An educational programme to support primary health care providers regarding the management of emergency contraceptives for adolescents in Ohangwena region, Namibia

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University of Namibia
Family planning (FP) could be called one of the most crucial decisions in a woman, young adult, and lately in an adolescent’s life. Emergency contraceptive refers to the strategies of birth control (FP) to prevent unwanted pregnancies after unprotected sexual intercourse (WHO, 2021). On a daily basis, healthcare facilities offer free services for emergency contraceptives (ECs) to women of childbearing age including adolescents and young people to prevent unwanted pregnancies. However, the impact of such services is minimal, and adolescent pregnancies remain a public health concern in Namibia. The Ohangwena region in Namibia is among the regions with the highest adolescent pregnancies. Therefore, the aim of this study was to assess the knowledge, attitudes and practices of Primary Health Care (PHC) providers regarding the management of ECs among adolescents in order to develop an educational programme for PHC providers. The objectives of the study were: to assess the knowledge, attitudes and practices of PHC providers regarding the management of emergency contraceptives for adolescents; determine the factors related PHC providers’ knowledge, attitudes and practices of ECs by PHC providers for adolescents; to develop a conceptual framework as the foundation for an educational programme; to develop an educational programme to support PHC providers regarding the management of ECs for adolescents; to implement the educational programme; and to evaluate the educational programme. The study adopted a quantitative approach. In this study, a descriptive cross-sectional study design was used in this study. The study was conducted in four phases. The first step was to conduct a situational analysis that assessed the knowledge, attitudes and practices of PHC providers regarding the management of ECs among adolescents as well as determine the factors related to PHC providers’ knowledge, attitudes and practices of ECs by PHC for adolescents. To collect data, a self-administered questionnaire was used, and a multi-stage stratified sampling method was used to select PHC providers from various health care facilities. A total of ninety-three PHC providers completed the self- ii administered questionnaire with a response rate of 100%. The collected data were entered into the statistical package SPSS version 26. Descriptive and inferential data analysis methods were used to analyse the data. In total, 79% of PHC providers had heard of emergency contraceptives (ECs). However, only 66% of the PHC providers know that combined pills are types of ECs methods, while only 14% correctly identified copper IUD as a method of ECs. In identifying those that are eligible for ECs use, a majority of respondents (76%) named women who had unprotected sex and only 12% identified adolescents as appropriate candidates for using ECs. Rape situations (79%) were the most frequently cited reason for EC prescriptions, followed by condom breakage (61%) and (16%) in case of missed contraceptive pills. Almost 64% of the respondents knew about the effective time to use ECs. The majority (78.3%) of the respondents knew that ECs are used in preventing unwanted pregnancies. The analytical findings revealed that the standardised direct (unmediated) effect of Negative Attitudes on Positive Attitudes was -0.452 (p < 0.01, which implies that a nurse with a negative attitude is likely to have a high misconception attitude and a low positive attitude towards EC. The study found that only 15.2% of the participants were trained in both FP and ECs, and this lack of training in FP and ECs can have a negative impact on ECs practices. As evidenced by less than 50% of participants reportedly providing ECs to clients, the practice of ECs was found to be poor. There is a significant relationship between demographic variables such as age (p=0.00), professional qualification (p=0.00), and work experience (p=0.02) and PHC providers' knowledge, attitudes, and practices. The study revealed a deficit in the knowledge, misconceptions, negative attitude and poor practice of ECs by the PHC providers, which may be barriers to accessing ECs by adolescents. These findings have negative consequences for adolescents’ usage of ECs. As a result, educational interventions should be provided to PHC providers on ECs the knowledge, demystification of misconceptions and for correction of negative attitudes towards EC services. iii Based on Dickoff, James, and Wiedenbach's survey list, the second phase addressed the conceptual framework to guide the development of an educational programme to support PHC providers in the management of ECs for adolescents. The third phase focused on developing an educational programme to assist PHC providers, guided by the Nicholls Cyclic Curriculum Development Model. The fourth stage dealt with programme implementation and evaluation. Knowles' Andragogy model and Kolb's experiential learning theory guided this phase. The educational programme was evaluated during and after its implementation. The findings indicated that the education programme was useful and supportive
A dissertation submitted in fulfilment of the requirements for the degree of doctorate of philosophy in public health
Educational programme, Primary health care, Emergency contraceptives, Ohangwena region, Family planning