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- Ghanbari-Homayi, Solmaz, et al.
(author)
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Validation of the Iranian version of the childbirth experience questionnaire 2.0
- 2019
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In: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 19
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Journal article (peer-reviewed)abstract
- © 2019 The Author(s). Background: Assessing women's childbirth experiences is a crucial indicator in maternity services because negative childbirth experiences are associated with maternal mortalities and morbidities. Due to the high caesarean birth rate in Iran, measuring childbirth experience is a top priority, however, there is no standard tool to measure this key indicator in Iran. The aim of present study is to adapt the "Childbirth Experience Questionnaire 2.0" to the Iranian context and determine its psychometric characteristics. Methods: Childbirth Experience Questionnaire 2.0 was translated into Farsi. A total of 500 primiparous women, at 4 to 16 weeks postpartum, were randomly selected from 54 healthcare centres in Tabriz. Internal consistency and reliability was calculated using the Cronbach's Coefficient alpha and Intraclass Correlation Coefficient, respectively. Construct validity was assessed using exploratory and confirmatory factor analysis and discriminant validity using the known-group method and the Mann-Whitney U-test. Results: The internal consistency and reliability for the total tool were high (Cronbach's alpha = 0.93; Intraclass Correlation Coefficient = 0.97). Explanatory factor analysis demonstrated the adequacy of the sampling (Kaiser-Meyer-Olkin = 0.923) and significant factorable sphericity (p < 0.001). Confirmation factor analysis demonstrated acceptable values of fitness (RMSEA = 0.07, SRMSEA = 0.06, TLI = 0.97, CFI > 0.91, x 2/ df = 4.23). Discriminatory validity of the tool was confirmed where the CEQ score and its subdomains were significantly higher in women who reported having control over their childbirth than women who did not. Conclusion: The Farsi version of the Childbirth Experience Questionnaire 2.0 tool is a valid and reliable tool and can be used to measure the childbirth experience in Iranian women.
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| 2. |
- Charandabi, Sakineh Mohammad-Alizadeh, et al.
(author)
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Effect of a peer-educational intervention on provider knowledge and reported performance in family planning services : a cluster randomized trial
- 2010
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In: BMC Medical Education. - : Springer Science and Business Media LLC. - 1472-6920. ; 10
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Journal article (peer-reviewed)abstract
- Background: Peer education is an interactive method of teaching or learning which is widely used for educating school and college students, in a variety of different forms. However, there are few studies on its effectiveness for in-service education. The aim of this study was to evaluate the effect of an educational programme including peer discussions, based on a needs assessment, on the providers' knowledge and reported performance in family planning services. Methods: An educational programme was designed and applied in a random selection of half of in-charges of the 74 family health units (intervention group) in Tabriz at a regular monthly meeting. The other half constituted the control group. The programme included eight pages of written material and a two-hour, face-to-face discussion session with emphasis on the weak areas identified through a needs assessment questionnaire. The educated incharges were requested to carry out a similar kind of programme with all peers at their health facilities within one month. All in-charges received one self-administered questionnaire containing knowledge questions one month after the in-charge education (follow-up I: 61 responses), and another one containing knowledge and self-reported performance questions 26 months later (follow-up II: 61 responses). Also, such tests were done for the peers facilitated by the in-charges one (105 responses) and 27 months (114 responses) after the peer discussions. Multiple linear regression was used for comparing mean total scores, and Chi square for comparing proportions between control and intervention groups, after defining facility as the unit of randomization. Results: The mean total percentage scores of knowledge (percent of maximal possible score) in the intervention group were significantly higher than in the control group, both at follow-up I (63%) and at follow-up II (57%); with a difference of 16 (95% CI: 11, 22) and 5 (95% CI: 0.4, 11) percentage units, respectively. Only two of the nine reported performance items were significantly different among the non in-charges in the intervention group at follow-up II. Conclusions: The educational programme including peer discussions using existing opportunities with no need for additional absence from the workplace might be a useful complement to formal large group education for the providers.
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| 3. |
- Mohammad-Alizadeh Charandabi, Sakineh
(author)
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Quality of reproductive health services at primary health centres in an urban area of Iran : Emphasis on family planning
- 2009
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Doctoral thesis (other academic/artistic)abstract
- Background: Detailed knowledge of the present situation is needed in order to design and implement quality improvement programmes to achieve the national goal of planned and safe fertility for all in Iran. An understanding of the perspectives and views of clients and providers are also much needed. When this study was initiated there was a lack of studies on the quality of family planning and other primary reproductive health services in the country. Aim: To describe and explore the quality of public primary reproductive health care services, especially family planning, in an urban area of Iran, in order to identify areas and measures for improvement. Methods: Structured observations of 469 client-provider interactions and some clinical procedures at 34 health facilities, and exit interviews with 416 of the observed clients. Quality of services was assessed using pre-defined indicators (study I). In the qualitative studies (II, III), content analysis was performed on material from nine focus group discussions (FGDs) with 53 married women of reproductive age (study II) and four FGDs with 20 midwives or other family health providers at the facilities (study III). In study IV, an educational programme on family planning services was applied at a regular monthly meeting with half of the in-charges after random selection of the total of 74 family health units (intervention group). The other half constituted the control group. The educated in-charges were requested to carry out a similar kind of programme with all peers at their health facilities within one month. All in-charges received one self-administered questionnaire one month (follow-up I) and 27 months (follow-up II) after the education. Such tests were also performed by the peers at their workplace within one month after the in-charges tests. Findings: The providers treated the clients respectfully in more than 80% of the consultations and discussed a return visit in 89%. Privacy was not assured in one-third of the cases. Over two-thirds of the clients were not encouraged to ask questions or raise concerns, and 54% were not satisfied with the amount of information given. The use of educational audio-visual and printed materials was very infrequent. Most new clients received their preferred contraceptive method, but were informed about neither other available methods, nor common side effects and warning symptoms related to the chosen method (study I). The women in the FGDs appreciated the public services for being generally accessible, but important shortcomings were identified. A need for improved privacy, a wider choice of contraceptive methods and clear information about side effects were stressed. Marital counselling was raised as a major unmet need. The women s sense of having the right to make autonomous reproductive health choices and to be treated with dignity and respect emerged as the main theme. A second, cross-cutting theme was their wish to get their husbands more strongly involved in family planning and sexual counselling (study II). The most satisfying for the providers was working with clients. A dominant theme in all FGDs was the providers frustration about a number of factors, most of which were beyond their control. There were five categories of system and organisational barriers: multiplicity of tasks and incompatibility with the providers own basic training; suboptimal supervision and management; too little time for clients; lack of privacy and appropriate materials for education and counselling; and inadequate opportunities for continuing education (study III). The health centres and health posts located in low-income areas on average had the highest workload for family planning and the highest turnover of staff. Knowledge (percent of maximal possible score) was significantly higher in the intervention group than in the control group, both at follow-up I (63%) and at follow-up II (57%); with a difference of 16 and 5 percentage units, respectively. Two of the nine reported items were performed at a significantly higher level among the non in-charges in the intervention group at follow-up II compared with the control group. Conclusions: There is a gap between the national policy and the reality in the public primary health facilities with regard to the quality of reproductive health services. Multifaceted interventions are recommended to improve performance of the providers, and quality and responsiveness of the services to ensure women s reproductive health needs and rights. Special attention should be paid to interactive communication, information given to clients, privacy and confidentiality. Interven-tions should also address needs-based in-service education, including on-site peer education, supportive supervision and management, provision of educational materials, simplifying record management, and appointing more staff in socio-economically deprived areas. Research is needed to identify the best ways to integrate the services without overloading and deskilling health workers and impairing their ability to deliver high quality services, as well as to find the most effective way of meeting the providers continuing educational needs.
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