Factors associated with the knowledge of unintended pregnancy among university students in nuol, lao pdr

1 MINISTRY OF HEALTH UNIVERSITY OF HEALTH SCIENCES, FACULTY OF PUBLIC HEALTH AND MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF HEALTH HANOI UNIVERSITY OF PUBLIC HEALTH PHATSALAPHONE SOULIYAVONG H P FACTORS ASSOCIATED WITH A KNOWLEDGE OF UNINTENDED PREGNANCY AMONG FEMALE U STUDENTS AT THE NATIONAL UNIVERSITY OF LAOS, LAO PDR, 2019 H MASTER THESIS MASTER OF PUBLIC HEALTH CODE: 8720701 HANOI, 2020 MINISTRY OF HEALTH UNIVERSITY OF HEALTH SCIENCES, FACULTY OF PUBLIC HEALTH AND MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF HEALTH HANOI UNIVERSITY OF PUBLIC HEALTH PHATSALAPHONE SOULIYAVONG H P FACTORS ASSOCIATED WITH A KNOWLEDGE OF UNINTENDED PREGNANCY AMONG FEMALE STUDENTS AT THE NATIONAL UNIVERSITY OF LAOS, LAO PDR, 2019 U MASTER THESIS MASTER OF PUBLIC HEALTH SUPERVISORS: H CODE: 8720701 ASSOC PROF NGUYEN THANH HUONG, PHD DR KHAMPHENG PHONGLUXA HANOI, 2020 i ACKNOWLEDGEMENTS This independent study would not have been possible without the help and support of many people I am very thankful to the Ministry of Health of the Lao PDR and to the LEARN Project for funding my study at the University of Health Sciences (UHS) and the Hanoi University of Public Health (HUPH) The help of the Hospital of the National University of Laos is also gratefully acknowledged for allowing me to study in this program H P My sincere and deep gratitude goes to my advisors Assoc Prof Nguyen Thanh Huong of the HUPH, Vietnam and Dr Khampheng Phongluxa of the Lao Tropical and Public Health Institute, for their constructive suggestions, guidance and encouragement in the course of my study I also would like to acknowledge valuable comments and encouragement from U the examination chair of my Independent Study Committee I also wish to thank the external member of the Independent Study Committee I am most grateful to the president, lecturers and students of the National H University of Laos (NUOL) who kindly accepted to help and participate in this research This study could not have been completed without their generous assistance I am grateful to all the lecturers, coordinators and staff of the UHS, Laos and the HUPH for their continuous assistance and helpful advice I would like to thank my classmates for their kindness during the period of my studies at the UHS and the HUPH Finally, I would like to thank my family for love, understanding, support, and encouragement during the time I studied in this program Ms Phatsalaphone Souliyavong ii CONTENTS ACKNOWLEDGEMENTS i LIST OF TABLES & CHARTS v LIST OF FIGURES vii ABBREVIATIONS & ACRONYMS viii SUMMARY ix INTRODUCTION .1 RESEARCH OBJECTIVES .4 H P CHAPTER LITERATURE REVIEW 1.1 Concept of unintended pregnancy .5 1.2 Situation of unintended pregnancy .6 U 1.3 Knowledge of unintended pregnancy 1.3.1 Knowledge about the prevention of unintended pregnancy 1.3.2 Knowledge of risk for unintended pregnancy 11 H 1.3.3 Knowledge of consequences of unintended pregnancy 11 1.4 Factors associated with a knowledge of unintended pregnancy 13 1.4.1 Individual factors 13 1.4.2 Interpersonal Factors 15 1.4.3 Organizational Factors .17 1.5 Introduction of study setting .18 1.6 Theoretical framework 19 CHAPTER 22 SUBJECTS AND RESEARCH METHOD 22 2.1 Subjects .22 2.2 Study site and duration 22 iii 2.3 Study design 23 2.4 Sample size 23 2.5 Sampling method 24 2.6 Data collection 26 2.7 Variables .27 2.8 Measures and assessment criteria .27 2.9 Data analysis method 29 2.10 Ethical issues .30 H P CHAPTER 32 RESULTS 32 3.1 General information of the study participants 32 3.2 Knowledge of unintended pregnancy among female students 33 3.3 Individual factors 36 U 3.3.1 Attitudes towards unintended pregnancy 36 3.3.2 Sexual behaviour factors 39 H 3.4 Interpersonal factors 40 3.5 Organizational factors 43 3.6 Associations between individual, interpersonal and organization factors, and a knowledge of UP among female students 45 CHAPTER 53 DISCUSSION 53 4.1 Discussion of the knowledge of unintended pregnancy .53 4.2 Factors associated with a knowledge of unintended pregnancy among students at the National University of Laos .56 4.3 The knowledge score measurement 61 4.4 Limitations and bias 62 CONCLUSION 63 iv RECOMMENDATIONS 64 REFERENCES 71 ANNEXES 83 Annex 1: Table of Definitions and Measurement of Variables in the Study .83 Annex 2: Consent Form 86 Annex 3: Questionnaire 87 Annex 4: Certificate of Approval 94 Annex 5: Thesis Comments 96 H P Annex 6: Minutes of Explanation 102 H U v LIST OF TABLES & CHARTS Table 2.1: The probability proportional to the quantity of students .26 Table 3.1: Individual characteristics of female students .32 Table 3.2: Knowledge of Unintended Pregnancy (n=400) 33 Pie chart 3.2.1: Level of Knowledge Regarding Unintended Pregnancy .35 Table 3.2.2: Cut-off point for finding factors associated with a knowledge of UP .35 Table 3.3: Detailed results of 12 questions measuring attitudes towards unintended H P pregnancy (n=400) 36 Pie chart 3.3.1: Attitude levels towards unintended pregnancy among 400 female students 38 Table 3.4: Sexual behaviours of female students 39 Table 3.5: Parents’ education (n=400) 40 U Table 3.6: Family communication about sex education (n=400) 41 Table 3.7: Friends’ communication about sex education (n=400) .42 H Table 3.8 Learning Institute (sex education course in class) (n=400) 43 Table 3.9: Individual factors associated with a knowledge of UP .45 Table 3.10: Attitudes towards UP associated with a knowledge of UP .46 Table 3.11: Sexual behaviours associated with a knowledge of UP 47 Table 3.12: Interpersonal factors (parents’ education) associated with a knowledge of UP .47 Table 3.13: Interpersonal factors (family communication about sex education) associated with a knowledge of UP 48 Table 3.14: Interpersonal factors (friends’ communication about sex education) associated with a knowledge of UP 49 vi Table 3.15: Organizational factors (learning sex education) associated with a knowledge of UP 50 Table 3.16: Factors associated with a knowledge of unintended pregnancy 51 Table 3.16: Factors associated with a knowledge of unintended pregnancy (con.t) .52 H P H U vii LIST OF FIGURES Figure 1.1 Social ecological model 19 Figure 1.2 Conceptual framework of the study .21 Figure 2.1: Flow chart of sampling procedures at NUOL .25 H P H U viii ABBREVIATIONS & ACRONYMS AOR Adjusted Odds Ratio BMC BioMed Central BMJ British Medical Journal CI Confidence Interval COR Crude Odds Ratio EC Emergency Contraceptive ECPs Emergency Contraceptive Pills FSWs Female Sex Workers Lao PDR Lao People’s Democratic Republic NUOL National University of Laos SE Sex Education SRH Sexual and Reproductive Health STIs Sexually Transmitted Infections UN United Nations UP Unintended Pregnancy WHO World Health Organization UNFPA United Nations Population Fund UNDP United Nations Development Program (in Lao PDR) UNICEF United Nations International Children's Emergency Fund HHS Health and Human Services MUHAS Muhimbili University of Health and Allied Sciences H P H U 91 D11 11 Expressing feelings and reasoning to deny, can  Yes reduce the chance of having sex that leads to  No unintended pregnancy  Not sure 12 A woman is most likely to become pregnant if she has sexual intercourse half way between her periods  Yes D12 D13 13  No  Not sure  Yes Young women who are irregular with their  No menstruation cannot become pregnant  Not sure Consequences of unintended pregnancy D14 14  Yes Unintended teenage pregnancies can lead to unsafe abortions  No H P  Not sure D15 15  Yes Female students must leave school if they have an  No unintended pregnancy  Not sure U Part5: Part5: Attitudes toward unintended pregnancy E H Strongly Statements I think that teenage pregnancy is a normal social practice I think that contraception is not necessary for sexual intercourse in adolescents I believe that condom use can prevent pregnancy agree Agree Neutral Disagree Strongly disagree 92 I believe that having contraceptive knowledge in the teenage years is a protective factor against unintended pregnancy I think that the family context is one of the causes of adolescent unintended pregnancy I think that teenage pregnancy can be disgraceful to both yourself and your H P family with respect to your social life I believe that an unintended pregnancy will eventually end up in an unsafe abortion I think that having a sexual U relationship with my boyfriend is the proof of our love H I believe that having a sexual relationship with my boyfriend while being of school age is normal for teenagers 10 I think that drinking alcohol is a risk to unintentional sexual intercourse 11 I think that watching erotic movies and reading pornographic books are normal 12 I think that denial to go out with your friend to the private place at night is an 93 appropriate manner for teenager Part F Part 6: Sexual behaviours  Yes Do you have a boyfriend? H P  No Have you ever been dating?  Yes  No Have you ever had physical contact such as  Yes holding hands or hugging?  No Have you ever kissed your boyfriend? H vaginal penetration)? U Have you ever had sexual intercourse (with full Have you ever had an unintended pregnancy?  Yes  No  Yes  No  Yes  No 94 Annex 4: Certificate of Approval H P H U 95 H P H U 96 Annex 5: Thesis Comments H P H U 97 H P H U 98 H P H U 99 H P H U 100 H P H U 101 H P H U 102 Annex 6: Minutes of Explanation H P H U 103 H P H U 104 H P H U 105 H P H U