Assessing the application of adapted theory of planned behaviour in predicting postpartum family planning intentions in a pragmatic randomized control trial in Western Kenya
Outcomes: Sexual and Reproductive Health
View SourceKey Social Norms Take-aways Social norms—captured as perceived normative beliefs and partner/community expectations—are a central driver of postpartum family planning (PPFP) intentions. The study shows that women are more likely to intend to use PPFP when they perceive approval and support from significant others (e.g., partners, family, providers). Normative beliefs operate alongside attitudes and perceived control, reinforcing that social expectations around fertility timing and contraceptive use are critical levers for behavior change.
Objectives To assess the application of an adapted Theory of Planned Behaviour (TPB) model in predicting intention to use early postpartum family planning among women in Western Kenya, and to identify key determinants influencing these intentions.
Methods A pragmatic randomized controlled trial was conducted with 246 pregnant women attending antenatal care, assigned to nurse-led, community health worker-led, or control groups. The intervention involved structured family planning counseling. Social norms were measured through perceived normative beliefs (e.g., partner approval, social expectations, perceived pressure), alongside other TPB constructs including attitudes, perceived behavioral control, satisfaction with counseling, and perceived risk. Data were collected using validated Likert-scale instruments and analyzed using structural equation modeling (SEM) to examine predictors of PPFP intention.
Results Early PPFP uptake was high overall (85.8%), with significantly higher uptake in intervention arms compared to control. SEM results showed that perceived normative beliefs, attitudes toward PPFP, perceived behavioral control, and satisfaction with counseling were significant predictors of intention. Normative beliefs had a strong positive association with intention (β≈0.24, p<0.0001), indicating the importance of social approval and expectations. Attitudes were the strongest predictor (β≈0.63), while perceived behavioral control also contributed significantly. Perceived risk of early pregnancy was not a significant predictor. The final model explained approximately 71% of the variance in intention. Conclusions: The adapted TPB model is effective in predicting postpartum family planning intentions in this context. Social norms—particularly perceived expectations and approval from partners and communities—play a critical role in shaping intentions, alongside individual attitudes and perceived control. Interventions aiming to increase PPFP uptake should therefore not only provide information but also actively engage social networks, address normative expectations, and strengthen supportive environments for contraceptive use.
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