Improving the quality of care in Chinese family planning programme.

PIP: The Chinese State Family Planning Commission (SFPC) is the government department responsible for coordinating and implementing the national population and family planning programs. The commission includes about 300,000 family planning workers and 50 million volunteers. Community workers provide IEC and technical services to couples of reproductive age. In July 1991, SFPC began a five year project to train rural family planning workers in contraceptive technology and interpersonal communication and counseling. These workers were important because of their service to a population of 800 million or 75% of total population. The training program was part of an effort to standardize training and institutionalize it throughout the country. The project involved 20 pilot training stations in 19 provinces. The primary task was to train family planning workers at the grassroots level. 80,000 persons were expected to be trained during the five years. Activities included a training needs assessment, development of training curricula and programs, training of workers, and monitoring and evaluation. Training techniques and topics will include participatory training methods, interpersonal communication and counseling, development of audience based training methods, issues of contraceptive choice and quality of care, and counseling issues such as sexually transmitted disease and HIV infection prevention. About 40,000 family planning workers and volunteers were trained by 1992 in counties, townships, and villages. Trainees learned about "informed choice" and the importance of counseling. Feedback from training activities focused on the appreciation for the participatory training methods such as brainstorming, case study, and role play. Workers appreciated the process involved in training as well as the information received. Evaluation showed that clients improved their knowledge and had positive interactions with workers.^ieng

Assessing the acceptability of NORPLANT implants in four countries: findings from focus group research.

In 1986-87, a qualitative research project was conducted in the Dominican Republic, Egypt, Indonesia, and Thailand to expand understanding of the acceptability of NORPLANT contraceptive implants beyond inferences made on the basis of continuation rates. In each of the four study sites, focus group discussions or in-depth interviews were held with potential acceptors, current NORPLANT users, discontinuers, husbands of women in these three groups, and service providers. Nonclinical participants generally had little formal education and lived primarily in urban or semi-urban areas where NORPLANT has been available for at least five years. The study focused on attitudes, perceptions, and experiences of each group regarding NORPLANT implants. Results suggest that factors having an impact on the acceptability of NORPLANT implants fall into three general categories: medical/technical, cultural/religious, and informational/educational. This article discusses each of these categories, including programmatic implications of the findings, and puts forward recommendations for enhancing NORPLANT introduction efforts on the basis of these findings.

PIP: In 1986-87, a qualitative research project was done in Thailand, Egypt, Indonesia, and the Dominican Republic to expand knowledge of the acceptability of NORPLANT contraceptive implants beyond continuation rates. In each of the 4 studies, in-depth interviews or focus group discussions were held with current NORPLANT users, potential acceptors, discontinuers, husband of women in the 3 groups, and service providers. The 4 countries were chosen because of their diverse cultures and religions. Most participants favored family planning. Many had used other contraceptives. Men and women in all countries were worried that oral female contraceptive agents (the pill) caused cancer. There were many objections to the IUD. In all countries but Thailand, there was little knowledge of NORPLANT. In the Dominican Republic, NORPLANT was used mostly as a child spacing method. In Indonesia, it was used for child spacing and termination of childbearing. Perceived advantages were alike in all countries. Pain during insertion and removal was a big concern of potential users. Men and women in all countries said that religion and traditional beliefs did not influence their family planning decisions. But many said that religion influenced their tolerance of side effects. In Egypt and Indonesia sterilization is unpopular because it is seen as violating Islamic law. Irregular bleeding was the major side effect and the main reason for discontinuation. Many satisfied users felt that the advantaged outweighed the side effects. Primary reasons for removal in all countries were irregular bleeding, amenorrhea, and the desire to give birth. The need for information was mentioned in all countries. In Egypt, Indonesia, and Thailand services providers reported the need for more thorough training in insertion and removal as well as continuing education sessions.

Spreading good ideas: adapting illustrated materials.

PIP: Adapting existing educational materials to fit local conditions is generally a less expenseive, less time consuming, often a more effective strategy than creating new educational materials. This is especially true for illustrated materials. Existing materials, which have been successfully used in 1 country or local setting must, of course, be carefully adapted and pretested before they are used in a new setting. Symbols are frequently culture specific, and adapted materials must utilize only those symbols which will be understood by the new targeted population. In adapting materials it is often necessary to insert additional information relevant to the needs of each new population. For example, if the target population has misconceptions about a contraceptive method, the educational materials concerning the method should incorporate messages to counter these misconceptions. Care must be taken to ensure that illustrated materials used in 1 culture do not offend members of another culture. New materials generally require much more testing than adapted materials. Once an appropriate format has been developed for transmitting technical information, it is relatively easy to adapt the format to other cultural settings because the technical information itself generally does not have to be modified. The Program for the Introduction and Adaptation of Contraceptive Technology and the Program for Appropriate Technology in Health (PIACT/PATH) provides assistance and information to organizations interested in adapting educational materials. Interested individuals may send inquiries to PIACT/PATH, suite 420, 1255 23rd Street, Northwest, Washington, District of Columbia, 20037, USA. Sample copies of family planning education materials and assistance in adapting these materials is also provided by the Population Communication Services Project at The Johns Hopkins University. Inquiries should be sent to Population Communication Services, The Johns Hopkins University, 624 North Broadway, Baltimore, Maryland, 21205, USA.^ieng