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Improving post-partum family planning services provided by female community health volunteers in Nepal: a mixed methods study

BACKGROUND: Family planning services in the post-partum period, termed post-partum family planning (PPFP) is critical to cover the unmet need for contraception, especially when institutional delivery rates have increased. However, the intention to choose PPFP methods such as post-partum intrauterine...

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Autores principales: Thapa, Kusum, Dhital, Rolina, Rajbhandari, Sameena, Mishra, Sangeeta, Subedi, Shanti, Dotel, Bhogendra Raj, Vaidya, Sapana, Pande, Saroja, Tunnacliffe, Emily-Anne, Makins, Anita, Arulkumaran, Sabaratnam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027278/
https://www.ncbi.nlm.nih.gov/pubmed/32066440
http://dx.doi.org/10.1186/s12913-020-4969-1
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author Thapa, Kusum
Dhital, Rolina
Rajbhandari, Sameena
Mishra, Sangeeta
Subedi, Shanti
Dotel, Bhogendra Raj
Vaidya, Sapana
Pande, Saroja
Tunnacliffe, Emily-Anne
Makins, Anita
Arulkumaran, Sabaratnam
author_facet Thapa, Kusum
Dhital, Rolina
Rajbhandari, Sameena
Mishra, Sangeeta
Subedi, Shanti
Dotel, Bhogendra Raj
Vaidya, Sapana
Pande, Saroja
Tunnacliffe, Emily-Anne
Makins, Anita
Arulkumaran, Sabaratnam
author_sort Thapa, Kusum
collection PubMed
description BACKGROUND: Family planning services in the post-partum period, termed post-partum family planning (PPFP) is critical to cover the unmet need for contraception, especially when institutional delivery rates have increased. However, the intention to choose PPFP methods such as post-partum intrauterine devices (PPIUD) remains low in countries such as Nepal. Community health workers such as Female Community Health Volunteers (FCHVs) could play an important role in improving the service coverage of PPFP in Nepal. However, their knowledge of PPFP and community-based services related to PPFP remain unclear. This study aims to assess the effect on community-based PPFP services by improving FCHV’s knowledge through orientation on PPFP. METHODS: We conducted this mixed-methods study in Morang District in Nepal. The intervention involved orientation of FCHVs on PPFP methods. We collected quantitative data from three sources; via a survey of FCHVs that assessed their knowledge before and after the intervention, from their monthly reporting forms on counseling coverage of women at different stages of pregnancy from the communities, and by interviewing mothers in their immediate post-partum period in two selected hospitals. We also conducted six focus group discussions with the FCHVs to understand their perception of PPFP and the intervention. We performed descriptive and multivariable analyses for quantitative results and thematic analysis for qualitative data. RESULTS: In total, 230 FCHVs participated in the intervention and their knowledge of PPFP improved significantly after it. The intervention was the only factor significantly associated with their improved knowledge (adjusted odds ratio = 24, P < 0.001) in the multivariable analysis. FCHVs were able to counsel 83.3% of 1872 mothers at different stages of pregnancy in the communities. In the two hospitals, the proportion of mothers in their immediate post-partum period whom reported they were counseled by FCHVs during their pregnancy increased. It improved from 7% before the intervention to 18.1% (P < 0.001) after the intervention. The qualitative findings suggested that the intervention improved their knowledge in providing PPFP counseling. CONCLUSION: The orientation improved the FCHV’s knowledge of PPFP and their community-based counseling. Follow-up studies are needed to assess the longer term effect of the FCHV’s role in improving community-based PPFP services.
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spelling pubmed-70272782020-02-24 Improving post-partum family planning services provided by female community health volunteers in Nepal: a mixed methods study Thapa, Kusum Dhital, Rolina Rajbhandari, Sameena Mishra, Sangeeta Subedi, Shanti Dotel, Bhogendra Raj Vaidya, Sapana Pande, Saroja Tunnacliffe, Emily-Anne Makins, Anita Arulkumaran, Sabaratnam BMC Health Serv Res Research Article BACKGROUND: Family planning services in the post-partum period, termed post-partum family planning (PPFP) is critical to cover the unmet need for contraception, especially when institutional delivery rates have increased. However, the intention to choose PPFP methods such as post-partum intrauterine devices (PPIUD) remains low in countries such as Nepal. Community health workers such as Female Community Health Volunteers (FCHVs) could play an important role in improving the service coverage of PPFP in Nepal. However, their knowledge of PPFP and community-based services related to PPFP remain unclear. This study aims to assess the effect on community-based PPFP services by improving FCHV’s knowledge through orientation on PPFP. METHODS: We conducted this mixed-methods study in Morang District in Nepal. The intervention involved orientation of FCHVs on PPFP methods. We collected quantitative data from three sources; via a survey of FCHVs that assessed their knowledge before and after the intervention, from their monthly reporting forms on counseling coverage of women at different stages of pregnancy from the communities, and by interviewing mothers in their immediate post-partum period in two selected hospitals. We also conducted six focus group discussions with the FCHVs to understand their perception of PPFP and the intervention. We performed descriptive and multivariable analyses for quantitative results and thematic analysis for qualitative data. RESULTS: In total, 230 FCHVs participated in the intervention and their knowledge of PPFP improved significantly after it. The intervention was the only factor significantly associated with their improved knowledge (adjusted odds ratio = 24, P < 0.001) in the multivariable analysis. FCHVs were able to counsel 83.3% of 1872 mothers at different stages of pregnancy in the communities. In the two hospitals, the proportion of mothers in their immediate post-partum period whom reported they were counseled by FCHVs during their pregnancy increased. It improved from 7% before the intervention to 18.1% (P < 0.001) after the intervention. The qualitative findings suggested that the intervention improved their knowledge in providing PPFP counseling. CONCLUSION: The orientation improved the FCHV’s knowledge of PPFP and their community-based counseling. Follow-up studies are needed to assess the longer term effect of the FCHV’s role in improving community-based PPFP services. BioMed Central 2020-02-17 /pmc/articles/PMC7027278/ /pubmed/32066440 http://dx.doi.org/10.1186/s12913-020-4969-1 Text en © The Author(s). 2020 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Thapa, Kusum
Dhital, Rolina
Rajbhandari, Sameena
Mishra, Sangeeta
Subedi, Shanti
Dotel, Bhogendra Raj
Vaidya, Sapana
Pande, Saroja
Tunnacliffe, Emily-Anne
Makins, Anita
Arulkumaran, Sabaratnam
Improving post-partum family planning services provided by female community health volunteers in Nepal: a mixed methods study
title Improving post-partum family planning services provided by female community health volunteers in Nepal: a mixed methods study
title_full Improving post-partum family planning services provided by female community health volunteers in Nepal: a mixed methods study
title_fullStr Improving post-partum family planning services provided by female community health volunteers in Nepal: a mixed methods study
title_full_unstemmed Improving post-partum family planning services provided by female community health volunteers in Nepal: a mixed methods study
title_short Improving post-partum family planning services provided by female community health volunteers in Nepal: a mixed methods study
title_sort improving post-partum family planning services provided by female community health volunteers in nepal: a mixed methods study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027278/
https://www.ncbi.nlm.nih.gov/pubmed/32066440
http://dx.doi.org/10.1186/s12913-020-4969-1
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