Nepal Society of Obstetricians and Gynaecologists, Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu, GPO: 23700, Nepal.
Department of Obstetrics and Gynecology, Lumbini Zonal Hospital, Butwal, Nepal.
BMC Pregnancy Childbirth. 2019 May 2;19(1):148. doi: 10.1186/s12884-019-2310-y.
The use of post-partum family planning (PPFP) methods such as post-partum intrauterine device (PPIUD) in general remains low despite its benefits for the women. The reasons or factors affecting the uptake and continuation of such PPFP methods in developing countries such as Nepal remains unclear. This qualitative research aims to explore the factors affecting PPIUD uptake and continuation related behaviors among post-partum mothers within 6 weeks of childbirth in Nepal.
This qualitative study was conducted through 43 in-depth interviews among post-partum mothers who delivered in 3 selected hospitals in Nepal. Data were analyzed through content analysis using the theory of planned behavior (TPB) as the theoretical framework.
The themes and categories were structured around the three major components of the TPB on attitude, subjective norms, and behavioral control. Majority of the women in this study, irrespective of their behavioral outcome expressed a positive attitude towards PPIUD use. However, the women who expressed an unfavorable attitude towards PPIUD influenced their behavior to not choose or discontinue PPIUD. Subjective norms such as the family, peer, and societal influences against PPIUD negatively affected the women's intention and behavior related to PPIUD. Whereas, the positive influence of the health providers positively affected their behavior. Regarding the behavior control, women who had their own control over decisions tended to use PPIUD. However, external factors such as their husband's preference or medical conditions also played a prominent role in preventing many to use PPIUD despite their positive intentions.
As suggested in TPB, this study shows that multiple factors that are interlinked affected the behaviors related to uptake and continuation of PPIUD. The attitude helped in s`haping intention but did not always lead to the behavioral outcome of PPIUD uptake and continuation. Subjective norms had a strong influence on both intention and behavior. Behavior control belief also had an important role in the outcome with respect to PPIUD uptake and continuation. Thus, a more layered, multidimensional and interlinked intervention is necessary to bring positive behavior changes related to PPIUD.
尽管产后宫内节育器（PPIUD）等产后计划生育（PPFP）方法对妇女有益，但在尼泊尔等发展中国家，其使用率仍然很低。影响这些 PPFP 方法的采用和持续使用的原因或因素在尼泊尔等发展中国家仍不清楚。本定性研究旨在探讨尼泊尔产后 6 周内分娩的产后母亲中影响 PPIUD 采用和持续相关行为的因素。
本定性研究通过在尼泊尔 3 家选定医院进行的 43 次深度访谈进行。使用计划行为理论（TPB）作为理论框架，通过内容分析对数据进行分析。
主题和类别围绕 TPB 的三个主要组成部分构建，即态度、主观规范和行为控制。本研究中的大多数女性，无论其行为结果如何，都对使用 PPIUD 持积极态度。然而，对 PPIUD 持不利态度的女性影响了她们不选择或停止使用 PPIUD 的行为。主观规范，如家庭、同伴和社会对 PPIUD 的影响，对女性与 PPIUD 相关的意图和行为产生负面影响。然而，卫生提供者的积极影响对她们的行为产生了积极影响。关于行为控制，能够自主决策的女性更倾向于使用 PPIUD。然而，尽管她们有积极的意图，但她们丈夫的偏好或医疗状况等外部因素也在很大程度上阻止了许多人使用 PPIUD。
正如 TPB 所建议的那样，本研究表明，多种相互关联的因素影响了与 PPIUD 的采用和持续相关的行为。态度有助于塑造意图，但并不总是导致 PPIUD 的采用和持续行为结果。主观规范对意图和行为都有很大影响。行为控制信念也在 PPIUD 的采用和持续方面起着重要作用。因此，需要更具层次、多维和相互关联的干预措施来带来与 PPIUD 相关的积极行为变化。
