Attitudes and practices related to intrauterine devices for nulliparous women among Chinese health care providers

Effectiveness of an educational intervention on knowledge and practice of young midwifery college students about IUD and Pap smear, Babol, Iran

OBJECTIVES

The high status of midwifery within the Millennium Development Goals (MDGs) is closely tied to enhancing clinical education. The purpose of this study was to review the effect of education on the knowledge and practice of midwifery students about Intrauterine Device (IUD) and Pap smears.

METHODS

This quasi-experimental study was conducted over the course of four semesters, involving 128 bachelor of midwifery students. The sampling method was non-random, utilizing convenience sampling. Four consecutive 45 min weekly sessions were held, which included three theory sessions and one practical training session. Education was conducted in face-to-face training sessions using different methods such as lectures, question and answer, slide shows, educational films and brochures, and training participants with moulage. The data were gathered using a questionnaire covering demographic characteristics, various aspects of IUD and Pap smear knowledge, along with checklists for IUD insertion and Pap smear. Paired-samples T-test and multiple regression test were used to analyze the data. A significance level of p<0.05 was set for the analysis.

RESULTS

The results of this study showed that there was a significant difference in the average knowledge across various aspects of IUD and Pap smear before and after the intervention (p<0.001). On multiple regression analysis, residence and income significantly influenced knowledge (β=0.313, p=0.001 and β=-0.384, p=0.001, respectively). Also, multiple regression analysis indicated that the use of IUD among family or friends and age significantly impacted practice (β=-0.450, p=0.005 and β=-0.206, p=0.030, respectively).

CONCLUSIONS

The educational intervention yielded a noticeable enhancement in the knowledge and practical skills of midwifery students. These students tend to achieve higher levels of success and deliver superior services to both patients and clients.

What do women need to know about long-acting reversible contraception? Perspectives of women from culturally and linguistically diverse backgrounds

AIM

To identify components of an online education intervention to improve preference for, and uptake of, long-acting reversible contraception in women from culturally and linguistically diverse backgrounds (CALD).

ISSUE ADDRESSED

Women from culturally and linguistically diverse (CALD) backgrounds have greater rates of unintended pregnancies than those born locally and are less likely to use long-acting reversible contraceptives (LARCs), which are highly effective at reducing unintended pregnancy. Increasing the uptake of LARC in women from CALD backgrounds may reduce the burden of unintended pregnancy in this high-risk group. An online education intervention has been shown to be effective at increasing preference for and uptake of LARC in young women. We aimed to describe what women from CALD backgrounds thought were the potentially effective components of an online education intervention to increase preference for, and uptake of, long-acting reversible contraception.

METHODS

This qualitative study involved semi-structured interviews with six Australian English-speaking women from each of Chinese, Indian, and Middle Eastern cultural backgrounds. Women were recruited through targeted Facebook advertising. Data were analysed using Braun and Clarke thematic analysis.

RESULTS

A total of 18 participants were interviewed. We have demonstrated the importance of messages tailored to cultural values, translating the video, widening the target audience to both men and women and using specific social media platforms. For all women, the video needs to highlight the covertness of contraceptive methods, alongside stating cost and approach to access. For Indian women, the video needs to highlight the effect of LARC methods on the menstrual period for Indian women and include basic information on women's health. For Middle Eastern women the video should be explicit about LARC not equating to abortion and emphasise the low efficacy of natural contraceptive methods. For Chinese women, the video should address the misconception that hormones damage the body. Regarding delivery of the video, it should be translated and delivered by a female doctor from the same culture. For Chinese women, the video should include women from the same culture sharing anecdotes and use WeChat and Chinese schools as a platform for dissemination. For Middle Eastern and Indian women government websites should be used for dissemination. The video should be made available to all decision-makers in the reproductive planning process including male partners of Middle Eastern women, parents and peers of Chinese women, and for Indian women the male partner, family, and community leaders.

CONCLUSIONS

There is a wide range of cultural adaptations that can be made to the online education videos about LARCs to improve uptake of LARCs and hence reduce the burden of unintended pregnancy in women from CALD grounds. SO WHAT?: Our findings will be used to modify an online education video about LARCs so that it is culturally appropriate for women from CALD backgrounds.

Impact of the intensive psychological intervention care on post-traumatic stress disorder and negative emotions of teenage female patients seeking an induced abortion

Aim

This study aimed to investigate the effects of intensive psychological intervention care on adverse emotions and post-traumatic stress disorder (PTSD) symptoms in female teenage patients after induced abortion.

Methods

This prospective cohort study included 100 teenage female patients seeking induced abortion who were randomly divided into two groups: the intervention group (n = 50) and the control group (n = 50). The intervention group received intensive psychological intervention care, while the control group received standard routine nursing. The scores of the PTSD checklist for DSM-5 (PCL-5), self-rating depression (SDS), and self-rating anxiety scale (SAS) were compared between the two groups at 1 month and 3 months after the operation.

Results

The intervention group had lower risk of developing PTSD (24% vs. 44%), depression (10% vs. 32%), and anxiety (0% vs. 12%) symptoms at 1 month after the surgery. However, there were no significant differences observed between the two groups at 3 months after the surgery. Furthermore, the intervention group had significantly lower scores in PCL-5 (27.4 ± 5.4 vs. 31.8 ± 5.7; 20.5 ± 7.1 vs. 25.0 ± 7.5; p < 0.05), SDS (31.8 ± 5.4 vs. 37.8 ± 6.6; 26.8 ± 5.0 vs. 31.4 ± 7.2; p < 0.05), and SAS (32.7 ± 5.0 vs. 39.8 ± 6.9; 25.0 ± 2.7 vs. 27.5 ± 2.8; p < 0.05) at 1 month and 3 months after induced abortion.

Conclusion

These findings suggest that intensive psychological intervention care can reduce the incidence and severity of depression, anxiety, and PTSD symptoms in teenage patients who undergo induced abortion.

Clinical trial registration

https://www.chictr.org.cn/showproj.html?proj=185200, identifier ChiCTR2300067531.

Reproductive care in Thai women with diabetes mellitus: a descriptive cross-sectional study

BACKGROUND

Pre-existing diabetes mellitus (DM) is a challenging pregnancy complication as poor glycemic control is associated with adverse maternal and fetal outcomes. In this study, we aimed to investigate DM-related knowledge, attitudes, preconception care practices, and contraceptive prevalence in women with DM.

METHODS

This descriptive cross-sectional survey was conducted among reproductive-aged Thai women receiving DM treatment at King Chulalongkorn Memorial Hospital between August 1, 2021, and June 30, 2022. Patients with DM who were not pregnant or trying to conceive and could be contacted via the phone were included and a validated self-administered questionnaire was distributed electronically.

RESULTS

A total of 238 participants were included in the final analysis, yielding 69.4% response rates. The mean (standard deviation) score for knowledge of pregnancy planning and pregnancy-related risks was 6.8 (3.5) out of 15. Only about half of the participants had discussed pregnancy planning with their physicians. Multivariable analysis showed that younger age at DM diagnosis, non-Buddhism, married, higher education, and medical personnel were significantly associated with higher knowledge scores. Women aged > 45 years and those with higher practice scores had significantly higher adjusted odds of using highly effective contraception; the most common methods included male condoms and combined oral contraceptive pills. There was an unmet need for contraception in 9.5% of women with DM.

CONCLUSIONS

Although highly effective contraception is safe for patients with DM, only about half of our participants used tier one or two contraceptives or had received consultation regarding preconception planning. There was a notable gap in care coordination among specialists; integrating reproductive healthcare into DM therapy would improve access to preconception care.

Utilization of long-acting contraceptive methods and associated factors among female healthcare providers in South Wollo Zone hospitals, Northeast, Ethiopia. A cross-sectional multicenter study

In Ethiopia Long-acting contraception method utilization was found low (22.7%) among female healthcare providers. However, there is no study has been conducted on the utilization long-acting contraception methods among female healthcare providers in the study area. These studies addressed important variables such as socio-demography and individual factors that might affect the use of long-acting contraceptive methods among female healthcare providers. We assessed the utilization of long-acting contraceptive methods and associated factors among healthcare providers in South Wollo Zone public hospitals, Amhara Region, Ethiopia, in 2021.An institutional-based cross-sectional study was conducted among 354 female healthcare workers in the South Wollo Zone hospitals from March to April, 2021. The participants were selected using a systematic random sampling technique. The data were collected using self-administered questionnaires entered into Epi-data version 4.1 and exported to SPSS version 25 for analysis. Bi-variable and multi-variable logistic regression analyses were performed. The adjusted odds ratio (AOR), along with a 95% confidence interval (CI), was estimated to measure the association. The significance level was set at a P- value under 0.05. The current utilization of long-acting contraceptive methods among female healthcare providers was found to be 33.6% [95%, CI 29-39)]. Discussion with a partner [AOR = 2.277,95% CI, (1.026-5.055)], method shift/switched [AOR = 4.302,95% CI, (2.285-8.102)], knowledge of the respondent [AOR = 1.887,95% CI, (1.020-3.491)], and ever birth [AOR = 15.670,95% CI, (5.065-48.49)] were significant factors toward the utilization of long-acting contraceptive methods. The current utilization of long-acting contraceptive methods was found to be low. Therefore, encouraging partner discussions through a targeted information education communication intervention strategy should be intensified to improve long-acting contraceptive methods utilization.

Expulsion and continuation rates of the levonorgestrel 52 mg intrauterine system was similar among nulligravid and parous users

OBJECTIVE

To compare the expulsion and continuation rates of the levonorgestrel (LNG) 52 mg intrauterine system (IUS) in a cohort of nulligravid and parous users.

METHODS

We conducted a retrospective cohort study that included 996 participants in whom we placed an LNG-IUS, and the participants were monitored for up to 5 years after device placement. We identify 498 nulligravid participants in the medical record database between 2012 and 2020. Each nulligravida was paired with a parous users who had an LNG-IUS inserted on the same day, just before or after the nulligravida. The Kaplan-Meier method and the log-rank test were used to compare the survival curves of the two groups.

RESULTS

By the fifth year of use, the expulsion rates were 7.6/100 and 8.2/100 women-years (W-Ys) and the continuation rates were 641/100 W-Ys and 65.4/100 W-Ys without difference among nulligravid and parous users, respectively (P = 0.782 and P = 0.564, respectively). We observed 29 and 31 expulsions among nulligravid and parous users, respectively.

CONCLUSION

Nulligravid and parous participants who used the 52 mg LNG-IUS showed similar expulsion and continuation rates during five years of use.

The effect of mobile video training for healthcare providers on long-acting reversible contraceptive (LARC) use among adolescents and young women

STUDY OBJECTIVE

To assess whether improving providers' education by video training using a mobile phone could affect providers' knowledge and attitude toward long-acting reversible contraceptives (LARCs), and thus further affect adolescents' and young nulliparous women's decisions to use LARCs. DESIGN, SETTING, PARTICIPANTS, INTERVENTION, AND MAIN OUTCOME MEASURES: This prospective case-control study was performed between 2019 and 2020. A total of 40 healthcare providers participated, of which 20 received "LARC First" video training, whereas the other 20 served as the control group and received no training. Surveys were conducted of 244 adolescents and young women who were consulted by these 2 groups of healthcare providers before abortion surgery. The data were used to analyze the relationship between providers' knowledge scores and the percentage of women who received counseling on LARCs decided to use LARCs, and what percentage continued to do so 12 months after surgery.

RESULTS

Providers from the study group scored higher in LARC knowledge than the control group. Compared to the control group, women in the study group reported receiving more counseling on LARCs (81.4% vs 7.9%) and more often chose to use LARCs (24.6% vs 2.4%). Twelve months later, there was no significant difference in contraceptive continuation between study and control groups, but study group participants were more likely to be using LARCs (P < .001).

CONCLUSION

Video training for providers improved both their knowledge and willingness to recommend LARCs and increased the probability of adolescent and young nulliparous women using these methods to reduce unintended pregnancy.

History of IUD utilization and the risk of preterm birth: a cohort study

OBJECTIVE

To explore whether a history of IUD use could increase the risk of subsequent preterm birth.

METHODS

We performed a cohort study of 24,496 multipara aged 19-48 years in Dongguan City. Each subject was followed up for 1 year, and 12,508 women obtained pregnancy outcomes. They were divided into 2 groups: 2130 subjects with IUD use history (exposure group), and 10,378 subjects without IUD use history (control group). The exposure group will remove the IUD before pregnancy. The primary outcomes were preterm birth (less than 37 weeks of gestation) and early preterm birth (less than 34 weeks of gestation). We used log-binomial regression to estimate adjusted risk ratios (aRR) of preterm birth and early preterm birth for women with a history of IUD. According to the different adjusted baseline data, three regression models were established, and the propensity matching score method was also used to verify the stability of the results.

RESULTS

The delivery rate of women with IUD history was 51.24%, and that of women without IUD was 51.03% (² = 0.063, P = 0.802). Six hundred and eighty-five women had preterm birth (5.48%, 95% CI 5.08-5.88) and 133 women had early preterm birth (1.06%, 95% CI 0.83-1.24). Compared with the control group, the incidence of preterm birth and early preterm birth in the exposure group were significantly lower. The results are stable in all four models. Subgroup analysis also supported the result. This study also found that the longer the women used IUD before pregnancy, the younger the age of first using IUD, and the shorter the time from condom removal to pregnancy, the lower the incidence of premature birth.

CONCLUSION

The women with a history of IUD use are less likely to have premature birth after the IUD is removed. More prospective studies are needed to confirm it.

Knowledge and attitude about intrauterine contraceptive devices among patients attending the National Guard Hospital in Jeddah, Saudi Arabia: a cross-sectional study

OBJECTIVES

To investigate women's knowledge and attitudes regarding the use of the intrauterine device (IUD) for contraceptive purposes and to explore eventual misconceptions about its benefits, and disadvantages.

METHODS

A cross-sectional study was conducted in the Obstetrics and Gynaecology (OB/GYN) outpatient department at King Khalid National Guard Hospital in King Abdul-Aziz Medical City, Jeddah, Saudi Arabia. It involved women aged 15-55 years, who attended the outpatient OB/GYN clinic from July 2018 till May 2019. A validated self-structured questionnaire was used to collect demographic data and clinical data; including, medical and surgical history, obstetrical and gynaecological history.

RESULTS

Of 269 participants, 32.3% reported a positive history of unintended pregnancy, and 28.6% declared using or having used IUD, with copper being the most frequent type (17.8%). A majority (81.4%) of the respondents viewed IUD as a contraceptive method only. In comparison, more than 70% declared not knowing the type of IUD used for bleeding control, cycle regulation, endometriosis treatment, cervix cancer prevention, and endometrial hyperplasia. Further, 21.9% and 55.4% believed that IUD increases the risk of ectopic pregnancy and infections, respectively.

CONCLUSION

Women attending outpatient clinics in our centre had poor knowledge levels about IUDs, with several misconceptions and apprehensions, especially regarding the risk of genital infections and ectopic pregnancy, which may constitute a significant psychological barrier use.

Misconceptions and Beliefs Regarding the Use of Intrauterine Devices for Nulliparous Women Among Chinese Health Care Providers

STUDY OBJECTIVE

To investigate the knowledge and beliefs regarding the use of intrauterine devices (IUDs) for nulliparous women among Chinese health care providers and assess the potential factors related to their misconceptions and conservative beliefs. DESIGN, SETTING, PARTICIPANT, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A self-administered survey was conducted at 2 Chinese national academic conferences in 2015. The questionnaire data obtained from 103 health care providers were analyzed to examine the providers' knowledge regarding the safety and effectiveness of IUDs and the complications associated with IUD use, as well as their beliefs regarding the suitability of IUDs for nulliparous women. An ordinal logistic regression model was used to evaluate the potential factors related to their beliefs.

RESULTS

Misconceptions about the complications associated with IUD use were common among our respondents, and they were least likely to know that IUDs do not increase the risk of developing pelvic inflammatory disease (26/97) or ectopic pregnancy (23/102) (22.5%-26.8%). Only approximately 10% of the providers believed that adolescents (9/94) or unmarried nulliparas (10/95) could be candidates for IUDs. In contrast, they were more likely (37/96, 38.5%) to consider married nulliparous women as appropriate candidates (P < .001). Misconceptions about the complications of IUD use were associated with more conservative beliefs regarding IUD use for nulliparous women (adjusted odds ratio, 1.34; 95% confidence interval, 1.00-1.79).

CONCLUSION

The health care providers' insufficient knowledge regarding IUDs contributed to their outdated and conservative beliefs about the suitability of IUDs for nulliparous women. In addition, the difference in the providers' beliefs regarding IUD use for married and unmarried nulliparous women might reflect the stigma associated with premarital sex in Chinese traditional culture.