Sağlık Okuryazarlığı Düzeyi ile Kontraseptif Yöntem Tercihleri Arasındaki İlişki: Rahim İçi Araç ve Elektif Küretaj

Abstract

Üreme sağlığı hizmetlerinin sağlanması sağlık sistemi için esastır. Üreme sağlığı, Dünya Sağlık Örgütü'nün önemli bir bileşeni olup, kadınların ve erkeklerin güvenli ve etkili kontraseptif yöntemler hakkında bilgi edinme ve bunlara erişim haklarının olduğunu belirtir. Ne yazık ki, günümüzde mevcut olan güvenilir kontraseptif yöntemlerden tüm bireyler haberdar değildir; bu durum, istenmeyen gebeliklere yol açan ve bu gebeliklerin elektif küretaj ile sonlandırılmasında ana faktördür. Bu çalışma, doğum kontrolü için rahim içi araç (RİA) kullanan hastalar ile istenmeyen gebelikleri sonlandırmak için elektif küretaj (E&C) uygulanan hastaların Sağlık Okuryazarlığı (SOY) düzeylerini karşılaştırmayı amaçlamaktadır. Bu kesitsel çalışma, istenmeyen gebeliklerini E&C ile sonlandırmak üzere Aile Planlaması Departmanı'na başvuran (n=59) ve doğum kontrolü için RİA kullanan (n=408) toplam 467 kişi ile gerçekleştirilmiştir. Çalışma, SOY ölçeği için belirlenen genel ölçek puanına göre gruplar arasında bir farklılık olmadığını göstermektedir. Ancak, “Sağlığın Geliştirilmesi” alt ölçeği üzerinden elde edilen medyan puanı E&C grubunda daha yüksektir (p=0,002). Lojistik regresyon analizi, çalışmayan kadınların E&C'yi tercih etme eğiliminin, çalışan kadınlara göre 11,15 kat daha fazla olduğunu göstermiştir. Ayrıca, küretaj öyküsü olan kadınların E&C yöntemini tercih etme riski 4,95 kat daha yüksektir. Sonuç olarak, bildiğimiz üzere “Sağlığın Geliştirilmesi”, çevrenin sağlık uyarılarını değerlendirme yeteneği ile ilgili olup bu durum, çevrenin, kadınların E&C tercihlerini etkilemiş olabileceği şeklinde yorumlanabilir. Çalışmayan kadınlarda E&C'ye sık başvurulması sosyokültürel bir bağlamda incelenmelidir.

Keywords

• Sağlık okuryazarlığı
• sağlığın geliştirilmesi
• Aile Planlaması Polikliniği
• rahim içi araç
• elektif küretaj

Relationship between Health Literacy Level and Contraceptive Method Preferences: Intrauterine Device vs. Elective Curettage

Abstract

Providing reproductive health services is essential to a healthcare system. Reproductive health is an important component of the World Health Organization, indicating that women and men have the right to information and access to safe and effective contraceptive methods. Unfortunately, not all individuals are aware of the reliable contraceptive methods currently available today; this is the main factor leading to unwanted pregnancy, which is terminated with Elective Curettage. The present study aims to compare the Health Literacy (HL) levels of patients who use intrauterine devices (IUD) for contraception with those who underwent Elective Curettage (E&C) to terminate unwanted pregnancies. This cross-sectional study was conducted with 467 participants who applied to the Family Planning Department to terminate unintended pregnancy with E&C (n=59) and those who used an IUD for contraception (n=408). The study shows no differences between the groups according to the HL level determined for the overall HL scale. However, the "Health Promotion" subscale's median score was higher in the E&C group (p=0.002). The logistic regression analysis showed that the tendency of unemployed women to prefer E&C was 11.15 times more than that of employed women. Moreover, those with a history of curettage were 4.95 times more likely to prefer the E&C method. In conclusion, "Health Promotion" is related to the ability to evaluate the health warnings of the environment. It can be interpreted that the environment influences women's E&C preferences. The frequent occurrence of E&C in unemployed women must also be examined in a sociocultural context.

Keywords

• health literacy
• health promotion
• family planning department
• intrauterine device
• elective curettage

References

1. 1. Organization W H, Achieving reproductive health for all. 1995, World Health Organization.
2. 2. Mansour D, Inki P, Gemzell-Danielsson K. Efficacy of contraceptive methods: a review of the literature. The European Journal of Contraception & Reproductive Health Care. 2010; 15(1): 4-16.
3. 3. Westfall J M, Sophocles A, Burggraf H, Ellis S. Manual vacuum aspiration for first-trimester abortion. Archives of family medicine. 1998; 7(6): 559.
4. 4. Sedgh G, Singh S, Hussain R. Intended and unintended pregnancies worldwide in 2012 and recent trends. Studies in family planning. 2014; 45(3): 301-314.
5. 5. Sedgh G, Bearak J, Singh S, et al. Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends. The Lancet. 2016; 388(10041): 258-267.
6. 6. Pazol K, Creanga A A, Zane S B, Burley K D, Jamieson D J. Abortion surveillance—United States, 2009. Morbidity and Mortality Weekly Report: Surveillance Summaries. 2012; 61(8): 1-44.
7. 7. Khan A, Shaikh B T. An all time low utilization of intrauterine contraceptive device as a birth spacing method-a qualitative descriptive study in district Rawalpindi, Pakistan. Reproductive health. 2013; 10: 1-5.
8. 8. Sørensen K, Van den Broucke S, Fullam J, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC public health. 2012. 12, 1-13 DOI: 10.1186/1471-2458-12-80.

9. 9. Hernandez L, Roundtable on health literacy, Board on Population Health and Public Health Practice, and Institute of Medicine. Measures of Health Literacy: Workshop Summary. 2009. 2016.
10. 10. Morris N S, MacLean C D, Littenberg B. Literacy and health outcomes: a cross-sectional study in 1002 adults with diabetes. BMC family practice. 2006; 7(1): 1-8.
11. 11. Kutner M, Greenburg E, Jin Y, Paulsen C. The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy. NCES 2006-483. National Center for Education Statistics. 2006
12. 12. Guclu O A, Demirci H, Ocakoglu G, et al. Relationship of pneumococcal and influenza vaccination frequency with health literacy in the rural population in Turkey. Vaccine. 2019; 37(44): 6617-6623.
13. 13. McCray A T. Promoting health literacy. Journal of the American Medical Informatics Association. 2005; 12(2): 152-163.
14. 14. Paakkari L, Okan O. COVID-19: health literacy is an underestimated problem. The lancet public health. 2020; 5(5): e249-e250.
15. 15. Woldegiorgis M A, Meyer D, Hiller J E, Mekonnen W, Bhowmik J. Inter-relationships among key reproductive health indicators in sub-Saharan Africa focusing on the central role of maternal literacy. International health. 2020
16. 16. Parker R M, Williams M V, Baker D W, Nurss J R. Literacy and contraception: exploring the link. Obstetrics & gynecology. 1996; 88(3): 72S-77S.
17. 17. Emiral G, Aygar H, Isiktekin B, et al. Health literacy scale-European union-Q16: a validity and reliability study in turkey. Int. Res. J. Med. Sci. 2018; 6: 1-7.
18. 18. Akoth C, Oguta J O, Gatimu S M. Prevalence and factors associated with covert contraceptive use in Kenya: a cross-sectional study. BMC Public Health. 2021; 21(1): 1-8.
19. 19. Dereje N, Engida B, Holland R P. Factors associated with intrauterine contraceptive device use among women of reproductive age group in Addis Ababa, Ethiopia: A case control study. PloS one. 2020; 15(2): e0229071.
20. 20. Twells L K, Gregory D M, Reddigan J, Midodzi W K. Current and predicted prevalence of obesity in Canada: a trend analysis. Canadian Medical Association Open Access Journal. 2014; 2(1): E18-E26.
21. 21. Vahratian A. Prevalence of overweight and obesity among women of childbearing age: results from the 2002 National Survey of Family Growth. Maternal and child health journal. 2009; 13(2): 268-273.
22. 22. Yu C, Teoh T, Robinson S. Obesity in pregnancy. BJOG: An International Journal of Obstetrics & Gynaecology. 2006; 113(10): 1117-1125.
23. 23. Chen K K. Obesity and Reproductive Health. Obstetric Medicine. 2009; 2(1): 43.
24. 24. Chuang C H, Chase G A, Bensyl D M, Weisman C S. Contraceptive use by diabetic and obese women. Women's Health Issues. 2005; 15(4): 167-173.
25. 25. Vayssière C, Gaudineau A, Attali L, et al. Elective abortion: Clinical practice guidelines from the French College of Gynecologists and Obstetricians (CNGOF). European Journal of Obstetrics & Gynecology and Reproductive Biology. 2018; 222: 95-101.