Assessing knowledge, attitudes, and practice of health providers towards the provision of postpartum intrauterine devices in Nepal: a two-year follow-up

Abstract

Background Health service providers play a key role in addressing women’s need for postpartum pregnancy prevention. Yet, in Nepal, little is known about providers’ knowledge, attitudes, and practice (KAP) on providing postpartum family planning (PPFP), particularly the immediate postpartum intrauterine device (PPIUD). This paper assesses providers KAP towards the provision of PPIUDs in Nepal prior to a PPIUD intervention to gain a baseline insight and analyzes whether their KAP changes both 6 and 24 months after the start of the intervention. Methods Data come from a randomized trial assessing the impact of a PPIUD intervention in Nepal between 2015 and 2017. We interviewed 96 providers working in six study hospitals who completed a baseline interview and follow-up interviews at 6 and 24 months. We used descriptive analysis, McNemar’s test and the Wilcoxon signed-rank test to assess KAP of providers over 2 years. Results The PPIUD KAP scores improved significantly between the baseline and 6-month follow-up. Knowledge scores increased from 2.9 out of 4 to 3.5, attitude scores increased from 4 out of 7 to 5.3, and practice scores increased from 0.9 out of 3 to 2.8. There was a significant increase in positive attitude and practice between 6 and 24 months. Knowledge on a women’s chance of getting pregnant while using an IUD was poor. Attitudes on recommending a PPIUD to different women significantly improved, however, attitudes towards recommending a PPIUD to unmarried women and women who have had an ectopic pregnancy improved the least. Practice of PPIUD counseling and insertion improved significantly from baseline to 24 months, from 10.4 and 9.4% to 99% respectively. Conclusions Although KAP improved significantly among providers during the PPIUD intervention, providers’ knowledge on a women’s chance of getting pregnant while using an IUD and attitudes towards recommending a PPIUD to unmarried women and women who have had an ectopic pregnancy improved the least. Provider KAP could be improved further through ongoing and more in-depth training to maintain providers’ knowledge, reduce provider bias and misconceptions about PPIUD eligibility, and to ensure providers understand the importance of birth spacing.

Women’s Choice of Immediate Postpartum Reversible Contraceptives Visiting a Tertiary Hospital of Nepal

“…26 According to study of postpartum IUCD in Nepal, healthcare providers knowledge, attitude and Practice towards PPIUCD counseling had biasness & misconceptions which can be improved with further in-depth training and making them understand the importance of birth spacing and improvement in service provider level. 27 The maximum women were of younger age group in our study and with past history of use of less effective contraceptives (least use: LARC) might be the result for high rate of pregnancy among the age group and so are the unintended pregnancy and its consequences with result similar to study by Secura, 12 Bajracharya 27 and Bhandari. 28 Women were Chhetri and Brahmin & spousal communication were highest in our study similar to study by Bhandari & his colleagues 28 but our study women had high percentage from rural area, primary level of education and lesser number refer husband as source of information contrary to their results.…”

Effect of Package of Interventions on the Use and Quality of Postpartum Family Planning Services at Yekatit 12 Hospital Medical College (Y12HMC), Addis Ababa, Ethiopia

“…24 Effectiveness of FP counseling and information provision are key points in this study and Frontline health professionals' capacity to deliver excellent PPFP services is hindered by their lack of knowledge and limited competence in providing PPFP services. 12,13 In this study there was a significant change in the proportion of respondents reporting that the health professionals explain properly how the method works, demonstrated how to use it and discussed possible side effects after intervention. These findings are aligned with studies done in northwest Ethiopia, Zambia and Afghanistan: that training and use of the WHO decision tool kit can help health-care practitioners perform better on counseling clients to provide effective PPFP service.…”

“…11 In less developed countries, there is a large knowledge gap regarding the full range of PPFP services and limited competence in providing PPFP services. [12][13][14] In addition to insufficient numbers of skilled care providers, poor organization of care processes, fragmented delivery of FP, routine maternal care, and a lack of a private counseling space for PPFP counseling are often barriers for postpartum women. [15][16][17] The aim of this study was to assess the combined effect of a package of interventions (creating a private counseling space near the postpartum ward and providing training for health care providers on the WHO decision tool kit and LACM) on the uptake and quality of PPFP services at Y12HMC, Addis Ababa, Ethiopia.…”

Integrating postpartum IUD counselling and insertion into routine maternity care in Nepal: Assessing trends over time

“…Low PPIUD knowledge among women counselled during the intervention could be attributed to poor PPIUD knowledge among providers. Though PPFP knowledge among community health volunteers was found to have increased after the intervention [ 28 ] as was the case for health providers participating in this study [ 29 ]. This reduction in knowledge highlights the challenges for continued effects and, importantly, shows the need for any scale up or future intervention to implement longer term, refresher training for health workers after such interventions to ensure good quality PPFP counselling [ 28 ].…”