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Background <p>There is mounting evidence that social norms affect attitudes, decision-making, and behaviors related to contraceptive use. Integral to the self-care movement for women to have more control over their reproductive health, subcutaneous depot medroxyprogesterone acetate (DMPA-SC) is a contraceptive that can be safely administered by women themselves after training. DMPA-SC was introduced in Uganda in 2017 and is slowly gaining traction, especially among women who value a convenient and private method. However, only a small percentage of DMPA-SC users choose to self-inject, perhaps missing women who could benefit from its convenience and privacy. To date, no studies have tested if and how social norms are associated with interest and use of DMPA-SC self-injection.</p> Methods <p>We analyzed two waves of data from rural Uganda collected as part of the Innovations for Choice and Autonomy (ICAN) cohort study (<i>n</i> = 2,170 women of reproductive age who were not using self-injectable contraception at baseline). First, we used exploratory factor analysis to create a self-injection social norms scale. Next, we used unadjusted logistic regression models&#xa0;to examine the association between self-injection social norms scale scores at baseline and the two outcomes (interest in self-injection at baseline and self-injection use at six-month follow-up). Finally, we used multivariable logistic regression to examine the same&#xa0;associations&#xa0;controlling for confounding by sociodemographic characteristics.</p> Results <p>Factor analysis showed a four item, one factor solution for the Self-injection Social Norms Scale (alpha = .78). After adjusting for confounding variables, Self-injection Social Norms Scale scores were associated with an increased odds of being interested in self-injecting at baseline (AOR: 1.92, CI: 1.66– 2.22) and increased odds of self-injecting at follow up (AOR: 1.55, CI: 1.19– 2.00).</p> Discussion <p>The Self-injection Social Norms Scale is a new 4-item measure that can be used by researchers and program implementors. Our finding that social norms related to self-injection are associated with women’s interest in, and subsequent use of, self-injectable contraception suggest that promoting supportive social norms around self-injection shows potential as one strategy to enhance programmatic work aimed at bolstering women’s ability to choose this method if it aligns with their preferences.</p>

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A longitudinal study examining how self-injection social norms are associated with contraceptive self-injectable interest and use in rural Uganda

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年6月30日

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  • Erica Sedlander,
  • Nitya Turaga,
  • Catherine Birabwa,
  • Ronald Wasswa,
  • Beth Phillips,
  • Dinah Amongin,
  • Sneha Challa,
  • Sylvie Nano,
  • Betty Kyobe,
  • Agnes Kayego,
  • Peter Waiswa,
  • Kelsey Holt

摘要

Background

There is mounting evidence that social norms affect attitudes, decision-making, and behaviors related to contraceptive use. Integral to the self-care movement for women to have more control over their reproductive health, subcutaneous depot medroxyprogesterone acetate (DMPA-SC) is a contraceptive that can be safely administered by women themselves after training. DMPA-SC was introduced in Uganda in 2017 and is slowly gaining traction, especially among women who value a convenient and private method. However, only a small percentage of DMPA-SC users choose to self-inject, perhaps missing women who could benefit from its convenience and privacy. To date, no studies have tested if and how social norms are associated with interest and use of DMPA-SC self-injection.

Methods

We analyzed two waves of data from rural Uganda collected as part of the Innovations for Choice and Autonomy (ICAN) cohort study (n = 2,170 women of reproductive age who were not using self-injectable contraception at baseline). First, we used exploratory factor analysis to create a self-injection social norms scale. Next, we used unadjusted logistic regression models to examine the association between self-injection social norms scale scores at baseline and the two outcomes (interest in self-injection at baseline and self-injection use at six-month follow-up). Finally, we used multivariable logistic regression to examine the same associations controlling for confounding by sociodemographic characteristics.

Results

Factor analysis showed a four item, one factor solution for the Self-injection Social Norms Scale (alpha = .78). After adjusting for confounding variables, Self-injection Social Norms Scale scores were associated with an increased odds of being interested in self-injecting at baseline (AOR: 1.92, CI: 1.66– 2.22) and increased odds of self-injecting at follow up (AOR: 1.55, CI: 1.19– 2.00).

Discussion

The Self-injection Social Norms Scale is a new 4-item measure that can be used by researchers and program implementors. Our finding that social norms related to self-injection are associated with women’s interest in, and subsequent use of, self-injectable contraception suggest that promoting supportive social norms around self-injection shows potential as one strategy to enhance programmatic work aimed at bolstering women’s ability to choose this method if it aligns with their preferences.