Predicting oral contraceptive continuation using the transtheoretical model of health behavior change

Male involvement in family planning program in Northern Ethiopia: an application of the Transtheoretical model

OBJECTIVE

The objective of this study is to use the Transtheoretical behavioral model to assess male involvement in family planning.

METHODS

A cross-sectional study was conducted in Angolela-Tera District of Amhara Region from February 15 to March 14, 2008 on married men. Multi-stage sampling technique was employed to select the 770 study participants. The relationship of stage of change and decisional balance, self-efficacy and processes of change was assessed by ANOVA tests.

RESULTS

225(30.5%) of the men were in the Precontemplation stage, 235(31.8%) were in the contemplation stage, 81(11.0%) were in preparation, 76(10.3%) were in action stage, and, 121(16.4%), were in the maintenance stage. Confidence increased across the stages while experiential and behavioral processes increased in the early stages and then decreased at a transition from action to maintenance stage. The pros were increased across the stages, the cons decreased and a crossover occurred prior to contemplation stage.

CONCLUSION

The findings suggest that counselors need to understand that behavior change is a process that occurs in a series of stages and therefore can facilitate behavioral changes with various strategies. Health educators need to develop educational components that match stages of change.

PRACTICAL IMPLICATIONS

Based on our results, programs aimed at promoting contraceptive prevalence for contraception should seek ways and means for increasing the pros and for increasing self-efficacy.

Findings from the use of a narrative story and leaflet to influence shifts along the behavior change continuum toward postpartum contraceptive uptake in Sylhet District, Bangladesh

OBJECTIVES

Postpartum women face uncertainty about timing of return to fecundity. Many women wait to use contraception until menses return, resulting in unintended pregnancies. This study explored the use of behavior change communication to address perceptions of postpartum return to fecundity and contraceptive adoption.

METHODS

This study, which took place in Sylhet District in Bangladesh, explored knowledge and perceptions about postpartum return to fecundity and used the Steps to Behavior Change framework to assess the reported influence of a leaflet and fictional story ("Asma's Story") incorporated within community health activities. The study relied on in- depth interviews and focus group discussions.

RESULTS

The study revealed nearly universal exposure to Asma's Story. Reported shifts in perceived susceptibility to pregnancy, benefits of pregnancy spacing, and increased social support for postpartum family planning (PPFP) were noted. However, only approximately one third of women were using a modern contraceptive method.

CONCLUSIONS

Using a fictional story offers a promising approach for motivating shifts along the continuum.

PRACTICE IMPLICATIONS

It is recommended that Asma's Story be incorporated within future efforts to scale up PPFP in Bangladesh, and that similar approaches be tailored and tested in other countries.

Hormonal contraceptive use before and after conception in relation to preterm birth and small for gestational age: an observational cohort study

OBJECTIVE

To evaluate whether hormonal contraceptives, used before or in early pregnancy, confer increased risk of preterm birth or reduced fetal growth.

DESIGN

Population-based cohort study conducted by the Norwegian Institute of Public Health (Mother and Child Cohort Study, 1998-2008) with linkage to the Norwegian Prescription Registry and to the Medical Birth Registry of Norway.

SETTING

Norway.

POPULATION

Of the 48,615 pregnancies meeting study inclusion criteria, 44,734 pregnancies were included in the complete case analysis.

METHODS

We characterised hormonal contraception by type (combination oral, progestin-only oral, vaginal ring, transdermal, and injectable) and specific progestin component. We used generalised estimating equations to estimate the odds of adverse outcome according to formulation used. Several sensitivity analyses were conducted.

MAIN OUTCOME MEASURES

Preterm birth, small for gestational age.

RESULTS

We observed a positive association between use of a combination oral contraceptive and preterm birth for all exposure periods (e.g. adjusted odds ratio 1.21, 95% confidence interval 1.04-1.41 for last use 12 to >4 months before conception); combination contraceptives containing the progestin norethisterone were consistently related to risk. Other types of hormonal contraception were generally not associated with preterm birth; none were related to small for gestational age. Observed associations were robust to sensitivity analyses.

CONCLUSION

Hormonally active agents may exert dose-, agent-, and timing-specific effects on growth and development. We found that the particular progestin component is important when assessing the potential for adverse effects among former users of hormonal contraceptives.

Applying Psychological Theories to Promote Healthy Lifestyles

Over the past few decades, researchers have been developing and refining psychological theories and models to provide solid behavioral frameworks for evidence-based research. Each year new theories and models are created; however, a select few appear to have withstood the test of time and continue to be frequently utilized in present-day research. The objectives of this review are to highlight these psychological theories and models and describe their application to various public health issues and behaviors. Descriptions and example applications of the following theories and models are described in this review: health belief model, theory of reasoned action/planned behavior, social cognitive theory, transtheoretical model, and socioecological model.