|Year : 2019 | Volume
| Issue : 2 | Page : 92-99
Effectiveness of an educational program in raising women’s knowledge and awareness about family planning methods in a rural area
Hayam Fathey A Eittah1, Hemat Mostafa Amer2
1 Department of Maternal and Newborn Health Nursing, Faculty of Nursing, Menoufia University, Menoufia; Department of Maternity and Childhood Nursing, Nursing College, Taibah University, Madina, KSA, Egypt
2 Department of Community Health Nursing, Faculty of Nursing, Menoufia University, Menoufia, Egypt
|Date of Submission||15-Sep-2019|
|Date of Acceptance||01-Oct-2019|
|Date of Web Publication||5-Dec-2019|
Hayam Fathey A Eittah
BCS Nursing, MSC Maternal and Newborn Heath Nursing, PhD of Maternal and New Born Health Nursing, Faculty of Nursing, Menoufia University
Source of Support: None, Conflict of Interest: None
Background Family planning is currently one of the most successful development interventions, with likely benefits on maternal and child health outcomes, educational advances, economic development, and welfare.
Purpose To evaluate the effectiveness of an educational program in raising women’s knowledge and awareness about family planning methods in a rural area.
Patients and methods Research design: a quasi-experimental research design (one group pre–posttest) was used. Settings: the study was carried out at primary health centers in Shebin Elkom district, Menoufia governorate, Egypt. Sample: a total of 150 married women of reproductive age who attended family planning clinics were recruited at convenience. Tools for data collection: tool I; an interviewing questionnaire that contained sociodemographic data and history. Tool II; pre–post knowledge test about family planning methods.
Results There were highly statistically significant differences in women’s knowledge and awareness about family planning methods at the pre–posttest among the studied women, with P value less than 0.000. There was a significant correlation and statistically significant difference in the women’s total score and their ages at P value less than 0.05. Furthermore, there was a positive correlation between the total knowledge score of the women studied and their educational level.
Conclusion An educational program significantly improves knowledge and awareness of women about all types of contraceptive methods. Recommendation: educational programs should be provided to all women about the safety and convenience of modern, long-term, reversible methods of contraception. Family planning counseling needs to be universally included in all clinics that focus on women health.
Keywords: contraceptive methods, educational programs, family planning, knowledge and awareness, rural area
|How to cite this article:|
Eittah HA, Amer HM. Effectiveness of an educational program in raising women’s knowledge and awareness about family planning methods in a rural area. Egypt Nurs J 2019;16:92-9
|How to cite this URL:|
Eittah HA, Amer HM. Effectiveness of an educational program in raising women’s knowledge and awareness about family planning methods in a rural area. Egypt Nurs J [serial online] 2019 [cited 2020 Apr 3];16:92-9. Available from: http://www.enj.eg.net/text.asp?2019/16/2/92/272396
| Introduction|| |
Family planning is the planning of when to have children and the use of a birth control method to implement these plans. The WHO (2019) defines it as ‘helps couples to anticipate and attain their needed number of children and the spacing and timing of their births.’ It is accomplished through the use of contraceptive methods and involuntary infertility treatment. The capacity of a woman to room and restrict her pregnancies has a direct influence on her health and well-being as well as on the outcome of each pregnancy. In addition, family planning, which is a voluntary and accessible technique of contraception, earlier referred to as birth control, can be tailored to the person’s needs with a range of methods that are acceptable to all and effective if used correctly (Shaw, 2010; WHO, 2010).
Family planning prevents about one-third of pregnancy-related fatalities as well as 44% of neonatal fatalities. This is because the timing and spacing of pregnancies at least 2 years between births is required to avoid negative results of pregnancy, including high incidence of premature, malnutrition, and stunting of children. The spacing of pregnancies for ideal outcomes applies worldwide, not only in poor settings (Tsui et al., 2010; Kumar et al., 2011; United Nation Population Fund (UNFPA), 2012; Guttmacher Institute, 2019). Short birth periods may have poor maternal and infant implications. Ideal birth spacing is often assumed to be accomplished through the use of family planning methods. Unplanned pregnancy is a significant public health problem that not only the family impacts directly but also the society indirectly (Yeakey et al., 2009; Awadalla, 2012).
As cited by Hong et al. (2012), the Egyptian government has been pursuing a national population control program in collaboration with various international donor agencies for more than two decades, with the aim of increasing contraceptive use and reducing fertility; the rapid growth of Egypt’s population in recent decades is considered a major obstacle to the Egyptian government’s development goals. Egypt is listed as one of the most unequal nations in terms of sex, and fertility is at a rate of 3.5 births per female for two decades. Women’s empowerment is a strategy used to encourage contraception and reduced fertility (World Economic Forum, 2017; Samari, 2018).
Despite the recent increase in contraceptive use, the general fertility rate in Egypt continues to exceed three live births per woman. The overall fertility rate in Egypt decreased from 3.9 in 1992 to 3.1 in 2005. Its preference, other discriminatory sex attitudes, optimistic economic expectations, and fear of the side effects of contraceptives are associated with low preference and ambivalence for having only two children. The total fertility rate is considerably higher in the rural than the urban areas. The observed fertility rates among women are 33% greater than the wanted fertility rates (El-Zeini, 2008, 2009; Tilahun et al., 2013). Good family planning infrastructure and adherence of providers to standard practices that address the issues and side effects of contraceptive methods, protect client privacy, evaluate reproductive and medical history, and conduct basic tests to ensure safe administration of methods were also linked to increased acceptance of family planning (Hong et al., 2011; Leslie et al., 2017).
An estimated 80 million unintended pregnancies are reported each year, and 42 million of these end in abortion. Abortion is primarily caused by ending an unplanned and unwanted pregnancy (Guttmacher Institute, 2019). The increasing use of family planning around the world has led to reduced maternal and infant mortality and other adverse effects (Dougherty et al., 2018). Selecting family planning methods usually based on good knowledge and awareness of woman. Lack of information is considered one of the most significant barriers to the utilization and continuation of contraception in Egypt (Eltomy et al., 2013).
Significance of the problem
Contraceptives discourage unintended pregnancies, decrease the incidence of abortions, and decrease the incidence of death and disability because of pregnancy and childbirth complications (WHO, 2019; United Nation Population Fund (UNFPA), 2012). Women in rural areas have poor knowledge of family planning methods and family planning services because of demographic factors such as age, education, and ethnicity, sociopsychological factors such as social class, personality, embarrassment, and fear, and also structural factors such as beliefs, attitude, and knowledge. The provision of family planning services requires unique skills, knowledge, and sensitivity to client needs; therefore, this study was carried out to raise women’s awareness of family planning, especially in rural areas.
| Aim|| |
To evaluate the effectiveness of an educational program in raising women’s knowledge and awareness about family planning methods in a rural area.
Women who received the intervention program had higher posttest knowledge and awareness scores than pretest scores.
| Participants and methods|| |
A quasi-experimental research design with a pre–posttest was used to achieve the aim of the study.
The study was carried out at six primary health centers affiliated to the Ministry of Health in Shebin Elkom district, Menoufia governorate, Egypt. The Shebin Elkom district has 252 primary health centers; the researchers select six centers randomly to carry out this study.
A convenient sample was used to select a total of 150 married women of reproductive age from the above-selected centers and who attend family planning centers. The women included in this study were selected according to the following inclusion criteria:
- Child-bearing age (15–49 years).
- Irrespective to educational level, job and/or economic status.
- Willing to participate in the study.
- Had at least one child.
- Who attend to ask for family planning services.
Exclusion criteria were as follows:
- Participants with mental problems.
- Participants with hearing problems.
Sample size calculation
The total sample was 150; this was estimated using a sample size calculator, with a confidence interval of 8. The confidence level was 95% and the population was 100 000.
Tools for data collection:
- Interviewing questionnaire: this included sociodemographic data such as age and educational level, obstetrical and gynecologic history such as age of menarche, age at last pregnancy, use of contraception, type of contraceptive methods used, source of contraceptive services, source of information about family planning. This took about 5 min to complete.
- Pre–post knowledge test about family planning methods. This was designed by the investigators to assess women’s knowledge of and awareness about family planning methods. It included simple eight questions about family planning such as the definition of family planning, importance, types, uses, side effects, and advantages and disadvantages of family planning. This took about 35–40 min to complete.
Eight questions were used to test women’s knowledge of family planning methods, with a total of 16 marks. It was distributed as follows; 50% or less mean unsatisfactory knowledge but over 50% considered satisfactory knowledge. Data were coded as (1 = do not know and 2 = know).
Tool validity and reliability
Tools were submitted to three experts in the field of community nursing, maternity, and newborn health nursing; they performed an evaluation of the conceptual and semantic equivalence of the questionnaire to verify the content validity, clarity, and comprehension of a questionnaire. All modifications were carried out according to the experts’ judgment. Test–retest reliability was determined to test the internal consistency of the tools. This involves the administration of the same instruments to the same participants under similar conditions on two or more occasions. Scores from repeated testing were compared using Cronbach’s alpha coefficient method. This was found to be R = 0.98.
A pilot study was carried out after developing the tools and before starting the data collection phase. The pilot study was carried out on 10% of the sample (15 women) who were not included in the main study sample. On the basis of the results of the pilot study, rephrasing of some questions was performed to ensure clarity of the questions and so that they could be understood easily by the participants. The time required for filling in the questionnaire was estimated to be 40–45 min. Modification of some questions was performed on the basis of the results of the pilot study.
Primary approval was obtained from the research ethic committee in the nursing college to carry out the study, with an explanation of the aim and the importance of the study to the centers’ authorities. Also, written approval permission was obtained from the administrator of each target setting included in the study. Women were required to provide written informed consent before study enrollment. The objectives and the nature of the study were explained to the women. The researchers emphasized that participation in the study was voluntary; anonymity and confidentiality were assured.
The study was carried out in three phases (interviewing/assessment phase, implementation phase, and evaluation phase). The data were collected from six primary health centers affiliated to the Ministry of Health in Shebin Elkom district, Menoufia governorate, Egypt. The data collection took 3 months: from January 2019 to March 2019. The researchers went to prementioned settings 3 days per week.
Phase I: interviewing/assessment phase: all women who have fulfilled the inclusion criteria were included in the study. Women were divided into groups to facilitate collection of data; each group included eight women. Each woman was assessed by determining her demographic data, history, and vital signs, and performing a physical examination to ensure that there was no health problem that could interfere with attending program such as hearing problem, deformities, and mental disorders. Each woman was asked to read the tool carefully and the investigators read out the tools to illiterate women. Each woman was asked to fill the interviewing questionnaire, and then asked to fill the pretest sheet. This phase took about 15–20 min.
Phase 2: implementation phase: the researchers conducted the lecture/educational program, which took about 20–30 min. Audio visual aids and pictures were used. The educational program included ‘definition of contraceptive methods, uses and importance of contraceptive methods, types of contraceptive methods, classification of contraceptive methods, advantages and disadvantages of contraceptive methods, side effects of contraceptive methods, complications and warning signs of each contraceptive methods and follow up instructions and return visits for each contraceptive methods.’ The researchers helped the illiterate participants to fill out the questionnaire.
Phase 3: evaluation was conducted by researchers after the completion of the educational program by administering the post-test to identify differences, similarities and areas of knowledge improvement of participants and limitation, which took about 10–15 min.
Data were tabulated, coded, and transformed into a specially designed form to be suitable for computer entry process. Data were entered and analyzed using SPSS, version 22. Graphics were calculated using Excel program. Quantitative data were expressed as mean and SD and analyzed using a t test for comparison of the same group on pretest and posttest. Qualitative data were expressed as number and percentage. These were analyzed using the χ2 test for a 2×2 table. Pearson correlation was used to explain the relationship between normally distributed quantitative variables.
A P value at 0.05 was used to determine the significance as follows:
- P value more than 0.05 was considered to be statistically insignificant.
- P value less than or equal to 0.05 was considered to be statistically significant.
- P value more than or equal to 0.001 was considered to be highly statistically significant.
| Results|| |
[Table 1] shows that the mean age of the women was 24.78 ± 5.4 years. More than half (56.66%) of the sample was illiterate. About 73.3% were housewives and (55.33%) of the women studied have enough income.
As shown in [Table 2], the mean age of last child among studied women was 8.34±4.7. Nearly half of the sample had three to four children. About 78.7% of the women studied experienced pregnancy when they were older than 30 years of age. More than half (56.67%) of the women used contraceptive methods, and 51.2% used mechanical and other methods as a type of contraceptive method. 89.41% of the women received contraceptive methods from MCH centers.
|Table 2 Distribution of the women studied in terms of obstetric history and family planning history|
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[Table 3] shows that there were highly statistically significant differences among all knowledge items about family planning methods at pretest compared with posttest among the women studied, with P value less than 0.000. In terms of the mean scores of women’s knowledge and awareness about family planning methods, as shown in the table, there was a considerable improvement in the posttest score compared with the posttest score; there was a statistically significant difference between pretest and posttest at P value 0.000.
|Table 3 Knowledge and awareness of studied women of family planning methods at pretest and posttest|
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[Figure 1] shows that 50.70% of women had satisfactory knowledge levels related to family planning methods at pretest compared to 88.70% at posttest.
|Figure 1 Levels of total knowledge about family planning among the women studied at pretest and posttest.|
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[Table 4] shows that there were negative correlations with statistically significant difference between women’s total knowledge score and their ages at P value less than 0.05, which means that the younger the women, the higher the knowledge improvement. Furthermore, there was a positive correlation between the studied women’s total knowledge score and their educational level, with no statistically significant difference.
|Table 4 Pearson correlation of women total scores of knowledge, age, and educational level|
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[Table 5] shows that there were no relations among the mean score of total knowledge and women’s sociodemographic data at pretest and posttest and there was no statistically significant difference, but there was a significant difference between women’s mean score of total knowledge and family income at posttest, with P value less than 0.05.
|Table 5 Relation between mean scores of total knowledge and studied women’s sociodemographic data at pretest and posttest|
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| Discussion|| |
Family planning care is a complex, multidimensional area. For example, the framework of quality includes six indicators: selection of methods, information provided to women, technical competence, and interpersonal relationships with client providers, follow-up and continuity processes, and suitable service constellation (Hong et al., 2006; Jain et al., 2012; Darney et al., 2016).
The current study shows that the mean age of women was 24.78±5.4; more than half of the sample was illiterate, which is in agreement with the study carried out by Ahmed and El Masry (2017). More than two-thirds of the women were housewives in the current study; this is in agreement with the study carried out by Mahamed et al. (2012), who showed that more than 90% of the sample included housewives. More than half of the women used contraceptive methods and three-fourths of them used mechanical type in the same line of this finding was the study carried out by Mustafa et al. (2008), which showed that 53% of women used contraception and the majority of the sample used IUD and condoms. In addition, Alege et al. (2016) reported that six in 10 women use any family planning methods and injection was the most one used.
This study showed that a high percentage of women used the contraceptive methods and they obtained it from MCH centers. This study was in agreement with the study carried out by Moronkola et al. (2006); Hong et al. (2011); Mersal and Keshk (2012), who reported that the majority of women depend on MCH centers to obtain contraceptive methods. In addition, Onwuzurike and Uzochukwu (2001); Mubita-Ngoma and Kadantu (2010); Salisbury et al. (2016) showed that the majority of the sample obtained family planning methods from public health facilities and their main source of information was the health workers. Furthermore, Alege et al. (2016) reported that public and private health facilities are the main sources of family planning services. In addition, Kamruzzaman and Abdul Hakim (2015), who studied family planning practices among married women in Bangladesh, found that about 87.7% had heard of and had knowledge about the family planning, and their source of information about family planning was the media.
In terms of awareness of women about family planning, the present study found a marked improvement in women’s knowledge in the posttest than the pretest and there was a highly statistically significant difference. The women in the present study were asked eight inquiries/questions about family planning that indicated a marked improvement in the dimension of learning in the posttest compared with the posttest on ‘meaning of family arranging, benefits of family planning, noncontraceptive benefits of family planning methods, types of family planning, classification of family planning methods, side effects of family planning methods, advantages of family planning methods, and disadvantages of family planning methods’ and showed a highly statistically significant difference. In the same line of this finding was the study carried by Mahamed et al. (2012); in their study, they showed that the mean scores of women’ knowledge were significantly different before and after the intervention. The respondents showed high scores in the posttest than the pretest in the intervention group than the control group. In addition, Shattuck et al. (2011) reported that men facilitated contraceptive use for their wives and education appears to be an important factor in increasing the use of family planning. Furthermore, Ali et al. (2019) reported that awareness of contraceptives increased by 30% among the population in the intervention area.
The majority of women in this study reported satisfactory knowledge in the posttest compared with the pretest, and this finding is in agreement with the study carried out by Ali et al. (2019), Mahamed et al. (2012), who showed that the women reported considerable improvement and satisfied level of knowledge and awareness after the intervention.
The current study found negative correlations with a statistically significant difference between women’s knowledge and age; the younger the women, the greater the knowledge improvement, and this finding is not in agreement with the study carried out by Darney et al. (2016). Furthermore, Najafi-Sharjabad et al. (2013) reported that cultural attitudes, lack of knowledge of different methods and reproduction, sociodemographic factors, and health service barriers are the main obstacles to contraceptive practices among women.
| Conclusion|| |
On the basis of the findings of this study, the educational program significantly improved the knowledge and awareness of women about all types of contraceptive methods. Almost 88.7% of women showed satisfactory knowledge about family planning methods in the posttest compared to 50.70% at the pretest. There was no relation between the mean score of women’s knowledge and their sociodemographic data.
The current study recommended that:
- Educational programs should be provided to the public about the safety and convenience of modern, long-term, reversible methods of contraception.
- Family planning counseling needs to be universally included in all clinics activities which serve women health.
- Improving female education is certain to improve the existing knowledge and also to scatter the existing misinformation and misperceptions about family planning methods.
- Further studies should be carried out in this area to improve women’s awareness about the modern methods of contraception.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ahmed N, El Masry S (2017). Enhancing of female rural leaders’ awareness about first aid activities using capacity development approach Int J Novel Res Healthcare Nurs 4;345–353
Alege S, Matovu J, Ssensalire S, Nabiwemba E (2016). Knowledge, sources and use of family planning methods among women aged 15-49 years in Uganda: a cross-sectional study. Pan Afr Med J 24:39.
Ali M, Azmat S, Hamza H, Rahman M, Hameed W (2019): Are family planning vouchers effective in increasing use, improving equity and reaching the underserved? An evaluation of a voucher program in Pakistan. BMC Health Serv Res 19:200.
Awadalla H (2012). Contraception use among Egyptian women: results from Egypt demographic and health survey in 2005. 13:167–173.
Darney B, Saavedra-Avendano B, Sosa-Rubi S, Lozano R, Rodriguezb M (2016). Comparison of family-planning service quality reported by adolescents and young adult women in Mexico. Int J Gynaecol Obstet 134:22–28.
Dougherty A, Kayongo A, Deans A, Mundaka J, Nassali F, Sewanyana J et al.
(2018). Knowledge and use of family planning among men in rural Uganda. BMC Public Health 18:1294.
Eltomy EM, Saboula NE, Hussein AA (2013). Barriers affecting utilization of family planning services among rural Egyptian women. East Mediterr Health J 19:400–408.
El-Zeini L (2008) The path to replacement fertility in Egypt: acceptance, preference, and achievement. Stud Fam Plann 39:161–176.
El-Zeini L (2009). The status of fertility transition in Egypt and Morocco: explaining the differences; Paper presented at 26th IUSSP International Population Conference; Morocco, Marrakech; September–October.
Hong R, Montana L, Mishra V (2006). Family planning services quality as a determinant of use of IUD in Egypt. BMC Health Serv 6:79.
Hong R, Mishra V, Fronczak N (2011). Impact of a quality improvement programme on family planning services in Egypt. East Mediterr Health J 17:4–10.
Hong R, Mishra V, Fronczak N (2012). Impact of a quality improvement programme on family planning services in Egypt. East Mediterr Health J 17:4–10.
Jain AK, Ramarao S, Kim J, Costello M (2012). Evaluation of an intervention to improve quality of care in family planning programme in the Philippines. J Biosoc Sci 44:27–41.
Kamruzzaman M, Abdul Hakim M (2015). Family planning practice among married women attending Primary Health Care Centers in Bangladesh. Int J Bioinformat Biomed Eng 1:251–255.
Kumar M, Meena J, Sharma S, Poddar A, Dhalliwal V, Modi-Satish Chander Modi SC, Singh K (2011). Contraceptive use among low-income urban married women in India. J Sex Med 8:376–82.
Leslie HH, Sun Z, Kruk ME (2017). Association between infrastructure and observed quality of care in 4 healthcare services: a cross-sectional study of 4,300 facilities in 8 countries. PLoS Med 14:e 1002464.
Mahamed F, Parhizkar S, Shirazi A (2012). Impact of family planning health education on the knowledge and attitude among Yasoujian women. Glob J Health Sci 4:110–118.
Mersal F, Keshk L (2012). Improving health education skills for nurses working in MCH centers in Egypt to enhance women awareness regarding family planning. J Am Sci 8:2.
Moronkola M, Ojediran M, Amosu A (2006). Reproductive health knowledge, beliefs and determinants of contraceptives use among women attending family planning clinics in Ibadan, Nigeria. Afr Health Sci 6:155–159.
Mubita-Ngoma C, Kadantu M (2010). Knowledge and use of modern family planning methods by rural women in Zambia. Curationis 33:17–22.
Mustafa R, Afreen U, Hashmi H (2008). Contraceptive knowledge, attitude and practice among rural women. J Coll Phys Surg Pak 18:542–545.
Najafi-Sharjabad F, Yahya S, Abdul Rahman H, Hanafiah M, Abdul Manaf R (2013). Barriers of modern contraceptive practices among Asian women: a mini literature review. Glob J Health Sci 5:181–192.
Onwuzurike BK, Uzochukwu BS (2001). Knowledge, attitude and practice of family planning amongst women in a high density low-income urban of Enugu, Nigeria. Afr J Reprod Health 5:83–89.
Salisbury P, Hall L, Kulkus S, Paw M, Tun N, Min A et al.
(2016). Family planning knowledge, attitudes and practices in refugee and migrant pregnant and post-partum women on the Thailand-Myanmar border − a mixed methods study. Reprod Health 13:94
Samari G (2018). Women’s empowerment and short- and long acting contraceptive method use in Egypt. Cult Health Sex 20:458–473.
Shattuck D, Kerner B, Gilles K, Hartmann M, Ng’ombe T, Guest G (2011). Encouraging contraceptive uptake by motivating men to communicate about family planning: the Malawi Male Motivator Project. Am J Public Health 101:1089–1095.
Tilahun T, Coene G, Luchters S, Kassahun W, Leye E, Temmerman M et al.
(2013) Family planning knowledge, attitude and practice among married couples in Jimma Zone, Ethiopia. PLoS ONE 8:e61335.
Tsui A, McDonald-Mosley R, Burke A (2010). Family planning and the burden of unintended pregnancies. Epidemiol Rev 32:152–174.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]