1 Faculty of Medicine
Department of Gynecology Mona Miran
Comparing the knowledge about contraceptives among 1
stand 6
thyear
international and Lithuanian students
Dr. Sonata Bariliene Kaunas, Lithuania, 2016
2
TABLE OF CONTENTS
01. TITLE PAGE 1 02. TABLE OF CONTENTS 2 03. SUMMARY 3 04. ACKNOWLEDGMENTS 4 05. CONFLICTS OF INTEREST 406. CLEARANCE ISSUED BY THE ETHICS COMMITTEE 4
07. ABBREVIATIONS 5
08. INTRODUCTION 6
09. AIM AND OBJECTIVES 7
10. LITERATURE REVIEW 7
11. RESEARCH METHODOLOGY AND METHODS 10
12. RESULTS 12
13. DISCUSSION OF THE RESULTS 21
14. CONCLUSIONS 22
15. PRACTICAL RECOMMENDATIONS 23
16. LITERATURE LIST 24
3
SUMMARY
Author: Mona Miran
Thesis: Comparing the knowledge of contraceptives among 1st and 6th year students.
Aim: To explore the knowledge about contraceptives when students are in first year of their medical studies and when the students are in their last year of medical studies.
Objectives:
1. To asses the knowledge about contraceptives among medical international and Lithuanian students of LUHS.
2. To measure the usage and experience of contraceptives among 1st and 6th year medical students.
3. To investigate the number/amount of students that would like to improve their knowledge about contraceptives among the international and Lithuanian medical students of LUHS.
4. To investigate the gender differences among the medical students regarding the knowledge of contraceptives.
5. To provide the university with the results and conclusion of the research work. The object of research: International and Lithuanian medical students of LUHS.
Methodology: Cross-sectional study. Questionnaires were distributed among 120 international and Lithuanian students of LUHS from first and sixth years of study of medical faculty.
The study participants: Randomly selected international and Lithuanian students of LUHS from first and sixth of study of medical faculty.
Research results: A total of 120, 50% international students, female were 56.7% and 60%, respectively international and Lithuanian 1st year, while 56,7% and 86,7%, respectively international and Lithuanian 6th year. Mean scores of knowledge, 8.7 (international) and 9.1 (Lithuanians) out of 10 after 6 years of studies. Condoms and oral contraceptives were the most popular contraceptive methods. Results also showed that female students have a higher knowledge about contraceptives compared to males.
Conclusions: There was a significant increase in knowledge about contraceptives among the students after their 6 years of medical studies. Condoms and oral contraceptives were the most commonly used contraceptive methods. Lithuanian students would wish to have a separate course about contraceptives during their studies. Females showed to have a higher knowledge compared to males.
4
ACKNOWLEDGEMENTS
The author would like to thank Edita Sakyte, whom contributed in this research with the data analysis, and the fellow student Mohammed Munir for the moral and technical support. Also to thank the medical students, both international and Lithuanian students who participated in filling the survey.
CONFLICTS OF INTEREST
The author reports no conflicts of interest.
ETHICS COMMITTEE CLEARANCE
Title: “Comparing the knowledge of contraceptives among 1st and 6th year international and Lithuanian students
Number of issue: 68C-MG-126 Date of issue: 2015-12-09
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ABBREVIATION LIST
1. Lithuanian University of Health Sciences (LUHS) 2. Sexually transmitted diseases (STDs)
3. Oral contraceptive pill (COP) 4. Intrauterine device (IUD)
5. Combined oral contraceptives (COCs) 6. United States of America (USA)
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INTRODUCTION
Contraceptives has always been a very important matter, and very often students tend to be irresponsible when it comes to usage of contraceptives, which in turn can lead to unwanted pregnancies and sexually transmitted diseases (STDs).
As medical students it is very important to improve the education and knowledge in this field. This will help the students, as future medical doctors to improve their own knowledge so that they can teach and advice their patients throughout their medical careers. It is interesting to measure how much knowledge medical students gain about contraceptives throughout the 6 years of their medical studies. In this way, the Lithuanian University of Health Sciences will get a better understanding regarding the student’s knowledge about contraceptives, so that the knowledge among the future medical doctors can get improved, already in their early years of studies. Studies have shown that medical students whom practice safe sex are more likely prone to teach safer sex practices to their patients.
The ability of medical students to teach their patients about contraceptives in the future are very much influenced by their own personal knowledge and experiences. [21]
Due to impacts, such as, gender, family, religion, and country of origin, lack in knowledge about contraceptives in medical students can be noticed. Due to this matter, all students does not have the same amount of knowledge about contraceptives when they first start their medical studies. Studies have shown that lack of knowledge and education about contraceptives can lead to STDs, unwanted pregnancies, abortions and sexual crimes. [22]
The aim of this study was to asses the knowledge about contraceptives among 1st and 6th year international and Lithuanian medical students of LUHS. The study was done to compare the knowledge of medical students when they first start their medical studies, and when they are about to finish their medical studies. In this way, the knowledge of contraceptives among medical students can be improved during the years of their medical studies. This in turn will contribute to a better communication with their patients in the future as well as teaching safer sex practices to their patients. This can also prevent many unwanted pregnancies and STDs.
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AIM AND OBJECTIVES OF THE THESIS
Aim: The study was to asses the knowledge about contraceptives among 1st and 6th year international and Lithuanian medical students of LUHS. The study was done to compare the knowledge of medical students when they first start their medical studies, and when they are about to finish their medical studies. In this way, the knowledge of contraceptives among medical students can be improved during the years of their medical studies. This in turn will contribute to a better communication with their patients in the future as well as teaching safer sex practices to their patients. This can also prevent many unwanted pregnancies and STDs.
Objectives:
1. To assess the knowledge about contraceptives among medical international and Lithuanian students of LUHS.
2. To measure the usage and experience of contraceptives among 1st and 6th year medical students.
3. To investigate the number/amount of students that would like to improve their knowledge about contraceptives among the international and Lithuanian medical students of LUHS. 4. To investigate the gender differences among the medical students about the knowledge of
contraceptives.
5. To provide the university with the results and conclusion of the research work.
LITERATURE REVIEW
Contraceptives has been a very important matter for many years and it is being used worldwide by different age groups. The first European guidelines for sexuality education was issued by World Health Organization (WHO) year 2010.
The focus of these guidelines were mostly on unwanted pregnancies, abortions and sexually transmitted diseases (STD’s).
8 According to WHO sexual education should start in children’s early ages, in order to develop a decent understanding about sexuality. Sources of sexual education from parents are usually not enough, this in turn leads to inadequate knowledge about contraception and STDs. [1]
Studies has shown that comprehensive sex education prevents unwanted pregnancies that could have lead to unsafe abortions. [2]
A study was done in Lithuania, Kaunas, on students from different faculties, including medicine and obstetrics. A questionnaire was distributed among the students which was divided into 4 clusters, whereas one of the clusters was to evaluate the student knowledge about contraception. This study showed that the most commonly used contraceptives were condoms (72.5%) and oral contraceptive pills (14.7%). 13% of the students used the withdrawal method, and 8.1% did not use any contraception method at all. They reached to the conclusion that the school- based sexuality education program has not seemed to be beneficial. This in turn, has lead to that, students do not have enough knowledge regarding contraception, and that a sexual education program could increase the knowledge about contraception among the students in the future. [1]
Another study in Lithuania showed that adolescent girls (high school) of age 15-19 years had a poor knowledge regarding contraceptives, and they were not using contraceptives on a regular basis. Only 30.0% (1/3) of the adolescent girls reported usage of contraceptives. [3]
According to another study that was done in Nigeria, schoolgirls mostly got their knowledge and information about contraceptives via mass media, and even though, there was a high awareness about contraceptives, the usage of contraceptives was poor. [4,20]
Studies has shown that males have less of a knowledge when it comes to contraceptives. It has been shown that an advanced study year was associated with a higher knowledge about contraceptives. [5]
Another study showed that medical students with higher medical education had a more positive aspect to contraceptives. This study also showed, that medical students in higher years used contraceptives
9 more frequently compared to those medical students in the lower years. This was due to the fact that medical students in higher years had a better knowledge about contraceptives. [6-7]
In a medical university in Greece, a study showed that medical students lacked knowledge about contraceptives. This study also showed that most of the students were not using any contraceptive method at all, and those students that actually were using any form of contraception, were using condoms as the only contraceptive method. Only 55.9% of the medical students had asked their gynecologist about contraception, and most of the students claimed that the contraceptives that they had been using were not effective. They reached to the conclusion that due to the poor knowledge of contraceptives among the medical students in Greece, much more time must be spent in Greek medical schools in order to teach medical students about contraceptive methods. This is considered to be a very important matter, especially when it comes to the knowledge about contraceptives among medical students. The more time that is being spent in teaching students about contraceptives, the better guidance there will be from future practitioners to their patients. [8-11]
Studies in India showed that medical students believed that doctors should be the ones that will provide the information about contraception to their patients. 95.1% stated that they would like to be responsible for providing information about contraception to their patients as future medical doctors. The study revealed that medical students in India claimed their knowledge about contraception to be fair-good. But even though the topics of reproductive health and contraceptive methods had been covered in their coursework, and they had passed the theoretical part, 1 out of 5 interns did not know that oral contraceptives should to be taken on a daily basis. [12]
In Romania, a study was done on female university students of age 19-30 years. The aim was to investigate the knowledge about contraception and the level of contraceptive use, with regard to combined oral contraceptives. It was stated that 69% of the students were using contraceptives, as well as they showed a positive attitude towards it. This study showed that the most commonly used contraceptive methods were, combined oral contraceptives (COCs), condoms and withdrawal method. [13]
10 They reached to the conclusion that, medical students showed higher knowledge about contraceptives compared to pharmacy and non-medical students. [14]
Due to this, they thought that an improvement of knowledge about contraceptives was needed among the students. [15]
In another study that was done in Plovdiv, Bulgaria, 160 female medical students were assessed with help of an anonymous questionnaire. 72,6% (only 95% of students filled out the questionnaire) used condoms, 5,9% used oral contraception pill (OCP) and 9% of the participants did not use any form of contraception. They reached to the conclusion that the teaching method of contraception should be changed in the medical university of Plovdiv, wishing that the medical students will increase their knowledge about contraception. They hope that this will result in that the medical students will be able to guide their patients about family planning even better as future practitioners.[16-19]
A study was done in the United States (USA) to assess the contraceptive knowledge among medical students from first academic year and interns. A survey regarding different methods of contraception was handed out. The different contraception methods included condoms, oral contraceptive pills, patches, diaphragms, intrauterine device (IUD), implants and natural family planning. In result, the interns had a higher knowledge about contraception compared to the first year students. The results also showed that women had a higher knowledge, and that higher age also resulted in a higher score (knowledge). They also reached to the conclusion that medical schools in the USA are better at teaching their students about contraception compared to international schools. [20]
RESEARCH METHODOLOGY AND METHODS
A questionnaire in English was made by the author, with 12 questions specifically about the knowledge and experience of contraceptives. Knowledge about contraceptives among students was assessed by using questionnaire. The object of the study included international as well as Lithuanian students of medical faculty. The study was conducted on 30 randomly selected international and Lithuanian medical students from year 1 and 6, in total 120 students. Every student completed the questionnaire anonymously after signed inform consent form.
11 This cross-sectional survey was conducted in Lithuanian University of Health Sciences and was carried out during December, 2015. The study was enrolled after clearance was obtained from the university and ethical committee.
The questionnaires were self-administered questionnaires which were distributed to the students before start of lecture sessions in a lecture hall with permission of the lecturer. The distribution was done separately according to the year of the study. A brief introduction and explanation was given to the students. They were told to follow the instructions and if any questions were unclear they could ask for a more precise explanation. The process of filling the questionnaires took 15-20 minutes. The questionnaires were collected on the same day, after completing the filling. The completion of the questionnaires was anonymous and voluntary. It would not affect their study progress in their medical course. Written informed consent forms were distributed to the students together with the questionnaires. Those who signed and agreed were the only students whom were enrolled in the study. The questionnaires were comprised of 12 simple questions; the questions were simply answered by ticking the most convenient box. Data on contraceptive knowledge and experience were collected by subject with response to statements such as, “Please mark the boxes for the contraceptives that you have used/tried” or “Please mark the boxes for the contraceptives that you have never heard about”. A variety of contraceptive options were listed. Some questions were objective with “yes” or “no” options, whereas a few questions were multiple choice. For the questions specifically about usage and experience of contraceptives students were given the option of selecting several or one alternatives (all contraceptives and methods were listed). Questions specifically about their knowledge of contraceptives were also included, where scores from 1-10 could be chosen, 1 being poor knowledge and 10 being excellent knowledge. The demographic details, such as age and gender were also recorded.
Data were analyzed using the Statistical Package of Social Sciences (SPSS) version 23.0. Descriptive statistics was performed. As well as crosstabs for most calculations of the results, whereas Chi-square test was performed to find and prove statistical significant among the data. The results were significant if p<0,05.
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RESULTS
Socio-demographic characteristics
A total of 120 medical students responded to the surveys: 60 participants from 1st year medical studies and 60 participants from 6th year. The surveys were distributed among both international and Lithuanian students. 56.7% (17) of the international participants from 1st year were female students, and 43.3% (13) male. Whereas among Lithuanian participants there were 60% (18) female and 40% (12) male students.
Among the 6th year students, there were 56.7% (17) female and 43.3% (12) male students, and among the Lithuanian 6th years, there were 86.7% (26) female and 13.3% (4) male students.
A socio-demographic characteristic – gender – is shown in Table 1.
Table 1: Socio-demographic characteristics of participants (1st year students) Gender
Total Female Male
Student type International students Count 17 13 30 % within student type 56,7% 43,3% 100,0% Lithuanians Count 18 12 30 % within student type 60,0% 40,0% 100,0% Total Count 35 25 60 % within student type 58,3% 41,7% 100,0%
Table 2: Socio-demographic characteristics of participants (6th year students) Gender
Total Female Male
Student type International students Count 17 13 30 % within student type 56,7% 43,3% 100,0% Lithuanians Count 26 4 30 % within student type 86,7% 13,3% 100,0% Total Count 43 17 60 % within student type 71,7% 28,3% 100,0% n=120
13 All international and Lithuanian students from 1st year, were between 17-25 years. Among 6th year international students, 43.3% (13) were between 17-25, and 56.7% (17) over 25 years. 86.7% (26) of the Lithuanian students were between the age 17-25 and 13.3% (4) over 25 years.
Students that had sexual education in primary school
All 30 (100%) international students from 1st year reported having sexual education during primary school. 83.3% (25) of the Lithuanian students said they had sexual education in primary school, and 16.7% (5) reported not having sexual education during primary school.
90% (27) of 6th year international students reported having sexual education in primary school and only 10% (3) reported not having sexual education in primary school. Among the Lithuanian students 76.7% (23) of the students reported having sexual education in primary school and 23% (7) reported not having sexual education in primary school.
Descriptive statistics were used to count the percentage and number to evaluate whether the students had any sexual education during primary school or not.
The Pearson chi-square showed 0.02 for the 1st year students, this means that there was a significant difference between international and Lithuanian students, whether they had sexual education in primary school or not. Results are shown in Table 3.
Table 3: Sexual education in primary school?
Did you have any sexual education in primary school?
Total
Yes No
Student type International students Count 30 0 30
% within student type 100,0% 0,0% 100,0% Lithuanians Count 25 5 30 % within student type 83,3% 16,7% 100,0% Total Count 55 5 60 % within student type 91,7% 8,3% 100,0% p<0,05
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Comparing proportion among international and Lithuanian students, whom sexual education has helped
Results were calculated in order to evaluate whether respondents thought that sexual education helped them to gain knowledge or not.
Among 1st year students 73.3% (International) and 64% (Lithuanian) said that the sexual education that was provided during primary school had helped them. 26.7% (International) and 36% (Lithuanian) reported that sexual education during primary school did not help them to gain knowledge.
A significant difference between international and Lithuanians 1st year students was found after receiving results from Pearson Chi-Square test. The P value was 0.0456, which is below 0,05, meaning a significance difference was found. (table 4).
The results showed that international students thought that sexual education in primary was more helpful compared to Lithuanian students.
There was no significance difference found among 6th year international and Lithuanian medical students. 66-70% of the students reported that the sexual education in primary school helped them to gain knowledge, and 30-33% reported that it did not help them.
Table 4: Comparing proportion among international and Lithuanian students, whom sexual education has helped
If you answered yes in the previous question, did it
help?
Total
Yes No
Student type International students Count 22 8 30
% within student type 73,3% 26,7% 100,0% Lithuanians Count 16 9 25 % within student type 64,0% 36,0% 100,0% Total Count 38 17 55 % within student type 69,1% 30,9% 100,0% P<0,05
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Comparison between International and Lithuanian students, when they got to know about contraceptives for the first time
In this part of the study, students were asked when they first got their knowledge about contraceptives. The main statistical difference was shown between 1st and 6th year students. 56.7% (Lithuanians) to 66.7% (International) from the 1st year students said they learned about contraceptives during primary school. Only 30% (Lithuanians) to 40% (International) from the 6th year students received information about contraceptives during primary school. By using Pearson Chi-square, as shown in table 5, a significant difference was shown between 1st and 6th year students, this shows that students nowadays get their first source of information about contraceptives in an earlier age compared to before. The table below (Table 5) also describes students who received their first knowledge about contraceptives during high school, due to own interest, from visiting a gynecologist, midwife or a general practitioner (GP).
There is a significance difference between the Lithuanian and international students when it comes to learning about contraceptives due to own interest. This study showed that only 16.7% of the international students tend to learn about contraceptives due to own interest. Whereas 53.3% of the Lithuanian 6th year students have gained their knowledge about contraceptives due to own interest. In general, very few students, get information about contraceptives from visiting Gynecologists, midwifes or general practitioners.
Table 5: Comparison between International and Lithuanian students, when they got to know about contraceptives for the first time
1st year 6th year International students, % Lithuanians, % International students, % Lithuanians, % Primary school 66,7 56,7 40A 30A High school 33,3 26,7 46,7 23,3
Due to own interest 0 13,3 16,7A,B 53,3A
From visiting a gynecologist,
midwife, or a GP 3,3 3,3 13,3 6,7
A p<0,05 compared to 1st year students B p<0,05 compared to Lithuanians
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Proportion of students, who would like to have a separate course about contraceptives
40% (international), respectively 56.7% (Lithuanian) 1st year students said they wanted to have a separate course about contraceptives. Among the 6th year students 33.3% (international), respectively 53,3% (Lithuanian) wanted to have a separate course about contraceptives. There was no significant difference found between any of the groups, but results showed a higher percentage of Lithuanian students that would like to have a separate course about contraceptives.
Table 6: Proportion of students, who would like to have a separate course about contraceptives Separate course about
contraceptives
Total Yes No/ Don't
care/ knowledge are enough Student type International
students Count 12 18 30 % within student type 40,0% 60,0% 100,0% Lithuanians Count 17 13 30 % within student type 56,7% 43,3% 100,0% Total Count 29 31 60 % within student type 48,3% 51,7% 100,0% a. Which year are you currently studying? = 1st
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Proportion of students, who have not heard about different contraceptive methods
From Table 8 we can understand that a huge proportion of the students were not familiar with the contraceptive method, diaphragm. 36.7% of the international 1st year and 46.7% of the Lithuanian 1st year students have never heard about diaphragms. 20% from the international 6th year students have never heard about diaphragms.
A significant difference was found between international and Lithuanian 6th year students. There is a significant difference when comparing the knowledge of condoms and oral contraceptives compared to diaphragms in all four groups.
Table 7: Student type * Separate course about contraceptives Crosstabulationa
Separate course about contraceptives Total Yes No/ Don't care/ knowledge are enough
Student type International students Count 10 20 30
% within student type 33,3% 66,7% 100,0% Lithuanians Count 16 14 30 % within student type 53,3% 46,7% 100,0% Total Count 26 34 60 % within student type 43,3% 56,7% 100,0%
18 Table 8: Proportion of students, who have not heard about the contraceptives listed below
1st year 6th year International students, % Lithuanians, % International students, % Lithuanians, % Condoms 0 0 0 0 Diaphargms 36,7C,D 46,7C,D 20B,C,D 0A Oral contraceptives 0 0 0 0 Implants 0 10 10 0 Injections 20B,C,D 73,3C,D 10 16,7A Patches 6,7 0 0 0 IUDs 36,7B,C,D 10 0A 0
Emergency contraceptive pill 3,3 0 0 0
Withdrawal method 3,3 6,7 0 6,7
Have not heard about at least one
contaceptive 63,3C,D 80C,D 20A,C,D 23,3A,C,D
Have heard about all 36,7 20 80A 76,7A
A p<0,05 compared to 1st year students B p<0,05 compared to Lithuanians C p<0,05 compared to condoms
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Proportion of students, who have used the contraceptive methods shown in Table 9
The most commonly used contraceptive methods are shown in Table 9. The most popular contraceptive method between the students are condoms. The second popular contraceptive method is oral contraceptives. From the 1st year students, 100% use condoms, whereas 86.7% (international) and 83.3% of the 6th year students use condoms as a contraceptive method. The results show a significance difference between 1st and 6th year students when it comes to the usage of condoms as a contraceptive method. However, 40% (international) and 33.3% (Lithuanian) of the 6th years still uses the withdrawal method and 13.3% uses no contraceptives at all. This shows a significance difference between the 1st and 6th year students.
Table 9. Proportion of students, who have used the contraceptive methods
1st year 6th year International students, % Lithuanians, % International students, % Lithuanians, % Condoms 100D 100D 86,7D 83,3A Diaphragms 0C,D 0C,D 0C,D 0C,D Oral contraceptives 43,3C 63,3C 53,3C 73,3 Implants 0C,D 0C,D 3,3C,D 0C,D Injections 0C,D 0C,D 0C,D 0C,D Patches 0C,D 0C,D 6,7C,D 0C,D IUDs 0C,D 0C,D 20A,B,C,D 0C,D
Emergency contraceptive pill 10C,D 16,7C,D 23,3C,D 26,7C,D
Withdrawal method 33,3B,C 10C,D 40C 33,3A,C,D
I don't use contraceptives 0 0 13,3A 13,3A
A p<0,05 compared to 1st year students B p<0,05 compared to Lithuanians C p<0,05 compared to condoms
D p<0,05 compared to oral contraceptives
Comparison of the knowledge about contraceptives when students are in first year of their medical studies, and when the students are in their last year of their medical studies
Comparing the knowledge of the 1st and 6th year students were simply done by asking the students to mark their knowledge about contraceptives on a scale of 1-10. 1 being considered as poor knowledge and 10 as excellent. The scores were calculated by using standard deviation, which showed that the students from 1st year had an average score of 5.3 (international) and 3.7 (Lithuanians). The results show a significance difference between international and Lithuanian 1st year students.
20 International students from 1st year tend to have more knowledge about contraceptives, compared to Lithuanian 1st year students.
The students from 6th year stated having a score of 5.2 (international) and 4.7 (Lithuanians) when they started their medical studies. Results shows that the 6th year Lithuanian students had more knowledge about contraceptives when they first started their medical studies, compared to the 1st students
(Lithuanian) now.
There is a significant improvement in knowledge about contraceptives in the 6th year students. Results showed scores of 8.7 (international) and 9.1 (Lithuanians). The knowledge about contraceptives among the 6th year Lithuanian students is proven to be higher compared to the international students.
Table 10: Comparison of the knowledge about contraceptives when students are in first year of their medical studies, and when they are in their last year of their medical studies
1st year 6th year International students Lithuanians International students Lithuanians Knowledge scores before studies 5,3 (±1,6) B 3,7 (±0,9) 5,2 (±2,1) 4,7 (±1,9) A Knowledge scores during studies 5,6 (±1,5)
B,C 4,6 (±0,9)
C 8,7 (±1,3)
A,C 9,1 (±0,7)
C
Knowledge scores gained during studies 0,3 (±0,5) B 0,9 (±0,9) 3,6 (±1,9) A 4,4 (±1,6) A A p<0,05 compared to 1st year students
B p<0,05 compared to Lithuanians
C p<0,05 compared to scores before studies
Investigation of gender differences when it comes to the knowledge about contraceptives
Results showed that females have a higher knowledge about contraceptives compared to females. A significant difference was found between the 6th year females and male students. Although among the 1st year students’ results did not show a significant difference, but female had slightly higher knowledge compared to the males. Results are shown in Table 11.
Table 11: Average (standard deviation) of knowledge scores
Females Males
All 1st 6th All 1st 6th
Knowledge scores before studies 4,67 (±1,74) 4,54 (±1,50) 5,35 (±2,09) 4,81 (±1,80) 4,44 (±1,5) 4,77 (±1,93) Knowledge scores during
studies 7,35 (±2,27) B,C 5,17 (±1,27) C 9,12 (±0,98) A,B,C 6,40 (±2,12) C 5,0 (±1,38) C 8,47 (±1,01) A A p<0,05 compared to 1st year students
B p<0,05 compared to males
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DISCUSSION OF THE RESULTS
The purpose of this study was to evaluate and compare 1st and 6th year student’s knowledge about contraceptives. This study was focused on how much knowledge the students have about different contraceptive methods, and how much knowledge that was gained during the years of their medical studies. This study shows that, even though the student’s have gained knowledge about contraceptives during their medical studies, the withdrawal is still being used. One could think that 1st year students are using the withdrawal method due to their lack of knowledge, but it is worrying when 33.3% (Lithuanian) and 40% (international) of the 6th year students still are choosing this method as an option. What else is worrying is that 13.3% of the 6th year students are not using any contraceptives at all.
Comparing to other studies that have been done in Lithuania, we can find similar results. One of the studies showed that 13% of the student’s used the withdrawal method and 8.1% did not use any contraceptive method at all. [1]
In a study made in Greece, results showed that medical students lacked knowledge about contraceptives, and that most of the students did now use any contraceptive method at all. [8]
Although, results of this study shows that contraceptives such as condoms and oral contraceptives are well known among both 1st and 6th year students, and these contraceptive methods are being used the most.
Similar results were found in a study that has been made in Lithuania (Kaunas), the study showed that 72.5% used condoms as a contraceptive method. [1] A similar study in Bulgaria showed that 72.6% uses condoms as a contraceptive method. [16]
This study shows that the usage of oral contraceptives is 43.3%-73.3%, which means that this method is being used more in this compared to other similar studies done in Lithuania [1], and Bulgaria. In the similar study that was done in Bulgaria, results showed that 5.9% of the medical students uses oral contraceptives. [16]
From this study we can understand that females have more knowledge about contraceptives compared to males. A similar study that was done in the United States showed the same results, that women had a higher knowledge about contraceptives. [20]
22 In order to increase the knowledge among the students even more, an option would be to provide an elective course about contraceptives, perhaps in 3rd year, and make sure that all students are provided with useful sexual and contraception education during younger ages. It is important to emphasize that the behavior of the students does not need to be due to lack of knowledge only, but also ignorance and being nonchalant when it comes to proper usage of contraceptives.
CONCLUSIONS
1. After comparing 2 scores investigating the knowledge of contraceptives the students had when they first started their medical studies, and about to finish. We can conclude that there was a significant increase in knowledge about contraceptives among the students.
2. Condoms and oral contraceptives were the most popular and commonly used contraceptives among the students. How ever many students are still using the withdrawal method, which means that students might need to improve their knowledge about contraceptives even more. 3. This study showed that the Lithuanian students would wish to have a separate course about
contraceptives during their medical studies. While the majority of international students stated that they were satisfied with their amount of knowledge without the need of a separate course. 4. This study showed a significant difference among female and male students when it comes to
knowledge about contraceptives. This study concludes that female students have more knowledge about contraceptives compared to male students.
23
PRACTICAL RECOMMENDATIONS
Since the topic of contraception is a very important topic and plays a major role in every student’s life, the university could arrange an elective just about contraceptives. If possible gynecologists could also arrange one counseling hour every other week. This could provide the students with beneficial knowledge and information about contraceptives if needed.
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LITERATURE LIST
1. Cerniauskiene M, Bernotaite M, Abraitis V, Nadisauskiene R. Students' Sexual Behavior and Knowledge about Sexual Education in Lithuania's City of Kaunas. Journal of Contraceptive Studies [Internet]. 2016 [cited 2 February 2016];. Available from:
http://contraceptivestudies.imedpub.com/students-sexual-behavior-and-knowledge-about-sexual-education-in-lithuanias-city-of-kaunas.php?aid=8198#1
2. Hogmark S, Klingberg-Allvin M, Gemzell-Danielsson K, Ohlsson H, Essen B. Medical students' knowledge, attitudes and perceptions towards contraceptive use and counselling: a cross-sectional survey in Maharashtra, India. BMJ Open [Internet]. 2013 [cited 5 December
2015];3(12):e003739-e003739. Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3863118/
3. Baseviciene I, Sumskas L. Use of contraceptives among adolescent girls and its relation with the Chlamydia trachomatis infection. Medicina (Kaunas, Lithuania) [Internet]. 2003 [cited 24
November 2015];40(10):997-1003. Available from:
http://europepmc.org/abstract/med/15516825
4. Ajah L, Onubogu E, Anozie O, Lawani L, Iyoke C, Onwe E et al. Adolescent reproductive health challenges among schoolgirls in southeast Nigeria: role of knowledge of menstrual pattern and contraceptive adherence. Patient Preference and Adherence [Internet]. 2015 [cited 3
December 2015];:1219. Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4556251/?report=reader%20http://www.macrot hink.org/journal/index.php/jsr/article/viewFile/2311/1936
5. Gazibara T, Trajkovic G, Kurtagic I, Kovacevic N, Nurkovic S, Kisic-Tepavcevic D et al. What Do Male Medical Students Know about the Pill? Study of Knowledge and Attitudes at the University of Belgrade. Gynecologic and Obstetric Investigation [Internet]. 2013 [cited 7
December 2015];75(4):224-229. Available from:
http://www.ncbi.nlm.nih.gov.ezproxy.dbazes.lsmuni.lt:2048/pubmed/23571223
6. Kajić M, Tomić V, Martinac M, Mikulić-Kajić M, Orlović M. Medical students' attitudes towards contraception. Psychiatr Danube [Internet]. 2015 [cited 25 November 2015];Dec(27 Suppl 2):590-2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26657987
7. Dinas K, Hatzipantelis E, Mavromatidis G, Zepiridis L, Tzafettas J. Knowledge and practice of contraception among Greek female medical students. The European Journal of Contraception & Reproductive Health Care [Internet]. 2008 [cited 5 December 2015];13(1):77-82. Available from: http://www.tandfonline.com/doi/abs/10.1080/13625180701577114?journalCode=iejc20
8. Edwards J, Oldman A, Smith L, McQuay H, Moore R. Women's knowledge of, and attitudes to, contraceptive effectiveness and adverse health effects. Journal of Family Planning and Reproductive Health Care [Internet]. 2000 [cited 28 November 2015];26(2):73-80. Available
from: http://jfprhc.bmj.com/content/26/2/73.abstract
9. Duru C, Iwu A, Diwe K, Uwakwe K, Merenu I, Emerole C et al. Sexual Behaviour, Contraceptive Knowledge and UseamongFemale Undergraduates in Tertiary Institutions in Imo State, Nigeria. American Journal of Medical Sciences and Medicine [Internet]. 2015 [cited 10 February 2016];3(5):61-66. Available from: http://pubs.sciepub.com/ajmsm/3/5/1/
25 10. Somba M, Mbonile M, Obure J, Mahande M. Sexual behaviour, contraceptive knowledge and use among female undergraduates’ students of Muhimbili and Dar es Salaam Universities, Tanzania: a cross-sectional study. BMC Women's Health [Internet]. 2014 [cited 30 November
2015];14(1):94. Available from:
http://bmcwomenshealth.biomedcentral.com/articles/10.1186/1472-6874-14-94
11. Hogmark S, Klingberg-Allvin M, Gemzell-Danielsson K, Ohlsson H, Essen B. Medical students' knowledge, attitudes and perceptions towards contraceptive use and counselling: a cross-sectional survey in Maharashtra, India. BMJ Open [Internet]. 2013 [cited 23 November
2015];3(12):e003739-e003739. Available from:
http://bmjopen.bmj.com/content/3/12/e003739.abstract
12. Renjhen P, Kumar A, Pattanshetty S, Sagir A, Samarasinghe C. A study on knowledge, attitude and practice of contraception among college students in Sikkim, India. Journal of the Turkish German Gynecological Association [Internet]. 2010 [cited 4 December 2015];11(2):78-81. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3939094/ 13. Ajmal F, Agha A, Zareen N, Karim M. Knowledge, attitudes and practices (KAP) regarding
sexuality, sexual behaviors and contraceptives among college/university students in Karachi, Pakistan. Journal of the College of Physicians and Surgeons Pakistan [Internet]. 2011 [cited 7
December 2015];21(3):164-8. Available from:
http://ecommons.aku.edu/pakistan_fhs_mc_radiol/5
14. Blidaru I, Furau G, Socolov D. Female Romanian university students’ attitudes and perceptions about contraception and motherhood. The European Journal of Contraception & Reproductive Health Care [Internet]. 2015 [cited 8 January 2016];21(1):39-48. Available from:
http://www.tandfonline.com/doi/abs/10.3109/13625187.2015.1066495?journalCode=iejc20
15. Pekhlivanov B, Malinova M, Dimitrakova E. [Contraception among female students in Medical University of Plovdiv]. Akusherstvo i ginekologiia [Internet]. 2008 [cited 8 January 2016];48(1):28-31. Available from: http://europepmc.org/abstract/med/19496461 16. Pătrașcu A, Gogănău A, Dumitrescu M, Iovan R, Damian C, Cotoi C et al. A study on medical
students of knowledge regarding contraception. [Internet]. 2013 [cited 6 December 2015];Vol. 9(Issue 2). Available from: http://gineco.eu/index.php/arhiv/203 17. Schrager S, Hoffmann S. Women's knowledge of commonly used contraceptive methods. -
PubMed - NCBI [Internet]. Ncbi.nlm.nih.gov. 2016 [cited 9 December 2015]. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/19180871
18. Gazibara T e. Oral contraceptives usage patterns: study of knowledge, attitudes and experience in Belgrade female medical students. - PubMed - NCBI [Internet]. Ncbi.nlm.nih.gov. 2016 [cited 11 December 2015]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23677419 19. Daniel D, Gabbur N. A Survey of Contraception Knowledge Among Incoming Interns and
Medical Students. Obstetrics & Gynecology [Internet]. 2014 [cited 17 December
2015];123:17S. Available from:
http://journals.lww.com/greenjournal/pages/articleviewer.aspx?year=2014&issue=05001&artic le=00033&type=abstract
26 20. Hagan J, Buxton C. Contraceptive Knowledge, Perceptions and Use among Adolescents in Selected Senior High Schools in the Central Region of Ghana. JSR [Internet]. 2012 [cited 25 January 2016];3(2). Available from: http://dx.doi.org/10.5296/jsr.v3i2.2311 21. Rowen T, Smith J, Eisenberg M, Breyer B, Drey E, Shindel A. Contraceptive usage patterns in
North American medical students. Contraception [Internet]. 2011 [cited 5 October 2015];83(5):459-465. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21477690
22. Mutha A. A Knowledge, Attitudes and Practices Survey regarding Sex, Contraception and Sexually Transmitted Diseases among Commerce College Students in Mumbai. JCDR [Internet]. 2014 [cited 5 October 2015];. Available from:
27
ANNEXES
28
Comparing the knowledge of contraceptives between 1
stand 6
thyear student
questionnaire
My name is Mona Miran and I am doing my thesis in Gynecology department about contraceptives, where I am going to compare the knowledge of contraceptives between first and sixth year students. I would be glad if I could take a few minutes of your time to answer few simple questions. J
1. Gender
[ ] Male [ ] Female 2. How old are you?
[ ] 17-25 [ ] 25-30 [ ] >30 3. Which year are you currently studying?
[ ] 1st [ ] 6th
4. Did you have any sexual education in primary school? [ ] Yes [ ] No
5. If you answered yes in the previous question, did it help? [ ] Yes [ ] No
6. When did you first get to know about contraceptives? [ ] Primary school
[ ] High School
[ ] I have knowledge about contraceptives due to own interest (Internet, books, etc.) [ ] I have knowledge about contraceptives from visiting a gynecologist, midwife or a GP
(General practitioner)
7. How much knowledge would say that you had about contraceptives before you started your medical studies? (1-Poor knowledge, 10- Excellent knowledge)
29 8. Would you wish to have a separate course only about contraceptives during your medical
studies? [ ] Yes [ ] No
[ ] I don’t care
[ ] My knowledge about contraceptives are already enough
9. Please mark the boxes for the contraceptives that you have never heard about: [ ] Condoms [ ] Diaphragms [ ] Oral contraceptives [ ] Implants [ ] Injections [ ] Patches
[ ] IUDs (Intrauterine devices) [ ] Emergency contraceptive pill [ ] Withdrawal method
10. Please mark the boxes for the contraceptive that you have used/tried: [ ] Condoms [ ] Diaphragms [ ] Oral contraceptives [ ] Implants [ ] Injections [ ] Patches
[ ] IUDs (Intrauterine devices) [ ] Emergency contraceptive pill [ ] Withdrawal method
[ ] I don’t use contraceptives (Go to question 10!)
11. What was your experience about it? [ ] Good
[ ] Bad
[ ] I would wish to try another form of contraceptive [ ] I don’t like contraceptives
12. From a scale 1-10, how much would you say that your knowledge about contraceptives are right now? (After you started your medical studies)
