Psychosocial correlates of patient–provider family planning discussions among HIV-infected pregnant women in South Africa

Figures & data

Table 1 Family planning knowledge questionnaire and scoring

Family planning knowledge

Instructions: The following questions are about couples in which one or both members could be HIV positive.

When trying to get pregnant, how much is a man at risk of HIV infection if the woman is positive?

No Chance of infection, 0—10—20—30—40—50—60—70—80—90— 100% will be infected

Score: 1 point if answer is between 10 and 90

When trying to get pregnant, how much is her partner at risk of HIV infection if a woman is taking HIV medication?

No Chance of infection, 0—10—20—30—40—50—60—70—80—90—100% will be infected

Score: 1 point if answer is less than 90

When trying to get pregnant, when in her monthly cycle is a woman the most likely to become pregnant?

1. During her bleeding

2. The weeks in the middle of the cycle

3. The week after the bleeding

4. The week before the bleeding

Score: 1 point if answer is ‘The weeks in the middle of the cycle’

When trying to get pregnant, how can a woman minimize the risk of her partner getting HIV if she is HIV positive?

By only having sexual intercourse without a condom when she is the most fertile

[] Yes [] No [] Do not know

Score: 1 point if answer is ‘Yes’

By taking HIV medications

[] Yes [] No [] Do not know

Score: 1 point if answer is ‘Yes’

When a woman is pregnant, does a man need to use a condom during her pregnancy if she is HIV+?

[] Yes [] No [] Do not know

Score: 1 point if answer is ‘Yes’

After a woman delivers her baby, does a man need to use a condom if she is HIV+?

[] Yes [] No [] Do not know

Score: 1 point if answer is ‘Yes’

If a woman is breastfeeding, does a man need to use a condom if she is HIV+?

[] Yes [] No [] Do not know

Score: 1 point if answer is ‘Yes’

Table 2 Patient–provider family planning discussions by demographic and psychosocial characteristics: bivariate associations (N=673)

Characteristics	All	Not discussed (n=359)	Discussed (n=314)	χ^2/z/t, p-Value
Age	28.39 (5.73)	28.76 (5.65)	27.97 (5.80)	−1.71, 0.088
Educational attainment, years
0–10	147 (21.8%)	71 (19.8%)	76 (24.2%)
10–11	334 (49.6%)	175 (48.7%)	159 (50.6%)
12 or more	192 (28.5%)	113 (31.5%)	79 (25.2%)	3.97, 0.138
Employment status
Unemployed	527 (78.3%)	276 (76.9%)	251 (79.9%)
Employed	116 (17.2%)	67 (18.7%)	49 (15.6%)
Volunteering or student	30 (4.5%)	16 (4.5%)	14 (4.5%)	1.11, 0.575
Monthly household income (South African Rand)
<310 (~$25)	221 (32.8%)	117 (32.6%)	104 (33.1%)
310–949 (~$76)	225 (33.9%)	124 (34.5%)	104 (33.1%)
950 or more	224 (33.3%)	118 (32.9%	106 (33.8%)	0.15, 0.926
Marital status
Not married, living separate	398 (59.1%)	218 (60.7%)	180 (57.3%)
Not married, living together	150 (22.3%)	71 (19.8%)	79 (25.2%)
Married	125 (18.6%)	70 (19.5%)	55 (17.5%)	2.86, 0.239
Number of children
None	139 (20.7%)	76 (21.2%)	63 (20.1%)
One or more	534 (79.3%)	283 (78.8%)	251 (79.9%)	0.123, 0.724
HIV serostatus of children
Do not know	506 (94.8%)	271 (95.8%)	235 (93.6%)
Positive	28 (5.2%)	12 (4.2%)	16 (6.4%)	1.122, 0.269
Diagnosed during this pregnancy
No	308 (45.8%)	160 (44.6%)	148 (47.1%)
Yes	365 (54.2%)	199 (55.4%)	166 (52.9%)	0.44, 0.505
Has discussed HIV transmission to baby with provider
No	98 (14.6%)	79 (22.0%)	19 (6.1%)	34.27, <0.001
Yes	575 (85.4%)	280 (78.0%)	295 (93.9%)
Planning to have more children
No	450 (66.9%)	247 (68.8%)	203 (64.6%)
Yes	223 (33.1%)	112 (31.2%)	111 (35.4%)	1.30, 0.254
Male involvement	7.10 (3.07)	6.42 (3.18)	7.87 (2.76)	−6.01, <0.001a
Family planning knowledge	4.30 (1.20)	4.20 (1.14)	4.42 (1.25)	−3.34, 0.001a
Stigma	0.77 (1.36)	0.91 (1.44)	0.62 (1.25)	−3.93, <0.001a
Depression	12.03 (5.97)	12.62 (5.95)	11.36 (5.93)	−2.94, 0.003a
Psychological IPV	3.20 (5.31)	3.82 (5.97)	2.49 (4.34)	−3.16, 0.002a

Notes: Data were presented as mean (SD) or n (%).

a Mann–Whitney test was used for comparison of groups. Bold denotes statistically significant bivariate association with patient–provider family planning discussions.

Abbreviations: SD, standard deviation; IPV, intimate partner violence.

Table 3 Multivariable associations with patient–provider family planning discussions: reduced multivariable analysis (N=673)

Predictors	b	SE	p-Value	OR	Lower 95% CI	Upper 95% CI
Age	−0.034	0.015	0.022	0.967	0.940	0.995
Discussed transmission of HIV with provider	1.243	0.279	<0.001	3.466	2.007	5.985
Male involvement	0.131	0.029	<0.001	1.140	1.077	1.207
Stigma	−0.139	0.066	0.035	0.870	0.765	0.990
Depression	−0.020	0.014	0.135	0.980	0.953	1.008
Psychological IPV	−0.030	0.017	0.081	0.970	0.938	1.004
Constant	−0.772	0.538	0.151	0.462

Notes: Nagelkerke R squared = 0.150, Hosmer and Lemeshow test, χ² = 16.467, 0.036. Bold denotes statistically significant multivariable association with patient–provider family planning discussions.

Abbreviations: SE, standard error; OR, odds ratio; CI, confidence interval; IPV, intimate partner violence.

Figure 1 Mediation model: indirect effect of depression on patient–provider family planning discussions through male involvement.

Notes: *p < 0.05; ***p < 0.001. c^a is the effect of depression on family planning discussions, c′ is the effect of depression on patient–provider family planning discussions after the effect of male involvement has been accounted for. ^b,cAdjusted for participant age, discussion with provider about MTCT, stigma, and psychological IPV. ^dAdjusted for depression, participant age, discussion with provider about MTCT, stigma, and psychological IPV. ^eAdjusted for male involvement, depression, participant age, discussion with provider about MTCT, stigma, and psychological IPV.
Abbreviations: MTCT, mother-to-child transmission; IPV, intimate partner violence; OR, odds ratio; CI, confidence interval.