الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Diabetes mellitus is increasingly recognized as a global epidemic and is one of the most common medical conditions in pregnancy. Approximately ١٩٩ million women live with diabetes which is projected to rise to ٣١٣ million by the year ٢٠٤٠. Girls and women with diabetes experience a range of challenges, starting with puberty, uncontrolled diabetes can have a major impact on menstruation, fertility and menopause. High blood sugar levels before and during pregnancy are associated with considerable risks to women and children, as well as posing an unnecessary financial
burden on health services and on society.
ANC provides an array of medical, nutritional, and educational interventions to reduce
the risk of adverse pregnancy outcomes. But many of these preventative strategies could be ineffective, because, by the time most women realize they are pregnant, the embryo has already begun to form. Therefore, all reproductive-aged women especially women with
chronic conditions, should be asked about their plans for pregnancy and informed about PC care. PC care provides similar aspects of ANC and focuses on the conditions and risk
factors that could affect a woman if she became pregnant. PC care can significantly reduce
the risks of maternal and fetal complications.
This study was conducted at all diabetes outpatient clinics affiliated to health
insurance department of schools and that of university students located at Alexandria
governorate in order to assess knowledge, beliefs, practices and intentions of students
towards seeking RH and PC counseling. All enlisted students aged ١٥ – ٢٤ yrs, have diabetes more than one yr duration, not currently or previously pregnant and agreed to participate in the study were included.
Data was collected from ١٦٩ students which constituted the current study sample using a predesigned self administrated questionnaire and medical record reviews.
The questionnaire used in the present study covered the following areas:
١. Socio-demographic characteristics.
٢. Medical, family and reproductive history.
٣. DM self management.
٤. Knowledge of the students: Five domains of knowledge were assessed in the current
study; a) Basic knowledge about diabetes, b) Basic RH knowledge, c) General PC
knowledge, d) RH and pregnancy risks of diabetes and d) PC care with diabetes.
٥. Students’ sources of knowledge about RH and PC counseling.
٦. Students’ beliefs, attitudes and intentions towards seeking RH and PC counseling,
based on three health theories; the HBM, the TRA and social cognitive theory.
Student beliefs were measured using the HBM (Janz and Becker, ١٩٨٤), which
measures four main constructs; Perceived susceptibility, perceived severity,
perceived benefits, perceived barriers, in addition to cues to action.
Attitudes, subjective norms and intentions were measured using the TRA.- Attitude: Behavioral beliefs (outcome expectations) and outcome evaluations of seeking a behavior.
- Subjective norms: The students’ beliefs about acceptance and rejection of their
referent groups regarding seeking a behavior and b) their corresponding
motivation to comply
Self efficacy was assessed under social cognitive theory
Data were collected and entered into the Statistical Package for Social Sciences
(SPSS) software version ٢٠.٠.
The main results of this study could be summarized as follows:
١- Results of the current study showed that many adolescents experienced reproductive
health morbidities (٤١.٤% reported menstrual irregularities and ٦٦.٩% reported vaginal infections) which in addition to lack of metabolic control of diabetes accumulates risks and adverse consequences though their reproductive life.
Unfortunately a small proportion of them (٢٧.٢%) had sought medical advice.
Furthermore, a minority (٨.٣%) of students had initiated discussions with their HCPs
regarding PC care and diabetes. Egyptian youth like many other counterparts
throughout the world experience social, cultural and economic barriers to the
information and health services they need to protect themselves against RH diseases.
٢- The current study showed that more than half (٥٧.٤%) of the students had poor
practice levels of diabetes, while only ٦.٥% had good levels.
٣- Assessment of knowledge: Regarding basic diabetes knowledge, results revealed that ٦١.٤% of the students had fair knowledge while ٣٢.٥% had poor knowledge levels. A worrying aspect is that students had areas of shortage concerning knowledge about normal blood glucose levels which posits the need for more education at this age
group for better management and early detection of complications. ٤- Students lack awareness regarding basic RH issues, as around half of them (٤٧.٩%)
had poor knowledge, while a minority (٨.٩%) of them had good knowledge. Many students exhibited misunderstanding and lack of awareness about menstrual cycle,
timing of fertilization, pregnancy prevention, genital infection and STDs. As regards
to students’ awareness of issues related to general PC health, many students correctly
identified the effect of certain risk factors such as smoking, exposure to domestic
violence, effect of obesity as well as the impact of nutritional status on pregnancy,
while a gap of knowledge was seen in other areas such as; correct timing of
organogenesis, use of herbs, if it’s safe to practice exercise and to take influenza
vaccine during pregnancy.
٥- Concerning knowledge about RH and pregnancy risks with diabetes, less than one
fifth (١٩.٥%) of the students had good knowledge while ٤٤.٤% of students had poor
knowledge. Many students were aware of the risk of poor glycemic control during
pregnancy for the mother (٦٨%) and for the fetus (٦٦.٩%), but significant gaps in
knowledge about specific maternal and fetal health risks of uncontrolled diabetes such as the risk of miscarriage (٣٢%), macrosomia (٢١.٩%) and congenital malformations
(٣٠.٨%) were noticed.
٦- Among the total students participated in this study, only ٣.٦% of them had good
knowledge about PC care with diabetes, while more than two-thirds (٦٦.٩%) having
poor knowledge. A notable gap in awareness regarding folic acid intake before
pregnancy (١٤%) and safety of using insulin during pregnancy (٦%) was noticed.
About half of students (٥٠.٣%) were aware of the importance of measuring thyroid
functions before pregnancy and less than half (٤٠.٢%) considered correctly the
necessity of postponing pregnancy in the presence of renal impairment. Many students
(٦٤.٥%) correctly identified the importance of seeking medical advice before
discontinuation of family planning methods use. Though, less than one fourth of them
(٢٣.١%) correctly knew that it’s safe for women with diabetes to use family planning
methods.
٧- Regarding the sources of knowledge for PC care, the most important sources of
information for female students were: The internet (٤٥.٩%), mass media (٢٧.١%) and
physicians (٢٣.٥%). While the most important sources of knowledge about RH were
as follows: The internet (٤٥.٩%), parents (٢٩.٤%) and physicians (٢٦.٥%).
٨- Assessment of beliefs: Results of the current study revealed that female youth with
diabetes had a sense of vulnerability to RH risks as about two- thirds of the students
(٦٧.٥%) perceived themselves highly susceptible to RH risks and pregnancy
complications of DM and more than half (٥٦.٢%) of them had high perceived severity
levels with a real concern for developing health problems for the baby. It is
noteworthy that students had strong perceived benefits of seeking RH and PC in
improving their chances of having healthier pregnancies as the greatest majority of the
students (٩٢.٣%) had high perceived benefits levels. Concerning perceived barriers,
about half of the students (٥٦.٨%) had moderate level of barriers. Unexpectedly ٤٠.٨% of the sample had low perceived barriers towards seeking RH and PC counseling. The most important barriers mentioned by students were being unmarried,
lack of medical advice from health providers, feeling embarrassed and fear of knowing
pregnancy risks of diabetes.
٩- There seemed to be an overall general agreement among students regarding their
attitudes towards RH and PC counseling, as the majority of them (٨٢.٧%) had positive
attitude towards the positive outcomes of obtaining RH and PC counseling which didn’t differ across age and other demographic variables. ١٠- As regards subjective norms, more than half of the students (٥٤.٩%) had low level <and ٣٥.٨% had moderate levels. This indicates that students’ had low levels of social support regarding their RH and Preconception seeking behavior. Social control particularly salient for young women in our culture is not supportive for adopting RH preventive behaviors, as it is believed that adolescents’ awareness of SRH would make them sexually active. But it is important to mention that the majority of students
(٩٤.٧%, ٩٧.٧%) valued the opinions of their physicians and were generally motivated
to comply to them most and all of the time with respect to RH and PC counseling
respectively.
١١- In this current study, more than half (٥٩.٢%) of the students had high intention levels
and only (١.٨%) of them had low intention levels towards seeking RH and PC counseling. This contradiction between willingness of adolescents to optimise their
health in preparation for pregnancy intention for behavior change and actual behavior
pose a dilemma for PC intervention development, though it might reflect the
receptiveness and the needs of female youth with diabetes for PC counseling. The
relationship between socioeconomic status and other socio-demographic variables
with students’ intentions were not significant. Findings of the current study revealed
that students who had their diabetes controlled and reported history of seeking RH and
PC counseling had higher significant mean intention scores. This shows that female
youth draw from their previous past behavior in the formation of their future intentions
١٢- A high proportion of the students in this study (٨٤.٢%) had high self efficacy levels
and the rest of them (١٥.٨%) had moderate levels, meaning that they are confident in
their ability to seek medical advice regarding the effect of DM on their current and
future RH and can follow recommendations by their HCPs as well. This perception of
personal responsibility might actually be considered given the early suffer of students
suffered with diabetes.
١٣- The results of regression analysis showed that the three health theories; the HBM,
TRA and SCT(self efficacy) which were adapted as a framework for this present study
individually represented important predictors, and explained ١٩%, ٨% and ١٨% of the
variance in students’ intentions towards seeking RH and PC counseling respectively.
With regard to the HBM, cues to action (t= ٦.٢٦٦, p=٠.٠٠٠) and perceived benefits (t=
٢.٤٤٧, p= ٠.٠١) were significant predictors for students intentions, where students who
had more cues and higher perceived benefits of RH and PC counseling showed higher
intentions. As for TRA, attitude was the important construct to show prediction for intention, (t= ٣.١٣٥, p= ٠.٠٠٢). ١٤- Results of final regression revealed that that demographic and health status variables
were insignificant predictors for intention towards seeking RH and PC counseling and
that knowledge and beliefs provided the strongest determinants of explaining a significant proportion of variance (٣٧%) in intention to seek RH and PC counseling among female youth with diabetes, while TRA lost its significance, due to the overlap between its constructs and those of the HBM. Based on the above results, we recommend the following: ١. Including age appropriate and culture sensitive contents related to PC care in
educational curricula of schools and universities to empower female youth to make
informed choices regarding their RH and future pregnancy.
٢. Mobile phones represent an underutilized resource that could be developed to support
electronic Health interventions for women with DM. Smart phones in particular, have
the capacity of both computers and the Internet. Their significant advantage over desktop computers, laptops, make them a valuable tool for giving more women access
to PC care This approach has the potential to increase women’s knowledge and enable behavior change, without inducing harm or anxiety.
٣. Establishing National campaigns to promote knowledge among youth about the
benefits of folic acid. Health information provided to youth through mass media (internet and television)
should be monitored and developed to ensure that female youth obtain accurate
knowledge about RH and PC care
٥. Designing intervention programs for female youth with DM utilizing different
constructs of HBM and self efficacy. The participation of youth in the design of these
programs should be guaranteed.
٦. For the success of any intervention targeted towards building SRH knowledge of
adolescents and youth, it is important to educate, train and involve their parents from
the beginning. Health education programs in the Middle East countries are working
closely with parents as no change is possible until parents and family are engaged.
This can be achieved either by education and training of parents or designing take
home questionnaires for them to fulfill.
٧. Understanding the existing gaps of knowledge and evaluating beliefs of female youth
with diabetes related to RH risks and PC with diabetes can helpfully help policy
makers about their needs.
٨. HCPs should consider every opportunity for providing female youth with diabetes
with PC evaluation and counseling and refer them if needed to the relevant centers.
٩. HCPs need to be aware of RH problems during a consultation with an adolescent and
provide confidential services that adolescents can trust.
١٠. The need to work with national and social media to shed the light on RH and PC care
benefits for young people, aiming to promote health and increase community
awareness of the impact of PC care on maternal, newborn and child health outcomes.
Recommendations for future research:
- Results of the current study suggest the need for further research on PC counseling
among adolescents in similar cultures since so little is known about this population.
- Comprehensive and in-depth exploration employing qualitative methods, within a mixed methods study design is needed to provide a rich and deep description of beliefs.