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Improving post-partum family planning services provided by female community health volunteers in Nepal: a mixed methods study.

Thapa, K; Dhital, R; Rajbhandari, S; Mishra, S; Subedi, S; Dotel, BR; Vaidya, S; Pande, S; Tunnacliffe, E-A; Makins, A; et al. Thapa, K; Dhital, R; Rajbhandari, S; Mishra, S; Subedi, S; Dotel, BR; Vaidya, S; Pande, S; Tunnacliffe, E-A; Makins, A; Arulkumaran, S (2020) Improving post-partum family planning services provided by female community health volunteers in Nepal: a mixed methods study. BMC Health Serv Res, 20 (1). p. 123. ISSN 1472-6963 https://doi.org/10.1186/s12913-020-4969-1
SGUL Authors: Arulkumaran, Sabaratnam

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Abstract

BACKGROUND: Family planning services in the post-partum period, termed post-partum family planning (PPFP) is critical to cover the unmet need for contraception, especially when institutional delivery rates have increased. However, the intention to choose PPFP methods such as post-partum intrauterine devices (PPIUD) remains low in countries such as Nepal. Community health workers such as Female Community Health Volunteers (FCHVs) could play an important role in improving the service coverage of PPFP in Nepal. However, their knowledge of PPFP and community-based services related to PPFP remain unclear. This study aims to assess the effect on community-based PPFP services by improving FCHV's knowledge through orientation on PPFP. METHODS: We conducted this mixed-methods study in Morang District in Nepal. The intervention involved orientation of FCHVs on PPFP methods. We collected quantitative data from three sources; via a survey of FCHVs that assessed their knowledge before and after the intervention, from their monthly reporting forms on counseling coverage of women at different stages of pregnancy from the communities, and by interviewing mothers in their immediate post-partum period in two selected hospitals. We also conducted six focus group discussions with the FCHVs to understand their perception of PPFP and the intervention. We performed descriptive and multivariable analyses for quantitative results and thematic analysis for qualitative data. RESULTS: In total, 230 FCHVs participated in the intervention and their knowledge of PPFP improved significantly after it. The intervention was the only factor significantly associated with their improved knowledge (adjusted odds ratio = 24, P < 0.001) in the multivariable analysis. FCHVs were able to counsel 83.3% of 1872 mothers at different stages of pregnancy in the communities. In the two hospitals, the proportion of mothers in their immediate post-partum period whom reported they were counseled by FCHVs during their pregnancy increased. It improved from 7% before the intervention to 18.1% (P < 0.001) after the intervention. The qualitative findings suggested that the intervention improved their knowledge in providing PPFP counseling. CONCLUSION: The orientation improved the FCHV's knowledge of PPFP and their community-based counseling. Follow-up studies are needed to assess the longer term effect of the FCHV's role in improving community-based PPFP services.

Item Type: Article
Additional Information: © The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Keywords: Community health workers, Contraception, Family planning services, Intrauterine devices, Post-partum period, Health Policy & Services, 1117 Public Health and Health Services, 0807 Library and Information Studies
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: BMC Health Serv Res
ISSN: 1472-6963
Language: eng
Dates:
DateEvent
17 February 2020Published
7 February 2020Accepted
PubMed ID: 32066440
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/111693
Publisher's version: https://doi.org/10.1186/s12913-020-4969-1

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