Effectiveness of couple-based maternity education on husbands' involvement in maternity continuum of care service utilization in rural communities of Central Ethiopia: Protocol of cluster randomized controlled trial.

BACKGROUND: Despite the availability of high-impact maternal survival interventions along the continuum of care strategies, maternal mortality remains the major tragedy in resource poor settings. In low income countries interventions addressing role of husband and its effect on maternal health is not well studied, particularly in rural set up of Ethiopia. Therefore this study is designed to evaluate the effect of couple-based maternity education on husband involvement on maternity continuum of care.

METHODS: We will use a cluster randomized controlled trial of two parallel groups to evaluate the effectiveness of couple-based maternity education on improving husband involvement in maternity continuum of care. Sample size is calculated by using G-power 3.1 and a 1:1 allocation ratio will be used. Sixteen kebeles will be randomly assigned to 8 interventions and 8 control groups with 248 couples in each group. Women who are in the early stages of their second trimester with their husbands will participate in the study. Group maternity education and home visits will be the intervention packages. Data analysis will be performed with an intention-to-treat analysis approach and will be analyzed using SPSS version 25.0 software. An independent effect of the intervention on the outcome of the interest will be assessed using multivariable logistic regression with generalized estimating equation model.

CONCLUSION: This trial result will generate conclusive evidence to policy makers about the effectiveness of couple-based maternity education to empower husband involvement in maternity continuum of care in rural Ethiopia.

TRIAL REGISTRATION: This trial was prospectively registered with the African Clinical Trials Registry on 04 December 2025 (PACTR202512868895726).