University Malaysia Sarawak

Faculty of Medicine and Health Science

Bachelor Degree in Nursing

2010

Course code: MDJ 3293 Research

Title: Research proposal

Knowledge, attitude and practice of oral contraceptive pills among women

tenants at reproductive age in Wisma Hopoh

Name: Jessica Goh Sing Fong

Matrix Number: 18624

Course coordinator: Dr. Sidiah John Siop

Supervisor: Madam Rose Nanju

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Introduction

Oral contraceptive pills are combined oral contraceptives that suppresses ovulation

by the combination action of hormones estrogens and progesterone (MedicineNet,

2009). Nowadays, different type of oral contraceptive pills are available in the

market with different trade name such as Marvelon, Mercilon, Loette, Yasmin etc

The instructions of taking one pill daily are the same for all types of oral

contraceptives in the market.

In a qualitative study by Williamson L.M, Parkes A., Wight D., Petticrew M. and

Hart G.J (2009) who did their study on developing country such as africa, thailand,

malaysia and indonesia, they found out that 90 percent of abortion related and 20

percent of pregnancy related morbidity and mortality along with 32 percent of

maternal deaths could be prevented by the usage of effective contraceptive. Thus,

family planning is very important and oral contraceptive pills serves as one of the

effective methods to prevent unwanted pregnancy.

Although oral contraceptive pills had proved to be saved and effective, however, a

lot of Malaysian women never try it. This could be due to poor knowledge

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dissemination both from health educator and mass media. Besides, there are also

women who took the oral contraceptive pills, but never understand the action,

contents, instruction and so forth which will leads to misuse and wastage.

Consequence, I would like to conduct a research which will focus on identifying the

level of knowledge, practice and attitude among women tenants of reproductive age

towards oral contraceptive pills and I choose my research setting in Wisma Hopoh.

Wisma Hopoh is located in the centre of the kuching city, at Jalan P. Ramlee, 93400

Kuching, Sarawak.

Background of the problem

Most of the crime such as teenage pregnancy, abortion, throw baby away cases

involved young women especially teenager and has become a growing epidemic

social issues in Malaysia. A few incidents was reported, for instance, the incident of

dead baby found in drain in wet market, Stutong Kuching happened in March, 2010

(TheBorneoPost, 2010), teen pregnant four time since 12 years old (TheStar, 2009),

one abortion in every five pregnancy (TheStar, 2009) etc. Consequences of this

problems leads to teenage dropped out from school, causing them not able to get

appropriate education. Apart from that, they will also suffer from social stigma such

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as abandoned by the family, teasing from peers, who will cause them emotional and

psychological disturbed, and when the symptoms prolonged may lead to mental

illness such as schizophrenia. Besides, it will also cause this youngster to involve in

other social issues such as drug addiction, have multiple partners which will leads to

sexual transmitted disease (STD), crime like become sexual worker and so forth. All

of these social issues leads to economy retardation as female teenage who will turn

into women later are the asset of the country. Thus, preventing pregnancy is very

crucial.

Oral contraceptives pills were given free in government polyclinic. However, there

are still women who either took or doesn't took the pills claimed they have poor

knowledge about oral contraceptive pills. However, there were no study designed to

understand the level of knowledge, attitude and practice of women tenants at

reproductive age in Wisma Hopoh regarding oral contraceptive pills.

Statement of the problem

Despite of Malaysia government policies to encounter social issues such as

unintended pregnancy, abortion and teenage pregnancy. However, there are still

tragedy happened elsewhere in Malaysia and some may not be reported. All this

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while, oral contraceptive pills are one of the family planning methods in controlling

number of children by couple. However, due to lack of knowledge and information

about the usage of emergency contraceptive pills, some women still get pregnant

even though they are on oral contraceptive pills. Community nowadays was also not

adequately exposing to sexual and reproductive health education as our society is

conservative where even parents does not share their sex knowledge to their children.

Besides, our society have the mindset that when government encourage teenager to

use oral contraceptive pills, this as if they encourage youngster to involve themselves

in sexual activity as community always tagged oral contraceptive pills with sexually

active and married women only.

Thus, contraception decision made with little or no experience may bring lifelong

consequences as gap between knowledge and practice regarding contraception

remains unanswerable.

Research questions

This study was designed to answer the following question:

1. What is the level of understanding of women tenants at reproductive age in

Wisma Hopoh about oral contraceptive pills?

2. What is the practice of oral contraceptive pills among women tenants at

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 reproductive age in Wisma Hopoh?

3. What are the attitudes of women tenants at reproductive age in Wisma Hopoh

about oral contraceptive pills?

4. What are the relationships between Socio demographic data and women

tenants at reproductive age in Wisma Hopoh’s knowledge about knowledge,

attitude and practice on oral contraceptive pills?

Objectives

1. To assess the level of understanding of women tenants at reproductive age in

Wisma Hopoh about oral contraceptive pills?

2. To determine the practice of oral contraceptive pills among women tenants at

reproductive age in Wisma Hopoh.

3. To identify the attitudes of women tenants at reproductive age in Wisma

Hopoh about oral contraceptive pills.

4. To explore the relationships between Socio demographic data and women

tenants at reproductive age in Wisma Hopoh’s knowledge about knowledge,

attitude and practice on oral contraceptive pills.

Significance of the research

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This research will hope to benefit the health care provider regarding the level of

knowledge, attitude and practice of women in Wisma Hopoh to obtain the baseline

data for further evaluation of the oral contraceptive usage. It will also help to set

target group that will benefit the government policy to supply more contraceptive

method prefer by women to the community to decrease unneeded wastage as oral

contraceptive pills are given free in government polyclinic and hospital. In addition,

this research will also explore women source of information regarding oral

contraceptive pills so that publicity of information regarding oral contraceptive pills

will be enhance to benefit the society which may lead to unintended pregnancy and

abortion prevention. Furthermore, this research can also contribute to compare oral

contraceptive pills with other contraceptive method in term of cost, availability, and

others as oral contraceptive pills are known to be the cheapest compare to other

modern contraceptive method.

Operational Definition of term

Oral contraceptive pills were defined as birth control pills by MedicineNet, 2009.

Based on this definition, I defined the term “oral contraceptive pills” as one of the

family planning method to prevent pregnancy, controlling size of the family, and a

medicine to reduce women fertility. Several issues will be focus in this study such as

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knowledge, attitude and practice of emergency contraceptive pills.

Knowledge regarding emergency contraceptive pills in this research will refers to the

fact or state of knowing of women tenants at reproductive age in Wisma Hopoh, in

term of different area about oral contraceptive pills, the side effect, benefits, usage,

pharmacology, content, where to obtain the pills, indication, contraindication of oral

contraceptive pills etc. This knowledge will help women in correctly use oral

contraceptive pills to prevent pregnancy.

Practice regarding oral contraceptive pills refers to a habit or custom of women

tenants at reproductive age in Wisma Hopoh regardless it is right or wrong about oral

contraceptive pills. The practice will include the assessment on experience using oral

contraceptive pills, reasons why women tenants at reproductive age in Wisma Hopoh

choose oral reproductive pills as the family planning method, and correct oral

contraceptive pills usage. Right practice contribute to the effectiveness of the drug

while misuse cause wastage and social issues.

Attitude regarding oral contraceptive pills refers to a manner, a disposition, feeling

and position regarding oral contraceptive pills in term of their acceptance, concern

about the side effect of oral contraceptive pills, discuss with partner about oral

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contraceptive pills etc. Attitude can be also categorized as positive or negative which

related to the fact of the issues.

Women tenants at reproductive age in Wisma Hopoh will be define as all women

including the supportive staff who already achieve their puberty, have all the years

that can conceive a child until the onset of menopause who working for more than 6

months in Wisma Hopoh. These are the criteria of women that will be included in the

sampling of this research.

Literature review

Oral contraceptive was widely used globally after the revolution of oral

contraceptive starts on October 15, 1950 when laboratory of Syntax Mexico City

succeeded in producing Norenthindrone, an orally active progestagen with an

activity eight times greater than naturally occurring progesterone (Peter H. P. 1998).

While in Malaysia, there are no information regarding when actually family planning

include oral contraceptive pills as one of the contraception method.

Oral contraception was reported predominant among unmarried Canadian women

aged between 15 to 17 years old, most of the married women in Malaysia, majority

of Women in Mukalla Yemen (54.2%), and women in turky (55.7%)( Fisher W.A.,

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Black A. 2007, Population Reference Bureau, 2006 , Jones R. K., Fennell J., Higgins

J. A. and Blanchard K., 2009, Baser M., Mucuk S. Bayraktar E., et al, 2009). A

study done by Joseph J.S., Ravenholt R.T., Mary E.I., 1989, who did their study on

acceptability of oral contraceptive pills mentioned that oral contraceptive pills are

popular during 1970-an in Malaysia as about 90 percent of all family planning

acceptor in Malaysia use the pills. Another study done by Ismail, M.T.M.; Kwa, S.K.,

1990, further proove the widespread of oral contraceptive pill as it registered 72 to

75% of the overall contraceptive usage ever since it was introduced in Malaysia and

it is still popular choice of contraception method until today as according to the

statistic done by Population Reference Bureau, 2006, oral contraceptive pills are still

most common used form of reversible birth control method in Malaysia. In contrast,

in india, oral pills was not popular among the women as only 3.87 % of women were

reported practicing it ( Suneeta M., Anupama B., Sharman J.B., 2007)

However, there are still a lot of unintended pregnancy, abortion, throw baby cases

happened regardless there are so many modern contraceptive method such as oral

contraceptive pills availabe at the market. According to a study done by Suneeta

Suneeta M., Anupama B., Sharman J.B., 2007, they stated that a very high number

(59.9%) of women in India had unplanned pregnancy while 43.3% of them had

pregnancy due to failure of contraceptive. High prevalence of this social issues also

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reported in Malaysia. It was reported in 2007 that one baby is abandoned every ten

days in Kuala Lumpur (Ang E. S., 2007, Adolescent health). From 2001 to 2004, the

Social Welfare Department recorded 315 cases of abandoned babies, while police

statistics revealed about 100 cases a year (Ang E. S., 2007, Adolescent health).

Oral contraceptive pills are controversial subject, either in global world or in

Malaysia. A study conducted in Kelantan by B Norsa’adah, B N Rusli, A K Imran, I

Naing, T Winn, 2005, detected a significant association between oral contraceptive

use and breast cancer, consistent with another local study by Lokman et al. However,

another recently study mentioned that in a long term, women who used oral

contraception had a significantly lower rate of death from any cause, including heart

disease and all cancers, compared with women who had never taken it (Philip H.,

2010).

Knowledge, practice and attitude are related and influence each other, either one of

this element if left out will cause pregnancy. Thus, by identifying the level of

knowledge, practice and attitude of women towards oral contraceptive pills, further

management can be done to decrease social issues such as teenage pregnancy,

unintended pregnancy and abortions.

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Methodology

Research design

This study will be conducted by using the cross-sectional descriptive quantitative

research design where researcher will find out the relationship between the

independent variables such as socio-demographic data and dependent variable like

knowledge, attitude and practice of oral contraceptive pills by women in Wisma

Hopoh. Source of information to formulate questions about oral contraceptive pills

was base on literature by other researchers.

Population and sampling

Population in Wisma Hopoh was reported 136 tenants and nerly 80 percent of the

tenants are female in 2009. This study was conducted in Wisma Hopoh which is

located in the centre of the kuching city, at Jalan P. Ramlee, 93400 Kuching,

Sarawak. Wisma Hopoh was located opposite to Radio Television Malaysia (RTM)

building and Sarawak Red Crescent Society headquarter was located beside Wisma

Hopoh. This shopping complex was operated since 1980. Female tenants in Wisma

Hopoh were selected as the population of study because of social perception about

the size of the family was put under women responsibilities. The sample of this study

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will be involved as many as I can but a minimum of 50 participants must be

obtained.

Wisma Hopoh was chosen as the setting of the research was due to its high

consistency of women tenant working in that shopping complex. Besides, the place

was also known to have a lot of female tenant misuse the oral contraceptive pills and

reported social cases like abortion and teenage pregnancy.

i) Inclusive criteria

Only female tenants at reproductive age that had working in any shop in Wisma

Hopoh for more than 6 month will be included as respondent in this study. This is

due to the fact that the objectives of this research are to look into women knowledge,

practice and attitude regarding oral contraceptive pill. In other word, I would like to

look into women experience in using oral contraceptive pills rather than women

limitation factor which influence women selection in family planning method. This

research does not limit to women marital status, age, household income and

occupation.

ii) Exclusive criteria

Based on the randomly selection sampling method, male are excluded and those

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women who refuse to answer the questionnaire will not be included in this study.

Instruments

This research will be conducted by using questionnaire contain 34 questions to

determine the relationship between socio demographic feature and knowledge,

attitude and practice of oral contraceptive pills by women in Wisma Hopoh. Socio

demographic characteristic in section one will include age, working period, religion,

race, marital status, level of education; number of living children, staying either in

rural or urban area, occupation and monthly household income while there will be 13

questions regarding knowledge of oral contraceptive pills in section 2, 8 questions

about attitude in section 3, and 5 questions about practice in section 4. The reasons

why socio demographic feature was consider in this study is because of the literature

review that had proved that women's background and family status will influence

women's knowledge, attitude and practice of oral contraceptive pills as the three

element are influencing with each other.

Section 2, which related to knowledge of participants will need candidate to choose

only the best answer from question 9 to 12. The following question in section 2, from

question 13 to 21 is a multiple choice question and thus respondent can thick (√)

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more than one answer. All the questions here were adapted from several resources

which include “Birth Control pills” from University of Rochester, “patients’

knowledge of emergency contraception” by Emergency contraception audit kit, the

University of Hull, May 1996. Women's knowledge will be assess as knowledge is

the key point to the correct practice of oral contraceptive pills which can prevent

unintended pregnancy.

In section 3, question 22 is a multiple choice question whereas question from 23 to

28 which covering the attitude of oral contraceptive pills will require participants to

answer “yes” or “no” on the questions. Attitudes towards the usage of oral

contraceptive pills will be assess as it determine the effectiveness of pregnancy

prevention. Even if the women have good knowledge about oral contraceptive pills

but with poor attitude, unintended pregnancy will still take place.

In section 4, question 29 required candidate to answer “yes” or “no” on question “do

you ever take any oral contraceptive pills?”, the rest of the question from 30 to 34 is

a multiple choice question regarding practice on oral contraceptive pills. Practice of

oral contraceptive pills will be assess to determine the correct usage of the pills.

Score for each question on knowledge and practice will be determine based on the

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most accuracy of the answer given by participants which range from 1 to 5 points for

each question. In addition, attitude questions will be evaluated as positive or negative

for related question.

3. Data collection

A minimum number of 50 women out of the total population in Wisma Hopoh will

be randomly selected as evaluation in this study. Self administered questionnaire

containing 34 questioned will be distribute to participants. Women who participate in

this study will be informed orally about the research and written consent will be

obtained. Respondents are given 2 days to answer the questionnaire and they are

required to leave their contact number. If participants have any doubt, she can

contact my phone number or if possible I will be by her side to clarify their doubt. A

box will be located at the Wisma Hopoh's manager office and respondent are require

to put the answered questionnaire to the box.

Pilot Study

Pilot study will also conduct at Wisma Saberkas, another shopping complex in

Kuching, to ensure the validity of the questions to be answered by the participants.

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Before running the pilot test, a sample of questionnaire will be submitted to prior

evaluation by reviewer who was the investigator with experience in women health

care research and in knowledge and practice survey methodology. While conducting

the pilot test, participant’s personal data such as name and identification number will

not be obtained to ensure anonymity and each questionnaire will be identified by

numbers.

Data analysis

Data collected will be analysing by using Statistical Package of Social Science

(SPSS) version 17.0 for Windows version. The descriptive statistic generated

demographic and women knowledge, attitude and practice about oral contraceptive

variables. Chi square test will be carried out to compare mean difference between

independent and dependent variables. An alpha level of P less than 0.05 or equal will

be considered statistically significant for all analysis. Besides, Microsoft Excel

software will also be used in the process of converting the data collected into table,

graft or figure form. Regarding the score obtained by participants, it will be

perceived as participants have good knowledge, attitude and practice when they

obtained higher score. However, if the score were not satisfactory, it does not means

that the participant is poor in every section regarding knowledge, attitude and

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practice of oral contraceptive method as all the sources are independent.

Limitation

Limitation of this study is on the population itself where the result of the research

can only reflect on the knowledge, practice and attitude of oral contraceptive user of

the population in Wisma Hopoh, but not in wide scale like Kuching city due to time

constriction and resources limitation.

Besides, there are also no previous study on knowledge, attitude and practice of

contraceptive method conducted in Kuching or even in Malaysia, making it hard to

formulate questionnaire as many questions were adapted from western context that

have to be modified to suit the local practice.

There will be hardship to distribute the questionnaire as to the respondent as some of

them cannot read and understand Malay. Thus, the questionnaire has to translate to

other language in order for them to answer the questionnaire. In addition, the women

tenants may have to answer the questionnaire during recess time this will cause

distress to the respondents as they have only two hour of recess time that is between

12pm to 2pm and this will further cause them refuse to answer the questionnaire.

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Reference:

Adinma J.I.b, Nwosu B.O., 2005, Family planning knowledge and practice among
Nigerian women attending an antenatal clinic, retrieved on April 8, 2010
from http://www.springerlink.com/content/k22527w275715211/

Barrett J. and Buckley C., 2007, Constrained Contraceptive Choice: IUD Prevalence
in Uzbekistan, International Family Planning Perspectives, 2007, 33(2):50–
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BorneoPostOnline, 2010, Women charged with murdering own baby, retrieved on

April 8, 2010, from http://www.theborneopost.com/?p=18188

Epigee, 2010, types of birth control, retrieved on January 23, 2010 from
http://www.epigee.org/types-birth-control.html

Fisher W.A, Black A., 2007, Contraception in Canada: a review of method choices,
characteristics, adherence and approaches to counselling, Canadian Med
Assoc. ,2007;176(7):953-61

Glasier A., Ketting E., Palan V.T., 1996, “Case studies in Emergency Contraception
from six country”, volume 22, Number 2,

Izatun S., Tan A., and Raman A., 2009, Teen pregnant four times since 2007
retrieved on April 8, 2010 from http://thestar.com.my/news/story.asp?
file=/2009/10/8/nation/4861519&sec=nation

Ng C. Y., Zulkiflia. R., 2009, one abortion for every five pregnancies, says survey
retrieved on April 8, 2010 from http://thestar.com.my/news/story.asp?
file=/2009/5/26/nation/3977852&sec=nation

Peter H.P., 1998, the stalled Revolution of Contraception, Discrete Dynamic in

Nature and Society, Vol. 3., Pg. 185-193.

Williamson L.M., Parkes A. Wight D., Petticrew M. and Hart G.J., 2009, Limits to
modern contraceptive use among young women in developing countries: a
systematic review of qualitative research retrieved on February 19, 2010 from
http://www.reproductive-health-journal.com/content/6/1/3

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Wong Y. M., 1994, Benefits beyond contraception with oral contraceptive pills
retrieved on April 8, 2010 from http://www.cornerstone-
msc.net/new_mps/html/CPEforumVol1Issue.pdf

Ang E. S., 2007, Adolescent health, Paper presented at the National Population

Conference, 3-5 July 2007, Kuala Lumpur, Malaysia

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