The Effect of Health Promotion Education Program on Reproductive Health Knowledge Attitudes and Practices (KAP) Among Reproductive Age Women in Rural Palestinian Community

The current study aimed at evaluating the effect of health promotion education program on reproductive health knowledge, attitudes and practices among reproductive age women in rural Palestinian community in Gaza and northern and southern regions of the West Bank area. To achieve our goals a specially designed questionnaire was prepared and the study was conducted at two phases. The first phase was carried out prior to the intervention of the health promotion educational program and the second was carried out after this intervention program. The study was conducted during the period 2001-2002. Data was collected through personal interview with the targeted groups and included 1,347 women (743 first phase and 604-second phase). In the pre phase, Gaza region was represented by 107 (14.4%) women while the southern and northern regions were represented by 291 (39.2%) and 345 (46.4%) cases, respectively. The sample was selected using simple random stratified method and the data was analyzed using the software SPSS (Statistical Package for Social Sciences). Similar age mean was found among the participants in both phases (29.9 year, for pre intervention and 30.3 for post phase). It was found that 55.2% were less than 18 years of age among the first phase group and the rate of 57.3% among the second group. This indicates a high percentage of early marriage in the rural areas and the mean age at marriage among both groups was 18.8 years. The findings of the study also showed a very low level of education in these areas as the average number of years of education was 7.83 and 8.84 for the pre and post intervention groups, respectively. It was also found that 93% of the study population in both phases did not exceed the secondary stage of education. The findings of the study showed a very low level of knowledge with respect to postnatal health care and it seems that the health promotion educational program did not improve knowledge in this field. Attitudes were highly positive and improvements in practices were also noted with the exception of practices concerning routine checkup of new the born. With respect to family planning issue, noticeable improvements was observed among the second phase participants, however, low level of knowledge concerning the concept of family planning was observed among both study groups (below 50%). Higher levels of positive attitudes with respect to use of family planning methods were observed among the first phase group (75.9%) compared to the second phase group (72.2%) indicating a limited use of family planning methods and this is also clear from the findings on number of pregnant women during the study period (79.3% and 78.1%) for pre and post phases, respectively. With respect to availability of family planning services, 93% (post phase) and 64.1% (pre phase) reported easy access to such services. Low level of improvement was observed with respect to knowledge concerning sexually transmitted infections among participants of the second phase as 90% were unable to recognize disease symptoms, 85% were unable to provide two examples of such diseases, 70% did no know preventive methods and 50% were unable to name three organs of the female reproductive system. Practices in this field seem to be acceptable among both study groups. With respect to regional differences, low knowledge levels were observed with respect to postnatal care in all regions, while highly positive attitudes were reported in the various regions concerning all studied variables in this field. This was very clear in Gaza region with respect to giving birth in hospitals (61.6% pre; 86.1% post), however, both the northern (90% pre; 84.8% post) and southern regions (89% pre; 83.1% post) showed low levels of positive attitudes towards giving birth in hospitals under medical care. Improvement in practices in this field was reported in all studied regions. Low knowledge levels concerning family planning was found in Gaza with respect to all studied variables among participant of the second phase and levels did not exceed 52%. Attitudes were highly positive in all regions. The findings also indicates improvements in practices concerning family planning and the highest reported rates of use of family planning methods was found among participants of northern region of the West Bank and lowest levels were reported by participants from Gaza region. This was evident form the number of children under the age of five years as the northern region was with the lowest mean value compared to the other two regions. Low knowledge levels were also found among participants from Gaza region with respect to sexually transmitted infections as only 3.7% were able to identify symptoms associated with such diseases. Improvement among second phase participants in the southern region was noted especially with respect to the need of treating affected partners, organs of female reproductive system, however limited knowledge was observed concerning other tested variables. With respect to attitudes towards sexually transmitted infections, highly positive attitudes were noted in all studied regions. Practices in this field were within acceptable levels in all regions. In general, these highly positive attitudes did not reflect on neither the poor practices nor the poor knowledge level in all studied regions and among both study groups. Although some improvements were observed in the post intervention group was found compared to the pre intervention phase of the educational program, the findings clearly indicate the need for further studies concerning priorities in health education programs.