The goal of the proposed study is to contribute to a better understanding of how women make decisions to use or not to use dual methods for protection against unintended pregnancy and STD/HIV. The study will (1) identify factors, both positive and negative, which influence dual method use (DMU) in two groups of women, one at high saliency for pregnancy (family planning clients) and one at high saliency for sexually transmitted disease (STD service clients); 2) develop a hierarchical model of the DMU decision-making process in each group by determining relative weights for important identified factors; (3) suggest possible strategies for improving adoption and continuation of DMU; and (4) draw implications from the modeling process for research DMU in other populations, e.g. men and adolescents, with emphasis on studies to document the predictive validity of the model. The methodology for this study integrates qualitative and quantitative data collection in a two-phase design. Phase 1 will consist of in-depth qualitative interviews in which participants will be asked to share their experiences and perspectives concerning DMU, identifying issues which they believe enter women's decisions to engage or not engage in DMU. Contributing factors thus identified will be the basis for a hierarchical model with ordering of factors under more general theoretical constructs. In Phase 2, the quantitative survey model with ordering of factors under more general theoretical constructs. In Phase 2, the quantitative survey component, this model will be evaluated by asking 180 women to weight the relative importance of each factor according to its potential influence on DMU decisions. New weight utility scores will then be calculated for each risk-saliency group. Investigators will use analysis of variance to compare factors between the groups and rank-ordering to identify differences in group profiles. Study outcomes will include implications for serve to women at dual reproductive risk and recommendations for continued DMU research to test the model in other populations.
