Study area, design, and period: An institutional-based cross-sectional study was conducted at public hospitals in the Sidama region of Ethiopia from June 1 - July 31, 2022. According to the regional health bureau report in 2022, the region has one comprehensive tertiary hospital, five general hospitals, 14 primary hospitals, 137 health centers, and 553 health posts. There are 1490 healthcare workers, and of these, 602 are working in the MCH case team, 385 are midwives, and all of the primary and general hospitals provide immediate long-term reversible contraceptives, but not all health centers.
Source population: All women who received immediate postpartum long-acting reversible contraceptives at public hospitals in the region.
Study population: All women who received immediate postpartum long-acting reversible contraceptives during data collection time at selected public hospitals in the region.
Inclusion criteria: Immediate postpartum long-acting reversible contraceptive users at selected public hospitals during the data collection period.
Exclusion criteria: Women who were ill during the data collection time.
Sample size, technique, and procedure
The sample size was calculated using a single proportion formula using the proportion of an informed choice (36.2%), from the Ethiopian demographic health survey.
n= (Z α/2)2 P (1-P) /d2 = (1.96)2 0.362(1-0.362) /0.052= 3.8416 (0.05)2 =355
Where: n - the required Sample size
P - Proportion of an informed choice (36.2%), from the Ethiopian demographic health survey (EDHS) 2016 [21]
Z - the 95% CI (1.96) and
d - the margin of error, 5%.
After adding a 5% of non-response rate total sample size becomes 373.
Sampling procedure: Firstly, Adare and Bona from the general hospital, Kebado, Yaye, Tulla, Hula, Chuko, and Aleta Wondo from the primary hospital were selected by lottery, and Hawassa University Comprehensive Specialized Hospital (HUCSH) was selected purposively. The previous nearly two-month average of records for a woman who received immediate postpartum LARCs from all selected hospitals was 890. Of these IPP LARCs users, 64, 420, and 406 were served at HUCSH, two general hospitals, and six primary hospitals in the region, respectively. An average of a similar number of postal natal women was assumed to receive LARCs at these public hospitals during the data collection time, and each hospital was given a proportional share of the required sample size based on the number of clients they served in the past two months. Finally, postpartum women who received LARCs were selected using a systematic random sampling technique by calculating the k value. Based on the K value, which is k = (N/n) (890/373 = 2), the first study unit was selected randomly.
Data collection instrument and procedure
A structured English version interviewer-administered questionnaire was adapted from different literature written on the related topic of study and then translated into Amharic and the local language (Sidamu afoo). The dependent variable was measured by the method information index plus which was adopted from the global initiative FP2030[24]. Independent variable instruments adapted and developed different sources [21,25]. All questionnaires were programmed into Kobo toolbox software for data collection purposes.
Operational definition
Method information index plus (MII (+): consists of four questions: Were you informed about other methods?, Were you informed about side effects? Were you told what to do if you experienced side effects? Were you told about the possibility of switching to another route if the method you have chosen is not suitable? [24]
Informed choice of immediate postpartum LARCs: Women who answered “yes” to all four questions of MII (+)[24]
Data entry and analysis
The collected data was downloaded from the Kobo toolbox server into an SPSS file. The downloaded SPPS file was analyzed using SPSS version 25. Frequency and percentage were computed to describe descriptive analysis. A logistic regression analysis model was used to identify predictor variables. Independent variables with a P-value of <less than 0.25 during bivariate analysis were selected for multivariate logistic regression analysis. A multivariable analysis was then carried out to determine statistically significant variables. Statistical significance was set at a P value of less than< 0.05. Hosmer and Lemeshow's goodness model was used to check for the model's fitness. To assess the possibility of multicollinearity among the independent variables, the variance inflation factor (VIF) was used.