A multicenter randomized controlled trial protocol to evaluate the effectiveness of an educational intervention on fertility knowledge, intention and behavior among Iranian new couples

Background: Recent evidence shows that men and women have inadequate fertility knowledge which may negatively affect their childbearing decisions in future. Given the fact that decision making for fertility needs accurate information, targeted educational interventions especially through media are needed to improve knowledge regarding the best age of fertility, factors affecting fertility potential and fertility options available for sub-fertile couples. Aim of the study is to evaluate whether a fertility educational program can be effective in increasing fertility knowledge, childbearing intention and the planned pregnancy rate among couples referring to premarital counselling centers. Methods: This study is a parallel randomised clinical trial with pre-test/post-test design. We will recruit 1240 marrying couples referring for compulsory premarital counselling in public health centers through stratified sampling in five metropolitan cities of Iran. The intervention group will receive both the typical premarital counselling training and a fertility knowledge package containing verbal and virtual educational package at five time episodes (one verbal session and four virtual sessions) within 4 weeks. The primary outcomes are fertility knowledge, childbearing intention and the first planned pregnancy rate (positive pregnancy test) and the secondary outcomes include contraception method use, miscarriage and unplanned pregnancy. Participants will respond to a self-administered demographic/reproductive characteristics questionnaire, the Cardiff Fertility Knowledge Scale (CFKS) and the childbearing intention questionnaire. Data will be collected through online questionnaires at baseline and 3, 12 and 18 months after the intervention. Data will be analyzed using Chi-square or Fisher-exact test for categorical variables, Independent sample t-test for normally distributed quantitative variables and Mann�Whitney U test for non-normally distributed quantitative variables. To compare the outcomes between the two groups over the time, repeated measures ANOVA will be used. We hypothesize that the positive impact of increasing the fertility knowledge is the reduced involuntarily childlessness. Discussion: The findings are proposed to inform government policies and public education strategies aiming at supporting childbearing among young couples who postpone their first pregnancy while they might not have any important social and economic obstacles. Trial registration: This study was approved by Iranian Registry of Clinical Trials (IRCT), Number: IRCT20201005048925N1, Date of registration: 2020-10-12. © 2020, The Author(s)

Paradoxical attitudes toward premarital dating and sexual encounters in Tehran, Iran: A cross-sectional study

Background: The purpose of this study is to assess attitudes toward premarital dating and sexual encounters in individuals aged 15-49 years in Tehran. Methods: Utilizing the attitudes section of an original cross-sectional study (n = 755) aimed at assessing sexual health needs of adults, this paper examined personal attitudes towards premarital dating, non-sexual relationships and sexual encounters in both male and female adults aged between 15-49 years. Multi-stage cluster random sampling and a validated/reliable questionnaire were used. Descriptive, bivariate and multivariate analyses were conducted using statistical software. Results: The results indicated that the majority of the participants were supportive of dating. Almost three-fourths of the males were more positively inclined towards non-sexual, yet tactile, affectionate interactions between unmarried males and females as opposed to only half of the females (70 vs. 50.5 ). Also, males held significantly more liberal attitudes than females in their acceptance of premarital sex. On preserving virginity prior to marriage, 43 of the males felt that it was important for a female to be a virgin, whereas only 26 felt it was important for males to remain a virgin. Interestingly, more females (61 ) supported the importance of a female's virginity compared with the importance of males' virginity (48 ). This study showed that, being a male, of a younger age, single, and being less religious or being secular were important determinants of a liberal sexual attitude. Conclusion: These results might reflect a socio-cultural transition in the sexual attitudes of different age groups of participants - a phenomenon that will need empirical studies to unpack in the Iranian socio-cultural context. © 2016 The Author(s)

The impact of a TPB-based educational intervention on nutritional behaviors in Iranian adolescent Girls: A randomized controlled trial

Nutritional behaviors of adolescent girls are a major health concern. Adolescents are considered main target group for improvement in nutritional behaviors. This study aimed to determine the impact of an educational intervention based on theory of planned behavior (TPB) on nutritional behaviors in Iranian adolescent girls. This randomized controlled trial study was conducted among 12-16 years old high-school girls in Tehran, Iran, from September 2015 to July 2016. The study subjects were selected using multistage random cluster sampling. Then, they were randomly assigned to the intervention (n=289) and control (n=289) groups. The school-based intervention including nutrition education program based on a modified TPB was performed among intervention group. The control group received only school routine education program. Both groups were assessed at baseline, and after 6-months follow-up. The significant improvement in attitude (15.5, 95 CI=14.7 to 19.3), subjective norms (17.5, 95 CI=15.1 to 0.19), perceived behavioral control (16.1, 95 CI=14.8 to 18.5), perceived parental control (13.4 , 95 CI=11.2 to 17.6), behavioral intention (16.4, 95 CI=14.7 to 19.3), and behavior (17.2, 95 CI=13.7 to 20.7) was observed in intervention group compared to control group (p<0.001 for all dimensions). This study evaluates the impact of a school-based intervention, guided by TPB, on nutritional behaviors improvement as well as knowledge of adolescent girls towards those behaviors. TPB-based educational intervention can effectively improve the healthy nutritional behaviors of adolescent girls. © by PSP

Sexual and Reproductive Health Knowledge Among Men and Women Aged 15 to 49Â Years in Metropolitan Tehran

Sexual and reproductive health (SRH) knowledge is an important predictor of an individual�s sexual behavior; however, little is known regarding this issue among Iranians. This study assessed sexual and reproductive health knowledge among men and women aged 15 to 49 years in Tehran. A total of 755 men and women aged 15 to 49 years were recruited using multistage, random cluster sampling in June 2014. An illustrative anonymous questionnaire endorsed by the World Health Organization (WHO) was used to collect the data. Bivariate and multivariate analyses were performed. The results showed that men and women were moderately knowledgeable about sexual and reproductive health (mean score of SRH knowledge = 39, range: 26 to 52); however, myths and misperceptions prevailed in different aspects of SRH. For example, only 45 of women and 38.7 of men accurately knew that a person infected with human immunodeficiency virus (HIV) can look healthy. Friends were identified as the primary or secondary source of knowledge about puberty and sex-related issues. A multivariate analysis showed that being female (coefficient = 0.139, p < 0.001) and being married (coefficient = 0.180, p < 0.001) were significant predictors of better SRH knowledge, while being young (age group 15 to 24) was a significant determinant of poor SRH knowledge (coefficient = �0.161, p < 0.001) when other influencing factors were controlled. Culturally appropriate and age-specific comprehensive education is recommended, particularly for men, the unmarried, and the younger generation in Iran. Copyright © The Society for the Scientific Study of Sexuality

Perceived Barriers to Implementing Sexual Health Programs from the Viewpoint of Health Policymakers in Iran: A Qualitative Study

Introduction: Despite the fact that sexual and reproductive health has been considered key aspects of the individual�s wellbeing and social welfare, there are no adequate policies and programs to deal with sexual health, particularly among young people. Methods: A qualitative study was conducted from February to December 2015. Twenty-five semi-structured in-depth interviews were conducted with health policymakers in Iran using a purposive sampling method. The qualitative data were analyzed using conventional content analysis with an inductive interpretive approach. Results: The perceived barriers for sexual health programs generated by health-policymakers reside in three main domains: individual, structural, and socio-cultural. Under the domain of individual, the category of policymakers� personal barriers comprises: �lack of knowledge,� �misperceptions,� and �stigma,� i.e., threat to their managerial positions. Under the domain of structural barriers, the category of �challenges in policy making processes� comprises: �the abstinence challenge/paradox of sexual health as a strategic goal,� �financial challenges,� �uncoordinated and unstable management of the program,� �challenges for data collection and planning,� and �lack of priority for sexual health.� Finally, under the domain of socio-cultural, the category of �conservative socio-cultural context, sexuality as a social taboo in Iranian society� emerged as a barrier for sexual health programs in Iran. Conclusions: To introduce sexual health programs in a conservative society, health-policymakers must begin by advocating for sexual health, in order to create positive attitudes toward sexual heath as a component of human wellbeing, and then address social and cultural sensitivities by promoting greater dialogue. Social and Public Policy Implications: Sexual health and sexual health needs are important aspects of life and warrant further research in Iran. Policy makers of the health system need to correct information of sexual health needs of people to health planning, and this clears barriers of sexual health planning in the health system of Iran. © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature