IDENTIFICATION OF RATE OF PPIUCD, ASSESSMENT OF KNOWLEDGE, ATTITUDE AND INFORMATION RECEIVED BEFORE AND AFTER INSERTION AMONG POSTNATAL WOMEN ATTENDING SELECTED DISTRICT HOSPITAL, WEST BENGAL
Ruma Bhakta 1, Moitreyee
Choudhuri 2
1 Sister-in-Charge, Kharagpur
Sub-divisional Hospital, Kharagpur, India
2 Professor, College of Nursing, Medical
College and Hospital, Kolkata, India
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ABSTRACT |
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A study was conducted on identification of rate of PPIUCD, assessment of knowledge, attitude and information received before and after insertion among postnatal women attending selected district hospital in West Bengal with the objectives of identifying the rate of PPIUCD, assess the knowledge, attitude, relationship between knowledge and attitude regarding PPIUCD and assess the information received before and after PPIUCD insertion among postnatal women. The conceptual framework was based on Rosentoch, Beckerand and Maiman’s Health Belief Model. The tools were used to record analysis proforma, structured interview schedule, five-point structured attitude scale to collect data from the respondents. Content validity and reliability of the tools were established. A pilot study was conducted to find out the feasibility of the study. Nonprobability purposive sampling technique were adopted to collect data from the respondents. Descriptive and inferential statistics were used to analyze the data. The study findings revealed that the rate of PPIUCD was 29.68%, 51% respondents had good knowledge with 73% had neutral attitude regarding PPIUCD. There was moderate positive correlation (r = 0.58) with ‘t’ value 10.07 [3.132 with df (198)] at 0.001 level of significance. Majority of respondents were informed regarding PPIUCD related information. The findings have several implications on nursing practice, education, administration, and research. The study can be replicated in large population. |
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Received 15 February 2023 Accepted 14 March 2023 Published 31 March 2023 Corresponding Author Ruma
Bhakta, rumabhakta2014@gmail.com
DOI 10.29121/granthaalayah.v11.i3.2023.5081 Funding: This research
received no specific grant from any funding agency in the public, commercial,
or not-for-profit sectors. Copyright: © 2023 The
Author(s). This work is licensed under a Creative Commons
Attribution 4.0 International License. With the
license CC-BY, authors retain the copyright, allowing anyone to download,
reuse, re-print, modify, distribute, and/or copy their contribution. The work
must be properly attributed to its author. |
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Keywords: Rate, PPIUCD, Postnatal, Knowledge,
Attitude, Information |
1. INTRODUCTION
Women have the most
complex physiology, not only being capable of giving birth but are also endowed with a multi-faceted
personality. They are the living embodiment of benevolence, adjustability,
integrity and tolerance. Although, in our society, a majority of them remain
silent and grossly under-represented in decision making, they play a
great part in the progress of our country. Women’s health can be improved by
reducing the maternal mortality and morbidity rate, enabling spacing in birth interval,
and avoiding abortion. Nath and Islam (2015) According to the 2011 census, India has the second
largest population in the world just behind China and is very close to acquire
the top spot. It contributes 17.5% of world population with an addition of
around 25 million births every year. 65% of the women population have unmet
need of family planning in first postpartum period. Chauhan et al. (2018).
According to a report of World Bank, UNFPA, WHO in 2012, India contributes to 20% of maternal deaths in the world. Family planning can avert more than 30% of maternal death and 10 % of child mortality if couples spaced their pregnancies for at least 2 years. Yadav et al. (2018), World Health Organization (WHO) (2006) Contraception methods (both temporary and permanent) are effective means of preventing unwanted pregnancy. Intrauterine contraceptive device like CUT–380A provides pregnancy protection up to 10 years. The World Health Organization (WHO) revised the use of intrauterine contraceptive device (IUCD) from 6th week postpartum to within 10 minutes of placental delivery to up to 48 hours of delivery. World Health Organization (WHO) (2006), IUCD Reference Manual for Medical Officers and Nursing Personnel (2013) Till recently, there was no spacing methods available to women in postpartum period in public health facilities. The recent introduction of Postpartum Intra Uterine Contraceptive Device (PPIUCD) in India has revolutionized the basket of choice for the women. In India 2012-2013 the rate of PPIUCD was around 0.9% (HMIS). Low percentage of PPIUCD may be attributed to non-operationalization of the facility in 2012 – 2013. India's 'VISION FP 2020’ (2014) Proportion of PPIUCD acceptors among institutional deliveries in 2013 are 27% in Assam, 14% in Madhya Pradesh , 12% in Punjab, 11% in Tamil Nādu , 9% in Haryana,9% in Uttarakhand , 8% in Delhi, 6% in Orissa , 6% in Jharkhand, 5% in Gujarat , 5% in Uttar Pradesh, 15% in West Bengal, 5% in Bihar, 4% in Karnataka, 4% in Maharashtra, 4% in Meghalaya, 4% in Chhattisgarh, 2% in Rajasthan and 2% in Andhra Pradesh. Gupta et al. (2017) In a women’s reproductive life, spacing between childbirths help to promote health and wellbeing of both the mother and the child. Spacing children for a minimum period of 3 years gives the child a healthier start, and the mother adequate time to recover from physiological and psychological stresses incurred from previous pregnancy and delivery. Studies have found that conceiving within 2 years of delivery leads to adverse events like abortion, premature labour, postpartum haemorrhage, LBW babies, fetal loss sometimes maternal death. Keeping these in mind, it is advisable to practice contraception within immediate postpartum period for the good of women’s health. IUCD is the most commonly used reversible method of contraception worldwide with about 127 million current users. Chauhan et al. (2018) Previous studies have shown that, PPIUCD is associated with less discomfort, has fewer side effects (bleeding problem, perforation) and lower incidence of infection. It’s also a relief from overcrowded outpatient facilities ensures protection against unwanted pregnancies and abortions. In addition to these, there are fewer reports of insertion complaints caused by lochia and cramping t. It is safe for the use by HIV positive women on ART. It also does not interfere with breastfeeding. IUCD Reference Manual for Medical Officers and Nursing Personnel (2013).
1.1. STATEMENT OF THE PROBLEM
Identification of rate of PPIUCD, assessment of knowledge, attitude and information received before and after insertion among postnatal women attending selected district hospitals, West Bengal. Bhakta (2019)
2. LITERATURE REVIEW
·
Literature
related to rate of PPIUCD inserted. Chauhan et al. (2018), Chethan et al. (2018), Ramya et al. (2017), Nayak and Jain (2017), Sharma et al. (2015).
·
Literature
related to knowledge of postnatal women regarding PPIUCD. Chethan et al. (2018), Tripathi and Sahu (2018), Valliappan et al. (2018), Gara et al. (2014), Anitha et al. (2013), Nigam et al. (2018).
·
Literature
related to attitude of postnatal women regarding PPIUCD. Sunanda and Sudha (2015), Yadav and Koshalya (2017).
·
Literature
related to co-relation between knowledge and attitude regarding PPIUCD among
postnatal women. Valliappan et al. (2018), Yadav and Koshalya (2017), Gupta et al. (2017).
·
Literature
related to information received before and after PPIUCD insertion by postnatal
women. Chauhan et al. (2018), Tomar et al. (2018), Shekhawat and Janwadkar (2016), Goswami et al. (2015).
3. METHODOLOGY
Research Approach: Non-experimental study.
Research Design: Descriptive survey design.
Setting: Tamluk district hospital, Purba Medinipur, West Bengal.
Population: In the present study population compromised of all postnatal women who had inserted PPIUCD.
Sample and Sampling Technique: In the present study sample was postnatal
women who had inserted PPIUCD within 48 hours of delivery. Sample was selected by purposive sampling
technique.
Sample size: The sample size was 200 for the present study.
Table 1
Table 1 Data Collection Tools and Techniques |
|||
Tool No. |
Tools |
Variables to be measured |
Techniques |
I |
Semi structured interview schedule |
Demographic variables |
Interviewing |
II |
Record analysis proforma |
Rate of PPIUCD |
Record analysis |
III |
Structured interview schedule |
Knowledge regarding PPIUCD |
Interviewing |
IV |
Structured attitude scale |
Attitude regarding PPIUCD |
Interviewing |
V |
Structured interview schedule |
Information received before and after PPIUCD insertion |
Interviewing |
Section I
Findings related to demographic characteristics of the postnatal
women.
Figure 1
Figure 1 Percentage Distribution of The Postnatal Women According to Their Age |
Figure 2
Figure 2 Percentage Distribution of the Postnatal Women According to Their Educational Status |
Figure 3
Figure 3 Percentage Distribution of the Postnatal Women According to Their Religion |
Table 2
Table 2 Frequency and Percentage Distribution of Postnatal Women According to Parity and Monthly Income in Rupees. n = 200 |
||
Demographic characteristics |
Frequency |
Percentage (%) |
Parity |
|
|
Primi gravida |
120 |
60 |
Second gravida |
63 |
31.5 |
Third gravida |
12 |
6 |
Forth and more |
5 |
2.5 |
Monthly income |
|
|
3000 – 7000 |
108 |
54 |
7001 – 11000 |
56 |
28 |
11001 – 15000 |
16 |
8 |
15001 – 19000 |
9 |
4.5 |
>190001 |
11 |
5.5 |
Figure 4
Figure 4 Percentage Distribution of the Postnatal Women According to Their Previous Exposure to IUCD |
Table 3
Table 3 Frequency and Percentage Distribution of Postnatal Women According to Undergone Counselling (Yes / No) n = 200 |
||
Demographic
characteristics |
Frequency |
Percentage
(%) |
Undergone
Counselling |
|
|
Yes |
200 |
100 |
No |
Nil |
- |
Section II
This
section depicts the rate of PPIUCD.
Table 4
Table 4 Frequency and Distribution Showing the Rate of PPIUCD As Per Delivery Status N = 896 |
||
Mode of Delivery |
Frequency |
Percentage
(%) |
Normal Vaginal Delivery (n2 = 438) |
438 |
48.88 |
PPIUCD inserted |
266 |
29.68 |
Not inserted |
172 |
19.20 |
Caesarean delivery (n3= 458) |
458 |
51.12 |
PPIUCD inserted |
Nil |
-- |
Section III Findings related to assessment of knowledge of postnatal women regarding PPIUCD.
Table 5
Table 5 Frequency and Percentage Distribution of Postnatal Women Regarding Knowledge of PPIUCD n = 200 |
|||||
Gradation |
Range
of score |
Percentage(%) |
Frequency |
Percentage(%) |
|
Very good |
19
– 22 |
81 – 100 |
82 |
41 |
|
Good |
14
– 18 |
61- 80 |
102 |
51 |
|
Fair |
09
– 13 |
40 – 60 |
16 |
8 |
|
Poor |
<
09 |
< 40 |
Nil |
-- |
|
Table 6
Table 6 Distribution of Maximum Possible Score, Range, Mean Score, Mean Percentage, Median and Standard Deviation of Knowledge Score Regarding PPIUCD Among Postnatal Women, Undergone PPIUCD. N = 200 |
|||||
Variables |
Range |
Mean |
Mean Percentage (%) |
Median |
SD |
Knowledge |
10-22 |
17.8 |
80.90 |
18 |
206 |
Table 7
Table 7 Area Wise Distribution of Range, Mean Score, Mean Percentage and Rank Order of Knowledge Score of Postnatal Women, Undergone PPIUCD Insertion Regarding PPIUCD. N= 200 |
||||
Area |
Maximum
possible score |
Mean
score |
Mean
Percentage (%) |
Rank order |
Concept |
6 |
3.87 |
64.5 |
4th |
Mode of
action |
1 |
0.47 |
47 |
5th |
Advantage |
9 |
7.43 |
82.55 |
3rd |
Follow up |
2 |
1.98 |
99.25 |
1st |
Warning
sign |
4 |
3.71 |
99.87 |
2nd |
Section IV
This section deals with the findings related to assessment of attitude of postnatal women regarding PPIUCD.
Table 8
Table 8 Frequency Percentage Distribution of
Attitude Score Regarding PPIUCD
Postnatal Women Undergone PPIUCD Insertion.
N =200 |
|||
Gradation |
Scoring |
Frequency |
Percentage (%) |
Favourable ≥ Mean + SD |
>79 |
33 |
16.5 |
Neutral ≥ Mean – SD to ≥ Mean + SD |
59 – 79 |
146 |
73 |
Unfavourable Mean – SD |
<59 |
21 |
10.5 |
Table 9
Table 9 Distribution of Range, Mean Score, Mean Percentage, Median and SD of Attitude Score Obtained by Postnatal Women Undergone PPIUCD Insertion Regarding PPIUCD. N=200 |
|||||
Variables |
Range |
Mean
score |
Mean percentage (%) |
Median |
SD |
Attitude |
45
- 86 |
68.23 |
75.81 |
69 |
9 |
Section V
This section depicts the findings showing relationship between knowledge and attitude of postnatal women regarding PPIUCD.
Table 10
Table 10 Correlation Co-Efficient and Their Significance Existing Between Knowledge and Attitude Regarding PPIUCD. n =200 |
||
Variables |
‘r’
value |
‘t’
value |
Knowledge |
|
|
vs |
0.58 |
10.07*** |
Attitude |
|
|
‘t’ (df- 198) = 3.132 p < 0.001*** |
The data presented in the Table 10 depicts ‘r’ value
which was computed between knowledge and attitude regarding PPIUCD among
postnatal women. The computed ‘r’ value
was 0.58 which indicates a moderately positive correlation between the above-mentioned
variables. The ‘t’ value computed in the given data (10.07) was statistically
significant at 0.001 level of significance, this shows that the obtained
relationship is a true relationship and not by chance. From the above results
it can be concluded that with increase in knowledge, attitude also increased
among postnatal women. So, it can be concluded that postnatal women who had
good knowledge regarding PPIUCD had also good attitude towards PPIUCD.
Section
VI
This
section deals with the findings related to assessment of information
received before and after PPIUCD insertion among postnatal women.
Figure 5
Figure 5 Bar Diagram Showing Percentage Distribution of Information Assessment Score of Postnatal Women Regarding PPIUCD |
Table 11
Table 11 Frequency Percentage Distribution of Information Related to Advantage of PPIUCD. n
= 200 |
||
Information |
Received Frequency
Percentage (%) |
Not received
Frequency Percentage (%) |
Advantages |
|
|
Speed of action |
143 71.5 |
57 28.5 |
Convenient |
200 100 |
Nil - |
Effect on breast feeding |
200 100 |
Nil - |
Risk of perforation |
200 100 |
Nil - |
Figure 6
Figure 6 Bar Diagram Showing Percentage Distribution of Information
Related to Limitation Of PPIUCD |
Table 12
Table 12 Frequency Percentage Distribution of Information Related to Misconception of PPIUCD N = 200 |
||
Information |
Received Frequency
Percentage (%) |
Not received Frequency Percentage (%) |
Misconceptions |
|
|
Travel through heart |
200 100 |
Nil -- |
Discomfort during sex |
200 100 |
Nil -- |
Causes
cancer |
200 100 |
Nil -- |
Causes infertility |
169 84.5 |
31 15.5 |
Table 13
Table 13 Frequency Percentage Distribution of Information Related to
Warning Sign After PPIUCD Insertion
n = 200 |
||
Information |
Received Frequency
Percentage (%) |
Not received Frequency Percentage (%) |
Warning
sign |
|
|
Foul
vaginal discharge |
200 100 |
Nil -- |
Fever
with chills |
200 100 |
Nil -- |
Pregnancy |
200 100 |
Nil -- |
Expulsion
of PPIUCD |
164 82 |
36 18 |
Table 14
Table 14 Frequency Percentage Distribution of
Information Related to Follow up After PPIUCD Insertion
N = 200 |
||
Information |
Received Frequency
Percentage (%) |
Not received Frequency Percentage (%) |
Follow
up |
|
|
Time of
follow up |
200 100 |
Nil -- |
PPIUCD |
141 70.5 |
59 29.5 |
4. DISCUSSION
Researcher found
that the rate of PPIUCD were very less related to total delivery. Knowledge
regarding PPIUCD were assessable, and maximum scored good, there were mild deviation of knowledge score and no
poor knowledge found. The maximum
attitude of the postnatal women regarding PPIUCD were also neutral, which
indicates still awareness is required for increasing positive attitude. There were positive co-relation seen between
knowledge and attitude, which proves that with increased knowledge, attitude
also increased among respondents. With regards to the information received by
the postnatal mother before and after PPIUCD, majority respondents were
informed regarding advantages, misconception, warning signs, follow-up advice
and only a minor section were not aware regarding limitations of PPIUCD.
The major findings of the study were as follows.
1) Findings related to demographic characteristics.
·
Majority
of the respondents (58%) were belong from the age group of 18-21.
·
Maximum
respondents (69%) belonged to secondary level of education.
·
Most
of respondents (62%) belonged from Hindu religion.
·
Among
all respondents (60%) were primipara mother.
·
Majority
of the respondents (54%) had their monthly income in between 3000– 7000.
·
Maximum
respondents (94%) did not use PPIUCD previously.
·
In
regard to the findings, (100%) postnatal women undergone PPIUCD.
·
counselling.
2) Findings related
to rate of PPIUCD.
·
The rate of PPIUCD were
inserted 266 (29.68 %) among total delivery (896).
·
Total
PPIUCD were inserted 266 (60.74%), among the total normal vaginal delivery
(438) women and
none of the postnatal women had inserted intra caesarean PPIUCD.
3) Findings related to knowledge of postnatal women regarding PPIUCD.
·
51% respondents had good knowledge
regarding PPIUCD.
·
No poor knowledge found
regarding PPIUCD among respondents.
·
Maximum knowledge found in
the area of follow up (99.25%), warning sign (92.87%), advantage (82.55%), concept
(64.5%), mode of action of PPIUCD (47%) consecutively.
4) Findings related
to attitude of postnatal women regarding PPIUCD.
·
Majority (73 %) respondents
had neutral attitude regarding PPIUCD.
·
Only 16.5% respondents had
favourable attitude regarding PPIUCD.
5) Findings related
to relationship between knowledge and attitude of postnatal women
regarding PPIUCD.
·
There
were a moderate positive correlation (r = 0.58) exist between knowledge and
attitude among respondents.
·
It
also seen that the calculated ‘t’(10.7) value was statistically significant ,
‘t’(df – 198) = 3.132 at 0.001 level of significance. So, it can be concluded
that there if knowledge is increased attitude supposed to be increased.
6) Findings related to information received before and after PPIUCD insertion among postnatal women.
·
100% respondents had
received general information, advantage, misconception, warning sign and post
insertion follow up visit required and 78.5% had received information regarding
limitation of PPIUCD before and after its insertion.
·
100% respondents were
informed about the area of general information all respondents had received
(100%) information related to birth spacing, pregnancy protection, removal
procedure and (69%) received information related to immediate return of
fertility.
·
In the context of advantage
of PPIUCD 100% respondents had received information that PPIUCD is most
convenient, no effects on breast feeding, no risk of perforation and (71.5%)
were informed that PPIUCD has rapid action to prevent pregnancy as soon as it
is inserted.
·
In the area of limitation
of PPIUCD (78.5%) respondents had received information that PPIUCD had higher
expulsion rate and only (47%) was informed that PPIUCD lacks protection from
HIV/STDs.
·
In the area of
misconception related to PPIUCD (100%) were informed that it did not travel
through heart, causes of discomfort during sex, causes cancer and (84.5%) were
informed that PPIUCD did not causes infertility.
·
100% respondents were
informed regarding warning sign after PPIUCD insertion that were foul vaginal
discharge, fever with chills, pregnancy and 82% were informed that PPIUCD may
fallen out.
·
100% respondents were
informed regarding follow up visit after PPIUCD insertion and 70.5% were
informed that PPIUCD string may not always feel by the hand always.
5. CONCLUSIONS
From the findings
of the present study the researcher had come to the conclusion that the rate of
PPIUCD was very less (although it was maximum for caesarean mothers who had
undergone ligation- a topic not under the researcher’s present study
objectives), the knowledge level was good, the attitude was neutral. Also, a
positive co-relation was found to exist between the knowledge and attitude and
the respondents who got maximum information regarding PPIUCD.
6. LIMITATIONS
The limitation of the study were:
·
The study was confined to a small size (200), so the
scope of generalization of the findings were limited.
·
The study was limited to the subjectivity of
self-reports by the respondents.
·
The study was limited to a particular period (1
month only).
7. RECOMMENDATIONS
On the basis of the findings following recommendations were offered for future research.
·
An
experimental study can be conducted on effectiveness of structured teaching
programme.
·
A
replication of the study can be proposed on larger sample for generalization of
finding.
·
A
comparative study can be conducted on knowledge and attitude about PPIUCD
between urban and rural postnatal women.
·
Study
can be conducted to assess the learning needs of the subjects and prepare
teaching programme.
·
A
descriptive survey design can be conducted to determine the contributing
factors in discontinuation of PPIUCD.
· An evaluative study can be conducted to investigate the effect of counselling on continuation of PPIUCD.
CONFLICT OF INTERESTS
None.
ACKNOWLEDGMENTS
Author is deeply indebted to her guide Smt. Moitreyee Choudhuri, Reader, West Bengal Govt. College of Nursing, for her expert guidance.
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