✪✪✪ Family Health Analysis

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Family Health Analysis



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Identify the information that your practice collects, manages, and shares. Identify third-party risks. What are the external sources of PHI? Do you work with vendors or consultants who create, receive, maintain, or share the personal information of your patients? Identify and document potential threats and vulnerabilities. How do employees access personal information? How do you restrict unauthorized access to information? Have your employees been trained to access and protect PHI appropriately? Do you currently encrypt the information that you store or transmit? Assess security measures, policies, and procedures. Do you have the appropriate policies and procedures in place to reduce risks and vulnerabilities?

Have you assigned security responsibility? Do you have policies and procedures in place regarding access and storage of PHI? Do you share information with third parties and have agreements in place that require them to safeguard your information? Many respondents indicated that women generally prefer to use family planning methods that do not have side-effects and are convenient to use. Although women trust healthcare providers and the information that they receive from them, they prefer to obtain contraceptive advice from friends and family members. Additionally, attitude of men toward childbearing, fertility desires, characteristics of providers, and religious beliefs of the couple exert considerable influence on family planning decisions.

Numerous factors influence family planning decision-making in Turkey. Women have a strong preference for traditional methods compared to modern contraceptives. Additionally, religious factors play a leading role in the choice of the particular method, such as withdrawal. Public health interventions should focus on incorporating men into their efforts and understanding how providers can better provide information to women about contraception. Peer Review reports. There is considerable literature on the decision-making process related to fertility, and various factors have been proposed as predictors of family planning decision-making. Additionally, previous studies have analyzed diverse factors that influence family planning decision-making within the family, such as power relations [ 3 ] and dominance of male partners [ 2 , 4 ].

Various studies in Turkey have found that many men are motivated to use family planning and would like to share responsibility for family planning decision-making to use or not use any family planning method [ 5 , 6 ]. We would like to emphasize that cultural values also play an important role in impacting the use of family planning. Among these cultural factors, perhaps religious values top our list. Previous studies have also included ethnicity, male preference, traditional family values as well as the economic value of children as potential causal factors in determining family planning decisions.

The present study aims at identifying significant contextual factors that are likely to influence use of family planning such as socio-cultural and religious norms. In the s, Turkey adopted a national family planning policy that advocated the use of both traditional and modern contraceptive methods i. Further, almost half of married women use a modern contraceptive method [ 8 ]. However, while the use of modern contraceptives increased steadily in the s and s, the prevalence rate has stagnated since the s.

Further, a sizable proportion of women continue to rely on traditional methods of family planning, such as withdrawal [ 8 ]. The dominant almost exclusive religion in Turkey is Islam. The government, which has been in power since , actively promotes policies that encourage high fertility and discourage contraception and abortion. The Turkish Ministry of Health is responsible for designing and implementing health policies and overseeing all private and public healthcare services in the country. Family planning and abortion services are provided both in public, and private sectors, and modern methods may be accessed for free in government-funded primary health care units and hospitals or from pharmacies and private practitioners for a fee [ 9 ].

In general, most women and couples obtain modern contraception from public sector sources, and pharmacies are the leading source of oral contraceptives and male condoms [ 8 ]. Women and men can also purchase emergency contraception, hormonal and copper IUDs, three-month contraceptive injections Depo-Provera , and one-month contraceptive injections Mesigyna from pharmacies. IUDs cannot be inserted at pharmacies but are taken to health facilities to be inserted. Male condoms can also be purchased from markets and beauty shops.

The Turkish national curriculum does not provide sex education and the subject is rarely discussed in schools [ 10 ]. Since there is no formal education on reproductive health, most people are informed about family planning though friends, relatives as well as printed or social media. Basic information, education, and communication materials about contraception are provided by health facilities.

This study aims to delineate the factors that influence family planning decision-making processes from the perspectives of community stakeholders such as prayer group leaders, parent-teacher association members, and family planning service providers. We attempt to understand and explain these factors within the context of social and political tensions in Turkey most important of which are ethnic and secular-religious cleavages. We used purposive sampling [ 11 , 12 ] to interview eight family planning service providers and eight community stakeholders in Bagcilar, Istanbul. Our sample includes fifteen females and one male participant. We determined the number of interviews based on the principles of theoretical saturation i. Bagcilar is one of the largest districts in Turkey with a population of , in [ 14 ].

We sampled key informants from different professional backgrounds, with different social status within their respective communities, and based on their role in influencing reproductive health. In-depth interviews were conducted between April and May We partnered with a local research firm that had extensive experience in conducting qualitative studies in the area. We identified service providers from public and private hospitals that offered family planning services in the study area, from a health facility assessment that we conducted less than six months prior.

To map the availability of and access to family planning and abortion services, we conducted a facility survey in public and private facilitates that provided reproductive health services in the study area. The facility survey captured data on service availability and facility readiness including staffing, hours of operation, and payment of user fees , services provided including counseling, physical examination and contraceptive, and abortion methods , and commodity supplies.

These were supplemented with in-depth interviews with key informants. The research firm used separate standardized scripts to recruit family planning providers and community stakeholders. The recruitment script included details about the study, its aim, and contact information for the principal investigators. The research firm scheduled a time for interview with providers and community stakeholders who were willing to participate in the study. All respondents spoke Turkish and interviews were conducted by a trained Turkish female interviewer who was employed by the research firm. The interviewer had a university degree and was employed as a fieldwork director by the local research firm at the time of the interview.

After a refresher training session about principles and techniques of qualitative research, ethics and confidentiality, and role-playing exercises with a supervisor, the interviewer piloted two different semi-structured interview guides see selected questions in Table 1 one interview with a family planning service provider and one interview with a community stakeholder. The interview guides were developed for this study in English and translated into Turkish see Additional files 1 and 2.

The service provider interview guide included several topics related to accessing family planning, factors influencing decision to use contraception, and barriers to and facilitators of family planning use in the community. The community stakeholder interviewer guide captured information on socio-cultural beliefs influencing community preferences and attitudes regarding family planning.

Topics were related to the availability and accessibility of contraceptives, the demand for contraception and abortion services, the influence of attitudes and beliefs on contraception and abortion accessibility, decision-making, and behavior of women regarding gender norms and decision-making between couples. The Turkish version of the interview guide was amended based on questions and feedback obtained during training and pilot test. All participants received written information about the study and provided oral consent to participate.

We did not collect any identifying information from participants. Face-to-face interviews were conducted in a private space i. The interviewer took field notes during the interview. On average, interviews lasted approximately one hour. After interviews were completed, the research team transcribed each interview in Turkish and then translated it into English for coding and analysis. Transcripts were double-coded by the research team to ensure accuracy. We did not share transcripts with participants. We further used an inductive, thematic analytical approach, guided by the principles of the constant comparative method to identify key themes arising from the data [ 12 ]. First, four researchers reviewed eight transcripts and developed an initial list of codes and general themes see Additional file 3.

Next, four members of the study team read two transcripts aloud together and open-coded all text, in line with the principles of open coding and an inductive approach [ 12 ]. We reviewed all codes together more than codes , merging similar codes and grouping codes into themes and sub-themes. Next, once all major themes and sub-themes were agreed upon, we generated a final codebook, which included 51 sub-codes in six main coding groups, including demographics, family planning, abortion, socially-oriented perspectives, quality of services, and family planning programs. The study team double coded all transcripts. Two members of the study team were assigned to each interview in order to enhance the quality of the analysis.

Several key themes emerged from the data related to family planning decision-making. All themes were identified by two members of the study team. We decided to characterize emerging dominant themes related to most frequently discussed topics across all interviews. Background characteristics of participants are shown in Table 2. The service providers in our sample had been providing family planning services for between one and 22 years.

We wanted to understand family planning decision-making process in relation to decisions about whether to avoid pregnancy or not. Three main themes identified by the study team emerged from the transcripts, including the decision-making process, the role of male partners, and the role of religious beliefs on reproductive health decisions, that provide insight into how women and couples decide to use contraception, how they learn about contraception, and the types of contraceptives women and couples prefer Table 3.

In general, we found that there was considerable demand for modern contraceptives among women. The majority of respondents mentioned the increasing awareness about modern contraceptive methods, most notably young women wishing to delay or space childbearing and women who wish to limit births once they achieve their ideal family size. Respondents differed in what they perceived as the most preferred contraceptive method for women. While they discussed a variety of modern contraceptive methods used by women in their communities, many agreed that traditional methods, such as withdrawal or periodic abstinence, were preferred.

They frequently believed these traditional methods to be more effective than other modern methods, and also explained that women prefer these methods to avoid side effects and also for convenience in use. A gynecologist who had been serving in this position for four months said:. If you leave it to the clients, they will still use the withdrawal method. It does not matter if they are educated or not. They say they have been using it for five years and nothing happened, so they continue [to use it]. Interviewee 15, Family planning provider. So the women make the decisions. Although most respondents agreed that women are more likely than men to be involved in the choice of a preferred contraceptive method, decision-making within a family is multi-layered.

Some respondents reported that mothers-in-law and fathers-in-law are also important actors who exert an influence on family planning matters. A physician who had been providing family planning services for approximately nine years explained:. I had a few clients whose mothers-in-law wanted their daughters-in-law to have more children. And this affects the spouses or the husbands and they think about having another child. As they live together, the mother-in-law or even the father-in-law influences [their decisions to have another child].

Interviewee 6, Family planning provider. All participants reported that modern contraceptive methods are widely available and easy to access from health care centers and pharmacies. The majority of respondents both providers and community stakeholders reported that women trust and respect family planning service providers. Nevertheless, with regard to obtaining information, women trust the contraceptive experience of other people like their friends and family members and therefore mostly rely on second hand information.

A community stakeholder commented:. First, they [women] talk among themselves. For example, she asks me how I manage birth control, how I prevent pregnancy. I say that I use the pill or injections or that my husband uses a method. She says that if it is good, she will do it too. Then she goes to the health center to ask the nurses…It is the culture of the women here, nothing else. It is better for them to hear it instead of searching and learning, I think. Interviewee 1, Community stakeholder. A few participants discussed the influence that the characteristics of providers can have on decision-making.

The narratives suggested that decision-making is influenced by accessibility and quality of services. One community stakeholder said:. Most participants did not report difficulties with accessing contraception for any particular group of women, and they agreed that unmarried women and adolescent girls can access modern contraception. A few reported that modern contraceptive methods are available, but it is difficult for single women to obtain them, which is an indication of barriers to access among this sub-group of women.

It is easily accessible, but the social pressure is serious. So, it is easily accessible, but it is hard to get. Interviewee 3, Community stakeholder. Our findings suggest that there is no single explanation for family planning decisions among women in the study setting. Various factors influence family planning decisions, and factors such as the source of information, characteristics of service provider, and marital status play a role.

Most respondents stated that demand for modern contraceptive services is stronger among women compared to men. The majority of respondents reported that men do not favor modern contraceptive use, but do not actively object to using them. Additionally, family planning service providers reported that men have very limited involvement with pregnancy planning and fertility decisions and that women often do not trust men to be involved in such decisions. Men are not trusted to be involved with family planning by women. Men do not care about it much. But a lot of men use birth control too. When the women use IUD or the pill and experience side-effects, I think the men understand and they resort to methods such as withdrawal and condoms.

Interviewee 10, Family planning provider. Participants reported that men are more likely to desire more children compared to women, but the burden of childrearing falls on women. A local midwife who had provided services for ten years in the community explained:. When [women] bear a child, most husbands do not help with childcare. It is as if the child belongs only to the mother; supposedly, he is the father. So, women want birth control methods to avoid consecutive births. Interviewee 14, Family planning provider. A local pharmacist who has been in that position for 36 years also indicated that men desire to have more children than their wives.

She said:. Participants reported few barriers to contraception, and the narratives suggest relatively few reasons for non-use. However, a frequent theme was the importance of religious beliefs on reproductive health decisions. A few participants reported that women believe that modern contraception, in general, or use of certain methods in particular, are sinful behavior.

A gynecologist who had been in that position for 20 years said:. What can you do with this person? Interviewee 9, Footnote 6 Family planning provider. Some spouses consider [birth control] to be a sin. We hear it from our friends … Interviewee 8, Community stakeholder. Actually, there is prejudice against most of the birth control methods in our society… Modern contraception is considered a sin. They [referring to the people in the community] do not want birth control. Women do not want IUD. They use the withdrawal method. Interviewee 13, Family planning provider. A pharmacist described the effects of shared beliefs around contraceptive decision-making, thus:. One of my clients said that she would not use birth control pills because it was a sin.

A couple of months later, she got pregnant and had to have an abortion. I asked her who had recommended it; it turned out to be someone I knew. She had to have an abortion. You are misinforming people and playing with their lives. A lifeless thing does not grow; it is alive since the first moment that sperm fertilizes the egg. Do not misinform people, please. The narratives suggest that there is contradiction between faith and behavior. In particular, women think that contraception could be against the will of God, but act in accordance with the dictates of modern life. The findings from this study highlight the major factors that influence family planning decision-making. According to the Turkey Demographic and Health Survey, Our results are consistent with the existing literature which shows that contraceptive methods either modern or traditional method are widely known in the community.

Thus, a key finding from the study is that women, and particularly married women, are aware of at least one method of contraception. Therefore, high levels of knowledge of contraceptives provide opportunities for programs to address barriers that could hinder translation of such knowledge into practice. We found that, according to the perceptions of key informants, traditional methods were preferred over modern methods, and most respondents explained that women prefer traditional methods mostly due to the absence of side effects and ease of use. There is widespread perception that modern methods might have undesired side effects.

According to Cebeci et al. The effect of religious beliefs on contraceptive choice may be the reason why couples continue to rely on traditional methods.

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