Knowledge and attitudes towards emergency contraception of health-care providers in a region with a high birth rate

Clinicians' knowledge and practices regarding family planning and intrauterine devices in China, Kazakhstan, Laos and Mexico

BACKGROUND

It is widely agreed that the practices of clinicians should be based on the best available research evidence, but too often this evidence is not reliably disseminated to people who can make use of it. This "know-do" gap leads to ineffective resource use and suboptimal provision of services, which is especially problematic in low- and middle-income countries (LMICs) which face greater resource limitations. Family planning, including intrauterine device (IUD) use, represents an important area to evaluate clinicians' knowledge and practices in order to make improvements.

METHODS

A questionnaire was developed, tested and administered to 438 individuals in China (n = 115), Kazakhstan (n = 110), Laos (n = 105), and Mexico (n = 108). The participants responded to ten questions assessing knowledge and practices relating to contraception and IUDs, and a series of questions used to determine their individual characteristics and working context. Ordinal logistic regressions were conducted with knowledge and practices as dependent variables.

RESULTS

Overall, a 96 % response rate was achieved (n = 438/458). Only 2.8 % of respondents were able to correctly answer all five knowledge-testing questions, and only 0.9 % self-reported "often" undertaking all four recommended clinical practices and "never" performing the one practice that was contrary to recommendation. Statistically significant factors associated with knowledge scores included: 1) having a masters or doctorate degree; and 2) often reading scientific journals from high-income countries. Significant factors associated with recommended practices included: 1) training in critically appraising systematic reviews; 2) training in the care of patients with IUDs; 3) believing that research performed in their own country is above average or excellent in quality; 4) being based in a facility operated by an NGO; and 5) having the view that higher quality available research is important to improving their work.

CONCLUSIONS

This analysis supports previous work emphasizing the need for improved knowledge and practices among clinicians concerning the use of IUDs for family planning. It also identifies areas in which targeted interventions may prove effective. Assessing opportunities for increasing education and training programs for clinicians in research and IUD provision could prove to be particularly effective.

Surveying the Knowledge and Practices of Health Professionals in China, India, Iran, and Mexico on Treating Tuberculosis

Research evidence continues to reveal findings important for health professionals' clinical practices, yet it is not consistently disseminated to those who can use it. The resulting deficits in knowledge and service provision may be especially pronounced in low- and middle-income countries that have greater resource constraints. Tuberculosis treatment is an important area for assessing professionals' knowledge and practices because of the effectiveness of existing treatments and recognized gaps in professionals' knowledge about treatment. This study surveyed 384 health professionals in China, India, Iran, and Mexico on their knowledge and practices related to tuberculosis treatment. Few respondents correctly answered all five knowledge questions (12%) or self-reported performing all five recommended clinical practices "often or very often" (3%). Factors associated with higher knowledge scores included clinical specialization and working with researchers. Factors associated with better practices included training in the care of tuberculosis patients, being based in a hospital, trusting systematic reviews of randomized controlled double-blind trials, and reading summaries of articles, reports, and reviews. This study highlights several strategies that may prove effective in improving health professionals' knowledge and practices related to tuberculosis treatment. Facilitating interactions with researchers and training in acquiring systematic reviews may be especially helpful.

Assessing healthcare providers' knowledge and practices relating to insecticide-treated nets and the prevention of malaria in Ghana, Laos, Senegal and Tanzania

BACKGROUND

Research evidence is not always being disseminated to healthcare providers who need it to inform their clinical practice. This can result in the provision of ineffective services and an inefficient use of resources, the implications of which might be felt particularly acutely in low- and middle-income countries. Malaria prevention is a particularly compelling domain to study evidence/practice gaps given the proven efficacy, cost-effectiveness and disappointing utilization of insecticide-treated nets (ITNs).

METHODS

This study compares what is known about ITNs to the related knowledge and practices of healthcare providers in four low- and middle-income countries. A new questionnaire was developed, pilot tested, translated and administered to 497 healthcare providers in Ghana (140), Laos (136), Senegal (100) and Tanzania (121). Ten questions tested participants' knowledge and clinical practice related to malaria prevention. Additional questions addressed their individual characteristics, working context and research-related activities. Ordinal logistic regressions with knowledge and practices as the dependent variable were conducted in addition to descriptive statistics.

RESULTS

The survey achieved a 75% response rate (372/497) across Ghana (107/140), Laos (136/136), Senegal (51/100) and Tanzania (78/121). Few participating healthcare providers correctly answered all five knowledge questions about ITNs (13%) or self-reported performing all five clinical practices according to established evidence (2%). Statistically significant factors associated with higher knowledge within each country included: 1) training in acquiring systematic reviews through the Cochrane Library (OR 2.48, 95% CI 1.30-4.73); and 2) ability to read and write English well or very well (OR 1.69, 95% CI 1.05-2.70). Statistically significant factors associated with better clinical practices within each country include: 1) reading scientific journals from their own country (OR 1.67, 95% CI 1.10-2.54); 2) working with researchers to improve their clinical practice or quality of working life (OR 1.44, 95% CI 1.04-1.98); 3) training on malaria prevention since their last degree (OR 1.68, 95% CI 1.17-2.39); and 4) easy access to the internet (OR 1.52, 95% CI 1.08-2.14).

CONCLUSIONS

Improving healthcare providers' knowledge and practices is an untapped opportunity for expanding ITN utilization and preventing malaria. This study points to several strategies that may help bridge the gap between what is known from research evidence and the knowledge and practices of healthcare providers. Training on acquiring systematic reviews and facilitating internet access may be particularly helpful.

Attitudes towards family planning among women seeking induced abortion in Izmir, Turkey

OBJECTIVES

To assess contraceptive knowledge, use of emergency contraception (EC) and the motives of women seeking induced abortion.

METHODS

A descriptive and cross-sectional study conducted at the T. C. Izmir Dr. Hayri Ekrem Ustundag Gynaecology and Maternity Hospital and the Izmir Ataturk Research and Teaching Hospital, Turkey. The research sample consisted of 440 women who requested an abortion between January and May 2010, and voluntarily agreed to participate.

RESULTS

Sixty-two percent of the women became pregnant while using family planning (FP) methods. The contraceptive used by 42% was the condom, and 45% believed that they had become pregnant because of improper use of the contraceptive. Ninety-three percent had never used EC. Thirty-seven percent wanted their pregnancy terminated because they did not want another child, whereas 26% viewed induced abortion as a method of FP. Sixty-nine percent of the women received FP counselling from health professionals, and 80% found the information provided adequate.

CONCLUSION

The women assessed were insufficiently knowledgeable about FP in general and EC in particular. Many had become pregnant as a result of inaccurate information.

Emergency contraception: a review

Emergency contraception (EC), also known as 'the morning after pill', or post-coital contraception, is a modality of preventing the establishment of a pregnancy after unprotected intercourse. Both a hormonal and an intrauterine form are available. Modern hormonal EC, with low side effects, was first proposed by Yuzpe in 1974. More recently, a new regimen, consisting of levonorgestrel administered alone, was introduced and found in clinical trials to be more effective (if taken as early as possible), and associated with less side effects than the Yuzpe regimen, which it has gradually replaced. The WHO developed another regimen based on the use of the selective progesterone receptor modulator (antiprogestin) mifepristone and conducted trials with different dosages. Intrauterine EC was first proposed by Lippes in 1976. It has the advantage of being applicable for almost a week and the disadvantage of a greater complexity. In addition, this modality is solely interceptive, acting by preventing implantation. Pregnancy rates reported following EC using an intrauterine device with more than 300 mm2 of copper are consistently low (0.1-0.2%).

Side effects and acceptability of Implanon: a pilot study conducted in eastern Turkey

OBJECTIVE

To assess side effects during the first 6 months of use of Implanon.

DESIGN AND METHODS

The study was conducted in eastern Turkey between June 2004 and May 2005. Forty-one healthy women, aged 18-40 years who chose to use Implanon participated in the study. The implant was inserted between days 1 and 5 of the menstrual cycle. Findings were recorded before and during 6 months following insertion. Statistical analyses were performed using SPSS package programme including paired samples t-test.

RESULTS

No pregnancy occurred during the study. Ninety days after initiation of therapy, three of the 41 patients (7.3%) had regular periods, 14 (34.1%) were amenorrhoeic and the remaining 24 (58.5%) had some type of abnormal bleeding. Dysmenorrhoea affected significantly less women (1/41, i.e. 2.4%) than before treatment (17/41, i.e. 41.5%), but mastalgia increased significantly as it was reported by five previously unaffected participants (12.2%). Mood changes appeared in seven patients (17.1%) and acne in 11 of them (26.8%). The circulating levels of protein C, total cholesterol and oestradiol dropped significantly. Endometrial thickness decreased significantly. At completion of the study period, removal of the implant was requested by eight of the 41 patients (19.5%) because of irregular bleeding (six women), depressive symptoms requiring treatment (one woman) or weight gain (one woman).

CONCLUSIONS

Mainly because of irregular bleeding, the discontinuation rate of Implanon at 6 months among the women in this region is high (19.5%).

Emergency contraception: knowledge and attitudes of Turkish nursing and midwifery students

OBJECTIVES

To assess the knowledge and attitudes of emergency contraception (EC) among nursing and midwifery students of a university in the Eastern-Mediterranean region of Turkey.

METHODS

The survey was conducted among 210 nursing and midwifery students.

RESULTS

One hundred and twenty-five participants (59.5%) knew at least one method of EC. One hundred and fourteen participants (54.3%) had heard about emergency contraceptive pills (ECPs), but only 17 (8.1%) knew what they contained. Rates of hearing about ECPs were statistically higher in third and fourth classes than first and second classes, and in midwifery students than in nursing students (P < 0.001). In spite of their very unsatisfactory level of knowledge, 166 students (79.0%) thought that ECPs should be sold in pharmacies.

CONCLUSION

The nursing and midwifery students we assessed have a very insufficient knowledge of EC. Probably therefore, many are prejudiced against it. They should be much better acquainted with this modality of contraception since, after graduation, they will play an important role in the dissemination of information about EC in the population.