Effect of implementing guideline instruction on awareness of newly married women regarding family planning methods

Introduction

Increasing population growth is a worldwide problem today. Family planning saves lives and can improve the health of women, children and society as a whole. Gaining control of one’s reproductive choices and fertility has health benefits for both mother and child. Some people have argued that enhanced living standards and life expectancy, education, and women’s emancipation are the most effective ways to reduce fertility and curb populations growth, though of course contraceptive methods should be available. However, it has been noted that having family planning programs and services available speeds up fertility decline and slows population growth. ⁽¹⁾

The health impact of family planning occurs primarily, through the avoidance of unwanted pregnancies, limiting the number of births,  proper spacing, and timing the births particularly the first and last, in relation to the age of the mother. ⁽²⁾  A variety of different methods of contraception are available, which are generally extremely safe compared with the risks associated with pregnancy and childbirth. Not all methods are suitable for everyone. Expanding the number of family planning options available to women is a critical part of increasing contraceptive coverage, decreasing unintended pregnancies and reducing maternal morbidity and mortality around the globe. ⁽³⁾

There are 5 primary ways family planning methods can work: 1) block sperm from reaching the egg; 2) change the man’s sperm so they cannot fertilize the egg; 3) prevent eggs from being released; 4) thicken mucus in the cervix, preventing sperm from passing; 5) alter the lining of the uterus (womb) so the fertilized egg does not attach or implant on. Many methods have multiple actions, and it is currently not possible to precisely determine the contribution of each. Periodic abstinence is often a part of fertility awareness-based methods (natural family planning). These methods can also be used to increase the chances of achieving a pregnancy. ⁽⁴⁾

Contraception (birth control) may be part of the nurse’s responsibility in family-planning clinics, in physician or nurse-midwife practices, or on the postpartum or gynecology units of an acute care hospital. The nurse’s role in family planning includes the following: (answering general questions about contraceptive methods, explaining different methods that are available, including accurate information about their advantages and disadvantages, and teaching the correct use of the method or methods of contraception that the patient chooses), etc. ⁽⁵⁾

Significance of the study

• In developing countries, there is lack of knowledge of newly married about different methods of family planning.
• High fertility and rapid population growth have an impact on the overall socio-economic development of the country in general and maternal and child health in particular. ⁽⁶⁾

Aim of the study

The aim of this study was to assess the effect of implementing educational guideline on awareness of newly married women regarding family planning methods.

Research question

What is the effect of implementing guideline instruction on awareness of newly married women regarding family planning methods?

Subjects and Methods

Research Design:

A Descriptive research design has been utilized in the present study.

Setting:

This study was carried out at MCH centers in Minia city especially at premarital counseling services office; there are 2 MCH centers in Minia city. Western MCH center serving Minia city only that is providing care for about one thousand woman each year. Eastern MCH center covering the whole Minia centers (9 centers) and providing care for about two thousands woman each year. Both centers work from 9 A.m to 2 p.m.

Sample

A purposive sample of newly prides was recruited in the current study according to Inclusion criteria: newly married women, Women who can read and write to be able to read the guideline. Exclusion criteria: previously married, divorced or widow women and prides went to perform the certificate after marriage has occurred. A total of 10% of prides presented to both MCH centers in 2016 with a total 3000 prides were recruited to be included in the study, so sample became 300 pride, 150 prides was taken from each MCH center.

Tools of the study:

A structured interviewing questionnaire tool was designed by the researcher that aims to identify the effect of implementing guideline instruction on awareness of newly married women regarding family planning methods in Minia city. The questionnaire was composed primarily of closed-ended questions with a set of defined answers, from which the interviewee was asked to choose one response in some questions and more answer in other questions. The interviewer was instructed to read the questions aloud and to record respondents’ answers.

The questionnaire includes the following parts:-

Part 1: Sociodemographic data: This includes (Participant’s age, educational level, occupation, Residence, Husband’s age, Husband’s occupation, average monthly income).

Part 2: Awareness about family planning methods: This includes questions to assess the woman's knowledge about family planning methods such as:

Whether she heard about the word "birth spacing"?, What does birth spacing mean to her? , different types of contraceptives, the first choice of contraceptive methods for newly married women, whether she use any one of them?, Sources of information regarding contraceptives, Side effects of family planning methods, the possible complications that may arise after using contraceptives, Who must prescribe the contraceptive methods?, What are places to go that introduce family planning services?, and whether she need for more information about contraceptive methods?.

Scoring system

Level of knowledge was assessed by evaluating questions of awareness, Each correct answer corresponds to 1 point, some questions have one answer so it takes either (zero if no answer or 1 if correct answer) and other questions have more than one answer that takes either (zero if no answer, 1if one answer or 2 if more than one answer) so there was a total of 31 points for questions that evaluate awareness. A total score of 10 or less was considered have poor knowledge, and participants who scored (11-19) were considered have good knowledge, while score of 20 or more considered to have very good knowledge.

Regarding guideline instruction, it contained all information the woman may need about different family planning methods, each method how it works, when to start, advantages, disadvantages, side effects, and complications. The guideline also supplied with figures.

Validity of tools

To establish validity, the questionnaire was piloted on Jury committee composed of a panel of 5 experts of Obstetrics and Gynecological staff, and Nursing professors (Minia and Assiut universities) who reviewed the tool for clarity, relevance, comprehensiveness, understanding, applicability and easiness.

Ethical consideration:

An official permission and consent was obtained from the dean of the Faculty of Nursing, as well as the directors of both MCH centers after explaining the nature and purpose of the study. Prides have the right to refuse to participate and or withdraw from the study without any rational any time. Prides privacy was considered during collection of data no health hazards were present.  Participants were assured that all their data are highly confidential.

A pilot study

A pilot study was done for (10%) of the participants (30 prides) from the sample to test the applicability and clarity of the questions in the tool and the necessary modification was done. According to the results of the pilot study, tools modifications were done and the prides that were tested in the pilot study were excluded from the main study sample. The total sample was collected on the modified sheet.

Procedure:

The following phases were adopted to fulfill the aim of the current study; assessment, planning, implementation, and evaluation phases. These phases were carried out from March 2016 to January 2017. Official approvals and letters to conduct this research were obtained from research ethical committee of faculty of nursing, dean of faculty and director of each MCH center.

Assessment phase: in which data was obtained and recorded by the researcher from the prides in the MCH center while she attended to perform premarital certificate. Data assess their knowledge about family planning methods, at the beginning of the interview the researcher greeted each participant, explained the purpose, duration, and activities of the study and taken oral consent.

Planning phase: in which the educational guideline was developed by the researchers based on relevant review of literature, in a form of printed Arabic brochure to satisfy the main aim of the research

The main objective of the educational intervention was to raise participants' awareness about different family planning methods

Implementation phase: After filling the questionnaire, the researcher provided health education about family planning methods and answer to all questions of participants related to this subject. Also corrects misconceptions inherited from different sources. At the end of each interview, each pride received a guideline. Then instruct participants to attend the MCH center after three months of  the guideline to carry the posttest test and evaluate its effect on their level of knowledge by the same format of the questionnaire.

Evaluation phase: Contact the woman after passing 3 months following marriage, some of them came to the center where follow up was carried out by actual interview and others apologized to attend so the researcher was obliged to perform the follow up through the telephone. Using the same interviewing questionnaire. The researcher turned to refill the same questionnaire to evaluate the effect of the implemented guideline on their awareness about contraceptives.

Statistical analysis

The collected data was tabulated, computerized, analyzed and summarized by using descriptive statistical tests to test research questions by using SPSS version (20). Comparison between pretest data and posttest data was done using Chi square and P. value considering P. value ≤ 0.05 (significant) and P≤ 0.001 (highly significant).

Result

Table (1): Distribution of the sample according to Personal data:

              Table (1): show the distribution of the studied sample according to personal data in which the mean prides age was (21.7± 4.5) years. Regarding educational level, it was observed that more than one third of the studied sample (37.3%) was secondary school, while (14%) only were primary education. The majority of the sample (75.3%) was housewives. According to residence, it was found that (78%) reside in rural areas. On the other side, it was found that the mean husbands age is (25.8± 3.8) yrs. And more than half of them were not working.

Table (2): Distribution of the sample according to types of contraceptive methods known

 ^*statistical significant at P≤ 0.05                                                  ** high statistical significant P≤0.001  

N.B1: (#) more than one item was checked and the table didn’t use normal distribution                            

N.B2: total is not 100% as women knew of multiple methods of contraception

Table (2) show that in the pretest, different types of contraceptives weren’t well known that was improved posttest with statistical significant difference at P≤0.05

Table (3): Distribution of the sample according to side effects of family planning methods known:

N.B:total is not 100% as more than one item was checked    * statistical significant at P≤0.05

Table (3): show that there was statistical significant differences (P=0.01) between pre and post test information about side effects of family planning methods known.

Figure (1): Distribution of the sample according to their level of knowledge about contraceptive methods:

Figure (1)

Figure (1) illustrates the distribution of the studied sample according to their level of knowledge about contraceptive methods where there was high statistical significant difference at (P≤ 0.001) between the level of knowledge pre and post intervention. Near half of them (47.3%) had poor level of knowledge before intervention and (49.3%) had moderate level of knowledge pretest that was improved after intervention to be (78.7%). Also good level of knowledge improved from (3.3% to 18.6%) pre and post test respectively.