Perception of family planning utilization among type 2 diabetes mellitus women, spouse and health care providers-a qualitative study / Santhi Subramaniam
Family planning is an effective intervention for reducing pregnancy-related complications and morbidity among women of reproductive age who have type 2 diabetes mellitus (T2DM). Primary healthcare facilities promote family planning services and cater for T2DM women. However, utilization of the fa...
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| Format: | Thesis |
| Published: |
2019
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| Online Access: | http://studentsrepo.um.edu.my/11456/4/santhi.pdf http://studentsrepo.um.edu.my/11456/ |
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| Summary: | Family planning is an effective intervention for reducing pregnancy-related
complications and morbidity among women of reproductive age who have type 2 diabetes
mellitus (T2DM). Primary healthcare facilities promote family planning services and cater
for T2DM women. However, utilization of the family planning methods offered by primary
healthcare facilities is reported to be low among T2DM women. Understanding this
underutilization of family planning methods and services is critical for pregnancy and disease
management optimization. Therefore the main aim of this study is to explore the factors
influencing family planning utilization among T2DM women from the perspectives of T2DM
women, their spouses and primary healthcare providers in Gombak district, Selangor,
Malaysia. This study took place in seven primary healthcare clinics from March to October
2017. This study adopted a qualitative approach that involved eight non-participant
observations conducted using a checklist (Adapted and Modified from: Tools to Assess
Family Planning Counselling: Observation and Interview) and 38 in-depth interviews. The
interviewees consisted of 11 T2DM women, seven spouses and 20 healthcare providers.
Purposive sampling was applied and the interviews were conducted by the researcher in
either the English or the Malay language and by following tailor-made semi-structured
interview guides that covered topics such as types of methods preferred and perceptions on
family planning utilization and services at primary healthcare services. All interviews were
recorded, transcribed and analysed by using thematic analysis. Data management was
performed by using NVIVO version 11 software. Several strategies were adopted to enhance
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the quality of data analysis, e.g. triangulation (data, method and investigator), peer review
and feedback from presentations at district meetings and conferences. Thematic analysis was
used to explore the findings from the interviews which were categorized into 14 themes at
three Socio-ecological model levels, the individual, interpersonal and organizational.
Underutilization of family planning was influenced by personal preferences and goals, and
lack of healthcare providers’ expertise delivering family planning services. This, followed
by information-seeking related to family planning methods from entrusted spouse, family
members, friends, and healthcare providers to enable decision-making related to utilization
of family planning methods. The study also elicited suggestions from the interviewed
healthcare providers regarding ways in which family planning services might be improved,
from which seven themes emerged. Improving the current services in primary healthcare
facilities and increasing knowledge among the healthcare providers are among strategies
suggested by the providers to increase family planning utilization. The findings of this study
suggest that an element of uniqueness exists because individual experiences with regard to
the side effects of family planning methods and complications are different for each woman.
This study also highlighted the importance of spouses’ role especially in family planning
utilization decision-making. They also underline the importance of the role of healthcare
providers and the current healthcare system in providing family planning services within
primary healthcare facilities. In addition, the findings imply that T2DM women should be
encouraged to share their concerns with their healthcare providers. Simultaneously,
healthcare providers should be equipped with adequate information and skills to provide
suitable family planning methods to diabetic women. This would reduce unnecessary
pregnancy-related complications being experienced by T2DM women. T2DM women should
be encouraged to share their concern on family planning methods with their healthcare
providers. Simultaneously, healthcare providers could encourage patients to verify any new
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information received from sources other than medical experts. The findings of this study are
believed to have broader applicability to women with other pre-existing medical illnesses
that are managed at primary healthcare facilities.
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