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NORPLANT CONTRACEPTION.
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Research proposal to develop data relevant to women's decisions about NORPLANT method of birth control.... More...
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Paper Abstract:
Research proposal to develop data relevant to women's decisions about NORPLANT method of birth control.
Paper Introduction:
ACCEPTANCE & PERCEPTIONS OF NORPLANT: A PROPOSAL FOR A REPLICATIVE STUDY
The Problem
Although research has established the NORPLANT method as one of the most effective approaches to contraception, the method has not been widely adopted by women (Cullins & Garcia, 1997). The need for a safe and effective approach, however, to contraception continues to be great (Wildemeersch, Van Kets, Vrijens, Delbarge, Van Trappen, Temmerman, Depypere, & Thiery, (1997). Better information is required in relation to why women select the NORPLANT method and why the method is rejected, if the use of this effective approach to contraception is to be increased.
Darney, Atkinson, Tanner, MacPherson, Hellerstein, and Alvar
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Recent applications of the TRA have been diverse (Olson & Zanna,1993). Compared with clinical trials, the study found a lowerprevalence but similar patterns of side effects. R., Krueger, S. (1997, June). Cullins, V. N., Lama, H., Dunson, T. Participation in the proposed will be completely voluntary. Menstrual irregularities,followed by mood changes and headaches, were the most important sideeffects associated with decisions for the early removal of NORPLANT. (1992). Studies in Family Planning, 28(2), 122-131. Journal of AppliedSocial Psychology, 19, 543-558. The analysis found that 21.6 percent of patientshad NORPLANT removed, a further 28.8 percent planned on early removal ofNORPLANT, and 49.6 percent desired continue use of NORPLANT. The role of external variables, especially prior behavior, continuesto be an issue of debate with respect to the TRA (Eiser, et al., 1989).Some critics contend that the effects of external variables and priorbehaviors are not always fully mediated by the attitudinal and normativecomponents of the model (Granberg & Holmberg, 199 ). Adolescentsmoking: Attitudes, norms and parental influence. Wildemeersch, D., Van Kets, H., Vrijens, M., Delbarge, W., VanTrappen, Y., Temmerman, M., Depypere, H., & Thiery, M. 2. Acceptance,efficacy, end side effects of Norplant implants in four counties in northChina. F., Heartwell, S., & Rulin,M. L., & Amatya, R. (1996, November). Chetri, M., Bhatta, A., Amatya, R. The term "decision to continue to use NORPLANT" will bedefined for the purposes of the proposed study as the decision to either(a) remove the NORPLANT implant prior to its scheduled removal or (b) optagainst the use of another NORPLANT implant subsequent to the scheduledremoval of an existing NORPLANT implant. The relation between perceived andpreventive action: A within-subject analysis of perceived driving risk andintentions to wear seatbelts. Within this context, the study findings reported by Darney,Atkinson, Tanner, MacPherson, Hellerstein, and Alvarado (199 ) are silenton some issues that are deemed to be highly relevant in the contemporaryperiod, such as the effect of NORPLANT on sexual pleasure and the costsassociated with the use of the NORPLANT method (Dunson, Krueger, & Amatya,1996; Davidson & Kalmuss, 1997). The target size of the researchsample will be 25 women. This latter finding is significantlyhigher than comparable perceptions among women who had NORPLANT removed orwho planned on an early removal of NORPLANT. Haugen,Evans, and Kim (1996) concluded that NORPLANT contraception was asatisfactory form of birth control for the majority of patients in spite ofthe reports of the frequent occurrence of side effects. (1996, May). H., & Balogh, S. D., Atkinson, E., Tanner, S., MacPherson, S., Hellerstein,S., & Alvarado, A. Dunson, T. Pilotadministrations of the instrument will be conducted that will involve asmall sample (25 women) drawn from the women using the family planningclinics in Albuquerque, Silver City, Phoenix, and El Paso. In addition to describing an individual'sbeliefs about health threats and behaviors, the TRA includes the componentsof subjective social norms about those health behaviors, thus describing amore complete sociocultural context for the behaviors. (1997, June). Thirdly, issues that appear to beimportant to the women who will use NORPLANT are, at times, glossed over byresearchers as being trivial. (1989). Nocoercion of any type will be used to persuade women in the family planningclinics to participate in the proposed study. The data will be analyzed through the application ofappropriate quantitative procedures. 3. Determinants of early implant discontinuationamong low-income women. Darney, Atkinson, Tanner, MacPherson, Hellerstein, and Alvarado (199 )conducted a study in the late-198 s to develop information in relation towhy women select the NORPLANT method and why the method is rejected. The TRA treats attitudes and subjective norms as independentpredictors of intentions. L. J., Scholder-Ellen, P., & Ajzen, I. (1989). The extent towhich the study findings remain relevant in the late-199 s is not known.Second, much of the data collected for the study was through the use of non-directional interview questionnaires. Contraception, 53(5), 285-291. Convenience, problems with other contraceptive methods, andeffectiveness were the most important reasons identified by Haugen, Evans,and Kim (1996) as to why patients chose NORPLANT as an approach tocontraception in the first place. (1996, November-December). (199 ). British Journal of SocialPsychology, 28, 193-2 2. All subjects will be assured that the confidentiality ofall responses to items on the survey questionnaire will be protected. Norman, N. Journal of SocialPsychology, 13 , 141-15 . Changes to thedata collection questionnaire will be made as indicated by the results ofthe pilot administrations. B., & Kim, M. Strader, M. Cushman, Davidson, Kalmuss, Heartwell, and Rulin (1996) documented thecounseling experiences and beliefs about NORPLANT implants that were heldby an ethnically diverse sample of low-income clinic patients in the UnitedStates. Data Collection The target population for the study will be women who uses theservices of family planning clinics. The survey questionnaire will becomprised of 25 items. Itreally does not matter what the validity of such a risk is, as long as theperception of that risk causes a woman to opt against the use of theNORPLANT method of contraception. F., Davidson, A. E., & Garcia, F. Current Opinion in Obstetrics and Gynecology,9(3), 169-174. The need for a safe andeffective approach, however, to contraception continues to be great(Wildemeersch, Van Kets, Vrijens, Delbarge, Van Trappen, Temmerman,Depypere, & Thiery, (1997). Menstrual changes were the most commonside effect identified, and were experienced by 8 percent of all womenwhose questionnaires were analyzed. Definition of Terms Three terms, the definitions of which are important for the conduct ofthe proposed study, are defined. Darney, P. In the Theory of Reasoned Action(TRA), Fishbein and Ajzen (1975) propose that attitudes and subjectivenorms combine to determine behavioral intentions, which in turn causevolitional behaviors. Are demographic variables relevant in explaining decisionsby women in relation to the use or continuation of the use of the NORPLANTmethod of contraception? Eiser, J. G.(1995, November). Effects of a persuasivecommunication on beliefs, attitudes, and career choice. Advances in Contraception, 12(3), 187-199. A total of 4 7 women enrolled in the clinical trial at two studysites located in Patan and Kathmandu areas of Nepal. Annals of the new York Academy of Science, (816), 44 -45 . R.,Spivey, S., McMahan, J. (1989). Studies in Family Planning, 21(3), 152-16 . Beliefs about NORPLANT implants among low income urbanwomen. Threespecific research questions will be investigated. Weight gain, headache, mood changes,mastalgia, and acne were reported frequently. Better information is required in relation towhy women select the NORPLANT method and why the method is rejected, if theuse of this effective approach to contraception is to be increased. One the members of the research sample have been selected, copies ofthe survey questionnaire will be provided to each subject during a visit bythe subject to one of the participating family planning clinics. Overall, Haugen, Evans, and Kim (1996) found that 88 percent ofNORPLANT users were at least somewhat satisfied with the implant. Attitudes and attitude change.Annual Review of Psychology, 44, 117-154. The data required for the proposed study will be collected in aquantitative form. R., & Kalmuss, D. This theory remains the dominant theoreticalframework in the attitude-behavior literature (Olson & Zanna, 1993). The study was designed toevaluate the contraceptive safety, efficacy, and overall acceptability ofNORPLANT. Noinformation will be developed or maintained that will permit anyone toassociate any specific response to a survey questionnaire item with anyspecific subject participating in the proposed study. 2. N. Riskfactors for discontinuation of NORPLANT implant are due to menstrualproblems. These terms, together with theirdefinitions, are as follows: 1. Data will b e collected from women in the targetpopulation (defined in the following section of this proposal) who haveused the NORPLANT method of contraception and women who have not used theNORPLANT method. Family Planning Perspectives, 28(6), 256-26 . Journal of Applied Social Psychology, 2 ,1541-1557. The pooled cumulative continuation rate for NORPLANT use was62 percent at the end of five years. These research questionsare as follows: 1. Women who had NORPLANTremoved were significantly more likely to have experienced dizziness whencompared to women who desired to continue to use NORPLANT. (199 ). The TRA can be considered an expansion of the Health Belief Model(Campbell, et al., 1995). This population will be sampledthrough the application of random selection procedures to those women usingfamily planning clinics located in Albuquerque and Silver City, New Mexico,Phoenix, Arizona, and El Paso, Texas. M., Evans, C. American Journal of Public Health, 87(4), 55 -551. A research study is proposed that would replicate the Darney,Atkinson, Tanner, MacPherson, Hellerstein, and Alvarado (199 ) study withsome modifications. percent had receivedreading material as part of their pre-placement counseling, while 35percent of those women who planned to continue to use NORPLANT felt thatthey had been adequately counseled. Journal ofApplied Social Psychology, 2 , 681-7 2. Self-presentation, reasonedaction, and adolescents' decisions to smoke cigarettes. Madden, T. Follow-up visits werescheduled at one, three, and six months after NORPLANT insertion and everysix months thereafter until removal or at the end of five years. Y. Women planningearly removal also were more likely to have experienced dizziness inaddition to acne, headache, hair loss and other side effects than werewomen who desired to continue to use NORPLANT. What effect does the provision of full information-positiveand negative-on the NORPLANT method of contraception have on decisions bywomen to either use or to continue to use NORPLANT as a contraceptivemethod? T. The pregnancy rate duringthe first two years of use was similar to that found in large-scaleclinical trials conducted throughout China; however, discontinuation of theuse of NORPLANT for other reasons was lower. Advances in Contraception, 12(3), 2 1-212. R., Morgan, M., Gammage, P., & Gray, E. Five-yearevaluation of safety, efficacy and acceptability of NORPLANT implants inNepal. The degree of intention formation asa moderator of the attitude-behavior relationship. Are the principal reasons cited by women for either using ornot using the NORPLANT method of contraception congruent with thedocumented findings of the effects of the use of the NORPLANT method ofcontraception? Stasson, M., & Fishbein, M. NORPLANT, for the purposes the proposed study will bedefined as either the original NORPLANT method, which involves the use ofsix capsules implanted in the patient, or NORPLANT-2, which involves theuse of two rods implanted in the patient. The survey questionnaire that will be used in theproposed study will be designed especially for use in the study. Theoretical Framework The theory of reasoned action will provide the theoretical frameworkfor the proposed replication of the Darney, Atkinson, Tanner, MacPherson,Hellerstein, and Alvarado (199 ) study. Several important patterns were foundin comparing the beliefs of patients choosing the NORPLANT system withthose of patients choosing other methods of birth control. Haugen, M. Haugen, Evans, and Kim (1996) investigated the experience of the usersof a levonorgestrel-releasing contraceptive implant (NORPLANT) and reasonsfor early removal. The initial acceptance of NORPLANT wasrelatively high but waned after the first year in three of the fourcounties. A three-level logisticregression analysis found significant variation in the probability ofdiscontinuation as a consequence of side effects. The TRA has been used successfully to predict intentions orbehaviors associated with smoking (Norman & Tedeschi, 1989), seat belt use(Stasson & Fishbein, 199 ), applying for a nursing program (Strader & Katz,199 ), and performing testicular self-examinations (Steffen, 199 ). The data required for the proposed study will be collected through theadministration of a survey questionnaire. Approximately all implant acceptors, but only about one-half ofthose choosing other contraceptives, receive information about the NORPLANTsystem during clinic-based counseling. (1996, September). Tu, P., Qiu, S., Fang, H., & Smith, H. P., & Yi. Olson, J. The term "decision to use NORPLANT" will be defined for thepurposes of the proposed study as the decision applicable to thedetermination on a first use by a patient of the NORPLANT method ofcontraception. Whatis important within the context of this issue, however, is how such a riskis perceived by the women who are expected to use the NORPLANT method. TheTRA is used to predict behavior in many contexts, and the model frequentlyserves as the standard to which new ideas and theories involving attitudeand subjective norms are compared. Exposure to group counseling and toa film regarding NORPLANT implants were found to be associated with highlevels of knowledge among acceptors. A statement of confidentiality will be incorporated into the surveyquestionnaire. R., Kalmuss, D., Heartwell, S., & Rulin,M. Review of the LiteratureAcceptance and Perceptions of NORPLANT Tu, Qiu, Fang, and Smith (1997) conducted a comprehensive analysis ofthe acceptability, side effects, and efficacy of NORPLANT as used in ruralareas, based on a field experiment conducted in four counties in Nebei andShandong Provinces, China. Two hundred fifty-one (251) women who had NORPLANTimplanted through the Ohio State University Department of Obstetrics andGynecology were sent a questionnaire that included general demographicquestions and questions concerning pre-placement education, reasons forchoosing NORPLANT, problems experienced because of NORPLANT, reasons forremoval of NORPLANT, if applicable, and overall satisfaction with NORPLANT.A total of 1 7 completed and usable questionnaires (44 percent) werereturned and analyzed. M., & Tedeschi, J. The TRA, thus, will provide a sound theoretical frameworkwithin which to evaluate subject intentions, perceptions, and actionsrelative to the NORPLANT method of contraception. 3. Campbell, J. (1997, 17 June).Intrauterine contraception in adolescent women: The GyneFix intrauterineimplant. Chetri, Bhatta, Amatya, Lama, Dunson, Spivey, McMahan, and Balogh(1996) conducted a five-year, non-comparative study of NORPLANTcontraceptive sub-dermal implants in Nepal. Cushman, L. The intention-behaviorrelationship among U.S. M., & Zanna, M. Implantable hormonal andemergency contraception. The pooled grosscumulative life-table pregnancy rate was .6 per 1 women at the end offive years. Kalmuss, D., Davidson, A. Steffen, V. P. Statement of the Purpose of the Study The purpose of the proposed research study will be to developinformation that is relevant in the contemporary period to decisions madeby women in relation to the NORPLANT method of contraception. Social Psychology Quarterly,53, 44-54. B., & Ewigman, B. Substantialproportions of the latter group were found to adhere to several inaccuratebeliefs about the NORPLANT method, associating its use with: (1) long-termhealth problems, (2) problems for future babies, (3) future fertilityproblems, (4) infection, and (5) high cost. The results ofthe pilot administrations of the instrument will be used to establish thereliability and validity coefficients of the instrument. Belief, attitude, intention, andbehavior: An Introduction to theory and research. A. Journal of Family Practice, 41(5), 457-464. H. Chetri, Bhatta, Amatya, Lama, Dunson,Spivey, McMahan, & Balogh (1996) concluded that the NORPLANT system is asafe and effective method of contraception. The research also found, however, that whenintentions were poorly formed, attitudes had a direct effect on behavior,unmediated by intentions. M. The three most frequently reportedreasons for the discontinuation of the use of NORPLANT were menstrualproblems, personal reasons, and medical reasons. (1993). Of the 125 women whocompleted a five-year user satisfaction questionnaire, the majority (86percent) indicated that they planned to continue using contraception afterthe completion of the study. D., Mitchell, P., Stanford, J. Subjects will be given theoption of returning completed survey questionnaires to the family planningclinic where they received the instrument. and Swedish voters. NORPLANT coercion-anoverstated threat. Kendzierski (199 )distinguished decision making from decision implementation in finding thatan intention to exercise physically was more likely to be implemented whenindividuals had engaged in planning than when they had not planned. Reading, Massachusetts:Addison-Wesley Publishing Co. Journal of Applied Social Psychology, 2 , 27-45. R., Cushman, L. First, the informationdeveloped was based on data that is now 1 -to-12 years old. The women who make decisions relative to the use NORPLANT may beassumed to employ all of the information available to them in reaching suchdecisions. Acceptance & Perceptions of NORPLANT: a proposal for A Replicative Study The Problem Although research has established the NORPLANT method as one of themost effective approaches to contraception, the method has not been widelyadopted by women (Cullins & Garcia, 1997). Within this context, the risk that animplant will cause some physical disfigurement is viewed as remote by mostresearchers (Kalmuss, Davidson, Cushman, Heartwell, & Rulin, 1996). A stamped, addressed envelope will be providedwith each questionnaire to facilitate the return of the completedquestionnaire to the researcher by the subject. (1975). A comparison ofthe theory of planned behavior and the theory of reasoned action.Personality and Social Psychology Bulletin, 18, 3-9. (199 ). Of thosewomen who planned to continue to use NORPLANT, 98. Althoughfive pregnancies were reported during the study, only two women werediagnosed as having become pregnant while using NORPLANT. (1997, April). References Bagozzi, R. Men's motivation to perform the testicle self-exam: Effects of prior knowledge and an educational brochure. Validating a model developed to predict prenatal careutilization. Completewritten instructions will accompany the survey questionnaire, and a contacttelephone number will be provided where subjects may obtain answers toquestions that arise later. Thus, a person will engage in aspecific behavior if he or she has information and/or beliefs that thebehavior will produce a specific, desirable outcome, and has appropriateresources as well as the opportunity to perform the behavior. (199 ). Whilethe information developed by this study was valuable at the time it wasreported, there are three problems that emerge when an attempt is made toapply the information in the contemporary period. Granberg, D., & Holmberg, S. Of these women (the 86 percent majority),almost one-half indicated that they planned to use a second NORPLANTimplant as the contraceptive method. (1996, September). J. Most people are likely to commit to a specificbehavior or set of behaviors if they believe the outcome is attainable(Madden, Scholder-Ellen, & Ajzen, 1992). Patientsatisfaction with a levonorgestrel-releasing contraceptive implant: Reasonsfor and patterns of removal. They concluded further thatNORPLANT is an acceptable method of contraception among Nepalese women. While there are valuable uses forthis approach to data collection, the non-directional approach does notassure that data relevant to some key issues involved in a problem will becollected. (199 ). Statistical analyses will beperformed through the use of the SPSS (Statistical Package for the SocialSciences) program. Decision making versus decisionimplementation: an action control approach to exercise adoption andadherence. Davidson, A. (199 ). K., & Katz, B. Kendzierski, D. Haugen, Evans, andKim (1996) concluded further that the provision to patient of readingmaterial concerning the benefits and side effects of NORPLANT is animportant aspect of patient counseling and may improve long-term use ofNORPLANT. The principal modifications would be the use of astructured, directional data collection instrument, together with theinclusion of questionnaire items dealing specifically with issues that werenot addressed in the findings of the Darney, Atkinson, Tanner, MacPherson,Hellerstein, and Alvarado (199 ) study. Social PsychologyQuarterly, 52, 266-279. Fishbein, M., & Ajzen, I. Journal of Reproductive Medicine, 41(11), 649-654. Bagozzi and Yi (1989) found that when intentions were well formed,intentions completely mediated the effects of attitudes on behavior aspredicted by the TRA.
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