Year

2002

Degree Name

Doctor of Philosophy

Department

Graduate School of Public Health

Abstract

Background Research suggests that family planning acceptance is likely to be more effective when men are actively involved. The goal of the study was to identify methods in which targeted health behavioural change programs for increasing men's acceptance of modem contraception might be best developed and implemented. The Transtheoretical Model (TTM) of behaviour change was used to examine men's readiness to accept lUD for contraception in rural Vietnam.

The three research questions were (1) to identify measures of rural Vietnamese men's readiness to accept lUD for contraception; (2) to identify modifiable factors that characterise in each stage of men's readiness to accept the lUD for contraception; and (3) to test whether an intervention targeting each stage of motivational readiness will result in increasing men's readiness to accept the lUD for contraception.

Methods Following a pilot study of 201 men, a quasi-experimental pretest-posttest study was undertaken, between March 2001 and June 2002, using multistage cluster sampling of 651 married men, aged 19 to 45 years, in the two mral communes of Quoc Tuan and An Hong, in An Hai district, Hai Phong province, Vietnam.

Local health workers carried out the cross-sectional surveys by face-to-face interviews. The questionnaires consisted of reliable and valid measures. Two rounds of interventions with stage-targeted letters and interpersonal counselling were provided to men in the intervention group. The posttest survey to evaluate the intervention was carried out after 6 months follow-up.

Results At the baseline survey, the staging algorithm identified that 29.5 percent of men were in the precontemplation stage, 10.6 percent of men in the contemplation/preparation stages, and 59.5 percent of men in the action/maintenance stage. Men in the precontemplation stage scored significantly higher cons for lUD use than those in the action/maintenance stages, while the reverse was reported for self-efficacy for convincing wives to use the lUD. The men's predictors at each stage of readiness to accept lUDs for contraception belonged to different categories. Two predictors were socio-demographic characteristics (having a son and wife's abortion history), one was contraceptive knowledge (spontaneous recall of traditional methods), one was communication (communication with wives on family planning) and two were TTM constructs (self-efficacy and cons for lUD use).

The results of posttest survey showed compelling evidences of intervention program on lowered cons for lUD use, an increased self-efficacy for lUD use, an increased recall of traditional contraceptive methods, improved communication between men and their wives on family planning, and an increased number of participants reported moving to the action/maintenance stage of change for lUD use.

Conclusions This is the first time that the TTM has been used as a theoretical framework for understanding men's contraceptive behaviour in Vietnam. Findings from the study provide evidence to support the claim that improving male involvement will increase contraceptive use. Targeting men with appropriate messages corresponding to their stage of readiness to accept the lUD for contraception increased their acceptance of the lUD and contraceptive prevalence in the two rural communes in Vietnam. Given the popularity of TTM in public health programs for reproductive health, findings of the study will hopefully contribute to an understanding of men's roles in acceptance of contraceptive methods in Vietnam.

Key words: intrauterine devices (lUD), male involvement, Transtheoretical Model (TTM), stages of change (SOC), decisional balance ('pros' and 'cons') and self-efficacy.

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Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.