Browsing by Author "Ouma, Collins"

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Assessing the application of adapted theory of planned behaviour in predicting postpartum family planning intentions in a pragmatic randomized control trial in Western Kenya
(PLoS One, 2025-02-06) Shisanya, Morris Senghor; Kipmerewo, Mary; Everlyne Morema; Ouma, Collins
Introduction In developing countries like Kenya, addressing the high population growth rate necessitates a focus on early Postpartum Family Planning (PPFP) use. Despite the critical need for PPFP, few researchers explore the application of health behaviour change theories to enhance FP use among postpartum women. This study assesses the application of adapted Theory of Planned Behaviour (TPB) in predicting intention for early PPFP in postpartum women in Western Kenya. Methods This randomized control trial included pregnant women aged 15 to 49 attending Antenatal Care (ANC) clinics, randomly assigned to the "Nurses’ arm," "Community arm," or "Control arm." The intervention provided family planning (FP) counseling. Trained nurses and Community Health Workers (CHW) delivered counseling in their respective arms, while the control arm received routine care. Adapted TPB was integrated into client exit interviews to identify constructs influencing early PPFP intentions. Structural equation modeling (SEM) was used to predict the intention for early PPFP in the adapted TPB. Results The SEM was optimized with the removal of client knowledge on early PPFP. The final model retained satisfaction with PPFP counseling, perceived normative beliefs, attitude towards PPFP, behaviour control of PPFP choice, and perceived risk of early postpartum pregnancy. Only satisfaction with counseling (P = 0.001), perceived normative beliefs (P<0.0001), attitude towards PPFP (P<0.0001), and behaviour control of PPFP choice (P = 0.018) significantly influenced early PPFP intention. Conclusion The study demonstrates a viable application of the adapted TPB model in predicting early PPFP intention in an interventional study.
Influence of Antenatal Family Planning Counselling on Attitude Towards Early Postpartum Family Planning: A Randomised Controlled Trial in Kenya
(East Africa Health Research Journal, 2025-06-09) Shisanya, Morris Senghor; Kipmerewo, Mary; Morema, Everlyne Nyanchera; Ouma, Collins
to understand the diverse aspects influencing women’s attitudes towards early PPFP to address them effectively. There is a lack of comparative studies on the effectiveness of interventions to improve attitudes towards early PPFP. Bridging this gap is vital for evidence-based FP promotion and better maternal and child health outcomes. This study, therefore, compared attitudes toward early PPFP across nurse-led, community-based, and routine ANC groups. Methods: The study was a randomised control trial conducted in Kisumu County among pregnant women. Three arms were established: nurses’ and community interventions and a control. Sample size was determined based on expected differences in contraceptive use postpartum. Multistage sampling involving purposive, cluster, and simple random sampling was used. The intervention involved providing antenatal information on postpartum family planning (PPFP) using a mobile phone-based tool. Attitudes towards PPFP were measured using Likert scales and analysed through ANOVA. The study aimed to assess the impact of interventions on attitudes towards early PPFP. Results: Most participants (96.4%) had a positive attitude towards early PPFP, though some factors were linked to reduced positivity. Higher education (OR 0.6, 95% CI, 0.4 to 0.9, P=.026), comorbidity (OR 0.2, 95% CI, 0.1 to 0.6, P=.006), and longer counselling waiting and turnaround times (OR 0.9, 95% CI, 0.8–1.0, P=.059) and (OR: 0.9, 95% CI: 0.9 to 1.0, P=.032) were associated with more negative attitudes, while good perceived health increased positivity (OR 3.1, 95% CI, 1.0 to 9.2, P=.043). There was no significant difference in attitude between study arms (F (2,243) =3.0, P=.053). Conclusion: The study found a generally positive attitude towards early PPFP among participants, but no significant difference in attitude between intervention and control arms. Negative attitudes were associated with comorbidities, longer waiting times, and counselling turnaround times. The study recommends improvements in counselling quality by optimising waiting and turnaround times.
Measuring the Effect of Different Modes of Mobile Phone-Based Antenatal Family Planning Counseling on the Intention for Early Postpartum Family Planning Uptake in Western Kenya: A Pragmatic Factorial Randomized Control Trial
(Ethiopian Journal of Reproductive Health (EJRH), 2025-01-24) Shisanya, Morris Senghor; Kipmerewo, Mary; Morema, Everlyne; Ouma, Collins
INTRODUCTION: The Maternal and Child Health care continuum offers a key opportunity to integrate postpartum family planning (PPFP) interventions, particularly through antenatal counseling. This study assessed the impact of mobile phone-based antenatal family planning counseling on the intention for early PPFP among postpartum mothers in Western Kenya. METHODOLOGY: This pragmatic factorial randomized controlled trial assessed the effectiveness of family planning counseling delivered by nurses and community health workers using a mobile phone-based tool, compared to routine counseling, on the intention for early postpartum family planning among postpartum mothers in Kisumu County, Western Kenya. Ordinal regression identified predictors of intention, while ANOVA evaluated the effectiveness of counseling modalities, with significance set at P < 0.05. Tukey’s post hoc test and partial eta² were used to determine differences between study arms and effect size, respectively. RESULTS: The mean intention for early PPFP on a 7-point Likert scale was 6.59±0.87 for the nurses’ arm, 6.05±0.86 for the community arm, and 6.03±0.69 for the control arm. ANOVA revealed a significant difference in mean intention scores between the arms (F(2,243)=12.43, P<0.0001). Tukey’s post hoc test showed significantly higher mean intention in the nurses’ arm compared to both the community (P<0.0001) and control arms (P<0.0001) with a medium effect size (partial eta² = 0.06 to <0.14). The combined mean intention for the two intervention arms (6.22±0.85) was significantly higher than the control arm (P=0.012) with a small effect size (partial eta² = 0.026). There was no significant difference between the community and control arms (P=0.986).CONCLUSION: Mobile phone-based antenatal family planning counseling by nurses was more effective in increasing intention for early postpartum family planning for participants in Kisumu County compared to community-based and routine delivery of counseling. Therefore, more efforts should be directed toward empowering nurses with mobile phone-based antenatal family planning counseling tools to enhance intention for early postpartum family planning.