Abstract
BACKGROUND:
Population growth is still a global concern. In spite of the decrease in population growth and conception rate, Iran and the world population will grow in coming years. Participation of men in contraception interventions to control population growth is of great importance.
METHODS:
This is a quasi-experimental study, in which the authors provided group training of contraceptive methods to 53 women, and then evaluated the effect of training on the dependent variable of husbands’ participation in family planning. The data was gathered using a questionnaire and a checklist, and then was analyzed using SPSS software, by paired t-test.
RESULTS:
The results indicated that the mean score of knowledge level of the case group members and their husbands changed significantly after the training program (p < 0.001). Also, it was found that 51% of the participants and their husbands used contraceptive methods after the training program.
CONCLUSIONS:
Considering the results, providing group training for couples to increase the participation rate of men in family planning programs is recommended.
Keywords: Group training, men's participation, family planning
Population growth is still one of the global concerns. In spite of the great attempt for family planning and controlling the population growth carried out in developing countries, an unprecedented world population growth was observed in the last fifty years. Now, the annual population growth is 77 million or 1.3%. The United Nations’ estimations indicate that world population will reach 9 billion in 2050.1,2
Although population growth rate and conception rate has decreased, the population of Iran and the world will increase in coming years, and particularly in developing areas, the absolute number of population will significantly increase.3
Currently, in family planning programs it is tried to encourage men to participate more in the program and make them understand that they are fifty percent responsible for family planning. Pramilla considered that “I believe that men attend the family planning programs more, but this is a long process and we need further programs to motivate and guide men”.4,5 According to the published results, in Iran, the participation of men in using contraceptive methods was one to 2.3 in Isfahan and the Falavarjan health network in 2005. The rate in Isfahan and health houses affiliated with Falavarjan health network was one to 2.1 in 2005.6 Furthermore, considering the cultural context of the country and the dominance of men's decisions in families and since men do not have fertilization limitations and they can marry more than once, it is important to pay special attention to participation of men in family planning programs.
However, as most employees of health houses of the country are women and also the working hour of the health houses are the same as those of many professional activities, men are rarely visited in the houses. On the other hand, considering the important role of men in family planning programs, providing the background required for participation of men in such programs is a must. One of these methods is presenting indirect training for men. Greater participation of men can be achieved by group training of their wives using educational leaflets and pamphlets and then asking the women to teach their husbands these items. Therefore, the authors carried out the study to evaluate the level of participation of men following the group training of their wives about family planning.
The detailed objectives of the study were as follows: comparison of the knowledge level of the men under study before and after the group training, comparison of the knowledge level of men about the family planning programs before and after the training, determination of the number of families using effective contraceptive methods after the intervention, and determination of the level of employment of different effective contraceptive methods by the participants and their husbands in the families receiving health services from the health houses of Falavarjan health network.
Method
The study population of this quasi-experimental study was all women receiving non-effective contraceptive methods from the family planning unit of selected health houses of Falavarjan health network and their families. Sample size was determined to be 53. The sampling method was as follows: first from among the 57 health houses of Falavarjan health network, five health houses were randomly selected and then in each health house, 10 to 12 women meeting the inclusion criteria were randomly selected.
After case selection, the basic tests on determination of knowledge level of the participants and their husbands from the family planning programs were given, and then group training was carried out in 8-10-individual groups for two months and in four sessions for each group. Finally, post-test evaluation was carried out two months after the end of the training. The data was collected using a questionnaire and an observational checklist. The tools were designed for evaluation of the knowledge level of the participants and their husbands about the family planning programs before and after the training, and determination of the degree of using effective contraceptive methods after the training program. The questionnaire included 11 items on personal profile of the participants and 19 items on measurement of knowledge level from the family planning programs. The overall score of the questionnaire was 35. In scoring the questionnaire, except for the items 1, 3, and 4, each correct answer scored one. for the first item (familiarity with family planning programs), 0-3 scores were considered on the basis of the choice chosen, and for items three and four, eight scores were considered with regard to the number of selected choices. Moreover, a checklist was prepared to determine the level of family planning coverage as well as the type of the contraceptive method, which was filled out after the end of the training program. Scientific reliability of the questionnaire was determined by re-test of ten families, and the validity of the questionnaire was analyzed using content validity method. The data was analyzed using descriptive and inferential statistical methods.
Results
With regard to the comparison of knowledge level of the participants about the family planning programs before and after the group training, the results showed that the pre-test and post-test scores were 22 and 33, respectively, and the mean difference test (paired t-test) demonstrated a significant difference in this respect (p=0.000).
Considering the comparison of men's knowledge about the family planning programs before and after the group training of their wives, it was demonstrated that the pre-test and post-test scores were 18 and 25, and the difference was statistically significant (p=0.001).
With respect to determination of the rate of families using contraceptive methods after the group training program, the results indicated that 51% of the families under evaluation used effective contraceptive methods after the group training program.
Considering the determination of making use of different effective contraceptive methods by the participants and their husbands, it was observed that 51% of the participants went to the health houses and used pills (22%) and condoms (18%). Also, 4%, 5%, and 2% were referred for IUD placement, vasectomy, and tubectomy, respectively. Of the participants, 49% used ineffective contraceptive methods after the training, as before, and did not use effective family planning methods.
Discussion
The results obtained demonstrated that the mean score of knowledge of the participants and their husbands significantly increased about family planning after the training.
In this respect, Hosseini carried out a study to evaluate the effect of training on the rate of participation of male workers in family planning programs. It was demonstrated that the mean score of knowledge of participants were 19.41 and 29.37 before and after the training, respectively. Moreover, according to the results obtained by paired t-test, the mean score of knowledge of the participants’ couples increased about the different contraceptive methods in the post-test. The results of chi-square test indicated a significant difference in the knowledge score of users of Norplants, diaphragms, and condoms.7
In other words, the results demonstrated an increase in the knowledge score of the participants about the family planning programs and also an increase in the participation of men in the programs. In this regard, the seventh general working program of World Health Organization state that the aim of training and informative activities for health should be based upon the potentials of the individual and the society to increase the participation and self-dependence in health, as well as promotion of healthy behaviors.8
Moreover, the results imply that while none of the family under evaluation used effective contraceptive methods before the training, 51% used these methods after the group training program. Among the contraceptive methods received from the health houses, 23% were male contraceptive methods.
The results of the study on workers of Isfahan refinery showed that after the training 78% of the participants and their families used contraceptive methods.
Comparing the results obtained in the current study and those in the study on Isfahan refinery workers, it can be observed that although women attended the training course in the current study (men attended the training sessions in the other study), 51% received contraceptive methods after the training, out of which 23% asked for male contraceptive methods. This shows the participation of men in family planning programs. According to Sedgh Azar, men and women are equally responsible for contraception, and if man or woman experienced a complication of the contraceptive method, the couple should support him or her. In family health support system, more attention should be paid to the supportive aspects of men. In general, men use the contraceptive methods personally and also play a role in consulting their wives in selection and use of a contraceptive method, determining the family size, and supporting their wives while using the methods.9
Therefore, the results indicate that the husbands of the participants of the study received the information from their wives, and participated in family planning programs using effective contraceptive methods and using male contraceptive methods. Thus, the hypothesis of the research, i.e., increased participation of men in family planning programs after group training of their wives, is supported.
The authors declare no conflict of interest in this study.
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