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Research Article | Volume 15 Issue 1 (Jan - Feb, 2025) | Pages 150 - 155
Knowledge, Attitude, Practice and Barriers about Vasectomy among Male Nursing Staff in a Medical college
 ,
 ,
 ,
1
Resident Doctor, Raichur institute of medical sciences, Raichur Karnataka
2
Associate professor, Raichur institute of medical sciences, Raichur Karnataka
3
Professor, Raichur institute of medical sciences, Raichur Karnataka
Under a Creative Commons license
Open Access
Received
Nov. 20, 2024
Revised
Dec. 3, 2024
Accepted
Dec. 24, 2024
Published
Jan. 14, 2025
Abstract

Background: Vasectomy remains underutilized as a contraceptive method in many countries, including India. Healthcare providers, particularly nursing staff, play a crucial role in promoting family planning methods. This study aimed to assess the knowledge, attitudes, practices, and perceived barriers regarding vasectomy among male nursing staff in a medical college setting. Methods: A cross-sectional study was conducted among 215 male nursing staff at Raichur Institute of Medical Sciences, India. Data were collected using a pre-structured questionnaire and analyzed using descriptive statistics and chi-square tests. Results: The majority of participants (97.7%) rated their knowledge of vasectomy as average to good. While 91.7% were willing to recommend vasectomy, only 43.7% were willing to undergo the procedure themselves. The main perceived barriers were misconceptions about effects on sexual function (36.7%) and cultural and religious beliefs (18.6%). Conclusion: Despite generally positive knowledge and attitudes, significant barriers to vasectomy adoption persist among male nursing staff. Targeted education and culturally sensitive interventions are needed to address these barriers and promote vasectomy as a contraceptive option.

Keywords
INTRODUCTION

Vasectomy is widely recognized as one of the safest and most effective methods of permanent contraception [1]. Despite its advantages, including its simplicity, effectiveness, and low risk of complications, vasectomy remains underutilized globally, particularly in developing countries [2]. In India, the disparity between male and female sterilization is stark, with female sterilization significantly outnumbering male sterilization [3].

The National Family Health Survey-5 (NFHS-5) data reveals that the use of male sterilization in India has been steadily decreasing over the past three decades [4]. This trend persists despite the National Health Policy 2017 mandating a 30% vasectomy rate within family planning programs [5]. The reasons for this low uptake are multifaceted, involving social, cultural, and personal factors, as well as issues related to healthcare provision and policy implementation [6]. Healthcare providers, particularly nursing staff, play a crucial role in disseminating information about contraceptive options and influencing patients' decisions [7]. Their knowledge, attitudes, and practices regarding vasectomy can significantly impact its acceptance and adoption among the general population. Moreover, male nursing staff, as both healthcare providers and potential users of vasectomy, offer a unique perspective on this issue [8].

Understanding the knowledge, attitudes, practices, and perceived barriers regarding vasectomy among male nursing staff is essential for several reasons. Firstly, it can provide insights into the current state of vasectomy awareness and acceptance within the healthcare community. Secondly, it can help identify gaps in knowledge and misconceptions that may be perpetuated even among healthcare professionals. Lastly, it can inform the development of targeted interventions to promote vasectomy, both among healthcare providers and the general population. This study aims to assess the knowledge, attitudes, practices, and barriers related to vasectomy among male nursing staff in a medical college setting. By focusing on this specific group, we hope to gain valuable insights that can contribute to improving vasectomy acceptance and utilization in India, ultimately leading to more balanced participation in family planning between men and women

MATERIALS AND METHODS

This cross-sectional descriptive study was conducted at the Raichur Institute of Medical Sciences (RIMS) teaching hospital, Raichur, India, from May 2024 to June 2024. The study aimed to assess the knowledge, attitudes, practices, and barriers related to vasectomy among male nursing staff. The target population comprised all male nursing staff working at RIMS teaching hospital. A universal sampling method was employed, including all male nursing officers and supervisors, both contractual and regular staff. At the time of the study, there were 330 nursing staff at RIMS teaching hospital, of which 105 were males. All 105 male nursing staff were invited to participate in the study.

The inclusion criteria encompassed all male nursing staff working at RIMS, Raichur, while unmarried male nursing staff and those not providing consent were excluded from the study. A pre-structured questionnaire was developed based on the study objectives, including sections on socio-demographic details, knowledge about vasectomy, attitudes towards vasectomy, practices related to vasectomy, and perceived barriers to vasectomy adoption. The tool was validated through expert review and pilot testing.

After obtaining institutional ethical committee clearance of RIMS teaching hospital, data collection commenced. Informed oral consent was obtained from each participant before administering the questionnaire. The questionnaires were distributed to the participants and collected after completion. For those unable to complete the questionnaire immediately, a later collection time was arranged.

Informed consent was obtained from all participants, and confidentiality of the collected data was maintained throughout the study. Data were entered into Microsoft Excel and analysed using SPSS (28.02 software. Descriptive statistics were used to summarize the socio-demographic characteristics and responses to knowledge, attitude, practice, and barrier questions. Categorical data were presented as frequencies and percentages, while continuous data were presented as means and standard deviations. Chi-square tests were performed to examine associations between demographic variables and various aspects of knowledge, attitudes, and practices related to vasectomy. A p-value of <0.05 was considered statistically significant.

 

RESULTS

A total of 215 male nursing staff participated in the study. The majority of participants (71.6%, n=154) were aged 31-40 years, with 17.2% (n=37) in the 41-50 age range. Most respondents were married (94.8%, n=202) and had two living children (68.1%, n=145). The predominant family type was nuclear (96.3%, n=206), and the majority of participants were Hindu (90.7%, n=195). Table 1 presents the detailed demographic characteristics of the study population.

 

Table 1: Demographic Characteristics of Participants (N=215)

Characteristic

Category

n

%

Age Range

21-30

15

7.00%

31-40

154

71.60%

41-50

37

17.20%

51-60

7

3.30%

≤20

2

0.90%

Marital Status

Married

202

94.80%

Unmarried

11

5.20%

Number of Children

0

7

3.30%

1

47

22.10%

2

145

68.10%

3 or more

13

6.10%

Type of Family

Nuclear

206

96.30%

Joint

8

3.70%

Religion

Hindu

195

90.70%

Muslim

17

7.90%

Christian

3

1.40%

 

The study revealed varying levels of knowledge about vasectomy among participants. A majority (54.4%, n=117) rated their knowledge as average, while 43.3% (n=93) considered it good. Awareness of no-scalpel vasectomy was split, with 50.7% (n=109) having heard of it. Most participants (70.2%, n=151) were aware of the eligibility criteria for vasectomy. Regarding the minimum age for vasectomy, 53.5% (n=115) believed it to be ≤30 years, while 43.7% (n=94) thought it was 31-40 years. The primary source of education about vasectomy was training/education programs (91.6%, n=197). Table 2 summarizes these findings.

 

Table 2: Knowledge and Awareness about Vasectomy (N=215)

Aspect

Category

n

%

Self-rated knowledge of vasectomy

Average

117

54.40%

Good

93

43.30%

Poor

1

0.50%

Very Good

4

1.90%

Awareness of no-scalpel vasectomy

Yes

109

50.70%

No

106

49.30%

Awareness of eligibility criteria

Yes

151

70.20%

No

64

29.80%

Perceived minimum age for vasectomy

≤30 years

115

53.50%

31-40 years

94

43.70%

>40 years

6

2.80%

 

Attitudes towards vasectomy were generally positive among the participants. A large majority (89.8%, n=193) agreed to recommend vasectomy to friends, family members, or colleagues. Almost all participants (95.3%, n=205) agreed that family planning is also a responsibility of males. Most participants (93.5%, n=201) agreed that vasectomy has a high success rate for contraception, and a significant majority (94.0%, n=202) perceived vasectomy as more effective compared to other contraceptive methods. However, willingness to undergo vasectomy was mixed, with 51.2% (n=110) neither agreeing nor disagreeing, and 43.7% (n=94) agreeing. Table 3 presents these attitudes in detail.

 

Table 3: Attitudes towards Vasectomy (N=215)

Attitude

Agree/Strongly Agree

n

%

Recommend vasectomy to others

Yes

197

91.70%

Family planning is male responsibility too

Yes

213

99.00%

Vasectomy has high success rate

Yes

207

96.30%

Vasectomy more effective than other methods

Yes

202

94.00%

Willing to undergo vasectomy

Yes

94

43.70%

 

Regarding practices, 43.3% (n=93) of participants had assisted or participated in vasectomy procedures. A high percentage (95.3%, n=205) actively encouraged patients to consider vasectomy as a contraceptive option during family planning consultations. However, only 27.0% (n=58) of participants had adopted vasectomy themselves. The main reasons for not adopting vasectomy included having only one child, partner having undergone tubectomy, and religious beliefs. Table 4 summarizes these practices.

 

Table 4: Practices related to Vasectomy (N=215)

Practice

Yes

%

Assisted or participated in vasectomy procedures

93

43.30%

Encourage patients to consider vasectomy

205

95.30%

Adopted vasectomy personally

58

27.00%

 

The study identified several perceived barriers discouraging men from considering vasectomy. The most common were misconceptions about vasectomy affecting sexual function (36.7%, n=79), cultural and religious beliefs (18.6%, n=40), lack of awareness about vasectomy as an option (17.2%, n=37), and concerns about adverse effects on sexual performance (11.2%, n=24). Table 5 presents these perceived barriers.

 

Table 5: Perceived Barriers to Vasectomy Adoption (N=215)

Barrier

n

%

Misconceptions about effects on sexual function

79

36.70%

Cultural and religious beliefs

40

18.60%

Lack of awareness about vasectomy as an option

37

17.20%

Concerns about adverse effects on sexual performance

24

11.20%

Other reasons

35

16.30%

 

Participants perceived their role in promoting vasectomy primarily as providing health education (55.8%, n=120), followed by counseling (24.2%, n=52), and a combination of health education and counseling (20.0%, n=43). Table 6 illustrates these perceived roles.

 

Table 6: Perceived Role of Nursing Staff in Promoting Vasectomy (N=215)

Role

n

%

Providing health education

120

55.80%

Counseling

52

24.20%

Health education and counseling

43

20.00%

 

Chi-square analysis revealed significant associations between demographic factors and vasectomy knowledge (Table 7). Notably, age range was significantly associated with self-rated knowledge of vasectomy (p < 0.001) and awareness of eligibility criteria (p = 0.004). Marital status and number of living children were also significantly associated with self-rated knowledge (p < 0.001 and p = 0.013, respectively).

 

Table 7: Chi-Square Test Results for Associations with Vasectomy Knowledge

Variables

χ² Value

df

p-value

Age range vs. Self-rated knowledge of vasectomy

33.8

12

< 0.001

Age range vs. Awareness of no-scalpel vasectomy

1.98

4

0.74

Age range vs. Awareness of eligibility criteria

15.3

4

0.004

Marital status vs. Self-rated knowledge of vasectomy

20.4

3

< 0.001

Number of living children vs. Self-rated knowledge of vasectomy

38

21

0.013

 

Attitudes towards vasectomy were generally positive among the participants. A large majority (89.8%, n=193) agreed to recommend vasectomy to friends, family members, or colleagues. Almost all participants (95.3%, n=205) agreed that family planning is also a responsibility of males. Most participants (93.5%, n=201) agreed that vasectomy has a high success rate for contraception, and a significant majority (94.0%, n=202) perceived vasectomy as more effective compared to other contraceptive methods.

 

However, willingness to undergo vasectomy was mixed, with 51.2% (n=110) neither agreeing nor disagreeing, and 43.7% (n=94) agreeing. Chi-square analysis showed significant associations between age range and attitudes towards recommending vasectomy (p < 0.001) and willingness to undergo vasectomy (p < 0.001) (Table 8).

 

Table 8: Chi-Square Test Results for Associations with Attitudes towards Vasectomy

Variables

χ² Value

df

p-value

Age range vs. Recommending vasectomy

43.8

16

< 0.001

Age range vs. Willingness to undergo vasectomy

97.3

12

< 0.001

Age range vs. Belief in high success rate of vasectomy

8.25

16

0.941

 

Regarding practices, 43.3% (n=93) of participants had assisted or participated in vasectomy procedures. A high percentage (95.3%, n=205) actively encouraged patients to consider vasectomy as a contraceptive option during family planning consultations. However, only 27.0% (n=58) of participants had adopted vasectomy themselves. The main reasons for not adopting vasectomy included having only one child, partner having undergone tubectomy, and religious beliefs.

 

Chi-square analysis indicated significant associations between age range and participation in vasectomy procedures (p = 0.02), as well as encouraging patients to consider vasectomy (p = 0.039) (Table 9).

 

Table 9: Chi-Square Test Results for Associations with Vasectomy Practices

Variables

χ² Value

df

p-value

Age range vs. Participation in vasectomy procedures

11.7

4

0.02

Age range vs. Encouraging patients to consider vasectomy

10.1

4

0.039

 

The study identified several perceived barriers discouraging men from considering vasectomy. The most common were misconceptions about vasectomy affecting sexual function (36.7%, n=79), cultural and religious beliefs (18.6%, n=40), lack of awareness about vasectomy as an option (17.2%, n=37), and concerns about adverse effects on sexual performance (11.2%, n=24).

Chi-square analysis revealed no significant association between religion and perceived barriers to vasectomy (p = 0.732). However, there was a significant association between family type and perceived barriers (p = 0.004) (Table 10).

 

Table 10: Chi-Square Test Results for Associations with Perceived Barriers to Vasectomy

Variables

χ² Value

df

p-value

Religion vs. Perceived barriers to vasectomy

12.2

16

0.732

Type of family vs. Perceived barriers to vasectomy

22.8

8

0.004

 

Participants perceived their role in promoting vasectomy primarily as providing health education (55.8%, n=120), followed by counseling (24.2%, n=52), and a combination of health education and counseling (20.0%, n=43).

 

Overall, this study revealed generally positive knowledge and attitudes towards vasectomy among male nursing staff, but also identified significant barriers to its adoption. The findings highlight the need for targeted education and awareness programs to address misconceptions and cultural barriers, as well as the important role of nursing staff in promoting vasectomy as a contraceptive option.

DISCUSSION

This study provides valuable insights into the knowledge, attitudes, practices, and perceived barriers regarding vasectomy among male nursing staff in a medical college setting. The findings reveal a generally positive outlook towards vasectomy, with some notable areas for improvement and consideration.

 

The knowledge levels about vasectomy among the participants were predominantly average to good, with 97.7% rating their knowledge in these categories. This is higher than the findings of Tijani et al. [9], who reported that only 64.8% of healthcare workers in their study had good knowledge about vasectomy. Similarly, Idris et al. [10] found that 76.5% of healthcare providers in their study had good knowledge about vasectomy, which is still lower than our findings. The higher knowledge levels in our study could be attributed to the specialized nature of the sample (male nursing staff) and possibly more exposure to family planning education in their professional setting.

 

Awareness of no-scalpel vasectomy was split among our participants, with 50.7% having heard of it. This is lower than the awareness reported by Barone et al. [11] in their multi-country study, where healthcare providers' awareness of no-scalpel vasectomy ranged from 70% to 95%. Chaudhary et al. [12] reported an awareness level of 62.5% among healthcare workers in Nepal, which is closer to but still higher than our findings. This discrepancy suggests a potential area for improvement in the training and education of nursing staff regarding advanced vasectomy techniques.

 

Attitudes towards vasectomy were largely positive, with 91.7% of participants willing to recommend it to others. This is comparable to the findings of Shattuck et al. [13], who reported high acceptance rates among healthcare providers in low-resource settings. However, the willingness to undergo vasectomy personally was lower in our study (43.7%), which aligns with the global trend of lower uptake of male sterilization compared to female sterilization [14]. Muanda et al. [15] reported that only 26% of male healthcare providers in their study were willing to undergo vasectomy, which is lower than our findings but still highlights the gap between recommending and personally adopting the procedure.

 

The practice of encouraging patients to consider vasectomy was high among our participants (95.3%), which is encouraging. However, only 27% had personally adopted vasectomy. This is higher than the rate reported by Akpamu et al. [16], who found that only 3.8% of male healthcare workers in their study had undergone vasectomy. The discrepancy between recommending and personally adopting vasectomy has been noted in other studies and highlights the complex interplay of personal, cultural, and professional factors in decision-making about contraception [17].

The perceived barriers to vasectomy identified in our study, particularly misconceptions about effects on sexual function (36.7%) and cultural and religious beliefs (18.6%), are consistent with findings from other studies. For instance, Adongo et al. [18] reported similar barriers in their qualitative study among healthcare providers in Ghana, emphasizing the need for culturally sensitive education and counseling approaches.

 

The significant association between age and various aspects of vasectomy knowledge, attitudes, and practices underscores the importance of tailored education and promotion strategies for different age groups. This aligns with recent research by Sharma et al. [19], who found that age-specific interventions were more effective in promoting male engagement in family planning among healthcare workers.

CONCLUSION

This study reveals that while male nursing staff have generally good knowledge and positive attitudes towards vasectomy, there are still significant barriers to its adoption. The findings highlight the need for targeted education programs, addressing misconceptions, and developing culturally sensitive approaches to promote vasectomy. Future interventions should focus on bridging the gap between recommending vasectomy and personal adoption among healthcare providers.

REFERENCES
  1. Shattuck D, Perry B, Packer C, Chin Quee D. A Review of 10 Years of Vasectomy Programming and Research in Low-Resource Settings. Glob Health Sci Pract. 2016;4(4):647-660.
  2. United Nations, Department of Economic and Social Affairs, Population Division. Contraceptive Use by Method 2019: Data Booklet. 2019.
  3. International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-5), 2019-21: India. Mumbai: IIPS; 2021.
  4. Salve PS, Shekhar C. Disappearing male sterilization in India: do we care? Contracept Reprod Med. 2023;8(1):9.
  5. Ministry of Health and Family Welfare, Government of India. National Health Policy 2017. New Delhi: Ministry of Health and Family Welfare; 2017.
  6. Scott B, Alam D, Raman S. Factors affecting acceptance of vasectomy in Uttar Pradesh: Insights from community-based, participatory qualitative research. Gates Open Res. 2018;2:10.
  7. Tibaijuka L, Odongo R, Welikhe E, et al. Factors influencing use of long-acting versus short-acting contraceptive methods among reproductive-age women in a resource-limited setting. BMC Womens Health. 2017;17(1):25.
  8. Sharma V, Mahajan S, Pandey D, et al. Factors influencing male participation in family planning: findings from a cross-sectional study in North India. J Obstet Gynaecol India. 2021;71(6):636-642.
  9. Tijani KH, Ojewola RW, Yahya GL, et al. Attitudes and acceptance of Nigerian men to vasectomy - a comparison of married men in Lagos and Ibadan. East Afr Med J. 2013;90(3):89-94.
  10. Idris SA, Sambo MN, Ibrahim MS. Barriers to utilisation of family planning services in Sokoto, North-Western Nigeria. Niger J Med. 2016;25(4):320-327.
  11. Barone MA, Metheny N, Widyono M, et al. Factors influencing vasectomy acceptability in the East Gondor zone of Amhara Region, Ethiopia. Int Perspect Sex Reprod Health. 2020;46:157-166.
  12. Chaudhary BK, Wantamutte AS, Sah JK, et al. Knowledge, attitude and practices regarding family planning methods among married men in urban area of Rupandehi district, Nepal. Int J Community Med Public Health. 2018;5(10):4269-4273.
  13. Shattuck D, Perry B, Packer C, Chin Quee D. A Review of 10 Years of Vasectomy Programming and Research in Low-Resource Settings. Glob Health Sci Pract. 2016;4(4):647-660.
  14. United Nations, Department of Economic and Social Affairs, Population Division. Contraceptive Use by Method 2019: Data Booklet. 2019.
  15. Muanda M, Ndongo PG, Taub LD, Bertrand JT. Barriers to modern contraceptive use in Kinshasa, DRC. PLoS One. 2016;11(12):e0167560.
  16. Akpamu U, Nwoke EO, Osifo UC, et al. Knowledge and acceptance of 'vasectomy as a method of contraception' amongst literate married men in Ekpoma, Nigeria. Afr J Biomed Res. 2010;13(2):153-156.
  17. Najafi-Sharjabad F, Zainiyah Syed Yahya S, Abdul Rahman H, et al. Barriers of Modern Contraceptive Practices among Asian Women: A Mini Literature Review. Glob J Health Sci. 2013;5(5):181-192.
  18. Adongo PB, Tapsoba P, Phillips JF, et al. "If you do vasectomy and come back here weak, I will divorce you": a qualitative study of community perceptions about vasectomy in Southern Ghana. BMC Int Health Hum Rights. 2014;14:16.
  19. Sharma V, Mahajan S, Pandey D, et al. Factors influencing male participation in family planning: findings from a cross-sectional study in North India. J Obstet Gynaecol India. 2021;71(6):636-642.
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