Effects of a community‐based, multi‐level family planning intervention on theoretically grounded intermediate outcomes for couples in rural Uganda: Results from a mixed methods pilot evaluation

Objectives This study tested the theoretically grounded conceptual model of a multi‐level intervention, Family Health = Family Wealth (FH = FW), by examining FH = FW's effect on intermediate outcomes among couples in rural Uganda. FH = FW is grounded in the social‐ecological model and the social psychological theory of transformative communication. Design A pilot quasi‐experimental controlled trial. Methods Two matched clusters (communities) were randomly allocated to receive the FH = FW intervention or an attention/time‐matched water, sanitation and hygiene intervention (N = 140, 35 couples per arm). Quantitative outcomes were collected through interviewer‐administered questionnaires at baseline, 7‐months and 10‐months follow‐up. Focus group discussions (n = 39) and semi‐structured interviews (n = 27) were conducted with subsets of FH = FW participants after data collection. Generalized estimated equations tested intervention effects on quantitative outcomes, and qualitative data were analysed through thematic analysis—these data were mixed and are presented by level of the social‐ecological model. Results The findings demonstrated an intervention effect on family planning determinants across social‐ecological levels. Improved individual‐level family planning knowledge, attitudes and intentions, and reduced inequitable gender attitudes, were observed in intervention versus comparator, corroborated by the qualitative findings. Interpersonal‐level changes included improved communication, shared decision‐making and equitable relationship dynamics. At the community level, FH = FW increased perceived acceptance of family planning among others (norms), and the qualitative findings highlighted how FH = FW's transformative communication approach reshaped definitions of a successful family to better align with family planning. Conclusions This mixed methods pilot evaluation supports FH = FW's theoretically grounded conceptual model and ability to affect multi‐level drivers of a high unmet need for family planning.