Accurate measurement of contraceptive knowledge among medical students remains a critical challenge due to limitations of traditional assessment tools. This study aimed to develop and validate the Clinical Contraceptive Knowledge Test (CCKT) using a modern psychometric framework. A cross-sectional multicenter study was conducted among undergraduate medical students in Vietnam (723 recruited; 636 retained for analysis). The instrument was developed through four sequential phases: (1) Item generation based on Bloom’s taxonomy and WHO Medical Eligibility Criteria (MEC), (2) expert review for content validity, (3) pilot testing using Classical Test Theory, and (4) large-scale validation using Item Response Theory (IRT). A two-parameter logistic (2PL) IRT model was applied to evaluate item characteristics, dimensionality, and measurement precision. The final instrument, CCKT-18, demonstrated strong psychometric performance. A unidimensional 2PL model was retained based on comparable fit to multidimensional models and high inter-factor correlations (r > 0.80). Model fit indices indicated good fit (CFI = 0.983, TLI = 0.980, RMSEA = 0.036, SRMR = 0.039). The scale showed high measurement precision across a broad range of ability levels, with peak information around the average proficiency level (marginal reliability = 0.844). Model fit and item parameters were stable in sensitivity analyses (ΔCFI = 0.003), supporting structural robustness. DIF analyses supported measurement invariance across sex, although several items demonstrated DIF across the training stage. The CCKT-18 demonstrated strong initial validity, reliability, and structural robustness for assessing contraceptive knowledge among medical students. Its IRT-based framework enables precise, competency-oriented evaluation and provides actionable insights for targeted curriculum improvement in reproductive health education.
Unintended pregnancy disproportionately affects young women living rurally. Inconsistent and ineffective contraceptive use contributes to this. To date, no published studies have explored young women’s views regarding contraceptive choice and decision-making in rural Australia. This qualitative study aimed to explore how young women in rural New South Wales, Australia, choose methods of contraception and to improve understanding of what factors influence these decisions when initiating and continuing contraception. Eighteen semi-structured online interviews were conducted, with one participant per interview, aged 17–23 years, across rural New South Wales using the Health Belief Model as a framework. Reflexive thematic analysis was used to analyse the data. The decision to initiate contraception typically followed a health threat: risk of an unintended pregnancy, a menstrual cycle disorder, sexually transmitted infections and/or acne. Choice of contraception was impacted by contraceptive familiarity and knowledge, accessibility to healthcare providers, relationship status, affordability, self-efficacy and non-contraceptive benefits. Additionally, contraceptive decision-making was influenced by medical advice, peer and family experiences and particularly, social media content. As a young woman’s personal circumstances change, contraceptive choice may also change, and it is important to re-evaluate these health needs. In rural areas, young women’s contraceptive choice is impacted by limited provider access, confidentiality concerns in close-knit communities, and logistical and financial barriers. These rural specific challenges contribute to reliance on self-managed methods and decision-making is often influenced by external opinions, particularly from social media. Increasing access to telehealth, local service information, and trustworthy online resources may support informed use. Further research could explore how rurality influences contraceptive attitudes, especially following unintended pregnancy, declining hormonal contraceptive use, and disparities in sexual health education to inform equitable health strategies.
A dual prevention pill (DPP) for co-delivery of pregnancy and HIV prevention is currently in development and will offer an alternative to taking two separate products. We examined behavioral, interpersonal partnership, social, and structural correlates of preferences for an over-encapsulated DPP (as a proxy for the co-formulated product under development/testing, consisting of oral contraceptive pill and oral HIV prevention pre-exposure prophylaxis (PrEP) pill) among women and adolescent girls in South Africa and Zimbabwe to inform DPP introduction and counseling strategies. This secondary analysis used data from two clinical crossover trials that compared the acceptability, adherence, and preference for the over-encapsulated DPP versus separate PrEP and oral contraceptives. HIV-negative, non-pregnant cisgender women were enrolled in Johannesburg, South Africa (n = 96, ages 18–40) and Harare, Zimbabwe (n = 30, ages 16–24). Participants were randomized 1:1 to use either DPP or two separate pills for three 28-day cycles, then switched. Preferences were measured at the end of crossover and via exit in-depth interviews. The mean age was 27 years in South Africa and 19 years for Zimbabwe. Most participants had completed secondary school, while childbearing experience was more common in Zimbabwe (97
Family planning, also known as contraception, is a cost-effective method that allows individuals and families globally to have control over the number of children they desire and space in between. In Nigeria, contraceptive prevalence remains low. However, factors shaping contraceptive use in Nigeria, around women’s lived experiences, cultural negotiations, and informal strategies around modern contraception, remain poorly understood. To explore women’s perspectives and experiences with modern contraceptive use, as well as the facilitators and barriers influencing the use of modern contraception. The study employed a focused ethnographic methodology developed by Roper and Shapira. Data were collected using purposive and snowball sampling through 21 in-depth interviews, two focus group discussions with 13 women, and 189 h of participant observation. Data analysis followed the approach described by Roper and Shapira. Three main themes were generated using the relationships and expectations and cultural empowerment domains of the PEN-3 cultural model: Perceptions, Nurturers, and Positive Factors. The findings under the theme of Perceptions revealed that women’s lack of awareness and knowledge of contraception limited access to and use of contraception. In addition, several locally accepted contraception myths increased fear and discouraged women from using contraceptives. Women also narrated unpleasant side effects of contraception as a factor that discouraged contraceptive use. Findings under the theme of Nurturers showed that religion was both a positive and a negative nurturer that encouraged and limited contraceptive use. In addition, polygamy, desire for more children, and Intergenerational cultural beliefs were found to be negative nurturers that limited women’s access to contraception. Finally, under the Positive theme, education was found to positively contribute to appropriate understanding and use of contraception. In addition, due to the challenging state of the Nigerian economy, women resort to contraceptive use to lessen the financial burden of unplanned pregnancies and children. Contraceptive use in Nigeria is shaped by multidimensional factors, including medical, cultural, religious, and social factors. Therefore, further studies are needed to identify approaches that promote tailored interventions to improve uptake and advance the achievement of SDG 3.7.1.
Assisted reproductive technology (ART) encompasses a range of fertility treatments involving the manipulation of oocytes, sperm, or embryos, while in vitro fertilization (IVF) is one specific form of ART. Although IVF utilization is increasing globally, evidence regarding perinatal outcomes following IVF remains limited in Ethiopia, particularly in resource-constrained settings. To determine the proportion of favorable and unfavorable perinatal outcomes and identify factors associated with unfavorable perinatal outcomes among reproductive-age women who conceived through in vitro fertilization (IVF) and delivered at Saint Paul Hospital, Addis Ababa, Ethiopia. A retrospective record review was conducted among reproductive-age women who conceived following IVF and delivered at Saint Paul Hospital, Addis Ababa, Ethiopia, between July 29, 2019, and December 30, 2023. A total of 422 eligible women were included, data were collected using structured questionnaires and document review and telephone interviews. Data analysis was performed using Epi Data Version 4.6 and STATA Version 14, with multiple binary logistic regression applied as the final model. Variables meeting the prespecified criterion in bivariable analysis were entered into the multivariable model, and adjusted odds ratios (AORs) with 95
