Promoting "dual protection" from pregnancy and sexually transmitted disease: a social ecological approach.

High rates of unintended pregnancy and sexually transmitted disease in women challenge health promotion to identify improvements in "dual protection" interventions. Findings from an exploratory qualitative study using a social ecological model identify causal, contextual, and intervening factors that influence dual protection. The study examined 48 U.S. women completing a sexually transmitted disease clinic process and focused on women at high risk of unwanted pregnancy and sexually transmitted disease. We frame findings from these interviews using social ecology to illustrate the levels where intervention to promote the concept of dual protection and associated behaviors might occur. Presenting findings within this framework offer an understanding of complex factors that influence dual protection and also present an opportunity to consider strategies for promoting dual protection that include interventions at the structural/environmental level, the social/interpersonal level, and the individual level.