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University Malaysia Sarawak
Faculty of Medicine and Health Science
Bachelor Degree in Nursing
2010
Course code: MDJ 3293 Research
Title: Research proposal
Knowledge, attitude and practice of oral contraceptive pills among women
tenants at reproductive age in Wisma Hopoh
Name: Jessica Goh Sing Fong
Matrix Number: 18624
Course coordinator: Dr. Sidiah John Siop
Supervisor: Madam Rose Nanju
1
Introduction
Oral contraceptive pills are combined oral contraceptives that suppresses ovulation
by the combination action of hormones estrogens and progesterone (MedicineNet,
2009). Nowadays, different type of oral contraceptive pills are available in the
market with different trade name such as Marvelon, Mercilon, Loette, Yasmin etc
The instructions of taking one pill daily are the same for all types of oral
contraceptives in the market.
In a qualitative study by Williamson L.M, Parkes A., Wight D., Petticrew M. and
Hart G.J (2009) who did their study on developing country such as africa, thailand,
malaysia and indonesia, they found out that 90 percent of abortion related and 20
percent of pregnancy related morbidity and mortality along with 32 percent of
maternal deaths could be prevented by the usage of effective contraceptive. Thus,
family planning is very important and oral contraceptive pills serves as one of the
effective methods to prevent unwanted pregnancy.
Although oral contraceptive pills had proved to be saved and effective, however, a
lot of Malaysian women never try it. This could be due to poor knowledge
2
dissemination both from health educator and mass media. Besides, there are also
women who took the oral contraceptive pills, but never understand the action,
contents, instruction and so forth which will leads to misuse and wastage.
Consequence, I would like to conduct a research which will focus on identifying the
level of knowledge, practice and attitude among women tenants of reproductive age
towards oral contraceptive pills and I choose my research setting in Wisma Hopoh.
Wisma Hopoh is located in the centre of the kuching city, at Jalan P. Ramlee, 93400
Kuching, Sarawak.
Background of the problem
Most of the crime such as teenage pregnancy, abortion, throw baby away cases
involved young women especially teenager and has become a growing epidemic
social issues in Malaysia. A few incidents was reported, for instance, the incident of
dead baby found in drain in wet market, Stutong Kuching happened in March, 2010
(TheBorneoPost, 2010), teen pregnant four time since 12 years old (TheStar, 2009),
one abortion in every five pregnancy (TheStar, 2009) etc. Consequences of this
problems leads to teenage dropped out from school, causing them not able to get
appropriate education. Apart from that, they will also suffer from social stigma such
3
as abandoned by the family, teasing from peers, who will cause them emotional and
psychological disturbed, and when the symptoms prolonged may lead to mental
illness such as schizophrenia. Besides, it will also cause this youngster to involve in
other social issues such as drug addiction, have multiple partners which will leads to
sexual transmitted disease (STD), crime like become sexual worker and so forth. All
of these social issues leads to economy retardation as female teenage who will turn
into women later are the asset of the country. Thus, preventing pregnancy is very
crucial.
Oral contraceptives pills were given free in government polyclinic. However, there
are still women who either took or doesn't took the pills claimed they have poor
knowledge about oral contraceptive pills. However, there were no study designed to
understand the level of knowledge, attitude and practice of women tenants at
reproductive age in Wisma Hopoh regarding oral contraceptive pills.
Statement of the problem
Despite of Malaysia government policies to encounter social issues such as
unintended pregnancy, abortion and teenage pregnancy. However, there are still
tragedy happened elsewhere in Malaysia and some may not be reported. All this
4
while, oral contraceptive pills are one of the family planning methods in controlling
number of children by couple. However, due to lack of knowledge and information
about the usage of emergency contraceptive pills, some women still get pregnant
even though they are on oral contraceptive pills. Community nowadays was also not
adequately exposing to sexual and reproductive health education as our society is
conservative where even parents does not share their sex knowledge to their children.
Besides, our society have the mindset that when government encourage teenager to
use oral contraceptive pills, this as if they encourage youngster to involve themselves
in sexual activity as community always tagged oral contraceptive pills with sexually
active and married women only.
Thus, contraception decision made with little or no experience may bring lifelong
consequences as gap between knowledge and practice regarding contraception
remains unanswerable.
Research questions
This study was designed to answer the following question:
1. What is the level of understanding of women tenants at reproductive age in
Wisma Hopoh about oral contraceptive pills?
2. What is the practice of oral contraceptive pills among women tenants at
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reproductive age in Wisma Hopoh?
3. What are the attitudes of women tenants at reproductive age in Wisma Hopoh
about oral contraceptive pills?
4. What are the relationships between Socio demographic data and women
tenants at reproductive age in Wisma Hopoh’s knowledge about knowledge,
attitude and practice on oral contraceptive pills?
Objectives
1. To assess the level of understanding of women tenants at reproductive age in
Wisma Hopoh about oral contraceptive pills?
2. To determine the practice of oral contraceptive pills among women tenants at
reproductive age in Wisma Hopoh.
3. To identify the attitudes of women tenants at reproductive age in Wisma
Hopoh about oral contraceptive pills.
4. To explore the relationships between Socio demographic data and women
tenants at reproductive age in Wisma Hopoh’s knowledge about knowledge,
attitude and practice on oral contraceptive pills.
Significance of the research
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This research will hope to benefit the health care provider regarding the level of
knowledge, attitude and practice of women in Wisma Hopoh to obtain the baseline
data for further evaluation of the oral contraceptive usage. It will also help to set
target group that will benefit the government policy to supply more contraceptive
method prefer by women to the community to decrease unneeded wastage as oral
contraceptive pills are given free in government polyclinic and hospital. In addition,
this research will also explore women source of information regarding oral
contraceptive pills so that publicity of information regarding oral contraceptive pills
will be enhance to benefit the society which may lead to unintended pregnancy and
abortion prevention. Furthermore, this research can also contribute to compare oral
contraceptive pills with other contraceptive method in term of cost, availability, and
others as oral contraceptive pills are known to be the cheapest compare to other
modern contraceptive method.
Operational Definition of term
Oral contraceptive pills were defined as birth control pills by MedicineNet, 2009.
Based on this definition, I defined the term “oral contraceptive pills” as one of the
family planning method to prevent pregnancy, controlling size of the family, and a
medicine to reduce women fertility. Several issues will be focus in this study such as
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knowledge, attitude and practice of emergency contraceptive pills.
Knowledge regarding emergency contraceptive pills in this research will refers to the
fact or state of knowing of women tenants at reproductive age in Wisma Hopoh, in
term of different area about oral contraceptive pills, the side effect, benefits, usage,
pharmacology, content, where to obtain the pills, indication, contraindication of oral
contraceptive pills etc. This knowledge will help women in correctly use oral
contraceptive pills to prevent pregnancy.
Practice regarding oral contraceptive pills refers to a habit or custom of women
tenants at reproductive age in Wisma Hopoh regardless it is right or wrong about oral
contraceptive pills. The practice will include the assessment on experience using oral
contraceptive pills, reasons why women tenants at reproductive age in Wisma Hopoh
choose oral reproductive pills as the family planning method, and correct oral
contraceptive pills usage. Right practice contribute to the effectiveness of the drug
while misuse cause wastage and social issues.
Attitude regarding oral contraceptive pills refers to a manner, a disposition, feeling
and position regarding oral contraceptive pills in term of their acceptance, concern
about the side effect of oral contraceptive pills, discuss with partner about oral
8
contraceptive pills etc. Attitude can be also categorized as positive or negative which
related to the fact of the issues.
Women tenants at reproductive age in Wisma Hopoh will be define as all women
including the supportive staff who already achieve their puberty, have all the years
that can conceive a child until the onset of menopause who working for more than 6
months in Wisma Hopoh. These are the criteria of women that will be included in the
sampling of this research.
Literature review
Oral contraceptive was widely used globally after the revolution of oral
contraceptive starts on October 15, 1950 when laboratory of Syntax Mexico City
succeeded in producing Norenthindrone, an orally active progestagen with an
activity eight times greater than naturally occurring progesterone (Peter H. P. 1998).
While in Malaysia, there are no information regarding when actually family planning
include oral contraceptive pills as one of the contraception method.
Oral contraception was reported predominant among unmarried Canadian women
aged between 15 to 17 years old, most of the married women in Malaysia, majority
of Women in Mukalla Yemen (54.2%), and women in turky (55.7%)( Fisher W.A.,
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Black A. 2007, Population Reference Bureau, 2006 , Jones R. K., Fennell J., Higgins
J. A. and Blanchard K., 2009, Baser M., Mucuk S. Bayraktar E., et al, 2009). A
study done by Joseph J.S., Ravenholt R.T., Mary E.I., 1989, who did their study on
acceptability of oral contraceptive pills mentioned that oral contraceptive pills are
popular during 1970-an in Malaysia as about 90 percent of all family planning
acceptor in Malaysia use the pills. Another study done by Ismail, M.T.M.; Kwa, S.K.,
1990, further proove the widespread of oral contraceptive pill as it registered 72 to
75% of the overall contraceptive usage ever since it was introduced in Malaysia and
it is still popular choice of contraception method until today as according to the
statistic done by Population Reference Bureau, 2006, oral contraceptive pills are still
most common used form of reversible birth control method in Malaysia. In contrast,
in india, oral pills was not popular among the women as only 3.87 % of women were
reported practicing it ( Suneeta M., Anupama B., Sharman J.B., 2007)
However, there are still a lot of unintended pregnancy, abortion, throw baby cases
happened regardless there are so many modern contraceptive method such as oral
contraceptive pills availabe at the market. According to a study done by Suneeta
Suneeta M., Anupama B., Sharman J.B., 2007, they stated that a very high number
(59.9%) of women in India had unplanned pregnancy while 43.3% of them had
pregnancy due to failure of contraceptive. High prevalence of this social issues also
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reported in Malaysia. It was reported in 2007 that one baby is abandoned every ten
days in Kuala Lumpur (Ang E. S., 2007, Adolescent health). From 2001 to 2004, the
Social Welfare Department recorded 315 cases of abandoned babies, while police
statistics revealed about 100 cases a year (Ang E. S., 2007, Adolescent health).
Oral contraceptive pills are controversial subject, either in global world or in
Malaysia. A study conducted in Kelantan by B Norsa’adah, B N Rusli, A K Imran, I
Naing, T Winn, 2005, detected a significant association between oral contraceptive
use and breast cancer, consistent with another local study by Lokman et al. However,
another recently study mentioned that in a long term, women who used oral
contraception had a significantly lower rate of death from any cause, including heart
disease and all cancers, compared with women who had never taken it (Philip H.,
2010).
Knowledge, practice and attitude are related and influence each other, either one of
this element if left out will cause pregnancy. Thus, by identifying the level of
knowledge, practice and attitude of women towards oral contraceptive pills, further
management can be done to decrease social issues such as teenage pregnancy,
unintended pregnancy and abortions.
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Methodology
Research design
This study will be conducted by using the cross-sectional descriptive quantitative
research design where researcher will find out the relationship between the
independent variables such as socio-demographic data and dependent variable like
knowledge, attitude and practice of oral contraceptive pills by women in Wisma
Hopoh. Source of information to formulate questions about oral contraceptive pills
was base on literature by other researchers.
Population and sampling
Population in Wisma Hopoh was reported 136 tenants and nerly 80 percent of the
tenants are female in 2009. This study was conducted in Wisma Hopoh which is
located in the centre of the kuching city, at Jalan P. Ramlee, 93400 Kuching,
Sarawak. Wisma Hopoh was located opposite to Radio Television Malaysia (RTM)
building and Sarawak Red Crescent Society headquarter was located beside Wisma
Hopoh. This shopping complex was operated since 1980. Female tenants in Wisma
Hopoh were selected as the population of study because of social perception about
the size of the family was put under women responsibilities. The sample of this study
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will be involved as many as I can but a minimum of 50 participants must be
obtained.
Wisma Hopoh was chosen as the setting of the research was due to its high
consistency of women tenant working in that shopping complex. Besides, the place
was also known to have a lot of female tenant misuse the oral contraceptive pills and
reported social cases like abortion and teenage pregnancy.
i) Inclusive criteria
Only female tenants at reproductive age that had working in any shop in Wisma
Hopoh for more than 6 month will be included as respondent in this study. This is
due to the fact that the objectives of this research are to look into women knowledge,
practice and attitude regarding oral contraceptive pill. In other word, I would like to
look into women experience in using oral contraceptive pills rather than women
limitation factor which influence women selection in family planning method. This
research does not limit to women marital status, age, household income and
occupation.
ii) Exclusive criteria
Based on the randomly selection sampling method, male are excluded and those
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women who refuse to answer the questionnaire will not be included in this study.
Instruments
This research will be conducted by using questionnaire contain 34 questions to
determine the relationship between socio demographic feature and knowledge,
attitude and practice of oral contraceptive pills by women in Wisma Hopoh. Socio
demographic characteristic in section one will include age, working period, religion,
race, marital status, level of education; number of living children, staying either in
rural or urban area, occupation and monthly household income while there will be 13
questions regarding knowledge of oral contraceptive pills in section 2, 8 questions
about attitude in section 3, and 5 questions about practice in section 4. The reasons
why socio demographic feature was consider in this study is because of the literature
review that had proved that women's background and family status will influence
women's knowledge, attitude and practice of oral contraceptive pills as the three
element are influencing with each other.
Section 2, which related to knowledge of participants will need candidate to choose
only the best answer from question 9 to 12. The following question in section 2, from
question 13 to 21 is a multiple choice question and thus respondent can thick (√)
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more than one answer. All the questions here were adapted from several resources
which include “Birth Control pills” from University of Rochester, “patients’
knowledge of emergency contraception” by Emergency contraception audit kit, the
University of Hull, May 1996. Women's knowledge will be assess as knowledge is
the key point to the correct practice of oral contraceptive pills which can prevent
unintended pregnancy.
In section 3, question 22 is a multiple choice question whereas question from 23 to
28 which covering the attitude of oral contraceptive pills will require participants to
answer “yes” or “no” on the questions. Attitudes towards the usage of oral
contraceptive pills will be assess as it determine the effectiveness of pregnancy
prevention. Even if the women have good knowledge about oral contraceptive pills
but with poor attitude, unintended pregnancy will still take place.
In section 4, question 29 required candidate to answer “yes” or “no” on question “do
you ever take any oral contraceptive pills?”, the rest of the question from 30 to 34 is
a multiple choice question regarding practice on oral contraceptive pills. Practice of
oral contraceptive pills will be assess to determine the correct usage of the pills.
Score for each question on knowledge and practice will be determine based on the
15
most accuracy of the answer given by participants which range from 1 to 5 points for
each question. In addition, attitude questions will be evaluated as positive or negative
for related question.
3. Data collection
A minimum number of 50 women out of the total population in Wisma Hopoh will
be randomly selected as evaluation in this study. Self administered questionnaire
containing 34 questioned will be distribute to participants. Women who participate in
this study will be informed orally about the research and written consent will be
obtained. Respondents are given 2 days to answer the questionnaire and they are
required to leave their contact number. If participants have any doubt, she can
contact my phone number or if possible I will be by her side to clarify their doubt. A
box will be located at the Wisma Hopoh's manager office and respondent are require
to put the answered questionnaire to the box.
Pilot Study
Pilot study will also conduct at Wisma Saberkas, another shopping complex in
Kuching, to ensure the validity of the questions to be answered by the participants.
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Before running the pilot test, a sample of questionnaire will be submitted to prior
evaluation by reviewer who was the investigator with experience in women health
care research and in knowledge and practice survey methodology. While conducting
the pilot test, participant’s personal data such as name and identification number will
not be obtained to ensure anonymity and each questionnaire will be identified by
numbers.
Data analysis
Data collected will be analysing by using Statistical Package of Social Science
(SPSS) version 17.0 for Windows version. The descriptive statistic generated
demographic and women knowledge, attitude and practice about oral contraceptive
variables. Chi square test will be carried out to compare mean difference between
independent and dependent variables. An alpha level of P less than 0.05 or equal will
be considered statistically significant for all analysis. Besides, Microsoft Excel
software will also be used in the process of converting the data collected into table,
graft or figure form. Regarding the score obtained by participants, it will be
perceived as participants have good knowledge, attitude and practice when they
obtained higher score. However, if the score were not satisfactory, it does not means
that the participant is poor in every section regarding knowledge, attitude and
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practice of oral contraceptive method as all the sources are independent.
Limitation
Limitation of this study is on the population itself where the result of the research
can only reflect on the knowledge, practice and attitude of oral contraceptive user of
the population in Wisma Hopoh, but not in wide scale like Kuching city due to time
constriction and resources limitation.
Besides, there are also no previous study on knowledge, attitude and practice of
contraceptive method conducted in Kuching or even in Malaysia, making it hard to
formulate questionnaire as many questions were adapted from western context that
have to be modified to suit the local practice.
There will be hardship to distribute the questionnaire as to the respondent as some of
them cannot read and understand Malay. Thus, the questionnaire has to translate to
other language in order for them to answer the questionnaire. In addition, the women
tenants may have to answer the questionnaire during recess time this will cause
distress to the respondents as they have only two hour of recess time that is between
12pm to 2pm and this will further cause them refuse to answer the questionnaire.
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Reference:
Adinma J.I.b, Nwosu B.O., 2005, Family planning knowledge and practice among Nigerian women attending an antenatal clinic, retrieved on April 8, 2010 from http://www.springerlink.com/content/k22527w275715211/
Barrett J. and Buckley C., 2007, Constrained Contraceptive Choice: IUD Prevalence in Uzbekistan, International Family Planning Perspectives, 2007, 33(2):50–57
BorneoPostOnline, 2010, Women charged with murdering own baby, retrieved on April 8, 2010, from http://www.theborneopost.com/?p=18188
Epigee, 2010, types of birth control, retrieved on January 23, 2010 from http://www.epigee.org/types-birth-control.html
Fisher W.A, Black A., 2007, Contraception in Canada: a review of method choices, characteristics, adherence and approaches to counselling, Canadian Med Assoc. ,2007;176(7):953-61
Glasier A., Ketting E., Palan V.T., 1996, “Case studies in Emergency Contraception from six country”, volume 22, Number 2,
Izatun S., Tan A., and Raman A., 2009, Teen pregnant four times since 2007 retrieved on April 8, 2010 from http://thestar.com.my/news/story.asp?file=/2009/10/8/nation/4861519&sec=nation
Ng C. Y., Zulkiflia. R., 2009, one abortion for every five pregnancies, says survey retrieved on April 8, 2010 from http://thestar.com.my/news/story.asp?file=/2009/5/26/nation/3977852&sec=nation
Peter H.P., 1998, the stalled Revolution of Contraception, Discrete Dynamic in Nature and Society, Vol. 3., Pg. 185-193.
Williamson L.M., Parkes A. Wight D., Petticrew M. and Hart G.J., 2009, Limits to modern contraceptive use among young women in developing countries: a systematic review of qualitative research retrieved on February 19, 2010 from
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http://www.reproductive-health-journal.com/content/6/1/3
Wong Y. M., 1994, Benefits beyond contraception with oral contraceptive pills retrieved on April 8, 2010 from http://www.cornerstone-msc.net/new_mps/html/CPEforumVol1Issue.pdf
Ang E. S., 2007, Adolescent health, Paper presented at the National Population
Conference, 3-5 July 2007, Kuala Lumpur, Malaysia
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