Practice in Miami Beach Area towards Female Condoms - Research Paper Example

? Exploring The Knowledge, Attitude and Practice of Women in Miami Beach area towards Female Condoms Amy Williams PSY 496 name Date submitted ? Abstract The rapidly increasing concern about HIV / AIDS has fueled multiple attempts to prevent its spread. There are a number of contraceptive and protective options that are available specifically for women that attempt to empower them and enable them to enjoy safe sex. The female condom is one such option that offers protection from both unwanted pregnancies and STI’s (Beksinska, Joanis, Usher-Patel, & Potter, 2011). In spite of its proven efficacy, the female condom has not found much favor from users. This study has been designed to study the way women – the target audience for the female condom – conceptualize the product, understand its utility as well as the reasons why they may choose to use or not use it. The Miami Beach area was chosen as the ideal location to carry out this study given its population dynamics as well as activity level – indicators of casual sexual activity which is a significant contributor to STI and HIV spread. Although this study is primarily a qualitative study, it combines quantitative methods with the qualitative methods in a bid to gain more information about the target population. Keywords: Female Condom, Miami Beach, Knowledge, Attitude, Projected use ? Introduction This study shall cover a wide range of women – the target population for the use of female condoms – and attempt to understand the knowledge that these woman have about the female condom, the attitudes they hold about it, as well as the likelihood of them using the said female condom, along with their reasons for their choice. It was deemed necessary to understand the reasons that affect the use of the female condom in women; and those who reside in the Miami Beach area were considered for the study. This data should help us understand the concerns and problems faced by the women participating (Sue, Price, & Straker, 1998), and should also help extract any misconceptions that they may have about the use of a female condom. On the basis of this information, it would be possible to make estimations about the way the population thinks and feels about the use of the female condom, and conduct campaigns that address mistaken beliefs and also bring to light any use – related problems that need to be addressed by the manufacturers. While this study is predominantly a qualitative exploration of the knowledge, attitudes and likelihood of use of female condoms, it is believed that quantitative measures will add significantly to the value of the study. Thus, some research questions have been addressed using quantitative measures. The problem under research in this study is “To explore the knowledge, attitude and practice of women in Miami Beach towards the use of female condoms as a means of prevention of STIs”. Review of literature The issue of STI’s has been a cause for concern over the last decade, and continues to grow at alarming rates (Riveria, 2010). This issue has become a social as well as a medical issue, given the number of individuals who are either in need of treatment or at risk of infection. In spite of these high risks, individuals continue to indulge in high – risk behaviors like unprotected sex. The reason often put forth for woman sidestepping the issue of protection during sexual experiences is that the cultural requirement from women is to refrain from direct communication about sexual activity, especially with men. This cultural training often causes women to feel shy and not make demands from a sexual partner, particularly male partners. Contraception that is specially designed for female use is considered as an empowering tool that helps women take matters of their personal health into their own hands. The female condom is one such item that not only protects against unwanted pregnancies, but also acts as an effective barrier against a number of STI’s including HIV (Beksinska, Joanis, Usher-Patel, & Potter, 2011). Female condoms have been available to the public since the early 1990s and are available over the counter in all regions though not as easily as male condoms. The first female condom, which was called Reality, was approved by the FDA (Food and Drug Administration) in the U.S.A in 1993 and was manufactured by the Female Health Company for over-the-counter (O.T.C.) sale within the United States. The Reality Female Condom was a soft, strong, and loose-fitting polyurethane sheath, 7.98cm in diameter and 17cm in length and contains two flexible polyurethane rings. Most of the available female condoms, is also known as the ‘femidoms’ is either made of polyurethane plastic or nitrile (Beksinska, Joanis, Usher-Patel, & Potter, 2011). The material used in the sheath is a thin (0.05mm) but impermeable material with sturdy, heat-transfer characteristics. These materials are stronger than latex and thus, less likely to tear or break. Unlike the latex condoms, the female condom is not affected when oil-based lubricants are used. It can also withstand storage better than latex does. The efficacy of the female condom in preventing pregnancy has been clinically documented and it has been found to be nearly as effective as the male condom (Beksinska, Joanis, Usher-Patel, & Potter, 2011). The failure rate for the female condom is in the range of 5-21% over 12 months depending on care in use, while that for the male condom is 3-14%. With consistent and appropriate use of the female condom, the failure rate for female condoms is 5%, while with proper use failure rate is 2.1%. Breakage rates are extremely low though the slippage rate – the tendency of it to be pushed up into the vagina or slip out – is 5.6%. Clinical failure studies include breakage during sex, turning wholly or partially inside out, slipping entirely out, displacement of the outer ring or penetration outside the condom and have found that the female condom can offer up to 95% effectiveness. Laboratory research has shown the female condom to be impermeable to bacteria also to HIV; making it an effective tool to aid female empowerment as well as HIV prevention. The female condom is inserted in the vagina before sexual intercourse. It is a pouch shaped sheath wider than the male condom but about the same length. It contains a loose ring at the closed end of the condom that serves as an insertion mechanism and also keeps it in place during sex serving as an internal anchor. The larger ring, at the open end, is left outside the vagina. This provides protection to woman’s external genitalia and the base of the penis (Beksinska, Joanis, Usher-Patel, & Potter, 2011). Lule, Seifman, & David (2009) have documented the effects of the HIV / AIDS pandemic in Sub-Saharan Africa, and have described the related growth challenge for the region. According to them, nearly 12 million African children have been orphaned and 22.5 million people in Africa – 61% of them women are battling the condition on a daily basis. It is thus necessary to emphasize the use of effective methods to protect the public from this disease. A female condom is an example of an effective method of protection against infections along with unwanted pregnancies. The Miami Beach area is home to individuals from disparate backgrounds and ages, and provides multiple recreational activities that provide the opportunity for individuals to meet and interact. Such interactions increase the probability of casual or recreational sex; and thus, of the transmitting of STI’s and HIV. Recently, there has been a rise in the STI cases documented in this area; leading to concern about the extent of unsafe sexual practices (Riveria, 2010). Thus, this area was chosen as a valuable location to understand the factors that affect the use of protective measures during sex. ? Research Questions The study attempts to answer a number of questions that pertain to the knowledge about, attitudes towards and the likelihood of the use of female condoms. 1. To determine the knowledge and likelihood of practice exhibited by women in the Miami Beach area towards female condoms as a means of prevention of STIs by means of a semi structured interview. 2. To determine the attitude exhibited by women in the Miami Beach area towards female condoms as a means of prevention of STIs as measured using a Likert scale as described in Spizzichino, Pedone, Gattari, Luzi, Gallo, Valli and Rezza (2007). 3. To determine the difference in the attitudes towards the use of female condoms as a means of prevention of STIs by women above and below 35 years of age in the Miami Beach area using a Likert scale as described in Spizzichino, Pedone, Gattari, Luzi, Gallo, Valli and Rezza (2007). Variables Under Study The variables under study are: The knowledge exhibited by the women from the Miami Beach area towards female condoms used as a means of prevention of STIs The attitude exhibited by women in the Miami Beach area towards female condoms as a means of prevention of STIs The likelihood of use of female condoms exhibited by the women from the Miami Beach area in an attempt to prevent STIs Data Collection Procedures The data to address research question 1 will be collected and evaluated using qualitative techniques. The data shall be collected in the form of responses to a pre constructed semi structured interview. The interview questions shall be developed to extract data about the participant’s knowledge about The existence of the female condom, The efficacy of the female condom The availability of the female condom The ease of use of the female condom. Further questions will probe for the opinion of the participant about • The value – for – money of the female condom • The opinions of partners • The assumptions about the female condom • The need for protection from STI’s. This research question will provide data about the extent to which the target participants understand the importance of the female condom as a means to protect them from STI infections, and the likelihood of their using the same (Trochin, & Donnelly, 2008). The data collected will be from female participants only; and will be collected from all participants who are sexually active. The second research question shall be studied using numerical data; but the question is nevertheless part of a qualitative study as it does not compare groups or attempt to find relationships. This data shall be observed in an attempt to record the attitude of the women participants from the Miami Beach area toward the use of the female condom in general, as well as to find any specific trends that may exist in the data. This information, when combined with the analysis of the knowledge that the participants have about the use of a female condom as a means of preventing STI’s will help us understand how the target population views the subject, and what needs be done to improve the attitudes held and thus, increase the likelihood of the use of the female condoms by the participants. Collecting the data using a Likert scale helps in quantifying the overall attitude; and this information may be used later, to test changes in attitudes if promotion campaigns and other attitude change tactics are employed as a part of a social change campaign. It is likely that older women and younger women will have different attitudes and understanding of the STI concern, about protection use, and about the female condom, given their differing familiarity with the concept. Cohort effects are often seen in the development of attitudes (Berk, 2007); and studying these effects across age groups will help identify populations that may be more at risk for STIs due to attitudinal differences towards the female condom. The data collected to study the third research question is quantitative and the analysis conducted will also follow quantitative methods. The scores will be gathered for the participants belonging to the two groups; and the average scores on Attitudes Towards the Female Condom will be compared across the two groups of participants (Sue, Price, & Straker, 1998). The groups will be divided according to age; and the same attitude scale will be given to both groups. The average scores of the two groups shall be compared using statistical analysis. The two groups will differ on a single variable – i.e. – age of participant; which is the independent variable (Gilford and Fruchter, 1973). The score on the Attitude Towards Use of the Female Condom scale will be the dependent variable. Population Sampling This study attempts to documents variables associated with a large population, and the sample selected needs to be an effective representation of that population in order that the study be representative. For the first research question, the data being collected shall be studied using a qualitative analyses of the responses obtained. Thus, the sample size chosen should be big enough to reflect the heterogeneity of the possible responses; but small enough to allow for effective analyses. The sample shall include women participants residing within the Miami Beach area; and will be required to include women from all age groups. Since this is quite a heterogeneous sample (U.S. Census Bureau, 2010); it would be prudent to include a relatively high number of participants even for a qualitative study. Thus, a minimum of 50 participants (an if possible, as many as a 100 participants) should be included who will respond to the semi structured interview. Given the expanse and heterogeneous nature of the population; it is necessary that the sampling technique represent this heterogeneity. Further literature review may show that certain demographics would be significant to the research questions at hand; and in this case it would be prudent to use a stratified sampling technique (Sue, Price, & Straker, 1998) and collect a corresponding percentage of the sample from each stratum. If no such trends are found; then a randomized sampling technique would be more appropriate. A randomized sample could be collected by using the database of social security numbers of the female residents of the Miami Beach area; by programming a computer to choose individuals at random from the data – base. The chosen individuals should be contacted and requested for permission to include them in the study. When an adequate number of individuals give their consent; the process shall be stopped. The data used to study the second research question is numerical; and thus comparatively easy to code and interpret as against responses to questionnaires and interviews (Trochin, & Donnelly, 2008). According to Gilford and Fruchter (1973), for a generic population, choosing a small fraction of the population using a random sampling technique is an acceptable procedure. Given the large population size; it would be prudent to include at least 100 participants in the study; and if permitted by resources, up to 500 participants may be included in the study. The minimum sample size for a study of this kind should not be less than 100 given the heterogeneity of the population on a number of factors. The sample shall be chosen using randomization techniques (Sue, Price, & Straker, 1998); possibly by using Social Security numbers as a database to choose individuals from. A computer program may be used to select random members of the population who are then contacted for participation in the study. The third research question is quantitative in nature, and compares the data collected from two groups of individuals using statistical analysis. given that numerical data is easier to code and interpret, it is possible to collect data from a large sample size in order to control for the population heterogeneity. The sample should be collected using a random sampling technique as described for Research Question #2. The minimum sample required for the statistical analysis is a sample of 30 individuals per group; but given the expanse and heterogeneity of the populations, a much larger sample size would be more effective in maintaining representativeness. Thus, a minimum of 75 – 100 individuals should be included in each group; although if permitted by resources, the sample size could as high as 250 individuals per group. As the size of the sample grows, it is more likely to approximate the population. Data Analysis The first research question requires the collection of qualitative data through the use of an interview. Thus, the best techniques for analysis would be content analyses techniques (Trochin, & Donnelly, 2008). Content analyses techniques are techniques that help in isolating the significant phrases and words used by the participants and then draw inferences and connections between the same. These techniques also help in identifying significant themes and trends in the data. The said themes and trends are useful in understanding what factors that affect the female condom use in the Miami Beach area and how they do so. They are also valuable in finding ways to improve safe practices and provide alternatives that will work. The second research question is to be studied using quantitative data; but the required analyses are observational in nature. It is expected that evaluating the trends presented by the data would help us understand how the population thinks and feels about the use of the female condom, and thus, possibly the motivation level of the participants to follow up on practice. This analysis will also help in identifying any concerns and mistaken beliefs that need to be addressed to promote safe sex behaviors. Given that the research question demands observational analyses; the ideal techniques would involve summary statistics like the measures of central tendency; the measures of variability; and the frequencies with which certain responses are given. This information will help us estimate the attitude of the entire population of women in the Miami Beach area towards female condoms. The third research question compares two groups on a single variable – the Attitude of Women living in the Miami Beach area towards the use of female condoms. It studies the possible effect of one variable – age – on another – attitude. The data collected for this analysis is quantitative; and is measured on an equal interval scale. Thus, it is possible to use parametric statistical techniques that help in examining the differences in the two groups; as well as estimate the differences in these same two groups in the population. The ideal statistical analysis which will enable us to evaluate the two groups for significant differences is the t-test (Sue, Price, & Straker, 1998). This statistical method provides us with an estimate of how applicable the differences that we observe in the data collected are when considering the entire population under study (Gilford and Fruchter, 1973). Conclusion In conclusion, this study shall provide data that will provide valuable insights into the knowledge about, the attitudes towards and the likelihood of use of female condoms in the Miami beach area – a location that has seen increase in the ill effects of unprotected sex in the form of increased rates of STI infections. The understanding gained from this data will provide answers for the increased risk in sexual behaviors, as well as providing a direction for education about safe sex practices as well as making the resources available to the people. This data will help in drawing an estimate of the issues that inhibit safe sex behaviors in general, thus providing cues to the practices and techniques that will help in countering these said issues. The HIV / AIDS pandemic is one of the biggest concerns when there is rampant unprotected sex. The ramifications of these conditions, combined with the lack of a cure are serious enough to warrant continued efforts in the prevention of infection. The use of female condoms returns the responsibility for a woman’s health to her own hands; and allows her to make choices that give her pleasure. Thus, it is essential to understand and resolve the issues in its use. ? References Beksinska M, S. J., Joanis C, Usher-Patel M, & Potter W. (2011). Female condom technology: new products and regulatory issues. Contraception, 83(4), 316-321. Berk, L. E. (2007). Development Through the Lifespan. Boston, MA: Allyn and Bacon. Guilford, J. P., & Fruchter, B. (1973). Fundamental statistics in psychology and education. (5th ed.). New York: McGraw-Hill. Spizzichino, L., Pedone, G., Gattari, P., Luzi, A.M., Gallo, P., Valli, R. & Rezza, G. (2007). The female condom: knowledge, attitude, and willingness to use. The first Italian study. Ann Ist super Sanita. Vol. 43(4) pp. 419-424. Lule, E., Seifman, R., & David, A. C. (2009). The changing HIV/AIDS landscape: selected papers for the World Bank's agenda for action in Africa, 2007-2011: World Bank. Sue, J., Price, C. J., & Straker, L. (1998). The researching therapist: a practical guide to planning, performing, and communicating research. Amsterdam, Netherlands: Elsevier Health Sciences. Riveria, L. (2010). STD’s on the rise in Miami-Dade county: Critical Advisory letter. Miami: Miami-Dade county health department Trochin, W.K. & Donnelly, J.P. (2008). Research Methods knowledge base (3rd. ed.). Mason, OH: Cengage Learning. U.S. Census Bureau (2010). Census data. 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