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1.
South Med J ; 114(3): 150-155, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33655308

RESUMEN

OBJECTIVES: Women veterans have a high prevalence of comorbidities that increase the risk of adverse pregnancy outcomes. Screening for pregnancy desires in primary care provider (PCP) visits offers an opportunity to optimize preconception health. This pilot quality improvement initiative sought to assess Veterans Healthcare Administration provider preferences on One Key Question (OKQ) implementation, identification of veterans' reproductive needs, and the effect of training on documentation in a women's primary care clinic in Salt Lake City, Utah. METHODS: We hosted OKQ training sessions for providers and staff, audio recorded group discussions on implementation barriers, and explored themes. Women veterans presenting for a PCP visit in July 2018 self-completed a paper OKQ screening tool. We calculated summary statistics on responses. We conducted a pre-post analysis, with respect to training sessions, to measure for changes in family planning documentation during PCP visits. RESULTS: Nineteen providers and staff completed the training. They acknowledged the importance, but believed that the screening tool should be completed by veterans and not be provider prompted. Forty-two women veterans completed the screening tool: 21% desired pregnancy in the next year and 26% desired contraceptive information. Chart reviews found a nonsignificant increase in current contraceptive method documentation between periods (20% vs 37%; P = 0.08), a decline in documentation of reproductive goals (22% vs 3%; P = 0.02), and no significant change in counseling. CONCLUSIONS: Veterans identify reproductive needs via the OKQ screening tool, but provider documentation did not reflect changes in care following training. Further study is necessary to develop an optimal, patient-centered tool and implementation plan to support women veterans in their reproductive goals.


Asunto(s)
Documentación/métodos , Servicios de Planificación Familiar/educación , Capacitación en Servicio/métodos , Tamizaje Masivo/métodos , Encuestas y Cuestionarios/normas , Veteranos/psicología , Adulto , Documentación/normas , Composición Familiar , Servicios de Planificación Familiar/métodos , Servicios de Planificación Familiar/normas , Femenino , Implementación de Plan de Salud , Humanos , Tamizaje Masivo/normas , Proyectos Piloto , Embarazo , Atención Primaria de Salud , Mejoramiento de la Calidad , Estudios Retrospectivos , Estados Unidos , United States Department of Veterans Affairs , Veteranos/estadística & datos numéricos , Adulto Joven
3.
BMC Public Health ; 20(1): 810, 2020 May 29.
Artículo en Inglés | MEDLINE | ID: mdl-32471393

RESUMEN

BACKGROUND: Fertility knowledge is vital to the fertility health of young people and greatly impacts their fertility choices. Delayed childbearing has been increasing in high-income countries, accompanied by the risk of involuntary childlessness or having fewer children than desired. The aim of this study was to investigate knowledge about fertility issues, the related influencing factors, the method of acquiring fertility knowledge, and the relationship between fertility knowledge and fertility intentions among college students. METHODS: An online cross-sectional survey of Chinese college students was conducted in Hunan Province from March to April 2018. A total of 867 college students from three comprehensive universities responded to a poster invitation utilizing the Chinese version of the Cardiff Fertility Knowledge Scale (CFKS-C). Data were explored and analysed by SPSS (version 22.0) software. Descriptive statistics, chi-squared tests, T-tests, and Pearson's correlations were used for the measurements. RESULTS: The average percent-correct score on the CFKS-C was 49.9% (SD = 20.8), with greater knowledge significantly related to living in a city district, being not single status, majoring in medicine, being in year 4 or above of study, and intention to have children (all p<0.05). A total of 81.9% of the participants reported that they would like to have children, the average score of the importance of childbearing was 6.3 (SD = 2.7), and the female score was lower than the male score (p = 0.001). A small positive relationship was observed between the CFKS-C and the importance of childbearing (r = 0.074, p = 0.035). Respondents indicated that they gained most of their knowledge from the media and internet (41.4%) and from schools (38.2%). CONCLUSION: Yong people in college have a modest level of fertility knowledge, a relatively low intention to have a child, and deficiencies in fertility health education. There is a need to improve the accessibility of fertility health services by developing a scientific and reliable fertility health promotion strategy.


Asunto(s)
Servicios de Planificación Familiar/educación , Fertilidad , Educación en Salud/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Estudiantes/psicología , Estudiantes/estadística & datos numéricos , Adolescente , Adulto , China , Estudios Transversales , Femenino , Humanos , Masculino , Encuestas y Cuestionarios , Universidades/estadística & datos numéricos , Adulto Joven
5.
Am J Obstet Gynecol ; 222(4S): S921.e1-S921.e13, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31837291

RESUMEN

BACKGROUND: Long-active reversible contraceptives reduce unintended pregnancy and abortions, but uptake is low. Interventions to increase uptake in family medicine settings are untested. OBJECTIVE: The Australian Contraceptive ChOice pRoject, which was adapted from the successful US Contraceptive CHOICE study, aimed to evaluate whether a complex intervention in family medicine practices resulted in increased long-active reversible contraceptive uptake. STUDY DESIGN: This cluster randomized controlled trial was set in family practices in metropolitan Melbourne, Australia. From April 2016 to January 2017, we recruited 57 family physicians by mail invitation. Each family physician aimed to recruit at least 14 female patients. Eligible family physicians worked ≥3 sessions per week in computerized practices. Eligible women were English-speaking, sexually active, not pregnant, not planning a pregnancy in the next year, 16-45 years old, and interested in discussing contraception or in starting a new, reversible method. With the use of a randomization sequence with permuted blocks that were stratified by whether the family physician performed long-active reversible contraceptive insertion or not, family physicians were assigned randomly to a complex intervention that involved training to provide structured effectiveness-based contraceptive counselling and access to rapid referral to long-active reversible contraceptive insertion clinics. The 6-hour, online educational intervention was based on the US Contraceptive CHOICE Project and adapted for the Australian context. The control family physicians received neither the educational intervention nor access to the long-active reversible contraceptive rapid referral clinics and conducted their usual contraception counselling. We used the chi-square test, which was adjusted for clustering and stratification by whether the family physician inserted long-active reversible contraceptives, and binary regression models with generalized estimating equations and robust standard errors to compare, between the intervention and control groups, the proportions of women who had a long-active reversible contraceptive inserted. The primary outcome was the proportion of women with long-active reversible contraceptives that were inserted at 4 weeks. Secondary outcomes included women's choice of contraceptive method, quality of life, and long-active reversible contraceptive use at 6 and 12 months. Analyses were performed according to intention-to-treat. RESULTS: A total of 25 intervention and 32 control family physicians recruited 307 and 433 women, respectively (N=740). Within 4 weeks, 19.3% of women in the intervention group and 12.9% of women in the control group had long-active reversible contraceptive inserted (relative risk, 2.0; 95% confidence interval, 1.1-3.9; P=.033). By 6 months, this number had risen to 44.4% and 29.3%, respectively (relative risk, 1.6; 95% confidence interval, 1.2-2.17; P=.001); by 12 months, it had risen to 46.6% and 32.8%, respectively (relative risk, 1.5; 95% confidence interval, 1.2-2.0; P=.0015). The levonorgestrel intrauterine system was the most commonly chosen long-active reversible contraceptive by women in the intervention group at all time points. Differences between intervention and control groups in mean quality-of-life scores across all domains at 6 and 12 months were small. CONCLUSION: A complex intervention combination of family physician training on contraceptive effectiveness counselling and rapid access to long-active reversible contraceptive insertion clinics resulted in greater long-active reversible contraceptive uptake and has the potential to reduce unintended pregnancies.


Asunto(s)
Consejo , Servicios de Planificación Familiar/métodos , Anticoncepción Reversible de Larga Duración/estadística & datos numéricos , Médicos de Familia/educación , Adolescente , Adulto , Australia , Agentes Anticonceptivos Hormonales/administración & dosificación , Educación a Distancia , Servicios de Planificación Familiar/educación , Medicina Familiar y Comunitaria , Femenino , Humanos , Dispositivos Intrauterinos Medicados , Levonorgestrel/administración & dosificación , Masculino , Persona de Mediana Edad , Derivación y Consulta , Adulto Joven
6.
Am J Obstet Gynecol ; 222(4S): S923.e1-S923.e8, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31866517

RESUMEN

BACKGROUND: Obstetrics-gynecology residents should graduate with competence in comprehensive contraceptive care, including long-acting reversible contraception. Lack of hands-on training and deficits in provider education are barriers to long-acting reversible contraception access. Identifying the number of long-acting reversible contraception insertions performed by obstetrics-gynecology residents could provide insight into the depth and breadth of long-acting reversible contraception training available to obstetrics-gynecology residents in Accreditation Council for Graduate Medical Education-accredited residency programs. OBJECTIVE: Our study investigates long-acting reversible contraception-specific training in obstetrics-gynecology residency programs across the United States, including the self-reported number of long-acting reversible contraception insertions per resident and the impact of resident demographic characteristics and residency program characteristics on training. STUDY DESIGN: Obstetrics-gynecology residents completed a voluntary electronic survey during the 2016 Council on Resident Education in Obstetrics and Gynecology examination. The survey included resident demographic characteristics and residency program characteristics as well as resident education and training in long-acting reversible contraception (number of intrauterine devices and implants inserted, training in immediate postpartum intrauterine device placement). A binary "long-acting reversible contraception insertion experience" variable dichotomized respondents as having a low level of long-acting reversible contraception insertions (0 implants and/or 10 or fewer intrauterine devices ) or a high level of long-acting reversible contraception insertions (1 or more implants and/or 11 or more intrauterine devices). χ2 tests were used to compare the presence of long-acting reversible contraception insertion experience by postgraduate year, resident demographic characteristics, and residency program characteristics. Adjusted logistic regression was performed to ascertain the independent effects of gender, race/ethnicity (non-Hispanic white vs other), residency program type (university vs community), and residency program geographic region on the likelihood of "low" overall long-acting reversible contraception insertion experience. RESULTS: In total, 5055 obstetrics-gynecology residents completed the survey (85%); analysis included only residents in United States obstetrics-gynecology programs (N=4322). Of the total analytic sample, 1777 (41.2%) had low long-acting reversible contraception insertion experience. As expected, the number of intrauterine device insertions, implant insertions, and overall long-acting reversible contraception experience increased as residents progressed through training. Long-acting reversible contraception insertion experience varied by residency program geographic region: 169 (27.1%) residents in programs in the West had low long-acting reversible contraception insertion experience compared with 498 (39.0%) in the South, 473 (45.3%) in the Midwest, and 615 (46.0%) in the Northeast. Only 152 (14.9%) of all postgraduate year 4 residents had low long-acting reversible contraception insertion experience. Among postgraduate year 4 residents, low long-acting reversible contraception insertion experience was significantly associated racial/ethnic minority status and community-based residency program type (compared with university-based). Postgraduate year 4 residents in programs located in the Northeast and Midwest had 4.25 (95% confidence interval, 2.04-8.85) and 2.75 (95% confidence interval, 1.27-5.97) times the odds of low long-acting reversible contraception experience compared with those in residency programs in the West, even after adjusting for other respondent characteristics and other residency program characteristics. CONCLUSION: Obstetrics-gynecology residents experience a range of long-acting reversible contraception training and insertions, which differed according to resident race/ethnicity and residency program characteristics (program type and geographic region). Residency programs with low long-acting reversible contraception training experience should consider opportunities to improve competence in this fundamental obstetrics-gynecology skill.


Asunto(s)
Competencia Clínica , Servicios de Planificación Familiar/educación , Ginecología/educación , Internado y Residencia , Anticoncepción Reversible de Larga Duración , Obstetricia/educación , Implantes de Medicamentos , Educación de Postgrado en Medicina , Grupos Étnicos/estadística & datos numéricos , Femenino , Geografía , Hospitales Comunitarios , Hospitales Universitarios , Humanos , Dispositivos Intrauterinos , Modelos Logísticos , Masculino , Análisis Multivariante , Factores Sexuales , Encuestas y Cuestionarios , Estados Unidos
7.
Am J Obstet Gynecol ; 222(3): 273.e1-273.e9, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31526788

RESUMEN

BACKGROUND: Catholic and other faith-based hospitals often restrict family planning service provision based on institutional doctrine. Approximately 11% of US accredited obstetrics and gynecology residency programs occur at such hospitals, creating a challenge to educational leaders who must ensure comprehensive family planning training. OBJECTIVE: To evaluate and summarize family planning training at obstetrics and gynecology residency programs that are affiliated with Catholic and other faith-based hospitals that restrict reproductive services. MATERIALS AND METHODS: Using an online database search and survey screening questions, we identified 30 of 278 accredited 2017-2018 programs in which at least 70% of resident time is spent in faith-based hospitals that restrict family planning services; Jewish programs were excluded. We queried program leaders between March 2017 and April 2018 about education and training using an online or paper survey, and asked them to report on training settings, provision of family planning services in such settings, and to rate aspects of training as "poor," "adequate," or "strong." We compared responses at Catholic versus other faith-based programs using Fisher exact tests, χ2 analyses, and median tests. RESULTS: Among 30 programs, 25 responded (83%); the majority of respondents were program directors (88%) and represented Catholic hospitals (76%). All reported adequate contraceptive training, with 47% of Catholic programs relying on off-site locations. The majority of Catholic sites (84%) relied on off-site sterilization training sites. Survey respondents from Catholic programs most commonly endorsed concerns for inadequate training in postpartum tubal ligations (53% of Catholic respondents versus 0% of other faith-based program respondents, P = .05). Approximately one-half (56%) offered abortion training as part of the curriculum ("routine"), 32% offered residents the opportunity to arrange training ("elective"), and 12% did not offer; the majority (84%) relied on off-site collaborations. Catholic sites were more likely than other religious programs to report poor abortion training (47% versus 0%, P = .04). Five Catholic programs (26% of Catholic programs) reported that their residents did not meet the graduate training requirement for completion of 20 dilation and curettage procedures. One-third reported a prior Residency Review Committee family planning citation(s), and many commented that these citations helped provide leverage for improved training. CONCLUSION: Although Catholic and other restrictive, faith-based obstetrics and gynecology residency training programs have developed strategies in response to institutional restrictions, many report ongoing deficiencies, and almost one-half reported they were noncompliant with abortion training requirements. Programs with deficient trainings may benefit from strategic approaches, including enhanced onsite education and collaborations with off-site facilities.


Asunto(s)
Servicios de Planificación Familiar/educación , Hospitales Religiosos , Internado y Residencia , Aborto Inducido/educación , Catolicismo , Curriculum , Dilatación y Legrado Uterino/educación , Femenino , Ginecología/educación , Humanos , Masculino , Obstetricia/educación , Embarazo , Encuestas y Cuestionarios , Estados Unidos
8.
J Womens Health (Larchmt) ; 29(2): 237-241, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-30681399

RESUMEN

Background: This 2016 study aimed to investigate the training in contraception and preconception counseling received by cardiovascular science fellows. Method: The authors surveyed current adult and pediatric cardiology fellows in the United States. Questions assessed the availability of family planning counseling training within their training program, current practices of contraception and preconception counseling, and use of available tools for risk stratification of patients. Bivariate logistic regressions were utilized to predict demographic variables associated with survey responses, and associations between hours of training or perceived preparedness and clinical use of training. Results: There were 101 survey responses. Most participating fellows disagreed that their fellowship training had prepared them to counsel patients on contraception (69%) and preconception planning (62%). Sixty-one percent of participants do not routinely discuss contraception options and 55% do not routinely discuss preconception counseling with reproductive-age female patients at routine visits. Having more than 1 hour of training was predictive of more consistent counseling for both contraception and preconception counseling. Approximately 40% of participants routinely refer patients to an OB/Gyn for contraception or preconception counseling. Conclusion: This study highlights the need for increased training in contraceptive and preconception counseling within adult and pediatric cardiology fellowship programs.


Asunto(s)
Cardiología/educación , Anticoncepción , Consejo , Servicios de Planificación Familiar/educación , Adulto , Competencia Clínica , Becas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Estados Unidos
9.
PLoS One ; 14(11): e0211168, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31693671

RESUMEN

OBJECTIVES: The objectives of the study were to assess the knowledge and skills of medical interns and nurses regarding family planning (FP) services, and document the prevailing FP practices in the teaching hospitals in India. STUDY DESIGN: A cross-sectional study was conducted in three states (Delhi, Rajasthan, and Maharashtra) of India, among randomly selected 163 participants, including medical interns (n = 81) and in-service nurses (n = 82), during 2017. The semi-structured, pre-tested interview schedule, was used to assess the knowledge and status of training received; and objective structured clinical examination (OSCE) based checklist was used to evaluate the skills. RESULTS: About 60% of the interns and 48% of the nurses knew more than five contraceptives that could be offered to the clients. About 22% (11.1% interns and 33.3% nurses) respondents believed that contraceptives should not be given to a married woman coming alone, and 31.9% (17.3% interns and 46.3% nurses) respondents reported that it was illegal to provide contraceptives to unmarried people. Nearly 43.3% interns and 69.5% nurses refused to demonstrate intrauterine contraceptive device (IUCD) insertion in the dummy uterus as per OSCE, and among those who did, 12.3% interns and 18.3% nurses had failed. About 63% interns and 63.4% of nurses had observed IUCD insertion, and 12.3% interns and 17.1% had performed IUCD insertion, during their training. CONCLUSIONS: Knowledge and skills of interns and nurses regarding FP services were inadequate. The medical training during graduation or internship, and during the job, was found to be inadequate to provide quality FP services as per guidelines of nursing/medical council of India and Government of India on FP.


Asunto(s)
Competencia Clínica , Servicios de Planificación Familiar , Internado y Residencia , Enfermeras y Enfermeros , Adulto , Anticonceptivos , Estudios Transversales , Servicios de Planificación Familiar/educación , Servicios de Planificación Familiar/métodos , Servicios de Planificación Familiar/normas , Femenino , Humanos , India , Dispositivos Intrauterinos , Masculino , Adulto Joven
11.
Ups J Med Sci ; 124(3): 203-212, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31495254

RESUMEN

Background: Reproductive life plan counseling (RLPC) is a tool to encourage women and men to reflect upon their reproduction, to avoid unintended pregnancies and negative health behavior that can threaten reproduction. The aim was to evaluate the effect of RLPC among women attending contraceptive counseling. Outcomes were knowledge about fertility and awareness of preconception health, use of contraception, and women's experience of RLPC. Material and methods: Swedish-speaking women, aged 20-40 years, were randomized to intervention group (IG) or control group (CG). Participants (n = 1,946) answered a questionnaire before and two months after (n = 1,198, 62%) the consultation. All women received standard contraceptive counseling, and the IG also received the RLPC, i.e. questions on reproductive intentions, information about fertility, and preconception health. Results: Women in the IG increased their knowledge about fertility: age and fertility, chances of getting pregnant, fecundity of an ovum, and chances of having a child with help of IVF. They also increased their awareness of factors affecting preconception health, such as to stop using tobacco, to refrain from alcohol, to be of normal weight, and to start with folic acid before a pregnancy. The most commonly used contraceptive method was combined oral contraceptives, followed by long-acting reversible contraception. Three out of four women (76%) in the IG stated that the RLPC should be part of the routine in contraceptive counseling. Conclusions: Knowledge about fertility and awareness of preconception health increased after the intervention. The RLPC can be recommended as a tool in contraceptive counseling.


Asunto(s)
Anticoncepción/métodos , Anticonceptivos/administración & dosificación , Consejo/métodos , Servicios de Planificación Familiar/educación , Conocimientos, Actitudes y Práctica en Salud , Salud Reproductiva/educación , Adulto , Concienciación , Consejo/estadística & datos numéricos , Femenino , Fertilidad/fisiología , Humanos , Atención Preconceptiva/métodos , Embarazo , Embarazo no Deseado , Medición de Riesgo , Encuestas y Cuestionarios , Suecia , Adulto Joven
12.
Soc Sci Med ; 238: 112478, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31445301

RESUMEN

At least one in ten married or in-union women of reproductive ages had an unmet need for family planning in 2017. Gender inequalities in multiple social settings, including education, work and household decision-making, influence access to family planning. In this paper, we examine whether laws and policies that increase gender equality in education can lead to improved family planning outcomes. In particular, we focus on tuition-free primary education policies as a means of change. We estimate the impact of girls being exposed to tuition-free primary education policies on their health decision-making and on their family planning needs as women. Using a difference-in-difference methodology on 17 low- and middle-income countries, we find that women who were exposed as children to tuition-free education policy throughout primary school have a greater likelihood of meeting their family planning needs and of shifting from traditional to modern contraceptives, relative to women without similar exposures. These women also have a greater likelihood of having some say in health-related decisions of the couple. More gender-equal decision-making is shown to mediate a portion of the positive impact of the education policy on reproductive health. The results of this study indicate the need for increased investments in education and for health policy makers to prioritize cross-sectoral engagements.


Asunto(s)
Toma de Decisiones , Educación/métodos , Servicios de Planificación Familiar/educación , Educación Sexual/economía , Adolescente , Niño , Estudios Transversales , Educación/economía , Educación/estadística & datos numéricos , Femenino , Accesibilidad a los Servicios de Salud/normas , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Educación Sexual/métodos , Educación Sexual/estadística & datos numéricos
13.
Reprod Health ; 16(1): 97, 2019 Jul 08.
Artículo en Inglés | MEDLINE | ID: mdl-31286989

RESUMEN

BACKGROUND: Unmet need for contraception is high during the postpartum period, increasing the risk of unintended subsequent pregnancy. We developed a client facing mobile phone-based family planning (FP) decision aid and assessed acceptability, feasibility, and utility of the tool among health care providers and postpartum women. METHODS: Semi-structured in-depth interviews (IDIs) were conducted among postpartum women (n = 25) and FP providers (n = 17) at 4 Kenyan maternal and child health clinics, 2 in the Nyanza region (Kisumu and Siaya Counties) and 2 in Nairobi. Stratified purposive sampling was used to enroll postpartum women and FP providers. Data were analyzed using an inductive content analysis approach by 3 independent coders, with consensual validation. RESULTS: FP providers stated that the Interactive Mobile Application for Contraceptive Choice (iMACC) tool contained the necessary information about contraceptive methods for postpartum women and believed that it would be a useful tool to help women make informed, voluntary decisions. Most women valued the decision aid content, and described it as being useful in helping to dispel myths and misconceptions, setting realistic expectations about potential side effects and maintaining confidentiality. Both women and providers expressed concerns about literacy and lack of familiarity with smart phones or tablets and suggested inclusion of interactive multimedia such as audio or videos to optimize the effectiveness of the tool. CONCLUSIONS: The iMACC decision aid was perceived to be an acceptable tool to deliver client-centered FP counseling by both women and providers. Counseling tools that can support FP providers to help postpartum women make informed and individualized FP decisions in resource-limited settings may help improve FP counseling and contraceptive use in the postpartum period.


Asunto(s)
Conducta Anticonceptiva/estadística & datos numéricos , Técnicas de Apoyo para la Decisión , Servicios de Planificación Familiar/educación , Conocimientos, Actitudes y Práctica en Salud , Periodo Posparto/psicología , Educación Sexual , Telemedicina , Adolescente , Adulto , Consejo , Estudios Transversales , Servicios de Planificación Familiar/métodos , Estudios de Factibilidad , Femenino , Personal de Salud , Humanos , Embarazo , Investigación Cualitativa , Adulto Joven
14.
BMC Res Notes ; 12(1): 374, 2019 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-31262350

RESUMEN

OBJECTIVE: Delayed childbearing is an emerging public health issue in developing countries compared with more developed countries, where it is already a major clinical and public health concern. Previous studies have mostly focused on either the health risks associated with delayed childbearing or the reasons for it with little done around the socio-demographic factors associated with it in developing countries. The objective of the study was to examine associated socio-demographic factors of delayed childbearing in Nigeria. RESULTS: The study used secondary data pooled from 2003 to 2013 Nigeria Demographic and Health Surveys. The outcome variable was delayed childbearing. The explanatory variables are selected individual socio-demographic characteristics and community characteristics. A weighted sample size of 20,550 women was analysed. Results showed a prevalence of 8.0% delayed childbearing in Nigeria. Socio-demographic factors such as higher maternal education, age at first marriage of 25 years or older, modern contraceptive use, and remarriage status were significantly associated with delayed childbearing. Significant associations were also observed with high community literacy level and high proportion of women who ever used modern contraceptive in the community.


Asunto(s)
Conducta Anticonceptiva/estadística & datos numéricos , Servicios de Planificación Familiar/educación , Conducta Reproductiva/estadística & datos numéricos , Factores Socioeconómicos , Adolescente , Adulto , Conducta Anticonceptiva/psicología , Escolaridad , Femenino , Humanos , Estado Civil , Persona de Mediana Edad , Nigeria , Conducta Reproductiva/psicología
15.
BMC Med Educ ; 19(1): 261, 2019 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-31307460

RESUMEN

BACKGROUND: Improved training approaches have the potential to overcome barriers to the use of postpartum intrauterine devices (PPIUDs) in Pakistan, including a shortage of female providers who are able to insert the device. This study assessed the effectiveness and acceptability of a competency-based onsite training approach that employed a newly developed anatomic model (the Mama-U) to train doctors and midwives on postpartum family planning (PPFP) and the insertion of PPIUDs. METHODS: An observational, mixed methods study conducted training evaluations and knowledge and skills assessments with 11 trainers and 88 doctors and midwives who participated in eight PPIUD training sessions. Two months later, follow-up interviews and clinical assessments were conducted with 20 providers, and interviews and a focus group discussion were conducted with 85 married women who received a PPIUD from a trained provider. RESULTS: The training significantly improved provider knowledge (p < 0.001), and follow-up assessments showed that clinical skills were retained for at least two months post-training. After training, 81.8% of providers were confident in their ability to provide PPIUD services, and midwives and doctors had similar PPIUD insertion skills. However, midwives were more likely than doctors to meet all 10 key requirements during PPIUD counseling sessions (63.9% versus 13.3%, p = 0.004). Providers found the Mama-U model to be a useful tool for client counseling as well as training and skills practice, and clients agreed. Trainers identified the low cost, light weight, and portability of the Mama-U model as advantages over the conventional training model and noted that its abstract shape reduced embarrassment among trainers, providers, and clients. CONCLUSIONS: Competency-based training with the Mama-U model can improve the quality of PPIUD counseling and PPIUD insertion services and has the potential to extend PPFP/PPIUD service delivery to midwives working in rural Pakistan. The portable, low-cost Mama-U permits onsite, on-the-job PPIUD insertion training that is tailored to the local setting; it is also well suited for the continuing practice that providers need to maintain their skills. Further research is needed to confirm the usefulness and cost-effectiveness of the Mama-U at scale and in other settings.


Asunto(s)
Competencia Clínica , Educación Basada en Competencias/métodos , Servicios de Planificación Familiar/educación , Dispositivos Intrauterinos/estadística & datos numéricos , Partería/educación , Entrenamiento Simulado/economía , Adolescente , Adulto , Ahorro de Costo , Países en Desarrollo , Femenino , Grupos Focales , Personal de Salud/educación , Humanos , Modelos Educacionales , Pakistán , Periodo Posparto , Embarazo , Adulto Joven
16.
BMJ Open ; 9(2): e023403, 2019 02 20.
Artículo en Inglés | MEDLINE | ID: mdl-30787080

RESUMEN

OBJECTIVE: To explore healthcare providers' views on barriers to and facilitators of use of the national family planning (FP) guideline for FP services in Amhara Region, Ethiopia. DESIGN: Qualitative study. SETTING: Nine health facilities including two hospitals, five health centres and two health posts in Amhara Region, Northwest Ethiopia. PARTICIPANTS: Twenty-one healthcare providers working in the provision of FP services in Amhara Region. PRIMARY AND SECONDARY OUTCOME MEASURES: Semistructured interviews were conducted to understand healthcare providers' views on barriers to and facilitators of the FP guideline use in the selected FP services. RESULTS: While the healthcare providers' views point to a few facilitators that promote use of the guideline, more barriers were identified. The barriers included: lack of knowledge about the guideline's existence, purpose and quality, healthcare providers' personal religious beliefs, reliance on prior knowledge and tradition rather than protocols and guidelines, lack of availability or insufficient access to the guideline and inadequate training on how to use the guideline. Facilitators for the guideline use were ready access to the guideline, convenience and ease of implementation and incentives. CONCLUSIONS: While development of the guideline is an important initiative by the Ethiopian government for improving quality of care in FP services, continued use of this resource by all healthcare providers requires planning to promote facilitating factors and address barriers to use of the FP guideline. Training that includes a discussion about healthcare providers' beliefs and traditional practices as well as other factors that reduce guideline use and increasing the sufficient number of guideline copies available at the local level, as well as translation of the guideline into local language are important to support provision of quality care in FP services.


Asunto(s)
Actitud del Personal de Salud , Servicios de Planificación Familiar/normas , Adhesión a Directriz , Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud , Adulto , Etiopía , Servicios de Planificación Familiar/educación , Femenino , Humanos , Masculino , Investigación Cualitativa
17.
Reprod Health ; 16(1): 17, 2019 Feb 11.
Artículo en Inglés | MEDLINE | ID: mdl-30744697

RESUMEN

BACKGROUND: Involving male partners in family planning (FP) education and counseling may improve FP utilization and help meet couples' reproductive health needs in the postpartum period. We aimed to explore Kenyan men's and women's perspectives on an interactive short message service (SMS) approach to support postpartum FP decision-making, and inform intervention content for a randomized controlled trial (RCT). METHODS: We conducted four focus group discussions (FGD) among men (n = 35) and two among pregnant/postpartum women (n = 15) in western Kenya. Female participants were recruited at antenatal clinics; male participants were referred by antenatal attendees. FGDs included participant critique of pilot theory-based SMS messages. FGD transcripts were coded by two investigators and analyzed using an iterative, modified grounded theory approach. These data informed the intervention and RCT design, in which women had the option to refer male partners for trial enrollment. RESULTS: Men strongly desired inclusion in FP programs, and frequently discussed negative relationship consequences of women's covert contraceptive use. Female and male participants voiced a variety of concerns about contraceptive side effects and potential harms, which were central to narratives of community influence on personal contraceptive choices. Most participants felt that receiving FP-focused SMS and including men would be beneficial. They perceived that SMS dialogue with a nurse about FP could reduce misperceptions and may stimulate communication within couples, thereby improving contraceptive access and continuation. Shared decision-making around FP within couple relationships, in consultation with clinicians, was highly valued. CONCLUSIONS: Health concerns about FP and limited couple communication are perceived contributors to postpartum unmet contraceptive need. With women's consent, the inclusion of male partners in FP services, and specifically in an mHealth SMS intervention, is acceptable and desired. Receiving SMS may trigger communication about postpartum FP within couples. SMS content should address contraceptive knowledge gaps, anticipated side effects and FP misperceptions, and allow for real-time method choice assistance.


Asunto(s)
Servicios de Planificación Familiar/educación , Aplicaciones Móviles , Periodo Posparto , Telemedicina , Adulto , Conducta Anticonceptiva/psicología , Consejo , Toma de Decisiones , Servicios de Planificación Familiar/métodos , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Kenia , Masculino , Servicios de Salud Materna , Hombres/psicología , Investigación Cualitativa , Ensayos Clínicos Controlados Aleatorios como Asunto , Educación Sexual , Envío de Mensajes de Texto , Mujeres/psicología
18.
Reprod Health ; 16(1): 6, 2019 Jan 21.
Artículo en Inglés | MEDLINE | ID: mdl-30665470

RESUMEN

BACKGROUND: Adolescents 360 (A360) is an initiative being rolled out across Ethiopia, Nigeria and Tanzania with the aim of increasing uptake of voluntary modern contraception among sexually active women aged 15 to 19 years. Using evaluation baseline survey data, we described key sexuality, fertility and contraceptive use characteristics of married women aged 15 to 19 years living in three sub-national settings. METHODS: Cross-sectional baseline surveys of married women aged 15 to 19 years were conducted in Oromia (Ethiopia), Nasarawa (Northern Nigeria), and Mwanza (Tanzania) between August 2017 and February 2018. We also interviewed the husbands of a sub-group of married respondents to measure spousal acceptance and support for adolescent women to use modern contraception. A clustered sampling design was used in all three countries. We produced descriptive statistics on the socio-demographic and sexual and reproductive health characteristics of married women aged 15 to 19 years by study setting. RESULTS: In Oromia, Nasarawa and Mwanza, 31.4% (327/1198), 27.4% (1321/4816) and 7.5% (15/201) of married women surveyed had no education, and 68.3, 81.3 and 83.1% had ever been pregnant, respectively. Unmet need for modern contraception was 20.5, 21.9 and 32.0% in married women in Oromia, Nasarawa and Mwanza, made up almost entirely of unmet need for spacing. The vast majority of married women surveyed in Oromia (89.1%) and Mwanza (90.1%) had seen or heard about contraception in the last 12 months, compared to 30.1% of those surveyed in Nasarawa. Modern contraceptive prevalence (mCPR) was highest in married women aged 15 to 19 years in Oromia (47.2%), followed by Mwanza (19.4%) and Nasarawa (8.7%). Of those using a modern method of contraception in Oromia, 93.4% were using injectables or long-acting methods, compared to 49.4% in Nasarawa and 69.6% in Mwanza. CONCLUSIONS: Overall, unmet need for modern contraception is high among married women aged 15 to 19 years across the three settings. mCPR for married women aged 15 to 19 years is low in Nasarawa and Mwanza. Ultimately, no single intervention will suit all situations, but improving the quality, analyses and utilisation of subnational data can help decision-makers design more context specific interventions.


Asunto(s)
Conducta Anticonceptiva/tendencias , Servicios de Planificación Familiar/estadística & datos numéricos , Fertilidad , Adolescente , Anticoncepción/métodos , Anticoncepción/estadística & datos numéricos , Anticoncepción/tendencias , Conducta Anticonceptiva/estadística & datos numéricos , Estudios Transversales , Etiopía , Servicios de Planificación Familiar/educación , Servicios de Planificación Familiar/tendencias , Femenino , Humanos , Nigeria , Conducta Sexual , Factores Socioeconómicos , Tanzanía , Adulto Joven
19.
J Obstet Gynecol Neonatal Nurs ; 48(2): 131-139, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30664840

RESUMEN

OBJECTIVE: To systematically review the literature on interventions for reproductive life planning (RLP). DATA SOURCES: We searched PubMed, CINAHL Plus, and PsycINFO for studies of the implementation and/or evaluation of an RLP intervention using the following search terms: reproductive life planning, intervention, program, evaluation, trial, strategy, assessment, survey, tool, and education. No limitations were set on languages or geographic locations of the studies. Records from 1990 through 2017 were searched. STUDY SELECTION: The initial search yielded 133 results after duplicates were excluded. Titles and abstracts were screened to determine whether articles met the inclusion criteria, and 110 articles were excluded. We completed a full-text review of 23 articles, and 9 articles met inclusion criteria. A secondary citations search and manual review of reference lists of articles already included in the review yielded an additional three articles. A total of 12 articles were identified for final inclusion. DATA EXTRACTION: We reviewed each article to assess study design, sample size and participants, study objectives, and outcome measures of the RLP intervention or evaluation implemented. DATA SYNTHESIS: We grouped studies into three categories according to outcomes measured: perceptions and acceptability of the intervention, change in knowledge after the intervention, and change in health behavior after the intervention. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to evaluate the evidence of effectiveness for each outcome measured in each study. CONCLUSION: There is a dearth of literature in which researchers tested and documented the effectiveness of extant RLP interventions. Current evidence highlights a positive reception of RLP in clinical practice, but data are limited with regard to its effectiveness in initiating changes in knowledge or behavioral outcomes. Process and outcome evaluations are needed to build the evidence base for RLP.


Asunto(s)
Servicios de Planificación Familiar/educación , Atención Preconceptiva/métodos , Salud Reproductiva/educación , Femenino , Humanos , Salud Materna , Embarazo , Embarazo no Planeado/psicología
20.
Afr J Reprod Health ; 22(3): 90-99, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30381936

RESUMEN

Robust evidence, including systematic reviews and recommendations from the 2016 Lancet Commission on Adolescent Health and Wellbeing, does not wholly support the unambiguous endorsement of peer-led community-based interventions. This study evaluated the effectiveness of an intensive three-day training for peer educators (PE) on dispelling myths and misconceptions about long-acting reversible contraceptives (LARCs) among Ethiopian youth. Post-training, PEs conducted demand-generation activities with their peers to encourage LARCs referrals. A convenience purposive sampling technique was used to select 20 health centers where peer educators referred clients: 10 each in Amhara and Tigray regions. The health centers were randomly allocated to the intervention (five) and non-intervention (five) study arms. Data were abstracted from the peer educators' monthly reporting forms over an 11-month period: 5 months pre-intervention and 6 months post-intervention. Analysis of family planning and LARCs referrals and chi-square tests of association were conducted. Odds of LARCs referrals at pre-intervention (0.96), fell to 0.83 for the post-intervention phase (p-value <0.6). Challenges, largely with data collection and reporting, may have exposed the study to Type II errors. We recommend focused and rigorous data collection in a multi-country 2X2 factorial design cluster randomized holistic intervention (service providers/clinic and PEs/community) trial to comprehensively determine effectiveness on demand for and uptake of LARCs among youth.


Asunto(s)
Anticonceptivos Femeninos/uso terapéutico , Servicios de Planificación Familiar/educación , Anticoncepción Reversible de Larga Duración/estadística & datos numéricos , Grupo Paritario , Adolescente , Servicios de Planificación Familiar/organización & administración , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Evaluación de Programas y Proyectos de Salud , Educación Sexual/métodos , Educación Sexual/organización & administración
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