Intention to switch from short-acting to long-acting reversible contraceptives among refugee women in Ethiopia: application of the theory of planned behavior

The validity of the theory of planned behavior (TPB) in predicting health behavior intention has proven its applicability to various health behaviors, such as condom uptake, HIV prevention, and contraception use in resource-limited settings. However, the effectiveness of the TPB framework in understanding refugee women’s intention to switch from short-acting contraceptives (SAC) to long-acting and reversible contraceptives (LARC) remains unclear. This study examined how the TPB predicts refugee women’s intention to switch from SAC to LARC. This study is a nested component of a larger retrospective cohort examining contraceptive use dynamics among women in Ethiopian refugee camps. Initially, 1,290 family planning records from selected health facilities in Ethiopian refugee camps were reviewed. These records included 551 women who began using contraceptives between September 2022 and February 2023 (387 started SAC and 164 started LARC). Among SAC users, 238 women who were current users and familiar with LARC methods (implants and/or IUDs) participated in this study. Data collection involved computer-assisted face-to-face interviews conducted using the Open Data Kit (ODK) toolkit. Four constructs, based on the TPB variables, measured using a 7-point Likert scale, were analyzed to explore the relationship between attitude, subjective norms, and perceived behavioral control as predictors of the intention to switch from SAC to LARC. The Structural Equation Model (SEM) with the Stata SEM Builder and maximum likelihood estimation was used to evaluate how well the data fit the TPB model and identify the key predictors of the intention to switch from SAC to LARC. All specified relations between the three constructs and the intention to switch from SAC to LARC in TPB were exhibited as statistically significant. The TPB model accounted for 66.3% of the variation in the intention to switch from SAC to LARC. A positive attitude toward LARC use (β = 0.16; P = .014), strong subjective norms (β = 0.46; P = .001), and higher perceived behavioral controls (β = 0.17; P = .001) had a positive influence on refugee women’s intention to switch from SAC to LARC. The TPB model demonstrated a good fit for examining refugee women’s intention to switch from SAC to LARC, with the subjective norm being the strongest predictor.