Evaluation of two intervention models on contraceptive attitudes and behaviors among nulliparous women in Shanghai, China: a clustered randomized controlled trial

Abstract

BackgroundWith increasing acceptance of premarital sex among young Chinese women, the rates of unintended pregnancies and induced abortions are becoming alarmingly high, suggesting the needs of educating women with adequate contraceptive knowledge and providing them with accessible contraceptive services. Previous studies have shown that knowledge and attitudes towards contraception could be modified through intervention strategies. This study aimed to evaluate the effects of two community intervention models on modifying contraceptive attitudes and behaviors among nulliparous women.MethodsIn this clustered randomized controlled trial, nulliparous women aged 18–40 years from 18 communities were enrolled and randomized to either the traditional community intervention model (TC model) or the more comprehensive new community-based intervention model (NC model) with a ratio of 1:2. Contraceptive attitudes and behaviors were assessed before and after the interventions.ResultsA total of 901 nulliparous women were followed. The most common contraceptive method in both groups was condom (approximately 80%) before or after interventions. The rates of using effective contraceptive methods were very low (<5%) even after the intervention. Comparing the NC with TC group, the adjusted ORs and 95% CIs regarding natural family planning, emergency contraceptive usage and short-acting OCPs were1.53 (95% CI: 1.11–2.13), 2.87 (95% CI: 2.05–4.02), and 2.71 (95% CI: 1.65–4.47), respectively; while the ORs and 95%CIs of gynecological examination and contraceptive use were 2.31 (95% CI: 1.63–3.27) and 2.89 (95% CI: 1.98–4.23), respectively. No statistical significant difference was found for the use of effective contraceptive methods at post-intervention among the two models.ConclusionsHigh proportions of nulliparous women held negative attitudes and behaviors towards effective contraceptive methods. The NC model, integrating existing health resources, had more positive influence than the TC model on the favorable contraceptive attitudes and behaviors towards the use of any contraceptive methods, but had limited impact on the use of effective contraceptive methods. Our study suggested the feasibility of applying the NC model in Shanghai. Interventions on contraceptive attitudes and behaviors should base on the existing health service system, synthesize resources and selectively apply to populations with distinct characteristics.

Effect of education on knowledge of fertility counseling and attitudes toward fertility control

“…They also stated that we should teach proper fertility counseling using educational methods. [ 29 ] In his research, Morgan examined the knowledge gap associated with contraceptive methods in students. By providing educational interventions, Morgan showed that students do not have sufficient level of knowledge and awareness in the use of contraceptive methods, and this level is improved by performing educational interventions.…”

“…The result of the present study is consistent with the results of research by Ramazani et al ., Modabber et al ., Alami et al ., Shokri et al ., He et al . [ 19 27 28 29 31 32 ] In the study of Ramazani et al . Entitled “The effect of premarital education and counseling program on the knowledge and attitude of couples towards reproductive health” a significant increase was observed in the mean score of couples' attitudes about reproductive health after the intervention.…”

“…Entitled the effect of using new educational methods in comparison with traditional methods and mere lectures, showed that the fertility attitude and the use of contraceptive methods in new educational methods are improved. [ 29 ] The reason for the increase in attitude in these studies can be considered in the use of different educational methods and establishing more and appropriate communication and interaction with people and expressing new concepts in the framework of educational intervention. Using a logical message transmission system in the curriculum can be effective in changing behavior and attitude.…”

“…Using a logical message transmission system in the curriculum can be effective in changing behavior and attitude. [ 29 ] Also, the results of Rahmati et al . 's study showed that counseling can increase the attitude and practice of health workers in providing counseling with a fertility promotion approach and raising the level of awareness and attitude toward fertility and fertility counseling skills of health workers.…”

Integrating contraceptive services into existing perinatal care: protocol for a community-based cluster randomised controlled trial in Shanghai, China

“…After randomisation, there will be seven clusters in the intervention group and six clusters in the control group. 23 …”