CALIFORNIA STATE UNIVERSITY, NORTHRIDGE
DESIGNING A HEALTH EDUCATION INSTRUMENT
FOR
SANTA MONICA ADOLESCENTS
A graduate project submitted in partial sa·tisfaction
of the requirements for the degree
of
Master of Public Health
By
Elena F. Estrin
/
June, 1979
r ,
The graduate project of Elena F. Estrin is approved:
California State University, Northridge
ii
ACKNOWLEDGEMENTS
Tnroughout this project many people have contributed
their time, thoughts and energy.
I am grateful to them all.
Special thanks to:
Anthony Alcocer, Dr. P.H., for his friendship as well
as his valued guidance throughout my academic career.
Michael Kline, Dr. P.H., whose advice helped me through
many crucial moments.
Inga Hoffman, R.N., M.P.H., who patiently and with
humor made this graduate project meaningful.
And to my friends and family whose constant encouragement was always appreciated.
iii
TABLE OF CONTENTS
Page
APPROVAL.
i
ACKNOWLEDGEMENT
iii
. yj._i
LIST OF TABLES
ABSTRACT.
X
Chapter
I.
II.
INTRODUCTION
1
STATEMENT OF THE PROBLEM
3
SIGNIFICANCE OF THE PROBLEM
4
OBJECTIVE OF THE PROJECT
5
DEFINITION OF
.
5
OUTLINE OF THE PAPER.
6
BACKGROUND INFORMATION •
8
Health Education .
8
TE~1S
Health Education Techniques
12
Effective of Health
15
Education.
Family Planning
17
Subsidized Family Planning in
The United States .
iv
19
Page
Chapter
Family Planning for
Adolescents .
25
. Summary .
SETTING OF THE PROJECT .
III.
20
27
The Community .
27
Writer's Involvement.
32
33
METHODOLOGY.
Phase I: Pertinent Literature.
33
Phase II: Community Resources
Development.
37
Phase III: Development of the
Pamphlet
43
Phase IV: Criteria for Pamphlet
Evaluation .
51
Phase V: Development of the
Questionnaire to Evaluate the
53
Pamphlet
IV.
56
RESULTS .
FINDINGS: PROFESSIONAL
QUESTIONNAIRE .
56
Professional Profile.
56
Content of the Instrument .
58
Clarity of the Instrument .
59
Efficacy of the Instrument.
60
v
Page
Chapter
FINDINGS: ADOLESCENT
V.
QUESTIONNAIRE .
62
Adolescent Profile
62
Clarity of the Instrument •
65
Efficacy of the Instrument.
67
SUMMARY, CONCLUSIONS AND
RECOMMENDATIONS
71
Summary .
71
Conclusions.
73
Recommendations
75
BIBLIOGRAPHY
78
APPENDICES
A.
SURVEY OF THE SUBSIDIZED FAMILY
PLANNING CLINICS IN THE SANTA
MONICA AREA
82
B.
TEST COVER PHRASES
96
c.
TEST PAMPHLET COVERS.
98
D.
PAMPHLET PROTOTYPE
103
E.
QUESTIONNAIRE A.
107
F.
QUESTIONNAIRE B.
110
vi
LIST OF TABLES
Page
Table
Respondents' Work Agency.
57
Job Description
57
III
Contact with Adolescents.
58
IV
Clarity of the Pamphlet .
59
I
II
V
To Whom Would You Give This
Pamphlet.
VI
60
Potential Utilization of the
Pamphlet
VII
VIII
IX
X
61
Adolescent Respondents' Sex.
62
Age at Last Birthday.
63
Prior Cognizance of Options
63
Cognizance of Family Planning
64
Clinics
Previous Utilization •
65
XII
Responses to Question #6.
66
XIII
Responses to Question #9.
66
XI
XIV
Would You Pick Up This Pamphlet
From the Cover Alone
XV
67
Do You Think This Pamphlet Contains
Information Important to
Your Age Group
vii
68
Page
Table
XVI
Would You Give This· Pamphlet
To A Friend
XVII
.
Would You Give This Pamphlet
To A Friend 13 years old.
XVIII
69
Respondents' Utilization of
The Pamphlet.
XIX
68
Recommended Pamphlet Distribution.
viii
69
70
LIST OF FIGURES
Figure
Page
I
Pamplet Format .
ix
52
ABSTRACT
DESIGNING A HEALTH EDUCATION INSTRUMENT
FOR
~ANTA
MONICA ADOLESCENTS
By
Elena F. Estrin
Master of Public Health
The purpose of this project was to develop, design,
and evaluate a health education instrument for raising the
level of awareness of adolescents in the Santa Monica area
of Los Angeles County regarding the availability of subsidized family planning services.
The decision to under-
take this project was based on a community resource assessment and interviews with concerned health professionals.
Preliminary surveys revealed the need for a resource to
assist adolescents in locating and using community family
planning services.
Prepartory to the development of the
X
pamphlet, pertinent literature and community demographic
data were reviewed.
The development of the pamphlet was divided into
four major segments: 1)
content of the instrument;
2) format of the instrument; 3) pretesting of the pamphlet,
and 4) design of the pamphlet cover.
The final prototype
for the pamphlet was the result of recommendations from
community health professionals, Santa Monica adolescents,
and guidelines for the development of health education
instruments.
Criteria for the evaluation of the pamphlet were
delineated and questionnaires were designed.
Community
adolescents were asked to ascertain the value of the pamphlet in relation to: 1) grammatical quality, 2) clarity of
objective, 3) prior knowledge of family planning services,
and 4) usability.
In addition, several health profession-
als and local agency personnel were asked to project their
potential utilization of the pamphlet.
Findings from the questionnaires suggested that the
instrument was clear and concise.
Adolescents and commun-
ity professionals indicated that they would use the pamphlet.
Methods of distribution were offered by both survey
populations.
Guidelines for more extensive field testing are
offered in addition to suggestions for updating and revisions.
xi
Chapter 1
INTRODUCTION
Medical science has made tremendous advances in
family planning technology over the past two decades.
Planning and prevention of births has become a relatively
safe and easy task for the American population.
Innova-
tions in birth control devices as well as prescription
medications are gaining popularity and acceptance.
Despite vast improvements in birth control services
and devices, there is a faction of the American population
that has an increasing rate of unplanned pregnancies,
births, and abortions.
In 1976, Los Angeles County re-
ported over 4,500 illegitimate births in the Coastal Health
Services Region.
Although there are no local statistics
available, California reported over 48,000 legal abortions
in the 15 to 19 year old category for that same year.
In
addition, California had the highest reported number of
abortions for women under 19 years of age in 1976 (Center
for Disease Control, 1977).
Health knowledge alone is not sufficient to change
1
2
behavior.
Health values, at times, become secondary to
other values.
Therefore, health education must be con-
cerned with competing value systems (Keyes,· 1972).
The
aim of health education is to help people achieve health
by their own actions and efforts.
It attempts to create
within people a sense of responsibility for their own
health betterment as individuals and as members of families
and communities.
Settlage, Baroff and Cooper (1975} reported that for
adolescents, initial pre-marital sexual relations were
typically unpremeditated.
Although teenagers may have
feared pregnancy, such fear was not a major deterrent to
sexual involvement.
In addition, studies indicated that
knowledge of contraception did not encourage sexual activity (Settlage, Baroff and Cooper, 1975).
California State law SB 395, Chapter 820 (1975)
allows for adolescents to receive treatment and services
related to the prevention of pregnancy and diagnosis and
treatment of venereal diseases without parental consent.
However, there are other obstacles which prevent adolescents from seeking out and utilizing available family
planning services.
In addition to economic and psycholo-
gical factors which might contribute to adolesence reticence, studies indicated that failure to utilize family
planning programs stemmed mainly from limited knowledge
of, and access to, available services (Scheyer, 1970).
3
STATEMENT OF THE PROBLEM
A survey of patients who utlized the five subsidized
family planning clinics in the Santa Monica area of Los
Angeles County seemed to indicate that the majority were
between the ages of 20 and 25.
For those patients who
were 15 to 19 years of age, 70 to 80 percent of their
first visits were for pregnancy tests or to terminate
unwanted pregnancies and not for contraceptive services
or information.
Los Angeles Regional Family Planning Council studies
indicated that in the West Health. Distrist of Los Angeles
County, there were over 9,000 15 to 19 year olds in need
of subsidized family planning services who were not receiving them.
In Santa Monica, clinic patient surveys and
health professionals indicated that there was a wide variance between the estimated needs and the utilization of
family planning services among teenagers.
Knowing how to gain access to birth control services
is a major problem.
The usual avenue a young person
utilizes to gain expert help, particularly medical help,
is his/her parents.
In most families, adolescents cannot
readily make inquiries about birth control services.
In
addition, at the inception of this project, Santa Monica
Unified School District offered no sex education curriculum in any of their classrooms.
A sampling of community
agencies with frequent adolescent contact disclosed a
4
reticence to become involved with adolescents' sexual
education.
For those adolescents who are aware of available
services in the community there are still constrain:tsin
making contact with those services.
of age requirements is common.
For example, ignorance
Many adolescents think a
patient must be 18 or older to receive services without
their parents' consent.
Lack of money may inhibit teen-
agers from seeking services since £inancial resources are
limited in this age group.
In addition, there is no past
experience on which to base an estimate of the possible
cost of services.
Accessibility may present a barrier to
services as many adolescents must depend on their parents
or older siblings for transportation.
These, as well as
other constraints, are factors that contribute to high
adolescent pregnancy rates.
Ado1escents require a clearer
picture of what services are available to them and of how
they can take responsibility for their own health care in
relation to family planning.
. SIGNIFICANCE OF THE
At the time of this
PROBLE~1
investig~tion
there were no re-
sources available in the Santa Monica area to assist
adolescents in locating and using family planning services.
The problem on which this project £ocused, then, was the
need to raise the level of awareness of adolescents in the
5
Santa Monica area in regards to the availability and utilization of family planning services.
OBJECTIVE OF THE PROJECT
The purpose of this project was to develop, design
and evaluate a health education instrument for raising the
level of awareness of adolescents in the Santa Monica area
of Los Angeles County regarding the availability of subsidized family planning services.
DEFINITION OF TERMS
The following definitions are pertinent to the
project:
Health Education Instrument:
Any method (including
talks, pamphlets,_ group discussions, films, etc.) that
can be used to inform individuals and groups about health
and to influence their attitudes and behavior so that they
will take more healthful actions.
For purposes of this
project, health education instrument refers to a pamphlet
designed to inform the community of the availability of
subsidized family planning services.
Health Education:
A process with intellectual,
psychological and social dimensions relating to activities
which increase the abilities of people to make informed
decisions affecting their personal, family and community
well-being.
This process, based on scientific principle,
6
facilitates learning and behavior change in both health
personnel and consumers, including children and youth
(Joint Committee on Health Education Terminology, 1973:6566) •
Awareness:
To have perception or knowledge of
(Webster, 1964).
Adolescents:
For the purpose of this project, adol-
escents are defined as individuals 15 through 19 years of
age.
Family Planning:
Those medical, educational, and
social services needed to enable people to choose freely
the number
7)
and spacing of their children (Young, 1973c:
0
Subsidized Family Planning: .Family Planning services
which are· provided to low income persons.
Programs mainly
serve persons unable to secure family planning services
from private physicians.
ing mixtures of government
Programs are financed with varyfunds~
private contributions,
and patient fees.
Santa Monica:
The city of Santa Monica and the com-
munities surrounding i t located in the western sector of
Los Angeles County, State of
Ca~i.fornia.
OUTLINE OF THE PAPER
Chapter 1 will serve to introduce the project and
the significance of the problem..
It clearly designates
7
the objective of the project and pertinent definitions.
Chapter II contains background information pertinent
to the project.
An extensive literature review was con-
ducted covering 1) health education, 2) health education
techniques, 3) effectiveness of health education, 4) family planning, 5) subsidized family planning in the United
States and 6) family planning for adolescents.
In
addition, the setting for the project was explored in
detail.
Demographic data is offered in support of the
project.
Chapter III describes the methods utilized in the
design of the pamphlet.
An in depth description of the
project development is subdivided into five phases:
1) pertinent literature review, 2) community resources
assessment, 3) development of the pamphlet, 4) criteria
for assessment of the pamphlet and 5) design of the
questionnaires to evaluate the pamphlet.
Chapter IV reviews the findings of the surveys
utilized in evaluating the pamphlet.
Community profess-
ionals and adolescents are treated as separate evaluative
populations.
Chapter V summarizes the survey findings and offers
conclusions relevant to health education instruments.
Recommendations for revisions and future utilization are
presented.
CHAPTER II
BACKGROUND INFORMATION
This chapter presents a review of the literature
pertinent to health education, family planning and
adolescents.
The setting of the project is also discussed.
REVIEW OF THE LITERATURE
The available literature for the following topic areas
is reviewed below:
(a)
Health education.
(b)
Health education techniques.
(c)
Effectiveness of health education.
(d)
Family planning.
(e)
Subsidized family planning in the United
States.
(f)
Family planning for adolescents.
Health Education
Simmons (1975) discussed the aim of health education
which she felt was to elicit, facilitate and maintain
positive health practices by assuring that people are
competent and supported in the activities w·hich
contribute to their optimum state of health.
8
These
9
actions include specific behaviors on the part of the
educator and the consumer.
thought of as anticipatory.
Health education can be
It has the intention of im-
proving present health status in addition to providing a
foundation for future health practices.
It is potentially
a part of every health program which requires voluntary
action by an individual, a family or a community.
Simmons
(1975) stated that behavioral changes resulting from education are, by definition, voluntary.
They are freely
adopted with knowledge of alternatives and their probable
consequences.
It is not telling people what to do, but
helping them to become the kinds of poeple who will know
what to do.
Another author saw health education as the
sum of experiences which favorab1y influence habits, attitudes and knowledge relating to individual, community and
racial health (Smolensky, 1972).
The process of health education begins with the
identification of those individuals who are at risk and
proceeds to make them aware of the risk involved and what
measures they can take to reduce the risk.
Health educa-
tion also directs people to the appropriate care setting
for whatever services they may require (John E. Fogarty
International Center for Advanced Study in the Health
Sciences, 1976).
Health education can be viewed as a segmented, yet
interrelated scheme concerned with activities which inform
10
people about health, illness and disability and the methods
which they can use to protect and improve their own health.
It is also concerned with motivating people to adopt more
healthful practices and in helping them learn the skills
necessary to adopt and maintain healthful practices (John
E. Fogarty International Center for Advanced Study in the
Health Sciences, 1976}.
Health education as a formal profession has only
recently been defined and its guidelines determined.
The
ultimate goal for any health education program is the improvement of people's health and the reduction of preventable illness, disability and death.
The field was born essentially of the
social need to adjust the health behavior of various population groups
to the results of medicine and to
adapt the functions of preventive,
curative and rehabilitative services
accordingly. (Steuart, 1969:189}.
In the past, our health care system has been based on
ad hoc medicine.
One of the greatest challenges to health
educators is to gain acceptance by people of maintenance
medicine as a normal pattern of health service.
The em-
phasis needs to shift from medical care to health care.
Health education needs to focus on staying well and developing health habits (Smolensky, 1972}.
Health education is a practical and dynamic concept
which finds a basis for the choice of its goals and methods
through the collection of appropriate health and social
11
data.
In program planning for health education, the
customary practice is to begin by obtaining basic data on
the knowledge, beliefs, opinions, attitudes, motives,
values and patterns of health behavior of the individuals
and groups that are to be influenced.
For a program to be
effective, it must be specifically designed to the internal
criteria! of the target population and the program goals
(Young, 1973b).
Health education activities vary so widely that it
is sometimes difficult to discern commonalities.
They can
take many forms through various methods and media and
require careful selection for effective educational
approaches.
The techniques used for health education have
been developed by many professions.
are unique to the health field.
There are few that
Their appropriate appli-
cation is situational (Simmons, 1975).
There is no fool-proof recipe for the selection of
the best educational method.
It must be suited to the
particular consumer and the particular situation in order
to encourage people to take desirable health actions consistent with their goals, values# and lifestyles.
Design-
ing a program scheme calls for looking at the causes of
the problem, contributing factors 1 barriers to change and
consideration of alternative ways of resolving the problem
(Simmons, 1975).
Methods selected to produce change should differ
12
according to the motivation of the group concerned.
Situ- ·
ations where people are not feeling hostile or negative
towards the health problem, and where there is a simple
lack of knowledge, should be dealt with differently from
those in which there is conflicting motivation and resistance to change (Young, 1973c).
In health education there is a need to discover
approaches that will lead to positive community health
practices and attitudes.
There are no limites as to what
can be considered a health education technique as long as
it is effective and causes people to improve or act in
regard to their health.
Some of the more conventional
methods can be grouped under two headings: mass media and
direct contact.
The best technique is simply the one
that WOrks nvilbur 1 196 8)
o
Health Education Techniques
·The most economical and widely effective avenue of
contact with the general public is through the mass media:
newspapers, pamphlets, radio, television and magazines.
Mass media techniques are most efficient in disseminating
information and increasing people's awareness (Young,
1973c).
When designing a mass media scheme it is important to
consider the goals for which it is being designed.
Is
the purpose to arouse interest, develop attitudes, or dis-
13
pense information?
How open to the communication will the
target population be?
Are they aware of the problem and
looking for solutions or are they ignorant of its existence (Wilbur, 1968)?
In matters of personal health, mass communications
help to create a Climate of acceptance.
They are effective
where the population is unaware of the existence of a
problem by bringing it to their attention.
Mass media
techniques are also effective in communicating information about services and solutions where the population is
already aware of a situation and the need for action
(Smolensky, 1972).
Communications involving interpersonal, or two-way
processes, provide the most favorable environment for
learning and generally have greater long-term behavioral
effects.
However, less personal short-run methods, such
as pamphlets or other mass media techniques, are often
appropriate in the early phase of a program or when other
methods are not feasible (Griffith, 1972).
Whatever method is chosen, it must be designed to
meet specific criteria in order to have an effect on the
target population.
Clients \vill learn only when the
message is relevant to them.
To increase the knowledge
of others and to create an interest, it is essential to
utilize terms that are familiar to the listener and
related to their personal circumstances. The information
14
included must be accurate, current and credible.
The
message must be clearly stated and on a level easily
understood by the target population.
Other helpful fea-
tures for mass communications include attractive presentations, repetition of the message and easy accessibility
{Smolensky, 1972).
Mass media methods are most effectively used alone
when there is a predisposition, or an already existing
awareness of the problem.
However, when used in conjunc-
tion with face-to-face methods of health education, the·
effectiveness spectrum widens.
The order in which educa-
tional activities are most usefully employed depends on
the target groups' predisposition to the situation, as
well as specific characteristics of the target population.
Among non-practitioners of a health behavior, the higher
the educational level, the more likely that sound evidence
from a 'trustworthy' source will be accepted.
Situation
interpretations vary with the population and problem.
A
reliable source for one group may be considered to be a
quack for another.
Values, attitudes, and personality
exert an important influence upon how a person perceives,
interprets, and responds to a message.
Hence, it is imper-
ative that the target population be narrowed down as much
as possible in order to design the communications, either
for mass media or direct contact, to be as effective as
possible (Smolensky, 1972).
15
Effectiveness of Health Education
It is difficult to assess with precision the effectiveness of health education techniques because of the influence of behavioral factors on behavior change.
It
becomes difficult to quantify and measure outcomes due to
the numerous variables impinging on individuals' motivations, behaviors and health.
In addition, like prevention,
health education is the least dramatic when it is most
effective.
When a problem is avoided, no crisis occurs,
no miracle need be performed and the results of the effort
lose visibility (Simmons, 1975).
Many studies have been conducted to determine and
explain why groups accept or reject a certain health measure or program.
There is, however, no simple answer.
A
person's behavior involves personal, social and emotional
factors, as well as time, place and situational influences.
Some of the variables that can be assessed in communications acceptance are: individual access to the message;
the media of communications used; the content of the
message; the receivers' predisposition to the message;
and the relationships within the group receiving the
message (Smolensky, 1972).
Two of the central questions that have plagued educators, especially in the field of health, is why and when
do people take specific behaviors related to health.
16
Rosenstock (1974) believes that for an individual to take
the recommended action to prevent or reduce the impact of
some threatening disease or complication, certain criteria
must be met:
1.
The individual must be aware of the
existence of a particular disease or
condition. S/he must believe that
s/he is truly susceptible to the
disease or condition in question.
People must believe they are vulnerable.
2.
Theindividual must believe that should
they contact the disease or condition
that it would have serious effects on
their life, either medical, social or
economic.
3.
The individual must believe that the
recommended preventive action is
available to them and that taking it
would be effective in reducing their
susceptibility to the disease or condition, or instrumental in reducing
the severity of the disease.
(Rosenstock, 1974).
An individual's decision leading to health action is
based on her/his awareness of the problem, what s/he knows
about the problem, as well as her/his goals and aspirations against which s/he may consciously or unconsciously
weigh her/his decision (John E. Fogarty International
Center for Advanced Study in the Health Sciences, 1976).
Jaccard (1975) agreed with Fishbein's theory that
there are two factors which act as the major determinants
of behavioral interventions:
17
1.
His/her beliefs. about the consequences
of performing a behavior and the value
these consequences have for that individual, and;
2.
Her/his belief and what relevant others
think s/he should do, and her/his motivation to comply with those others
(Jaccard, 19 7 5) .
"Of central importance for a given behavior is the
strength of the perceived relationship between performance and the consequence or outcome (Jaccard, 1975:156) ."
Acceptance of medical services and of new ideas and
techniques requires more than merely making them available.
It may be more important to change the psychological and
social environment in order for people to accept changes
in their physical environment.
People gain perceptions,
interpretations and behavior through an acquired sensitivity to values and attitudes that are approved of in their
group and culture.
Reactions to ·things are most likely
governed by role expectations, values, previous experiences and the degree of perceived danger (Smolensky, 1972).
Family Planning
In 1965 the World Health Assembly formulated the
following definition of family planning:
"
.a way of thinking and living that is
adop·ted voluntarily upon the basis of knowledge, attitudes and responsible decisions by
individuals and couples in order to promote
health and welfare of the family group and
thus contribute effectively to the social
development of a country. Within this context,
18
family planning implies knowledge and actions
that will help people to achieve their family
goals for the betterment of their living conditions.
It also implies the provision of
relevant information, education and health
services, so that individuals and couples,
irrespective of their socio-economic status,
may make informed decisions and take appropriate action about how to live and how to plan
and raise their families." {Young, 1973c:2).
In ,Qc'tober 1969, the U.S. Department of Health, Education and Welfare established the National Center for
Family Planning which defines family planning as "
those medical, educational and social services necessary
to enable people freely to choose the number and spacing
of their children." (Young, 1973c:7).
Public Law 91-752, the Family Planning Services and
Population Research Act of 1970,
"
.Specifically provides for the provision
of voluntary medical and edu:ational services to
all persons desiring them with a priority to
be placed on persons from low income families
who can not otherwise obtain needed care."
"The end or purpose of family planning, reduced to
its simplest terms is a healthy baby born to a healthy
mother who very much wants the child"
(Scheyer, 1970:22).
The goals for family planning are interwoven.
Of primary
important is that the target population achieve and sustain a high motivation to plan their families.
In order
to attain this goal, it is essential that the group have
a knowledge of contraceptive techniques, and.that the contraceptive technology be available, accessible, and accept-
19
able to them.
In addition, the target group must be aware
of the services and use them properly (Barr, 1972).
Subsidized Family Planning in the United States
Of the 46 million women 15 to 45 years old in the
.--- ..
United States in 1975, 65 percent were estimated to be
fecund, sexually active and not pregnant or trying to
become pregnant.
That is, there were almost 30 million
women who were at risk of unplanned pregnancy.
It is
assumed that if a woman is fertile, sexually active and
not trying to become pregnant, she is in need of family
planning services of some kind.
This need can be met by
a variety of methods, including private medical doctors,
welfare agencies and subsidized family planning programs
(Dryfoos, 1976).
Subsidized family planning's primary objective is to
enable women to freely determine the number and spacing of
their children, with a priority assigned to providing
services to low income persons as defined by the Federal
Poverty Index.
Programs for the most part serve persons
unable to secure family planning services from private
physicians, whether for economic or other reasons.
Pro-
grams are financed with a varying mixture of government
funds, private contributions and patient fees
1976).
(Lewis,
20
When discussing subsidized family planning, most
sources define a category of women in need according to:
1) financial status, 2) age, and 3) fecundity.
National
Family Planning Programs are directed at specific populations.
One group is composed of those women whose total
family income is low or marginal, according to the census
definition of
povert~and
they are classified as 'in need'.
In addition, all women aged 15 to 19 are considered to be
'in need' because of their special situation, including
lack of own funds and inaccessibility of the family physician for birth control services.
Women in these groups
accounted for over 12 million of the at risk of pregnancy
population of the United States in 1975 (Dryfoos, 1976).
Family Planning for Adolescents
"The incidence of sexual activity among unmarried
women, especially among adolescents, appears to have increased over the past five years." (Dryfoos, 1975:173).
Premarital intercourse is beginning at younger ages.
The
likelihood that a young, never married woman has had intercourse rose. dramatically with age.
Studies demonstrated
that the percentage of women who have had intercourse
increased from 10 percent at age 13 to 31 percent at age
16 to 51 percent at age 19 (Kanter and Zelnik, 1972). In
a study done by Kanter and Zelnik (1972) on teenage sexuality, 28 percent of never married teenagers, aged 15 to
21
19 reported having had sex.
Of these sexually experienced
women, less than 20 percent reported always using some
method to prevent contraception, including douching, withdrawal, rhythm or medically supervised contraceptives.
Teenage pregnancy is a long standing social situation
which has only recently received public attention.
In
1971, 28 percent of the reported legal abortions were performed on women between the ages of 15 and 19.
this figure had risen to over 31 percent.
By 1972
In the United
States in 1974, nearly 608,000 teenagers gave birth, while
an estimated 300,000 had abortions. "As unwanted fertility
has decreased among married couples, out of wedlock births
have continued to rise, especially to teenagers."
1974:91}.
(Morris,
In addition, over one third of the legal abor-
tions in the United States are performed on women under 20
years of age (Morris, 1974}.
There were over 800,000 reported legal abortions in
the United States in 1976.
in California alone.
Of these, over 142,000 were
Women under 15 in California report-
edly had 1,900 abortions while in the 15 to 19 year old
category there were over 47,000 reported legal abortions.
California has the highest reported number of abortions
for women under 19 years of age (Center for Disease Control, 1977).
In addition, teenage pregnancy has its own risks to
mother and child, including a high incidence of toxemia.
22
Frequently the mother is nutritionally deficient at the
onset of pregnancy and develops acute anemia.
In girls
under 15, formation of the pelvic area is incomplete, and
there is a high risk with delivery, while low birth weight
is a health hazard to the infant.
The highest United
States infant mortality is among babies born to teenagers,
largely because of lack of prenatal care (Beyette, 1977).
In 1974, Morris conducted a study of teenage sexuality in order to estimate their needs for contraceptive
services.
He found that in the population of 15 to 19
year olds, never married and sexually active, 5 percent of
the population utlized private physicians for contracep"""
tive services, 15 percent were in continuing need (already
using subsidized family planning services) and 80 percent
were not receiving medically supervised contraceptive
services.
Dryfoos (1975), from her studies of adolescent
sexuality, contraception and pregnancy, projected that 1.4
to 2.3 million never married women, aged 15 to 19, in the
United States were in need of contraceptive services.
Almost all of these women needed services from organized
programs.
Today, unmarried teenagers are legally entitled to
contraceptive services on their own consent in 27 states,
including California.
Obstacles to securing and utilizing
contraceptive services were especially evident among
sexually active teenagers, only a small percentage of whom
23
were using the most effective methods of contraception.
Evaluation of one's own fecundity appeared to relate
strongly and rationally to the use of contraceptives (Shah,
Zelnik and Kanter, 1975).
It was necessary to consider non-economic as well
as economic obstacles to services when trying to promote
an increase in awareness of the need for contraceptive
usage.
Many young women considered the use of birth con-
trol as cold and calculating, tinged with promiscuity, too
rational and lacking spontaneity and romance (Young, 1973b).
Many teens felt that due to their youth, they would not
become pregnant.
In addition, using contraceptives in-
creased the risk that a young woman's sexual activity would
be discovered (Shah, Zelnik and Kanter, 1975).
The majority of studies found only a small correlation between teenagers' attitudes toward family planning
and actual contraceptive acceptance.
Apparently, there
were variables other than attitude that had an influence
on behavior (Young, 1973a).
Studies indicated that fail-
ure to practice birth control stemmed more from limited
knowledge and access than from cu1tural values and stigmas.
The location of the clinic, in terms of how easy it was to
get there and return home, and the surrounding neighborhood all seemed to have an effect on attendance.
In
addition, language barriers sometimes existed between
members of the clinic staff and minority components of the
24
target population (Scheyer, 1970}.
Assuming that there are resources available and accessible to the target population, the first step should
be to make this availability known.
Because young women
have not usually entered the existing maternal care systern, or may be reticent in seeking out family planning
information, it is imperative that services for this
group include extensive outreach work (Scheyer, 1970).
"If we want people to change behavior, then
we must use the widest range of message inputs available and seek to provide information that is directly related to the needs
and interests of our audience"(Barr, 1972:84).
Actual changes in health and family planning behavior
depended on how well the media was chosen and the messages
designed, how effectively they were utilized, and the extent to which communications efforts were coordinated with
the service facilities essential for the adoption of the
new
~ecommended
behaviors (Young, 1973c).
Comprehensive communication strategies need to take
into account the fact that individuals and population
groups are located at different points and stages along
the family -planning adoption continuum.
Therefore, cornmun-
ications must be tailored for a variety of particular
groups (Young, 1973c).
There is a wide spectrum of
communication channels, media and techniques available
that can be designed to meet these needs.
Mass media has
proved very useful, but inadequate to carry the load
p '
25
alone.
To be more effective, mass communications must be
built into a system that combines then with personal
communications and the necessary supporting services. Mass
media is a facilitator rather than a mover, a director
rather than a persuader.
It is used most effectively in
alliance with other types of communications (Sweeney,
1972).
Young (1973c) concluded from studies on media effectiveness that printed materials are an inexpensive, practical and quite effective method of reaching a high percentage of the literate population with family planning
information.
Morris and Weinstock (1969) studied sources
of referral to a privately supported Los Angeles Family
Planning Center.
The clients were varied in social and
ethnic backgrounds.
They found that most often, women
were referred by friends
(19%).
(35%} or by their own initiative
In addition, they found that although mass media
may not be considered as the most effective means of
immediate referral, it may have some long range effects
on diffusion of family planning information.
Summary
The literature reviewed indicated that the autonomous nature of health behavior is an essential ingredient
in health education.
Attention can be drawn to health
risks, but the decision to act and which behaviors will be
26
incorporated into lifestyles lies with the individual.
Numerous studies have been conducted in attempts to quantify and measure the effectiveness of health education techniques.
However, lifestyles, beliefs, customs, socio-eco-
nomic standing, age and knowledge all influence behavior
and, therefore, the success or failure of health education
methodology.
Hence, the most effective techniques are
those designed for specific consumers and program goals.
Of the more conventional health education techniques,
studies have indicated that mass media has the widest
potential contact with the general public.
In addition,
mass communication techniques are very effective in bringing about an increase in awareness of specific health
problems and possible services and solutions which can be
utilized to alleviate those problems.
In regards to subsidized family planning programs,
the literature affirms the importance of providing women
with the option of planning the number and spacing of their
childrenr regardless of financial status or age.
Adoles-
cents are a main focus of these programs due to their lack
of funds and need for special considerations.
Altho~ghadolescents
were participating in sexual
activity, a review of the literature disclosed that the
majority were not utilizing any method of contraception.
For some, non-usage is a result of negative attitudes and
the social connotation they perceive in conjunction with
27
birth control.
For others, failure to practice birth con-
trol is more a consequence of limited knowledge and access
than from social stigma.
Assuming that adequate resources are available, it is
of primary importance to publicize that availability in
addition to other information that might motivate adolescents to use family planning services.
SETTING OF THE PROJECT
The Co:rn:munity
The project was undertaken in the City of Santa
Monica, California, which is located in the western section
of Los Angeles County.
It is bordered by Pacific Palisades
on the east, Venice on the South, and the Pacific Ocean on
the west.
It is part of the Coastal Health Region of the
Los Angeles County Department of Health Services, and more
specifically, the West Health District.
As of March, 1977, the city's population was estimated to be 93,800, an increase of over 4 percent since the
1970 Census was conducted.
Although the number of women of
reproductive age (15 to 45 years) has increased almost 8
percent over the past decade, the overall number of births
has shown a steady decline.
of a national trend.
This decline is a reflection
Contributing to this decreasing birth
rate is a change in attitude towards large families.
A
28
survey of married women 18 to 24 years of age, conducted by
the Bureau of Census in Santa Monica in 1972, indicated
that these women expected to have an average of 2.3 births,
a decrease from the expected 2.9 births per married woman
in 1967.
The decline in birth rate seems to indicate that
the largest contribution to the population increase has
been through immigration.
More people are moving into the
city than are leaving it (Planning Department, City of
Santa Monica, 1977).
Although Santa Monica is predominantly a white
community, the overall proportion of minority races to
total population is growing.
During the last census period
the minority population increased by 23.9 percent.
This
accounts, however, for only those members of the population
that are routinely surveyed.
In addition, Santa Monica has
a large population of undocumented aliens who are not
counted in the census, and their number appears to be increasing.
Minorities other than Spanish surname make up
7.2 percent of the population (Planning Department, City
of Santa Monica, 1977).
In the 1970 census, the Spanish surname population
accounted for 12.1 percent of the total population in
Santa Monica, an increase of over 77 percent since 1960.
In addition, the Santa Monica Planning Department predicted
a large increase in the Spanish surname population by the
mid 1970's.
This prediction is reinforced by the fact that
29
Spanish surname students had the largest percentage of increase of the total sturentbody since the fall of 1970
(Planning Department, City of Santa Monica, 1977).
Overall, blacks and Spanish Americans have lower incomes than their white counterparts.
The median income
for white families in 1970 was $11,000; for black families
$7,000.00, and for Spanish Americans, $8,900.00.
The
variance in the standard of living becomes greater than the
difference in median income indicates when consideration is
given to the traditionally larger family size of blacks and
Spanish Americans (Planning Department, City of Santa
Monica, 1977).
Over one-half of the city's
mino~ity
residents live
in two census tracts (7018.01 and 7018.2) located east of
Lincoln Boulevard and north of Pico Boulevard.
These areas
also have the largest number of multifamily dwellings and
the
~ighest
level.
concetration of families below the poverty
It is of interest to note that whereas among the
whites, the greatest concentration of poor people were the
elderly, among the minority populations it is the young
and middle aged adults (Planning Department, City of Santa
Monica, 1977) .
Santa Monica is an incorporated city which maintains
many of its own service agencies.
Included in these is
the Santa Monica Unified School District with its own
Board of Education.
The Santa Monica school requirement
30
for health education was met by discussions of alcohol and
drug abuse, general hygiene and venereal disease.
There was
no current curriculum in use for sex education at any grade
levelin the Santa Monica Unified School District.
Sexual
education was conducted at the discretion of the individual
teacher.
The age distribution in the area was rapidly changing.
In 1976, there were approximately 5,000 15 to 19 year olds
who were residents of Santa Monica, a decrease of over 8
percent since the 1970 census.
The trend was towards an
increase in the over 60 population, with an inverse relationship for the young.
The high cost of housing in the
area was forcing younger families to move out of the area,
with a concurrent decrease in the number of young married
residents (Planning Department, City of Santa Monica, 1977).
For the third consecutive year, Los Angeles County
births increased both in number and rate in 1976.
The in-
crease was unevenly distributed throughout the County,
however, and the Coastal Health Services Region, although
reporting the most births overall, did not increase its
birth rate (County of Los Angeles, Department of Health
Services, 1977).
Recent statistics from the Los Angeles County
~
Department of Records and Statistics (1977), indicated that
in 1976 there were over 4,200 births to married women under
19 years of age in the Coastal Health Region.
For the same
31
year and area, there were over 4,500 illegitimate births.
Of these births, 1,415 were to white mothers, 1,456 were to
mothers with Spanish surnames, and 1,426 were to black
mothers.
Although there are no statistics that correlate
this racial breakdown with age, i t is important to note
that while the Spanish surname and black populations are
not a large proportion of the total population, they have
comparable illegitimacy numbers.
Los Angeles has an organizing agency that funds and
supports various family planning services.
Part of the
function of the Los Angeles Regional Family Planning
Council (LARFPC) is to accumulate statistics for the purpose of health services planning.
According to LARFPC
statistics, the projected total need for subsidized family
planning services in Los Angeles County for 1977 was
327,599 women.
After subtracting the number of women whose
needs would be met either by private medical doctors or by
existing programs (based on services provided in 1976),
177,219 women, or 54 percent of the at risk of pregnancy
and 'in need' population in Los Angeles will not utilize
family planning services in 1977 {Los Angeles Regional
Family Planning Council Statistics, 1977).
The reality is that no recent comprehensive study
exists on adolescents' utilization of family planning
clinics for preventive health care and information.
In
addition, the investigator was unable to locate any docu-
32
·I
mentable statistics on sexual activity in Santa Monica.
However, on a larger scale, in the West Health District of
Los Angeles County, which encompasses Culver City, Mar
Vista, Venice, Santa Monica and West Los Angeles, the total
. I
projected need for 1977 was 20,370 women.
After accounting
for possible services provided based on projections from
1976 statistics, the unmet need for 1977 in the West Health
District totaled over 12,000 women.
Further division of
the total unmet need indicated that there were over 9,000
15 to 19 year olds in need of organized family planning
services in the West Health District {Los Angeles Regional
Family Planning Council Statistics, 1977).
Writer's Involvement
Inga Hoffman, Senior Health Educator, West District
Health Center, Los Angeles County Department of Health
Services, was concerned with the low attendance of adolescents at community family planning clinics.
It was with
the intention of assessing this situation that the author
initiated this project and subsequently designed a pamphlet
to increase the awareness of clinic services and consequently increase utilization.
. CHAPTER III
METHODOLOGY
This chapter presents the methods utilized in planning, designing and evaluating the community health education instrument.
The project is subdivided into five
phases of development: 1) pertinent literature, 2) community resources assessment, 3) development of the pamphlet,
4) criteria for assessment of the pamphlet, and 5) development of questionnaires to assess the pamphlet.
Phase I: Pertinent Literature
Several techniques were employed to gather the data
necessary for designing the health education instrument.
The first procedure was a review of the current literature
related to : 1) objectives of health education instruments,
2) design of health education instruments, 3) family
planning objectives and 4) use and effect of mass media
techniques in health education.
Scheyer (1970) has stated that if family planning
services are indeed available and accessible to the target
population, the first step in increasing their usage is to
make this availability known.
Young women may be reluc-
tant to seek out family planning information and/or
33
34
services.
Therefore, it is imperative that services for
adolescents include extensive out-reach work.
(Scheyer,
1970) •
Mass media techniques have been found to be effective
when combined with other supporting systems of health
education.
They are most effective as facilitators when
used with a literate population (Barr, 1972).
The literature review revealed specific criteria to
be considered in the selection of mass media techniques for
health education purposes.
When choosing a media approach
it is important to consider:
1.
The purpose and/or objectLve of the
instrument.
Is it intended to change
behavior, attitudes and/or arouse
action?
2.
The audience or target population for
which it is being designed.
Are they
already familiar with the subject
matter?
What are some of their charac-
teristics that might effect their
behavior (age, education, etc.)?
3.
Is the objective behavior accessible to
the target population?
Will
there be
adequate resources available to the target
population if they do change their
behavior?
35
4.
Budget for the project.
How much money
is available for the job and how many
copies are needed?
5.
Time schedule for the job.
How immediate
is the need and how long will the need
continue to exist?
6.
Distribution of the finished product.
Who is to carry it out, when, where and
how?
7.
Community's viewpoint on the project.
Is the community willing to back the
project and help in any of the steps
towards obtaining its goals?
(Muriel Wilbur: Education Tools for
Health Personnel, 1968).
In family planning communications there are definite
advantages to utilizing printed materials.
1.
Standardized form:
For example:
Once completed and
tested for accuracy, printed materials
can provide consistent information.
2.
Durability:
A pamphle·t or brochure can
remain with the client.
It provides
them with a continuous referral for
questions and/or information and can
be referred to later in privacy.
In
addition, it can be passed on to other
36
members of the community or target
population.
3.
Individualized learning or information.
Education and information can
be absorbed at the individual's own
rate.
4.
Attention getting and reinforcing:
Effective use of printed materials
can attract and hold attention.
When referred to later, printed
materials can serve as reinforcement for new health behaviors.
5.
Broadening access to information:
Materials can be distributed so as
to provide information and education
to a wide range of community members.
(Practical Suggestions for Family
Planning Education, 1975).
Guidelines for the development of printed materials
have been suggested in Practical Suggestions for Family
Planning Education (1975) published by the United States
Department of Health, Education and Welfare.
Questions
that need to be answered prior to final printing include:
1.
Is the material applicable to the
age, race, economic status and reading
level of the target population?
37
2.
Has the material been evaluated by the
target population?
Their needs often do
not coincide with professional perceptions
of their needs.
3.
Is the material free of bias: age,
sexual, racial or any other?
4.
Is the information included honest,
current, correct and comprehensive?
5.
Are all options presented without
judgment?
6.
Is the objective of the material clear?
7.
Is the information presented brief and
simply stated and free from unnecessary
crowding or extraneous material?
8.
Is the material logically developed
and the information pertinent?
Phase II:
Community Resources Assessment
Family Planning Clinics and Services:
"Medical care is an.individual and family affair,
taking place in a community setting, dependent
upon local resources, acting locally. To be
useful, a program must be relevant to ·local needs
and made available in ways that encourage local
adaptation." (Scheyer, 1970:23)
An integral component to the objective of the project
was a survey of the community to assess the actual availability of family planning services.
The Santa Monica
community was assessed by this writer as to the adequacy
38
of existing family planning services (see Appendix A} .
Informal interviews were conducted in an attempt to determine not only the availability of services, but also if
indeed a need did exist for adolescents to increase their
utilization of family planning services.
In the West Health District there were five major
clinics that provided the population with subsidized family
planning services.
Each clinic provided services in an
atmosphere that was unique and closely tied to their overall philosophies on women and hea1th care.
All of the family planning c.linics in the Santa
Monica area were located on major ·thoroughfares, providing
good accessibility by private automobile or public transportation.
The neighborhoods surrounding the clinics were
middle to lower-middle class residential.
Two of the
facilities were not in areas that were well enough illuminated for evening usage.
Family planning services were available during both
day and evening hours.
To facilitate operations, clinics
scheduled specific hours for many of the special services
they provided.
General family p1anning information and
appointment services were availah1e at all clinics during
daytime hours.
Historically, patients were seen on a walk-
in basis, with no appointments necessary.
Patient loads
had increased, however, and in an attempt to avoid overcrowding during clinic hours, all facilities were requiring
39
appointments.
All clinics had a waiting period ranging
from one day to two weeks.
The family planning services offered were quite comprehensive.
Without having to leave the community, patients
could obtain financially subsidized health care ranging
from sex education to vasectomies.
All facilities required
a gynecological examination prior to receiving any method
of birth control.
Although most of the clinics were very
conscientious in providing family planning education, one
of the clinics felt it was only necessary to explain the
. individual·
patient'.s chosen method of birth control.
The
remainder of the clinics provided classes which covered the
spectrum of methods to prevent pregnancy as well as abortion and general sexual information.
In addition to determining the available family
planning services, the investigator attempted to assess
each clinic's cognizance of the need for community outreach work and the manner in which they attempted to meet
that need.
All of the clinics attempted to maintain an
awareness of the particular needs of the community with
varying degrees of success.
Most of the clinics employed
a community worker to preserve contact with their respective neighborhoods.
In addition, two of the clinics
trained speakers to teach family planning to school and
cmmnuni ty groups.
Both of these clinics stated that re-
quests from Santa Monica schools were infrequent.
Some
40
community outreach was being conducted through adolescent
groups and other community associations.
Although all of
the clinics attempted to meet the specific needs of the
Spanish speaking population, only two employed Spanish
speaking staff on a full time basis.
The other clinics
stated that at present they were not involved in any
active outreach work for the adolescent population.
From statistics collected by the Los Angeles Regional
Family Planning Council it was evident that the average
patient in a Santa Monica subsidized family planning clinic
was in their early twenties, white and from a middle-class
upbringing.
Some of the clinic personnel expressed the
feeling that their patients were mostly from the local universities.
If this feeling represents fact, then although
all of the clinics were operating with full patient loads
each clinic session, it was questionable whether the
people who have the greatest need of these services were
utilizing them.
One of the family planning clinics was relatively
new to the Santa Monica area and was concerned with building a clien·tele and establishing its credibility.
They
were slowly expanding and reassigning their clinic schedule
to better meet the needs of patients and the community.
The remainder of the clinics had established clinic
schedules which were felt to be appropriate for the community.
41
Subsidized family planning ranges from no patient
fees to full payment of clinic costs.
In most cases, full
payment of clinic costs were still well below the prevailing charges made by private physicians.
All clinics
dis-
tinguished paying from nonpaying patients based on ability
to pay.
In addition, some of the clinics utilized a
'sliding fee scale' with a range of payments based on the
patient's income.
Furthermore, none of the clinics with-
held services for lack of funds.
All were subsidized by
agencies which filled in the deficits left by non-paying
patients.
Clinic personnel have expressed the opinion that for
most adolescents, their first visit to the clinic was for
a pregnancy test, not for birth control.
In addition, many
new patients indicated that they were unaware that parents'
signatures were not required and that they could obtain
services for low fees or for free.
It was also thought
that many teenagers were unsure of how to obtain preventive
health care relevant to family planning.
Charges, services and situational information for
each of the family planning clinics in the Santa Monica
area have been reported in detail in Appendix A, page 82 •
From this information, it became clear that the Santa
Monica community had a variety of family planning services
to choose from.
Services could be obtained at hours that
were convenient either during the day or evening, on week-
42
days or Saturdays.
Cost presented no barrier as services
were available for little or no charge to the patient.
Age
was no longer a criteria for refusing services as patients
could take action to prevent pregnancy and treat venereal
disease without parental consent.
As much as possible,
situational and financial barriers to receiving family
planning services had been dealt
with and minimized.
Other Relevant Community Resources:
In Santa Monica
there were numerous community agencies which had frequent
contact with the adolescent population.
Informal inter-
views were conducted by the investigator with local school
nurses, agency directors, recreation leaders, and social
program coordinators.
Impressions and reactions from these
consultations were integral to the development of the project.
_ Most community agencies did not offer any family
planning resources for teenagers.
In interviews conducted
with more than ten agencies in the Santa Monica area,
staffs indicated that family planning and sexuality was an
area of maturation that they did not care to become involved in.
Although they admitted to the need for educa-
tion and services, they expressed that it was not a topic
which they emphasized.
The Santa Monica High School nurse expressed the
opinion that adolescents only retained information that was
43
pertinent to their evaluation of their life's situations.
For most, the need for family planning only bec:ame apparent
with the fear of pregnancy, not with the onset of intercourse.
Because the schools did not offer any sex educa-
tion, she felt the students needed some other source of
information.
The Los Angeles County Department of Health Services,
West District Health Educator stated that teenagers received most of their health care information from peers and
parents.
Family planning, however, was still surrounded by
social stigmas, and few adolescents would ask, even their
close
friends, where they could get "the pill".
The Santa Monica community was either unaware or
negligent of the adolescents' need for family planning information and/or services.
The schools did not wish to
take an active role in helping students to find the services
they may require.
In addition, most of the organizations
and agencies contacted by the investigator either refused
to acknowledge the problem or felt that, although it
might indeed be a problem, it was someone else's responsibility.
There were very few agencies that offered guidance
in this crucial area of adolescent health care.
Phase III.
Development of the Pamphlet
The development of the pamphlet was divided into four
major segments: 1) content of the instrument, 2) format of
44
the instrument, 3) pretesting of the pamphlet, and 4) design of the pamphlet cover.
Content of the Instrument:
Three major steps were involved
in developing the content:
1.
Consultations with the staffs from
each of the family planning clinics.
2.
Consultations with health professionals
from the Santa Monica area.
3.
Interviews with adolescents from the
Santa Monica area.
The focus of the instrument was to advertise the
availability of subsidized family planning services.
Of
primary importance in publicizing this availability was the
specific services and the hours these services were offered.
In addition, the investigator chose to include information
that might respond to specific hesitations expressed by
community teenagers.
Confidentiality of services and cost
were major areas of concern to Santa Monica adolescents.
Hence, this information, as well as special services
offered by some clinics, was included in the content.
The investigator determined that specific information
on family planning methodology would reduce the utility of
the instrument due to fluctuations in communications relevant to some of the methods.
In addition, since all of the
clinics offer comprehensive information on family planning
45
methodology and options, it was felt that to include
this
information would be redundant.
After considering the suggestions of the target population and health professionals, ten information areas
were selected:
1.
Hours to call for an appointment.
2.
Hours to come in for birth control
information.
3.
Hours for birth control services
(including pap smears and exams).
4.
Hours and procedures for pregnancy
testing.
5.
Hours and procedures for venereal
disease testing.
6.
Hours and procedures for abortions.
7.
Costs of services.
8.
Confidentiality of services.
9.
Availability of Spanish speaking staff.
10.
Special services offered by each
clinic.
Once the areas of information were determined, it
became necessary to decide what information was to be included.
Within each topic area several factors were deemed
of primary importance:
1.
The hours each service was available.
2.
Special procedures prior to securing
46
services (i.e., were appointments
necessary; would the clinic accept
cash only; methods of collecting
urine samples for pregnancy tests;
etc.) .
This information was outlined as it applied to each
family planning clinic.
acteristics in common.
All of the clinics held some charOf these, confidentiality of ser-
vices was felt by this author and the community health professionals to be of primary importance to the target population.
Therefore, it was decided that this information
should be presented so that it would receive special
emphasis.
In checking the data charted for accuracy, the investigator discovered that some of the information was incorrect due to schedule changes at the clinics.
Hours of
availability vary according to the need indicated by patients' use of services.
In order to extend the usability
of the instrument it was decided that specific hours could
be eliminated and the designation of "day" or "evening
hours" substituted.
Interviews with clinic personnel and health experts
indicated
a need to add emphasis to several facts.
State-
ments regarding: 1) the importance of calling prior to
attending any of the clinics, 2) the confidentiality of
all services and 3) the non-existence of any upper and lower
47
age limits, were added.
Format of the Instrument:
The objective of the instrument
was to advertise the availability of family planning pro-grams to adolescents.
The need for this information does
not occur at a consistent age; hence, the investigator
believed that the instrument should be easy to secure and
retain for later reference.
Other criteria for design of
the instrument included: 1) clarity of objective, 2) adequate information to obtain objective and 3) simplicity of
presentation.
With consideration to the above criteria, the investigator chose a pamphlet format as a means of increasing the
awareness of adolescents in the Santa Monica area of available subsidized family planning services.
The pamphlet
was developed with consideration to the review of the
lite~ature,
suggestions offered by health professionals and
experts in the field of family planning and input from the
target population.
A pamphlet can be an attractive and relatively inexpensive method of mass communication.
It can be of a
size that allows it to be folded and stored for later
reference.
When correctly designed, it can provide under-
standable and concise information and motivation to act by
furnishing a clear perspective of options available.
A chart format was used with the names, addresses
48
and telephone numbers of each clinic listed (See Figure 1
on page 52).
Each clinics' services were presented as
separate units.
The chart thus constructed was filled out
with pertinent facts relevant to each specific clinic and
category.
Theoretically, an adolescent interested in birth
control information classes could find the topic listed
across the top of the
pamphlet~
then locate a clinic whose
hours and location met his/her needs.
Pretesting the Pamphlet:
A test pamphlet was constructed
that included all the pertinent content.
The investigator
distributed the pilot instrument to three health educators
for evaluation and several suggestions were offered.
The
categories for availability of Spanish speaking staff and
special services were combined to allow more space in the
over-crowded chart.
Most of the specific instructions,
such as "for pregnancy tests bring in the first urine
sample of the morning", or "old patients seen between 4:00
and 6:00 and new patients between 6:00 and 8:00" were eliminated and "call for specific instructions", or "call for
an appointment", substituted in their place.
In addition,
the West District Health Educator suggested that for the
sake of readability, the clinics
and their services should
be separated by heavy dark lines creating a b9x like .chart.
The data within the category "hours to call for an
appointment" was identical with that included in "hours to
49
come in for birth control information".
Therefore, these
two categories were combined under the heading of "birth
control information and rap sessions".
The remaining cate-
gory headings were shortened to exclude the words "hours
and procedures for" since this information is included within the chart.
The health education professionals consulted stated
that people generally read only the first part of any
printed material unless there is specific information they
require.
Hence, it is important to place that information
deemed most central to the objective of the instrument at
the beginning.
Information gather1ng is the first step in
obtaining family planning information and/or services;
hence, the first category contained birth control information.
The remaining topics were ordered in a style that
the author felt would be easy to follow.
The objective of the pamphlet was to present options
without judgment.
In addition to the five clinics that
offered services and information on the accepted methods of
birth control, there was an experimental program in progress that offered subsidized "natural family planning" for
women who met their entrance criteria.
This too was an
option that was available to some adolescents; therefore,
the name and phone number of the institution and "natural
family planning services available, call for more information" was added to the chart.
50
Design of the Pamphlet Cover:
Printed materials, as with
any mass media technique, are only valuable if they are
read.
For pamphlets, an important area of motivation is
the cover.
The cover must have an attraction that causes
the target population to want to read further.
This attrac-
tion can be verbal, visual, or both.
Health professionals and community agency representatives surveyed felt that due to the community's apparent
conservative views on family planning for adolescents, a
direct declaration that the pamphlet contained birth control information might hinder teenagers acquiring the pamphlet.
It was decided that the cover need not refer to
family planning services, but instead should be attractive
to adolescents and motivate them to read the pamphlet.
Eight possible cover phrases were decided upon (see
Appendix B) .
ten
~7
These eight test expressions were shown to
year old women who chose the four they felt would
most likely motivate them to pick up a pamphlet.
These
four phrases included:
1.
DO SOMETHING GOOD FOR YOURSELF.
2.
WANT TO KNOW A SECRET?
3.
SOMETHING'S HAPPENING
4.
THERE'S SOMETHING SPECIAL YOU SHOULD KNOW ABOUT.
A graphic artist was commissioned to design covers
to accompany the test phrases (see Appendix C) .
These four
prototypes were field tested on adolescents at the Santa
51
Monica Pier.
Thirty teenagers were surveyed to determine
if any of the covers would induce ·them to pick up::.and read the
pamphlet.
From this field test and
con~ents
reported to
the author by other teenagers, a final cover design and
phrase were selected (see Appendix D) .
The final prototype pamphlet was designed and printed
for evaluation (see Appendix D).
Phase IV:
Criteria for Pamphlet EV-aluation
Ideally, health education ha:s the goal of affecting
health behavior.
The effectiveness of planned activities
for health education can be evalua,ted by the extent to
which that goal is achieved.
Rea~istically,
when dealing
with a population, it is improbabl.e that all the effecting
variables can be controlled.
Therefore, evaluations are
limited and must be interpreted as such.
Time and resources did not permit a rigorous evaluation of the instrument's effect on the cognizance of Santa
Monica adolescents of available subsidized family planning
services.
Alternative criteria for evaluation of the
pamphlet were established by the author.
and
Content, clarity,
efficacy of the instrument we.re to be evaluated.
In
addition, the author felt it would be beneficial if the
pamphlet were to be reviewed not only by the target population of Santa Monica adolescents., but also by community
agency personnel who might have contact with adolescents.
WEST*' L.A. FAM\LY PLANNING SERVICES
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53
Phase V: Development of the Questionnaire to Evaluate
The Pamphlet
The development of the evaluative questionnaire was
divided into four segments: 1) type of questionnaire, 2)
target population, 3) objective of the questionnaire and
4) administration of the questionnaire.
Type of Questionnaire:
In order to simplify the evaluative
process for the respondents as well as for the investigator,
an objective format was chosen for the questionnaire.
It
was felt by the investigator that more direct and explicit
responses would be returned on a multiple choice format.
However, in order not to exclude any possible additional
responses, adequate space for comments was allowed.
In
addition, the investigator felt that to expedite questionnaire administration, it should be .a single page printed
on both sides.
Target Population for the Questionnaire:
Adolescents of
the Santa Monica area were the pr:bmary target for the
pamphlet and therefore an essential evaluative population.
In addition, there were other community members whose
assess!l"ents would be valuable to t-..he evaluation of the
pamphlet.
Many community agency personnel had primary con-
tacts with adolescents and would therefore have an idea of
what information was pertinent as ·well as representing
54
In addition, local health
potential distribution sites.
professionals would ideally have a more distinct sense of
the community and be more qualified to assess community
needs and responsiveness.
Therefore, two discreet ques-
tionnaires were developed to eval.uate the pamphlet.
Questionnaire A was developed for the responses of community
organization personnel and health professionals.
Question-
naire B was designed to be completed by community adolescents.
Objective of the Questionnaire:
In order to evaluate the
pamphlet, questionnaires were designed to determine: 1)
grammatical quality, 2) clarity of objective, 3) comprehensiveness, 4) value to the community, and 5) value to
adolescents.
For statistical integrity, the age and sex of the
adolescents was requested and the agency and job description were required of the professional respondents.
The community
professiona~s'
questionnaire {see
Appendix E) aimed particularly at the value of the instrument to each respondent in their contact with adolescents
as well as for the
commun~ty
in general.
The aim of the
adolescents' survey {see Appendix F) was to ascertain the
value of the instrument in relation to: 1) grammatical
quality, 2) clarity of objective, 3) prior knowledge of
family planning services and 4) adolescents' evaluation of
55
their own requirements for such an instrument.
Administration of the Questionnaire,:
Questionnaire A (see
Appendix E) was completed_ by health professionals and
community organization personnel.
It was felt by the
writer that agency staffs might return a more thoughtful
and honest analysis if given more time to respond.
Respon-
dents were chosen on the basis of their agency affiliation,
expertise and willingness to participate.
Over thirty A-
type questionnaires were distributed to be returned by mail
in self-addressed, stamped envelopes.
Agencies contacted
included the Santa Monica Library-, three of the Santa
Monica family planning clinics, Santa Monica High School
and a yout.h association.
Questionnaire B (see Appendix F) was constructed to
be hand distributed in conjunction with the pamphlet to
cornm~nity
adolescents.
Respondents were chosen on the
basis of age and willingness to participate.
The research-
er and an associate spent four hours on two separate occasions distributing questionnaires and pamphlets a±
tions.
two loca-
Ten questionnaires were collected from the Santa
Monica Mall and sixteen from the Santa Monica Pier.
All
but one of the respondents were under twenty years of age.
The results of the evaluation and suggested revisions are discussed in the follow.ing chapters.
CHAPTER IV
RESULTS
FINDINGS:
PROFESSIONAL QUESTIONNAIRE
Thirty questionnaires were distributed to agencies
in the Santa Monica community.
These agencies were
chosen on the basis of their contact with adolescents
and/or provision of health related services.
questionnaires were completed and returned.
Thirteen
The data
collected from these questionnaires were utilized in the
evaluation of the pamphlet.
Professional Profile
All thirteen of the respondents were female.
The
majority of the survey population reported working for
a private or public community agency.
None of the
questionnaires distributed to the county clinics or the
school were returned. (See Table I)
Four of the thirteen respondants described their job
category as nurse/medical.
The next most chosen job
description was clinic worker or clinic assistant.
(See
Table II)
A majority, or 85 percent of the respondents vlOrked
with adolescents on a regular basis.
56
(See Table III)
57
TABLE I
RESPONDENTS '
~V'ORK
AGENCY
AGENCY
NUMBER
PERCENTAGE
County Clinic
Non-County Clinic
Private/Public
Community Agency
School
Library
0
1
0
8%
10
0
2
77%
0
15%
13
100%
Totals
TABI..E II
JOB DESCRIPTION
JOB DESCRIPTION
Administrator/Director
Counselor/Teacher
Nurse/Medical
Clerical/Receptionist
Librarian
Other (Clinic Worker)
Totals
NUMBER
PERCENTAGE
2
2
3
8%
8%
31%
15%
15%
23%
13
100%
1
1
4
58
TABLE III
CONTACT WITH ADOLESCENTS
RESPONSE
NUMBER
PERCENTAGE
NO
11
2
85%
15%
Totals
13
100%
YES
The typical respondent to the professional questionnaire was female and worked often with adolescents.
They
were employed by a private or public community agency
and worked most often in a medical capacity or as a clinic
assistant.
Content of the Instrument
Eight respondents felt there were no important
content areas that were left uncov,ered.
Of the five
respondents who did feel there were additional topics that
needed to be included, only three specified what that
additional information was.
In regards to comprehensiveness of the pamphlet, two
respondents suggested additional topics.
It was recom-
mended that the venereal disease and rape hot-line numbers
be listed.
In addition, another category for pre-natal
59
clinics was proposed.
The only additional suggestion was
to eliminate "day or evening hours'fl from the clinic
schedules and substitute "call for information."
Clarity of the Instrument
Almost all of the respondents felt that the pamphlet
was easy to follow.
(See Table IV)4
One person commented
that the cover was misleading and should state the purpose
of the pamphlet.
TABLE IV
CLARITY OF THE PAMPHLET
Easy to Follow
Too confusing
- No response
Totals
NUMBER
PERCENTAGE
11
1
1
85%
7.5%
7.5%
13
100%
All those interviewed stated that the information in
the pamphlet was clear.
One person suggested that includ-
ing hours for services was unnecessary, and that "call for
an appointment" or "call for more information" was sufficient.
'
'
.
---~--
.
--·
-
-- - - - - -
60
Efficacy of the Instrument
Eight of the thirteen respondents stated they would
give the pamphlet to either males or females 13 years or
older.
Only one of the remaining interviewees stated
they would give the pamphlet to males 16 or older.
Table V)
(See
One respondent did not answer the question.
TABLE V
TO WHOM WOULD YOU GIVE THIS PAMPHLET?
Females 13-15 years old
Females 16-19 years old
Females 20 or older
Males 13-15 years old
Males 16-19 years old
Males 20 or older
11
12
12
8
9
9
When asked if the pamphlet would be useful for the
parents of adolescents, all but one interviewee stated
that it would.
In regards to usefulness of the pamphlet for referring
teenagers for family planning related services, 77 percent
replied positively.
The remaining respondents stated
that their clinics already offered all of the services,
therefore they would have no need for referring teenagers
elsewhere.
Responses to the question "How and when would you
use this pamphlet" fall into seven categories. (See
Table VI)
TABLE VI
POTENTIAL UTILIZATION OF THE PAMPHLET
RESPONSE
As handouts in the library
For telephone referrals
If patient could not make it during
"our" clinic hours
To give to high school groups
For venereal disease information
For free pregnancy tests
To give to my own friends
NUMBER
3
5
5
3
3
2
2
FINDINGS: ADOLESCENT QUESTIONNAIRE
Twenty-six questionnaires were collected from
adolescents in Santa Monica.
The investigator surveyed
teenagers on the Santa Monica Pier and in the Santa
Monica Mall.
Respondents were chosen on the basis of
age and willingness to complete the questionnaire.
The
data collected from these questionnaires were utilized
in the evaluation of the pamphlet.
Adolescent Profile
Of the 26 questionnaires collected, 73 percent of
the respondents were female.
(See Table VII)
TABLE VII
ADOLESCENT RESPONDENT'S SEX
SEX
NUMBER
PERCENTAGE
MALE
FEMALE
19
7
27%
73%
,Total
26
100%
Of those teenagers who answered the questionnaire, it
was found that the mean age was 15 years.
62
(See Table VIII)
63
TABLE VIII
AGE AT LAST BIRTHDAY
NUMBER
AGE
Under 13 years
13
14
15
16
17
18
19
20
21
Over 21 years
Totals
PERCENTAGE
3
0
0
2
0
1
11%
8%
8%
27io
23%
11%
0
0
8%
0
4%
26
100%
3
2
2
7
6
Eight percent of the population surveyed stated that
they were not aware of all the clinics that were available
for family planning information/services.
(See Table IX)
TABLE IX
PRIOR COGNIZANCE OF OPTIONS
RESPONSE
NUMBER
PERCENTAGE
NO
5
21
20%
80%
Total
26
100%
YES
64
Thirty percent of the teenage respondents were not
aware of any of the clinics that offered subsidized family
planning information/services.
Of those adolescents who
were aware of family planning clinics in the area, they
most often knew of the Planned Parenthood Clinic (See
Table X) .
TABLE X
COGNIZANCE OF FAMILY PLANNING CLINICS
NUMBER
CLINIC
Planned Parenthood
Venice Evening Clinic
Venice Family Planning Center
Westside Women's Clinic
West District Health Center
None
6
4
3
5
5
8
When asked if they had ever been to any of the
clinics, 80 percent responded they had not.
Of the five
teenagers who had utilized one or more of the clinics,
Planned Parenthood and Westside Women's Clinic had been
chosen most often (See Table XI) •
The typical respondent to the adolescent questionnaire
was a 15 year old female.
Most of these teenagers were not
aware of all of the options available to them for family
planning services/information.
Of those who were aware of
the existence of some of the clinics, most often they knew
65
about Planned Parenthood.
Of the few adolescents who had
ever utilized any of the services, they chose either Planned
Parenthood or Westside Women's Clinic.
TABLE XI
PREVIOUS UTILIZATION
NUMBER
CLINIC
Planned Parenthood
Venice Evening Clinic
Venice Family Planning Center
Westside Women's Clinic
West District Health Center
2
1
1
2
0
Clarity of the Instrument
To evaluate the clarity of the pamphlet two objective
questions were included in the survey.
Respondents were
asked to discover from the pamphlet where they could find
specific services at appointed times.
When asked where to go for a pregnancy test on a
Thursday afternoon, all but five interviewees responded
correctly.
However, most chose on1y .one clinic where four
of them would have been appropriate (See Table XII) .
A similar pattern of response was received on the
question of where to find birth control information on a
Friday evening.
(See Table XIII}.
In addition, there were
66
four incorrect responses to this question.
The investiga-
tor feels a possible explanation for the disparity of
answers could be the ambiguity of the original question.
TABLE XII
RESPONSES TO QUESTION #6
NUMBER
CLINIC
Planned Parenthood
(correct)
Venice Evening Clinic
(correct}
Venice Family Planning
Center
{correct)
Westside Women's Clinic
{correct)
West District Health Center{incorrect)
No response
10
6
5
10
2
3
TABLE XIII
RESPONSES TO QUESTION #9
CLINIC
Planned Parenthood
(correct)
Venice Evening Clinic
{correct)
Venice Family Planning
Center
(correct)
Westside Women's Clinic
(correct)
West District H~alth Center{incorrect)
No response
NUMBER
4
18
4
5
4
2
When asked if the pamphlet was easy to read and
67
understand, 100 percent of the survey population responded
"yes".
Efficacy of the Instrument
Over half of the survey population stated they would
pick up the pamphlet from the cover alone.
(See Table XIV).
Of those teenagers who would not, most commented that the
pamphlet looked "like a church program."
TABLE XIV
WOULD YOU PICK UP THIS PAMPHLET FROM THE COVER ALONE?
RESPONSE
YES
NO
Totals
NUMBER
PERCENTAGE
15
11
58%
42%
.26
100%
Eighty-nine percent of the respondents felt that the
information in the pamphlet was important to their age
group.
(See Table XV).
However, only 65 percent stated
they would give the pamphlet to a friend.
(See Table XVI) .
Reasons given for not personally distributing the pamphlet
included: 1) no one needs it, 2) none of my business, and
3) they already use birth control.
68
TABLE XV
DO YOU THINK THIS PAMPHLET CONTAINS INFORMATION IMPORTANT
TO YOUR AGE GROUP?
RESPONSE
NUMBER
PERCENTAGE
YES
NO
23
3
89%
11%
Totals
26
100%
TABLE XVI
WOULD YOU GIVE THIS PAMPHLET TO A FRIEND?
RESPONSE
NUMBER
PERCENTAGE
YES
NO
17
9
65%
35%
Totals
26
100%
Most of the respondents did not think they would give
the pamphlet to a friend 13 years old.
(See Table XVII):.
They commented that 13 years old was too young to need this
type of information.
Of those who stated they would pass
it on, most stated that even 13 year olds sometimes need
information on this subject.
69
TABLE XVII
WOULD YOU GIVE THIS PAMPHLET TO A FRIEND 13 YEARS OLD?
RESPONSE
NUMBER
PERCENTAGE
YES
NO
10
16
38%
62%
Totals
26
100%
A majority of teenagers surveyed stated they would
read and keep the pamphlet.
(See Table XVIII) .
Only one
respondent commented that they would not want their mother
to find a pamphlet "about this kind of thing."
TABLE XVIII
RESPONDENTS' UTILIZATION OF THE PAMPHLET
USE
NUMBER
Read and keep this pamphlet
Read it and throw it away
Not read it at all
Totals
PERCENTAGE
19
6
1
73%
23%
4%
26
100%
Seventy three percent of the respondents felt schools
were a good place to have the pamphlet accessible.
library was also chosen as a means of distribution.
The
Teen-
70
agers suggested movie theaters and pinball arcades as
additional options for dispersing the pamphlet.
XIX).
TABLE XIX
RECOMMENDED PAMPHLET DISTRIBUTIONS
RESPONSE
Library
School
Drugstore
Parks
Markets
Movie Theatres
Pinball Arcades
NUMBER
12
19
8
4
7
10
9
(See Table
,CHAPTER V
-SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
In this chapter a discussion of the results is presented.
In addition, recommendations are suggested for
future development of health education instruments.
Summary
The purpose of this project was to design a community
health education instrument that would increase the awareness of adolescents in the Santa Monica area of Los Angeles
County of the availability of subsidized family planning
services.
Two questionnaires were developed to evaluate
the ability of the instrument to meet that goal relevant
to content, clarity and efficacy of the instrument.
Content of the Instrument:
The study findings indicated
that the survey respondents found all of the content included in the pamphlet was essential in providing information of the availability of servi.ces to adolescents.
content was found to be accurate and credible.
The
It was
suggested by the respondents that the inclusion of all
relevant sexual information wou1d extend the efficacy of
71
72
the instrument to the target population.
Hence, the addi-
tion of categories regarding pre-natal care, rape and
venerealdisease was recommended.
Clarity of the Instrument:
The efficacy of mass media
techniques is dependent upon effective design.
It is
essential that the intended message and goals be clearly
stated and easily understood.
The survey findings indi-
cated that the pamphlet was easy to read and understand.
Although the adolescents surveyed agreed with community
professionals that the pamphlet was easily understood, the
majority did not respond correctly to objective questions
designed to indicate the ease with which information
could be located on the pamphlet.
These results could
imply that either the questions themselves were unclear and
ambiguous or that the information in the pamphlet was not
presented in an understandable fashion.
In addition, it
was noted by several respondents that the cover of the
pamphlet was misleading and should more clearly specify
the intent of the instrument.
Efficacy of the Instrument:
There was a consensus of re-
spondents that family planning information is of importance
to the adolescent population in the Santa Monica area.
The majority of the respondents felt that the pamphlet
would be very useful as a referral resource.
Most adoles-
73
cents stated that they would read and keep the pamphlet
for later reference.
Coincidentally, both the community
professionals and adolescents agreed that they would not
offer this pamphlet to a younger (13 to 15 year old)
friend because they probably did not yet require this information.
Only 58 percent of the responding adolescents felt
that the cover would motivate them to pick up the pamphlet.
This corresponds with a few of the community professionals
who expressed the importance of the cover more clearly
defining the pamphlet's intent.
The two groups of respondents agreed that community
distribution would have an important effect on the usefulness of the pamphlet.
They agreed that schools, libraries,
and community businesses would be effective avenues for
community distribution.
Conclusions
Content of the Instrument:
The findings of the survey
seem to indicate that additional content would increase
the value of the instrument.
To reinforce the abilities
of adolescents in making informed decisions from the
knowledge of options available to them, it is imperative
that all pertinent information be included in health education instruments.
In addition, i t is necessary that all
information included be current, accurate and easily
74
understood.
Clarity of the Instrument:
Adolescents' insufficient re-
sponses to objective questions on the availability of services may have been due in part to ambiguity of the original question or presentation of the cqntent.
It is essen-
tial in designing a health education instrument that relevant information be provided in a format that allows for
clarity and easy accessibility.
Overloading of information
may cause clouding of the data necessary to meet the original goals of the instrument.
It is therefore important to
designate that information paramount to achieving the instrument's goals and present that data in a manner that is
easily understood by the target population.
This presen-
tation should include words and symbols that are familiar
and clearly understood by the target group.
Efficacy of the Instrument:
The finding that 80 percent of
the responding adolescents were not aware of the family
planning options available to them in their community reinforces the importance of providing teenagers with this information in arnanner that most effectively meets their
needs and circumstances.
easy accessibility.
A pamphlet format allows for
In addition, it can be easily referred
to at a later time when additional questions or need for
services arise.
A pamphlet can be distributed throughout
• I
75
the community with emphasis placed on distribution to
agencies with high adolescent usage such as teen posts,
libraries, YMCA, YWCA, and schools.
Care should be taken
to pilot test all phases of a pamphlet's design.
In
addition . to updating and clarification of the pamphlet's
content, it is essential that the cover be field tested to
determine its ability to stimulate the target population
to pick it up and read it.
Recommendations
In view of the project findings and conclusions, the
following recommendations are offered:
1)
Field testing of community health education
instruments on the proposed target population
is essential to the efficacy of such an instrument and should be conducted on a large
population sample.
2)
Findings from pilot testing should be incorporated and instruments revised to meet the
needs of the target population.
3)
The distribution of the project pamphlet
should include any community groups and/or
agencies which have contact with adolescents.
4)
The pamphlet should be evaluated bi-annually
by clinic staff for accuracy and clarity of
the content.
I
76
5)
Long term evaluation of the effectiveness of
the instrument should be conducted via a random
community survey of adolescents' cognizance of
family planning services prior to distribution
of the pamphlet and at six months and one year
after distribution
Summary of the Project
Adolescents in the Santa Monica area of Los Angeles
County were not aware of subsidized family planning services available to them without parental consent.
project goal
~as
The
to design a health education instrument
that would increase Santa Monica adolescents' knowledge of
options open to them in their area.
An extensive review of literature concerned with
1) health education, 2) health education techniques, 3)
effectiveness of health education, 4) family planning,
5) subsidized family planning in the United States, and
6) family planning for adolescents is offered.
In addi-
tion, the setting of the project is discussed in detail.
Demographic data is offered in support of the project as
well as an in depth discussion of what family planning
services were actually available to community adolescents.
Definitions pertinent to the project are presented
in conjunction with an in depth description of the design
and development of the pamphlet as well as methods utilized
77
in evaluating the instrument.
Findings of the two surveys utilized in evaluating
the pamphlet are discussed.
each survey population.
is reported.
are offered.
Results are broken down for
A summary of the survey findings
In addition, conclusions and recommendations
.I
BIBLIOGRAPHY
Barr, Harriet, ed.
1972 "Family Planning and Population Education Issue."
Health Educators at Work. 23 (November):43-78.
Beyette, Beverly
1977 "Sexuality and the Drama That's Real." Los
Angeles Times. Section IV (September 22):1.
Center for Disease Control
1977 Morbidity and Mortality Weekly Report. 25, No. 53
(August):38-39.
County of Los Angeles, Department of Health Services
1977 From telephone interview with representative of
the Records and Statistics Division on October 18.
Dryfoos, Joy G.
1975 "Women Who Need and Receive Family Planning
Services: Estimates at Mid-Decade." Family
Planning Perspectives. 7, No.4 (July/August):
172-179.
Dryfoos, Joy G.
1976 "The U.S. National Family Planning Program 19681974." Studies in Family Planning. 7, No. 3
(March):80-92.
Griffiths, Villiam
1972 11 Health Education Definitions, Problems and Philosophies." Health Education Monographs. 31.
International Seminar on Health Education
1969 "Behavior Change through Health Education:
Problems of Methodology.lt International Journal
of Health Education. Hamburg, Federal Republic
of Germany (March).
Jaccard, James
1975 "A Theoretical Analysis of Selected Factors
Important to Health Education Strategies."
78
79
Health Education Monographs. 3,No. 2 (Summer):
152.;...167.
John E. Fogarty International Center for Advanced Study
in the Health Sciences
1976 "Health Promotion and Consumer Health Education:
A Task Force Report." {June).
Joint Committee on Health Education Terminology
1973 "New Definitions: Report of the 1972-1973 Joint
Committee on Health Education Terminology."
Health Education Monographs. No. 33:65-66.
Kantne~
1972
John and Melvin Zelnik
"Sexual Experience of Young Unmarried 't->7omen in
the United States." Family Planning Perspectives.
4, No. 4 (October): 9-18.
Kantner, John and Melvin Zelnik
1973 "Contraception and Pregnancy: Experiences of
Young Unmarried Women in the United States."
Family Planning Perspectives. 5, No. 1 (Winter):
21-35.
Keyes, Lynford
1972 "Health Education in Perspective-An Overview."
Health Education Monographs. 31.
Lewis, Deborah, Joan Mackenzie, R. Barry Nestor and
Barbara Shprecher
1976 "Expenditures for Organized Family Planning Services in the United States: 1974." Family
Planning Perspectives. 8, No. !(January/February):
39-42.
Los Angeles Regional Family Planning Council
1977 "LARFPC--Year End Summary: Summary of Need Estimates for West Health District, 1977."
Morris, Leo
1974 "Estimating the Need for Family Planning Services
among Unwed Teenagers ... Family Planning Perspectives. 6, No.2 (Spring} :91-97.
Morris, Miriam and Edward Weinstock
1969 "Sources of Referral to a Los Angeles Family
Planning Cer1ter." Public Health Reports. 84 (May)~
404-408.
Planning Department, City of Santa Monica
1977 "Socio/Economic Study."
80
I'
•
Practical Suggestions for Family Planning Education
1975
U.S. Department of Health, .Education and
Welfare, DHEW Publications No. {HSA)75-16007.
29-67.
Rosenstock, I.M.
1974 "The Health Belief Model and Preventive Health
Behavior." Health Education Monographs.
2, No. 4 (Winter) :354.
Scheyer, Stanley
1970 "DREW's New Center: The National Commitment to
Family Planning." Family Planning Perspectives.
2. No. l(January) :22-25.
Settlage, Diane, Sheldon Baroff and Donna Cooper
1975 11 Sexual Experience of Young Teenage Girls
Seeking Contraceptive Assistance for the
First Time." Family Planning Perspectives.
5. No.4 {Fall):223-226.
Shah, Far ida, .r-1e1 vin Zelnik and. John Kantner
1975 "Unprotected Intercourse Among Unwed Teenagers."
Family Planning Perspectives •· 7 No. 1
(January/February) :39-44.
Simmons, Jeanette, ed.
1975 11 Making Health Education Work. 11 American Journal
of Public Health. 65 (October) :1-34.
Smolensky, J. and F.B. Hoar
1972 Principles of Community Heal.th.
W.B. Saunders Co.
Philadelphia:
Steuart, Guy
1969 As quoted in 11 Behavior Change through Health
Education: Problems of Methodology." International Journal of Health Education. Hamburg,
Federal Republic of Germany (March) :189.
Sweeney, William
1972 11 The Role of Communication in Population and
Family Planning Programs.". Health Educators
at Work. 23 (November) :43-53.
Wilbur, Muriel
1968 Education Tools for Health Personnel. New
York:The MacMillan Co., 3-34 & 176-194.
Young, Marjorie A., ed.
1973a "Review of Research and Studies (1967-1971):
School and College Programs of Family Life
. I
I
81
Education~"
Health Education Monographs.33
Young, Marjorie A., ed.
1973b "Review of Research and Studies on the Health
Education and Related Aspects of Family
Planning (1967-1971) : Behavioral and Cultural
Factors." Health Education Honographs.34.
Young, Marjorie A.,ed.
1973c "Review of Research and Studies on the Health
Education and Related Aspects of Family
Planning (1967-1971) :Communication, Program
Planning and Evaluation." Health Education
Monographs. 35.
APPENDIX A
SURVEY OF THE SUBSIDIZED FAMILY PLANNING CLINICS
IN THE SANTA MONICA AREA
82
83
SURVEY OF THE FAMILY PLANNING CLINICS
I.
VENICE FAMILY PLANNING CLINIC:
1501 Pacific Avenue
Venice, California
Interviewed: March, 1977
Affiliations:
The Venice Family Planning Clinic was one
of the six Family Planning Centers of Greater Los Angeles.
The clinic had been in Venice for twelve years and was the
first family planning clinic in the area.
Location:
The clinic was located in a very transient
neighborhood in close proximity to the beach.
was easily accessible by bus or car.
The street
The surrounding area
was fairly poor and run down, but near enough to the
Marina to be part of the recent reconstruction projects.
Hours:
Clinic hours varied according to the day and ser-
vices provided.
9:00 a.m.
p.m.
It was open Monday through Friday from
to 5:00 p.m. and Thursday evenings until 8:00
They also offered services on Saturday from 9:00 a.m.
to 12:00 p.m.
The majority of their hours were staffed by
a nurse practitioner, with the doctor in attendance only
on Thursday evenings and Saturday mornings.
The nurse
practitioner was qualified to perform gynecological examinations and pap smearsr but the doctor signed and authorized
84
all prescriptions for pills and diaphragms and inserted all
IUDs.
The clinic operated on an appointment only basis,
although they did reserve some appointment sloiS for emergencies.
Services:
The Venice Family Planning Clinic offered a com-
prehensive spectrum of services.
They conducted birth
control education on a one to one basis.
As a client
entered, a trained counselor explained the patient's choice
of birth control to them.
gynecological exams,
The nurse practitioner conducted
diaphragm fittings, pap smears and
could check for venereal infections.
In addition, the
doctor inserted intrauterine devices and wrote prescriptions for birth control pills.
twice a month to low income men.
Vasectomies were offered
Although they would check
for venereal diseases, they referred to the County clinics
for treatment.
Pregnancy tests were done on awalk in
basis and results were given by a trained counselor.
At
the present, patients were referred to three private
physicians who accepted Medical for abortions.
The clinic
was staffed totally by paid personnel as volunteers had
proven too undependable in the past.
Special Services:
On Thursday evenings, when the doctor
was in attendance, the clinic also had a Spanish speaking
medical assistant in addition to the two members of the
regular staff that spoke passable Spanish.
Community out-
reach was limited, consisting mostly of word of mouth
85
referrals from past patients and their reputation from
having been in the area for over twelve years.
Who Is Using the Services:
According to staff impressions,
the average patient was 17 to 24 years old.
Most of the
patient population was transient, corning in for services
only one time.
new.
Consequently, most of their patients were
They did have a very small core of regular returning
patients.
Most of the patients lived in the Santa Monica,
Venice, Mar Vista or Culver City areas.
In 1975, the
Venice Family Planning Center saw 556 patients for various
services throughout the year, or 12.4 percent of the
patients who utilized subsidized family planning services
from the West Health District.
Although no statistics were
available, the staffs' impressions of their patient load
was that the majority are low-income whites, with very few
blacks or chicanas.
had no children.
' Clinic Funding:
funds
Most of the women were single and
(LARFPC, 1976).
The Venice Family Planning Center received
from the State,
Los Angeles Regional Family
Planning Council and from patient fees.
Patients could
either qualify for Health, Education and Welfare funding
and receive services for free, or paid the fees established
by the Family Planning Centers of Greater Los Angeles.
The
majority of their patients quali£1ed for Health, Education
and Welfare funding.
86
II.
PLANNED PARENTHOOD, MAR VISTA
12027 Venice Boulevard
Mar Vista, California
Interviewed: April, 1977
Affiliations:
The Mar Vista clinic was part of the Planned
Parenthood of Greater Los Angeles Association.
It was one
of their six family planning clinics that offered subsidized services in Los Angeles County.
At the time of the
survey they had only been in existence for two years and
were, therefore, still working on establishing themselves
for maximum usability in the community.
Location:
The clinic was located on Venice Boulevard,
.which had easily accessible bus routes as well as being a
major street.
They were located in a medical building and
shared parking and building access with a private physician.
The surrounding neighborhood was a middle-income
area and mostly residential.
Hours:
The clinic was still relatively new and therefore,
their hours were still in a state of fluctuation.
As the
clinics began to show community interest and support, they
would add more open clinic hours.
They were open Monday
through Friday, from 9:00 a.m. to 5:00 p.m. and Saturday
from 8:30 a.m. to noon.
In addition, they were open Tues-
day, Wednesday and Thursday evening until 9:00.
The doc-
tors were in attendance Tuesday, Wednesday and Thursday
from 3:00 to 9:00 and on Saturday from 8:30 to noon.
The
87
remaining time was available for pregnancy testing, counseling and supply distribution to returning patients.
The
staff felt that afternoon hours were more accessible to the
population and all patients were seen on an appointment
basis.
Services:
All methods of birth control were available to
patients, with doctors' recommendation.
In addition, the
clinic offered venereal disease screening and treatment
for women.
Eight classes a week were offered in family
planning information and new patients were required to
attend prior to receiving any other service.
These classes
provided information on all methods of birth control, from
withdrawal and rhythm to sterilization and abortion.
They
also included a component on preventive health care such
as breast self-examinations.
Classes were conducted in
small groups and tried to encourage participation of the
patients.
In addition, each patient was interviewed pri-
vately and had a chance to ask any additional questions
they might have had.
Patients were referred to other
Planned Parenthood clinics or to local hospitals for abortions.
The Mar Vista Clinic offered counseling for pre-
natal and abortion patients.
Special Services:
The clinic tried to have a Spanish
speaking volunteer at every clinic.
In addition, they had
a full-time community educator that coordinated a speakers'
bureau.
The speakers were trained to conduct groups
88
dealing with birth control, abortion and sexuality, as
well as other relevant topics.
They also maintained a
family planning library which was open to the public.
The
clinic used volunteers in many capacities, and had been
very successful in eliciting dedication from them.
Who Is Using the Services:
The staff's impression of their
clientele was that they are mostly students from the UCLA
and Santa Monica City Colleges with an average patient age
of 22.
In 1975, during which they only saw patients for
about six months, they saw 177 patients, or about four per
cent of the West Health District's patients who utilized
subsidized family planning services.
The staff then saw
an average of forty patients at each of their doctor
attended clinQcs.
Clinic Funding:
(LARFPC, 1976).
Planned Parenthood received funds from
the Los Angeles Regional Family Planning Council and from
state and federal agencies.
Patients paid, based on a
sliding fee scale, according to their income.
If patients
could not afford to pay anything, Planned Parenthood had
government funds to cover the cost of services.
also accepted MediCal and patient donations.
III.
WESTSIDE WOMEN'S HEALTH CARE PROJECT
1711 Ocean Park
Ocean Park, California
Interviewed: March, 1977
They
89
Affiliations:
The Westside Women 1 s Health Care Project
was an independent organization with no other official
clinic affiliations.
Location:
The Clinic was located in two adjacent medical
offices on Ocean Park Boulevard, near the beach.
Although
there were bus lines covering Ocean Park, the building was
difficult to identify since there was no sign large enough
to be read from the street.
The surrounding neighborhood
was residential.
Hours:
Westside Women's Clinic was open every day except
Friday and Sunday.
day.and time.
The services provided varied with the
The clinic was open Monday through Thursday
and Saturday for information and gynecological examinations
during the day.
In addition, they were open Monday and
Wednesday evening.
Abortions were performed within the
clinic on Tuesday and Thursday evening.
The clinics were
staffed at all times by a trained gynecological nurse
practitioner who is authorized to per£6rm gynecological
examinations and prescribe medication.
In addition, a
woman gynecologist was on staff and held some examination
hours.
Services:
Routine gynocologica.l. examinations and all
birth control methods were available through Westside
Women's Health Care Project.
Theyoonducted education
classes in small groups of two or three, and discussed all
possible methods for preventing pregnancy.
Th~maintained
90
a specially trained staff for abortions and pregnancy counseling.
Pregnancy tests were done on a.walk-in basis
during regular clinic hours.
Special Services:
Westside \vomen' s Health Care Project
maintained that the community responds best to a culturally heterogeneous facility.
Therefore, their staff was
composed of Latins, blacks, and whites.
There was always
a Spanish speaking receptionist or counselor available.
Birth control classes were taught in Spanish and literature was bilingual.
The clinic had abortion clinics two
nights a week for pregnancies of up to ten weeks.
In
addition, the clinic was very much oriented towards equal..:..
ity for women.
The clinic sponsored a group called the
"Fat Underground" and maintained the philosophy of no
prejudices against women for any reason.
Who Is Using the Services:
The staffs' impressions were
that about two-thirds of the patients were middle-class,
well educated women, either from the local high school or
college.
Another large segment of their population was
Spanish speaking.
Very few blacks utilized the clinic.
In 1975, Westside Women's Health Care Project saw 266
patients from the West Health District, or 5.1 percent of
the population that sought services from subsidized family
planning clinics.
Clinic Funding:
The Westside Women's Health Care Project
maintained a sliding fee scale, but the average cost to the
91
patient was higher here than at the other family planning
clinics.
Their philosophy was that women want to pay for
family planning services.
If a woman could not afford the
assigned fees, they had referrals for patients to obtain
MediCal funding.
The clinic itself was funded by a Los
Angeles Regional Family Planning Council grant, and from
patient fees.
IV.
VENICE EVENING CLINIC:
905 Venice Boulevard
Venice, California
Interviewed: April, 1977
Affiliations:
The Venice Evening clinic, sometimes also
called the Venice Youth Clinic, was a subcenter of the
West District Health Center of the Los Angeles County
Department of Health Services.
This was a special service
provided to the local community by the Health Department.
Location:
The Venice clinic was located on Venice Boule-
vard, near the beach.
Buses were routed down Venice Boule-
vard from all parts of the city making it an easily accessible clinic.
The area was mainly residential and lower-
middle income.
Hours:
The Venice sUbcenter was open from 8:00a.m.,
Monday through Friday.
However, the evening clinics
usually began around 5:00 p.m.
9:00 p.m.
Patients were taken until
Gynecology clinics were held Monday, Wednesday
92
and Friday evenings.
In addition, family planning informa-
tion classes were held on these same evenings.
Physicians
saw patients Monday through Friday from 5:00 to 9:00 for
any health related problems.
A1l patients were seen on an
appointment basis which could be made the same day.
Services:
Family planning information classes, gynecolo-
gical examinations and birth control services were offered
in the evening clinics.
In addition, testing and treat-
ment for venereal disease was offered.
Pregnancy tests
were done during regular clinic hours on a walk-in basis.
A social worker was on staff to counsel abortion and prenatal patients.
Women reques·ting abortions were referred
to private or county facilities.
Special Services:
The clinic attempted to have Spanish
speaking staff working during clinic hours.
The Venice
Evening Clinic offered general ambulatory medical care in
addition to family planning services.
The clinic offered
services to men, including testing ,and treatment for venereal diseases.
The clinic was well known and had the
community's support.
Who Is Using the Services:
The clinic drew a large pro-
portion of the Spanish speaking population who utilized
subsidized family planning services.
They saw an average
of forty to fifty patients at each family planning clinic.
Of these patients, the staff felt that about 50 percent
were Spanish speaking.
The clinic was known in the
93
community as a youth clinic, so the majority of their
clients were under 20, but they also served anyone who
needed medical care.
Clinic Funding:
free.
All services at the Evening Clinic were
The clinic was a subcenter of the West District
Health Center, hence all medical care was paid for by Los
Angeles County.
V.
WEST DISTRICT HEALTH CENTER
2509 Pico Boulevard
Santa Monica, California
Interviewed: March, 1977
Affiliations:
Los Angeles County Department of Health
Services maintained health centers which provided general
medical ambulatory care.
The West District Health Center
was the central clinic for the West Health District.
Location:
The clinic was located on Pica Boulevard, a
main-thoroughfare in the Santa Monica area.
accessible by bus or car.
It was easily
The surrounding neighborhood
was primarily multi-family dwellings, and some small
businesses.
The clinic itself was a large three-story
structure which housed administrative and service personnel.
Hours:
The clinic operated three family planning clinics
each month.
There were two evening and one morning clinic.
In addition, the Health Center maintained separate hours
94
for pregnancy testing and venereal disease testing and
treatment.
Pregnancy tests were conducted one morning each
week, while venereal disease treatment clinics were held
three mornings each week.
Services:
As in other County Health Clinics, the West
District offered general medical care for thecornrnunity.
Specific clinics, such as family planning or
pre-natal
programs were offered on a weekly or monthly schedule in
an attempt to meet the needs of the patients.
Special Services:
The Health Center was utilized by many
community families for all of their medical care needs.
Most of the clinic staff spoke Spanish and most of their
patient education classes were conducted in both English
and Spanish.
In addition to direct medical services, the
health center housed the District's nutritionist, environmental sanitarians and health educator as well as other
health professionals which provided assistance to the
community.
Who Is Using the Services:
As with the Venice sub-center,
the West District Health Center served a large segment of
the Spanish. speaking community.
This clinic seemed to
attract an older population for their family planning
clinics.
Most of their patient load already had families
and were utilizing birth control to space or control the
number of births.
Many of these women had been using the
Health Center for all of their medical care and learned of
95
the family planning services through the pre-natal and wellbaby clinics.
Clinic Funding: The West District Health Center was subsidized by Los Angeles County, therefore, all services to
the community were free of any charge.
APPENDIX B
TEST COVER
96
PHP~SES
97
TEST COVER PHRASES
1.
WANT TO KNOW A SECRET?
2.
SOMETHING'S HAPPENING
3.
DO SOMETHING GOOD FOR YOURSELF
4.
HAD ANY LATELY?
5.
KNOW WHERE TO GET SOME?
6.
THERE'S SOMETHING SPECIAL YOU SHOULD KNOW ABOUT
7.
WHERE DO YOU GO FOR . . . . . ?
8.
BIRTH CONTROL INFORMATION IN WEST LOS ANGELES
APPENDIX C
TEST PAMPHLET COVERS
98
99
+here's
some
Spte.cla I
.
'
yc:u., shoulcl
know about.
100
YOURSELF
101
Some.i:hinJ 's
ho ppeni'2_9!
1C2
:psssst ...
WtAnt
to
know
CJ.
SeCJf"~
APPENDIX D
PAMPHLET PROTOTYPE
103
104
WEST'*"ALLL.A. FAMILY PLANNING SERVICES
SERVICES CONJ::I DENTIAL
Blf\"11+ CONTROL B IRI-IT CON"mOL
INFo~MATJOt.l
AA f>
J1..ANNE:D ~11\COD ;
MAR. VISTA
12.01.7
V~nic6
B\lld.
Nar Vista
:3 91 -
SE.SS\ON'S
Call for- an
appointme?t:
I
CLINIC.
1711 Ocean t&r~ :BJ..d
appointment
Call for a.n
appoint rnent
l-1or0Mf~ Sc.dv~
FAMILY
t'l..J>..NNIN6- CEtiiTEFVENICE
?ac.i.flc..
of evel'l.f rncnth .-
ot
abo
3 n:1 lvwr5daj
( ::lh Spar\.V. -loo)
A.ve..
Vee;, ice.
.:39.2-4147
Come:
~on<fa( ~ FriCiay
'\C!\?'\-5pm
So...tvrd<!>f
6 -)Ia,..,
f'O ap9o\ntm!'nt is
nece~
Call
VEil/ICE EVcNJNtr
CLINIC
qos \1'421\ic.e. Blv.:t.
- - - •-
Vert ice
you.
"It-
eat'V'I.
ycv.. ~
Call f;f'St -FOr
il?str"LAChons
"lests
Ca II
.fOr
<Y1
appoin~t
seRvrce:s.
<!.V\
fR !DAY
momin~
at S: 26"a.m.
no df>?Oir'ltment is
P€e~ de~d a'!
how m<.ACh
::r-F you
for-
ro pay,
Call
fi r'lSt"
~bre dane.
IS
FREE.
Come:
~~~~~~a.;',7'3CHIW
frid~ /
"'·,..·
i3e SlAY~ 4o come
1. Spanish
MOnda&.(~ Frt~~
t; ___ _ q - --
is.
~pol<en
l?ef~,.-,-.als
l'vai !able ft,r
other medica\
serv•ce<O.
call -tor
i ntot-rna:tion
1.~i..h
is
Spoken
Z. The ht-alfh cenkr
o.;rers
C'aJJ for
no Af>f>o"mtment i:s
neceO!!ISiltrY
i nfor-ma.ti()n
1. Sptnish is
cal\
for
iY'lfo~tion
~
t.
FRe-E. V«Sedtrnit"S
call for
info~ion
Ca II -fl:> r- <Y~
1. 9 pav~ish i.s.
appoint~t.
Tasti~ ~
treat mer'Tt"
o~r
rn~ic:a I s~rvices.
eaviy
Feterrals to
othet" clinice. .
"6ewices ~re
:still ovailal?le.
dYl
appoinf~nt".
5. Communi-1-y
rde"""l S!'Y'IiOE'S.
only)
t.r~otme"t
a¥e.
Sl"t>>)fS.
z. 1./or-,yy
~oVHily pJanni!!J
-For cost
No t~in.sor
earn.
unalole
commmi~y
2.
(women
IS
'fOU
1. Sp~~k~IS ~vail~
for $d?ool anct ·
and a ppointinent.
necessary
appointment
oppointm~t.
Call
EveYLf
lhO~IM(
Coul?~li~ by
done.
a\'50
31-d
Fridot.(
a.ppointWlt!'rlt.
do.ys only.
o..vo.ilable.
I st OY'd 3rd. TIN!'Sclal(
ever"L{ I'V'lOrTtYl -
Ca II i'ov)
~s ckpencl en
how mlAch
c~ll tor en
appoint V\'lel'lt .
Clinics held:
and
(women only)
~ttl\
Clinics held:
191: ord 3rd T()SS~
Pico
Senta \-tonica
\.50 I
Cal\ tor an
dPf>O i rrt rn;nt; .
TCA~day
~II for- cost
aV7d oppoi~
~vices
Spen"~hioo')
Counselinq
lol.f
vnalo\e it> ~.
al"'e.
~~
~mqs
:250C\
appoil"''tmerrf:.
evenanqs
So.tvro.a.y mominqs
'Sa.-tord~s
W'BST DISTRICT
HE.I\LTH CENTER.
Call foron
O.ay~
a:,u for-dn
(!n
SPeCIAL
A:eoRTIONS
3evvices a.vo.ildb~
Serv·ICE'S Clva"a\•lc.\e.
~Por-k
DF
' c~ll .for en
. .appoint~.
e~..,mc:;s
WDMENS
Ca5T
EXAM IJIJA TIOIIIS
So.:turollk( mominqs ·
WtsTSIDe"
f
lv\01d<llf --:»S,.ivn:iay Hcnddl.{ ~,Sl:tv~
Services dvai Ia !:ole:
dalfs.
C)(obl
!!eRVICCS
spoken
call
tor-
i nfo rrnatli::ln
z. Clinic
otne~
offier:s
medical
a..CI'If"'\JVP.A.
104
.
r
IF
I
You~
A
FR\END NEED
CONTROL
OR
\3\ RTH
HAVE OTHER CONCERNS .
A'BOUT SEX ...
' SOMETH-IN6\-\\:RES
You DoN'T
WANT
r
I
TO M\SS
IF
YOU CR A
Be
coli
FR\END NEED
"BlRTH
CONTROL
OR
I
heRr;;
nr.; , l: C.
w;
.
cr-..~.-,..1~:Tui~>.!6,
"AJr 11.. , fi 11 "~ .
ahead -
Clinic. hours may
\-!AVE OTiiE.R CONCERNS
AWUT SEX ...
I
sure 1:0
chonse..
AH
sexvic.es a~·,\ab\e
ye,~)f{~\t}~~
CIT ~~
You DoN'T
WANT
DO
SOMETHING
TO MlSS
"Pamnts consetli 1 signc.ture,
or a.wrcVd\ is not
needed fo- any din"1c
G-OOD
FOR YOURSE.LF
sexv 1ce<;; -accxxcli ~
+o teder.:.\
\d.W.
C.)\1 SZ'I-2"111 - l'le<~lfh educ•tl011 .for
ddd"d·\oni>.\ pi'>Y>lphle;t.s..
1-'
0
U1
WEST*"AU.L.A. FAM \LY PLANN lNG SERVICES
SeRVICES CONI=! DENTIAL
~
~
l:ht.~~
MAR. VISTA
ltO:t7 Vcn;c... "BI\I:i.
t-t.... v;..t.
810\Th CONTROL !lti\TII- CDil'l1'\0I..
INR:l1<,._11\Tlcti
AA V SES51o>l&
Coll·fc>.- an
apfcintm<nt
1-\0'Idl>j...,..S>iurrlaj
.5ewvkeiS d\ll:lilaUe=
dalf'.
3'11- ()(..t,l
... ~~~
e~
.S:...turd814
V!!i?ISlpff
WOHIHIS
G~
1711 Oc&n "A.rl<. !1-.:l
Oc.e..., P•ri<.
P\OI"hinct•
-i-50-ztql
O:•
F«& clo!pend on
t>ow
ycu"'"''"
earn.
HatcJ.olj-~
:r.f you-
.s.vvo:... ...,..;bbl.:
~!~-
Vfli>l:le to fi'LI,
'S8f"'/W:.e.s
(.,II
for
&1'\
<>fp:>i..t -nt.
~scicpo>dcn
how "'"'~h
yov. _..,,
'IT-you-
c.Eim&
Pi"~
:!.et'Vicn a.-e.
...t.n
s,.,o.t.~co)
1.. ..-d il"'~loiOIOdlof
t-f.,.t-bd
t~
(&II fo~..,.
appoinlmMt.
"""•t
'"{'fcOnhnont: ;,
n,...........y
Cost• ,. s.oo
Call
::fy"
f; rn -tOr
Itt..,.. yli
o.o.il•~.
... mly)
r~
lbst·
~!5.00
(wonv.n only)
~
£6t1l.LY
£!J.~~
1::!101
\kniu..
-
QUIJ:UI..
~lc.
"*·
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t-1~-?fYid"
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'Th~f
frt tDAY
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~
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cu~
qo5 """'4 l3hd.
Va-l ice.
li'21-:3484
ST. ~HN:,
Hosf'l,.-,..1...
-
f"C<.e$5~
F<~e.- c;t4'Ulcf 01
t4onJ"'f-+ fi.id"(
h<>w mtAclf
q.'"- ~
you e&m.
Cll111c.S neld •
~)/OW~
d~ '._ _.,·...g,
u.,;oble k:l ~.
an ""'"'"""'~
~Y'Viu$ &Ye
1'0 ~u.t ......tio.
MOr'Yiiref'.
:still 61/ailabl!!.
"""e~-
Coli for- ...,
appoinfmomt'.
1-lor.J&7
awc"nt...-....t.
E11ewytni~
M"""I.OJ
IS
w.-dnt-oday *""'";~~ 'fl'>i""""•Y
frid)o
Fridoy
C""""""ify
~'IM-12
11.crdl:mol
.....'"""ay
......,;t<l'$.
1. Sf"'"ish ,,.
apo~-.
.,..,ilobl" for
...... -lo CD'tleo
ea.ty
C&ll
Be'r/1~.
inf,.·ma.tion
s~
t. 71'1<!
h<'"ollk omlor
Dff•I"J otJ1olt•
""""i<:•l afi'Vbtl.
t-all -fbr
lni\:>,.,.,...tion
nO appa·,.t....,....t is
-tr~"t"""n
1. Sponiah io.
Fefe,.,.l,
w
call for
ln~tlen
~
t.
FREE llaosotdlnics
c•ll for
in~ion
;.
-til"'lt'
tests ...... da-re.
51""'- 91"',
other ,.,.:ll<a\
1 Sj>.nio.h ;..,
f-er
call
o~clinica-
n~ag:.:.Vntn....t
at¥~
S""'f'f'-
z.;;~pMnnii!J
a..-d appointm!nt
No tqsti',;ior
-n......~ .....;:~
Hond"'f"+ITtd"'-1
!=RES
f.,.- 101ool
nec11~
C<rrle:
&.t.vro"'/
8-llam
Cau for""
~
a.ppoit1tM_,t
<~--sprn
Cou,.S<> 11.., loy
appoi"t,...,t.
c....... ,
Eve"'{
t'IO ~i11t"'-"t i.
.{~
"'"""'f'f"l'
-1. S'f>"''k...., •~IIOI:k
0.11 -!<>.-cost
1>'10fT1~......
ate:
,.,v,...~
3eRvu:ll!s.
z. fl<of<v,-,.ls
0 .....
szq • .t'\11
.vt
bppoi ntmont
faro ~i~
"li'sts ch'l6
dc.ys t;!!]_ly.
i$
FP.I'ic;;
,...,i<lly
Th<S~·r1<1
Fri aLl
Gall
Cdll .for
i>tstYUCh""S
Cov...li~
k>l.j &ppOint......,t.
~lvnl"{• t.x. -..~~
no
Sf'!!CIAL..
A~"TicNS
Tt:!!>-n>
"'.,., ii7 )««
lolond.., i
'1~-...,;~t:t·
E"~l~
Cllnl•~ l\<lld•
e.,., ,.,.,lh .- loi ~l'e>ij """"*"31-d
"''""
:w "''""""
.....-.... ..,)
c.. ,,-10.-_
Come:
.J
Sr!wta lbdUi
OI~E
Tt::s-r.s
VnAio\e. io plOt,
..
Clinkshtl4:
VEriER.IOI>.L..
f'fE6 tlA.X:.V
..-e
stin ....... ii..I:J"-
9c>""'""•t ......... ;,q•
..C'111i ·\'.,-;~-- C..ll for~
<~fpointfl'ol!tlt.
"'f>POil>t.........t.
Wfi?.T.I2!§I.fi.)g
:i!:::K>'t
OF
E>e!NICeS
.Spf"irrb,..,t.
o.vo.'ll•'D\e.
~~
~,.,~
C~T
Coli .for ...,..
f-1,""' ..,_ SMrcl.aJ
s.erv·~
f
~t41NATION,!;
Chll fcrdn
appol... t.-ne11:
e--•..q~
.H5~"01.
:lei'-'I!Ce.S
U.ll
-ll,,....,.,
appo;nt,....,t.
Tl!»ti~
!
tr~...emc<Tt
H<>n<l•y ~ Fri.l'"''l'
c:ovn:seli~
"'f!X>i
CliU
-t«
infO~
1.9~,.,
;..,
&poken
z.Ciir1iG
~
CJtl>oo' nV>:!bl
~-
5-"11""'
NAIUI1~L
FAMt LY PLANNitJ&
CALL -BZ'\·,Z6b
SE~IIll:;E:S
FOR. 1-101<6
AVAI L"-Bl.S
INtl::fU..tATION
---~
-----------
1-'
0
0\.
APPENDIX E
QUESTIONNAIRE A
107
108
QUESTIONNAIRE "A"
The attacL'O:;d pamphlet was designed to make the community
aware of the family planning services available in the
West Los .~1geles area. This brief questionnaire was
designed to help evaluate the value of the publication
for this community. Would you p1ease take five minutes
and fill out the questionnaire as completely as possible.
Please comment wherever you feel it is appropriate. All
answers are anonymous, no names are asked for. Your help
will aid in the updating and changing of the pamphlet to
meet the needs of the community. When you have finished,
please mail the questionnaire in the attached stamped/
addressed envelope by December 30, 1977.
1. Do you work at a:
County clinic
Non-county clinic
Private/public community agency
School
-----Library
~------
-------------
2. Check the box that best describes your job:
Administrator/director
C1erical/receptionist
--Counselor/teacher
Librarian
Nurse/medical _ _ _ _ _Other (describ-e')_ _ _ _ __
3.
Are you a:
male
4.
Is the pamphlet: easy to follow?
Comment:
5.
Is the information given in the pamphlet clear?
Yes
No
Comment:
-----
female
------too confusing___
6. Do you work on a regular basis with adolescents
(13-19 year olds)? yes
no
-Comment:
7. To whom would you give this pamphlet? (you may check
more than one answer)
Female 13-15 years old
female 16-19 years old
Female 20 years or olderma.le 13-15 years ol-=-d--Male 16-19 years old
male 20 years or older
----
~--
8. Do you think this pamphlet would be useful for the
parents of adolescents? Yes
No
Comment:
-------
109
9. Do you think this pamphlet will be helpful to you in
referring teenagers for family planning related services?
Yes
No
If no, why wouldn't it be useful for
you~
10. Do you think there is a need for this pamphlet in
your community? Yes
No
---Why?
11. Are there any topics that were not included in the
pamphlet that you feel should have been covered?
Yes
No
Which ones?
12. Are there some topics that have been included in the
pamphlet that you feel are unnecessary? Yes
No
--Which ones?
Why?
13.
How and when would you use this pamphlet?
Thank you for your help. This pamphlet was designed as
part of a graduate student's f~eld project in health
edu<;:ation. Your contribution to this project is greatly
appreciated.
APPENDIX F
QUESTIONNAIRE B
110
111
QUESTIONNAIRE "B"
The attached pamphlet was designed to make teenagers aware
of the family planning services available,in the West Los
Angeles area.
This brief questionnaire was designed to
help evaluate the value of the publication for this community. Would you please take five minutes and fill out
the questionnaire as completely as possible. Please
comment wherever you feel it is appropriate. All answers
are anonymous, no names are asked for.
The pamphlet was
designed as part of a field project for a student in
health education. Your help will aid in the updating and
changing of the pamphlet to meet the needs of the community. When you have finished, please return the questionnaire to the person who gave it to you.
The pamphlet is
yours to keep. THANK YOU FOR YOUR HELP!
1. Please check the age you were at your last birthday:
under 13
13
14
15
16
17
18
19
20
2.
21--- over-21
Are you a male
female
3. Would you pick up this pamphlet from the cover alone?
Yes
No
Comment:
4.
Do you think this pamphlet contains information important to your age group? Yes
No______
Comment:
5. -Where would you think is a good place to leave these
pamphlets so that teenagers can get them?{check all
appropriate answers) Library
School
Parks
Drugstore
Markets
Other places you would
recommend:
-=--~-
6. After reading this pamphlet, where could you go for
a pregnancy test on a Thursday afternoon? (Check all
appropriate answers) : Planned Parenthood
Venice Evening Clinic
Westside Womens' Clinic
--Venice Family Planning Center
West District Health Center -----7. Do you find the pamphlet easy to read and understand?
Yes
No
Comment:
112
8. Will you: read and keep this pamphlet--::--;-.,read it and throw it away
or not read it at all
Comment:
9. From the pamphlet can you find where to get birth
control information on a Friday evening?
Planned Parenthood
Venice Evening Clinic
West District Health Center
Westside Women-s''--::C:::-:1'1.....-.n-ic
Venice Family Planning Center--
____
10. Before reading this pamphlet were you aware of all
the places you could go to for family planning information/services? Yes
No
Check those clinics you knew about before reading this
pamphlet: Planned Parenthood
.---=Venice Evening Clinic
Venice
.Family Planning Center
Westside Womens' Clinrc-- West District Health Center --11.
Yes
Would you give this pamphlet to a friend?
No
Comment:
12. Have you ever been to any of these family planning
clinics before? Yes
No
If yes, which ones?
Planned Parenthood
Venice Evening Clinic
Venice Family Planning Center
Westside Womens' Clinic
West District Health Center ----=-~::-;--
13. Who do you think needs the information in this
pamphlet?
14. Would you give this pamphlet to a friend 13 years
old? Yes
No
Why?
15. Now that you know where to go for birth control information/services, will you be using any of these
clinics? Yes
No
Why?
THANK YOU FOR YOUR HELP!!