@2024 Afarand., IRAN

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ISSN: 2383-2150    Journal of Education and Community Health 2014;1(1):55-61

Background
... [1-2]. There are several methods of family planning, including equipment and techniques that one can use them to prevent pregnancy. One of these methods is tubectomy or tubal ligation. This procedure is a permanent birth control method [3].
Previous Studies
... [4-9].A study in India showed that complications after tubal ligation are classified in three categories: issues related to menstruation, sexuality and depression. . Most mental disorders, which have been reported after tubal ligation involve anxiety, depression, irritability, fear, memory disorders, hysteria, and neurosis or mental illness stated in 15 to 20% of patients [7].... [10-11].
Aim(s)
This study aimed to estimate the impact of education in reducing the amount of depression in women with a history of tubal ligation operation.
Research type
This study is quasi -experimental intervention.
Research society, place and time
The study was done in 2012 over 80 women with a history of tubal ligation operation who had referred to health care centers in Kaboudarahang where one of the Hamedan’s suburbs is.
Sampling method and number
Using statistics relating to the number of tubectomy for women in health care centers and by taking into account the statistical confidence level of 95%, test power 90% at the level of type 1 error 5% and a minimum difference of about 0.3, a sample size of 40 patients in both intervention and control groups was considered. Among the health care centers in the city of Kaboudarahang, two health centers were taken as an intervention group and as a control group and 40 patients were randomly selected in each group from the list of family planning offices of these centers and they were enrolled . The two groups were matched according to age, education level and employment status. Entry requirement for patients involved, passing at least 6 months from tubectomy operation, no acute problem within the last month, residency in the city of Kabodarahang, being interested in answering questions and participating in the study.
Used devices&materials
In this study, two kinds of questionnaires: the demographic questionnaires consisting 11 questions and GHQ-28 General Health Questionnaire were used. The questionnaire includes four indicators of somatic symptom, anxiety and insomnia, social dysfunction and depression that each one was scored by 7 questions and four options. In this scoring methodology, earning a higher score was indicator of the possibility of psychological disorders among the study participants. Internal correlation coefficient of the questions for different aspects of the questionnaire has been reported by Noorbala and Palahang between 0.82 and 0.93. Mental health level of two groups in form of pretest was assessedby using GHQ-28 questionnaire. Then the women participating in the intervention group received four sessions of the training program within two months. In this meetings, teaching lecture strategies and question and answer sessions as face-to-face and group work was used. Depending on people’s questions, almost every session lasted 30 minutes. The content of educational programs that has been offered included life skills, tubal ligation and its results, stress management, problem and anger-solving and, self-awareness and so on. 2 months after the educational of both intervention and control groups, were given them after test, to determine the effectiveness of educational intervention on the promotion and reduction of depression symptoms among women. Statistical analysis: Data analysis had been performed using SPSS version 18 software, in this study, independent t test, Mann-Whitney, chi-square, Fisher's exact test, covariance (ANCOVA) and Pearson correlation coefficient were used. The significance level for all tests was less than 0.05.
Findings by Text
In the study participants, age was between 27 and 47 years with the mean of 36.7 ± 4.2, and most people (67.5%) were in the age range 35 to 45 years old. However, the mean age in the intervention group was 37.75 and in the control group was 35.67 that according to the independent t-test, the difference between the two groups was statistically significant (p=0.023). Therefore, comparison of mental health and its components between the intervention and control groups was performed by controlling age variable. Table 1 shows the demographic characteristics of the study's participants. Based on chi-square test and Fisher's exact test there were no significant differences in terms of educational level, employment status, spouse's job and his educational level and the amount of income before the study between two groups (intervention and control) (p>0.05). With respect to the number of boys and girls, Mann-Whitney nonparametric test was used and the number of children in both groups had the same distribution (p>0.05).In addition, the total score on mental health and its components using independent t-test showed there wasn’t a significant difference between intervention and control groups before educational intervention.(p>0.05). The results of the study in case of mental health score changes before and after the intervention (by controlling the effect of age) have been presented in Table 2. Results show that difference in mental health score between two groups after intervention that this issue implies that the effect of education on the mental health promotion, among women’s group is considerable (p<0.001, F=355.1). This means that the mean score of mental health in the intervention group has reached from 29.85 to 15.23 after the training. while there was no significant difference before training. However, in the control group even mental health status of women has worsened. According to the findings presented in Table 3, changes in mean scores before and after the study, in somatic symptoms, anxiety and insomnia, social dysfunction and depression in the intervention and control groups were statistically significant(p<0.001). In other words, the difference between the intervention and control groups was not significant before the intervention, but after intervention, the difference was statistically significant. In other variables, based on the results, no significant relationship was seen between the age and age of the spouse with any indicators of mental health and depression. While there was statistically significant relation between the education of participants and the education of their spouse with mental health indicators (p<0.05). It was found that physical symptoms, impaired social functioning, anxiety and insomnia among employees were better while mental health mean scores in the self-employed was higher than other professional groups. In all parameters, the mean score of mental health was higher among unemployment group and this group had the worse condition for all mental health parameters compared to the other groups. The situation was the same in people who had unemployed husbands. The mean scores of the all mental health parameters were lower in mothers with no girl; and this group of mothers were better in terms of mental health indicators. In all four parameters (somatic symptoms, social dysfunction, anxiety and insomnia, and depression), the mean score of mental health of the mother of two daughters and more, was higher and this group of mothers had worse situation for all mental health and depression parameters compared to other groups. The difference in mean scores of all parameters in the groups were significant and mothers having more daughters had the highest amount of depression (p<0.05). The mean of all indicators (somatic symptoms, social dysfunction, anxiety and insomnia) were higher in the group of mothers without sons; and this group of women in have been worse in terms of mental health indicators.
Main comparison to the similar studies
… [12, 13] Offered training could reduce the amount of depression in women significantly. The study showed that 100% of women had better improvement after the intervention in the form of training, compared to the control group. The findings of this study is consistent with the study of Nikkhooi et al. [14] that aimed to investigate the effect of counseling on reducing depression after vasectomy and tubal ligation. In addition, the other studies in this domain, have reported similar gains to the results of this study[12]. ... [15-17].
Suggestions
It is recommended to provide training courses and counseling in the form of a tracking system after sterilization, that will greatly prevent the expansion of mental disorders that come after sterilization.
Limitations
About the limitations of this study, the lack of access to women because of their lack of familiarity with training courses can be noted.
Conclusions
The results of this study confirm the importance of education in improving the mental health of women with a history of tubal ligation.
Acknowledgments
The authors thank and appreciate for the sincere cooperation of the staff and the women who had referred to health centers of Kabudrahang city.
Conflict of interest
Non-declared
Ethical Permissions
All participants were assured that all questionnaires, while maintaining confidentiality, would be gathered together for statistical analysis. Participants were enrolled in the study with the informed consent. This study was approved by the ethics committee of Tehran University of Medical Sciences. For observing ethical considerations for the control group, the training course the same as those for intervention group was held for them after the post-test
Funding Sources
This research is a part of a master's thesis in health education major approved by Tehran University of Medical Sciences.

TABLES and CHARTS

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