Development of a community-based peer-support intervention to improve contraceptive agency and diffuse...

The low use of self-injectable contraception, coupled with the recognition that many individuals need support beyond training to use self-care technologies successfully, suggests the need for innovative programming. We describe the participatory human-centered design process we used in two districts of Uganda to develop a community-based peer support intervention to improve women's agency to make and act on contraceptive decisions and help diffuse self-injectable contraception.

The design team included multi-disciplinary researchers from Uganda and the United States, representatives of local community-based organizations and village health teams, and local women of reproductive age. The research group conducted 21 in-depth interviews, 12 observations, and six focus group discussions to understand women's social support needs, contraceptive-seeking experiences, and communication channels. From these data, the design team derived insights into needs and opportunities to improve contraceptive agency and support self-injection use among interested women, spurring a creative idea-generation process to develop a large set of potential solutions. We collectively prioritized the most promising ideas into an integrated, theoretically informed intervention and subsequently prototyped, tested, and refined the intervention.

Design insights included: women value information from experienced peers and want support to navigate uneven partner dynamics, conflicting contraceptive information, concerns about contraceptive-related side effects, and unreliable contraception services. The final intervention-called I-CAN (English), Nsobola (Lusoga), An Atwero (Langi)-engages experienced self-injection users as 'mentors' to support other women ('mentees') they recruit in community-based settings. Mentors provide informational, instrumental, appraisal, and emotional support tailored to the individual needs of mentees. This support is designed to improve mentees' knowledge, consciousness of their rights related to contraception, self-efficacy, and perceived control related to contraceptive decision-making, self-injection self-efficacy, contraceptive access, and ability to act on preferences.

Our iterative human-centered design process incorporated diverse, lived experiences and scientific expertise and resulted in a peer support intervention with the potential to fill an important gap in contraception service delivery in Uganda. Our approach demonstrates that creating complex interventions to prioritize support for women's agency related to contraception in line with a human rights-based approach and to spread new contraceptive methods is feasible.