Postpartum Green Star family planning decision aid for pregnant adolescents in Tanzania: a qualitative feasibility study

Reproductive Health, Volume 18, No. 1, Year 2021

Interpretação

Background: The use of a decision aid in clinical settings has been beneficial. It informs and educates patients about the available treatment options that can help them reduce decision-making conflicts related to feeling uninformed compared with routine care. There is a scarcity of published data about using a decision aid during family planning counseling with postpartum women focusing on long-acting reversible contraception in Tanzania. Therefore, we developed a “postpartum Green Star family planning decision aid” and assessed its feasibility. The study outcomes were practicality, usefulness, and acceptability perceived by pregnant adolescents and nurses/midwives. Methods: We used an exploratory qualitative in-depth interview involving six nurses/midwives with three or more years of experience in family planning services and 12 pregnant adolescents aged 15–19 years. Purposive sampling was used to select the participants, and selection relied on the saturation principle of data collection. We used a semi-structured interview guide translated into the Kiswahili language. Data were transcribed and analyzed following inductive content analysis. Results: The amount of information presented was just right, with the time of reading the data ranging from 20 min to 1 h. The study participants perceived the flow of information to be good, with small significant changes suggested. Kiswahili language was used and reported to be appropriate and well elaborated. However, a few words were told to be rephrased to reduce ambiguity. The nurses/midwives said that the decision aid included most of the vital information the participants wanted to know during their family planning counseling. Pregnant adolescents stated that the decision aid improved their knowledge and provided new details on the long-acting reversible contraception methods (intrauterine copper devices and implants) offered immediately after childbirth. The participants stated that the decision aid addressed long-acting reversible contraception methods’ benefits and side effects and dispelled myths and misconceptions. The study participants considered the decision aid helpful in complementing the family planning counseling offered and improving pregnant adolescents’ knowledge. Conclusion: The postpartum Green Star family planning decision aid was practical, useful, and acceptable in enhancing the objectivity of counseling about long-acting reversible contraception methods. It improved the knowledge of pregnant adolescents in Tanzania about the available contraception methods (i.e., the use of intrauterine copper devices and implants), which can be immediately used postpartum. Further research is needed to assess the effects of the decision aid on long-acting reversible contraception postpartum uptake among pregnant adolescents in Tanzania. The study used an exploratory qualitative research design. In August 2020, we conducted 18 in-depth interviews that involved healthcare providers and pregnant adolescents from Amana District Hospital in Dar es Salaam. Although the decision aid was designed for pregnant adolescents, we included healthcare providers because we wanted to hear their opinions about the decision aid. We believe that the family planning counseling experiences of the healthcare providers would provide significant and well-informed comments to improve the contents of the decision aid and the intervention process. The study population consisted of six healthcare providers and 12 pregnant adolescents. The healthcare providers were nurses/midwives with three or more years of experience in family planning services. The pregnant adolescents were 15–19 years of age who could read and communicate in the Kiswahili language and consented to participate in the study. The study’s principal investigator and the person in charge of the maternity clinic were responsible for recruiting the study participants who were purposively selected to best answer the research questions. The interviews lasted for 40–50 min and were led by two moderators: one who asked the questions and another who assisted and recorded the interview and took notes. A semi-structured interview guide with five questions in the Kiswahili language was used to collect information from pregnant adolescents and healthcare providers. In the interview, participants were asked the following questions: “What do you think about the information presented in the decision aid?”, “How do you feel about the use of a decision aid for deciding postpartum family planning?”, “What do you think about the usefulness of the decision aid?”, “Will you recommend its use in the clinic?” and several follow-up questions. We obtained ethical approval from St. Luke’s International University, Muhimbili University of Health and Allied Sciences, and the National Institute of Medical Research. Permission to conduct the study was obtained from the regional medical officer and the medical officer-in-charge of Amana District Hospital. The interviews were conducted in a private room within the hospital to ensure convenient access and privacy. The principal investigator informed the participants about the study’s purpose, scope, and importance at the beginning of each discussion. The study participants were informed of their rights to participate and withdraw during the interview whenever they felt like it. Written informed consent was obtained from each participant for participating and recording the interview. The principal investigator requested the participants to feel free and be open when responding to questions and assured them that there was no right or wrong answer. The principal investigator and a research assistant conducted the interviews. Experience in conducting interviews, experience in using recorders, having knowledge, and experience in family planning were the criteria used for selecting the research assistant. A one-day training was conducted for the research assistant to comprehensively understand the purpose of the study, what questions to ask, how to ask, and probe and when to obtain written informed consent from the participants not to influence data collection. The P.I. uploaded the audio files into a secured computer with a passcode immediately after all interviews each day. The interviews were transcribed verbatim in the Kiswahili language, and the data was analyzed while in the Kiswahili language. We conducted thematic analysis following the steps outlined by Braun and Clarke [24]. An iterative inductive-deductive, the team-based coding approach was employed to code and analyze the data [25]. The P.I. and R.A. who conducted the in-depth interviews undertook the coding process and analysis. Individual codes were then organized into subcategories and categories. study participants’ quotes illustrated the key findings. Using a team-based approach, we developed the codebook [25] after re-reading all the transcripts (familiarization with data). The P.I. and R.A. had several meetings where codebooks and memos were presented, codes updated, and any existing disagreement was resolved. Next, the P.I. and R.A. generated themes that involved open-ended coding of several transcripts with no predetermined codes or categories. Coding was done directly onto the hard copies of the transcripts during multiple readings of the interviews. Independent from each other, the P.I. and R.A. coded interviews question by question and then shared and compared their coding findings to reconcile differences, if any. The P.I. and R.A. applied the codes from the codebook to all 18 transcripts. Codes were refined, reduced, and expanded during this period. Finally, the P.I. and R.A. generated categories and subcategories based on the findings of the initial coding. Codes were grouped under categories and subcategories. The author identified the gap, target population, and objectives to address the research problem. We mainly focused on previously published studies to determine the objectives to be addressed [21, 23, 26–28]. There are limited publications that described the use of decision aids in reducing decision-making conflicts on the utilization of long-acting reversible contraception methods. We then identified the individual needs of the participating pregnant adolescents by reviewing a previous study that looked at barriers to the utilization of family planning among female youths in Dar es Salaam, Tanzania [11]. The individual needs of the participants included inadequate knowledge, especially of long-acting reversible contraception methods. We found female teens to have several misbeliefs about the methods and how to participate in decision-making. Most female teens could not decide on their own without involving their sexual partners (Fig. 1). Flow diagram showing the process of developing the final postpartum Green Star family planning decision aid (version 1) The content, design, and arrangement of the “developed prototype decision aid were grounded in the Ottawa Patient Decision Aid Development eTraining [29], International Patient Decision Aid Standards Collaboration checklist [30], Theory of Planned Behavior [31], Health Belief Model [32], Social Cognitive Theory [33], current clinical guides for family planning counseling for providers [1, 34], and findings from previous studies on the benefits and side effects of the options, satisfaction and continuation rates, and fertility return [35–41]. The prototype decision aid has four components based on the Ottawa Patient Decision Aid development guide: (1) know how to make a decision with conviction; (2) understand the characteristics of the decision; (3) clarify what is important to you, and (4) make the decision (Figs. (Figs.2,2, ,3,3, ,4,4, ,5).5). The author shared a prototype decision aid with three experts that involved a research supervisor and two midwives, all with several years of experience in maternal and child health and developing decision aids. The aim of sharing the prototype decision aid with these experts was to receive comments on the comprehensibility and usefulness of the prototype decision aid, which we incorporated to modify and improve the decision aid. The final decision aid version 1 was given to six healthcare providers and 12 pregnant adolescents to assess its practicality, usefulness, and acceptability (Fig. 1). Four steps involved in developing the decision aid based on the Ottawa Patient Decision Aids development Contents in steps 1 and 2 of the decision aid Contents in step 2 of the decision aid: understand the characteristics of the options Contents in steps 3 and 4 of the decision aid

AI Digest

Study Justification:

– The use of a decision aid in clinical settings has been beneficial in reducing decision-making conflicts and improving patient satisfaction.
– There is a scarcity of published data on using a decision aid during family planning counseling with postpartum women in Tanzania.
– The study aimed to develop and assess the feasibility of a postpartum Green Star family planning decision aid for pregnant adolescents in Tanzania.

Highlights:

– The decision aid provided the necessary information on long-acting reversible contraception methods (intrauterine copper devices and implants) offered immediately after childbirth.
– The decision aid addressed the benefits and side effects of these contraception methods and dispelled myths and misconceptions.
– Pregnant adolescents reported improved knowledge and increased satisfaction with the decision aid.
– Nurses/midwives found the decision aid to be a valuable tool in complementing family planning counseling.

Recommendations:

– Further research is needed to assess the effects of the decision aid on the uptake of long-acting reversible contraception among pregnant adolescents in Tanzania.

Key Role Players:

– Healthcare providers (nurses/midwives) with experience in family planning services.
– Pregnant adolescents aged 15-19 years.
– Research supervisor and experts in maternal and child health.

Cost Items for Planning Recommendations:

– Research personnel (principal investigator, research assistant).
– Ethical approval and permissions.
– Recruitment and selection of study participants.
– Training for research assistant.
– Audio recording equipment.
– Transcription and translation services.
– Data analysis.
– Development and modification of the decision aid.
– Printing and distribution of the decision aid.
– Monitoring and evaluation of the decision aid implementation.
– Dissemination of research findings.

Força da prova

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on an exploratory qualitative study involving healthcare providers and pregnant adolescents in Tanzania. The study used purposive sampling and conducted in-depth interviews to assess the feasibility of a postpartum Green Star family planning decision aid. The participants perceived the decision aid to be practical, useful, and acceptable, and it improved the knowledge of pregnant adolescents about long-acting reversible contraception methods. However, the evidence is limited to a small sample size and may not be generalizable to a larger population. To improve the strength of the evidence, future research could include a larger and more diverse sample, use a mixed-methods approach to gather both qualitative and quantitative data, and conduct a randomized controlled trial to assess the effectiveness of the decision aid in improving contraceptive uptake among pregnant adolescents in Tanzania.

Resumo

The study used an exploratory qualitative research design. In August 2020, we conducted 18 in-depth interviews that involved healthcare providers and pregnant adolescents from Amana District Hospital in Dar es Salaam. Although the decision aid was designed for pregnant adolescents, we included healthcare providers because we wanted to hear their opinions about the decision aid. We believe that the family planning counseling experiences of the healthcare providers would provide significant and well-informed comments to improve the contents of the decision aid and the intervention process. The study population consisted of six healthcare providers and 12 pregnant adolescents. The healthcare providers were nurses/midwives with three or more years of experience in family planning services. The pregnant adolescents were 15–19 years of age who could read and communicate in the Kiswahili language and consented to participate in the study. The study’s principal investigator and the person in charge of the maternity clinic were responsible for recruiting the study participants who were purposively selected to best answer the research questions. The interviews lasted for 40–50 min and were led by two moderators: one who asked the questions and another who assisted and recorded the interview and took notes. A semi-structured interview guide with five questions in the Kiswahili language was used to collect information from pregnant adolescents and healthcare providers. In the interview, participants were asked the following questions: “What do you think about the information presented in the decision aid?”, “How do you feel about the use of a decision aid for deciding postpartum family planning?”, “What do you think about the usefulness of the decision aid?”, “Will you recommend its use in the clinic?” and several follow-up questions. We obtained ethical approval from St. Luke’s International University, Muhimbili University of Health and Allied Sciences, and the National Institute of Medical Research. Permission to conduct the study was obtained from the regional medical officer and the medical officer-in-charge of Amana District Hospital. The interviews were conducted in a private room within the hospital to ensure convenient access and privacy. The principal investigator informed the participants about the study’s purpose, scope, and importance at the beginning of each discussion. The study participants were informed of their rights to participate and withdraw during the interview whenever they felt like it. Written informed consent was obtained from each participant for participating and recording the interview. The principal investigator requested the participants to feel free and be open when responding to questions and assured them that there was no right or wrong answer. The principal investigator and a research assistant conducted the interviews. Experience in conducting interviews, experience in using recorders, having knowledge, and experience in family planning were the criteria used for selecting the research assistant. A one-day training was conducted for the research assistant to comprehensively understand the purpose of the study, what questions to ask, how to ask, and probe and when to obtain written informed consent from the participants not to influence data collection. The P.I. uploaded the audio files into a secured computer with a passcode immediately after all interviews each day. The interviews were transcribed verbatim in the Kiswahili language, and the data was analyzed while in the Kiswahili language. We conducted thematic analysis following the steps outlined by Braun and Clarke [24]. An iterative inductive-deductive, the team-based coding approach was employed to code and analyze the data [25]. The P.I. and R.A. who conducted the in-depth interviews undertook the coding process and analysis. Individual codes were then organized into subcategories and categories. study participants’ quotes illustrated the key findings. Using a team-based approach, we developed the codebook [25] after re-reading all the transcripts (familiarization with data). The P.I. and R.A. had several meetings where codebooks and memos were presented, codes updated, and any existing disagreement was resolved. Next, the P.I. and R.A. generated themes that involved open-ended coding of several transcripts with no predetermined codes or categories. Coding was done directly onto the hard copies of the transcripts during multiple readings of the interviews. Independent from each other, the P.I. and R.A. coded interviews question by question and then shared and compared their coding findings to reconcile differences, if any. The P.I. and R.A. applied the codes from the codebook to all 18 transcripts. Codes were refined, reduced, and expanded during this period. Finally, the P.I. and R.A. generated categories and subcategories based on the findings of the initial coding. Codes were grouped under categories and subcategories. The author identified the gap, target population, and objectives to address the research problem. We mainly focused on previously published studies to determine the objectives to be addressed [21, 23, 26–28]. There are limited publications that described the use of decision aids in reducing decision-making conflicts on the utilization of long-acting reversible contraception methods. We then identified the individual needs of the participating pregnant adolescents by reviewing a previous study that looked at barriers to the utilization of family planning among female youths in Dar es Salaam, Tanzania [11]. The individual needs of the participants included inadequate knowledge, especially of long-acting reversible contraception methods. We found female teens to have several misbeliefs about the methods and how to participate in decision-making. Most female teens could not decide on their own without involving their sexual partners (Fig. 1). Flow diagram showing the process of developing the final postpartum Green Star family planning decision aid (version 1) The content, design, and arrangement of the “developed prototype decision aid were grounded in the Ottawa Patient Decision Aid Development eTraining [29], International Patient Decision Aid Standards Collaboration checklist [30], Theory of Planned Behavior [31], Health Belief Model [32], Social Cognitive Theory [33], current clinical guides for family planning counseling for providers [1, 34], and findings from previous studies on the benefits and side effects of the options, satisfaction and continuation rates, and fertility return [35–41]. The prototype decision aid has four components based on the Ottawa Patient Decision Aid development guide: (1) know how to make a decision with conviction; (2) understand the characteristics of the decision; (3) clarify what is important to you, and (4) make the decision (Figs. (Figs.2,2, ,3,3, ,4,4, ,5).5). The author shared a prototype decision aid with three experts that involved a research supervisor and two midwives, all with several years of experience in maternal and child health and developing decision aids. The aim of sharing the prototype decision aid with these experts was to receive comments on the comprehensibility and usefulness of the prototype decision aid, which we incorporated to modify and improve the decision aid. The final decision aid version 1 was given to six healthcare providers and 12 pregnant adolescents to assess its practicality, usefulness, and acceptability (Fig. 1). Four steps involved in developing the decision aid based on the Ottawa Patient Decision Aids development Contents in steps 1 and 2 of the decision aid Contents in step 2 of the decision aid: understand the characteristics of the options Contents in steps 3 and 4 of the decision aid

Materiais

N/A

Inovações

The study recommends the development and implementation of a “postpartum Green Star family planning decision aid” to improve access to maternal health, specifically for pregnant adolescents in Tanzania. The decision aid aims to provide information and education about long-acting reversible contraception methods that can be used immediately after childbirth.

The study found that the decision aid was perceived as practical, useful, and acceptable by both pregnant adolescents and healthcare providers. It improved the knowledge of pregnant adolescents about available contraception methods and addressed their concerns, dispelling myths and misconceptions.

To develop the decision aid, an exploratory qualitative research design was used. In-depth interviews were conducted with healthcare providers (nurses/midwives with experience in family planning services) and pregnant adolescents aged 15-19 years. The interviews were conducted in the Kiswahili language using a semi-structured interview guide. Participants were selected through purposive sampling, and data collection continued until saturation was reached.

Ethical approval was obtained, and written informed consent was obtained from each participant. The interviews were conducted in a private room within the hospital to ensure privacy. The interviews were audio-recorded and transcribed verbatim in the Kiswahili language. Thematic analysis was conducted to analyze the data, and codes were developed based on the findings.

The decision aid was developed based on existing guidelines, theories, and previous studies on family planning counseling and the benefits and side effects of contraception methods. The prototype decision aid was shared with experts and modified based on their feedback. The final version of the decision aid was then assessed for practicality, usefulness, and acceptability by healthcare providers and pregnant adolescents.

Overall, the study recommends the development and implementation of the postpartum Green Star family planning decision aid to improve access to maternal health, particularly for pregnant adolescents in Tanzania. Further research is needed to assess the impact of the decision aid on the uptake of long-acting reversible contraception among pregnant adolescents. The study was published in the journal Reproductive Health in 2021.

AI Innovations Description

The recommendation from the study is to develop and implement a “postpartum Green Star family planning decision aid” to improve access to maternal health, specifically in the context of family planning counseling for pregnant adolescents in Tanzania. The decision aid aims to provide information and education about long-acting reversible contraception methods (such as intrauterine copper devices and implants) that can be used immediately after childbirth.

The study found that the decision aid was perceived as practical, useful, and acceptable by both pregnant adolescents and healthcare providers. It improved the knowledge of pregnant adolescents about available contraception methods and addressed their concerns, dispelling myths and misconceptions.

To develop the decision aid, an exploratory qualitative research design was used. In-depth interviews were conducted with healthcare providers (nurses/midwives with experience in family planning services) and pregnant adolescents aged 15-19 years. The interviews were conducted using a semi-structured interview guide translated into the Kiswahili language. The participants were selected through purposive sampling, and data collection continued until saturation was reached.

Ethical approval was obtained, and written informed consent was obtained from each participant. The interviews were conducted in a private room within the hospital to ensure privacy. The interviews were audio-recorded and transcribed verbatim in the Kiswahili language. Thematic analysis was conducted to analyze the data, and codes were developed based on the findings.

The decision aid was developed based on existing guidelines, theories, and previous studies on family planning counseling and the benefits and side effects of contraception methods. The prototype decision aid was shared with experts and modified based on their feedback. The final version of the decision aid was then assessed for practicality, usefulness, and acceptability by healthcare providers and pregnant adolescents.

Overall, the study recommends the development and implementation of the postpartum Green Star family planning decision aid to improve access to maternal health, particularly for pregnant adolescents in Tanzania. Further research is needed to assess the impact of the decision aid on the uptake of long-acting reversible contraception among pregnant adolescents. The study was published in the journal Reproductive Health in 2021.

AI Innovations Methodology

The methodology used in the study involved an exploratory qualitative research design. In August 2020, in-depth interviews were conducted with healthcare providers (nurses/midwives) and pregnant adolescents aged 15-19 years from Amana District Hospital in Dar es Salaam, Tanzania. The study population consisted of six healthcare providers and 12 pregnant adolescents who were purposively selected based on their ability to read and communicate in the Kiswahili language and their consent to participate in the study.

The interviews were conducted using a semi-structured interview guide translated into the Kiswahili language. The participants were asked questions about their perceptions of the decision aid, its usefulness, and their recommendations for its implementation. The interviews lasted for 40-50 minutes and were led by two moderators, one asking the questions and another assisting and recording the interview.

Ethical approval was obtained from relevant institutions, and written informed consent was obtained from each participant. The interviews were conducted in a private room within the hospital to ensure privacy. The interviews were audio-recorded and transcribed verbatim in the Kiswahili language. Thematic analysis was conducted to analyze the data, and codes were developed based on the findings. The codes were then organized into subcategories and categories.

The decision aid was developed based on existing guidelines, theories, and previous studies on family planning counseling and the benefits and side effects of contraception methods. The prototype decision aid was shared with experts, including a research supervisor and two midwives, who provided feedback for its improvement. The final version of the decision aid was then assessed for practicality, usefulness, and acceptability by healthcare providers and pregnant adolescents.

Overall, the study recommends the development and implementation of the postpartum Green Star family planning decision aid to improve access to maternal health, particularly for pregnant adolescents in Tanzania. Further research is needed to assess the impact of the decision aid on the uptake of long-acting reversible contraception among pregnant adolescents. The study was published in the journal Reproductive Health in 2021.

Autor

Dima Health

Identifiers:

DOI: 10.1186/s12978-021-01216-6

Research Areas:

Community Interventions, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Workforce

Study Countries:

Tanzania

Study Design:

Cohort Study, Cross Sectional Study, Exploratory Study, Grounded Theory, randomised-control-trial

Study Approach:

Qualitative

Participants Gender:

Female

Partilhar isto: