Developing postpartum family planning attitude scale

Introduction and Aim: Family planning (FP) is an essential part of maternal and infant health in postpartum period; it is one of the most fundamental components of health care services during the prenatal and postnatal period. The aim of this study was to develop a scale based on the Health Belief Model in order to evaluate the FP attitudes of postpartum women with 0-12 months old infants living in eight neighborhoods of Bornova province. In addition to this, it is aimed to evaluate the relationship between sociodemographic and fertility characteristics of women, FP method usage and FP counseling status with developed 'Postpartum Family Planning Attitude Scale' (PFPAS) mean scores. Material and Methods: The study consists of two parts and the first part is only methodological; the second part is in the field application of methodological study and cross-sectional study design. The sample size was determined to be at least 270 women, suitably 10 times the scale items. The target population of this study was 302 women with 0-12 months old baby that were recorded by The Municipality of Bornova Health Directorate. In the data collection process, due to inclusion and exclusion criterias, 292 volunteer women were included in the survey. The dependent variable of the study was the attitude level of women in the postpartum period regarding family planning. In order to evaluate this level; PFPAS was developed in four stages: scale item pool was consisted, content validity was evaluated, pilot study was conducted, reliability and validity of scale was evaluated. Developed scale was consisted of 27 items and six subscales those were "perceived susceptibility", "perceived severity", "perceived benefits", "perceived barriers ", "cue to action", "self-efficacy". Scale items included phrases which measure the attitudes towards birth interval, birth control methods, access to health services, external factors those affecting FP attitude. The independent variables were grouped under five headings; socio-demographic and economic, fertility characteristics, FP method use, FP counseling status and FP knowledge level. The questions in the questionnaire containing variables were asked to women by home visit, face to face by the researcher. In the statistical analysis of the collected data, a score indicating the FP attitude level was generated. In determining the factors associated with FP attitude level score; Student's T test, Spearman correlation analysis and multiple linear regression analysis were used. The Cronbach alpha coefficient was calculated to evaluate the reliability of the developed scale. Explanatory and confirmatory factor analysis was performed to evaluate the construct validity. Results: The mean age of women was 27.90 ± 5.94 and 51.4% of them had primary education level. In the group, 90.1% of women were housewives, and 19.9% did not have any health insurance. As to husbands of women, 60.3% of the spouses had primary education level and 25.7% of them work in precarious non-permanent works and 19.5% of them did not have social security. The first marriage age of women was 20.48 ± 3.94 and one third of them were married before 18 years of age. The mean number of pregnancies in the group was 2.6 ± 1.5, the mean number of births was 2.3 ± 1.3; 22.9% of them had four or more pregnancies, and 14.4% of them had four or more births. In the group, 55.8% of women had used modern AP method at least once in their lives and 44.9% of them continued to use effective methods in postpartum period. When family planning counseling is considered, it is determined that 58.2% of the group received prenatal FP counseling and 53.8% of the group received FP counseling in postpartum period. The most known method was intrauterine device and almost all of them knew all modern FP methods. It was determined that the total variance explained by the PFPAS in the explanatory factor analysis was 57.2% and the Cronbach alpha coefficient was 0.878. In the confirmatory factor analysis which the scale structure was tested, the chi-square / degree of freedom was found to be 2.24, the RMSEA value was found to be 0.068, and the CFI value was found to be 0.95 and the structural validity of the scale was validated. The lowest score was 27 and the maximum score was 135 for the PFPAS and the total mean score for the scale was 105.32 ± 11.91. The PFPAS score was 6.52 times higher in women who had spouses working in secured and permanent jobs compared to those working in precarious and non-permanent jobs. Those who had previously used FP method and who continued to use a FP method in postpartum period had respectively 9.18 and 5.40 times more PFPAS score than those who did not use FP method. Conclusion: In this study; the scale which was developed to evaluate the FP attitudes of women in postpartum period had valid and reliable results. The social class of the spouses of women, the use of the FP method and the current use status were associated with the level of attitude. It is necessary to identify the barriers to women's positive attitude towards FP and to develop community-oriented accessible services in order to support the improvement of proper health behavior. Key Words: Postpartum; Family Planning; Attitude; Health Belief Model; Validity; Reliability