Natl. J. Physiol. Pharm. Pharmacol. (2025), Vol. 15(2): 140-146

Research Article

10.5455/NJPPP.2025.v15.i2.5

Effectiveness of a planned teaching program on knowledge and perception regarding no-scalpel vasectomy among community health workers in an urban area of Murshidabad, West Bengal

Debayan Dey, Malay Kumar Das, Prithwish Bandyopadhyay* and Monojit Das

Department of Community Medicine, Murshidabad Medical College, Berhampore, India

*Corresponding Author: Prithwish Bandyopadhyay. Department of Community Medicine, Murshidabad Medical College, India. Email: prithwishbanerjee92 [at] gmail.com

Submitted: 03/10/2024 Accepted: 09/01/2025 Published: 28/02/2025

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ABSTRACT

Background: No-scalpel vasectomy (NSV) is a newer vasectomy technique that is less invasive than traditional vasectomy. The uptake of NSV among eligible males in India and West Bengal remains unacceptably low. Community health workers play a pivotal role in motivating and providing counseling for family planning programs.

Aim: We aimed to assess the effectiveness of a planned teaching program on knowledge and perception regarding NSV among community health workers in an urban area of Murshidabad, West Bengal.

Methods: We conducted a quasi-experimental study with pretest-posttest design during January-March’2024, among all 44 community-level health workers in Berhampore Municipality, Murshidabad. The baseline knowledge and perception of the participants was assessed through a structured questionnaire; followed by imparting a planned teaching program using the NSV teaching module and post-intervention assessment through the same questionnaire after 2 weeks. The paired t-test and McNemars chi-square test were applied.

Results: The overall mean post-test knowledge score (12.27) of participants was significantly higher than the overall mean pre-test score (4.41) [t=26.77, p < 0.0001]. Wrong perceptions were also favorably changed after the planned teaching program. McNemars chi-square test revealed, there was a significant association between the planned teaching intervention and variation of correct responses during the post-test phase.

Conclusion: Improvements in knowledge and perception regarding NSV indicate the need for a planned teaching program to promote and accept NSV in the community. Further research with larger samples and longer follow-up periods is necessary to confirm the long-term impact of such programs on NSV uptake.

Keywords: Effectiveness, Planned teaching program, Quasi-experimental study, No-scalpel vasectomy, Community health workers.

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Introduction

No scalpel vasectomy (NSV), a permanent sterilization option for males, is a newer vasectomy technique that is less invasive than traditional vasectomy and does not require stitches or incisions. This is a safe and effective method of vasectomy with low complication rates and greater patient compliance, with a success rate similar to that of traditional vasectomy. Since 1992, NSV has been incorporated into the National Family Planning Programme of India. Subsequently, with the initiatives of the Government of India, nationwide promotion, skill training, and advocacy on the NSV procedure was conducted, which resulted in several State/District level trainers and NSV service providers in almost all the districts of the country (Bhuyan et al., 2012).

However, acceptance of NSV as a method of family planning remains negligible. As per NFHS-5, only 0.1% of family planning acceptors in India have undergone NSV, and the proportion is even lower in West Bengal, 0.05% (Bengal).

Social stigma, lack of awareness about NSV, and lack of access to quality NSV services are reported to be the factors for low NSV levels in India. The government of India has launched several initiatives to promote vasectomy and NSV, but these initiatives have had limited success. More needs to be done to increase the awareness and acceptance of NSV in India among both the beneficiary and provider/facilitators groups. Evidence shows that some of the reasons for not opting for vasectomy are: afraid of the pain and side effects, such as erectile dysfunction; misconception of affected masculinity and its irreversibility; and discomfort talking about their reproductive health with their partners or health care providers (Bhuyan et al., 2012).

In healthcare delivery systems, community health workers (CHWs) play an important role in disseminating information about health programs and available health services. In family planning programs, CHWs are supposed to mobilize the community through IEC activities, including counseling, providing information, discussing communities’ issues, and clearing doubts about different family planning methods. They also need to include a discussion of male participation for effective family planning. However, despite having an established health system and a high number of community health workers, the target population does not have an informed choice; as a result, family planning is perceived to be the responsibility of females only in the Indian community. Studies conducted in different parts of the country showed that although male participants in family planning are low, they are interested in acquiring information on family planning methods; but due to a lack of complete and correct information, they are not able to make informed decisions. This results in low acceptance of male sterilization/ or NSV (Dunn et al., 2004; Saha et al., 2007; Char et al., 2009). Also, a study in Jharkhand in 2014 by Mahapatra et al. (2014) showed that around 62% of the CHWs had a wrong perception of men’s sexual performance after NSV and around 77% did not have any idea about the time required to resume normal work (Mahapatra et al., 2014).

This raises a question on the knowledge and perception of community health workers regarding why they are not able to mobilize the male population to accept no-scalpel vasectomy, which is safer than female sterilization. It is expected that an adequate understanding of NSV and communication skills among community health workers can positively empower individuals and couples to make informed choices. In this context, it is hypothesized that a planned teaching program can increase the knowledge and perception of community health workers significantly, enabling them to improve overall community mobilization for NSV acceptance. However, given the low acceptance of NSV in India as well as West Bengal, no such attempt has yet been contemplated in Murshidabad district.

In this overall perspective, the present study was undertaken with the objective of assessing the effectiveness of a planned teaching program on knowledge and perception regarding no-scalpel vasectomy among community health workers in an urban area of Murshidabad, West Bengal.

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Materials and Methods

Study type, design, and area

A quasi-experimental study with a one-group pretest–posttest design was conducted for a period of 3 months (1^st January–31st March, 2024) in Berhampore Municipality of Murshidabad district.

Study population, sample size, and sampling technique

All the ANMs and ASHAs (total 48) working in 4 UPHCs under Berhampore Municipality, Murshidabad, and those who remained present in both sessions were taken as the study population. However, those who were not willing to participate were excluded from the study.

A complete enumeration technique was used to select all community health workers (ANMs, ASHAs) working in UPHCs in Berhampore Municipality, Murshidabad.

Tools, techniques, and data collection

Pre-designed, pretested, semi-structured questionnaires and predesigned, prevalidated education modules on NSV based on available literature were the study tools.

A predesigned pretested questionnaire was prepared. The questionnaire was translated into Bengali and retranslated back into English. A teaching module on NSV was prepared based on the available literature and official documents (Reference Manual for Male Sterilization Family Planning Division, Ministry of Health and Family Welfare, Government of India. 2013; World Vasectomy Day (7 th November) Information for the General Public: NSV Services). Face, content (CVI 0.80), and linguistic validation of the Bengali-translated version of the education module were obtained from experts and faculties of Murshidabad Medical College. A planned teaching program was organized according to the convenience of the community health workers in the Murshidabad study area.

Pretest phase, including the teaching intervention

After obtaining ethical approval from the Institutional Ethics Committee of Murshidabad Medical College, necessary permissions were obtained from the CMOH. All study participants were provided an explanation regarding the purpose of the study, and informed written consent was obtained from them. First, a semistructured pretest questionnaire was administered to the participants to assess baseline knowledge.

There were a total of 13 questions in the questionnaire. For each correct response, one mark was allotted, and for other responses (wrong ones/not sure), zero marks were given. For the last two questions, which were based on a Likert scale, responses of “comfortable”; “agree”; “strongly agree” were awarded with one mark, and the rest were given as zero. Pretesting was performed among a subset of the study population using the Bengali-translated version of the questionnaire, for which Cronbach’s alpha was 0.832.

After receiving the responses from the pretest questionnaire, a 15-minute planned teaching program was conducted using a teaching module on the NSV on the same day. The contents of the module wcomprisedcriteria of ideal candidates, procedures, and complications of NSV, postoperative advice, benefits of NSV, and schemes on NSV.

Posttest phase

Subsequently, in the next setting, after a gap of 14 days, as part of posttest assessment, the same questionnaire was administered to the same group and the effectiveness of the planned teaching programme was assessed by appropriate statistical methods. A total of 44 study participants were assessed in both the settings (Pretest and posttest) for the planned teaching program.

Data analysis

Data were analyzed using SPSS Version 20.0. Means, proportions, and SDs were computed as a part of descriptive statistics. McNemar’s chi-square test and paired t-test were applied as part of inferential statistics to assess the association between teaching interventions, and the variation of responses and the effectiveness of the planned teaching program, respectively.

Ethical approval

Ethical approval was obtained from the Institutional Ethics Committee of Murshidabad Medical College [Memo No. MSD/MCH/PR/219A/2024].

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Results

Analysis of study participants’ background data

A total of 44 community health workers were interviewed (drop out 8.3%). Of them, 35 were ANMs and 9 were ASHAs. Approximately 80% of the participants were older than 40 years of age, and approximately 20% belonged to the age group of 20–40 years, with a mean age of 48.8 (SD ± 9) years.

Among the study participants, approximately 61.4% were educated up to the secondary level of schooling. 56.8% had more than 5 years of experience in health care (Table 1).

Pre-test and posttest knowledge assessment in terms of frequency and percentage of responses

Approximately 52% had correct knowledge about the eligibility criteria of NSV clients and also knew that it is a stitch-free technique. Around 11.4 % responded correctly about the average duration of NSV procedure, whereas only 9% knew the correct duration of postoperative contraceptive use after NSV. Only 18% of respondents knew that insurance was provided in case of failure or complications. Approximately 43 % and 34% had the perception of falling sick frequently and having low sexual power after NSV, respectively. Only 20.5% of the participants knew that the time required to resume normal work after NSV was 2–3 days.

In the pretest response analysis, approximately 86.4% of the study participants had inadequate (<50%) knowledge and perception regarding NSV, whereas 13.6% had moderate (51%–75%) knowledge and perception level. However, after the planned teaching program, during posttest responses, approximately 95.5% had adequate (>75%) knowledge and perception, and only 4.5% had moderate knowledge and perception of NSV. This knowledge classification criteria was obtained from a study conducted in rural areas of Coimbatore, India, by Gandhimathi (2021) (Government of India, National Institute of Public Cooperation and Child Development, New Delhi, 2012).

Table 1. Distribution of background variables among the participants (n=44).

Analysis of data related to the effectiveness of a planned teaching program on the knowledge and perception of NSV

In Table 2, bivariate analysis based on McNemar’s chi-square test shows that there is a significant association between the planned teaching intervention and variation of responses, as there is a significant improvement in the number of correct responses during the post-test phase due to the intervention. For question number 1, there are 42 correct responses in post-test compared to 23 during the pre-test, whereas, for question numbers 2, 6, 10, and 13, all the participants gave correct responses during post-test phase, and for the rest of the questions, there is evidence of a significant increase in correct responses during the post-test phase.

Table 3 shows that the overall mean posttest scores (94.38%) of respondents who were exposed to a planned teaching program is significantly higher than the overall mean pretest scores (33.92%), and the mean difference was 60.46% (Fig. 1). The computed “t” value (t=26.77) was higher than the tabular value (table value=1.68) at the 5% level of significance. As part of the normality test, Shapiro-Wilk test was performed, which was not significant (p=0.099).

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Discussion

The present quasi-experimental study in an urban area of Murshidabad revealed very low levels of knowledge and perception regarding NSV among community health workers. Surprisingly, none of them had undergone any prior official training on NSV. However, the planned teaching programme was found to be significantly effective in enhancing their knowledge.

NSV, a modified and sophisticated technique used for sterilization, is a safe and effective procedure with low complication rates and greater patient compliance. Community health workers play a pivotal role in disseminating information, counseling, discussing community issues, and clearing doubts. Hence, adequate knowledge and perception of CHWs are imperative to transfer information to target populations. In the present study, we found a very low level of knowledge and perception among community health workers (86.4%) regarding NSV; nearly half (48%) were unaware of the eligibility criteria for NSV and thought that NSV is not a stitch-free technique. In addition, the majority of the workers did not know the exact duration of postoperative contraceptive use and were not aware of the provision of insurance in case of failure or complications after NSV. This reflects the lack of knowledge by community health workers regarding NSV. Similarly, the National Institute of Public Cooperation and Child Development, New Delhi, evaluated the functioning of ASHAs, and results showed that 98% of the ASHAs had knowledge about family planning methods, whereas only 69% had knowledge about vasectomy. These findings are in congruence with the findings of the current study (Government of India, National Institute of Public Cooperation and Child Development, New Delhi, 2012).

Table 2. Bivariate analysis showing measures of association between teaching intervention and variation in paired responses among the study subjects based on Mc. Namers chi-square test (n=44).

Table 3. Comparison of study participants’ scores before and after the teaching intervention based on paired t-test (n=44).

Fig. 1. Bar diagram showing differences in mean percentage scores on knowledge and perception of NSV among the study participants (n=44).

In concordance, a study conducted by Mahapatra et al. (2014) in Jharkhand, (Mahapatra et al., 2014) showed that around half of the health workers (54.5%) were aware that NSV is a stitch-free procedure and knew about the eligibility criteria of candidates (77%). However, only 11.4% of the patients knew the duration of the NSV procedure, and most were not sure about possible complications after the procedure (77%).

Wrong perceptions of sexual performance are a major concern for low acceptance of NSV. The current study found that community health workers had the wrong perception of deterioration of sexual performance (34%) following NSV and thought that participants may fall sick frequently (43%). Approximately 68% of our study participants responded that they feel very uncomfortable when discussing NSV among potential male candidates. This might be due to a number of factors such as lack of complete knowledge, lack of confidence in initiating such conversations due to perceived cultural barriers, fear of judgment, or inadequate training in communication strategies. Only 20.5% of the participants knew that the time required to resume normal work after NSV was 2–3 days, and only 4.5% agreed that NSV was better than female sterilization. Inadequate knowledge and incorrect perception of CHWs regarding postoperative complications, rest, and care may discourage those who are willing to undergo NSV but are concerned with losing their Machismo, work, and daily wages for a longer time. This is consistent with the findings of the study by Mahapatra et al. (2014) conducted in Jharkhand, which showed that 62% of the community health workers thought that man’s sexual performance was affected after NSV, and 77% did not have any idea about the time required to resume normal work (Mahapatra et al., 2014). In contrast, a study conducted in Andhra Pradesh during 2020 revealed that, the majority (95.29%) of ASHAs had knowledge that vasectomy does not change a man’s sexual ability; whereas only 30% were aware of the correct period of condom use that can be suggested during the post vasectomy period (Palla and Komaram 2020).

In the current study, a planned teaching programme was effectively implemented to address the knowledge and perception of the CHW regarding NSV. A remarkable improvement in response was found during posttests, with approximately 95.5% achieving adequate knowledge and perception and only 4.5% having moderate knowledge and perception of NSV. This is congruent with a study conducted in rural areas of Coimbatore, India, by Gandhimathi (2021), among married men and women, which showed that during the pretest phase, 61.7% had inadequate knowledge and 38.3% had moderate knowledge, whereas, during the post-test, around 65% and 35% of the study participants had adequate and moderate knowledge, respectively. A study by Rani et al. (2023) “Effectiveness of Structured Teaching Programme on Knowledge Regarding Non-scalpel Vasectomy among Accredited Social Health Activists in a Selected Area of Delhi” revealed that the mean knowledge scores of the pretest and posttest were 5.8 and 7.4, respectively. The posttest scores were statistically higher than the pretest scores (Rani et al., 2023). This indicates the necessity of an effective training program on NSV for community health workers to increase male participation in family planning.

Although the present study was able to establish the effectiveness of the planned teaching programme on NSV, it also had a few limitations, such as a limited sample size and a short follow-up period. Future research with larger sample sizes and longer follow-up periods is needed to confirm the long-term impact of the program.

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Conclusion

This study highlights the potential of educational interventions to equip Community Health Workers with the knowledge and confidence to effectively advocate for NSV as a viable family planning option in their communities. Further research with larger samples and longer follow-up periods is necessary to confirm the long-term impact of such programs on NSV uptake.

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Acknowledgments

The authors are indebted to the Chief Medical Officer of Health, Murshidabad district, Nodal, the staff of Berhampore municipality, and all the study participants for their constant support and cooperation during the data collection process.

Conflicts of interest

The authors declare no conflict of interest.

Funding

This was a self-funded study, and no external funding was received from any sources for this study.

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