Assiut Scientific Nursing Journal

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Effect of Premarital Orientation Program Regarding Sexual and Reproductive Health:

A step to Increase Rural Adolescents’ Female Awareness
Ayat M., Omar1, Sharbat T., Hasaneen 2, Shaimaa G. Hassen3, & Manal M., Mostafa4
1.
Assistant Professor of Maternal and Neonatal Health Nursing Department, Faculty of Nursing, Fayoum
University, Egypt
2.
Assistant Professor of Community Health Nursing Department, Faculty of Nursing, Fayoum University, Egypt
3.
Lecturer of Maternal and Neonatal Health Nursing Department, Faculty of Nursing, Assiut University, Egypt
4.
Assistant Professor Community Health Nursing Department, Faculty of Nursing, Fayoum University, Egypt

Abstract
Background: The awareness of human rights in reproductive health and the lack of adequate warning may owing to
many hazards. One of the best times for preparing for these problems is pre-marriage. Aim: This study aimed to
evaluate the effects of premarital orientation program on the female adolescent’s awareness about sexual and
reproductive health. Design: A quasi- experimental, pre-test and post-test one-group only design was utilized in this
study. Setting: this study was conducted at the international conference hall of the Fayoum University. Sample: A
purposive sample of 180 female adolescents living in rural villages at Fayoum governorate, planning and coming to
marriage were recruited in this study. Data collection tool: Data were collected by an interview questionnaire used
in two stages of pre and post program implementation. Results: the current study findings illustrated that the total
mean score of correct answers was significantly increased among participants after receiving program. Conclusion
& recommendations: Premarital orientation program was p.0.001 successful in attaining its aim of positively
changing the knowledge of participant’s female adolescent. So recommend to eestablish continuous educational
training program among health care providers responsible on premarital counseling clinics in rural health center
about adolescent’s reproductive and sexual health issues.

Keywords: Premarital Orientation, Sexual, Reproductive Health &Rural Adolescents.

Introduction and reproduction taboos that need to be examined in

Adolescent sexual and reproductive health refers to order to protect health (Muhammad & Mamdouh
physical and emotional wellbeing it includes the 2012).
ability to remain free from unwanted pregnancy, In fulfilling their sexual and reproductive health
STIs, unsafe abortion and also all forms of sexual needs, adolescent (10-19 years of age) around the
violence and coercion. One of the most basic aspects world face enormous challenges and in adequate
of life is reproductive health (RH). Yet, due to access to knowledge and resources for health. For
cultural and political sensitivities, especially in low- people, couples and families, sexual and reproductive
income communities, In public policy debates, they health (SRH) is important. Is important to maintain
frequently receive little consideration (WHO, 2014). healthy reproduction, greater interaction between
Adolescence is described as the period of life between partners should be done in order to make healthier
the ages of 10-19 by the World Health Organization sexual decisions and to participate in the social
(WHO). This period requires development from development of their countries. (Chuang & Chen
secondary sex (puberty) characteristics to complete 2015). Despite the high risks that countries face
sexual reproductive maturity. Every year, because of their negligence, adolescent sexual and
approximately 11 % of all births all over the world, reproductive health (ASRH) has traditionally been
sixteen million girls aged 15-19 give birth, 95 % of ignored. Its issues, including gender discrimination,
these births occur in developing countries (United abortion, unplanned pregnancies, polygamy, early
Nations Population Division, 2011). Egypt had the marriage, female genital mutilation, repeated
highest percentage of girls who are married and pregnancies, STIs, are some of the challenges
childbearing between (15-19) years reaches 14%, encountered among adolescents across the world. The
particularly in rural areas (14 %). Egyptians generally most critical factors hindering their health care are the
believe that once they are married, young people don't in accessibility to suitable health care, education and
need to worry about RH problems. This notion is communication. (UNICEF, 2010) & (Vamos, et al.,
rooted in cultural beliefs and long-standing sexuality 2020)

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Premarital care (PMC) promotes the health and governorate of Fayoum. The future of every culture is
wellbeing of a woman and her partner before represented by adolescent girls. Better education and
marriage and pregnancy; it is considered as the public health interventions can be highly beneficial
primary health care method for marriage and for their health and wellbeing. The researchers find
conception planning for couples; it can recognise and that this study offers an opportunity to address and
alter medical, behavioural, and other known health meet the needs of adolescent females about
risk factors that influencing outcomes of pregnancy reproductive and sexual health issues.
(Chuang & Chen 2015). Study aim:
One of the ideal resources used to improve Aim of this study was:
awareness, skills and motivation for individuals to To evaluate the effect of premarital orientation
make healthy lifestyle choices, particularly when program on the female adolescents awareness
properly targeted is health education. Female regarding sexual and reproductive health.
adolescent group in Egypt need to be informed with Research hypothesis:
more information on their reproductive health and Total post-test score of female adolescent’s awareness
access to resources before having the first child, level regarding premarital sexual and reproductive
according to .( Beamish 2001.). A considerable health would be significantly higher than pretest.
percentage of primary maternity and child health care
providers need basic premarital therapy training. Material and methods.
Although information on reproductive health, Research design:
counselling and the provision of services have been A quasi- experimental, pre-test and post-test one-
recognized for decades as necessary programs for group only design was utilized in this study.
adults and have become increasingly available, the Setting:
availability of such programs has more recently been This study implemented in the international
endorsed for adolescents. (UNFPA, 2010) A smaller conference hall of the Fayoum University, Fayoum
number of studies were conducted to determine the Governorate
effect of youth intervention in health education in Sample:
Egypt ( Bastani, 2010). The importance of premarital A purposive samples of 180 adolescent’s female were
education has been emphasized by many researchers. included in this study according to the following
Egyptian female adolescents currently receive little criteria:
accurate health and sexual information, making them  Age group 15-19 years
more prone to violence, accidental pregnancy,  living in rural villages at Fayoum governorate
coercion and sexually transmitted infections  Planning and coming to marriage.
(Rezaeyan & Morteza 2017). Finally, healthcare  Agree to participate in the study
providers are very well positioned to impact and  Attended the conference
maintain service access for those who will work to  Never attended any orientation program
ensure that early and personalized maternal services regarding reproductive or sexual health
are given to young pregnant women to resolve their  Have a telephone number for subsequent follow
unique concerns and high risk. In addition to up communication
developing programs to encourage a healthier Data collection tools:
lifestyle and also engaging in teaching workshops A structured interviewing schedule: it designed to
focusing on specific aspects of reproductive and assess the participant’s awareness about reproductive
sexual health. and sexual health issues based on a review of
literature and similar studies conducted elsewhere.
Study significance This questionnaire included two sections.
The National Council for Childhood and Motherhood Part 1: participant’s socio-demographic
(2014) confirmed that adolescent marriage, especially characteristics related data: including (age,
(rural girls) under 18 years of age, can be vulnerable religion, level of education, residence and housing
to many problems and challenges in reproductive and condition).
sexual health, such as initiation of sexual activity Part 2: participant’s reproductive and sexual
while missing adequate knowledge and skills, higher health related knowledge (pretest and post- test):
risk of early childbearing, unintended pregnancy , it consisted of 20 close ended questions to assess the
sexually transmitted infections (Muhammad & participant's knowledge regarding sexual issues of
Mamdouh 2012). The provision of information and marital life (definition of marriage, sexual health,
services is limited by numerous political, economic sexual relation and its stages, hymen, positions of
and sociocultural factors; for this community, sexual relation, first night of penetration and its
especially in rural communities such as the common types of problems and hygienic care

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Assiut Scientific Nursing Journal Omar et al.,

measures, essential factors to get pregnancy). It used  The topics presented during the lectures were an
at two interval (pre and post-test) outline of sexual & reproductive health including
Scoring system: a score of ‘1’ assigned for each (reproductive organs physiology, sexual relation
correct answer and a score of ‘zero’ assigned for and its stages, sexual intercourse positions,
wrong answer. The maximum score is when the characteristics of healthy marital sexual relation,
respondents obtain 20 grades which represents100% first night of penetration and its common types of
and categorized into two levels as following: problems, hygienic care measures, characteristics of
satisfactory >50%, unsatisfactory <50%. fertile period, essential factors to get pregnancy,
Part 3: Follow up assessment data: it includes one family planning methods, genital tract infections
close end question and 2 open end questions to assess and sexual transmitted disease types, causes ,signs
the health problems that encountered among and symptoms , complications and it’s preventive
adolescent females after marriage and its early measures
management of each  The researcher was used different teaching methods
The content validity of the tool was valid by such as audio - visual aids to further guide of the
reviewing the tool by five specialists in Obstetrics and participant's during the sessions (figures and
Gynecological Nursing and Community Health models, videos) in addition to a booklet given to
Nursing field each participants at the end of the sessions that
Procedure: prepared in a clear Arabic language containing a
 A scientific seminar was organized by Al- Fayoum sufficient knowledge about the previous mentioned
University represented in Faculty of Nursing in topics.
collaboration with community development Evaluation phase:
associations at Al-Fayoum governorate and The effectiveness of the program was evaluated
associated with the Ministry of Social Solidarity immediately after completing the sessions using the
 An official approval was obtained before the study same pretest questionnaire (part 2) as a post- test for
was conducted from the official sponsors of the all participants.
scientific seminar [Vice President for Community Follow up phase:
Services at Al-Fayoum University This phase conducted after marriage for girls
 The study was conducted through the following accordingly by contacting them via telephone call to
phases: assess the reproductive health problems and for
Assessment phase referral if needed and early management as, urinary
 During which pre-interventional evaluation was tract infection, genital tract infections, sexual health
carried out after receiving verbal consent from the problems, as well as problems related to delaying
participant, using the structured questionnaire to test pregnancy .etc.
the needs and awareness of the participant on the Ethical consideration:
previously described subjects of sexuality and Prior to the study's conduct an official permission and
reproductive health issues in Arabic language. It consent from the dean of the Faculty of Nursing, as
lasting nearly 15 minutes for the questionnaire to be well as from the official sponsors of the scientific
completed. seminar [Vice President for Community Services at
 To test the reliability and applicability of the Fayoum University] were obtained. Before inclusion
questionnaire, a pilot study was executed on 10 in the study, informed consent was obtained from
percent of the study’s participant (18 participants) every participant. Participant's data were dealt
and the required modifications were made with highly confidentiality and anonymity to ensure
accordingly. those pilot participants were included their privacy. Only the researchers and the
in the study sample participants were accessible with details.
Implementation phase Statistical analysis:
 Interventional education comprised of a full day (8 The data was coded for entry and tested using the
hours) seminar covering 4 sessions lectured by the Social Sciences Statistical Software Package (SPSS
researchers, including related material on sexual and version 18.0). Percentages and frequencies forms of
reproductive issues. descriptive statistics, data was presented. Variables of
 The scientific lectures divided into four sessions the interval and ratio were provided in the form of
each one lasting approximately 1 hour. mean and standard deviations and checked by t-test
 Queries and a panel discussion (2 hours) after all participants. Person's r was used for correlation
lectures were encouraged by the researchers team checking. When (p < 0.05), the significance level was
selected.

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Results:
Table (1): Distribution of demographic characteristics among studied participants (No. 180)
Items No. %
Age/years
Range 16-19 years
Mean+SD 16.8 ± 4.8
Religion
Muslim 142 78.9
Christian 38 21.1
Type of family
Nuclear family 112 62.2
Extended family 68 37.8
Level of education
Illiterate 42 28.3
Read and write 39 26.7
Primary education 27 15
Secondary education 72 30
Higher education 0 0
Table (2): Participant’s knowledge regarding the marital sexuality matters (N.180)
Pre intervention Post intervention
TOPICS Correct Incorrect Correct Incorrect
P-value
No. % No. % No. %. No. %
Definition of reproductive health 12 6.7 168 93.3 142 78.9 38 21.1
The reproductive organs 23 12.8 157 87.2 126 70 54 30
Definition of sexual relation / 57 31.7 123 68.3 167 92.8 13 7.2
intercourse
Characteristics of healthy marital sexual 11 6.1 169 93.9 154 85.6 26 14.4
relation
0.001*
Positions of sexual intercourse 13 7.2 167 92.8 163 90.6 17 9.4
Sexual intercourse related hygiene 8 4.4 172 95.6 148 82.2 32 17.8
Common reproductive health problems 19 10.6 161 89.4 112 62.2 68 37.8
after marriage
Preventive measures and care of 9 5 171 95 136 75.6 44 24.4
reproductive health problems after
marriage
Total mean +SD score of correct 19.4 ± 7.1 134.5 ± 12.4
answer
Statistically significant at p < 0.05
Table (3): Participant’s knowledge regarding fertility and contraceptive methods
TOPICS Pre intervention Post intervention
P-
Correct Incorrect Correct Incorrect
value
No. % No. % No. %. No. %
Reproduction and fertility information
 Definition of fertility 22 12.2 158 87.8 128 71.1 52 28.9
 Physiology of reproduction 18 10 162 90 109 60.6 71 39.4
 Knowledge of the fertile Period 29 16.1 151 83.9 171 95 9 5 0.033
 Essential factors to get pregnancy 25 13.9 155 86.1 159 88.3 21 11.7
Total mean +SD of correct answer
Family planning 21.2 ± 6.4 151.3 ± 9.8
 Definition of family planning /birth spacing 14 7.8 166 92.2 112 62.2 68 37.8
 Common methods of family planning 26 14.4 154 85.6 124 68.9 56 31.1
0.002
 Advantages & disadvantages of family 17 9.4 163 90.6 111 61.7 69 38.3
planning
Total Mean +SD score of correct answer 20.2 ± 3.4 133.5 ± 11.4
Statistically significant at p < 0.05

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Table (4): Knowledge of the studied participants regarding RTIs/STDs

Pre intervention Post intervention
P-value
TOPICS Correct Incorrect Correct Incorrect
No. % No. % No. %. No. %
Definition of GTI/STDs 15 8.3 165 91.7 134 74.4 46 25.6
Common types 4 2.2 176 97.8 116 64.4 64 35.6
causes of GTI/STDs 7 3.9 173 96.1 109 60.6 71 39.4
Routes of transmission 17 9.4 163 90.6 123 68.3 57 31.7
0.001
Signs &symptoms 9 5 171 95 98 54.4 82 45.6
Complications 3 1.7 177 98.3 107 59.4 73 40.6
Preventive measures 8 4.4 172 95.6 147 81.7 33 18.3
Total mean +SD score of 7.3 ±3.4 121.6 ± 8.4
correct answers
Statistically significant at p < 0.05

Table (5): Participant’s knowledge regarding premarital screening and tests

Pre intervention Post intervention
p-value
TOPICS Correct Incorrect Correct Incorrect
No. % No. % No. %. No. %
Concept of Premarital screening and tests 15 8.3 165 91.7 168 93.3 12 6.7
Importance of Premarital screening and 28 15.6 152 84.4 156 86.7 24 13.3
tests
Components of Premarital screening 6 3.3 174 96.7 159 88.3 21 11.7 0.004
Suitable Timing of Premarital screening 34 18.9 146 81.1 162 90 18 10
and tests
Total Mean +SD score of correct 9.2 ± 4.4 158.6 ±8.6
answers
Statistically significant at p < 0.05

Figure (1): Most common source of prior knowledge regarding sexual and reproductive health
among studied participants

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Assiut Scientific Nursing Journal Omar et al.,

Figure (2): Common reported post marriage reproductive & sexual health problems among
participants N. (47).

Table (6): Relationship between satisfactory pot-test level of knowledge and level of education
among studied participants.
Satisfactory level of knowledge
Socio-demographic characteristics
X2 P.
Level of education 18.5 0.003
Statistically significant at p < 0.05

Table (7): Correlation between common post marriage sexual reproductive health problems and
age, level of education, pot-test satisfactory level of knowledge among studied participants
Common post marriage sexual reproductive health problems
Items
(r ) P.
Age 21.3 0.021*
Level of education -16.01 0.003**
Satisfactory pot-test level of - 28.27 0.001**
knowledge
(r) Correlation coefficient
(*)Statistically significant at p < 0.05
(**) highly statistical significant at p < 0.01

Table (1): Clear up that the participants age ranged Table (2): As regards knowledge of participants on
from 16 -20 years, more than two thirds were marital sexual matters revealed that mean +SD score
Muslim (78.9% , and 62.2% living with nuclear of participant’s correct answers were significantly
family. regarding education level nearly illiterate and increased after program implementation P-value
read and write group were constitute the half of the (0.001).
sample and more(55.%).

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Assiut Scientific Nursing Journal Omar et al.,

Table (3): Illustrated that the Mean +SD score of awareness of rural adolescent girls' knowledge and
participants correct answers regarding reproduction understanding of reproductive and sexual health. The
and fertility before program implementation was gross inadequate of knowledge regarding
121.2 ± 6.4 that after program this score significantly reproductive health and sexual health among the
increased to the 151.3 ± 9.8 (p=0.033). moreover; the participants was noticed in this report. In addition to
same table reported that mean +SD total score of the sensitive nature of the subjects, the gross
participants knowledge regarding family planning inadequacy of the participants' awareness may be
methods were significantly increased in post attributed to insufficient sexual and reproductive
intervention than pre intervention(133.5 ± 11.4 vs. instructional content, resources and guidance in their
20.2 ± 3.4) p. value 0.002 societies. It is true that reproductive health education
Table (4): Concerning knowledge of the studied is not given due consideration in developed countries.
participants regarding RTIs/STDs showed that the Sexual wellbeing is viewed as a biomedical concept
participants total mean +SD score of correct answers rather than an significant component of full well-
were significantly increased in post intervention than being because of socio-cultural and economic
pre intervention 7.3 ±3.4 vs. 121.6 ± 8.4 p. value variables. Our findings also reported that the studied
0.001. participants knowledge regarding reproduction and
Table (5): Premarital screening knowledge of studied fertility topics increase significantly after receiving
participants were significantly increased after the program p. value. 0.000.
receiving the program than before p. value (0.004), Similar studies by (Rezaeyan & Morteza 2017).
as well as their total mean +SD score of correct Showed that the level of awareness regarding
answers in pre intervention was 9.2 ± 4.4 changed to reproductive health following program
158.6 ±8.6 in post intervention implementation was significantly increased with
Figure (1): Demonstrated that the most common regard to changes in girls' understanding after
source of knowledge among studied participants who premarital education in Iran. This is agreed with
have a prior knowledge on sexual and reproductive (Dhital et al., 2005). Study conducted in Dhahran
health (58.9%) were their friends (64.1%), followed conducted to assessing the structured educational
by their family members (21.7%). program among adolescent students in enhancing
Figure (2): Illustrates that nearly 47(26.0%) of total school-going adolescents’ awareness and attitude of
participants reported that they suffered from on reproductive health. In addition to their results, the
reproductive & sexual health problems after marriage mean pre-test score of the experimental group
mentioned in form of genital tract infections (68.0%) infortion was low while was high for the control
and sexual relation problems (32.0%). group ( Kumi-Kyereme 's, 2014) research also aimed
Table (6): Clear up those individuals with an high at evaluating the adolescent’s KAP and gatekeepers
educational levels were attained significantly higher on adolescent reproductive health issues in Mumbai,
score of satisfactory level of knowledge than those understanding the actions of adolescent’s pursuing
with lower educational levels, p. value 0.003. health. The sample size of 600 adolescents from both
Table (7): show that there were a significant genders in the age group of 10-19 years will be
positive correlation between the common post surveyed similarly. The focus group discussion with
marriage sexual reproductive health problems that different groups showed that among this
encountered among adolescents female and their age demographic, awareness of reproductive health was
(p.0.021), while significant negative correlation was very low. Aligned with these results another study
observed regarding level of education (p.0.003), and findings revealed that mean score of awareness
pot-test level of knowledge ( p. 0.001). before and after training regarding reproductive
health index, reproductive health and family planning
Discussion: were significantly different (P = 0.000). They further
Worldwide, adolescents’ reproductive and sexual claimed that after the consultation program, the
wellbeing is a matter of great concern. Sexuality average reproductive health awareness scores were
information is a fundamental need and right and a statistically significant.) P<0.001((Taghinejad et al.,
crucial but not adequate part of what young people 2013).
require for good reproductive health, while studies, Online Fertility Awareness research by (Daniluk &
mostly from the U.S., have defined components of Koer, 2015) found that the fertility and ART
effective curriculum for sex education, such knowledge scores of participants increased
requirements can be difficult to meet in the short term significantly immediately following the intervention,
for developing countries (United Nations Population as did their trust in their knowledge of fertility. The
Division, 2011). The study aim was to demonstrate views of participants on the optimal and recent age
the premarital orientation program influence on the for a woman or man to consider limiting the growth

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Assiut Scientific Nursing Journal Omar et al.,

of an infant. Six months later, however the beliefs and SRH data. Participants addressed knowledge
levels of awareness of the participants largely comprehension facilitators (e.g. use of visuals) and
returned to their pre-intervention levels particularly obstacles (e.g. medical jargon); and personal lifestyle,
for the men in the study. family / friendly guidance, symptoms, and sexual
Regards knowledge of the studied participants in term partners as evaluation variables. By connecting with
family planning/ contraceptive methods current study friends / providers and finding healthcare, participants
showed significant increase in correct answers after used data. The results, however, were not linear and
the implementation of the program p.value not mutually exclusive, reflecting the interaction of
(0.002),this is agreed with study was conducted in skills in health literacy. (Vamos, et al, 2018).
Chandigarh among adolescent’s female aged 15-19
years to evaluate the reproductive health educational Conclusions:
package effectiveness in enhancing their knowledge. Baseding on this study results, the following
A research was carried out by (Rao, et al., 2008) in conclusion emphasized that:
Uduppi district of Karnataka among adolescent girls Adolescent’s female were lacked appropriate
aged 16-19 years to assess the health education knowledge on sexual and reproductive health in pre-
effectiveness in improving reproductive health program phase. Meanwhile; after implementation of
awareness. Their comprehension evaluated the program significant improvement was found in
immediately after intervention showed a significant knowledge and awareness on reproductive and
increase in information after intervention of p <0.01 sexual health after using public seminar orientation
in contraception was observed. program so it was effective in attaining its aim of
On the other hand (Abd Alazeem et al., 2011) positively shifting the knowledge of those adolescent.
research, showed high awareness scores in the pre-
test attributed to the participant’s medical condition Recommendations:
of the participants. Similar results of relevant In light of the current study findings, the following
researches have been reported by (Coonrod et al., recommendations are suggested
2009) & (Gharaibeh & Mater, 2009). That could be Establish collaborative communication channels
due to participant’s educational level variations who among concerned community authorities to develop
are medical students and participants in our study strategies to overcome the barriers of utilization
who were rural peasants, most of whom were reproductive health services. , Establish separate
illiterate and read and write. Starting in 1988, In specialized "Adolescent reproductive health in a
Uganda, a study on adolescent fertility was variety health care setting”. Establish continuous
conducted. educational training program among health care
This study presents data from household and providers responsible on premarital counseling clinics
individual questionnaires gathered for the third phase in rural health center about adolescent’s reproductive
in August 1990 in the Mabel Area. It was found that and sexual health issues.
most reported having received reproductive health Acknowledgement:
information, but few can describe a woman's secure The researchers would like to acknowledge the
period in the menstrual cycle. An additional research contribution of all participants who kindly agreed to
by (Halpern et al., 2008) presents findings of the be a part of this work grateful thanks for all
multi-year web-based trial Teen Network project in authorities facilitate the implementations of the
two urban areas for health education: Nairobi, Kenya. educational seminar .
Most of the measures revealed a significant difference
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