Study design and setting
This was a community-based household cross-sectional study, that was conducted in 12 communities located in the three Senatorial Zones of Abia State in southeastern Nigeria. It had an estimated population of 3,901,620 in 2018 projected from the 2006 national population census with an annual growth rate of 2.7%. Geopolitically, Abia State is divided into three senatorial districts―Abia North, Abia South, and Abia Central―with 17 Local Government Areas (LGAs) and has 291 political wards. Igbo language with varying dialects, and English are the major languages for communication. Abia State is inhabited mostly by the Igbo ethnic group, who are predominantly Christians with a few people who practice traditional religion. The Catholic doctrine forbids the use of modern family planning methods.
There are 517 public primary healthcare centres, 17 public secondary healthcare facilities, and two public tertiary healthcare centres. Family planning services are available across all health facilities and can be assessed at all levels of health facilities in the state, including chemist stores and private health facilities. There are no known existing taboos against family planning use in the state. In Nigeria, an urban area is defined as an area with a population size of ≥20,000 people, with basic social and physical infrastructure, and so designated through legal or administrative instruments . Based on the above definitions, the LGAs in Abia State have been categorized into rural and urban in the various senatorial zones. The state has 730 autonomous communities in Abia State, each with an Eze as the traditional ruler.
Sample size determination
Estimation of sample size was done using the sample size formula for cross-sectional studies. A minimum sample size of 616 was determined at a confidence level of 95%, a design effect of 1.5 with a margin error of 5%. This was based on the proportion of male involvement in reproductive services (30.9%) in a previous study. A non-response rate of 20% was assumed.
Study population and sampling strategy
The study population included men in a marital/cohabiting relationship with a spouse or partner from the selected communities. This category of men is believed to have had some experiences relating to reproductive health issues in marriage and/or fatherhood. Participants were included in the study if they met the eligibility criteria of being in the age group (15-59 years) as defined by NDHS , in a marital or cohabiting relationship, and living in the study area 6 months prior to the study. However, those with debilitating illnesses such as cerebrovascular diseases that could interfere with communication were excluded. A total of 616 men were recruited using the multistage sampling technique. Stage one: Six LGAs were selected using the balloting technique. They included Aba North, Umuahia North, Ohafia, Ugwunagbo, Bende, and Ikwuano LGAs. Stage two: In each LGA selected, the list of communities was obtained and they served as clusters. In each of the LGAs, two clusters were selected using a simple random sampling technique. In each cluster selected, fifty-two respondents were selected. Stage three: The grid method was used with the spinning of a pen to define the direction of flow to select the households. An eligible respondent was selected in each household visited until the required sample size was attained.
Study tool and data collection process
A pre-tested interviewer-administered semi-structured questionnaire with open- and closed-ended questions was used to collect information from the participants by trained research assistants over a month (November-December 2019). The questionnaire was adapted from previous studies.[11,20] The Cronbach's alpha index was 0.71. The Igbo translated version which was translated back to English to ensure that the original meaning was maintained, was also available for use. The questionnaire used for this study has four sections. Section 1 addressed sociodemographic variables such as age, marriage type, educational status, occupational status, religion, and denomination. Section 2 included socio-economic variables such as income, access to mass media, number of living children, educational status of spouse, and employment status of spouse. Section 3 included socio-cultural variables such as decision-maker on FP issues, accompanying spouse to FP clinic, and community and family support for accompanying spouse to FP clinic. Section 4 contained composite questions to measure the level of male involvement in family planning services. These included; Are you currently using any family planning method (s)? Have you ever discussed FP with your spouse/partner? Are you aware of any male FP method (s)? Have you ever attended any FP clinic? Have you ever discussed FP with a friend? And would you recommend FP to a friend?
Quality control and data management
The research assistants were properly trained to ensure accuracy in data collection. The questionnaire was pre-tested to detect and correct possible errors and identify any ambiguities before the initiation of the study using sixty (60) respondents (10% of the study sample size) in Old Umuahia (Umuahia South LGA) which was not selected for the study,
Measurement of variables
The dependent variable was the level of male involvement in family planning services. It was created as a composite variable comprising six (6) questions covering respondents' FP practices and FP perceptions. The responses were dichotomized (Yes/No), with a score of ‘No’= 0 and ‘Yes’ = 1. This gave a maximal score of six (6) and a minimum score of zero (0). A total score of 0 was classified as ‘None involvement’, while a score of 1-3 was classified as ‘passive involvement’ and a score of 4-6 was classified as ‘active involvement’. For the logistic regression, a score of 0-3 was recoded as ‘passive involvement’. The independent variables included age, educational status, occupational status, average monthly income, number of living children, educational status/employment status of spouse, decision-maker on FP issues, accompanying spouse to FP clinic, community and family support on accompanying spouse to FP clinic
Data coding, entry, cleaning, and analysis was done using SPSS version 20 statistical program for Windows. Univariate analysis was done to compare the independent variables of study subjects within the rural/urban settlements. Association between male involvement and the independent variables in family planning services was determined using chi-square (χ2-test) respectively, across both groups of comparison. The variables were dichotomized for ease of data analysis and interpretation. P values <0.05 and 95% confidence interval excluding the null values were considered significant. Logistic regression analysis was done to identify the significant predictors of men's involvement in family planning services. Factors that fitted into the regression model, were those with P values <0.2 at the level of bivariate analysis. The analysis was done based on a significance level of 5%. Adjusted odds ratios with 95% confidence intervals were computed for the significant variables at the level of bivariate analysis. Appropriate charts and tables were used to display the results.