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

https://doi.org/10.1016/j.pec.2014.12.012Get rights and content

Highlights

  • Significantly higher scores for precontemplation stage were observed.

  • Differences were found in different stages of self-efficacy for contraception use.

  • The majority of married men were in the precontemplation and contemplation stage.

Abstract

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.

Introduction

Reproductive health programs have traditionally focused on women whilst, male involvement in family planning (FP) became a priority following the International Conference on Population and Development (ICPD) 1994 [1]. Limited research on male roles in Ethiopia and sub-Saharan Africa has consistently found that decisions regarding family size and contraception are dominated by husbands, who expect to have large families [2]. Contraceptive use is an instance of healthy behavior that requires behavior change. One of the most popular models for studying behavioral determinants and informing interventions is the Transtheoretical model (TTM) of behavior change [3].

The TTM has been presented as an integrative and comprehensive model of behavior change [4], offers a relatively new approach for examining how and why people change their behaviors [5], [6]. The stages that have been categorized in the behavioral change process include pre-contemplation, contemplation, preparation, action, and maintenance. An understanding of Prochaska's theory helps to explain the lack of success in increasing contraceptive usage. The model proposes that people have different stages to adopt any change, and the appropriate process or technique should be used to target behavioral change for people in a certain stage. This theory is important to intervene according to the levels of their stages of change [5]. Previous studies have been demonstrated the use of TTM in family planning behavior [7], [8], [9].

According to the 2007 Central Statistical Agency (Ethiopia) report, the population of the country stood at 73,918,505. Of whom, 36,621,848 (49.5%) were females [10]. The Ethiopia Demographic Health Survey (EDHS) 2005, reports that the contraceptive prevalence rate for Ethiopia was 14.7% while it was only 8.9% among currently married teenaged women between 15 and 19 years [11]. Fertility in Ethiopia declined from 5.9 to 5.4 per women within five years [12], [13]. High risk births can be prevented through the use of family planning services [14], [15]. In Ethiopian studies, when men were involved in home visit talks about family planning there was greater use of contraception and modern methods [2], Tilahun et al. study found out that over half of the couples wanted more children (non willing to use contraceptive) and 30% of the spouses differed about the desire for more children [16]. In Alemayehu et al. study (2013) more than half of the married Ethiopian women had negative attitude towards using long acting and permanent contraceptive methods (LAPMs) (still 12% of the women used them, when the rest used other methods) [17]. Need for more children, husband approval, couple's discussion about family planning issues, monthly family income and number of living children were significantly associated with the use of modern contraceptives [18]. Factors that are associated with the use of modern contraceptive includes individual attitudinal, educational, cognitive, emotional and interpersonal barriers to uptake the FP, broader socio-cultural, and religious, and cultural norms and practices concerning the use of FP; geographic, administrative barriers as well as barriers relating to quality of care barriers; misinformation: – knowledge of different family planning methods: – fear of side effects (health concerns); husbands not supporting the use and fear of infertility after use [19], [20].

Men's lack of access to information and services is a barrier to using a family planning method [21]. Despite reported high knowledge of family planning in the EDHS 2005, married adolescents report very limited use of contraception methods [11]. Investigating the male factors that affect the reproductive health of the women including family planning is of great importance and is currently receiving increased attention. So this study aimed to identify demographic and attitudinal characteristics of men associated with different TTM stages of contraceptive use so as to better tailor future interventions.

Section snippets

Study setting

The study area was Angolela-Tera District, one of the 22 districts in North Shoa Zone, Amhara Region of Amhara. It is located 110 km north of the capital Addis Ababa and 656 km South East of the regional capital Bahir Dar Chacha is the capital town of the district. The district has an estimated total population of 97,287 that resides in the 20 kebeles. The district has two health centers, and seventeen health posts. The study was conducted from February 15 to March 14, 2008 in Angolela Tera

Socio-demographic characteristics

In this study, 738 married males participated with a response rate of 95.8%. Six hundred thirty five (86.0%) of the respondents were rural dwellers and 677 (91.7%) of the study population were from Amhara ethnic group. The mean age of the respondents was (37.6 ± 7.8) years. Little more than one third 281 (38.1%) of the study population were unable to read and write (see Table 1).

Stages of change for contraceptive use

The result showed that 225 (30.5%) of the men were in the precontemplation stage, 235 (31.8%) were in the contemplation

Discussion

The study showed that majority of the participants were in the contemplation/precontemplation (62.3%) stages and only 26.7% were in the action and maintenance stages. This finding reflected higher contraception usage pattern in the district which was 26.7% as compared to the Amhara region contraceptive prevalence which was 16.1% and national average [11]. This might be due to increased awareness and knowledge of the community about contraception and increased access of family planning services

Competing interests

The author(s) declare that they have no competing interests.

Acknowledgements

This work was supported by the financial support obtained from Jimma University. Our appreciation also extends to Angolela Tera Woreda administration and to the study participants, supervisors, and the data collectors for their full participation, responsible for data collection and support.

References (35)

  • PAI

    How family planning benefits the health of women and children

    (2003)
  • N. United
  • A. Terefe et al.

    Modern contraception use in Ethiopia: does involving husbands make a difference?

    Am J Public Health

    (1993)
  • E. De Vet et al.

    The Transtheoretical model for fruit, vegetable and fish consumption: associations between intakes, stages of change and stage transition determinants

    Int J Behav Nutr Phys Act

    (2006)
  • B.T. Ha et al.

    Male involvement in family planning in rural Vietnam: an application of the Transtheoretical Model

    Health Educ Res

    (2003)
  • O. James et al.

    Changing for good: a revolutionary six-stage program for overcoming bad habits and moving your life positively

    (1994)
  • Carlo C. DiClemente et al.

    Self-efficacy and the stages of self-change of smoking

    Cognitive Ther Res

    (1985)
  • M.J. Stark et al.

    Psychosocial factors associated with the stages of change for condom use among women at risk for HIV and STDs: implications for intervention development

    J Consult Clin Psychol

    (1998)
  • C. Galavotti et al.

    Validation of measures of condom and other contraceptive use among women at high risk for HIV infection and unintended pregnancy

    Health Psychol

    (1995)
  • D.M. Grimley et al.

    Contraceptive and condom use adoption and maintenance: a stage paradigm approach

    Health Educ Q

    (1995)
  • FDRE
  • CSA
  • FHI

    The importance of family planning in reducing maternal mortality

    (1995)
  • PRB

    World population data

    (2005)
  • L. Touré

    Male involvement in family planning

    A review of the literature and selected program initiatives in Africa

    (1996)
  • T. Tilahun et al.

    Spousal discordance on fertility preference and its effect on contraceptive practice among married couples in Jimma zone, Ethiopia

    Reprod Health

    (2014)
  • M. Alemayehu et al.

    Factors associated with utilization of long acting and permanent contraceptive methods among married women of reproductive age in Mekelle town, Tigray region north Ethiopia

    BMC Pregnancy Childbirth

    (2012)
  • View full text