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Design and pilot testing of a church-based intervention to address interpersonal and intrapersonal barriers to uptake of family planning in rural Tanzania: a qualitative implementation study
  1. Christine Aristide1,
  2. Agrey Mwakisole2,
  3. Nelusigwe Mwakisole2,
  4. Mary Emmanuel2,
  5. Evarist Laizer2,
  6. Albert Kihunrwa3,
  7. David Downs4,
  8. Joyce Wamoyi5,
  9. Jennifer Downs1,6
  1. 1 Center for Global Health, Weill Cornell Medical College, New York, New York, USA
  2. 2 St Paul College, Mwanza, United Republic of Tanzania
  3. 3 Department of Gynecology and Obstetrics, Weill Bugando Medical Centre, Mwanza, United Republic of Tanzania
  4. 4 Keble College, University of Oxford, Oxford, UK
  5. 5 National Institute for Medical Research Mwanza Research Centre, Mwanza, United Republic of Tanzania
  6. 6 Internal Medicine, Weill Bugando Medical Centre, Mwanza, United Republic of Tanzania
  1. Correspondence to Christine Aristide, Center for Global Health, Weill Cornell Medical College, New York City, NY 10065, USA; cha4002{at}


Background Use of family planning (FP) saves the lives of mothers and children, and contributes to better economic outcomes for households and empowerment for women. In Tanzania, the overall unmet need for FP is high. This study aimed: (1) to use focus group data to construct a theoretical framework to understand the multidimensional factors impacting the decision to use FP in rural Tanzania; (2) to design and pilot-test an educational seminar, informed by this framework, to promote uptake of FP; and (3) to assess acceptability and further refine the educational seminar based on focus group data collected 3 months after the education was provided.

Methods We performed a thematic analysis of 10 focus group discussions about social and religious aspects of FP from predominantly Protestant church attenders prior to any intervention, and afterwards from six groups of church leaders who had attended the educational seminar.

Results Key interpersonal influences included lack of support from husband/partner, family members, neighbours and church communities. Major intrapersonal factors impeding FP use were lack of medical knowledge and information, misconceptions, and perceived incompatibility of FP and Christian faith. Post-seminar, leaders reported renewed intrapersonal perspectives on FP and reported teaching these perspectives to community members.

Conclusions Addressing intrapersonal barriers to FP use for leaders led them to subsequently address both intrapersonal and interpersonal barriers in their church communities. This occurred primarily by increasing knowledge and support for FP in men, family members, neighbours and church communities.

  • education and training
  • family planning service provision
  • ethnic minority and cultural issues
  • qualitative research

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  • Funding This work was made possible by the support of grants from the Weill Cornell Dean’s Diversity and Healthcare Disparity Research Award and the John Templeton Foundation.

  • Disclaimer The views expressed in this publication are those of the authors and do not necessarily reflect the views of the John Templeton Foundation. The funders had no role in the study design, analysis, manuscript writing, or decision to publish.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. De-identified qualitative data are available to qualified researchers for defined research projects. Please submit requests to Christine Aristide (ORCID number 0000-0001-9109-0117).

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