A model to promote the use of implant contraceptive method in Vhembe District, Limpopo Province

Abstract

Background: Around 80 million unintended pregnancies occurred worldwide annually, and most of them are due to the non-use or the inconsistent use of contraceptive methods. Implant contraceptive method provides long-term pregnancy prevention for a period of three to five years, depending on the type of the device. Implant contraceptive method is typically associated with lower failure rates in preventing unintended pregnancies than methods that required self-administration. Types of implants includes Norplant, Implanon, Jadelle and Sino-implant and are currently available in more than 30 countries of the world. Purpose: The purpose of this study is to develop a model to promote the use of implant contraceptive method at Primary Health Care facilities in Vhembe District, Limpopo Province. The study is conducted in two phases. Phase1: Objectives; To explore the perceptions of sexually active women about the usage of Implant contraceptive method; To identify the factors that influence the utilization and non-utilization of Implant contraceptive method by sexually active women in Vhembe District. To explore professional nurses’ views about factors contributing to the utilization of Implant contraceptive method by sexually active women and to determine the available strategies to promote the utilization of Implant contraceptive method. Phase 2: Objectives; To conduct a concept analysis of the core-concept identified; To develop a model to promote the use of Implant contraceptive method by sexually active women; To validate the developed model to promote the use of Implant contraceptive method by sexually active women. Theoretical framework: The study is conceptualized within the Health Belief Model. This study focused on the six components of Health Belief Model, which are perceived seriousness, perceived susceptibility, perceived benefits, perceived barriers, modifying variables and cues to actions. It is used to understand sexually active women’s health-related behaviours and the reasons for non-compliance on the use of Implant contraceptive method. Methods: This study engaged a qualitative, explorative and descriptive research design in Phase 1. Study population comprised of two groups: sixty-two (62) sexually active women aged 18 to 45 years’ and ten (10) senior professional nurses trained on insertion of implant contraceptive method. Study population are obtained through non-probability purposive sampling method. Data was collected through semi-structured interviews for professional nurses and focus group discussions for sexually active women. Data is analyzed utilizing Tesch’s open-coding method. Trustworthiness is ensured by using the principles of credibility, dependability, conformability and transferability. Ethical clearance was obtained from the University of Venda Research Ethics Committee. Permission to conduct study obtained the Limpopo Provincial Department of Health, Vhembe District Executive Manager, Musina and Thulamela Sub-Districts Managers. Results: The findings revealed that few professional nurses trained on insertion of Implanon, inadequate training affected the quality of services provided. A major barrier for use of Implanon is lack of knowledge and fear of side effects. Furthermore, challenges affecting the use of Implanon is inadequate family and sexual partners’ support. In Phase 2: From the findings of the study, the core concept analyzed is ‘promote the uptake of Implanon.’ The method followed is guided by concept analysis proposed Walker and Avant (2014). Following concept analysis, a model to promote the use of implant contraceptive method at Primary health care facilities in Vhembe District, Limpopo Province is developed. The model was developed using six steps according Dickoff et al., (1968). The steps are context, agents, recipients, procedures, dynamics and terminus/goals. The developed model is validated by using the quantitative design; participants include facility operational managers and professional nurses. Process: The process of the model to promote the use of implant contraceptive model at Primary health care facilities in Vhembe District, takes place in the following three levels, namely: Level 1; Inadequate training of professional nurses, Level 2; Promote the uptake of implants and Level 3; Compliance with the outcomes. Recommendations: Nursing practice, comprehensive training of professional nurses on newly introduced family planning methods including, how to meet the reproductive health services for sexually active women. Effective educative interventions could promote broader knowledge about a range of implantable contraceptives. Nursing research, challenges faced by sexually active women in childbearing ages regarding newly introduced Implant contraceptive method need further investigation in nursing education. The developed model should be included in continuous professional development programme to increase the knowledge and understanding of the Implant contraceptive method as one of long acting reversible contraceptives.