Key Social Norms Take-aways Social norms—particularly perceived expectations and approval from partners, family members, and peers—play a critical role in shaping refugee women’s contraceptive decision-making. The study found that subjective norms were the strongest predictor of women’s intention to switch from short-acting contraceptives (SAC) to long-acting reversible contraceptives (LARC). This suggests that contraceptive choices in humanitarian settings are strongly influenced by social approval and community relationships, highlighting the importance of engaging partners, families, and community networks in family planning interventions.
Objectives The study aimed to assess whether the Theory of Planned Behavior (TPB) can predict refugee women’s intention to switch from SAC to LARC in Ethiopian refugee camps and identify the key psychological and social factors influencing this intention.
Methods This study was conducted as a nested component of a retrospective cohort study on contraceptive use among refugee women in Ethiopia. Family planning records were initially reviewed, and 238 current SAC users who were aware of LARC methods participated in computer-assisted face-to-face interviews. The study measured attitudes toward LARC, subjective norms, perceived behavioral control, and intention to switch methods using seven-point Likert-scale items. Structural Equation Modeling (SEM) was used to test how well TPB constructs predicted intention to switch contraceptive methods.
Results Refugee women’s intention to switch from SAC to LARC was generally low, with only about one-quarter reporting positive intention. However, the TPB model explained 66.3% of the variation in switching intention. All three TPB constructs were significant predictors: positive attitudes toward LARC (β=0.16), stronger subjective norms (β=0.46), and greater perceived behavioral control (β=0.17) increased women’s intention to switch methods. Among these factors, subjective norms had the largest influence, indicating that social pressure and approval from important others strongly shape contraceptive intentions.
Conclusions The study demonstrates that the TPB framework is effective for understanding contraceptive decision-making among refugee women in humanitarian settings. Social norms—particularly perceived support or pressure from partners, families, and peers—are central to shaping intentions to switch contraceptive methods. Family planning programs aiming to increase LARC uptake in refugee contexts should therefore address social influences and promote supportive community environments alongside improving women’s access to services.