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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 22  |  Issue : 2  |  Page : 168-173

Effectiveness of virtual learning module on knowledge and attitude regarding standard days method among public health workers


1 Assistant Professor, College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
2 Nursing Tutor, College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
3 B.Sc Nursing Students, College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Date of Submission24-Jul-2020
Date of Decision21-Nov-2020
Date of Acceptance05-Feb-2021
Date of Web Publication11-Nov-2021

Correspondence Address:
Dr. Rajarajeswari Kuppuswamy
College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJCN.IJCN_70_20

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  Abstract 

Standard Days Method (SDM) is an effective, inexpensive, natural, affordable, non-hormonal and modern family planning method that is easy to teach and use. The aim of this study was to assess the knowledge and attitude about SDM and preference of CycleBeads over CycleBead mobile application amongst accredited social health activist (ASHA) as a public health worker. A mixed-method study was conducted on 140 ASHA workers, allocated into two groups of 70 members each in experimental and control group. A simple random sampling technique was used for quantitative strand and purposive sampling for qualitative strand. A self-structured knowledge questionnaire, attitude scale and focus group discussion were used for data collection. Self-developed virtual learning module (VLM) on SDM with CycleBeads was used as an intervention. In the experimental group, there was a significant difference between pre-existing (5.74 ± 2.05) and post-test (14.64 ± 2.25) knowledge score, whereas the difference between the mean of pre-test (4.32 ± 0.67) and post-test (4.68 ± 0.46) attitude scores was not significant. There was no statistically significant difference in the knowledge and attitude scores in the control group. In the qualitative interview, participants expressed their preference for CycleBeads over CycleBead mobile application to teach women about SDM. VLM is useful in improving the knowledge regarding SDM of ASHAs as a public health worker. Public health workers (ASHA) preferred teaching SDM with CycleBeads in person instead of a mobile application for educating the beneficiaries.

Keywords: Accredited social health activist workers, attitude, cycle beads, knowledge, standard days method, virtual learning module


How to cite this article:
Kuppuswamy R, Narayan D, Tiwari J, Koulash H, Kaur A, Gehlot I, Lamo J, Saini D, Grewal A, Dolma C, Meena D. Effectiveness of virtual learning module on knowledge and attitude regarding standard days method among public health workers. Indian J Cont Nsg Edn 2021;22:168-73

How to cite this URL:
Kuppuswamy R, Narayan D, Tiwari J, Koulash H, Kaur A, Gehlot I, Lamo J, Saini D, Grewal A, Dolma C, Meena D. Effectiveness of virtual learning module on knowledge and attitude regarding standard days method among public health workers. Indian J Cont Nsg Edn [serial online] 2021 [cited 2022 May 28];22:168-73. Available from: https://www.ijcne.org/text.asp?2021/22/2/168/330336




  Introduction Top


An expert committee (1971) of WHO defined family planning as 'a way of thinking and living that is adopted voluntarily, upon the basis of knowledge, attitude and responsible decisions by individuals and couples, in order to promote the health and welfare of the family group and thus contribute effectively to the social development of the country'.[1] The Institute of Reproductive Health (IRH) developed the Standard Days Method (SDM) for family planning. Victoria Jennings, a researcher at the University of Georgetown's IRH, along with her team created CycleBeads to provide a visual, tangible tool to help women follow the method.[2]

Family planning has got a direct impact on the health and well-being of women and plays a major role in reducing maternal as well as infant mortality rates worldwide.[3] The SDM is an effective, cheap, natural, affordable, non-hormonal and modern family planning method that is easy to teach and use. It can be used by both literate and illiterate women. It is a fertility awareness-based practice of family planning with the least side effects. SDM in comparison with traditional periodic abstinence helps couples to understand when to use a condom or avoid sexual intercourse to prevent pregnancy.[4] It can increase male participation in family planning and couple communication. The SDM is 70% reliable in predicting ovulation.[5] Both users and providers perceive SDM to be religiously and culturally acceptable.[6] A low level of knowledge about the fertile period is an important factor accounting for unplanned pregnancies.[3] A study revealed the cumulative probability of pregnancy of 4.75% over 13 cycles of correct use of the method and an 11.96% probability of pregnancy under typical use.[7] A series of 14 strategically designed pilot studies in diverse settings around the world found demand for the method by abroad range of women. Users learned the method in a single visit, usually <30 min, and were generally satisfied with it. Most women (90%–99%) found this method easy to learn, simple to use, effective and without side effects.[8]

CycleBeads is a colour-coded string of beads [Figure 1] that helps a woman to use the SDM. SDM is a clinically proved natural family planning method that allows women to manage their own fertility. This method is used by women with a most menstrual cycle within the 26–32 days range and proves to be effective even if they occasionally have a cycle outside of this range, provided that this does not occur more than once in a calendar year.[7] Using CycleBeads, a woman can track her menstrual cycle, can also recognise the days when unprotected intercourse is expected to result in pregnancy and also check her cycle length. She either uses a barrier method or abstains on her potentially fertile days – identified as days 8–19 of the menstrual cycle in order to avoid pregnancy.[4]
Figure 1: Structure of CycleBeads

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CycleBeads consists of a red bead which shows the 1st day of menstrual bleeding, brown beads show non-fertile days, white beads show the fertile days and a darker brown bead that helps a woman to monitor her cycle length and know if it is shorter than 26 days.[4] It also helps to monitor her days of fertility.

The study objectives were to determine the effectiveness of virtual learning module (VLM) regarding SDM with CycleBeads on knowledge and attitude regarding SDM amongst accredited social health activist (ASHA) workers.

  1. Find the association between the knowledge and attitude regarding SDM with selected socio-demographic variables of ASHA workers
  2. Ascertain the preference of ASHA workers for the use of CycleBeads in person or mobile application to teach women on SDM.


Overall goal

The overall goal of the study was to assess the knowledge and attitude about SDM and preference of CycleBeads over CycleBead mobile application amongst public healthcare worker.


  Materials and Methods Top


A mixed-method approach using an embedded research design was used to assess the knowledge and attitude regarding SDM amongst 140 public health workers (ASHA workers) of a selected community block, Haridwar. CycleBeads is a colour-coded string of beads that helps a woman to use the SDM. ASHA workers were not teaching this method to women in the community at the time of this study. For the quantitative strand, the participants were randomly allocated into the study and control groups (70 in each). For the qualitative study, 10 participants were selected using a purposive sampling technique. The research tool comprised socio-demographic variables pro forma, self-structured knowledge questionnaire and attitude scale for quantitative strand. The socio-demographic profile included age, habitat, qualification and years of work experience as public health workers (ASHA). A self-structured knowledge questionnaire with 20 items divided into knowledge on SDM (11 items), CycleBeads (4 items) and mobile application of CycleBeads (5 items) was included to assess the level of knowledge regarding SDM amongst public health workers (ASHA workers). A self-structured 5-point Likert scale was utilised to assess the attitude of public health workers (ASHA workers) regarding SDM which contains ten items which are rated from strongly agree to strongly disagree. The reliability of the self-structured knowledge questionnaire was checked using a split-half method and it was 0.79. The reliability of the self-structured attitude scale was checked using the Cronbach Alpha method and it was 0.89. The attitude scale used language that is commonly used amongst the participants and they understood the questions very well.

A focus group discussion (FGD) with 10 participants was conducted to assess the preference of using CycleBeads for teaching SDM in person or using of mobile application on CycleBeads for educating the women in the community. Data collection with the prior consent of the available participants was done after explaining the purpose, process and probable implications of the study. For the quantitative strand, a pre-test was conducted using a self-structured knowledge questionnaire and attitude scale for both experimental and control groups. Then, the experimental group had the intervention. The intervention included an e-

1 of the VLM showing the explanation regarding SDM and CycleBeads, its usage, application and special considerations of using it. The use of beads was demonstrated. Then, a post-test was conducted for both control and experimental groups. The control group was informed about the SDM after the study. For the qualitative study, a focused group discussion was conducted in which interviewees were asked to express their views regarding the preference of CycleBeads teaching on SDM in person over CycleBead mobile application and the discussions with the interviewees were audio recorded.

Ethical approval was obtained from the institutional ethical committee to conduct the study. Informed written consent has been obtained from the participants. Quantitative data were analysed using descriptive and inferential statistics. Qualitative data were narratively summarised and concluded. Calculations were done using IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY, USA: IBM Corp. Percentage and frequency distribution were utilised to assess the demographic variables and knowledge amongst public health workers (ASHA workers) regarding SDM.


  Results Top


[Table 1] gives information regarding the demographic profile of public health workers (ASHA workers) including age, educational status and years of experience as public health workers (ASHA). Majority of the participants were in the age group of 31–40 years in both control (42.9%) and experimental (45.7%) groups. In the experimental group, 23 (32.9%) participants were educated up to primary school and in the control group, 25 (35.7%) were educated up to primary school. In the experimental group, most of the participants (41.4%) had 6–10 years of experience as public health workers (ASHA). Amongst the control group, most of the participants (41.4%) had a work experience of 11–15 years.
Table 1: Socio-demographic profile of public health workers (accredited social health activist workers) (n=140)

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[Table 2] and [Figure 2] and [Figure 3] depict the difference in the mean knowledge score of the participants. In the experimental group, pre-test and post-test knowledge scores were 5.74 ± 2.05 and 14.64 ± 2.25, respectively, and the difference was statically significant (P < 0.001). In the control group, pre-test and post-test knowledge scores were 5.94 ± 1.58 and 6.77 ± 1.81, respectively, and the difference was not significant.
Figure 2: Bar graph showing pre-test and post-test knowledge scores of the experimental group

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Figure 3: Bar graph showing pre-test and post-test knowledge score of the control group

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Table 2: Mean and standard deviation of pre-test and post-test knowledge score (experimental and control group) (n=140)

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[Table 3] and [Figure 4] and [Figure 5] show the pre-test and post-test attitude mean score of both experimental and control groups. In the experimental group, the pre-test and post-test mean attitude scores were 4.32 ± 0.67 and 4.68 ± 0.46, respectively. In the control group, the pre-test and post-test mean were 4.57 ± 0.49 and 4.65 ± 0.47, respectively. The difference was not statically significant in both the groups.
Figure 4: Bar graph showing pre-test and post-test attitude scores of the participants of the experimental group

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Figure 5: Bar graph showing pre-test and post-test attitude scores of the participants of the control group

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Table 3: Mean and standard deviation of pre-test and post-test attitude score (experimental and control group) (n=140)

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With regard to knowledge score, there was no difference between the groups at pre-test, but the difference was significant (P < 0.01) at post-test, showing that the VLM was effective in improving knowledge on SDM. As far as the attitude was concerned, the difference was significant (P < 0.01) between groups at pre-test but was not different at post-test. Both the groups showed an increased positive attitude at post-test [Table 4].
Table 4: Comparison of the mean and standard deviation of knowledge and attitude scores between experimental and control groups in pre-test and post-test

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There was no significant association of post-test knowledge score, attitude with selected demographic variables (age, education and years of experience) in both experimental and control group.

Preference for cycle beads or mobile application

The FGD amongst 10 participants (ASHA workers) selected by purposive sampling was conducted to give insight on which the mode of teaching is preferred by ASHA workers. Comparatively, majority of participants (6) were inclined towards the use of CycleBeads in person. Most of the participants chose CycleBeads because they expressed that the teaching and learning process would be better when it is demonstrated before the learners rather than explaining virtually through the application, making it easy to understand. Use of CycleBeads can be shown to more number of people, unlike the mobile application which can only be taught to 1 or 2 people at a time. The drawback of the mobile application is that it cannot be used for illiterates and for those who do not have android mobile. Few participants chose to use the mobile application. They found it informative and felt that they could educate the community more effectively using it. They found the mobile application more convenient as it can be used anytime using an android mobile. A mobile application also omits the chances of human error. Based on the discussion with the participants, it was evident that CycleBeads was preferred more than the mobile application for educating the community.


  Discussion Top


This study aimed to assess the knowledge and attitude of the SDM using CycleBeads amongst ASHA workers as public health workers. In this study, all of the ASHAs as public healthcare workers belonged to the local community.

Amongst the experimental group of pre-test, majority of the participants that is 37 (52.9%) scored average knowledge. It was observed that the mean of pre-test knowledge and attitude was 5.74 ± 2.05 and 4.32 ± 0.67, respectively. In the control group of pre-test, the majority of participants that is 42 (60.0%) scored average knowledge. It was found that the mean of pre-test knowledge and attitude was 5.94 ± 1.58 and 4.57 ± 0.49, respectively. In the experimental group, the pre-test and post-test mean attitude scores were 4.32 ± 0.67 and 4.68 ± 0.46, respectively. In the control group, the pre-test mean and post-test mean were 4.57 ± 0.49 and 4.65 ± 0.47, respectively, whereas the previous study in various countries assessed the effect on contraceptive use and prevalence of introducing SDM into family planning services showed that the fraction of respondents who had heard the SDM in India, Peru and Rwanda were 59.2%, 63.3% and 90%, respectively.[9]

In the experimental group, the pre-test and post-test mean attitude scores were 4.32 ± 0.67 and 4.68 ± 0.46, respectively. In the control group, the pre-test and post-test mean attitude scores were 4.57 ± 0.49 and 4.65 ± 0.47, respectively. A previous experimental study with one group pre-test-post-test design revealed that there was an increase in the mean knowledge and attitude score in post-test,[10] whereas another study, a quasi-experimental design with pre- and post-intervention on necklace method as a natural family planning, showed that the level of knowledge and practice were statistically significant after administering the educational intervention.[11]

The present study revealed that there was a major increase in knowledge in post-test after administering the VLM, but there was a minimal increase in post-test attitude regarding SDM amongst the public health workers (ASHA workers). The reason that the researcher could not change the attitude within 7 days might be because it takes a minimum of 66 days to change the attitude of a participant.[12]

In the present study, the association of knowledge and attitude of experimental and control group amongst public health workers (ASHA workers) showed that there is no association of post-test knowledge score and attitude score with selected demographic variables that is age, education and years of experience as public healthcare worker (ASHA), whereas in previous studies assessing client's knowledge and to measure its correct use who chose to use it in the community showed that out of 184 participants, 80.4% were using SDM at the time of the survey, 35% used it for 6–12 months and 42% had used it for more than a year. Nearly 91% said that SDM does not protect from STD/AIDS, 75% correctly identified the colour of CycleBeads and 90.5% of women practice it correctly.[12]

The reason for the lack of knowledge about the method is that it is not in practice amongst Indian scenarios and they had not been trained about this method. Hence, it is recommended that the curriculum for ASHA workers includes the SDM, and use of beads as it is a simple and effective family planning method that can be taught to women.

In the FGD, more number of participants was inclined towards the use of CycleBeads. Most of the participants chose CycleBeads because they felt that teaching and learning process would be better when it is demonstrated before the learners rather than explaining virtually through the mobile application making it easy to understand. Few participants chose to use the mobile application. They found it informative and felt that they could educate the community more effectively using it, but its drawback is that it cannot be used for illiterates and for those who do not have an android mobile. Hence, it was concluded that CycleBeads was preferred more than the mobile application for educating the community, whereas a similar study conducted to assess the potential of CycleBeads app in several countries showed that 39.9% used the app for preventing pregnancy, 38.5% for planning pregnancy and 21.6% were keeping an eye on their cycles. Sixty percentage of women reported satisfaction with the app.[13]


  Conclusion Top


VLM was found to be effective in enhancing the knowledge of public health workers (ASHA workers) regarding SDM. Even though the virtual platform was found to be beneficial for ASHA workers, they preferred demonstrating/explaining SDM using cycle beads over mobile app. Hence, it is preferable to use CycleBeads more than the application for educating the community. The study also has emphasised the need for educating all grass root level workers like ASHA on the use of CycleBeads and SDM as an effective family planning method. The effectiveness of this teaching on women's practice and the outcome in terms of family planning need further investigation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Park K. Textbook of Preventive and Social Medicine. 25th ed. Jabalpur: Bhanot Publications; 2019. p. 532,542-3.  Back to cited text no. 1
    
2.
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Jayaranjan N, CCP. Global Health Learning. Standard Days Method. The Institute of Reproductive Health, Georgetown University; 2012. Available from: https://www.globalhealthlearning.org/course/standard-days-method. [Last accessed on 2012 Sep 28].  Back to cited text no. 4
    
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Johnson S, Marriott L, Zinaman M. Can apps and calendar methods predict ovulation with accuracy? Curr Med Res Opin 2018;34:1587-94.  Back to cited text no. 5
    
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Arévalo M, Jennings V, Sinai I. Efficacy of a new method of family planning: The standard days method. Contraception 2002;65:333-8.  Back to cited text no. 7
    
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Gribble JN, Lundgren RI, Velasquez C, Anastasi EE. Being strategic about contraceptive introduction: The experience of the standard days method. Contraception 2008;77:147-54.  Back to cited text no. 8
    
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Lundgren R, Sinai I, Jha P, Mukabatsinda M, Sacieta L, León FR. Assessing the effect of introducing a new method into family planning programs in India, Peru, and Rwanda. Reprod Health 2012;9:17.  Back to cited text no. 9
    
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Menachery PB, Noronha JA, Fernanades S. Improving the knowledge and attitude on 'standard days method' of family planning through a promotional program among Indian postgraduate students. J Obstet Gynaecol India 2017;67:286-90.  Back to cited text no. 10
    
11.
Ramesh J, Chandrababu R. Community-based educational intervention on necklace method as a natural family planning amongst reproductive age group women in India. Int J Nurs Sci 2018;5:29-32.  Back to cited text no. 11
    
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Bekele B, Fantahun M. The standard days method: An addition to the arsenal of family planning method choice in Ethiopia. J Fam Plann Reprod Health Care 2012;38:157-66.  Back to cited text no. 12
    
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Haile LT, Fultz HM, Simmons RG, Shelus V. Market-testing a smartphone application for family planning: Assessing potential of the cycle beads app in seven countries through digital monitoring. Mhealth 2018;4:27.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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