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首页> 外文期刊>BMC Health Services Research >Adaptation of community-based distribution of family planning services to context-specific social networks: a case of marriage counsellors in Lusaka district, Zambia
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Adaptation of community-based distribution of family planning services to context-specific social networks: a case of marriage counsellors in Lusaka district, Zambia

机译：适应基于社区的计划生育服务的分布到特定于情像社交网络：赞比亚卢萨卡区的婚姻辅导员案例

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The significant contribution of community-based distribution (CBD) of family planning services and contraceptives to the uptake of contraceptives in hard-to-reach communities has resulted in the scaling-up of this approach in many Sub-Saharan countries. However, contextual factors need to be taken into consideration. For example, social network influence (e.g. spouse/partner, in-laws, and parents) on fertility decisions in many African and Asian societies is inevitable because of the social organisational structures. Hence the need to adapt CBD strategies to the social network context of a given society. Data collection involved structured interviews from August 2018 to March 2019. Randomly selected respondents (n?=?149) were recruited from four purposively selected health facilities in Lusaka district, Zambia. Respondents were screened for age (?15?yrs.) and marital status. A mix of categorical and qualitative data was generated. The Statistical Package for Social Sciences (SPSS?24) was used to carry out descriptive analysis and tests of association (Fisher’s exact) while Nvivo?12 was used to analyse the qualitative data using a deductive thematic approach. The results indicate that pre-marriage counselling (pre-MC) influences key elements of the husband-wife relationship (p??0.005), namely; sexual relationship, inter-personal communication, assignation of roles and responsibilities, leadership and authority. These elements of the husband-wife relationship also affect how spouses/partners interact when making fertility decisions. More importantly, the majority (86%) of the respondents indicated having a continuing relationship with their marriage counsellors because of the need to consult them on marital issues. Marriage counsellors, though hardly reported in fertility studies, are important ‘constituents’ of the social network in the Zambian society. This is because marriage counsellors are trusted sources of information about marital issues and often consulted about family planning but perceived not to have the correct information about modern contraceptives. In this context, pre-MC offers a readily available, sustainable and culturally appropriate platform for disseminating accurate information about modern contraceptives provided in a private and personal manner. Therefore, the CBD strategy in Zambia can harness marriage counsellors by recruiting and training them as community agents.
机译：基于社区的分销（CBD）的计划生育服务和避孕药避孕药的重大贡献导致了在许多撒哈拉国家的这种方法的扩大。但是，需要考虑上下文因素。例如，由于社会组织结构，许多非洲和亚洲社会在许多非洲和亚洲社会中的生育决策的社会网络影响（例如配偶/伴侣，惯例）是不可避免的。因此，需要使CBD策略适应特定社会的社会网络背景。数据收集涉及2018年8月至2019年3月的结构化访谈。随机选定的受访者（N？= 149）是从赞比亚卢萨卡区的四个有动的选定的卫生设施招募的。受访者被筛选为年龄（＆ 15？YRS。）和婚姻状况。生成了分类和定性数据的混合。社会科学（SPSS？24）的统计包装用于对关联（Fisher的确切）进行描述性分析和测试，而NVIVO？12用于使用演绎专题方法分析定性数据。结果表明，婚前咨询（PRE-MC）影响了丈夫 - 妻子关系的关键要素（P？＆？0.005），即;性关系，个人沟通，角色和责任的分配，领导和权力。这些丈夫 - 妻子关系的要素也会影响配偶/合作伙伴在生育决策时的互动。更重要的是，大多数（86％）的受访者表示，由于需要在婚姻问题上咨询他们的婚姻辅导员，这一受访者表示持续的关系。婚姻顾问虽然在生育研究中几乎没有报道，是赞比亚社会中社会网络的重要“成员”。这是因为婚姻辅导员是有信任的有关婚姻问题信息的信息，并且经常咨询计划生育，但感受到不具有关于现代避孕药的正确信息。在这方面，PRE-MC提供了一项可获得的，可持续和文化的合适的平台，用于传播有关以私人和个人方式提供的现代避孕药的准确信息。因此，赞比亚的CBD战略可以通过招募和培训作为社区代理人来利用婚姻辅导员。

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