Table 1 Overview of the Family Health = Family Wealth Intervention, Uganda 2021-22

Health worker capacity building (pre-couple sessions)

• Family planning refresher training provided to health workers at participating intervention health facility in partnership with the District Health Team to address training gaps in contraceptive knowledge and skills (identified through a needs assessment). Topics covered included information on contraceptive methods (efficacy, side effects, etc.), the technical provision of methods (including practicum-based learning on methods insertion/removal), and the provision of individual- and couples-based counseling.

Reduced wait time

• Intervention participants (as individual women or couples) can go ahead in the queue for family planning with study ID card, reinforcing existing “skip the queue” initiatives to incentive men’s engagement in women’s reproductive health services (couples attending together are worked on first), and expanding it by rewarding men’s attendance of family planning community dialogues by allowing women to skip the queue without her partner present if he was part of the group sessions.

Method distribution

• Counseling and short-term methods (i.e., condoms, pills), or referral to care for other methods, offered at the end of sessions 3 and 4 from a local health worker.

Group Sessions

Session 1

Men’s Only Session

~ 90 min

• Guided discussion to identify definitions of “family wealth,” barriers to family health and wealth, and redefine group definitions of a “successful” family. Content tailored to analyze and reshape norms relevant to men and women’s separate groups.

• Community leader endorses program participation and family planning.

Women’s Only Session

~ 90 min

Session 2

Men’s Only Session

~ 2 h

• Relationship Health: Guided discussion on healthy relationships and family planning (partner violence, communication, decision-making, caregiver roles, gender norms); gender equitable role modeling through vignettes

• Economic Health: Business skill training co-facilitated with a local business expert to increase interest in the program, improve couples’ shared decision-making, and highlight the importance of planning children to economic health.

Women’s Only Session

~ 2 h

• Physical Health: Contraceptive education co-facilitated with a local health worker

• Economic Health: Business skill training co-facilitated with a local business expert to increase interest in the program, improve couples’ shared decision-making, and highlight the importance of planning children to economic health.

Session 3

Couples’ Session

~ 2 h

• Physical Health: Contraceptive education co-facilitated with local health worker; Health worker provides family planning/linkages to care; couples create a “Family Action Plan” – setting family size and contraception goals

• Relationship Health: Communication skills building activities; couples set relationship goals in their Family Action Plan (take home assignment)

• Economic Health: Couples family budgeting; emphasizes the importance of budgeting for the future and highlights the importance of family planning by including the costs of raising children

Session 4

Couples’ Session

~ 2 h

• Relationship Health: Communication skills building activity (health communication/conflict resolution)

• Revisit Family Action Plan goals as a couple

• Economic Health: Couples set economic goals in their Family Action Plan (take home assignment)

• Guided discussion to identify community-level barriers and solutions for family planning acceptance, integrated into a “Community Action Plan” co-facilitated with community leader

• Physical Health: Local health worker to offer family planning/linkages to care

• Community leader concludes the program, with final messaging endorsing family planning