پیش بینی رفتارهای حمایتی پرستار نسبت به خدمات بهداشت باروری زنان معلولیت ذهنی

Although many previous studies have begun to address the reproductive health needs of women with intellectual disabilities; however, the supportive behaviors of caregivers to assist their reproductive health is not well understood. Data from a cross-sectional survey of “2009 National Survey on Reproductive Health Care Needs and Health Education Strategies for Women with Intellectual Disabilities in Taiwan” were analyzed. Study sample consisted of 1152 caregivers who working in 32 disability institutions have been analyzed in the study. The results showed that the caregiver did not have adequate supportive behaviors towards reproductive health care for women with ID (mean score was 29.84 out of 60), particularly in the arrangement of preventive reproductive health services. We analyzed the potential significant variables in a multiple linear regression model to examine the factors which affect the caregiver's supportive behaviors of reproductive health for women with ID. The model revealed that the factor of respondent's gender, job category, working years in disability setting, helping experience of reproductive health for women with ID, perception of reproductive health knowledge, in-job training of reproductive health, perceived adequacy of public reproductive health service for the client, scores of reproductive health knowledge and reproductive health attitude were significantly correlated to their supportive behavioral score of reproductive health for women with ID. These factors can explain 23.6% of the variation of supportive behavioral score. The present study suggests the reproductive health interventions need to take into account the perspectives of health workers, caregivers and women, as well as the constraints they face in providing and receiving services, respectively.

Women with disabilities encounter various social, attitudinal and physical barriers to accessing safe motherhood and reproductive health services in society (Smith, Murray, Yousafzai, & Kasonka, 2004). Bremer, Cockburn, and Ruth (2010) investigated the reproductive health experiences among women with physical disabilities in Cameroon of Canada. They found this group of women had limited understanding of reproductive health and many had not received basic reproductive health education. Furthermore, Mele, Archer, and Pusch (2005) revealed that women with physical disabilities face both financial and nonfinancial barriers to access that may result in delayed detection and increased risk of poorer outcomes from breast cancer. Both of the above studies concluded that women with disabilities need greater education on reproductive health and improved access to health care, and the health service providers require education about working with women with disabilities. In general, disabled women do not get the appropriate information and treatment regarding reproductive health care, they rarely get information about sexuality, birth control, sexually transmitted diseases or pregnancy and motherhood from mainstream health care facilities. If disabled women get these services at all, they get them from friends and from the disability community (Degener, 2000). In modern society, although health professionals have begun to address the health needs of women with disabilities, representation of women with ID in health research and health-care practice remains inadequate. The health policy requires more information about their health concerns, and appropriate health services and options (Brown & Gill, 2002).