Knowledge and personal opinions of secondary school biology teachers in Hanoi and Dien Bien about reproductive health

JOURNAL OF SCIENCE OF HNUE Chemical and Biological Sci., 2014, Vol. 59, No. 9, pp. 161-168 This paper is available online at KNOWLEDGE AND PERSONAL OPINIONS OF SECONDARY SCHOOL BIOLOGY TEACHERS IN HANOI AND DIEN BIEN ABOUT REPRODUCTIVE HEALTH Nguyen Thi Hong Hanh, Duong Thi Anh Dao, Le Thi Tuyet, Nguyen Thi Trung Thu and Nguyen Phuc Hung Faculty of Biology, Hanoi National University of Education Abstract. This study looked at 128 secondary school biology teachers aged 23 - 34 in Hanoi and Dien Bien to ascertain their knowledge and personal opinions about reproductive health. It was found that 68.4% of the teachers had a ‘good’ level of knowledge about reproductive health with no difference between teachers in Hanoi and Dien Bien. Unfortunately, only 39.7% fully understood the mechanism and usage of contraception methods, with teachers in Dien Bien scoring slightly higher than those in Hanoi (P < 0.05). It was found that 99.2% of the teachers in Dien Bien were aware of the causes, symptoms and prevention of HIV/AIDS and sexually transmitted infections (STIs) while only 43.7% of the teachers in Hanoi were aware. Most of the teachers accept the current State guidelines on family planning and the Law on Marriage and Family. Many teachers in Dien Bien were not even aware of the concept of gender equality. These findings point directly to the need for teacher reeducation in the areas of contraception, sexually transmitted disease and gender equality. Keywords: Biology teachers, reproductive health, knowledge, personal opinion. 1. Introduction Young Vietnamese people are now living in the integrated environment in which material conditions are improving. A higher percent of young Vietnamese people are getting the opportunity to study. However, adolescents, particularly those at the secondary school level, know little about reproductive health [1]. This lack of knowledge increases their risk of contracting HIV/AIDS and sexually transmitted infections (STIs); it makes it more likely that they will have sexual intercourse early and in an unsafe manner and it Received November 11, 2014. Accepted December 20, 2014. Contact Nguyen Thi Hong Hanh, e-mail address: honghanhnt111@gmail.com 161 Nguyen Thi Hong Hanh, Duong Thi Anh Dao, Le Thi Tuyet, Nguyen Thi Trung Thu and Nguyen Phuc Hung makes more likely that they will have an undesired pregnancy followed by an abortion. This situation is good for neither their physical nor psychological health. According to the latest survey of the Vietnam Family Planning Association, about 300,000 girls aged 15 - 19 had an abortion last year and 100,00 - 200,000 of them were students. In number of adolescents getting an abortion, Vietnam ranks No. 1 in Southeast Asia and fifth in the world. Regarding STIs, 800,000 - 1,000,000 people treated for STIs each year, 40% of them adolescents [2]. In many Vietnamese secondary schools, the subject of reproductive health is being taught, somewhat, by the geography teacher, in a civics class or in the biology classroom. However, teachers are not required to present this information and many do not do so due to their own discomfort or ignorance, or because there is "no time" for it. According to the General Office for Population Family Planning, 87% of the teachers readily agreed to teach reproductive health while only 28% of them had sufficient knowledge of the subject to do so [3]. The current method of allowing teachers to elect to present reproductive health information to students has resulted in a failure to deliver this information. When students of Truong Dinh high school in Hanoi were asked if they wanted to learn about reproductive health at school, 98% said "yes". When asked if they were getting the reproductive health information they need in school now, 90% said "no" [4]. This study on the Knowledge and personal opinions of secondary school biology teachers in Hanoi and Dien Bien about reproductive health was conducted to obtain basic information that might be used to improve teachers’ awareness and ability to teach reproductive health in schools all over the country. 2. Content 2.1. Materials and methods * Study population The study population consisted of 128 lower secondary school biology teachers (30 men and 98 women) 68 of them teaching in Hanoi and 60 teaching in Dien Bien. The percentage of teachers who live in remote areas is 46.86%, 9.38% live in urban areas was 9.38% while 90.62% live in rural areas. *Methods - Data collection: Each participant was asked to answer a prepared questionnaire of 30 questions that was approved by Reproductive Health Education and Family Planning Center, Hanoi National University of Education. Twelve of the questions were about human reproduction, 10 were about contraception methods and 8 were about STIs and HIV/AIDS. Each question was multiple choice having four possible answers and only one correct answer. Participants were instructed to circle the best possible answer. They were 162 Knowledge and personal opinions of secondary school biology teachers in Hanoi... given 15 minutes to answer as many questions as they could and they were not allowed to speak to each other or use reference materials. - Data analysis: The completed questionnaires were assessed and classified as follows: For each correct answer one point was given. A score of 26 to 30 is ‘Very Good’; 20 to 25 points is ‘Good’; 16 to 19 points is ‘Fair’ and 0 to 15 points is ‘Poor’. Data analysis was displayed as median and 25th - 75th percentile of marks and percentage of people choosing the same option. Quantitative variables of 3 groups were compared using one-way analysis of variance (ANOVA). SPSS 16.0 software, 2 test, Mann-Whitney U test were used to analyze data. Significance is to a 5% level of probability. 2.2. Results and discussion 2.2.1. Knowledge about reproductive health * Average points obtained The average number of points and classifications of the teachers in Hanoi and Dien Bien are shown in Table 1. Table 1. Average number of points and categories Classifications Total Hanoi Dien Bien P Average number of points 26 (25 - 27) 26 (25 - 27) 26 (24 - 27) 0.121a Very Good 64.8 70.6 58.3 0.078b Good 33.6 26.5 41.7 0.078b Fair 0.0 0.0 0.0 - Poor 1.6 2.9 0.0 0.078b aData are presented as median and 25th - 75th percentile, P from the Mann - Whitney U test b 2 test was used to compare percentage between two groups As shown in Table 1, the average number of points obtained by the teachers was 26, and there was no difference between the teachers in Hanoi and Dien Bien. Most of the teachers ranked Very Good (64.8%) with 70.6% of the Hanoi teacher ranking Very Good compared to 58.3% of the Dien Bien teachers, P = 0.078. On the other hand, there were more Good teachers in Dien Bien than there were in Hanoi. Remarkably, 2.9% of the Hanoi teachers were Poor while no teacher in Dien Bien scored so low. Of the 30 questions, question number 8 (Where will the fertilized ovum nest and develop) and question number 26 (What is the way that most people get infected with HIV/AIDS) were answered correctly most often (> 99%) while question number 29 (When can an HIV antibody test be done on children?) was answered incorrectly most often (3.9%). 163 Nguyen Thi Hong Hanh, Duong Thi Anh Dao, Le Thi Tuyet, Nguyen Thi Trung Thu and Nguyen Phuc Hung * Knowledge about contraceptive methods The biology teachers’ knowledge is presented in Table 2. Table 2. Knowledge about contraceptive methods of teachers in Hanoi and Dien Bien Name of contraceptive method Heard something Know all about Do not know about it but do not it and know know how to use how to use Total Hanoi Dien Bien Total Hanoi Dien Bien Total Hanoi Dien Bien Daily contraception pills 9.4∗∗ 11.8∗∗+ 6.7∗∗ 43.0 52.9+ 31.7 47.7 35.3+ 61.7 Contraception injection 31.2∗∗ 38.2∗∗+ 23.3∗ 55.5 55.9+ 55.0 13.3 5.9+ 21.7 Contraception stick 34.4∗∗ 41.2∗∗ 26.7∗∗ 57.8 52.9 63.3 7.8 5.9 10.0 Urgent contraceptive pills 16.4∗∗ 13.2∗∗+ 20.0∗ 50.0 60.3+ 38.3 33.6 26.5+ 41.7 Condom 2.3∗∗ 1.5∗∗++ 3.3∗∗ 23.5 36.8++ 8.3 74.2 61.8++ 88.3 Intrauterine device 17.2∗∗ 20.6∗∗++ 13.3∗ 56.2 69.1++ 41.7 26.6 10.3++ 45.0 Sterilization 10.1∗∗ 10.3∗∗ 10.0∗∗ 71.1 77.9 63.3 18.8 11.8 26.7 Rythme 3.9∗∗ 1.5∗∗+ 6.7∗∗ 23.4 32.4+ 13.3 72.7 66.2+ 80.0 Coitus interruptus 7.8∗∗ 5.9∗∗++ 10.0∗∗ 29.7 45.6++ 11.7 62.5 48.5++ 78.3 Average 14.7∗∗ 16.0∗∗ 13.3∗∗ 45.6 53.7 36.3 39.7 30.2 50.4 P < 0.05, P < 0.001, compared among groups of Do not know, Heard something about it and Know all about it. +P < 0.05, ++P < 0.001, comparing Hanoi and Dien Bien Table 2 shows that most teachers knew about Daily contraceptive pills, Condoms, the Rhythm method and Coitus interruptus, with more aware of Condom use (74.2%) then the other methods. There were more teachers who were aware of the mechanism and usage of those methods than those did not know or heard something about it but did not know how to use it. The difference is significant with P < 0.001. For other contraceptive methods, most of the teachers had heard something about it but didn’t know how to use it. Most of the teachers knew what sterilization was but didn’t know how it was used as a form of contraceptive (71.1%). It should be of some concern that 11.7% (15) of the teachers knew nothing about any of the forms of contraception or how to use them. Of the 9 contraception methods, 19.5% of the teachers knew of 4 or more. To their credit, 4 of the 128 teachers (3.1 %) were aware of the mechanism and proper use of all nine contraceptive methods. It can be compared from the results between Hanoi and Dien Bien that The percent of Dien Bien teachers who knew all about contraception methods (Contraception pills, Contraception injection, Urgent contraception pills, Condoms, Intraterine device, Coitus interruptus) was much higher than that of Hanoi teachers. The reason for this difference 164 Knowledge and personal opinions of secondary school biology teachers in Hanoi... might be that the average age of the Dien Bien teachers was 29 (28 - 30) while the average age of the Hanoi teachers was 24 (24 - 25), with P < 0.001. A study done by Hoang Thi Tam in 2003 [5] of high school students in Hue revealed that the percentage of students who know about contraception methods was quite high (98.4%). Of these students, 90.4% knew about condom use, 78.6% knew about birth control pills, 64.6% knew about intrauterine devices, 46.6% knew about sterilization and 13.2% knew about urgent contraception pills. At the same time 4.1% did not know about any contraception method. Most of the students knew about four methods of contraception. * Knowledge of STIs and HIV/AIDS Teacher knowledge of STIs and HIV/AIDS is shown in Table 3. Table 3. Knowledge of STIs and HIV/AIDS Disease Heard something Know all about Do not know about it but do not it and know the know causes, symptoms, causes, symptoms and and means of prevention means of prevention Total Hanoi Dien Bien Total Hanoi Dien Bien Total Hanoi Dien Bien Sexually transmitted infections Gonorrhoea 0.8∗ 0.0∗∗ 1.7∗∗ 10.9 5.9 16.7 88.3 94.1 81.7 Syphilis 0.8∗ 0.0∗∗ 1.7∗∗ 9.4 7.4 11.7 89.8 92.6 86.7 Chlamydia 51.5∗ 57.4∗∗ 45.0∗ 34.4 27.9 41.7 14.1 14.7 13.3 Trichomonas 35.1∗ 38.2∗ 31.7∗∗ 51.6 44.1 60.0 13.3 17.6 8.3 Herpes 47.7∗ 51.5∗ 43.3∗ 35.9 30.9 41.7 16.4 17.6 15.0 Condyloma 13.3∗ 10.3∗∗ 16.7∗ 54.7 57.4 51.7 32.0 32.4 31.7 Candida 25∗ 26.5 23.3∗ 50.0 47.1 53.3 25.0 26.5 23.3 Hepatitis B 1.6∗ 1.5∗∗ 1.7∗∗ 27.3 19.1 36.7 71.1 79.4 61.7 Average 21.9∗ 23.2∗ 20.6∗∗ 34.4 30.0 39.2 43.7 46.9 40.2 HIV/AIDS 0.0∗ 0.0 0.0 0.8 1.5 0.0 99.2 98.5 100 P < 0.05; P < 0.001, comparison of the groups Do not know, Heard something about it and Know all about it. +P < 0.05; ++P < 0.001, comparison between Hanoi and Dien Bien According to Table 3, nearly half or 43.7% knew all about the causes, symptoms and prevention of STIs. This compares to 21.9% who Do not know and 34.4% who Heard something about it but do not know the causes, symptoms or way to prevent it. (P < 0.001). Regarding STIs, more teachers knew about Gonorrhoea and Syphilis (88.3% and 89.8%, respectively) than the others. Most of the teachers had never heard of Chlammydia (51.5%) or Herpes (47.7%). As for Trichomonas and Candida, half of the participants indicated that they heard of it but don’t know causes, symptoms or means of prevention. 165 Nguyen Thi Hong Hanh, Duong Thi Anh Dao, Le Thi Tuyet, Nguyen Thi Trung Thu and Nguyen Phuc Hung 37.5% of the teachers knew for at least 4 of the 9 STIs. Most of the teachers knew all about HIV/AIDS with 99.2% knowing the causes, symptoms and means of prevention. They had all heard about this disease and only one person (0.8%) did not know the causes, symptoms or means of prevention. There was no significant difference in terms of knowledge about STIs and HIV/AIDS between the teachers in Hanoi and Dien Bien. The percent of Hue high school students who knew all about HIV/AIDS was 84% [5]. The number is lower than that of our study. However, the proportion knowing about STIs (75% [5]) was higher than in our study. This shows that education about STIs in Hue high school was comparatively good. 2.2.2. Personal opinions Teachers’ opinions about family planning and gender equality are presented in Table 4. Table 4. Teachers’ opinions about family planning and gender equality Opinion Disagree Not sure Agree Total Hanoi Dien Bien Total Hanoi Dien Bien Total Hanoi Dien Bien Virginity before marriage is important 25∗∗ 22.1∗∗ 28.3∗∗ 8.6 8.8 8.3 66.4 69.1 63.3 No sex until after marriage 5.5∗∗ 2.9∗∗ 8.3∗∗ 5.5 5.9 5.0 89.0 91.2 86.7 Use contraceptive methods when having sex before marriage 1.6∗∗ 0.0∗∗ 3.3∗∗ 4.7 5.9 3.3 93.8 94.1 93.3 Married couples should have one or two children 1.6∗∗ 1.5∗∗ 1.7∗∗ 0.8 0.0 1.7 97.7 98.5 96.7 Children should be born 5 years apart. 6.2∗∗ 2.9∗∗ 10.0∗∗ 1.6 2.9 0.0 92.2 94.1 90.0 It is not necessary for a couple to have a son 3.1∗∗ 0.0∗∗+ 6.7∗∗ 6.2 8.8+ 3.3 90.6 91.2+ 90.0 Females should not get married until they are 20 5.5∗∗ 2.9∗∗ 8.3∗∗ 2.3 4.4 0.0 92.2 92.6 91.7 Males should not get married until they are 22 5.5∗∗ 4.4∗∗ 6.7∗∗ 3.9 4.4 3.3 90.6 91.2 90.0 Females should have their first baby at the age of 22 or later 4.7∗∗ 2.9∗∗ 6.7∗∗ 7.0 5.9 8.3 88.3 91.2 85.0 P < 0.05; P < 0.001, comparison among groups of Do not know, Heard something about it and Know all about it. +P < 0,05; ++P < 0,001, comparison between Hanoi and Dien Bien 166 Knowledge and personal opinions of secondary school biology teachers in Hanoi... Table 4 shows that most teachers strongly agree with the family planning guideline issued by the State and the Law on Marriage and Family, particularly with: “married couples should have 1 or 2 children”; “Children should be born 5 years apart”; “it is not necessary for a couple to have a son”; “Females should not get married until they are 20 and males should not get married until they are 22”. The percent of those who strongly agreed were 97.7%, 92.2%, 90.6%, 92.2% and 90.6%, respectively. This could be regarded as a reflection of the teachers’ unwillingness to express a viewpoint which differs from that of the State. It could also reflect the uniformity of opinion that exists within Vietnamese culture. This does should that teachers are most likely teaching their students to hold the State’s viewpoint on family planning. Interestingly, 93.8% of the teachers checked the answer, ‘it is advisable to use contraceptive methods while having sex before marriage’, to one of the questions in the questionnaire. These days, some young people would like to live a western lifestyle in which it is acceptable to have sex before marriage. Some 25% of the teachers also felt that there’s nothing wrong with having sex before marriage. However, 66.4% are fully supportive of their male students who say that they would not marry a girl unless she was a virgin. When comparing Hanoi and Dien Bien, the only difference was with regards to the feeling that a couple must produce a son. Of the Dien Bien teachers, 6.7% felt that a son in the family is a must while none of the Hanoi teachers felt this way. The percent of teachers that thought a son was not compulsory was 91.2% in Hanoi and 90% in Dien Bien (P = 0.046). This implies that the concept of gender equality is less popular in Dien Bien than it is in Hanoi. The current study has several limitations that should be noted. First, the number of participants in each group was small. Second, the age of the Hanoi teachers differed markedly from that of the age of the Dien Bien teachers. Third, this study did not look at how or why the teachers know (and don’t know) what they know, or have the personal opinion that they hold. We do hope to do a full longitudinal association analysis using larger samples in a future study. 3. Conclusion Most teachers did know the fundamentals about reproductive health. A full 68.4% of the teachers were at the level Very Good with no significant difference between the Hanoi and Dien Bien teachers. The percent of teachers who had a clear understanding of the mechanism and use of contraception methods was only 39.7% with Dien Bien teachers scoring slightly better than Hanoi teachers. The percent of teachers who knew all about the HIV/AIDS causes, symptoms and means of prevention was 99.2% but for some reason only have of the teachers (43.7%) 167 Nguyen Thi Hong Hanh, Duong Thi Anh Dao, Le Thi Tuyet, Nguyen Thi Trung Thu and Nguyen Phuc Hung showed that they knew the causes, symptoms and ways to prevent STIs. Most of teachers agreed with State policies on family planning and in the Law on Marriage and Family. The concept of gender equality is more foreign to teachers in Dien Bien than it is to teachers in Hanoi. Teachers need to learn more about the mechanism and use of the different forms of contraception, about sexually transmitted diseases, and about gender equalization to further the cause of national development, to avoid unwanted pregnancies and to remove Vietnam from its position of No. 1 provider of abortions to adolescents in Southeast Asia. REFERENCES [1] Nguyen Dinh Cu, 2007. Tendencies of Changing Population in Vietnam. The agricultural publishing house. [2] General state survey about adolescents and youngsters, 2nd time, 2010. [3] Gia Han, 2013. Workshop on Reproductive Health and sex education for Youth. Journal of Vietnam Population 2, No. 143. [4] Pham Thi Hong, 2011. Reality caring of reproductive health education demand of students in Truong Dinh high school, Hoang Mai, Hanoi. Thesis of education. [5] Hoang Thi Tam, 2004. A Study on Current Knowledge, Attitude and Behavior about Reproductive Health of High-school Students in Hue. Committee of Population, Family and Children, Thua Thien-Hue. 168