Reasons for low utilization of intrauterine device utilisation amongst short term contraceptive users in Hossana town, Southern Ethiopia: a qualitative study

BMC Women's Health, Volume 22, No. 1, Year 2022

Interpretation

Background: Intrauterine devices (IUDs) are one of the long-acting, safe and effective methods of contraception in women across the world. However, this method is underutilised in many countries, including Ethiopia. Several quantitative studies have been used to address this problem and generated a list of factors associated with this problem. However, this list lacks detailed and local contexts that are necessary to inform local solutions. The current study uses a qualitative method to explore determinants of IUDs underutilization among short term modern contraceptive users from the maternal health services in the study setting. The use of a qualitative study design is necessary to obtain and rich contextual details that can inform the development of locally appropriate strategies to increase the IUDs uptake in the study area and improve women’s reproductive health outcomes. Method: A qualitative study was conducted in Hossana town public health facilities, Southern Ethiopia from November 1–30, 2019. A total of thirteen in-depth interviews were conducted including with: 11 short term contraceptive users, one health centre head and one health extension worker. The interview guide comprised semi-structured questions. Interviews were audio recorded, transcribed and collected data analysed thematically. Result: The main key determinants of IUDs service underutilisation were identified from participants’ narratives, including: (1) poor knowledge about the benefits of IUDs, (2) insufficient counselling and ineffective delivery of health information to aid women in decision making, (3) the absence of trained health personals, and shortage of supplies. Conclusion: Results indicate that the poor utilisation of IUDs services is determined by both the service provider and the consumer related factors. Poor knowledge of short term users of contraception is a critical factor because without knowledge, clients may not use the available services effectively. The shortage of necessary supplies, poor provider–client relationships, and poor counselling by service providers are also service factors that act as barriers to uptake of IUDs. Efforts should be made to increase IUDs utilization by focusing on educating women about the importance of IUDs, improving counselling of mothers and strengthening the health systems, including allocating more resources to increase access to IUDs among the service users. The study was conducted in Hossana town, the capital of Hadiya Zone, located 235 km far from Addis Ababa, the capital city of Ethiopia, and 194 km far from the regional city, Hawassa. According to the 2015/2016 Hossana town report, the town had a total population of 100,501, of which 50.73% were males and 49.27% were females. This study setting was purposively selected in consultation with regional health bureaus based on the low utilization of IUD as the main criteria. Between 1st and 30th November 2019, a qualitative inquiry using in-depth interviews was conducted with 13 participants. These comprised: 11 short term modern contraceptive service users from three health centers and two key informant Interviewees (KIIs) one of whom was the head of the health center and another, the urban health extension worker. These health centres have the similar characteristics including socio-demographic, sociocultural and low utilization of IUDs. The purposively selected short term contraceptive users were interviewed in the health center during their visits for short term family planning methods. Interviewees were invited from this set of participants until the saturation was reached including when there were no new ideas generated. The two key informants were selected based on their role in family planning service provision in the maternal health service program in Hossana town. The semi structured open ended interview collection guide was developed after defining the research objectives and reviewing relevant literatures. The tool was first developed in English then translated into a local language, Amharic. A pre-testing of the tool was carried out in Fonko health centre and Balesa health centre which are services outside of the study setting, Hossana town. Interviews were tape recorded and field notes taken. Interviews were conducted by the principal investigator (DW) and a trained data collector who was familiar with the qualitative data collection method and family planning services. The interviews lasted an average of 45 min and were held in a free room near the family planning departments. The key informants were interviewed in their offices as these were quiet and private. Data were transcribed verbatim and translated into English language. The two researchers (DW and AA who speak both English and Amharic fluently) critically read and reviewed all the transcripts for accuracy and completeness and analysed the data using a thematic analysis (TA) method for identifying and analysing patterns of meaning in qualitative dataset [31]. For the TA, an initial coding structure was developed through open coding method. In order to ensure the relevance and appropriateness of the coding structure, one coder (AA) conducted open coding of emergent themes associated with the study objectives. The second coder (DW) independently coded the same transcripts. Finally, the two coders reviewed the coded transcripts to reach consensus on coding structure and consistent code definitions which was used to code all transcripts and in organising themes and sub-themes, supported with key quotes and narrations. To ensure the quality of the data, data collectors were recruited from study communities and were trained. The appropriateness and relevance of the guides were ensured through expert reviews and pre-testing. To enhance inter-coder reliability, the researchers independently applied the code guide to a selected transcript, and then reviewed and resolved any differences. Reports of quotations for selected codes were generated and the researchers prepared content summaries of thematic findings. The Ethics approval was obtained from Wachemo University College of Medicine and Health Science institutional Review Board, and the research was conducted in accordance with the ethical principles. Permissions were obtained from relevant offices. Informed Written consent was obtained from all participants after explaining the study purpose and data collection procedures. All participants were anonymised for privacy purposes.

AI Digest

Study Justification:

– Intrauterine devices (IUDs) are a safe and effective method of contraception, but they are underutilized in many countries, including Ethiopia.
– Previous quantitative studies have identified factors associated with low IUD utilization, but lack detailed local contexts.
– This qualitative study aims to explore the determinants of IUD underutilization among short-term contraceptive users in Hossana town, Southern Ethiopia, to inform locally appropriate strategies.

Study Highlights:

– The study was conducted in Hossana town, Southern Ethiopia, with a total of 13 participants, including 11 short-term contraceptive users, one health center head, and one health extension worker.
– Key determinants of IUD underutilization were identified, including poor knowledge about the benefits of IUDs, insufficient counseling and delivery of health information, absence of trained health personnel, and shortage of supplies.
– The study highlights the importance of addressing both service provider and consumer-related factors to improve IUD utilization.
– Recommendations include increasing education about the importance of IUDs, improving counseling for mothers, and strengthening the health system by allocating more resources for IUD access.

Recommendations for Lay Reader and Policy Maker:

– Lay Reader: The study found that the low utilization of IUDs is influenced by factors such as poor knowledge, inadequate counseling, and supply shortages. It is recommended to educate women about the benefits of IUDs, improve counseling services, and allocate more resources to increase access to IUDs.
– Policy Maker: The study highlights the need to address both service provider and consumer-related factors to improve IUD utilization. Policy recommendations include investing in training for health personnel, ensuring an adequate supply of IUDs, and implementing educational campaigns to raise awareness about the benefits of IUDs.

Key Role Players:

– Health center staff: Trained health personnel are needed to provide effective counseling and information about IUDs.
– Health extension workers: These workers play a crucial role in delivering health information and counseling to women in the community.
– Policy makers: Policy makers are responsible for allocating resources and implementing strategies to improve IUD utilization.

Cost Items for Planning Recommendations:

– Training programs for health personnel: Budget for training programs to improve the knowledge and skills of health center staff in providing counseling and information about IUDs.
– Supplies and equipment: Allocate funds for ensuring an adequate supply of IUDs and related equipment.
– Educational campaigns: Budget for awareness campaigns to educate women about the benefits of IUDs and promote their utilization.
– Monitoring and evaluation: Set aside funds for monitoring and evaluating the implementation and impact of the recommendations.

Strength of Evidence

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is rated 8 because it provides a clear description of the study design, data collection methods, and key findings. However, the abstract could be improved by including information on the sample size and demographic characteristics of the participants. Additionally, it would be helpful to provide more details on the thematic analysis method used and how the researchers ensured the quality of the data. To improve the evidence, the abstract could also include information on the limitations of the study and suggestions for future research.

Abstract

The study was conducted in Hossana town, the capital of Hadiya Zone, located 235 km far from Addis Ababa, the capital city of Ethiopia, and 194 km far from the regional city, Hawassa. According to the 2015/2016 Hossana town report, the town had a total population of 100,501, of which 50.73% were males and 49.27% were females. This study setting was purposively selected in consultation with regional health bureaus based on the low utilization of IUD as the main criteria. Between 1st and 30th November 2019, a qualitative inquiry using in-depth interviews was conducted with 13 participants. These comprised: 11 short term modern contraceptive service users from three health centers and two key informant Interviewees (KIIs) one of whom was the head of the health center and another, the urban health extension worker. These health centres have the similar characteristics including socio-demographic, sociocultural and low utilization of IUDs. The purposively selected short term contraceptive users were interviewed in the health center during their visits for short term family planning methods. Interviewees were invited from this set of participants until the saturation was reached including when there were no new ideas generated. The two key informants were selected based on their role in family planning service provision in the maternal health service program in Hossana town. The semi structured open ended interview collection guide was developed after defining the research objectives and reviewing relevant literatures. The tool was first developed in English then translated into a local language, Amharic. A pre-testing of the tool was carried out in Fonko health centre and Balesa health centre which are services outside of the study setting, Hossana town. Interviews were tape recorded and field notes taken. Interviews were conducted by the principal investigator (DW) and a trained data collector who was familiar with the qualitative data collection method and family planning services. The interviews lasted an average of 45 min and were held in a free room near the family planning departments. The key informants were interviewed in their offices as these were quiet and private. Data were transcribed verbatim and translated into English language. The two researchers (DW and AA who speak both English and Amharic fluently) critically read and reviewed all the transcripts for accuracy and completeness and analysed the data using a thematic analysis (TA) method for identifying and analysing patterns of meaning in qualitative dataset [31]. For the TA, an initial coding structure was developed through open coding method. In order to ensure the relevance and appropriateness of the coding structure, one coder (AA) conducted open coding of emergent themes associated with the study objectives. The second coder (DW) independently coded the same transcripts. Finally, the two coders reviewed the coded transcripts to reach consensus on coding structure and consistent code definitions which was used to code all transcripts and in organising themes and sub-themes, supported with key quotes and narrations. To ensure the quality of the data, data collectors were recruited from study communities and were trained. The appropriateness and relevance of the guides were ensured through expert reviews and pre-testing. To enhance inter-coder reliability, the researchers independently applied the code guide to a selected transcript, and then reviewed and resolved any differences. Reports of quotations for selected codes were generated and the researchers prepared content summaries of thematic findings. The Ethics approval was obtained from Wachemo University College of Medicine and Health Science institutional Review Board, and the research was conducted in accordance with the ethical principles. Permissions were obtained from relevant offices. Informed Written consent was obtained from all participants after explaining the study purpose and data collection procedures. All participants were anonymised for privacy purposes.

Materials

N/A

Innovations

The study titled “Reasons for low utilization of intrauterine device utilization amongst short-term contraceptive users in Hossana town, Southern Ethiopia: a qualitative study” aims to explore the determinants of underutilization of intrauterine devices (IUDs) among short-term modern contraceptive users in Hossana town, Southern Ethiopia. The study uses a qualitative research design to gather rich contextual details that can inform the development of locally appropriate strategies to increase IUD uptake and improve women’s reproductive health outcomes.

The study was conducted in Hossana town, which is the capital of Hadiya Zone in Ethiopia. The town has a population of approximately 100,501, with a nearly equal distribution of males and females. The selection of Hossana town as the study setting was based on the low utilization of IUDs as the main criteria.

Thirteen participants were included in the study, including 11 short-term modern contraceptive users from three health centers and two key informants (one health center head and one urban health extension worker). The participants were selected purposively, and interviews were conducted during their visits to the health centers for short-term family planning methods. The interviews were conducted using a semi-structured interview guide, which was developed in English and translated into the local language, Amharic. The interviews were audio-recorded, transcribed, and analyzed thematically.

The study identified several key determinants of IUD service underutilization based on the participants’ narratives. These determinants include poor knowledge about the benefits of IUDs, insufficient counseling and ineffective delivery of health information to aid women in decision-making, the absence of trained healthcare personnel, and shortage of supplies.

The study concludes that the poor utilization of IUD services is influenced by both service provider and consumer-related factors. It emphasizes the importance of increasing knowledge about the benefits of IUDs among short-term contraceptive users, improving counseling services provided by healthcare providers, and strengthening the health system, including allocating more resources to increase access to IUDs.

The study was published in BMC Women’s Health in 2022.

AI Innovations Description

Based on the findings of the study, here is a recommendation that can be developed into an innovation to improve access to maternal health:

Title: Strengthening IUD Utilization through Comprehensive Education and Improved Service Delivery

Recommendation: To address the low utilization of intrauterine devices (IUDs) among short-term contraceptive users in Hossana town, Southern Ethiopia, it is recommended to develop an innovative approach that focuses on comprehensive education and improved service delivery. This can be achieved through the following strategies:

1. Education and Awareness: Develop targeted educational campaigns to increase knowledge and awareness about the benefits of IUDs among women of reproductive age. This can include community outreach programs, health education sessions, and the use of local media channels to disseminate information.

2. Counseling and Decision-Making Support: Strengthen the counseling services provided by healthcare providers to ensure that women receive accurate and comprehensive information about IUDs. This can involve training healthcare professionals on effective counseling techniques and providing them with updated resources and materials to support informed decision-making.

3. Training and Capacity Building: Address the shortage of trained healthcare personnel by investing in training programs for healthcare providers on IUD insertion and removal techniques. This will help increase the availability of skilled providers and improve the quality of IUD services.

4. Supply Chain Management: Address the issue of supply shortages by improving the management of IUD supplies at health facilities. This can involve regular monitoring of stock levels, efficient procurement processes, and collaboration with relevant stakeholders to ensure a consistent supply of IUDs.

5. Strengthening Health Systems: Allocate more resources to maternal health services, including the provision of IUDs, to improve access and availability. This can involve increasing funding for maternal health programs, improving infrastructure and equipment at health facilities, and strengthening referral systems to ensure seamless access to IUD services.

By implementing these recommendations, it is expected that the utilization of IUDs among short-term contraceptive users in Hossana town will increase, leading to improved reproductive health outcomes for women in the area.

AI Innovations Methodology

The methodology used in the study to simulate the impact of the main recommendations on improving access to maternal health in Hossana town, Southern Ethiopia, involved a qualitative research design. The study aimed to explore the determinants of low utilization of intrauterine devices (IUDs) among short-term modern contraceptive users in the area.

Here is a summary of the methodology:

1. Study Setting: The study was conducted in Hossana town, the capital of Hadiya Zone in Southern Ethiopia. This location was purposively selected based on the low utilization of IUDs as the main criteria.

2. Participants: Thirteen participants were included in the study, consisting of 11 short-term modern contraceptive users from three health centers and two key informants (one health center head and one urban health extension worker). The participants were selected based on their role in family planning service provision and their experience with IUD utilization.

3. Data Collection: In-depth interviews were conducted with the participants between November 1 and 30, 2019. The interviews were semi-structured and included open-ended questions. The interviews were audio recorded and transcribed for analysis.

4. Data Analysis: Thematic analysis was used to analyze the collected data. An initial coding structure was developed through open coding, and two coders independently coded the transcripts. Consensus was reached on the coding structure and consistent code definitions. Themes and sub-themes were organized based on the coded data, supported by key quotes and narrations.

5. Ethical Considerations: Ethics approval was obtained from Wachemo University College of Medicine and Health Science Institutional Review Board. Permissions were obtained from relevant offices, and informed written consent was obtained from all participants. Anonymity was ensured to protect the privacy of the participants.

The findings of the study identified key determinants of low IUD utilization, including poor knowledge about the benefits of IUDs, insufficient counseling and ineffective delivery of health information, the absence of trained healthcare personnel, and shortage of supplies. Based on these findings, the study recommended strategies to improve access to maternal health, such as comprehensive education, improved counseling, training and capacity building, supply chain management, and strengthening health systems.

The study was published in BMC Women’s Health, Volume 22, No. 1, in the year 2022.

Author

Dima Health

Statistics:

Citations: 1

Identifiers:

DOI: 10.1186/s12905-022-01611-6

Research Areas:

Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health

Study Countries:

Ethiopia

Study Design:

Cross Sectional Study, Grounded Theory, Phenomenological Study

Study Approach:

Mixed-methods, Qualitative, Quantitative

Participants Gender:

Female