Integrating qualitative and quantitative research methods to understand determinants of continued female condom use
In a 6-month follow-up study of women at high risk of sexually transmitted infection in Birmingham and Huntsville, Alabama (the “Female Condom Study”), participants received a behavioral intervention promoting the use of female and male condoms. All study participants provided epidemiologic, behavioral, psychosocial, and demographic data through participating in a series of quantitative interviews. A subset also participated in a semistructured qualitative interview.
In the present integrated qualitative-quantitative study, semistructured interview data from the qualitative study subgroup (n = 33) were used to strengthen quantitative model building in the entire study (N = 402). Qualitative methods were used to identify potential determinants of female condom use, and numerical measures were created to represent qualitative concepts. A composite numerical measure was then designed to combine multiple dimensions of a qualitative concept into a single measure—Couples' Female Condom Enjoyment (CFCE). Ten quantitative questionnaire items were selected and used to build linear discriminant functions that distinguished between categories of CFCE. Finally, CFCE was estimated for all study participants and entered as an independent variable in a theory-based multiple regression model of psychosocial predictors of continued female condom use.
Adjusting for other predictors, women with high CFCE were nearly three times as likely to use female condoms at least six times during the study period, as compared to women with low CFCE (OR: 2.8, 95% CI: 1.4, 5.6). Furthermore, CFCE enhanced the predictive properties of the regression model (Likelihood ratio test p-value: <10−16</super>).
The present study combined qualitative and quantitative information in a novel way. We believe that the methodological approach used in this study may prove valuable in other studies of health-related behavior. Furthermore, this study identified and tested a meaningful and statistically significant predictor of continued female condom use that would not have been readily identified through quantitative methods alone. CFCE was a strong and independent predictor of continued female condom use among women with primary sexual partners. For health providers, focusing on enjoyment may be an effective strategy for increasing levels of barrier protection among women in primary partnerships who are concerned with avoiding pregnancy or STI.