Most existing flexible count regression models allow only approximate inference. Balanced discretization is a simple method to produce a mean-parametrizable flexible count distribution starting from a continuous probability distribution. This makes easy the definition of flexible count regression models allowing exact inference under various types of dispersion (equi-, under- and overdispersion). This study describes maximum likelihood (ML) estimation and inference in count regression based on balanced discrete gamma (BDG) distribution and introduces a likelihood ratio based latent equidispersion (LE) test to identify the parsimonious dispersion model for a particular dataset. A series of Monte Carlo experiments were carried out to assess the performance of ML estimates and the LE test in the BDG regression model, as compared to the popular Conway-Maxwell-Poisson model (CMP). The results show that the two evaluated models recover population effects even under misspecification of dispersion related covariates, with coverage rates of asymptotic 95% confidence interval approaching the nominal level as the sample size increases. The BDG regression approach, nevertheless, outperforms CMP regression in very small samples (n = 15 − 30), mostly in overdispersed data. The LE test proves appropriate to detect latent equidispersion, with rejection rates converging to the nominal level as the sample size increases. Two applications on real data are given to illustrate the use of the proposed approach to count regression analysis.

Dual-method use is the most reliable form of protection against unintended pregnancies and HIV/STIs. Although dual-method use remains uncommon among women in stable relationships, some women do practice it. In this study, we explored the barriers that make dual-method use rare and the behaviors of women who practice dual-method use using a positive deviance framework in Uganda. We screened 150 women using highly effective contraceptives at five health facilities. We identified nine women who practiced dual-method use and 141 women who did not. In a qualitative study, we conducted in-depth interviews with all nine women practicing dual-method use and 10 women randomly selected out of the 141 who did not. We performed a thematic analysis using the positive deviance framework. Regardless of practicing dual-method use or not, women faced perceived barriers against dual-method use, such as partner’s objection, distrust, shyness about introducing condoms into marital relationships, and limited access to condoms. However, women practicing dual-method use had higher levels of risk perception about unintended pregnancies and HIV/STIs. They also engaged in unique behaviors, such as influencing their partners’ condom use by initiating discussions, educating their partners on sexual risks and condom use, and obtaining condoms by themselves. These findings will be useful in developing effective community-led and peer-based interventions promoting dual-method use to reduce the dual burden of unintended pregnancies and HIV/STIs among women in Uganda.