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Knowledge and perceptions of the intrauterine device among family planning providers in Nepal: a cross-sectional analysis by cadre and sector.
BMC Health Serv Res 2015; 15:39BH

Abstract

BACKGROUND

Nepal has high unmet need for family planning and low use of intrauterine devices (IUDs). While clients' attitudes toward the IUD are known in a variety of contexts, little is known about providers' knowledge and perceptions of the IUD in developing countries. Nepal's liberal IUD service provision policies allow the opportunity to explore provider knowledge and perceptions across cadres and sectors. This research contributes to an understanding of providers' IUD perceptions in low-resource environments, and increases evidence for IUD task-sharing and private sector involvement.

METHODS

A questionnaire was administered to 345 nurses and auxiliary nurse midwives (ANMs) affiliated with the private Mahila Swastha Sewa (MSS) franchise, public sector, or private non-franchise sector. All providers had been trained in TCu 380A IUD insertion and removal. The questionnaire captured providers' IUD experience, knowledge, and perceived barriers to recommendation. Descriptive, multivariate linear, and multinomial logistic regression was conducted, comparing providers between cadre and sector.

RESULTS

On average, providers answered 21.5 of 35 questions correctly, for a score of 61.4%. Providers scored the lowest on IUD medical eligibility, answering 5.9 of 14 questions correctly. Over 50% of providers were able to name the four side effects most frequently associated with the IUD; however, one-third of all providers found at least one of these side effects unacceptable. Adjusted results show that cadre does not significantly impact provider's IUD knowledge scores or side effect perceptions. Public sector affiliation was associated with higher knowledge scores regarding personal characteristic eligibility and more negative perceptions of two normal IUD side effects. IUD knowledge is significantly associated with provider's recent training and employment at multiple facilities, and side effect perceptions are significantly associated with client volume, range of family planning methods, and region.

CONCLUSIONS

Provider knowledge and attitudes towards IUD provision are similar across cadre and sector, supporting WHO task-sharing guidelines and validating Nepal's family planning policies. However, overall provider knowledge is low. We recommend that providers need to receive further training and support to improve knowledge, manage side effects, and recognize women in periods of high unmet need--such as post-partum or post-abortion women--as suitable candidates for IUDs.

Authors+Show Affiliations

Population Services International, Washington, DC, USA. nchakraborty@psi.org.Population Services International, Washington, DC, USA. cait.m.murphy@gmail.com.Population Services International, Kathmandu, Nepal. mahesh@psi.org.np.Helen Keller International Nepal, Lalitpur, Nepal. srijusharma@gmail.com.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25627578

Citation

Chakraborty, Nirali M., et al. "Knowledge and Perceptions of the Intrauterine Device Among Family Planning Providers in Nepal: a Cross-sectional Analysis By Cadre and Sector." BMC Health Services Research, vol. 15, 2015, p. 39.
Chakraborty NM, Murphy C, Paudel M, et al. Knowledge and perceptions of the intrauterine device among family planning providers in Nepal: a cross-sectional analysis by cadre and sector. BMC Health Serv Res. 2015;15:39.
Chakraborty, N. M., Murphy, C., Paudel, M., & Sharma, S. (2015). Knowledge and perceptions of the intrauterine device among family planning providers in Nepal: a cross-sectional analysis by cadre and sector. BMC Health Services Research, 15, p. 39. doi:10.1186/s12913-015-0701-y.
Chakraborty NM, et al. Knowledge and Perceptions of the Intrauterine Device Among Family Planning Providers in Nepal: a Cross-sectional Analysis By Cadre and Sector. BMC Health Serv Res. 2015 Jan 28;15:39. PubMed PMID: 25627578.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Knowledge and perceptions of the intrauterine device among family planning providers in Nepal: a cross-sectional analysis by cadre and sector. AU - Chakraborty,Nirali M, AU - Murphy,Caitlin, AU - Paudel,Mahesh, AU - Sharma,Sriju, Y1 - 2015/01/28/ PY - 2013/11/21/received PY - 2015/01/07/accepted PY - 2015/1/29/entrez PY - 2015/1/30/pubmed PY - 2016/5/18/medline SP - 39 EP - 39 JF - BMC health services research JO - BMC Health Serv Res VL - 15 N2 - BACKGROUND: Nepal has high unmet need for family planning and low use of intrauterine devices (IUDs). While clients' attitudes toward the IUD are known in a variety of contexts, little is known about providers' knowledge and perceptions of the IUD in developing countries. Nepal's liberal IUD service provision policies allow the opportunity to explore provider knowledge and perceptions across cadres and sectors. This research contributes to an understanding of providers' IUD perceptions in low-resource environments, and increases evidence for IUD task-sharing and private sector involvement. METHODS: A questionnaire was administered to 345 nurses and auxiliary nurse midwives (ANMs) affiliated with the private Mahila Swastha Sewa (MSS) franchise, public sector, or private non-franchise sector. All providers had been trained in TCu 380A IUD insertion and removal. The questionnaire captured providers' IUD experience, knowledge, and perceived barriers to recommendation. Descriptive, multivariate linear, and multinomial logistic regression was conducted, comparing providers between cadre and sector. RESULTS: On average, providers answered 21.5 of 35 questions correctly, for a score of 61.4%. Providers scored the lowest on IUD medical eligibility, answering 5.9 of 14 questions correctly. Over 50% of providers were able to name the four side effects most frequently associated with the IUD; however, one-third of all providers found at least one of these side effects unacceptable. Adjusted results show that cadre does not significantly impact provider's IUD knowledge scores or side effect perceptions. Public sector affiliation was associated with higher knowledge scores regarding personal characteristic eligibility and more negative perceptions of two normal IUD side effects. IUD knowledge is significantly associated with provider's recent training and employment at multiple facilities, and side effect perceptions are significantly associated with client volume, range of family planning methods, and region. CONCLUSIONS: Provider knowledge and attitudes towards IUD provision are similar across cadre and sector, supporting WHO task-sharing guidelines and validating Nepal's family planning policies. However, overall provider knowledge is low. We recommend that providers need to receive further training and support to improve knowledge, manage side effects, and recognize women in periods of high unmet need--such as post-partum or post-abortion women--as suitable candidates for IUDs. SN - 1472-6963 UR - https://www.unboundmedicine.com/medline/citation/25627578/Knowledge_and_perceptions_of_the_intrauterine_device_among_family_planning_providers_in_Nepal:_a_cross_sectional_analysis_by_cadre_and_sector_ L2 - https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-015-0701-y DB - PRIME DP - Unbound Medicine ER -