Int
ern
at
i
onal
Journ
al of
P
u
bli
c Hea
lt
h S
c
ie
nce
(I
JPHS)
Vo
l.
6
,
No.
3
,
S
eptem
ber
201
7
, pp.
23
1~
23
6
IS
S
N:
22
52
-
8806, DO
I: 10
.11
591/ij
phs.
v6
i
3.
7
614
231
Journ
al h
om
e
page
:
https:
//
ww
w.i
aesco
re
.c
om
/j
our
nals/
ind
ex.
php/IJP
H
S
The Effe
ctiveness
of Coun
seling th
ro
u
gh Vas
ec
t
om
y Modul
e in
North
Kolak
a, Indonesi
a
Ask
reni
n
g, H
endra Y
uli
ta
Depa
rtment
o
f M
idwife
r
y
,
Pol
yte
chn
ic
of
He
al
t
h
Kenda
ri
,
Indon
esia
Art
ic
le
In
f
o
ABSTR
A
CT
Art
ic
le
history:
Re
cei
ved
J
un
13
, 2
017
Re
vised A
ug 12
, 2
017
Accepte
d Aug
26
, 201
7
The
m
ai
n
probl
e
m
fac
ed
nowada
y
s
is
the
low
p
a
rti
ci
p
ation
of
m
en
in
term
s
of
implementa
t
i
on
of
the
Fam
ily
Pla
nn
ing
Program
.
The
figu
re
s
for
famil
y
pla
nning
in
Ind
onesia
onl
y
d
emons
tra
te
a
high
r
at
e
on
cont
r
acep
ti
on
use
in
wom
en
not
in
m
en.
The
Strateg
y
to
improve
knowledge
b
y
prom
oti
on
ac
t
ivi
ties
of
famil
y
p
la
nning
of
m
en
with
a
var
ie
t
y
of
m
edia
an
d
form
s
are
expe
c
te
d
to
in
cre
ase
knowled
ge.
Thi
s
stud
y
ai
m
ed
to
ana
l
y
z
e
th
e
eff
ective
n
ess
of
m
edi
a
m
odule
s
to
improve
know
le
dge
and
a
tt
i
tud
es
and
al
so
ana
l
y
z
e
th
e
fac
t
ors
tha
t
le
ad
to
l
ow
p
art
ic
ip
at
ion
of
famil
y
pla
nn
ing
in
Nort
h
Kolaka
.
Thi
s
st
ud
y
used
Mixed
Method
design
which
combine
s
qual
itativ
e
and
quan
titative
m
et
hod.
The
r
ese
arc
h
was
co
nduct
ed
in
Nort
h
Kolaka
in
Jul
y
and
Augus
t
201
6.
The
popu
la
ti
on
of
thi
s
stu
d
y
was
all
of
hu
sbands
who
cl
assifi
ed
as
a
c
ouple
r
epr
oducti
ve
ag
es
in
No
rt
h
Kolaka
with
t
he
total
of
19,
819
peop
le.
Sam
ple
s
were
divi
ded
int
o
tw
o
groups:
th
e
e
xper
imental
group
gi
ven
cou
nseli
ng
th
rough
m
odule
s
about
v
ase
ct
om
y
wer
e
124
people
and
the
cont
ro
l
group
give
n
counse
li
ng
without
a
m
odule
were
126
peopl
e
.
The
m
odule
is
m
ore
eff
e
ct
iv
e
to
improvi
ng
knowledge
a
nd
at
titudes
tha
n
counse
l
ing
with
out
m
odule
.
The
m
ost
reas
on
for
rej
ec
ti
o
n
vase
ct
om
y
was
they
w
ant
t
o
have
ch
il
dre
n
,
fea
r
of
surg
er
y
and
re
li
gious
issues.
He
al
th
prom
oti
on
through
m
odule
s
m
us
t
be
expa
nded
a
nd
improved
by
the
distri
c
t
gover
nm
ent
of
North
Kolaka
.
I
m
ple
m
ent
ing
prom
oti
on
prog
rams
should
t
invol
ve
religious
leade
rs.
Ke
yw
or
d:
Counseli
ng
Module
Vasectom
y
Copyright
©
201
7
Instit
ut
e
o
f Ad
vanc
ed
Engi
n
ee
r
ing
and
S
cienc
e
.
Al
l
rights re
serv
ed
.
Corres
pond
in
g
Aut
h
or
:
Askre
ning
,
Dep
a
rtm
ent o
f
Mi
dw
ife
r
y
,
Po
ly
te
chn
ic
of
Healt
h
Kenda
ri,
I
ndonesi
a
.
Em
a
il
: askr
eni
ngkdi@
gm
ail.co
m
1.
INTROD
U
CTION
Accor
ding
to
the
popula
ti
on
cens
us
of
2010
,
Indonesia
ha
d
a
popula
ti
on
of
23
7.6
m
i
ll
io
n
pe
op
le
,
s
o
it
is cla
ssifie
d as t
he fo
ur
t
h
la
rg
est
popula
ti
on in
the
w
or
ld
[1
]
. It
w
a
s also
r
ep
ort
ed
t
hat the m
at
ern
al
m
or
ta
li
ty
rate
in
I
ndone
sia
reache
d
228
de
at
hs
per
100,0
00
birth
s
.
This
fi
gure
is
higher
c
om
pared
to
oth
e
r
A
sean
countries,
s
uc
h
as
Thail
an
d,
Ma
la
ysi
a,
Viet
nam
,
Brun
ei
,
an
d
Sin
gapo
re
[2
]
.
T
he
M
inist
ry
of
heal
th
of
Ind
on
esi
a
i
n
a
n
ef
f
or
t
to
acc
el
erate
the
m
a
te
rn
al
m
or
ta
li
t
y
issue
poli
ci
es
thr
ough
the
four
pill
ars
of
saf
e
m
oth
erh
oo
d,
t
he
one
is
th
e
fam
i
ly
plann
in
g
pr
ogram
.
This
pr
ogra
m
is
on
e
m
e
thod
to
c
ontr
ol
the
popula
ti
on
[3
].
Re
producti
on
involves
bo
t
h
a
m
al
e
and
fem
al
e,
bu
t
gen
er
al
ly
,
fam
il
y
plann
i
ng
program
s
j
us
t
ta
rg
et
in
g
the
wo
m
en
[4
]
-
[6
]
.
In
dev
el
op
i
ng
co
un
t
ries,
th
e
serv
ic
e
of
fa
m
ily
plann
in
g
pro
gr
am
s
that
include
ta
rg
et
ed
in
for
m
at
ion
,
e
du
cat
ion
a
nd
c
omm
un
ic
at
io
n
i
n
in
creased
kn
ow
l
edg
e
an
d
us
e
of
c
on
trac
eptio
n
is
m
or
e
fo
c
us
e
d
on
w
om
en
[4
]
,
[
7].
As
a
res
ult,
th
e
m
al
e
par
ti
cip
at
ion
i
n
the
im
ple
m
entat
ion
of
fam
il
y
plann
i
ng
pro
gr
am
s
to
be
red
uc
ed
[
8]
,
[
9]
.
T
he
par
ti
ci
pa
ti
on
of
Indon
esi
an
m
arr
ie
d
m
en
in
fam
il
y
plan
ning
pro
gra
m
s
is
sti
ll
low
at
5.
5%
[
10
]
,
if
com
par
ed
with
oth
er
co
untri
es
su
ch
as
Ba
ng
la
des
h
19.
1%,
10.
9%
P
akista
n,
and N
e
pal
18%, the
r
at
e is
ve
ry lo
w
[
11]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
IS
S
N
:
2252
-
8806
IJPHS
V
ol.
6
, No
.
3
,
Septem
ber
201
7
:
23
1
–
23
6
232
Fam
il
y
plann
in
g
pa
rtic
ipant
in
I
ndonesi
a
only
sh
ow
a
high
rate
on
c
ontr
acepti
on
us
e
i
n
wo
m
en
not
in
m
en.
The
lo
w
pa
rtic
ipati
on
of
m
en
in
fam
il
y
plann
in
g
is
cause
d
by
a
va
riet
y
of
dem
og
raphic
fact
or
s
(
age,
nu
m
ber
of
ch
il
dr
en
,
an
d
s
ex
of
the
ch
il
d)
,
fact
or
of
so
ci
al
struc
t
ur
e
(e
ducat
io
n,
sci
ence
,
re
li
gio
n,
so
ci
oec
onom
ic
sta
tus
an
d
welfare
),
f
act
ors
s
pous
e
(w
i
fe'
s
healt
h
a
nd
s
up
port
a
wi
fe
)
a
nd
t
he
a
vaila
bili
ty
of
healt
h resou
rce
s (heal
th in
sura
nce,
acc
ess to
i
nfor
m
at
ion
, dis
ta
nce to
healt
h
facil
it
ie
s an
d h
eal
th worker
s [1
2].
Th
e
m
ajo
r
c
ontracepti
on
m
eth
ods
at
prese
nt
is
vasectom
y,
an
d
acce
pte
d
by
m
or
e
than
40
m
il
l
ion
m
en
as
a
m
et
h
od
of
m
al
e
ste
r
il
iz
at
ion
in
w
orl
dw
ide [13
]
-
[17].
I
n
I
ndonesi
a,
Ge
ner
al
ly
husba
nd'
s
par
ti
c
ipati
on
in
fam
ily
plann
in
g
pro
gram
s
is
sti
l
l
low.
th
is
is
ind
ic
at
ed
by
the
opini
on
of
the
husb
a
nd
that
fam
ily
plann
i
ng
is
a
m
a
tt
er
fo
r
the
wo
m
an
an
d
the
w
om
an
sh
ould
ste
rili
ze
d.
O
n
the
oth
e
r
ha
nd,
the
lo
w
pa
rtic
ipati
on
of
m
en
in
to
fam
i
ly
pl
ann
i
ng
al
s
o
cause
d
by
wives
who
are
le
ss
su
pp
or
ti
ve
m
ale
con
trace
ptiv
e
m
et
ho
ds
,
es
pe
ci
al
ly
on
vasectom
ies.
This
is
du
e
t
o
the
fear
t
hat
the
con
t
racepti
ve
vasect
om
y
m
ay
be
neg
at
ive
co
ns
e
qu
e
nc
es
that
their
hu
s
ba
nds
are c
heati
ng and a
fr
ai
d w
he
n ac
ti
viti
es d
uri
ng inte
rcourse i
s
less sat
isfyi
ng
[12].
The
par
ti
ci
pati
on
rate
of
hu
s
bands
in
fam
ily
plan
ning
by
us
in
g
operati
ng
m
et
ho
d
m
an
(
vasectom
y)
in
va
rio
us
distr
ic
t
in
Southea
s
t
Su
la
wesi
is
sti
ll
ver
y
lo
w.
B
ased
on
Nati
on
al
Fam
il
y
Plann
in
g
Bo
ar
d
(
N
FPB)
Southeast
Su
la
wesi
prov
i
nce
in
20
16,
N
or
th
K
olaka
is
a
n
a
rea
with
t
he
lo
west
at
t
ai
nm
ent
of
va
sect
om
y
th
a
n
oth
e
r
district
in
southea
st
Sul
awesi
pro
vin
c
e
[18].
Ef
forts
sh
oul
d
be
m
ade
to
increase
m
al
e
par
ti
ci
pation
in
fam
i
ly
plann
i
ng
ca
n
be
do
ne
thr
ough
the
prom
otion
of
fa
m
ily
plan
ning
and
the
m
an
w
it
h
the
f
or
m
[19]
,
[
20
]
.
This
stu
dy
wa
s
aim
ed
to
anali
ze
the
eff
ect
iveness
of
co
un
s
el
ing
by
va
sect
om
y
m
od
ule
in
North
Ko
la
ka
district
, Sou
t
he
ast
Su
la
wesi P
r
ov
i
nce
.
2.
RESEA
R
CH MET
HO
D
This
stu
dy
use
d
m
ixed
m
eth
od
desig
n
w
hich
c
om
bin
es
qu
al
it
at
ive
and
qu
antit
at
ive
m
et
ho
d.
qu
al
it
at
ive
m
eth
ods
de
pth
int
erv
ie
ws
t
o
e
va
luate
local
governm
ent
po
li
cy
relat
ed
t
o
t
he
e
xer
ci
se
of
m
ale
con
t
raceptive
m
et
ho
ds
of
op
erati
on.
Wh
il
e
the
quantit
at
ive
m
et
ho
d
is
done
by
us
in
g
qu
asi
-
ex
pe
rim
ental
researc
h desig
n
in
the
f
or
m
N
one
qu
i
valent
Con
tr
ol
Gro
up
Desig
n [21].
The
resea
rch
was
c
onduct
ed
in
N
or
th
K
ola
ka
from
Septem
ber
to
N
ove
m
ber
2016.
Th
e
popula
ti
on
was
the
husb
a
nd
w
ho
cl
assi
f
ie
d
as
co
up
le
reprod
uctive
a
ge
in
North
K
olaka
as
m
any
as
19
,
81
9
pe
op
le
.
Sam
pling
us
in
g
qual
it
y
assurance
LOT
(Lo
t
Qu
al
it
y
Assu
r
ance
-
L
Q
A
S
).
The
pur
pose
is
to
ascerta
in
wh
et
her
the
popula
ti
on
achieve
so
m
e
sta
nd
a
rds
to
f
ol
low
the
healt
h
care
pro
gr
am
,
in
this
case
the
m
et
ho
d
of
fa
m
ily
plan
ning se
rv
ic
es w
as
ope
rati
on m
an
m
et
hod or vasect
om
y.
Ba
sed
on
a
sa
m
ple
siz
e
ta
bl
e
f
or
sam
pling
in
the
L
ot
Q
ualit
y
Assura
nc
e
(L
QAS)
,
if
no
case
is
acce
ptable
(i
f
no
par
ti
ci
pa
nt
of
husb
a
nd
rec
ei
ve
vasect
omy
)
with
95%
c
on
fide
nce
in
prevale
nce
to
1.25%
to
20,00
0
a
nd
po
pu
la
ti
on
hu
s
ba
nd
as
c
ouple
r
epro
du
ct
ive
ag
e,
the
n
ob
ta
ine
d
a
sam
ple
siz
e
of
23
8
hu
s
ba
nd
a
s
couple
repr
oduc
ti
ve
age
[
22]
.
These
sam
ples
we
re
div
id
ed
into
2
gro
ups:
t
he
e
xperim
ent
al
gro
up
we
re
giv
e
n
counseli
ng
th
r
ough
m
od
ules
vasectom
y
wit
h
the
total
of
119
pe
op
le
a
nd
a
con
t
ro
l
group
that
wer
e
c
ou
ns
el
in
g
without
m
od
ule
with
the
total
of
119
pe
opl
e.
This
resea
rc
h
is
a
su
rv
ey
by
m
eans
of
sam
pl
ing
us
i
ng
c
luster
rand
om
sa
m
pl
ing
is
ra
ndom
sam
pling
of
a
gro
up
of
in
div
id
uals
base
d
on
ge
ogra
phic
area
s,
w
he
re
the
sam
pling
p
la
n
us
in
g
a
fram
e
work that c
ons
ist
s o
f
a cluste
r
of cluste
rs [22
]
.
The
resea
rch
i
nte
r
ven
ti
on
is
counseli
ng
ser
vices
thr
ough
vasectom
y
m
o
du
le
, w
he
re
th
e
final
sta
ge
of
this
stud
y
is
to
m
easur
e
at
ti
tud
es
c
han
ge.
T
he
in
dicat
or
of
at
ti
tud
es
cha
nge
is
acce
pta
nc
e
of
vasect
om
y
by
hu
s
ba
nd
who
c
la
ssifi
ed
co
up
l
e
rep
r
od
uctiv
e
age.
T
his
study
inv
olv
e
tw
o
gro
up
s:
the
ex
per
im
ental
gr
oup
was
giv
e
n
co
u
ns
el
ing
a
nd
a
co
ntr
ol
gro
up
was
not
giv
e
n
c
ounse
li
ng
.
B
oth
e
xperim
ental
gr
oup
a
nd
co
ntr
ol
gro
up
will
b
e m
easure
d bef
or
e
and a
fter in
te
rv
e
ntio
n (pret
est
and
po
stt
est
)
.
An
al
ysi
s
un
i
va
riable
is
use
d
to
descr
i
be
al
l
the
var
ia
bles
(
knowle
dge,
ed
uc
at
ion
a
nd
at
ti
t
ud
e
)
in
the
fr
e
qu
e
ncy
distrib
ution
ta
ble.
Bi
var
ia
ble
an
al
ysi
s
is
us
ed
to
kn
ow
the
e
ff
ect
ive
ness
of
inter
ven
ti
ons
us
in
g
counseli
ng
t
hroug
h
vasectom
y
m
od
ule
to
wa
rd
s
e
nh
a
ncem
e
nt
of
m
al
e
par
ti
ci
pation
i
n
fa
m
ily
plan
ning.
Data
analy
sis
te
chn
iqu
e
s
in
this
stud
y
us
in
g
the
sta
ti
sti
cal
te
st
Pa
ired
T.Test.
T
hi
s
te
st
is
us
e
d
to
com
par
e
two
set
s
of d
at
a,
both
e
xp
e
rim
ental
g
r
oup
a
nd
c
on
t
r
ol
g
r
oup by m
easur
em
ent scal
e
int
er
val and
ra
ti
o.
3.
RESU
LT
S
A
N
D A
NA
L
Y
SIS
3.1.
Results
3.1.1.
Charac
teristic
s of resp
onde
nt
s
ba
se
d ed
u
cat
i
on
and
occ
upation
Table
1
s
hows
cha
racteri
ti
cs
of
res
ponde
nts
base
d
e
ducat
ion
al
le
vel.
It
i
s
in
dicat
ed
t
he
m
ay
or
ity
pro
portion o
f
r
esp
onde
nt for
edu
cat
io
n
le
vel
is Se
nio
r
h
i
gh
sch
oo
l
with t
he
total
of
46
.4
%
.
Evaluation Warning : The document was created with Spire.PDF for Python.
IJPHS
IS
S
N:
22
52
-
8806
Th
e
Eff
ect
iv
eness
of C
ouns
el
i
ng thr
ough V
ase
ct
om
y
Mod
ule in N
or
th K
ol
aka,
Ind
on
esi
a (
Askrenin
g)
233
Table
1.
T
he
c
har
act
erist
ic
s
of
Re
s
pondents
Ba
sed
on
E
du
c
at
ion
E
ducat
io
n
Le
vel
Edu
catio
n
Level
Co
u
n
seling
with
o
u
t
Mod
u
le
Co
u
n
seling b
y
M
o
d
u
le
Total
n
(%)
n
%
n
%
Ele
m
an
ta
ry
s
ch
o
o
l
19
1
5
.1
8
6
.5
27
1
0
.8
Ju
n
io
r
h
ig
h
sch
o
o
l
34
2
7
.0
15
1
2
.1
49
1
9
.6
Sen
io
r
h
ig
h
sch
o
o
l
56
4
4
.4
60
4
8
.4
116
4
6
.4
Un
iv
ersity
17
1
3
.5
41
3
3
.1
58
2
3
.2
Total
126
1
0
0
.0
124
1
0
0
.0
250
1
0
0
.0
3.1.2.
The
resp
on
de
nt
s
re
ason
did
not
u
se
va
se
ct
om
y
Table
2
s
hows
res
ponden
t
re
aso
n
di
d
no
t
use
vasect
om
y.
Ba
sed
on
Ta
ble
2,
the
re
are
three
reas
on
s
that
cause
t
he
m
ajo
rity
of
r
esp
onde
nts
di
d
no
t
us
e
vasec
tom
y,
wh
ic
h
s
ti
ll
wan
ts
to
ha
ve
c
hildr
e
n
(
34%),
reasons
r
el
at
ed
to rel
igio
n by
18.4%, a
nd
16.
8%
a
re a
fr
ai
d s
u
r
ger
y.
Table
2.
R
eas
on
of
N
ot Use
V
asect
om
y
Reas
o
n
Did
Not U
se
Vasecto
m
y
Co
u
n
seling with
o
u
t
Mod
u
le
Co
u
n
seling b
y
Mo
d
u
le
Total
n
(%)
n
%
n
%
W
an
t to h
av
e child
ren
42
3
3
.3
43
3
4
.7
85
3
4
.0
Scared towa
rd su
r
g
ery
23
1
8
.3
19
1
5
.3
42
1
6
.8
Hav
e no
t a
ch
ild
re
n
2
1
.6
1
.8
3
1
.2
Co
sts
0
0
2
1
.6
2
.8
Af
raid to
ward
v
ase
cto
m
y
r
isk
3
2
.4
0
0
3
1
.2
Do
es n
o
t kn
o
w
2
1
.6
3
2
.4
5
2
.0
No
t r
eady
5
4
.0
2
1
.6
7
2
.8
Un
m
an
ly
13
1
0
.3
12
9
.7
25
1
0
.0
Relig
io
n
23
1
8
.3
23
1
8
.5
46
1
8
.4
alternativ
e
0
0
7
5
.6
7
2
.8
Per
m
an
en
t
co
n
trac
ep
tio
n
2
1
.6
1
.8
3
1
.2
Fa
m
il
y
plan
n
in
g
is wif
e con
cern
6
4
.8
7
5
.6
13
5
.2
Can
no
t ejaculate
3
2
.4
2
1
.6
5
2
.0
Sterile
2
1
.6
2
1
.6
4
1
.6
Total
126
1
0
0
.0
124
1
0
0
.0
250
1
0
0
.0
3.1.3.
Diff
ere
nces
of
kn
owle
dg
e
an
d att
i
tu
des
wi
th
counsel
in
g
Ba
sed
on
T
abl
e
3,
a
ve
rag
e
knowle
dge
of
re
sp
on
de
nt
after
counsele
d
is
4.
6,
wh
il
e
resp
onde
nts
were
giv
e
n
a
m
od
ule
is
6.
9.
The
aver
a
ge
val
ue
of
the
res
pond
ents'
at
t
it
ud
es
that
go
t
co
uns
el
ing
with
out
is
4.6,
wh
il
e the
att
it
ud
e
of r
es
ponde
nts wh
o ha
ve
r
ecei
ved
t
he
c
ounse
li
ng b
y m
odule a
ver
a
ge sc
or
e
is
5.3.
Table
3
. Dif
fere
nces
of
K
now
le
dg
e
a
nd
Atti
tud
e
s w
it
h
Co
uns
el
in
g
Grou
p
n
Mean
t
-
test
p
Kn
o
wled
g
e sco
re
Co
u
n
seling with
m
o
d
u
l
124
6
.90
3
2
1
0
.74
1
0.
000
Co
u
n
seling with
o
u
t
m
o
d
u
le
126
4
.57
9
4
Attitu
d
e sco
re
Co
u
n
seling with
m
o
d
u
l
124
5
.26
6
1
3
.06
0
0
.00
2
Co
u
n
seling with
o
u
t
m
o
d
u
le
126
4
.63
4
9
3.1.4.
Results
of
in
d
epth
in
ter
view
s
In
te
r
view
s
we
re
co
nducte
d
in
f
our
pa
rtic
ipants
from
local
governm
e
nt,
healt
h
aut
horiti
es,
an
d
Nati
on
al
Fam
i
ly
Plann
in
g
B
oard
(N
F
PB).
The
m
ai
n
qu
e
sti
on
is
how
a
tt
it
ud
es
towa
r
d
vasectom
y.
V
ario
us
answers i
n wr
it
ing
show
ed
on T
able
4.
Table
4.
A
ns
w
er
of
Re
s
ponde
nt
In
dep
t
h
I
nte
rv
ie
ws
An
swer
Participan
t
Male
co
n
trace
p
tiv
es
an
d
v
asecto
m
i
es
I
d
isag
ree,
b
e
caus
e
f
a
m
il
y
p
lan
n
in
g
wo
m
en
's
co
n
cern, vasecto
m
y
is the s
a
m
e
in th
e geld
in
g
Inf
o
r
m
an
1
Disag
ree
v
asecto
m
y
b
ecaus
e
it
is
n
o
t
in
accord
an
ce
with
th
e
teac
h
in
g
s
o
f
Isla
m
,
Fa
m
il
y
Plan
n
in
g
q
u
ite wif
e do
Inf
o
r
m
an
2
Disag
ree,
alth
o
u
g
h
i
wo
rk
at
NFPB
,
b
ecaus
e
v
asecto
m
y
p
rov
id
e
o
p
p
o
rtun
ities
to
ch
eatin
g
of
hu
s
b
an
d
.
Inf
o
r
m
an
3
This
f
ath
er
d
id
n
o
t
h
av
e
ch
ild
ren,
an
d
h
e
is
d
isag
ree
with
v
asecto
m
y
b
ecaus
e
n
o
t
accord
an
ce with
m
o
sle
m
wa
y
of
lif
e.
Inf
o
r
m
an
4
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IS
S
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:
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8806
IJPHS
V
ol.
6
, No
.
3
,
Septem
ber
201
7
:
23
1
–
23
6
234
3.2.
Discussio
n
The
Vasect
omy
m
od
ule
is
te
ste
d
to
124
re
sp
on
de
nts,
t
he
n
m
easur
e
d
e
f
fecti
ven
es
s
by
com
par
in
g
with
res
ponde
nts
w
ho
ha
ve
r
ec
ei
ved
c
ounse
li
ng
with
out
m
od
ule
.
The
r
esults
showe
d
there
we
re
di
fference
s
in
the
value
of
knowle
dge
a
nd
at
ti
tud
es,
w
he
re
the
ave
rag
e
knowle
dge
of
r
esp
onde
nts
w
ho
hav
e
recei
ve
d
the
m
od
ule
are
hi
gher
t
han
res
pond
e
nts
w
ho
ha
ve
recei
v
ed
c
ounse
li
ng.
A
verage
kn
ow
le
dg
e
of
respo
nd
e
nt
s
w
ho
go
t
a
m
od
ule
is
6.
9,
w
hile
respond
e
nts
who
receive
d
co
un
s
el
ing
is
4.
6.
T
his
dif
fer
e
nce
sta
ti
sti
cal
l
y
was
sign
ific
a
nt
(
p
=
0.0
00).
T
he
re
is
no
diff
e
r
ence
i
n
at
ti
tude
m
easur
em
en
t
res
ults,
re
sponde
nts
who
go
t
a
counseli
ng
by
m
od
ule
hav
in
g
a
scor
e
higher
than
the
at
ti
tud
e
of
respo
nd
e
nts
who
ha
ve
r
ecei
ved
co
uns
el
in
g
without
m
od
ule.
The
ave
ra
ge
scor
e
of
the
a
tt
it
ud
e
of
res
po
nde
nts
w
ho
got
a
counseli
ng
by
m
od
ule
is
5.
3,
wh
il
e
respo
nd
e
nts
w
ho
receiv
ed
c
ouns
el
in
g
w
it
hout
m
od
u
l
e
is
4.6.
T
he
at
ti
tud
e
sc
or
e
dif
fer
e
nce
sta
ti
stical
ly
was
si
gn
i
ficant
(p
-
0.002
)
.
The
res
ults
ab
ove
s
how
the
m
et
hods
of
healt
h
prom
otion
w
it
h
the
m
edia
m
od
ule
is
m
or
e
effe
ct
ive
in
i
m
pr
ovin
g
knowle
dge
of
the
respo
nd
e
nt.
Se
le
ct
ion
m
et
ho
ds
in
healt
h
pro
m
ot
ion
s
houl
d
pay
at
te
ntio
n
to
the
factors
that
inf
luence
the
su
c
cess
of
healt
h
prom
otion
,
inc
lud
in
g
the
abil
it
y
of
the
pr
om
oter,
the
sta
t
e
of
the
ta
rg
et
gro
up
[
23
]
.
The
m
odule
is
one
of
the
m
edia
healt
h
prom
otion
i
n
the
form
of
read
i
ng
m
at
erial
.
In
su
bst
ance
m
od
ules
t
hat
em
ph
a
siz
e
the
in
dep
e
ndence
(s
el
f
-
le
ar
ning)
.
Module
s
ca
n
be
f
or
m
ulate
d
as
a
com
plete
un
it
and
sta
nd
-
al
one
unit
an
d
c
onsist
s
of
a
se
ries
of
act
ivit
ie
s
orga
nized
help
par
ti
ci
pa
nts
ac
hieve
a
nu
m
ber
of
obje
ct
ives
that
wer
e
def
i
ned
s
pe
ci
fical
ly
and
cl
early
.
Me
dia
m
od
ule
spur
creati
vity
and
pro
vide
opport
un
it
ie
s
f
or
par
ti
ci
pa
nts
to
m
ast
er
the
m
at
erial
in
accor
da
nce
wit
h
the
ci
rc
um
st
ances
of
each
.
The
m
od
ule
fits
pe
rf
ect
ly
with
th
e
sta
te
of
s
ocie
ty
in
the
st
ud
y
beca
us
e
flexi
bi
li
t
y
is
us
e
d
.
C
ouns
el
in
g
m
odule
is
on
e
of
t
he
eff
ect
ive
m
eth
ods
to
diss
e
m
inate
aud
iov
is
ual
vasec
tom
ie
s.
Accord
i
ng
t
o
B
ha
nd
a
ri
and
S
hrest
ha
[
24
]
,
au
diovisu
al
m
edia
exp
osure
is
im
po
rtant
for
m
en
in
determ
ining
th
e
beh
a
vior
ass
ociat
ed
with c
on
t
racep
ti
on
.
Va
rio
us
stu
die
s
reg
a
rd
i
ng
the
us
e
of
m
edia
to
prom
ote
the
act
ive
pa
rtic
ipati
on
of
m
en
in
fam
il
y
plan
ning
pro
gra
m
s
sh
ow
s
tha
t
the
m
edia
is
ver
y
i
m
po
rta
nt
as
a
m
eans
to
p
ro
m
ote
fam
ily
plann
in
g
pro
gr
am
[
25
]
-
[
29
]
.
Re
search
c
onduct
ed
by
Musafa
ah
[
30
]
s
howe
d
that
the
resp
on
den
ts
we
re
exposed
to
th
e
m
ass
m
edia
m
or
e
in
t
he
pro
gr
am
of
fam
i
ly
plann
i
ng
tha
n
t
hose
not
e
xpose
d
t
o
the
m
as
s
m
edia.
The
r
e
is
a
sign
ific
a
nt
rel
at
ion
s
hip
bet
ween
the
m
ass
m
edia
acce
ss
to
t
he
c
ontrace
ptive
m
et
hod
in
m
ales
[
25
]
.
Eff
ect
ive
ness
researc
h
c
onduct
ed
by
m
e
d
ia
m
od
ules
hav
e
S
utanto,
et
al
[
31
]
wh
ic
h
e
xam
in
ed
th
e
eff
ect
ive
ness
of
nutrit
io
n
co
unsel
in
g
m
od
ul
es,
w
her
e
t
he
m
od
ules
are
ef
fecti
ve
in
im
pr
ov
i
ng
postu
re
bu
t
is
no
t e
ff
ect
i
ve
f
or
know
le
dge a
nd b
e
ha
vior.
Kno
wled
ge
an
d
Atti
t
ud
es
is
a
pr
edict
or
of
a
per
s
on'
s
beh
avi
or.
The
us
e
of
m
od
ule
s
in
healt
h
prom
otion
is
exp
ect
e
d
to
c
hange
the
behavio
r
of
pe
op
l
e
to
us
e
a
vas
ect
omy
.
The
f
ind
in
gs
of
this
stud
y
descr
i
bes
the
va
rio
us
co
ns
trai
nts
af
fecti
ng
t
he
su
ccess
fu
l
use
of
vasect
omy
as
a
m
al
e
con
trace
ptive
in
North
Ko
la
ka.
Var
i
ous
ob
sta
cl
es
ca
n
be
seen
from
the
res
ults
of
researc
h
on
t
he
reasons
for
r
efu
sal
vasecto
m
y
and
from
interview
s
with
healt
h
a
utho
riti
es,
l
oca
l
gove
rn
m
ents,
an
d
em
plo
ye
es
at
N
FPB
.
T
he
res
ults
of
th
e
st
udy
descr
i
bes
th
e
vi
ews
of
m
en
about
vasect
omy
dr
aw
n
f
ro
m
answerin
g
qu
e
sti
on
s
rea
son
not
to
us
e
the
l
arg
est
su
c
h
vasect
omy
becau
se
they
wan
t
to
hav
e
childre
n,
fear
of
s
urge
ry,
reli
gion
(m
os
lem
per
ce
ptio
n)
,
a
nd
los
t
virili
ty
.
In
t
his
stu
dy
di
d
not
fin
d
a
n
a
ss
ociat
ion
betwe
en
vasectom
y
disap
pro
val
r
easo
ns
to
ed
uc
at
io
n.
Re
search
c
onduct
ed
by
Bi
est
ch
[
27
]
f
ou
nd
t
hat
pe
ople
w
ho
are
hi
gh
ly
e
ducat
ed
m
or
e
rec
ei
ve
fam
ily
plann
i
ng
pro
gr
am
.
The
res
ults
of
in
-
de
pth
i
nterv
ie
ws
ra
nks
of
gove
rn
m
ent
and
relat
ed
a
gen
ci
es
il
lustr
at
es
how
a
vasectom
y
reject
ion
ass
ociat
ed
with
i
gnora
nce
of
wh
ic
h
is
base
d
on
the
answers
t
hat
fam
i
ly
plann
in
g
is
a
wo
m
an'
s
pr
obl
e
m
,
as
well
as
vasectom
ie
s
i
n
the
gel
ding.
Anothe
r
sig
nif
ic
ant
reason
is
relat
ed
to
reli
gion.
The
res
ults
show
46%
of
re
sp
on
de
nts
cl
ai
m
to
re
j
ect
f
a
m
ily
plan
ning
because
of
reli
gion
(m
ajo
rity
reli
gion
of
s
ociet
y
in
N
or
t
h
K
olaka
is
a
m
os
lem
).
It
al
so
stren
gth
e
ne
d
the
res
ults
of
in
-
dep
t
h
int
erv
ie
ws,
wh
e
re
so
m
e
respo
nd
e
nts
a
nswere
d
vasect
om
y
is
con
tra
r
y
to
the
te
achi
ng
s
of
the
reli
gion
(
Isla
m
per
cepti
on)
.
Re
s
earc
h
cond
ucted
by
Bi
est
ch
[
27
]
r
eported
that
a
m
on
g
m
us
lim
s
is
lower
in
r
ecei
vin
g
fam
i
l
y
plann
in
g
pr
ogra
m
com
par
ed
Ch
risti
ans
so
ci
et
y.
Anothe
r
reas
on
res
ponde
nts
do
no
t
a
ppr
ov
e
of
va
sect
om
y
is
their
worr
ie
r
s
if
his
wife
ha
ve perc
eption
that
vas
ect
omy
m
ake husban
d
aesy
t
o cheat
ing.
In
c
ontrast
to
r
esearch
co
nduc
te
d
by
Kh
al
if
a
[
32
]
re
ported
that
91%
of
m
en
in
suda
n
re
cei
ve
fam
il
y
plan
ning
pro
gra
m
s
if
their
w
ives
ar
e
in
po
or
healt
h,
wh
i
le
57%
of
m
e
n
in
S
udan
us
ing
fam
ily
plann
i
ng
pro
gr
am
s
b
ecause
of
econom
ic
lim
i
ta
ti
on
s.
Pakistan
re
port
ed
that
m
or
e
m
en
are
receiv
in
g
co
ntrace
ptive
us
e
than
wo
m
en
[
33
]
.
T
he
res
ults
of
in
-
de
pth
i
nter
views
t
o
pro
vid
e
i
nput
re
gardin
g
furthe
r
inter
ve
ntion
wh
i
c
h
m
ay
be
m
ade
by
the
NF
PB
in
or
de
r
to
increase
the
pa
rti
ci
pation
of
m
en
in
fa
m
ily
plann
i
ng
pr
ogram
s,
especial
ly
vasectom
ie
s.
In
li
ne
with
resea
r
c
h
co
nducte
d
by
Buzy
and
S
m
it
h
[
34
]
re
ported
that
the
in
te
rv
i
e
w
with
F
oc
us
gro
up
s
can
incr
ea
se
the
m
al
e
ro
le
in
pr
ov
i
ding
input
f
or
t
he
s
uccess
of
the
i
nter
ven
ti
on
prog
ram
on m
al
e con
tra
cepti
on.
Evaluation Warning : The document was created with Spire.PDF for Python.
IJPHS
IS
S
N:
22
52
-
8806
Th
e
Eff
ect
iv
eness
of C
ouns
el
i
ng thr
ough V
ase
ct
om
y
Mod
ule in N
or
th K
ol
aka,
Ind
on
esi
a (
Askrenin
g)
235
The
s
uccess
of
vase
ct
om
y
c
on
t
raceptive
m
et
ho
d
al
s
o
r
equ
i
res
the
s
uppo
rt
of
reli
gi
on
le
a
der
s
or
reli
gion
insti
tu
ti
os
to
acce
le
r
at
e
the
su
cce
s
s
o
f
va
sect
omy
.
Adv
ocacy
of
reli
gi
on
s
inst
it
ution
s
of
I
ndon
e
sia
sh
oul
d
be
co
nducte
d
relat
ed
to
fa
m
il
y
plann
i
ng
pro
gr
a
m
.
The
m
od
ul
e
is
m
or
e
eff
ect
ive
to
i
m
pr
ov
i
ng
knowle
dge
a
nd
at
ti
tud
es
tha
n
counseli
ng
without
m
od
ule.
The
m
os
t
reas
on
f
or
re
j
ect
io
n
vasectom
y
was
they
wan
t t
o hav
e
c
hildr
e
n, fea
r of su
rg
e
ry a
nd r
e
li
gio
us i
ssu
es
.
4.
CONCL
US
I
O
N
The
re
su
lt
s
of
this
stu
dy
showe
d
that
vas
ect
omy
m
od
ul
e
can
be
use
d
as
an
e
ff
ect
iv
e
m
et
ho
d
t
o
increase acce
pt
abili
ty
o
f
m
a
le
ste
rili
zat
ion
am
on
g
m
en
in N
ort
h Ko
la
ka,
Southeast S
ula
wesi. Besi
des
t
hat, the
su
ccess
of
vase
ct
omy
m
od
ule
al
so
r
e
quires t
he
sup
port of
reli
gio
n l
eade
rs
i
n North
Kolak
a.
ACKN
OWLE
DGE
MENTS
The
aut
hors
a
re
gr
at
e
fu
ll
to
the
insti
tuton
Po
ly
te
chn
ic
of
healt
h
Ke
nd
ari,
Mi
nistry
of
Healt
h
of
Re
public I
ndonesi
a,
for
t
he
fi
nan
ci
al
s
upport
.
REFERE
NCE
S
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Na’i
m
A
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and
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y
aput
r
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H.
,
“
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ara
a
n,
Suku
Bangsa,
Agam
a,
Dan
Baha
sa
Sehar
i
-
Hari
Penduduk
I
ndonesia
:
Hasil
Sensus
Penduduk
2010
,”
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r
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ti
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g
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roduc
tive
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fer
ence,
”
Dem
ogra
phic
an
d
Hea
lt
h
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y
,
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par
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i
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die
s.
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ber
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y
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A
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y
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and
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y
ib
le
P.
,
“
The
rol
e
of
m
en
in
famil
y
Planni
ng
an
exam
ina
ti
on
of
m
e
n'
s
knowledg
e
a
nd
at
tit
ude
to cont
r
a
ce
pt
ive
use
Am
ong
the Yorubas
,”
Af
ri
can
popul
St
ud
,
vol
/i
ss
ue:
18
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,
pp
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35
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49
,
2
003
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Bangl
ad
esh
De
m
ogra
phiv
and
Hea
lt
h
Surve
y
,
“
Bangl
ade
sh
de
m
ogra
phic
and
Hea
lt
Surve
y
1
999
-
2000
,”
US
A:
Bangl
ad
esh,
Mit
ra
and
As
socia
t
e
s,
Ban
gl
ade
sh
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d
Mac
ro
Inte
rn
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BKK
BN,
“
Methods
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pti
on
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ss
on
ele
ct
ed
,”
Jaka
rt
a
,
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G.
,
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t
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ta
tus
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Fem
ale
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liza
ti
on
Vas
in
Chin
a
,”
Int
J
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prod
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vase
ct
om
y
and
Hea
lt
h
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Resul
ts
from
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le
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ai
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ese
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IS
S
N
:
2252
-
8806
IJPHS
V
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6
, No
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3
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Septem
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201
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ti
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onta
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ept
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e
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ic Health
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ubli
c
Heal
J
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t
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vo
l/
issue:
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