Table 2. Acceptability componentsa with illustrative quotations.
| (A) Use attributes: Ease and comfort of use, physical sensation in situ, discreetness/secrecy, side effects, ancillary benefits | I like them because once you wear it, you don't feel it, and nobody can suspect that you are wearing something. I like it because nothing changes regarding how we live as women [nobody can tell she is using the ring]. (SIDI1, Lilongwe) |
| (B) Delivery mechanism: Tablet, gel, ring, film, suppository, injectable | Because once we have worn the ring, it will be for once and for all [there is nothing more to be done apart from inserting the ring every month], we will have no inconveniences of carrying it around like we do with condoms. Even the use is different, because it is the man who puts on the condom; a woman does not put on the condom, and so nobody will know that you have the ring. (SIDI2, Lilongwe) |
| (C) Product characteristics: Color, size, smell, volume, consistency | When you seeing the ring for the first time you get shocked, I was too and almost quit because of the size of the ring. When you (are) using it you realise that it's easy to use, it's not a problem. I think what will happen is HIV will continue to spread even if the ring is found effective because people will look at the ring and think it's difficult to be used. I think there will be a need for classes to educate women about the ring …. It wasn't difficult, I got enough education before using it because I was really scared when I first saw it. I thought I was going to quit. But during education I learned that the ring was soft, I thought the ring was hard and painful. They showed that to insert the ring you need to twist it like 8 and when I tried it, it was easy and doable. (SIDI3, Durban) |
| (D) Dosing regimen: Daily, precoital, intermittent | Alright I, I just like that when you have inserted the ring you have inserted it [you are done] …. What's left is to come for the next visit. It's not like you will insert it every day or you will take it [orally] or what. It stays in there, I do not check it, I do not detach it, that is what I like on us-about the way it is used. (SIDI1, Harare) |
| (E) Effects on the sexualencounter: Lubrication, effect on sexual pleasure, timing of use | I noticed a difference before I had the ring and after I had the ring, I enjoy [sex] now, and my partner enjoys it. I don't have anything, I don't have a rash, I don't have a discharge, I am just the same, I don't have a problem with the ring … You see my vagina, I think it [the ring] tightened it [the vagina] and became small. Since I started using the ring, I can feel that when my partner and I are having sex, when he penetrates, I can feel the difference, because it [vagina] is tightened, you see. (SIDI1, Johannesburg) |
| (F) Partners attitude about product: Awareness, support of product use, approval/disapproval |
My husband and I accepted and I got support from him. You know some men might not want their partners to insert things in their vagina, but mine accepted it because he saw it was helping both of us. (SIDI2, Kampala) Yes he thought it was for family planning, then he said, ‘Please tell me (what this ring is).’ Then I said, ‘It does not concern you; it's about my life,’ and he said, ‘I will not give it to you.’ And he took it. (SIDI2, Kampala) |
| (G) Product associated norms: Stigma, community norms about product formulation | Some are saying that it is of some benefit because they will know whether the ring is effective in protecting women from STIs like HIV, while others say that there is no evidence [that the ring works], it is all a farce, that the drugs in the ring will cause problems, and that our systems will not function effectively in our bodies. (SIDI2, Lilongwe) |
a
As defined in Mensch et al. [18] conceptual model.