"When you are willing, you can do it" Changes in Knowledge, Self-Efficacy, and Hope among Zambian Providers Receiving LARC Training. A mixed-methods study Open Access
Craven, Meredith Ruth-Ann (2014)
Abstract
Background: Zambians face a number of obstacles in achieving reproductive health including a high total fertility rate, a high maternal mortality rate, and a high infant mortality rate - all of which are linked to poor access to and use of family planning methods. Additionally, there is a high adult HIV prevalence. These factors combine to make unplanned pregnancies even more dangerous. One way to combat these obstacles is to increase access, use and adherence to family planning methods, specifically long acting reversible contraception (LARC) methods. LARC methods are safe, highly effective, long-lasting and cost-effective. Trained health care providers are fundamental in increasing access, use and adherence to LARC methods, thus considering their attitudes, motivations, perceptions and struggles is warranted.
Objectives: Two theories were used in a mixed methods approach to examine how health care providers perceived LARC methods and how impactful LARC insertion and removal training was on their knowledge, self-efficacy, and general sense of hope.
Methods: In the summer of 2013 in various cities in Zambia, 14 qualitative interviews were performed with female health care providers. The providers were asked about their perceptions of and attitudes towards LARC methods in addition to general questions regarding work experiences and goals. Thematic analysis, with influences from grounded theory, was used to analyze the interviews. Two LARC insertion and removal trainings were also observed, during which pre and post assessments were given to measure knowledge, self-efficacy, and hope. Paired sample t-tests were run to assess whether participants' knowledge, hope, and self-efficacy changed significantly from baseline to post-training.
Results: Several pervasive and influential themes emerged from the interviews, including the attitudes and perceived benefits of both the LARC methods and the LARC insertion and removal training. Additionally, other prominent themes were identified including: the importance of the role of the client-provider relationship, the prevalence of past experiences contributing to a sense of self-efficacy, and barriers to the provision of LARC methods. Quantitative results demonstrated significant changes post-training in both knowledge and hope, but not self-efficacy.
Conclusion/Implications: As health care providers are integral in the dissemination of LARC methods, understanding their attitudes and perceptions is necessary. Evaluating the effectiveness of LARC training to increase provider knowledge, self-efficacy, and hope is an important step to increasing LARC dissemination. Future LARC training and research should consider ways to enhance and measure self-efficacy, decrease barriers to the provision of LARC methods, and focus on the role of culture and the client-provider relationship.
Table of Contents
CHAPTER I: INTRODUCTION 1
Global Health Issue: Risks of Unplanned Pregnancies 1
Increased Access to FP as a Promising Solution 1
Increasing Access Through Trained Health Care Providers 2
The Case for ZEHRP 3
Research Hypotheses 8
CHAPTER II: LITERATURE REVIEW 9
Impact and Prevalence of Lack of Knowledge 9
Training To Increase Knowledge 11
Increasing Acceptability, Access and Use Among Providers and
Clients 13
Knowledge and Self-Efficacy: Improving Attitudes 15
Relationship Of Knowledge/Training and Self-Efficacy 16
Self-Efficacy to Improve Care and Client Outcomes 17
Hope 18
CHAPTER III: METHODS 21
Research Design 21
Participants 21
Measures 22
Procedure 25
Data Analysis 26
CHAPTER IV: RESULTS 28
Quantitative Results 28
Qualitative Results 29
Comparison Matrix 44
CHAPTER V: DISCUSSION 46
Limitations 48
Recommendations/Implications for Future Research: 49
REFERENCES 51
APPENDIX I 58
APPENDIX II 61
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