Knowledge, Attitudes, and Practices Towards Infertility Among Women Living in Jordan: A Cross-sectional Study

doi:10.21203/rs.3.rs-3102408/v1

Download PDF

Research Article

Knowledge, Attitudes, and Practices Towards Infertility Among Women Living in Jordan: A Cross-sectional Study

https://doi.org/10.21203/rs.3.rs-3102408/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Background

Infertility is a common health issue worldwide. In Jordan, the burden of infertility is understudied, and the prevalence is likely underestimated. We aimed to assess the perceptions and level of awareness of Jordanian women concerning infertility and its health and social implications.

Study design:

429 women living in Jordan were invited to fill out an online questionnaire evaluating their knowledge of infertility, attitudes, and related perceptions. Linear regression was conducted to screen for variables affecting participants’ knowledge of infertility.

Results

The diagnosis of infertility was reported by 13% of participants. The majority of the participants reported that infertility adds strain to the marriage, and about 40% agreed that it is a valid reason for divorce. Almost half of the participants agreed that the community’s view of them would change had they learned of their infertility. Moreover, three-quarters of the participants (73%) believed that neither males nor females are to blame for infertility. Even though about ninety percent (88.1%) agreed that infertility should be treated, less than half of the participants (45.7%) considered it a disease. The majority preferred to discuss gynecologic and infertility-related issues and concerns with a female physician (57.8%, n = 248). Knowledge of infertility was found to be inadequate among the study population (average knowledge score of 51.8%). Furthermore, having a higher household income, carrying a healthcare-related degree and previously visiting an infertility clinic were significantly associated with a higher knowledge score.

Conclusion

In the setting of the lacking literature regarding infertility in Jordan, this study offers valuable insight into the knowledge, attitudes, and practices that are common among women residing in Jordan. Results from this study highlight negative trends in the help-seeking behavior of women, and gaps in infertility-related knowledge. This should prompt the adoption of educational programs as part of a nationwide approach addressing infertility and encouraging people to seek help when needed, emphasizing the role of primary healthcare in managing fertility issues. Official efforts are needed to collect data at a national level.

Knowledge

Perceptions

Infertility

Healthcare

Jordan

Women

Infertility is a global issue affecting the productive health of people of different ethnicities, nationalities, and beliefs (1). Infertility is a disease characterized by the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse or an impairment of a person's capacity to reproduce either as an individual or with his/her partner (2). The World Health Organization (WHO) estimated that 48 million couples and 186 million individuals suffer from infertility globally (3), yet it is still poorly understood by the general public.

Despite the lack of studies regarding infertility in Jordan, our search of the literature yielded some studies in the neighboring countries. A study conducted in Saudi Arabia showed an infertility prevalence of 18.93% (4). Building a family is a dream and the main achievement that many people aim to accomplish in their lives, which is why fertility issues can be (5, 6). In a Jordanian study, women reported being stigmatized, blamed, and held responsible by society for their infertility(6, 7). Also, infertile females were more likely to suffer from psychological distress, depression, and anxiety than their fertile counterparts (8, 9).

Of the few studies conducted in the region, one was done in Lebanon in 2020 to evaluate the social and cultural perspective toward infertility, and it found that almost all the participants think that infertility is medically treatable, and only 52.5% considered infertility to be a disease (10).

A study conducted in Saudi Arabia showed that there was generally poor knowledge concerning infertility, and many mistaken beliefs were prevalent among their population, such as supernatural effects and black magic being the reason behind infertility (11).

Right now, there is a clear lack of literature regarding infertility in the Middle East region, particularly in Jordan, despite it being an important issue that impacts the lives of many people worldwide and causes psychological as well as social stress. Therefore, our study aims to shed light on infertility by assessing knowledge, attitudes, and perceptions of women living in Jordan.

Study design, participants, and settings

The study was a cross-sectional study conducted through an online distributed questionnaire via social media platforms (WhatsApp and Facebook). The questionnaire was designed using “Google Forms”. The study was conducted over a period of one month, during January 2023, targeting women between the ages of 18 and 55 who currently live in Jordan. Inclusion criteria: Participants included in our study are females of reproductive age (between 18 and 55 years of age), who currently live in Jordan. Jordanian females living in other countries were excluded from the analysis.

Sample size

The minimum representative sample size was calculated using an online version of Cochran’s formula, with a 95% confidence interval, a 5% acceptable margin of error, and an estimated proportion of 0.5, which was found to be 385 participants.

Study Variables and Measurements

A structured questionnaire was used to collect data from the participants. The questionnaire was constructed via a standardized methodology (12, 13). The questionnaire was initially written in English, was translated to Arabic and back-translated to English. We used an adaptation of the back-translation technique developed by Brislin (14) to eliminate language barriers.

The questionnaire was reviewed and evaluated by the researchers in a series of meetings. Four experts, with experience in both infertility and the field of research, validated the questionnaire. A pilot study of 40 participants was conducted, where participants were interviewed to assess the questionnaire’s relevance, clarity, and composition. The questionnaire consisted of 4 sections, including close-ended questions, multiple-choice questions, checklists, and 5-point Likert scale statements. The first section gathered sociodemographic data from the participants, the second section assessed the participants’ knowledge of infertility using a knowledge scale of 28 questions covering definitions, risk factors and potential treatments. The third evaluated the participants’ perceptions about infertility, and the last section evaluated participants’ attitudes and practices towards infertility.

Ethical consideration

The Ethics committee provided Institutional Review Board (IRB) approval at the University of Jordan (Approval Number: 10/2023/589; 3rd of January 2023). The participants were informed that their responses were anonymous, and their data will be kept confidential.

Statistical analysis

Statistical analysis was performed using IBM SPSS Statistics v.26. Qualitative variables were presented as frequencies and percentages, while continuous variables were presented as means and standard deviations, or medians and interquartile ranges. Different graphs and charts were used to display responses when needed. Pearson Chi-square (χ2) was used to assess the associations between different variables at a 95% confidence interval, and significant associations were reported as crude odds ratio with a 95% confidence interval. Linear regression was conducted to screen for variables affecting participants’ knowledge of infertility. Variables that had a p-value < 0.2 from the univariate analysis were included in the multiple linear regression model to control for possible confounding factors. A p-value < 0.05 was considered statistically significant.

In this study, 478 participants completed the questionnaire, of which 429 met the inclusion criteria, agreed to participate, and signed the electronic consent at the beginning of the survey. 25 participants were above the age of 55 and 24 participants were not currently living in Jordan, and were excluded from the analysis.

Sociodemographic characteristics

The sociodemographic characteristics of the participants can be found in Table 1in the appendix. The median age of the participants was 32 years (an interquartile range (IQR) of 19.0) with more than half (n = 236, 55%) being married. A great majority (n = 365, 85%) of the respondents had a bachelor’s degree or a higher level of education. Also, most of the participants live in central Jordan (n = 402, 93.7%). A healthcare-related degree was held by 36.6% (n = 157) of the participants in the survey.

Table 1

Sociodemographic characteristics of the study sample.
Parameter Median (IQR), [Range]	n(%)
Age 32 (19.0), [18–55]
18–25	146 (34)
26–35	106 (24.7)
36–45	105 (24.5)
46–55	72 (16.8)
Marital status
Single	166 (38.7)
Married	238 (55.5)
Widowed	6 (1.4)
Divorced/separated	19 (4.4)
Nationality
Jordanian	391 (91.1)
Palestinian	21 (4.9)
Syrian	9 (2.1)
Others	8 (1.9)
Medical degree
Yes	157 (36.6)
No	272 (63.4)
Employment status
Student	112 (26.1)
Employed	174 (40.6)
Unemployed	128 (29.8)
Retired	15 (3.5)
Religion
Islam	419 (97.7)
Christianity	4 (0.9)
I`d rather not say	6 (1.4)
Household monthly income
0-250 JDs	45 (10.5)
251–500 JDs	108 (25.2)
501–750	72 (16.8)
751–1000	73 (17)
1001 + JDs	131 (30.5)
Smoking
Yes	52 (12.1)
No	377 (87.9)
Place of residence
Northern	22 (5.1)
Central	402 (93.7)
Southern	5 (1.2)
Insurance
Yes	325 (75.8)
No	104 (24.2)
Education
Middle school	1 (0.2)
High school	61 (14.2)
Bachelor`s degree	297 (69.2)
Higher education	70 (16.3)
IQR: Interquartile range, JD: Jordanian dinar

Figure 1 shows that doctor consultations were the most commonly used source to obtain medical information (69%, n = 294), followed by google (56%, n = 240), and official health websites (42%, n = 180).

Figure 1. Sources of medical knowledge

Knowledge of infertility

Participants’ responses to questions assessing their knowledge of infertility are presented in Table 2in the appendix. The mean knowledge score among the 429 participants was 13.99 ± 3.05 with 248 (57.8%) scoring ≥ 14 (with a maximum possible score of 27), indicating fair knowledge overall. A hundred and fifty-five participants (36.1%) correctly identified the length of time after which infertility can be diagnosed (12–24 months). Most participants (86.9%) correctly recognized that the menstrual cycle usually stops within the age range 45–50. Furthermore, around half of the participants (49.4%) correctly recognized that the mid-cycle is the most fertile period during the menstrual cycle, followed by a considerable proportion of the participants (34.7%) believing it to be just after menstruation. Less than a quarter (22.1%) of participants correctly recognized that men and women are equally likely to be infertile, which was the least agreed-upon answer. Figure 2 shows the participants’ knowledge of myths and causes of infertility.

Table 2

Knowledge about infertility
Parameter	n (%)
How long does a couple need to attempt to conceive before being diagnosed with infertility
<6 months	13 (3.0)
6–12 months	131 (30.5)
12–24 months	155 (36.1)
>24 months	52 (12.1)
I don't know	78 (18.2)
What's the most fertile period during the menstrual cycle?
Just after menstruation	149 (34.7)
Just before menstruation	28 (6.5)
Mid-cycle	212 (49.4)
I don't know	40 (9.3)
In what age range does the menstrual cycle stop?
24–29	2 (0.5)
30–34	1 (0.2)
35–39	2 (0.5)
40–44	48 (11.2)
45–50	373 (86.9)
I don't know	3 (0.7)
Who's more likely to be infertile
Males	98 (22.8)
Females	107 (24.9)
Both are equally likely	95 (22.1)
I don't know	129 (30.1)
Can being overweight and/or underweight cause infertility?
Overweight causes infertility	170 (39.6)
Underweight causes infertility	4 (0.9)
Both can cause	179 (41.7)
Neither can cause	25 (5.8)
I don't know	51 (11.9)
Which thyroid disorders increase the risk of infertility
Hyperthyroidism	36 (8.4)
Hypothyroidism	45 (10.5)
Both	195 (45.5)
Neither	30 (7)
I don't know	123 (28.7)
Can infertility be treated?
Yes	403 (93.9)
No	4 (0.9)
I don't know	22 (5.1)

Figure 2. Causes of infertility by percentages

In addition, when asked which methods could possibly be used to treat infertility, the participants’ responses majorly favored the utilization of medical interventions such as in vitro fertilization (IVF) and medications, along with lifestyle changes, (83%, 72%, and 70% respectively). Further details are shown in Fig. 3.

Figure 3. Methods that can be used to treat infertility.

Assessment of infertility-related practices

Certain practices concerning infertility were inquired about and displayed in Table 3. Of the participating females, around 20% (n = 83) had visited an infertility specialist in the past, and around 13% (n = 56) reported being diagnosed with infertility problems by a physician. To add, most of the respondents (94.4%, n = 407) said that they would first visit a gynecologist if they suffered from infertility, while only a few participants would visit a general practitioner or a primary healthcare center (1.9%, n = 8).

Perceptions and attitudes towards infertility

Participants’ attitudes toward infertility are outlined in Table 4. Approximately half of the participants (52.2%) consider infertility to be uncommon in Jordan. Three-quarters of the participants (73%) believe that neither males nor females are to blame for infertility. Furthermore, most of the participants did not believe any association between stigma and infertility or visiting a fertility clinic existed (n = 282, 65.7% and, n = 353, 82.3% respectively).

Participants’ responses to certain statements about infertility are presented in Table 5. 378 (88.1%) participants agreed that infertility should be treated, yet 196 (45.7%) agreed that infertility is a disease. Approximately half of the participants (49.2%) agreed that having infertility would affect the community’s view of them. The vast majority (82.1%) agreed that having infertility would add strain to their marriage with 178 (41.5%) participants considering it a valid reason for divorce.

Table 3

Practices of the participants towards infertility
Parameter	n (%)
Have you ever visited a fertility doctor
Yes	83 (19.3)
No	346 (80.7)
Have you been diagnosed with infertility by a physician
Yes	56 (13.1)
No	373 (86.9)
Do you have children
Yes	245 (57.1)
No	184 (42.9)
Do you plan on having children
Yes	168 (39.2)
No	196 (45.7)
I don't know	65 (15.2)
Do you know any relatives or friends who suffer/suffered from infertility
Yes	320 (74.6)
No	109 (25.4)
If you had fertility issues/concerns, you would prefer to discuss these with:
Male physician	24 (5.6)
Female physician	248 (57.8)
I don't mind	157 (36.6)
Who would you first visit if you suffer from infertility?
Pharmacist	2 (0.5)
Family/friends	6 (1.4)
Sheikh/Spiritual healer	1 (0.2)
General practitioner/ primary health care center	8 (1.9)
Herbalist	2 (0.5)
Gynecologist	407 (94.9)
No one	3 (0.7)

Table 4

Participants` attitudes towards infertility
Parameters	n (%)
How common do you think infertility is in Jordan
Very rare	10 (2.3)
Rare	52 (12.1)
Uncommon	224 (52.2)
Common	97 (22.6)
Very common	46 (10.7)
In your opinion, who is to blame for infertility?
Male	5 (1.2)
Female	11 (2.6)
Both are equally to blame	100 (23.3)
Neither is to blame	313 (73)
In your opinion, does COVID 19 infection impact fertility?
Yes	160 (37.3)
No	269 (62.7)
In your opinion, does the COVID 19 vaccine affect fertility?
Yes	170 (39.6)
No	259 (60.4)
Do you think there is a stigma associated with infertility in general?
Yes	98 (22.8)
No	282 (65.7)
I don't know	49 (11.4)
Do you think there is a stigma associated with visiting a fertility clinic?
Yes	45 (10.5)
No	353 (82.3)
I don't know	31 (7.2)

Factors affecting the knowledge about infertility among Jordanian women were investigated using univariate and multivariate linear regression, as presented in Table (6). Studying a healthcare-related degree, having a monthly household income of 500 more, having children, and having visited a fertility doctor were significantly associated with a higher knowledge score (P-values: <0.001, < 0.001, 0.049, and 0.026 respectively).

Table 5

Perception towards infertility
	Participants' responses n (%)
Statement	Strongly agree/agree	Neutral	Strongly disagree/disagree
I think infertility is a disease	196 (45.7)	104 (24.2)	129 (30.1)
I think infertility should be treated	378 (88.1)	37 (8.6)	14 (3.3)
Having infertility will change the community's view of me	211 (49.2)	88 (20.3)	130 (30.3)
Having infertility will add strain to my marriage	352 (82.1)	56 (13.1)	21 (4.9)
I think infertility is a valid reason for divorce	178 (41.5)	107 (24.9)	144 (33.6)
I would feel upset if I learned that I have infertility	283 (66.0)	84 (19.6)	62 (14.5)
I think emotions affect fertility	242 (56.4)	116 (27.0)	71 (16.6)

Our study collected information about the knowledge, attitudes, and perceptions regarding infertility among women living in Jordan. Knowledge about infertility is suboptimal worldwide. An international study that included more than 10000 participants from 79 countries demonstrated that people had a modest level of knowledge regarding fertility and infertility (15). Those findings agree with our results, which showed an average knowledge score of 51.8%. We consider this knowledge score to be inadequate but better than what has been reported in several adjacent countries (11, 16).The infertility knowledge questions covered important aspects that govern people in guarding their fertility (e.g., risk factors associated with infertility), and seeking timely and appropriate medical advice (e.g., criteria for infertility, and treatment options). The questionnaire also assessed multiple misconceptions present in the population (e.g., sitting cross-legged and infertility).

Table 6

Multiple linear regression screening of variables with knowledge score
Parameter	Knowledge score
	Beta	P-value#	Beta	P-value $
Age	0.077	0.110^	0.044	0.480
Place of residence
South and North governorates	Reference
Central governorates	-0.032	0.505
Level of education
High school or below	Reference
Bachelor's degree or higher	0.110	0.023^	0.07	0.12
Health insurance
No	Reference
Yes	0.079	0.104^	-0.016	0.721
Smoking
No	Reference
Yes	-0.036	0.452
Monthly household income
≤ 500	Reference
> 500	0.253	0.000^	0.186	0.000*
Studied/Studying a medical related degree
No	Reference
Yes	0.331	0.000^	0.364	0.000*
Do you have children?
No	Reference
Yes	0.104	0.031^	0.126	.049*
Have you ever visited a fertility doctor?
No	Reference
Yes	0.122	0.012^	0.103	.026*
Do you know any relatives or friends who suffer/suffered from infertility?
No	Reference
Yes	0.153	0.001^	0.074	0.102
# Using simple linear regression, $ Using multiple linear regression, ^ Eligible for entry into multiple linear regression, * Significant at 0.05 significance level

Fertility being a tabooed topic in Middle Eastern culture means that the behaviors of individuals are guided by misconceptions as much as it is guided by facts, which in turn endangers the reproductive health of those individuals. Our data demonstrates that the variation in knowledge in our sample was mainly explained by the socio-demographic factors (household income, having a degree in medical sciences), previously visiting a fertility doctor, and having children. These findings indicate that the practice of patient-education among obstetricians and gynecologists regarding infertility is prevalent. On the other hand, even though those who had a medical background had higher knowledge scores compared to other participants, their scores were inadequate, indicating a deficiency in the curriculum for health-related degrees in matters of reproductive health and fertility.

Individuals’ knowledge regarding signs, symptoms, and risk factors of a disease has been found to decrease the risk of the disease, reduce the delay in seeking medical advice, and to improve outcome (17, 18). Our results show that the knowledge about risk factors of infertility is not only lacking, but rather concerning. About 52% of childbearing married women in Jordan reported using a contraceptive method, of which, the intrauterine contraceptive device (IUD) was used by 21% of them, and the contraceptive pills were used by 8% (19).Our results shed a new perspective on why women in Jordan prefer the use of IUD over the pills. Our data showed that about 40% of the participants believed that the use of oral contraceptive pills was associated with future infertility, while only 20% chose IUD as a risk factor for infertility. These results indicate that women may be misinformed about contraceptive techniques, and if they were to make an informed choice regarding what contraceptive method to use, correct information about different methods of contraception must be made available to them.

Multiple other risk factors were assessed in this study, these included factors related to the reproductive history, lifestyle habits, and other health conditions. Of those, less than half of the participants identified smoking as a risk factor for infertility, this is worrisome because of the high and increasing rates of smoking in Jordan (20).

Three quarters of participants stated that they know relatives who suffer or previously suffered from infertility, in addition 13% of participants claim to have been diagnosed with infertility. However, two thirds of participants thought that infertility is not a common issue, which leads us to believe that infertility is underestimated. The self-reported prevalence of infertility among our participants is similar to that reported in Saudi Arabia and the Middle East and North African region (MENA) (18% and 17% respectively) (4, 21).

Infertility can pose a huge burden on individuals, especially women, and this burden can affect them in different aspects. Most of the participants reported that infertility adds strain to a marriage, and about 40% agreed that it is a valid reason for divorce. This might stem from two factors, the first being that participants regard parenthood a “right” to which they are entitled, and infertility can cause a profound feeling of loss. Secondly, the community’s view that bearing a child is somehow a duty that they should fulfill puts them under more stress.

Moreover, when asked who is more likely to be infertile, 47.7% of the participants chose either males or females. This agrees with a study done in Pakistan which showed that 50% of people did not believe that females and males contribute to infertility equally (22).At the same time, about three quarters of our participants said that neither of the couple should be blamed for being infertile, further supporting the aforementioned idea that being infertile is out of their hands.

Our study also addressed the help-seeking behavior of women in Jordan. When asked who they would first visit if they noticed any problem with their fertility, it was almost unanimous that they would first visit a gynecologist, while only 2% said they would first visit a primary healthcare center or a general physician. This shows that the primary healthcare system in Jordan is underutilized.

Strengths and Limitations

Assumptions drawn upon data acquired from cross-sectional surveys are limited in that they can only establish correlations between the variables, but no causal relationships can be affirmed by them.

One of the major limitations of our study was the sampling approach we hired. A convenient recruitment method yielded a sample that was concentrated in the central region of Jordan and was characterized by a high educational level. This recruitment method is subject to sampling bias where also a high proportion of the participants held a healthcare-related degree, which is likely due to the easier access to this demographic.

Another point worth mentioning is the use of online-based surveys. This could have limited our sample to those who were oriented to the technological requirements of the survey. At the same time, the participants filled out the questionnaire in the comfort of their homes, where they might have accessed the internet or other resources to aid them in answering the questionnaire.

This is the first study regarding infertility that seeks to study the knowledge, attitudes, and perceptions of women living in Jordan. The lack of literature in this field in Jordan gives our study substantial value as a pilot study; by providing preliminary data and estimates on individuals’ behaviors and knowledge regarding their fertility. Our results shed light on multiple misconceptions, misbehaviors, and gaps in fertility-related knowledge that should influence the policy making process and ensure that educational efforts in schools and clinics are satisfactory. Also, it should be further addressed and studied further by future research on a wider, more diverse spectrum.

WHO

World health organization

IRB

Insitutional review board

IQR

Interquartile range

IVF

in vitro fertilization

IUD

Intrauterine device

MENA

Middle East and North African region

Ethical approval and consent to participate

This study was approved by the ethics committee of the Jordan University Hospital (Approval Number: 10/2023/589; 3rd of January 2023). Written consent was obtained from the participants, and they were assured of the confidentiality of their information.

Consent for publication

Not applicable.

Availability of data and materials

Please contact the authors for data requests.

Competing interests

The authors declare that they have no competing interests.

Funding

Not applicable.

Authors’ contributions

KJ carried out the statistical analysis of the data and drafted the manuscript. KA participated in the statistical analysis of the data and contributed to the development of the questionnaire. OI participated in the development of the questionnaire and drafted the manuscript. YJ conceived the study and participated in the distribution of the questionnaire. AA participated in the distribution of the questionnaire and helped draft the manuscript. AY contributed to the development of the questionnaire and helped draft the manuscript. NM supervised the work, participated in the design of the study and the development of the questionnaire. All authors read and approved the final manuscript.

Acknowledgement

We would like to express our gratitude to Ms Rand Anwar Jebrein for her help in the translation process of the questionnaire.

Authors’ information

Not applicable.

Tanywe, A., Matchawe, C., Fernandez, R., & Lapkin, S. (2018). Experiences of women living with infertility in Africa: a qualitative systematic review protocol. JBI Evidence Synthesis, 16(9), 1772-1778.
Zegers-Hochschild, F., Adamson, G. D., Dyer, S., Racowsky, C., De Mouzon, J., Sokol, R., ... & Van Der Poel, S. (2017). The international glossary on infertility and fertility care, 2017. Human reproduction, 32(9), 1786-1801.
Infertility. https://www.who.int/news-room/fact-sheets/detail/infertility. Accessed 15 February 2023.
Al-Turki, H. A. (2015). Prevalence of primary and secondary infertility from tertiary center in eastern Saudi Arabia. Middle East Fertility Society Journal, 20(4), 237-240.
Passet-Wittig, J., & Greil, A. L. (2021). Factors associated with medical help-seeking for infertility in developed countries: A narrative review of recent literature. Social Science & Medicine, 277, 113782.
Obeidat, H. M., Hamlan, A. M., & Callister, L. C. (2014). Missing motherhood: Jordanian women's experiences with infertility. Advances in Psychiatry, 2014.
Roberts, L., Renati, S., Solomon, S., & Montgomery, S. (2020). Women and infertility in a pronatalist culture: mental health in the slums of Mumbai. International Journal of Women's Health, 993-1003.
Hazlina, N. H. N., Norhayati, M. N., Bahari, I. S., & Arif, N. A. N. M. (2022). Worldwide prevalence, risk factors and psychological impact of infertility among women: a systematic review and meta-analysis. BMJ open, 12(3), e057132.
Zayed, A. A., & El-Hadidy, M. A. (2020). Sexual satisfaction and self-esteem in women with primary infertility. Middle East Fertility Society Journal, 25, 1-5.
Sahakian, J. P. K., El Helou, E., Azoury, J., Salameh, L., Abou Jaoude, I., & Sleilaty, G. (2020). Infertility within the Lebanese population: beliefs and realities. Middle East Fertility Society Journal, 25, 1-8.
Abolfotouh, M. A., Alabdrabalnabi, A. A., Albacker, R. B., Al-Jughaiman, U. A., & Hassan, S. N. (2013). Knowledge, attitude, and practices of infertility among Saudi couples. International journal of general medicine, 563-573.
Ishii, H., Shimatsu, A., Okimura, Y., Tanaka, T., Hizuka, N., Kaji, H., ... & Chihara, K. (2012). Development and validation of a new questionnaire assessing quality of life in adults with hypopituitarism: Adult Hypopituitarism Questionnaire (AHQ)..
Arora, C., Sinha, B., Malhotra, A., & Ranjan, P. (2017). Development and validation of health education tools and evaluation questionnaires for improving patient care in lifestyle related diseases. Journal of clinical and diagnostic research: JCDR, 11(5), JE06.
Brislin, R. W. (1970). Back-translation for cross-cultural research. Journal of cross-cultural psychology, 1(3), 185-216.
Bunting, L., Tsibulsky, I., & Boivin, J. (2013). Fertility knowledge and beliefs about fertility treatment: findings from the International Fertility Decision-making Study. Human reproduction, 28(2), 385-397.
Ali, S., Sophie, R., Imam, A. M., Khan, F. I., Ali, S. F., Shaikh, A., & Farid-ul-Hasnain, S. (2011). Knowledge, perceptions and myths regarding infertility among selected adult population in Pakistan: a cross-sectional study. BMC public health, 11, 1-7.
Oliveria, S. A., Christos, P. J., Halpern, A. C., Fine, J. A., Barnhill, R. L., & Berwick, M. (1999). Patient knowledge, awareness, and delay in seeking medical attention for malignant melanoma. Journal of clinical epidemiology, 52(11), 1111-1116.
Patra, S., & Unisa, S. (2022). An exploration of treatment seeking behavior of women experienced infertility and need for services in rural India. Frontiers in Reproductive Health, 4.
Statistics Do, Amman J. Jordan Population and Family Health Survey. 2018.
Belbeisi, A., Al Nsour, M., Batieha, A., Brown, D. W., & Walke, H. T. (2009). A surveillance summary of smoking and review of tobacco control in Jordan. Globalization and Health, 5, 1-6.
Eldib, A., & Tashani, O. A. (2018). Infertility in the Middle East and North Africa Region: A systematic review with meta-Analysis of prevalence surveys. Libyan Journal of Medical Sciences, 2(2), 37-44.
Ahmed, H. M., Khan, M., Yasmin, F., Jawaid, H., Khalid, H., Shigri, A., ... & Hasan, C. A. (2020). Awareness regarding causes of infertility among out-patients at a tertiary care hospital in Karachi, Pakistan. Cureus, 12(4).

Questionnaire.docx

Download PDF

Version 1

posted

You are reading this latest preprint version

Knowledge, Attitudes, and Practices Towards Infertility Among Women Living in Jordan: A Cross-sectional Study

Status:

Version 1

Abstract

Background

Study design:

Results

Conclusion

Figures

Background

Methodology

Study design, participants, and settings

Sample size

Study Variables and Measurements

Ethical consideration

Statistical analysis

Results

Sociodemographic characteristics

Knowledge of infertility

Assessment of infertility-related practices

Perceptions and attitudes towards infertility

Discussion

Strengths and Limitations

Conclusion

Abbreviations

Declarations

References

Supplementary Files

Status:

Version 1