Competency assessment of the medical interns and nurses and documenting prevailing practices to provide family planning services in teaching hospitals in three states of India


Autoři: Madhu Gupta aff001;  Madhur Verma aff001;  Kiranjit Kaur aff001;  Kirti Iyengar aff002;  Tarundeep Singh aff001;  Anju Singh aff003
Působiště autorů: Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India aff001;  United Nations Population Fund, New Delhi, India aff002;  Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India aff003
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0211168

Souhrn

Objectives

The objectives of the study were to assess the knowledge and skills of medical interns and nurses regarding family planning (FP) services, and document the prevailing FP practices in the teaching hospitals in India.

Study design

A cross-sectional study was conducted in three states (Delhi, Rajasthan, and Maharashtra) of India, among randomly selected 163 participants, including medical interns (n = 81) and in-service nurses (n = 82), during 2017. The semi-structured, pre-tested interview schedule, was used to assess the knowledge and status of training received; and objective structured clinical examination (OSCE) based checklist was used to evaluate the skills.

Results

About 60% of the interns and 48% of the nurses knew more than five contraceptives that could be offered to the clients. About 22% (11.1% interns and 33.3% nurses) respondents believed that contraceptives should not be given to a married woman coming alone, and 31.9% (17.3% interns and 46.3% nurses) respondents reported that it was illegal to provide contraceptives to unmarried people. Nearly 43.3% interns and 69.5% nurses refused to demonstrate intrauterine contraceptive device (IUCD) insertion in the dummy uterus as per OSCE, and among those who did, 12.3% interns and 18.3% nurses had failed. About 63% interns and 63.4% of nurses had observed IUCD insertion, and 12.3% interns and 17.1% had performed IUCD insertion, during their training.

Conclusions

Knowledge and skills of interns and nurses regarding FP services were inadequate. The medical training during graduation or internship, and during the job, was found to be inadequate to provide quality FP services as per guidelines of nursing/medical council of India and Government of India on FP.

Klíčová slova:

Contraceptives – Female contraception – Human families – India – Medical education – Nurses – Obstetrics and gynecology – Male contraception


Zdroje

1. Ahmed S, Li Q, Liu L, Tsui AO. Maternal deaths averted by contraceptive use: An analysis of 172 countries. Lancet. 2012 Jul 14;380(9837):111–25. doi: 10.1016/S0140-6736(12)60478-4 22784531

2. World Health Organization. Sustainable Development Goal 3: Ensure healthy lives and promote well-being for all at all ages [Internet]. World Health Organization, Geneva, Switzerland; 2015 [cited 2019 Jun 5]. Available from: https://www.who.int/sdg/targets/en/

3. Glasier A, Gülmezoglu AM. Putting sexual and reproductive health on the agenda. Lancet. 2006 Nov 4;368(9547):1550–1. doi: 10.1016/S0140-6736(06)69485-3 17084739

4. Wulifan JK, Brenner S, Jahn A, De Allegri M. A scoping review on determinants of unmet need for family planning among women of reproductive age in low and middle income countries. BMC Womens Health. 2016 Dec 15;16(1):2.

5. Ewerling F, Victora CG, Raj A, Coll CVN, Hellwig F, Barros AJD. Demand for family planning satisfied with modern methods among sexually active women in low- and middle-income countries: who is lagging behind? Reprod Health. 2018 Dec 6;15(1):42. doi: 10.1186/s12978-018-0483-x 29510682

6. World bank. World Bank Data-India [Internet]. World Bank. 2014 [cited 2019 Jun 2]. Available from: https://data.worldbank.org/country/india

7. United Nations Foundation. Family Planning 2020 [Internet]. 2012 [cited 2019 Sep 11]. Available from: https://www.familyplanning2020.org/

8. Government of India. India’s ‘VISION FP 2020’ [Internet]. New Delhi; 2014 [cited 2019 May 3]. p. 162. Available from: https://advancefamilyplanning.org/sites/default/files/resources/FP2020-Vision-DocumentIndia.pdf

9. Family Planning 2020. India- Commitment Maker Since 2012 [Internet]. [cited 2019 May 4]. Available from: https://www.familyplanning2020.org/india

10. Government of India. FP2020: Annual commitment update questionnaire response-India [Internet]. 2016 [cited 2019 May 4]. p. 4. Available from: https://www.familyplanning2020.org/sites/default/files/FP2020_2016_Annual_Commitment_Update_Questionnaire-India_DLC.pdf

11. Government of India. Family Planning; Annual Report 2017–18 [Internet]. Ministry of Health and Family Welfare. 2017 [cited 2019 May 3]. Available from: https://mohfw.gov.in/sites/default/files/06Chapter.pdf

12. National Health Mission; Ministry of Health and Family Welfare. Government of India. Background for Family Planning:: National Health Mission [Internet]. [cited 2019 May 3]. Available from: https://nhm.gov.in/nhm/index1.php?lang=1&level=1&sublinkid=365&lid=398

13. Vital Statistics Division; Office of the Registrar General of India., Office of the Registrar General. SRS bulletin [Internet]. Vol. 52, Sample Registration System. New Delhi; 2019 [cited 2019 Jun 2]. p. 1–9. Available from: http://www.censusindia.gov.in/vital_statistics/SRS_Bulletins/SRS_Bulletin-Rate-2017-_May_2019.pdf

14. International Institute for Population Sciences (IIPS). National Family Health Survey (NFHS-4) 2015–16 India [Internet]. National Family Health Survey (NFHS-4) 2015-16- India. 2017. p. 1–671. Available from: http://rchiips.org/NFHS/NFHS-4Reports/India.pdf

15. Pachauri S. Priority strategies for India’s family planning programme. Indian J Med Res. 2014 Nov;140 Suppl(Suppl 1):S137–46.

16. World Health Organization. Family Planning/Contraception [Internet]. 2018 [cited 2019 Aug 30]. Available from: https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception

17. Pachauri S. Expanding Contraceptive choices in India: Issues and evidence. J Fam Welf. 2004;50:13–25.

18. Ministry of Health and Family Welfare; Govt. of India. Family Planning. Annual Report 2015–16 [Internet]. Family Planning Report. 2016. Available from: https://mohfw.gov.in/sites/default/files/56324455632156323214.pdf

19. Heil SH, Gaalema DE, Herrmann ES. Incentives to promote family planning. Prev Med (Baltim). 2012 Nov;55 Suppl(Suppl):S106–12.

20. Singh A, Ogollah R, Ram F, Pallikadavath S. Sterilization Regret Among Married Women in India: Implications for the Indian National Family Planning Program. Int Perspect Sex Reprod Health. 2012 Dec;38(04):187–95.

21. Koenig MA. The Impact of Quality of Care on Contraceptive Use: Evidence from Longitudinal Data from Rural Bangladesh. Baltimore; 2003.

22. Cottingham J, Germain A, Hunt P. Use of human rights to meet the unmet need for family planning. Lancet. 2012 Jul 14;380(9837):172–80. doi: 10.1016/S0140-6736(12)60732-6 22784536

23. Curtis S, Evens E, Sambisa W. Contraceptive Discontinuation and Unintended Pregnancy: An Imperfect Relationship. Int Perspect Sex Reprod Health. 2011 Jun;37(02):058–66.

24. Ghooi R, Deshpande S. Evidence-based medicine: A non-starter in India? Indian J Heal Sci. 2016;9(1):121.

25. Kumar J, Hardee K. Rights-Based Family Planning: 12 Resources to Guide Programming [Internet]. 2017 [cited 2019 May 3]. Available from: http://ec2-54-210-230-186.compute-1.amazonaws.com/wp-content/uploads/2017/04/Resource-Guide-of-RBA-to-FP-Updated-April_2017.pdf

26. United States Agency for International Development, World Health Organisation, United Nations Population Fund. The Family Planning Training Resource Package (TRP) [Internet]. 2019 [cited 2019 Sep 12]. Available from: http://www.fptraining.org/

27. National Family Health Survey (NFHS 4). State Fact Sheet, NCT Delhi [Internet]. 2016. Available from: http://rchiips.org/NFHS/pdf/NFHS4/DL_FactSheet.pdf

28. Ministry of Health and Family Welfare; Government of India. National Family Health Survey (NFHS-4). Press Information Bureau. 2017. p. 1.

29. Antonisamy B, Premkumar PS, Christopher S. Principles and Practice of Biostatistics—E-book. 2017. 390 p.

30. Sullivan KM, Dean A, Soe MM. OpenEpi: a web-based epidemiologic and statistical calculator for public health. Public Health Rep. 2009;124(3):471–4. doi: 10.1177/003335490912400320 19445426

31. Medical Council of India. Medical Council of India regulations on graduate medical education, 1997 [Internet]. 2017 [cited 2019 Sep 19]. Available from: https://www.mciindia.org/documents/rulesAndRegulations/GME_REGULATIONS.pdf

32. Consortium for Emergency Contraception in India. Guide Book for Health-Care Providers [Internet]. [cited 2019 Jun 2]. Available from: https://www.aiims.edu/aiims/events/Gynaewebsite/ec_site/manual/7_intra-uterine.htm

33. Hogmark S, Klingberg-Allvin M, Gemzell-Danielsson K, Ohlsson H, Essén B. Medical students’ knowledge, attitudes and perceptions towards contraceptive use and counselling: a cross-sectional survey in Maharashtra, India. BMJ Open. 2013 Dec 11;3(12):e003739. doi: 10.1136/bmjopen-2013-003739 24334156

34. Muganyizi PS, Ishengoma J, Kanama J, Kikumbih N, Mwanga F, Killian R, et al. An analysis of pre-service family planning teaching in clinical and nursing education in Tanzania. BMC Med Educ. 2014 Dec 12;14(1):142.

35. Division FP. New Contraceptives [Internet]. Ministry of Health and Family Welfare-Government of India. [cited 2019 Sep 19]. Available from: https://humdo.nhp.gov.in/new-contraceptives/

36. Family Planning Division; Ministry of Health and Family Welfare-Government of India. Postpartum IUCD Reference Manual [Internet]. 2010 [cited 2019 Sep 19]. Available from: http://www.nrhmtn.gov.in/modules/PPIUCDReferenceManual.pdf

37. Raselekoane NR, Morwe KG, Tshitangano T. University of Venda’s male students’ attitudes towards contraception and family planning. African J Prim Heal Care Fam Med. 2016 Jul 8;8(2):e1–7.

38. Kabagenyi A, Jennings L, Reid A, Nalwadda G, Ntozi J, Atuyambe L. Barriers to male involvement in contraceptive uptake and reproductive health services: a qualitative study of men and women’s perceptions in two rural districts in Uganda. Reprod Health. 2014 Dec 5;11(1):21. doi: 10.1186/1742-4755-11-21 24597502

39. De Vargas Nunes Coll C, Ewerling F, Hellwig F, de Barros AJD. Contraception in adolescence: the influence of parity and marital status on contraceptive use in 73 low-and middle-income countries. Reprod Health. 2019 Dec 21;16(1):21. doi: 10.1186/s12978-019-0686-9 30791914

40. Ministry of Health and Family Welfare; Govt. of India. A strategic approach to Reproductive, maternal, newborn, child and adolescent health [Internet]. 2013 [cited 2019 Sep 12]. p. 1–83. Available from: http://www.cghealth.nic.in/nhmcg/Informations/RMNCH/1_RMNCHA_Strategy.pdf

41. Fehring R, Hanson L, Stanford J. Nurse-midwives knowledge and promotion of lactational amenorrhea and other natural family-planning methods for child spacing. J Midwifery Womens Heal. 2001;46(2):68–73.

42. Jain AK. Information about methods received by contraceptive users in india. J Biosoc Sci. 2017 Nov 8;49(6):798–810. doi: 10.1017/S0021932016000602 27821190

43. Tilahun M, Mengistie B, Egata G, Reda AA. Health workers’ attitudes toward sexual and reproductive health services for unmarried adolescents in Ethiopia. Reprod Health. 2012 Dec 3;9(1):19.

44. Nath A. HIV/AIDS and Indian youth—a review of the literature (1980–2008). SAHARA J J Soc Asp HIV/AIDS Res Alliance. 2009 Mar;6(1):2–8.

45. Brown SS, Burdette L, Rodriguez P. Looking inward: provider-based barriers to contraception among teens and young adults. Contraception. 2008 Nov;78(5):355–7. doi: 10.1016/j.contraception.2008.07.021 18929730

46. Campbell M, Sahin-Hodoglugil NN, Potts M. Barriers to fertility regulation: a review of the literature. Stud Fam Plann. 2006 Jun;37(2):87–98. 16832983

47. World Health Organization. Contraception-Issues in Adolescent Health and Development [Internet]. World Health Organization. 2004 [cited 2019 Sep 19]. Available from: https://apps.who.int/iris/bitstream/handle/10665/42901/9241591447_eng.pdf?sequence=1

48. Van Zijl S, Morroni C, van der Spuy ZM. A survey to assess knowledge and acceptability of the intrauterine device in the Family Planning Services in Cape Town, South Africa. J Fam Plan Reprod Heal Care. 2010 Apr 1;36(2):73–8.

49. Najafi-Sharjabad F, Hajivandi A, Rayani M. Knowledge, attitude, and practice about Emergency Contraception among health staff in Bushehr state, south of Iran. Glob J Health Sci. 2013 Oct 12;6(1):52–60. doi: 10.5539/gjhs.v6n1p52 24373264

50. Mitchell HS, Stephens E. Contraception choice for HIV positive women. Sex Transm Infect. 2004 Jun;80(3):167–73. doi: 10.1136/sti.2003.008441 15169996

51. World health organisation. Sexual and reproductive health [Internet]. WHO. World Health Organization; 2019 [cited 2019 Sep 12]. Available from: https://www.who.int/reproductivehealth/publications/en/

52. Rutter W, Knight C, Vizzard J, Mira M, Abraham S. Women’s attitudes to withdrawal bleeding and their knowledge and beliefs about the oral contraceptive pill. Med J Aust. 1988 Oct 17;149(8):417–9. 3173203

53. Simbar M, Tehrani FR, Hashemi Z. Reproductive health knowledge, attitudes and practices of Iranian college students. East Mediterr Health J. 11(5–6):888–97. 16761658

54. Hight-Laukaran V, Labbok MH, Peterson AE, Fletcher V, von Hertzen H, Van Look PF, et al. Multicenter Study of the Lactational Amenorrhea Method (LAM): II. Acceptability, Utility, and Policy Implications.

55. Singh S, Mittal S, Anandalakshmy PN, Goel V. Emergency contraception: knowledge and views of doctors in Delhi. Vol. 25, Health and Population-Perspectives and Issues. 2002.

56. Atuahene MD, Afari EO, Adjuik M, Obed S. Health knowledge, attitudes and practices of family planning service providers and clients in Akwapim North District of Ghana. Contracept Reprod Med. 2016 Dec 7;1(1):5.

57. Ndulo J, Faxelid E, Krantz I. Quality of care in sexually transmitted diseases in Zambia: patients’ perspective. East Afr Med J. 1995 Oct;72(10):641–4. 8904043

58. Whittaker M, Mita R, Hossain B, Koenig M. Evaluating rural Bangladeshi women’s perspectives of quality in family planning services. Health Care Women Int. 17(5):393–411. 8868615

59. Grand’Maison P, Lescop J, Rainsberry P, Brailovsky CA. Large-scale use of an objective, structured clinical examination for licensing family physicians. CMAJ. 1992 May 15;146(10):1735–40. 1596809

60. Bartfay WJ, Rombough R, Howse E, Leblanc R. Evaluation. The OSCE approach in nursing education. Can Nurse. 2004 Mar;100(3):18–23. 15077517

61. Alinier G, Hunt B, Gordon R, Harwood C. Effectiveness of intermediate-fidelity simulation training technology in undergraduate nursing education. J Adv Nurs. 2006 May;54(3):359–69. doi: 10.1111/j.1365-2648.2006.03810.x 16629920

62. Lim MSC, Zhang X-D, Kennedy E, Li Y, Yang Y, Li L, et al. Sexual and Reproductive Health Knowledge, Contraception Uptake, and Factors Associated with Unmet Need for Modern Contraception among Adolescent Female Sex Workers in China. Bhattacharya S, editor. PLoS One. 2015 Jan 27;10(1):e0115435. doi: 10.1371/journal.pone.0115435 25625194

63. World Health Organization. WHO Medical Eligibility Criteria Wheel for Contraceptive Use 2015 Update. [Internet]. World Health Organization; 2015 [cited 2019 May 3]. Available from: https://apps.who.int/bookorders/anglais/detart1.jsp?codlan=1&codcol=15&codcch=900

64. Furnham A. Response bias, social desirability and dissimulation. Pers Individ Dif. 1986 Jan 1;7(3):385–400.

65. Medical council of India. Competency based under graduate curriculum [Internet]. 2019 [cited 2019 Sep 18]. Available from: https://www.mciindia.org/CMS/information-desk/for-colleges/ug-curriculum

66. Gebremeskel BG, Teklu AM, Gebremedhin LT, Beza SW, Yigzaw T, Eshetu MK, et al. Structured integration of family planning curriculum: comparative assessment of knowledge and skills among new medical graduates in Ethiopia. Contraception. 2018 Aug 13;98(2):89–94.

67. Mugore S, Mwanja M, Mmari V, Kalula A. Adaptation of the Training Resource Package to Strengthen Preservice Family Planning Training for Nurses and Midwives in Tanzania and Uganda. Glob Heal Sci Pract. 2018;6(3):584–93.

68. Berdzuli N, Rossi E, Zlidar V. Improving Family Planning PreService Education: Experience from the Eastern Europe and Eurasia Region. Europe and Eurasia Regional Family Planning Activity for the U.S. Agency for International Development. 2009.

69. Ozek B, Tüzer T, Dean T, Levin L, Brechin SJG. Establishing integrated family planning / reproductive health preservice and inservice national clinical training systems in Turkey. TT -. 2003.

70. Linhares JJ, Dutra B de AL, Ponte MF da, Tofoli LFF de, Távora PC, Macedo FS de, et al. Construction of a competence-based curriculum for internship in obstetrics and gynecology within the medical course at the Federal University of Ceará (Sobral campus). Sao Paulo Med J. 2015 Apr 14;133(3):264–70. doi: 10.1590/1516-3180.2014.0804872 25885488

71. Thind A, Singh R, Kumar A, Gambhir P. Competency Based Learning of Interns in Spirometry. IOSR J Dent Med Sci. 2016;15(9):71–3.

72. Moudgil T, Bansal Y, Arora R, Bandhu SD. Assessment of Clinical Competence of Interns using Work Place Based Assessment in Ophthalmology Rotational Posting. J Clin diagnostic Res. 2019;13(6):NC01-08.


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PLOS One


2019 Číslo 11