Key Social Norms Take-aways This study demonstrates the power of community-based, gender-transformative dialogue to shift entrenched social norms that hinder contraceptive use among couples in rural Uganda. Using the theory of transformative communication, the intervention successfully challenged norms around gender inequity and large family size by reshaping perceptions of a “successful family” and fostering more equitable household dynamics. Community dialogues and couple-based discussions played a pivotal role in altering individual attitudes, improving partner communication, and transforming perceived community acceptance of family planning.
Objectives The study aimed to assess the preliminary effects of the “Family Health = Family Wealth” intervention on intermediate family planning outcomes among couples in rural Uganda, examining changes across individual, interpersonal, and community levels.
Methods A mixed-methods embedded experimental design was used, comprising a quasi-experimental controlled trial with 140 participants (70 couples) and qualitative data collection through focus groups and interviews. Quantitative data were gathered via structured questionnaires at baseline, 7, and 10 months, and analyzed using generalized estimating equations. Thematic analysis was applied to qualitative data, and findings were integrated using a QUAN(+qual) design.
Intervention Details Family Health = Family Wealth is a multi-level, community-based intervention grounded in the social-ecological model and transformative communication theory. It involved four facilitated group dialogue sessions (two gender-segregated, two mixed-gender) for couples, complemented by health system strengthening. The sessions addressed gender norms, family planning, and definitions of family success, and included skill-building, goal-setting exercises, and involvement of community leaders to promote male engagement and family planning acceptance.
Results The intervention led to significant improvements in contraceptive knowledge, positive attitudes toward family planning, and intentions to use it. It also reduced inequitable gender attitudes, enhanced spousal communication, and increased joint decision-making. At the community level, perceived norms favoring family planning acceptance rose. Qualitative findings confirmed that both men and women challenged traditional roles, adopted more equitable behaviors, and redefined success in family life to include planning and gender partnership.
Conclusions This pilot evaluation supports the Family Health = Family Wealth model’s effectiveness in shifting key determinants of contraceptive use by addressing social norms across ecological levels. Its transformative dialogue approach offers a promising framework for future interventions aiming to reduce unmet family planning needs in similar low-resource contexts.