Jordan has a higher fertility rate (3.8) than the averages of countries similar in income to Jordan (2.2) and compared to the Middle East and North Africa region as a whole (2.8) (WHO, WB, UNICEF, & DHS, 2011). The findings of the 2009 Jordanian Population and Family Health Survey demonstrated that the total fertility rate (TFR) has stopped declining in the country since 2002 (DOS, 2010b; USAID, 2010). The prevalence of contraceptive use has also shown little change in Jordan over the last decade (DOS, 2010b; USAID, 2010). Given that contraception is one of the proximate determinants of fertility (Rahayu et al., 2009), the main purpose of this study was to investigate which factors are contributing to women's current contraceptive behavior and intention for future contraceptive use. Research questions were developed in a comprehensive framework that considers women's intention and actual behavior as outcomes of various interactive factors within a socio-cultural context. In particular, the study's framework was directed by a theoretical basis adapted from Ajzen and Fishbein's Theory of Reasoned Action (TRA) and an extensive review of the available literature in the research area. Obviously, the social set-up and cultural norms in the study setting, together with attitudes toward children and family, represent a traditional scenario that could help explain the consistency of fertility and contraceptive use in the country. Further, the influences of background characteristics on women's contraceptive behaviors and intentions provide another scenario that could help assess the current situation of family planning (FP) in Jordan. In this study, demographic factors, spousal communication variables and healthcare system-related factors are all defined as background characteristics. Attitudes and social norms reflect the women's behavioral determinants and represent the main constructs of the TRA. In fact, involving a set of factors related to women's beliefs and social norms in the study's framework provided an opportunity to explore how these factors might promote or inhibit a woman's intentions and behaviors in respect to contraceptive use. In a three-manuscript format, this research was designed to achieve a number of objectives. The first manuscript aimed at identifying the major factors associated with the current use of contraception among women of childbearing age in northern Jordan. The second manuscript focused on investigating the main factors that are associated with women's contraceptive method preference (e.g. the choice of modern contraceptives as effective methods in preventing pregnancy versus the choice of traditional contraceptives as methods with high failure rates). The third manuscript attempted to explore the key factors associated with women's intention for future contraceptive use since the existence of such an intention would consequently translate into an actual behavior later. In 2010, original cross-section data were collected by means of a face-to-face interview using a structured pre-tested survey. The study sample included women who were currently married and were between 18 and 49 years old. Applying a systematic random sampling procedure, all respondents were recruited from the waiting rooms of five randomly selected Maternal and Child Health (MCH) centers in the Governorate of Irbid, northern Jordan. Using a list provided by the Ministry of Health, all centers in the Governorate were stratified according to the region (urban vs. rural) and randomly selected in proportion to their number in each region. The final sample size for this research consisted of 536 women surveyed, giving a response rate of 92.4 percent. Utilizing logistic regression analyses, the results of the dissertation manuscripts indicate that women's behaviors and intentions toward the use of contraception are affected by a number of factors at the individual, familial and institutional levels. The findings that emerged from the three manuscripts provide health professionals and policy makers with important information to assist in the design of FP programs and campaigns aimed at increasing current contraceptive use, enhancing the adoption of modern contraception and motivating the intention for future contraceptive use. This research strongly suggests that health professionals develop health policies that both expand the availability of MCH centers and strengthen the role of healthcare providers to dispel the numerous rumors and misconceptions surrounding the use of contraceptives, particularly modern ones. Health workers at the MCH centers need to ensure that women have sufficient information about the benefits and side effects of different types of contraception by offering proper FP counseling. The messages that religious leaders can use in advocating for FP would also help make contraceptive use socially acceptable since their opinions are often followed by the majority. This would be a key step toward removing the barriers to contraceptive use. Moreover, to design effective FP interventions, planners should take into account women's attitudes toward the use of contraceptive methods and the components of those attitudes (e.g. women's approval of contraceptive use for birth spacing and perceptions regarding the value of large family sizes and the importance of having male children in Jordanian families). / Graduation date: 2012 / Access restricted to the OSU Community at author's request from May 9, 2012 - May 9, 2013

Compared to males in almost any social group in all affluent nations, Australia's Aboriginal and Torres Strait Islander men suffer from substantially more serious illnesses and early death. To date, research done by or in collaboration with Indigenous communities has revealed the extent of the problems that arise from diabetes, heart disease, hypertension, cancers, respiratory diseases, psychological disorders, accidental injuries, violence and other causes. Reproductive health, however, rarely has been studied among Indigenous men. To date, research in this field has been limited mainly to studies of sexually transmitted infections. No data has been published on Aboriginal men's symptoms of prostate disease or erectile dysfunction, nor has the clinical screening and treatment of these disorders among these men been assessed. In-depth search of the worldwide web demonstrated that little information on these issues was available from other Indigenous populations. It does appear that Indigenous men in Australia, New Zealand and North America are less likely than European-ancestry men to die from prostate cancer, or for living cases to be recorded on cancer registries. This may arise because Indigenous men genuinely have a lower risk, or because they are not captured by official statistics, or because they do not live long enough to develop severe prostate disease. We also know very little about other reproductive health problems such as sexual dysfunction and specifically erectile difficulties. One reason for our scant knowledge is that research mainly relies on self-report of sensitive information. The aim of the research study was to improve the understanding of sexual and reproductive health problems experienced by Indigenous men. This is best gathered by Aboriginal males who are inside the culture of middleaged and older Indigenous men, but until now this has not been attempted. In this study we adopted the World Health Organization (WHO) definitions for Reproductive and Sexual Health (WHO, 2001). Thus, we consider reproductive system disorders (prostate disease, erectile dysfunction) and related health care-seeking, and also men's perceptions about a "satisfying and safe sexual life". The methodology was framed within an Aboriginal and Torres Strait Islander research protocol that advocates respect for cultural, social and community customs. A mixed method design combined qualitative inquiry (4 focus groups and 18 in-depth interviews) and quantitative survey (n=301) involving men living in remote, rural and urban communities (Tiwi Islands, Darwin and north and south-east Queensland). Survey data were compared to recently published self-reports from 5990 randomly selected men aged over 40 years in Australia (Holden et al., 2005, The Lancet, 366, 218-224. The qualitative interviews revealed that most men were silent about reproductive health. They were unwilling to reveal their inner feelings to wives or partners, and they were unwilling to discuss such issues with doctors and other health care workers. Men's reaction to sexual difficulties included shame, denial, substance abuse and occasionally violence. On a positive note many men said they want to learn about it, so they understand how to cope with such problems. The Indigenous men reported symptoms of erectile dysfunction at least as much as non-Indigenous men in other Australian studies. Bivariate analysis showed that erectile dysfunction was correlated with many health and lifestyle variable. However multivariate analysis revealed that only three factors significantly predicted ED: presence of chronic disease, presence of pain when working, and living in a remote geographic location The quantitative survey data indicate that Indigenous men have more symptoms of prostate disease than non-Indigenous men. The syndrome appears to be poorly managed in clinical practice (e.g. rates of PSA testing and digital-rectal examination are only one-third the rate reported by non-Aboriginal men, despite equivalent likelihood of GP visits). The research study adds to the literature by providing better insight and depth into the issues impacting on Aboriginal and Torres Strait Islander males experiencing reproductive and sexual health difficulties. It also provides a platform to undertake comprehensive research with Aboriginal and Torres Strait Islander men to explore a wider spectrum of questions in this important but neglected area. Implications for education of primary healthcare workers and community-based awareness campaigns for Indigenous males are discussed. Most of all, this study revealed "layers" of silence around sexual and reproductive health of Indigenous men. This includes silence in the scientific establishments in health services, and in the community. It is hoped that this study puts the voices of the men forward to help to break down this silence.

Vietnam is a populous nation experiencing rapid social and economic transition. These changes, in combination with the spread of sexually transmitted infections such as HIV/AIDS, are compromising the reproductive health of young Vietnamese. Access to reliable reproductive health information is limited and social taboos prevent young people from talking openly about this topic. A huge number of young people living in Vietnam thus find themselves without access to relevant, accurate, non-threatening and unbiased information about sexuality and sexual health. The research outlined in this thesis approaches the issue of sexual health information provision for young people living in Vietnam from a participatory action research foundation. A key focus is investigation of the ways in which young people living in Vietnam can be included in the development of online sexual health communication tools by, for and about young Vietnamese. As part of this investigation, this thesis describes research conducted with young Vietnamese in Australia and Vietnam to identify and elucidate their reproductive health information needs, as situated within the contemporary Vietnamese socio-cultural context. The research was undertaken in order to determine how an online resource might meet these needs. This exploratory process involved the utilisation of a range of research methods to determine the website's optimal content, style, features and tone in relation to the Vietnamese context and requirements of its target users. It is hoped that the record of discovery resulting from this research journey will contribute to the existing body of knowledge on online health communication and participatory approaches to the development of context-sensitive health and behaviour-change communication.

Vietnam is a populous nation experiencing rapid social and economic transition. These changes, in combination with the spread of sexually transmitted infections such as HIV/AIDS, are compromising the reproductive health of young Vietnamese. Access to reliable reproductive health information is limited and social taboos prevent young people from talking openly about this topic. A huge number of young people living in Vietnam thus find themselves without access to relevant, accurate, non-threatening and unbiased information about sexuality and sexual health. The research outlined in this thesis approaches the issue of sexual health information provision for young people living in Vietnam from a participatory action research foundation. A key focus is investigation of the ways in which young people living in Vietnam can be included in the development of online sexual health communication tools by, for and about young Vietnamese. As part of this investigation, this thesis describes research conducted with young Vietnamese in Australia and Vietnam to identify and elucidate their reproductive health information needs, as situated within the contemporary Vietnamese socio-cultural context. The research was undertaken in order to determine how an online resource might meet these needs. This exploratory process involved the utilisation of a range of research methods to determine the website's optimal content, style, features and tone in relation to the Vietnamese context and requirements of its target users. It is hoped that the record of discovery resulting from this research journey will contribute to the existing body of knowledge on online health communication and participatory approaches to the development of context-sensitive health and behaviour-change communication.

The study was done to assess the information and care the men and women have on PCC and develop strategies that could improve provision of PCC that could advance maternal and newborn outcome after pregnancy in Malawi. Most for the interventions to improve pregnancy outcome are done too late in Malawi but there is an opportunity during preconception period to plan to improve the health of the couple so that the goal of a healthy mother and baby is attained. The objectives were to: explore and describe the knowledge men and women of childbearing age have on HTSP and PCC, identify variables that influence men and women to acquire appropriate knowledge on PCC and finally to develop strategies that could assist provision of PCC in developing countries like Malawi. Adverse issues that affect the couples could be addressed promptly before the occurrence of pregnancy. A quantitative non-experimental descriptive-correlation design method was used to determine the knowledge men and women of childbearing have on HTSP and PCC. A structured questionnaire was used to collect data from 300 men and women of childbearing age. The target population for the study was prospective parents that are couples that have an intention to conceive, women of childbearing age that could be accessible at family planning, gyneacological and under-five clinics between the ages of 18-35 years. A questionnaire was adapted from a study conducted in Texas. SPSS version 20 was used to analyse the data by generating frequencies and chi- square. Kruskal Wallis test was used to determine relationship between variables and knowledge on preconception care. The constructs examined were psychological preparation, reproductive health care and the physical care that are provided to ensure a healthy pregnancy outcome. With a 100% response rate the findings indicated a gap of information and care on PCC.Services on PCC were not available in the clinics which indicated a great need to empower health care providers on PCC that could reduce maternal and neonatal mortality rate. The findings were used to develop relevant preconception strategies that would assist health providers to give PCC that would improve maternal and newborn outcomes in Malawi. / D. Litt. et Phil. (Health Studies)

Adolescent pregnancy is a worldwide problem. This study attempted to describe and explore the knowledge of female adolescents in Angola's knowledge with regard to contraception. The research results, obtained from interview schedules, revealed that the respondents lacked knowledge about themselves as adolescents as well as a lack of knowledge of their reproductive health and development. Furthermore, the results portrayed a lack of knowledge of contraceptives. The study findings may assist health care providers to identify educational programmes on contraception at schools, markets and in the community. / Health Studies / Thesis (M.A. (Health Studies))

This quantitative, explorative and descriptive survey attempted to determine factors that influence the adolescent pregnancy rate in the Greater Giyani Municipality. Data were gathered from adolescent girls attending four selected high schools. Non-probability convenient sample of 147 respondents was used with 100% return rate. Data was collected using a questionnaire which had a reliability of 0.65. Data were analysed using the SAS/Basic computer program, version 9.2. Findings indicated that 56.34% of respondents reported key psychosocial variables such as peer pressure and 58.90% of them changed values as contributory to high pregnancy rates. .Health services were reported as not freely available and relationships with nurses significantly cited as poor by 72.41% respondents with regard to maintenance of confidentiality. Recommendations were made to improve school health services, reproductive education and future research / Health Studies / M.A. (Health Studies)

This study was intended to explore the role male partners play in preventing adolescent pregnancy in the Letlhabile area, of Brits district, which is located in the North West Province. Adolescent males and females whose ages ranged between 13-20 years were included in the sample. The inclusion criteria was determined on the basis of the adolescents who were pregnant and non- pregnant, as well as males who had already became parents and those who hadn't experienced fatherhood. Focus group discussions and individual in-depth interviews were conducted.ObservaJions and the review of existing documents were triangulated to gather valid and reliable information. Quantitative and qualitative data analysis were blended. The findings revealed significant factors that ranged from the reaction of parents and/or partner to the announcement of pregnancy, to issues that impact on consequences of multiple sex partners. The recommendations of this project deal with aspects that include contraception, sexuality education, parental involvement among many relevant policy issues. / Health Studies / M.A. (Nursing Science)

The purpose of this study was to assess men’s knowledge and attitude towards vasectomy as a family planning method options available to men in East Wollega zone of Oromia Region. Male sterilisation in sub-Saharan countries including Ethiopia is very much limited due to lots of reasons despite its many advantages than other family planning methods. Quantitative, descriptive cross-sectional research was used to describe level of knowledge and attitude towards vasectomy. Data were collected using structured questionnaire in which a total of 150 respondents, who were selected using non-random purposive sampling technique participated in the study. The data were analysed using SPSS version 20. Hence the findings revealed the lack of knowledge and low interest on vasectomy among respondents. The concerted effort from all stakeholders and use of multiple strategies to educate the community will raise awareness which in turn improves vasectomy service uptake / Health Studies / M.A. (Public Health)

BACKGROUND: Studies done in both developed and developing countries have reported the tendencies of adolescents to engage in risky behaviours. Such behaviours include indulging in early and unsafe sexual activities, having multiple sexual partners, alcohol and drug use and dropping out of school among others. PURPOSE: The main aim of the study was to develop intervention strategies for reducing sexual risk practices among adolescents in Ethiopia. METHODS: A mixed method approach using quantitative and qualitative approaches was employed in order to investigate the risks of sexual practices among urban and rural adolescents in the selected area. A cross-sectional survey was used to gather data quantitatively and focus group discussions were used for the qualitative part of data collection. A total of 449 students and 72 FGD participants were selected for quantitative and qualitative study respectively using systematic random sampling technique. Logistic regression was done to identify possible factors associated with knowledge on emergency contraceptive, condom utilisation, pre-marital sex practices and perception of risky sexual practices. RESULTS: One hundred and seventy (37.9%) respondents had experienced sexual intercourse at the time of the study. The higher proportion (42.6%) of those who had engaged in sexual relationships was from the rural school compared to 33.1% in the urban schools. The proportion of sexually active respondents was higher among males (44.8%) compared to (29%) females. Multiple partners were higher in rural adolescents (44.7%) compared to 31.8% among urban adolescents. Sexually Transmitted Diseases were reported by 28.6% of the sexually active adolescents and the prevalence was higher among males (73.5%) compared to 27% females. 87% of the sexually active adolescents rarely used a condom. CONCLUSION: The study identified a knowledge gap on ASRH which limited adolescents to access reproductive services. Social, cultural and economic factors contributed to adolescent engagement in risky sexual behaviours. Based on the major findings of this study, intervention strategies targeting behavioural, biomedical and structural interventions were proposed. / Health Studies / D. Litt. et Phil. (Health Studies)