PMID- 32066440 OWN - NLM STAT- MEDLINE DCOM- 20200624 LR - 20200624 IS - 1472-6963 (Electronic) IS - 1472-6963 (Linking) VI - 20 IP - 1 DP - 2020 Feb 17 TI - Improving post-partum family planning services provided by female community health volunteers in Nepal: a mixed methods study. PG - 123 LID - 10.1186/s12913-020-4969-1 [doi] LID - 123 AB - BACKGROUND: Family planning services in the post-partum period, termed post-partum family planning (PPFP) is critical to cover the unmet need for contraception, especially when institutional delivery rates have increased. However, the intention to choose PPFP methods such as post-partum intrauterine devices (PPIUD) remains low in countries such as Nepal. Community health workers such as Female Community Health Volunteers (FCHVs) could play an important role in improving the service coverage of PPFP in Nepal. However, their knowledge of PPFP and community-based services related to PPFP remain unclear. This study aims to assess the effect on community-based PPFP services by improving FCHV's knowledge through orientation on PPFP. METHODS: We conducted this mixed-methods study in Morang District in Nepal. The intervention involved orientation of FCHVs on PPFP methods. We collected quantitative data from three sources; via a survey of FCHVs that assessed their knowledge before and after the intervention, from their monthly reporting forms on counseling coverage of women at different stages of pregnancy from the communities, and by interviewing mothers in their immediate post-partum period in two selected hospitals. We also conducted six focus group discussions with the FCHVs to understand their perception of PPFP and the intervention. We performed descriptive and multivariable analyses for quantitative results and thematic analysis for qualitative data. RESULTS: In total, 230 FCHVs participated in the intervention and their knowledge of PPFP improved significantly after it. The intervention was the only factor significantly associated with their improved knowledge (adjusted odds ratio = 24, P < 0.001) in the multivariable analysis. FCHVs were able to counsel 83.3% of 1872 mothers at different stages of pregnancy in the communities. In the two hospitals, the proportion of mothers in their immediate post-partum period whom reported they were counseled by FCHVs during their pregnancy increased. It improved from 7% before the intervention to 18.1% (P < 0.001) after the intervention. The qualitative findings suggested that the intervention improved their knowledge in providing PPFP counseling. CONCLUSION: The orientation improved the FCHV's knowledge of PPFP and their community-based counseling. Follow-up studies are needed to assess the longer term effect of the FCHV's role in improving community-based PPFP services. FAU - Thapa, Kusum AU - Thapa K AUID- ORCID: 0000-0003-3051-0426 AD - Nepal Society of Obstetricians and Gynaecologists, Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu, GPO: 23700, Nepal. kusumthapa2006@gmail.com. FAU - Dhital, Rolina AU - Dhital R AD - Nepal Society of Obstetricians and Gynaecologists, Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu, GPO: 23700, Nepal. FAU - Rajbhandari, Sameena AU - Rajbhandari S AD - Nepal Society of Obstetricians and Gynaecologists, Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu, GPO: 23700, Nepal. FAU - Mishra, Sangeeta AU - Mishra S AD - Koshi Zonal Hospital, Biratnagar, Morang District, Province One, Nepal. FAU - Subedi, Shanti AU - Subedi S AD - Nobel Medical College Teaching Hospital, Biratnagar, Morang District, Province One, Nepal. FAU - Dotel, Bhogendra Raj AU - Dotel BR AD - Health Directorate-Province One, Dhankuta, Nepal. FAU - Vaidya, Sapana AU - Vaidya S AD - Nepal Society of Obstetricians and Gynaecologists, Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu, GPO: 23700, Nepal. FAU - Pande, Saroja AU - Pande S AD - Nepal Society of Obstetricians and Gynaecologists, Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu, GPO: 23700, Nepal. FAU - Tunnacliffe, Emily-Anne AU - Tunnacliffe EA AD - International Federation of Obstetrics and Gynecology, London, UK. FAU - Makins, Anita AU - Makins A AD - International Federation of Obstetrics and Gynecology, London, UK. FAU - Arulkumaran, Sabaratnam AU - Arulkumaran S AD - International Federation of Obstetrics and Gynecology, London, UK. LA - eng PT - Journal Article DEP - 20200217 PL - England TA - BMC Health Serv Res JT - BMC health services research JID - 101088677 SB - IM MH - Community Health Workers/*education MH - Contraception MH - Counseling/statistics & numerical data MH - Family Planning Services/*organization & administration/*standards MH - Female MH - Focus Groups MH - Health Knowledge, Attitudes, Practice MH - Health Services Research MH - Humans MH - *Inservice Training MH - Intrauterine Devices/statistics & numerical data MH - Nepal MH - *Postpartum Period MH - Qualitative Research MH - Quality Improvement/*organization & administration MH - Surveys and Questionnaires MH - Volunteers/*education PMC - PMC7027278 OTO - NOTNLM OT - Community health workers OT - Contraception OT - Family planning services OT - Intrauterine devices OT - Post-partum period COIS- The authors declare that they have no competing interests. EDAT- 2020/02/19 06:00 MHDA- 2020/06/25 06:00 PMCR- 2020/02/17 CRDT- 2020/02/19 06:00 PHST- 2019/05/02 00:00 [received] PHST- 2020/02/07 00:00 [accepted] PHST- 2020/02/19 06:00 [entrez] PHST- 2020/02/19 06:00 [pubmed] PHST- 2020/06/25 06:00 [medline] PHST- 2020/02/17 00:00 [pmc-release] AID - 10.1186/s12913-020-4969-1 [pii] AID - 4969 [pii] AID - 10.1186/s12913-020-4969-1 [doi] PST - epublish SO - BMC Health Serv Res. 2020 Feb 17;20(1):123. doi: 10.1186/s12913-020-4969-1.