across the countries except Senegal (39.8%). The results for long-acting reversible contraceptives (LARC) were not consistent across the five countries: whereas, LARC utilisation was lower among severely deprived women in Nigeria (9.1%), Guinea (9.6%), and Mali (19.3%), utilisation was similar across the deprivation groups in Benin and Senegal. In the multivariable analyses, the log-odds of modern contraceptive utilisation decreases by 0.27 among the moderately deprived (ß = −0.27, SE = 0.05, p < 0.01) and by 0.75 among the severely deprived women (ß = −0.75, SE = 0.05, p < 0.01) compared with those with no/low deprivation, with variations across the countries. Similarly, the log-odds of LARC utilisation decreases by 0.44–0.72 among the severely deprived women compared with those with no/low deprivation across the countries except Senegal. This study concluded that family planning intervention programmes and policies need to underscore the deprivation context of urban geographies, particularly among women living in informal settlements.

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Is Co-Management Still Feasible to Advance the Sustainability of Small-Scale African Inland Fisheries? Assessing Stakeholders’ Perspectives in Zambia

Sustainability ◽

10.3390/su132413986 ◽

2021 ◽

Vol 13 (24) ◽

pp. 13986

Author(s):

Sydney Kapembwa ◽

Jόn G. Pétursson ◽

Alan J. Gardiner

Keyword(s):

Small Scale ◽

Structured Interviews ◽

Focus Group Discussions ◽

African Countries ◽

Group Discussions ◽

Inland Fisheries ◽

Fisheries Resources ◽

Alternative Approach ◽

Fisheries Policy ◽

Governance Strategies

Co-management has been promoted as an alternative approach to the governance of small-scale inland fisheries resources and has been implemented in many African countries. It has, however, not proven to be a simple solution to improve their governance; hence, most African inland fisheries are still experiencing unsustainable overexploitation of their resources. As such, there is a need for reassessing the application of governance strategies for co-management that should strive to strengthen the participation of stakeholders, primarily the local fishers, as they are fundamental in the governance of fisheries resources. Therefore, this study set out to explore the prospects of a co-management governance approach at a Lake Itezhi-Tezhi small-scale fishery in Zambia. Focus group discussions with fishers and semi-structured interviews with other stakeholders were used to collect data. This study revealed that the stakeholders perceive co-management as a feasible approach to governance of the Lake Itezhi-Tezhi fishery. However, the feasibility of the co-management arrangement would be dependent mostly on the stakeholders’ ability to address most of the ‘key conditions’ criteria highlighted in the study. This study also identified the need to establish a fisheries policy to provide guidelines for the co-management, coming with decentralisation of power and authority to the local fishers.

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“As a woman who watches how my family is… I take the difficult decisions”: a qualitative study on integrated family planning and childhood immunisation services in five African countries

Reproductive Health ◽

10.1186/s12978-021-01091-1 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Jenna Hoyt ◽

Shari Krishnaratne ◽

Jessie K. Hamon ◽

Lydia Boudarene ◽

Tracey Chantler ◽

...

Keyword(s):

Decision Making ◽

Family Planning ◽

Unmet Need ◽

Economic Benefits ◽

Sub Saharan Africa ◽

Cultural Norms ◽

Modern Contraceptive ◽

Health Providers ◽

Childhood Immunisation ◽

African Countries

Abstract Background Family planning (FP) has the potential to improve maternal and child health outcomes and to reduce poverty in sub-Saharan Africa. However, substantial unmet need for modern contraceptive methods (MCMs) persists in this region. Current literature highlights multi-level barriers, including socio-cultural norms that discourage the use of MCMs. This paper explores women’s choices and decision-making around MCM use and examines whether integrating FP services with childhood immunisations influenced women’s perceptions of, and decision to use, an MCM. Methods 94 semi-structured interviews and 21 focus group discussions with women, health providers, and community members (N = 253) were conducted in health facilities and outreach clinics where an intervention was delivering integrated FP and childhood immunisation services in Benin, Ethiopia, Kenya, Malawi and Uganda. Data were coded using Nvivo software and an analytical framework was developed to support interpretative and thematic analyses on women’s decision-making about MCM use. Results Most women shared the reproductive desire to space or limit births because of the perceived benefits of improved health and welfare for themselves and for their children, including the economic advantages. For some, choices about MCM use were restricted because of wider societal influences. Women’s decision to use MCMs was driven by their reproductive desires, but for some that was stymied by fears of side effects, community stigma, and disapproving husbands, which led to clandestine MCM use. Health providers acknowledged that women understood the benefits of using MCMs, but highlighted that the wider socio-cultural norms of their community often contributed to a reluctance to use them. Integration of FP and childhood immunisation services provided repeat opportunities for health providers to counter misinformation and it improved access to MCMs, including for women who needed to use them covertly. Conclusions Some women chose to use MCMs without the approval of their husbands, and/or despite cultural norms, because of the perceived health and economic benefits for themselves and for their families, and because they lived with the consequences of short birth intervals and large families. Integrated FP and childhood immunisation services expanded women’s choices about MCM use and created opportunities for women to make decisions autonomously.

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“… the way we welcome them is how we will lead them to love family planning.”: family planning providers in Rwanda foster compassionate relationships with clients despite workplace challenges

BMC Health Services Research ◽

10.1186/s12913-021-06282-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hilary M. Schwandt ◽

Angel Boulware ◽

Julia Corey ◽

Ana Herrera ◽

Ethan Hudler ◽

...

Keyword(s):

Data Analysis ◽

Family Planning ◽

Contraceptive Use ◽

Health Workers ◽

Government Support ◽

Modern Contraceptive ◽

Group Discussions ◽

Short Period ◽

Study Participants ◽

Depth Interviews

Abstract Background Rwanda has markedly increased the nation’s contraceptive use in a short period of time, tripling contraceptive prevalence in just 5 years between 2005 and 2010. An integral aspect of family planning programs is the interactions between family planning providers and clients. This study aims to understand the client-provider relationship in the Rwandan family planning program and to also examine barriers to those relationships. Methods This qualitative study in Rwanda utilized convenience sampling to include eight focus group discussions with family planning providers, both family planning nurses and community health workers, as well as in-depth interviews with 32 experienced modern contraceptive users. Study participants were drawn from the two districts in Rwanda with the highest and lowest modern contraceptive rates, Musanze and Nyamasheke, respectively Data analysis was guided by the thematic content approach, Atlas.ti 8 was utilized for coding the transcripts and collating the coding results, and Microsoft Excel for analyzing the data within code. Results Data analysis revealed that, despite workplace related challenges – including inadequate staffing, training, and resources, relationships between providers and clients are strong. Family planning providers work hard to understand, learn from, and support clients in their initiation and sustained use of contraceptives. Conclusion Given the existing context of purposeful efforts on the part of family planning providers to build relationships with their clients, if the current level of government support for family planning service provision is enhanced, Rwanda will likely sustain many current users of contraception and engage even more Rwandans in contraceptive services in the future.

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