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1
Effect of Emergency Contraception Guidelines Intervention on
Women's Knowledge and Attitude
Somaya Ouda AbdElmoniem1 and Eman Mohammed Abdelhakam2
1,2Lecturer of Obstetric &Women's Health Nursing, Faculty of Nursing, Benha University, Egypt.
Abstract:
Aim: The aim of the study was to evaluate the effect of emergency contraception guidelines on
women's knowledge and attitude. Design : A quasi-experimental study was utilized Setting: the
study conducted in Obstetrics and Gynecological Out Patient Clinic at Benha University Hospital
. Sampling: A convenient sample including all women admitted to Out Patient Clinic for a
period of six months were collected after approving to participate in the study and utilizing
emergency contraception guidelines intervention. Tools: Two tools were used :1- A structure
interviewing questionnaire included a) Socio demographic data of studied women. b) women’s
knowledge about emergency contraception. II- Likert scale tool to assess women’s attitude
toward emergency contraception . Results: There is a poor knowledge about emergency
contraceptives among studied women , 55.0% do not know emergency contraceptives. also more
than one third 38.5% had unwanted pregnancies prior to the time of the study. In addition ,
55.0% had negative attitude pre intervention toward emergency contraceptives, There was highly
significant improvement in women’ knowledge score and significant positive attitude post
intervention. Conclusion: There was a highly significant improvement in women’ knowledge,
and attitude after application of guidelines intervention about emergency contraception. This
supported the main hypotheses of the study. Recommendations: The study recommended
provision of the guidelines about emergency contraception in different hospitals and maternal
child centers to improve women's knowledge and attitude.
______________________________________________________________________________
Keywords: Attitude , Knowledge, Emergency Contraception, Guidelines and Intervention.
.
2
1- INTRODUCTION
Emergency contraception (EC) is defined as utilization of a method for contraception after
unprotected intercourse to prevent unintended pregnancy. All over the world, more than 25% of
all pregnancies are unintended. Annually, 40-60 million women seek evacuation of an
undesirable pregnancy under unsafe conditions of which 95% occurs in the developing world.
Recent studies demonstrated that (13%) of pregnancy-related deaths is to be due to unsafe
abortions. Poor quality maternal care also affects the health of the newborn. In Egypt, each year,
216,000 women are admitted to hospital with complications of abortion, despite abortion being
legal. Emergency contraception plays a vital role in reducing maternal mortality substantially
and improves maternal health by avoiding unwanted pregnancy and unsafe abortion (Thapa,
2013;Shaaban, et al., 2011).
Emergency contraception is successful if taken just in the initial few days after intercourse
before the ovum is discharged from the ovary and before the sperm fertilizes the ovum.
Emergency contraceptive pills cannot interrupt or damage a developing fetus (World Health
Organization, 2012). Emergency contraception is not prescribed as a normal conception
prevention technique. Rather, it is utilized for emergency as it were. if a couple is sex and the
condom breaks or slips off, if a diaphragm or cervical cap slips strange, or if a young lady
neglected to take conception prevention pills for 2 days in succession, a young woman might
need to consider utilizing EC(Gavin, 2013).
Emergency contraception methods are classified into emergency preventative pills (ECPs)
taken as one dosage of levonorgestrel 1.5 mg, taken for five days (120 hours) of unprotected
intercourse and copper-bearing Intra Uterine Devices (IUDs) embedded inside five days of
unprotected intercourse, a copper-bearing IUD is the best type of emergency contraception
accessible. EC has been accessible and enrolled for quite a while in Egypt and some other Center
Eastern nations, for example, Algeria, Lebanon, Libya, Mauritania, Morocco, Tunisia, and
Yemen ( Foster&Wyn,2012).
Side effects of emergency preventative pills are same as conception prevention pills. Including
nausea, abdominal ache, weakness, headache, and menstrual changes. Breast tenderness, fluid
retention, and dizziness may likewise happen. A large portion of symptoms might be less
extreme with progestin-just or intrauterine types of EC. Serious dangers incorporate heart
3
assault, blood clumps, and strokes. emergency prophylactic pills do not keep on protecting
against pregnancy during the rest of the cycle. EC may not counteract tubal pregnancy. Also
,side effects of IUDs utilized for EC are the same as birth control IUDs. On the other hand EC is
not secure against sexually transmitted diseases (Samra et al., 2014).
The most recent Egyptian Demographic Health Survey (EDHS) has demonstrated a decrease
of total fertility rate (TFR) in Egypt from 5.3 births per woman at the time of the 1980 Egyptian
Fertility Survey (EFS) to 3 births per woman at the time of the 2008 EDHS. Additionally ,it
demonstrated that present utilization of any contraception technique was 60% and that 25% of
women end the contraception strategy inside one year of utilization due to different reasons
including contraceptive failure, dissatisfaction with the method, and wellbeing concerns. Clearly,
EC can act as a move down method for women ending a contraceptive technique because of any
of these reasons( Ibrahim, et al., 2013).
Moreover, in about half of all unwanted pregnancies, conception happens because of deficient
guidance to utilize contraception goodly, including the users’ inability to address their feelings,
poor attitudes towards contraceptives, and absence of motivations. Unplanned pregnancy is a
reason for intended abortion, low birth weight (LBW), delay in pregnancy care, increased mother
and child mental and physical diseases (Langille, 2012).
Emergency contraception in the previous two decades had been proven to be effective and
well tolerated. Nursing role including advising , counseling and prescription of EC in practice
guidelines in the developed countries for its potential to reduce the number of unintended
pregnancies and abortions(El-Sabaa, et al., 2013). An essential component of programs
providing EC is education , training and advising women about essential choices before
requiring it. Since, the time span for intercession is short. Efficacy decreases with every day or
even hour of postponement. Women should be aware that EC is an alternative and should start as
soon as possible after unprotected or ingoodly protected intercourse (Dinku., 2007).
4
Significance of the study
Preventing unintended pregnancy is a personal goal for most couples. Diminishing the
national level of unintended pregnancy is one of the most important reproductive health goals
identified by most nations especially The United States department of health and human services
(Finer &Zolna, 2011).Many pregnancies are unplanned and unwanted in spite of the availability
of highly effective methods of contraception, These pregnancies convey higher danger of
morbidity and mortality, often due to unsafe abortion , most of these unwanted pregnancies can
be avoided by utilization of EC; health education and counselling about EC are the
resbonsibilities of health team mainly nurses (Sindawe &Nzama, 2013).
Women utilizing contraception can still have an unintended pregnancy because of
contraceptive failure which may be happen for two reasons: inaccurate utilization of a method or
an issue with the technique itself. Contraceptive failure seems to be a major issue in Egypt. 7 %
of all pregnancies and 29 %of unintended pregnancies are due to contraceptive failure. The rates
are higher for Jordan, where 14 % of all pregnancies and 39 % of unintended pregnancies result
from contraceptive failure.(Roudi& Abdul Monem,2010)EC has been called “the best-kept
secret” in reproductive health because, despite its unique potential for helping women prevent
pregnancies and satisfy their reproductive intentions, rates of use and of counseling about the
method are quite low (Palermo et al.,2014).
II. Aim of the study
The aim of this study was to evaluate the effect of emergency contraception guidelines
intervention on women’s knowledge and attitude . This aim was attained through:
1- Assessing women’s knowledge about emergency contraception.
2- Assessing women’s attitude toward emergency contraception.
3- Designing and implement guidelines intervention about emergency contraception.
4- Evaluating the effect of guidelines intervention on women’s knowledge and attitude
towards emergency contraception.
5
Hypotheses:
H1.Women who received guidelines intervention about emergency contraception will exhibit
higher scores in knowledge level than those who do not received these guidelines .
H2.Women who received guidelines intervention about emergency contraception will exhibit
higher scores in their attitude than those who do not received these guidelines .
III. Subjects & Methods
Study design: Quasi-experimental study.
Study setting: the study was conducted in Obstetrics and Gynecology Out Patient Clinic at
Benha University Hospital
Sampling:
Sample type: A convenient sample.
Sample size: All women admitted to Out Patient Clinic for a period of six months were
included after approved to participate in the study to utilize emergency contraception
guidelines intervention.
Sample technique : The researchers attended the Clinic three days per week for six
months and daily collect all women approved to participate in the study in waiting room
of clinic. The researchers introduced themselves to the selected women , explained the
purpose and nature of the study.
Tools of data collection:
The following tools were designed and used by the researchers after reviewing a related
literature:
1- A Structure interviewing questionnaire: It divided into three parts :
a- Socio demographic data : Such as (age , level of education, residence, occupation ,
previous program related emergency contraception and source of information ).
6
b- Obstetric history such as (parity, number of abortion, mode of delivery, history of
family planning and previous un wanted pregnancies).
c- Assessment of women’s knowledge about emergency contraception (EC) such as
meaning , indication, contraindication, methods , timing ,types, interval between
doses , side effects and efficiency of EC.
Scoring system:
The knowledge level were weighted according to items included in each question, The
answers of the questions were classified into three categories. The answer would have
score (2) for good knowledge, score (1) for average knowledge and the answer would
have score (0) if it was do not know.
The score of total knowledge was classified as the following
Good ≥75%
average 60-<75%
poor <60%
Tool Validity and Reliability:
The developed tool was reviewed for appropriateness of items and measuring the concepts
through five an expert jury. panel in the field of maternity nursing and obstetric medicine
especially to assure content validity. The questionnaires were modified according to the panel
judgment on clarity of sentences and appropriateness of content (The reliability was done by
Cronbach's Alpha coefficient test equal 0.87).
II-Likert scale tool: The researchers assessed attitude of the studied women toward emergency
contraception using likert scale tool which adopted from (Thapa,2013). The scale consisted of
sixteen statements from three –points ;disagree, uncertain & agree (likert scale type) about
several issues.
Scoring system
Each statement scored as following (2)if response was disagree, (1) if it was uncertain
and(zero) if it was agree. The total score of attitude was considered as following
Positive attitude ≥75%
Uncertain attitude 60%-<75%
7
Negative attitude <60%
Tools Validity and Reliability :
Tools of the study was given to 3 experts in the field of maternity nursing and obstetric
medicine to test the content validity of the tool and clarifies the sentences as well as ,
appropriateness of content . After the questionnaire was collected ,test-retest reliability was
applied by the researchers . It was done through the administration of the same tools to the same
participants on two or more occasions .Scores from repeated testing were compared.
Ethical considerations:
Ethical aspects should be considered before starting the study including that oral consent
should be obtained from participants, maintain confidentiality, self-esteem, and dignity of
subject, reassured that the study guidelines was harmless and each subject was free to withdraw
from the study at any time.
Approval:
A written official approval to conduct this research was obtained from the director of Benha
University hospital and head of Obstetrics and Gynecological Department in order to obtain their
agreement to conduct the study after explaining its purpose
Operational Design:
A- Pilot study:A Pilot study was conducted for three weeks to test the clarity, validity &
reliability of tools used . Subjects included in the pilot study were included in the study
sample due to no modification needed in tools after pilot study implementation.
B- Field work: The study was conducted in a period ranging from the beginning of
January 2015 to the end of July 2015.
1. Assessment phase:
8
Tools were used to get a base-line assessment for women’s needs prior to development
of the guidelines content and also used post implementation in order to compare between
the results (pre and post) test to determine the level of improvement.
2. Planning phase:
The content of the emergency contraception guidelines intervention was designed to
meet the following objectives;
General objective: The general objective was to improve women’s knowledge and
changing their attitude toward positive one.
Specific objectives: At the end of the guidelines intervention session each woman
included in the study should be able to :
1. Define emergency contraception.
2. List indications and contraindications of emergency contraception methods.
3. Determine time for starting emergency contraceptions pills or IUD after sex.
4. Explain emergency contraception safety.
5. Explain intervention applied after emergency contraception.
6. List types of emergency contraception.
7. Differentiate between side effects of each methods of emergency contraception.
8. Explain using emergency contraception during breast feeding.
9. Determine efficiency of each method of emergency contraception.
3. Implementation phase:
Implementation was carried out in Obstetrics and Gynecology Out Patient Clinic at
Benha University HospitalThe researchers attended the clinic three days per week for six
months and collected daily all women approved to participate in the study in waiting
room of Clinic .Firstly The researchers introduced themselves to the studied women ,
explained the purpose and nature of the study and obtained consent from the women to be
involved in the study. Pre test was done by distribution of previously mentioned tools, the
time taken for pre test was 30 min. Secondly the researchers implemented emergency
contraception guidelines intervention session, the duration of this session was 60-90 min.
At the beginning of this session an orientation to the significance of the study, general
and specific objectives were explained .Arabic languish was used to suit all women level
9
of understanding. An instructional media was used such as booklet, colored posters and
real objects as emergency contraceptive pills and copper bearing intra uterine devices.
Most of women were cooperative with the researchers and interested by the topic.
4. Evaluation phase:
After completion of previous phase the same tools were filled again as post test to
evaluate the effectiveness of guidelines intervention on women’s knowledge and attitude.
Statistical analysis:
Data were cleaned, edited, coded and entered into SPSS windows version 20
software,descriptive statistics were applied e.g., frequencies, percentage, mean and standard
deviation. Chi square tests and pearson correlation coefficient were used to estimate the
statistical significant differences. A significant P-value was considered when P-value was less
than 0.05 and it was considered highly significant when P-value was less than or equal to 0.01.
IV. Results
Table 1 :Shows that 34.5% of women age <25years, 57.0% live in urban residence, 75% were
range between secondary and university graduates, Concerning women occupation, 55.5% were
employee and 44.5% were housewives.
Table 2: Shows that 52.5% of women were para one, 61% were delivered by cesarean section
(C.S). concerning family planning history 82.0% were using it and 38.5% had unwanted
pregnancies prior to the time of the study.
Table 3:Reveals that pre intervention 55.0% of women do not know meaning of EC,70.0% of
studied women had poor knowledge about indication of EC,67.5% about types of EC while 82.5,
85.0% of women had poor knowledge about timing started EC after sex whether pills or IUD and
92.5% don’t know interval between doses. This table shows also significant improvement in
women’s level of knowledge post intervention.
Table 4:Indicates that 83.0, 82.0% of studied women unknown efficiency of EC whether pills or
IUD pre intervention,95.0%do not know EC safety and there is also significant improvement in
women’s level of knowledge post intervention.
10
Table 5:Shows that, 87.5%of studied women had incorrect answer about take the dose again if
vomiting within one hour of the first dose EC pre intervention, 85% had incorrect answer about
EC cause abortion or not with the significant difference post intervention.
Table 6:Presents that 55.0% of the studied women had negative attitude pre intervention about
availability of EC services, 65.0% also negative attitude pre intervention about accesses to EC
without a prescription reduce the use of regular contraceptive. Concerning morality and religion
about EC the present study revealed that 52.0% negative attitude pre intervention with the
significant difference post intervention.
Table 7: Shows correlations between women’s knowledge and attitude about emergency
contraception, there were highly statistical significant difference post intervention.
Table 8:Shows that there were significant difference between general characteristics of women
and total women knowledge score about emergency contraception p value ≤0.001.
Table 9:Reveals that there were significant difference between general characteristics of women
and total women attitude score about emergency contraception p value ≤0.001.
Figure 1: Shows that 40.8% source of knowledge was from health Clinics, while 10.4% from
mass media.
Figure 2:Reveals that there was significant improvement regarding total knowledge score post
intervention.
Figure 3:Illustrates that there was clear significant positive attitude post intervention.
11
Table 1: General characteristics of studied sample (n=200)
women n=200
Variables
%
No
30.0
34.5
15.5
20.0
60
69
31
40
Age in (years)
<25
25-29
30-35
>35
( 28.42+6.30)
(Mean+SD)
57.0
43.0
114
86
Residence
Urban
Rural
35.5
71
Education
Illiteracy
Read and write + basic education
Secondary Education
University education
44.5
89
Occupation (women)
Employee
House wife
45.0
55.0
90
110
Absence of husband from House due
to work
Yes
No
38.9
38.9
5.6
5.6
11.0
Period of time that the husband
absent from House due to work
(n=90)
Less than a week
A week - two weeks
Month
Less than a year
Year or more
12
Table 2: Obstetric history of the studied sample:
Postpartum women
N=200
Obstetric History
%
No
47.5
95
Parity:
Para one
Twice or more
13.0
26
Number of abortion
No
Once
Twice or more
Mode of deliveries:
Vaginal Delivery.
Cesarean section.
Age of the last child
Less than one year
-2
More than 2 years
82.0
18.0
164
36
History of family planning
Yes
No
42.7
32.9
21.3
3.1
History type of
contraceptiveuse(n=164)
IUD
Pills
Injection
Barriers method
`
Had previous unwanted pregnancies
Yes
No
13
Figure (1): Percentage distribution of studied women regarding Source of information
about emergency contraception.
Figure (2) :Percentage distribution of studied women regarding total
knowledge score pre and post intervention about emergency contraception (EC)
14
Table 3:Percentage distribution of studied women regarding their knowledge about
emergency contraception
p
valu
e
Chi
square
test
Post intervention
Pre intervention
Variables
Incorrect
Incomplet
e correct
Complete
correct
Incorrect
Incomplet
e correct
Complete
correct
%
No
%
No
%
No
%
No
%
No
%
No
<0.0
01**
137.33
5.0
10
52.
5
105
42.5
85
55.0
110
37.5
75
7.5
15
meaning of
EC
<0.0
01**
211.96
4.0
8
48.
5
97
47.5
95
70.5
141
27.0
54
2.5
5
Indication of
EC
<0.0
01**
177.11
13.
5
27
0.0
0
86.5
173
84.0
168
0.0
0
16.0
32
Using EC
during breast
feeding
<0.0
01**
198.93
7.5
15
50.
0
100
42.5
85
67.5
135
30.0
60
2.5
5
Types of EC
<0.0
01**
158.28
15
0.0
0
92.5
185
82.5
165
0.0
0
17.5
35
Timing start
EC pills after
sex
<0.0
01**
136.85
9.5
19
0.0
0
90.5
181
85.0
170
0.0
0
15.0
30
Timing start
EC IUD after
sex
<0.0
01**
227.27
0.0
0
43.
0
86
57.0
114
33.0
66
52.0
104
15.0
30
Methods can
be used
immediately
after EC
<0.0
01**
228.70
5.0
10
0.0
0
95.0
190
92.5
185
0.0
0
7.5
15
Interval
between doses
ofEC
<0.0
01**
116.70
17.
5
35
0.0
0
82.5
165
72.5
145
0.0
0
27.5
55
Examine
pelvic before
EC pills
** Highly statistically significant difference at P ≤ .001
15
Table 4: Percentage distribution of studied women regarding their knowledge about
efficiency of emergency contraception.
p value
Chi
square
test
Post intervention
Pre intervention
Variables
Incorrect
Correct
Incorrect
Correct
%
No
%
No
%
No
%
No
<0.001**
306.44
21.0
42
79.0
158
83.0
166
17.0
34
Efficiency of the
EC pills
<0.001**
122.22
14.0
28
86.0
172
82.0
164
18.0
36
Efficiency of the
EC IUD
<0.001**
185.25
12.5
25
87.5
95.0
190
5.0
10
EC safety
<0.001**
273.79
30.5
61
69.5
139
79.5
159
20.5
41
Proportion of
pregnant women
after use EC
<0.001**
97.01
10.5
21
89.5
179
19.0
38
EC effective as
regular
contraceptive
method
<0.001**
200.25
6.5
13
93.5
187
90.0
180
10.0
20
EC protection
against HIV and
other sexually
transmitted
disease
** Highly statistically significant difference at P ≤ .001
16
Table 5: Percentage distribution of studied women regarding their knowledge about side
effect and contraindication of emergency contraception
** Highly statistically significant difference at P ≤ .001
p
valu
e
Chi
square
test
Post intervention
Pre intervention
Variables
Incorrect
Incomplet
e correct
Complete
correct
Incorrect
Incomplete
correct
Complete
correct
%
No
%
No
%
No
%
No
%
No
%
No
<0.0
01**
146.78
2.5
5
55.5
111
Side effect of EC
<0.0
01**
168.26
0.0
0
175
0.0
0
25
Take the dose
again if vomiting
within one hour
of the first dose
EC
<0.0
01**
93.29
38.0
76
0.0
0
62.0
124
85.0
170
0.0
0
15.0
30
EC cause abortion
<0.0
01**
139.36
19.0
0.0
0
81.0
162
0.0
0
22.0
44
The impact of EC
on the ability of
reproduction
<0.0
01**
145.04
0.0
0
179
0.0
0
61
EC cause ectopic
pregnancy
<0.0
01**
149.53
2.5
5
37.
5
75
60.0
120
37.5
75
55.0
110
7.5
15
EC pills
contraindication
<0.0
01**
126.04
7.5
15
40.
5
81
52.0
104
48.0
96
44.5
89
7.5
15
EC IUD
contraindication
17
Table (6):Frequency distribution of women according to their attitude toward emergency
contraception (N=200)
** Highly statistically significant difference at P ≤ .001
p
value
Chi
squar
e test
Post intervention
Pre intervention
Variables
Disagree
Uncertain
Agree
Disagree
Uncertain
Agree
%
No
%
No
%
No
%
No
%
No
%
No
<0.001
**
103.45
57.5
115
40.0
80
2.5
5
20.0
40
39.5
79
40.5
81
EC used after sexual intercourse
is not useful and non-secure.
<0.001
**
134.79
125
65
5.0
10
17.5
35
27.5
55
55.0
110
EC service not available
<0.001
**
139.32
121
5.5
11
70
52.5
105
EC not good idea for all women.
<0.001
**
172.11
38.0
76
0.0
0
53.0
106
Repeated use EC is a danger on
the health.
<0.001
**
128.12
5.0
10
25
50.0
100
Use of EC reduces the
continued use of condoms.
<0.001
**
191.49
2.0
4
48.0
96
All EC aren’t available without
a prescription a doctor or
consulting pharmacist.
<0.001
**
140.08
12.5
25
5.0
10
65.0
130
Accesses to EC without a
prescription reduce the use of
regular contraceptive.
<0.001
**
116.13
47.5
95
42.5
85
10.0
20
7.5
15
40.0
80
52.5
105
Not recommend the use of EC if
sex during unsafe period
18
Figure (3):Percentage distribution of studied women regarding total score of attitude
toward emergency contraception (N=200)
Table (7):Correlation between women knowledge and attitude about emergency
contraception (N=200)
Total women knowledge post
intervention
Total women knowledge
pre intervention
Variable
P value
r
P value
r
-
-
≤0.001
0.922**
Total attitude Pre
intervention
≤0.001
0.761**
-
-
Total attitude Post
intervention
19
Table (8): Relation between general characteristics and total women knowledge score about
emergency contraception
** Highly statistically significant difference at P ≤ .001
Post intervention
Pre intervention
Variables
Good
Average
Poor
Good
Average
Poor
%
No
%
No
%
No
%
No
%
No
%
No
30.0
24.5
8.0
6.5
13
2.5
5.0
7.5
5.5
11
2.0
0.5
0.0
8.0
16
6.0
0.0
0.0
0.0
0
13.0
0.5
0.0
0.0
15.5
29.5
15.5
20.0
0
Age in (years)
<25
25-29
30-35
>35
75.07 p value ≤0.001
p value ≤0.001
X2 p value
0.0
0.0
35.5
33.5
67
9.5
5.0
4.0
2.0
4
8.0
2.5
0.0
0.0
0
0
0
0
6.0
12
0.0
0.0
0.5
13.0
26
17.5
7.5
39.0
16.5
33
Education
Illiteracy
Read and write + basic
education
Secondary education
University education
157.52 p value ≤0.001
81.25 p value ≤0.001
X2 p value
42.0
27.0
54
14.5
6.0
12
0.5
10.0
20
6.0
0.0
0
13.5
0.0
0
37.5
43.0
8
6
Residence
Urban
Rural
27.37 p value ≤0.001
36.54 p value ≤0.001
X2 p value
42.5
26.5
85
53
11.5
9.0
23
18
1.5
9.0
3
18
3.0
3.0
6
6
4.5
9.0
1
8
48.0
32.5
65
Occupation (women)
Employee
House wife
16.52 p value ≤0.001
6.62 p value0.036
X2 p value
37.0
32.0
74
64
6.0
14.5
12
29
2.0
8.5
4
17
0.0
4.5
0
9
9.0
6.0
18
12
36.0
44.5
72
89
Absence the husband from
house due to work
Yes
No
13.96 0.001
14.94 0.001
X2 p value
36.7
31.1
5.6
5.6
3.3
3
2.2
3.3
0.0
0.0
7.8
7
0.0
4.4
0.0
0.0
0.0
0
0.0
0.0
0.0
0.0
0.0
0
11.1
8.9
0.0
0.0
0.0
10
8
0
0
0
27.7
30.0
5.6
5.6
11.1
10
Period of time
thehusbandabsence from
house due to work (n=90)
Less than a week
A week - two weeks
Month
Less than a year
Year or more
39.70 p value ≤0.001
24.33p value .007
X2 p value
20
Table (9): Relation between general characteristics and total women attitude score about
emergency contraception
** Highly statistically significant difference at P ≤ .001
Post intervention
Pre intervention
Variables
Positive
Uncertain
Negative
Positive
Uncertain
Negative
%
No
%
No
%
No
%
No
%
No
%
No
29.5
20.0
7.5
5.0
9=
84
59
10
3.0
7.0
7.5
5.0
:
58
59
10
2.0
3.0
0.5
10.0
8
:
5
20
11.5
0.0
0.0
0.0
67
4
4
0
8.5
0
0.5
0.0
5;
4
5
0
14.5
30.0
15.0
20
6=
:4
74
40
Age in (years)
<25
25-29
30-35
>35
70.41 p value ≤0.001
91.19 p value ≤0.001
X2 p value
2.5
0.0
34.5
25.0
9
4
:=
50
4.5
3.0
4.5
10.5
=
:
=
65
5409
809
409
404
65
=
5
4
0.0
0.0
0.0
11.5
4
4
4
23
0.0
0.5
0.0
8.5
4
5
4
17
17.5
7.0
39.5
15.5
79
58
;=
31
Education
Illiteracy
Read and write + basic education
Secondary Education
University education
124.47 p value ≤0.001
87.61 p value ≤0.001
X2 p value
39.5
22.5
;=
45
16.5
6.0
77
12
1.0
14.5
6
29
11.5
0.0
67
0
9.0
0.0
5<
0
36.5
43.0
;7
<:
Residence
Urban
Rural
39.49 p value ≤0.001
38.90 p value ≤0.001
X2 p value
33.5
28.5
:;
57
18.5
4.0
37
8
3.5
12.0
;
24
3.0
8.5
:
17
5.5
3.5
55
;
47.0
32.5
=8
65
Occupation (women)
Employee
House wife
26.72 p value ≤0.001
9.130 p value 0 .010
X2 p value
35.0
27.0
70 54
7.5
15.0
15 30
2.5
13.0
5 26
2.0
9.5
4
19
<04
504
16
2
35.0
44.5
70 89
Absence the husband from
House due to work
Yes
No
19.48 p value ≤0.001
21.15 p value ≤0.001
X2 p value
33.3
27.8
5.6
5.6
5.6
74
69
9
9
5
5.6
6.6
0.0
0.0
4.4
9
:
4
4
4
0.0
4.4
0.0
0.0
1.1
4
8
4
4
1
4.4
0.0
0.0
0.0
0.0
8
4
4
4
0
6.6
11.1
0.0
0.0
0.0
:
54
4
4
0
27.8
27.8
5.6
5.6
11.1
69
69
9
9
10
Period of time the husband
absent From House due to
work (n=90)
Less than a week
A week - two weeks
Month
Less than a year
Year or more
27.658 p value 0.002
36.75 p value ≤0.001
X2 p value
21
V. DISCUSSION
The aim of the present study was to evaluate the effect of emergency contraception guidelines
intervention on women's knowledge and attitude at Benha University Hospital. This aim was
achieved through assessing women's knowledge about EC and their subsequent attitude,
designing and implementing guidelines intervention about EC . Finally,evaluating the effect of
these guidelines intervention on women's knowledge and their attitude towards EC.
The present study showed that the majority of studied women had poor knowledge about EC
before guidelines intervention with significant difference post intervention . These findings
follow the same line of El-Sabaa, et al .(2013) who reported that,there is a deficient knowledge
about emergency contraceptives among women of reproductive age. The majority of them had
not been offered data or counseling about EC, but were willing to get data and utilize these
techniques when required. Additionally consistent with Morhason-Bello et al. (2014)who
mentioned that complete formation and counseling as well as a wide choice of modern
contraceptives, including EC should be part of a comprehensive program that addressing other
sexual and reproductive health needs. Also,in accordance with Sedigheh et al. (2014) who stated
that women need education about all aspects of EC, planning to achieve this aim. Physicians,
nurses and midwifes can educate women through books,pamphlets, films in this matter because
with exact planning for healthy women.
Regarding to the side effects of ECPs, the most well-known side effects are nausea and
vomiting .The present study revealed that more than half of studied women had poor knowledge
about taking the dose again if vomiting within one hour of the first dose EC pre intervention
with the significant difference post intervention . This result disagrees with Charandabi et al.
(2012) who reported that around 40% of providers did not know about the need to repeat the
dose in case of vomiting within two hours after taking the ECPs. Also, another study in Pakistan,
by Chung (2008) showed that 33% of individuals did not know about this issue.
22
With respect to the main source of their knowledge about emergency contraception, the
studied women demonstrated that nearly half of studied women source of knowledge was health
clinics, while few women regard mass media as their source of knowledge. The poor knowledge
level among women in this study might be attributed to lack of any educational program and
service promotion on emergency contraception. This disagrees with Lakkawar,etal. (2014 )who
reported that clinician and electronic media were the most important source of information about
EC. Likewise, conflicting with Tajure and Pharm(2010)who exhibit that the most basic sources
of information were friends and radio . This also agrees with a report from Uganda among
university students in which the main source was friends (34%), health institutions (24.8%) and
schools (19.4%).
Regarding to the attitude of the studied women toward EC, the study revealed that more than
half had negative attitude pre intervention about the availability of EC, this may be due to lack of
counseling in family planning clinics about EC to women. On the other hand , more than two
thirds of the studied women showed positive attitude toward using EC in case of the availability
at the pharmacies and used in unprotected sexual intercourse , and EC is a good idea for all
women post intervention . This is steady with El-Zanatyetal. (2009)who reported that despite its
appealing role and long lasting legitimacy in Egypt, EC has not broadly acquired an established
role in the arrangement of contraception. In the mentioned latest University of Maine at
Farmington(2015), just 5.6% of respondents knew about EC, in contrast to 99.7% and 99.8%
who knew about pills and IUCDs. Also in the same line with Shaaban et al. (2011) who stated
that in Egypt there is a big gap in knowledge level of EC which leads to non use or incorrect use
of EC and negative attitude toward it. If health planners and policy makers could fill this gap, a
considerable decline in the prevalence of unwanted pregnancy might be accomplished by
utilizing EC.
Concerning morality and religion about EC ,the present study revealed that the majority of
studied women had negative attitude pre intervention but post intervention more than two thirds
had positive attitude about EC . The results are consistent with Tilahumet etal. (2010)who
mentioned that negative attitude towards EC is likely to hinge around the social and moral
23
contexts of the sex preceding EC use, rather than focusing on mechanism of action. Regarding
relation between general characteristics and total women attitude score showed that significant
relation also revealed significant association between general characteristics and total women
knowledge score about emergency contraception . on the other hand Ahmed et al.(2012) who
mentioned that there is no statistically significant association between women perception about
the existence of EC and their socio demographic characteristicsbut there is significant
association between EC attitude and sociodemographic status of female remained when it was
adjusted for age, region, , ethnicity, marital status, and family education.
Concerning correlation between women’s knowledge and attitude about emergency
contraception the present study revealed that positive correlation between knowledge and
attitude pre and post intervention . This is similar with other reports Langille ,etal. ( 2012) ; Xu,
etal. (2007) who have demonstrated that the group of good knowledge has a significantly higher
positive attitude than those with poor knowledge but disagree with Golezar, et al. ( 2014)who
showed that there is no significant correlation among level of knowledge, attitude and age.
Finally the results of the present study indicated that the studied women after implementing
guidelines interventions had higher score in knowledge level and attitude than before
intervention .Hence the current study supported the research hypotheses and significantly
achieved the aim of the study .
VI. Conclusion
The study concluded that the majority of studied women had a poor knowledge about EC
before guidelines intervention with significant difference post intervention.Also, more than half
had negative attitude pre intervention about the availability of EC. There was a significant
difference between general characteristics of women and total knowledge score about emergency
contraception, there was a significant difference between general characteristics of women and
total attitude score about emergency contraception. And also, there was a significant
improvement regarding total knowledge score and significant positive attitude post intervention.
Finally, it was cleared from the findings that hypotheses were supported .
24
VII. Recommendations
Based on the findings, the current study recommended that information about emergency
contraceptives should be widely available and reach through health educational classes at the
health settings and the private health sectors. Health care providers should be trained and
encouraged to discuss the issue of emergency contraceptives with couples.
Acknowledgements
Researchers would like to thank all the women who participated in implementing this study,
all who have directly or indirectly helped us to complete this study and their support in each
major step of the study.
Conflicts of Interest Disclosure
The authors declare that there is no conflict of interests regarding the publication of this paper
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