Abstract
To study the role of perceived threat of infertility, barriers, and facilitators in intention to anticipate childbearing, a cross-sectional study was conducted with 240 women desiring to have children and committed in a heterosexual relationship. Participants answered an online survey between July 2016 and February 2018. Results showed that perceiving infertility as a strong barrier and being willing to use fertility treatment as a facilitator fully mediated the effect of perceived threat on intention to anticipate childbearing. In conclusion, women who perceive themselves at risk of being infertile will consider, to a higher degree, infertility as a strong barrier to achieve their reproductive life plan or will report higher willingness to use fertility treatments, which in turn would increase intentions to anticipate childbearing. Since evidence showed lack of fertility awareness, intervention initiatives should target these mediators.
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Abiodun, O., Alausa, K., & Olasehinde, O. (2016). Ignorance could hurt: An assessment of fertility awareness, childbirth intentions and parenting attitudes among university students. International Journal of Adolescent Medicine and Health, 30, 1–11. https://doi.org/10.1515/ijamh-2016-0091.
Anderson, K., Nisenblat, V., & Norman, R. (2010). Lifestyle factors in people seeking infertility treatment—A review: Invited review. Australian and New Zealand Journal of Obstetrics and Gynaecology, 50, 8–20. https://doi.org/10.1111/j.1479-828X.2009.01119.x.
Berrington, A., & Pattaro, S. (2014). Educational differences in fertility desires, intentions and behaviour: A life course perspective. Advances in Life Course Research, 21, 10–27. https://doi.org/10.1016/j.alcr.2013.12.003.
Boivin, J., Koert, E., Harris, T., O’Shea, L., Perryman, A., Parker, K., & Harrison, C. (2018). An experimental evaluation of the benefits and costs of providing fertility information to adolescents and emerging adults. Human Reproduction, 33, 1247–1253. https://doi.org/10.1093/humrep/dey107.
Brecher, L. S., Pomerantz, S. C., Snyder, B. A., Janora, D. M., Klotzbach-Simomura, K., & Cavalieri, T. A. (2002). Osteoporosis prevention project: A model multidisciplinary educational intervention. Journal of the American Osteopathic Association, 102, 327–335.
Buglar, M. E., White, K. M., & Robinson, N. G. (2010). The role of self-efficacy in dental patients’ brushing and flossing: Testing an extended Health Belief Model. Patient Education and Counseling, 78, 269–272. https://doi.org/10.1016/j.pec.2009.06.014.
Bunting, L., & Boivin, J. (2007). Decision-making about seeking medical advice in an internet sample of women trying to get pregnant. Human Reproduction, 22, 1662–1668. https://doi.org/10.1093/humrep/dem057.
Bunting, L., & Boivin, J. (2010). Development and preliminary validation of the fertility status awareness tool: FertiSTAT. Human Reproduction, 25, 1722–1733. https://doi.org/10.1093/humrep/deq087.
Carpenter, C. J. (2010). A meta-analysis of the effectiveness of health belief model variables in predicting behavior. Health Communication, 25, 661–669. https://doi.org/10.1080/10410236.2010.521906.
Champion, V. L., & Skinner, C. S. (2008). The Health Belief Model. In K. Glanz, B. Rimer, & K. Viswanath (Eds.), Health behavior and health education—Theory, research, and practice (4th ed., pp. 45–65). San Francisco, CA: Jossey-Bass.
Chelli, L., Riquet, S., Perrin, J., & Courbiere, B. (2015). Should we better inform young women about fertility? A state-of-knowledge study in a student population. Gynécologie, Obstétrique & Fertilité, 43, 128–132. https://doi.org/10.1016/j.gyobfe.2015.01.002.
Collins, G. G., & Rossi, B. V. (2015). The impact of lifestyle modifications, diet, and vitamin supplementation on natural fertility. Fertility Research & Practice, 1, 1–9. https://doi.org/10.1186/s40738-015-0003-4.
Conceição, C., Pedro, J., & Martins, M. V. (2017). Effectiveness of a video intervention on fertility knowledge among university students: A randomised pre-test/post-test study. The European Journal of Contraception & Reproductive Health Care, 22, 107–113. https://doi.org/10.1080/13625187.2017.1288903.
Cooke, A., Mills, T., & Lavender, T. (2012). Advanced maternal age: Delayed childbearing is rarely a conscious choice. A qualitative study of women’s views and experiences. International Journal of Nursing Studies, 49, 30–39. https://doi.org/10.1016/j.ijnurstu.2011.07.013.
Daniluk, J. C., & Koert, E. (2015). Fertility awareness online: The efficacy of a fertility education website in increasing knowledge and changing fertility beliefs. Human Reproduction, 30, 353–363. https://doi.org/10.1093/humrep/deu328.
Deshpande, S., Basil, M. D., & Basil, D. Z. (2009). Factors influencing healthy eating habits among college students: An application of the health belief model. Health Marketing Quarterly, 26, 145–164. https://doi.org/10.1080/07359680802619834.
Dyer, S. J. (2008). Infertility-related reproductive health knowledge and help-seeking behaviour in African countries. Human Reproduction, 1, 29–33.
Ekelin, M., Åkesson, C., Ångerud, M., & Kvist, L. J. (2012). Swedish high school students ’ knowledge and attitudes regarding fertility and family building. Reproductive Health, 9, 1–8. https://doi.org/10.1186/1742-4755-9-6.
Fahlén, S. (2013). Capabilities and Childbearing Intentions in Europe: The association between work-family reconciliation policies, economic uncertainties and women’s fertility plans. European Societies, 15, 639–662. https://doi.org/10.1080/14616696.2013.798018.
Fotopoulou, V., Chasiakou, A., Gryparis, A., & Baka, S. (2015). Women’s health care greek medical student’s knowledge and attitudes towards infertility and assisted reproductive technologies (Greek Medical Students and ART). Womens Health Care, 4, 4–7. https://doi.org/10.4172/2167-0420.1000.
Fritz, M. S., & Mackinnon, D. P. (2007). Required sample size to detect the mediated effect. Psychological Science, 18, 233–239. https://doi.org/10.1111/j.1467-9280.2007.01882.x.
Fulford, B., Bunting, L., Tsibulsky, I., & Boivin, J. (2013). The role of knowledge and perceived susceptibility in intentions to optimize fertility: Findings from the International Fertility Decision-Making Study (IFDMS). Human Reproduction, 28, 3253–3262. https://doi.org/10.1093/humrep/det373.
García, D., Vassena, R., Prat, A., & Vernaeve, V. (2017). Poor knowledge of age-related fertility decline and assisted reproduction among healthcare professionals. Reproductive BioMedicine Online, 34, 32–37. https://doi.org/10.1016/j.rbmo.2016.09.013.
García, D., Vassena, R., Trullenque, M., Rodríguez, A., & Vernaeve, V. (2015). Fertility knowledge and awareness in oocyte donors in Spain. Patient Education and Counseling, 98, 96–101. https://doi.org/10.1016/j.pec.2014.10.009.
Habbema, J. D. F., Eijkemans, M. J. C., Leridon, H., & Te Velde, E. R. (2015). Realizing a desired family size: When should couples start? Human Reproduction, 30, 2215–2221. https://doi.org/10.1093/humrep/dev148.
Hammarberg, K. (2016). Knowledge, attitudes and practices relating to fertility among nurses working in primary health. Australian Journal of Advanced Nursing, 34, 6–13.
Hammarberg, K., Collins, V., Holden, C., Young, K., & McLachlan, R. (2017). Men’s knowledge, attitudes and behaviours relating to fertility. Human Reproduction Update, 23, 458–480. https://doi.org/10.1093/humupd/dmx005.
Harper, J., Boivin, J., O’Neill, H. C., Brian, K., Dhingra, J., Dugdale, G., …, Balen, A. (2017). The need to improve fertility awareness. Reproductive Biomedicine and Society Online, 4, 18–20. https://doi.org/10.1016/j.rbms.2017.03.00.
Hayes, A. F. (2012). PROCESS: A versatile computational tool for observed variable mediation, moderation, and conditional process modeling [White paper]. Retrieved from http://www.afhayes.com/public/process2012.pdf.
Hochbaum, G., Kegels, S., & Rosenstock, I. (1952). Health belief model. Unites States Public Health Service.
Homan, G., Davies, M., & Norman, R. (2007). The impact of lifestyle factors on reproductive performance in the general population and those undergoing infertility treatment: A review. Human Reproduction Update, 13, 209–223. https://doi.org/10.1093/humupd/dml056.
Kalebic, N. L. (2011). Delaying parenthood: Choice or circumstance?. Cardiff: Cardiff University.
Klonoff-Cohen, H., & Natarajan, L. (2004). The concerns during assisted reproductive technologies (CART) scale and pregnancy outcomes. Fertility and Sterility, 81, 982–988. https://doi.org/10.1016/j.fertnstert.2003.08.050.
Lampic, C., Svanberg, A. S., Karlström, P., & Tydén, T. (2006). Fertility awareness, intentions concerning childbearing, and attitudes towards parenthood among female and male academics. Human Reproduction, 21, 558–564. https://doi.org/10.1093/humrep/dei367.
Maeda, E., Nakamura, F., Kobayashi, Y., Boivin, J., Sugimori, H., Murata, K., & Saito, H. (2016). Effects of fertility education on knowledge, desires and anxiety among the reproductive-aged population: Findings from a randomized controlled trial. Human Reproduction, 31, 2051–2060. https://doi.org/10.1093/humrep/dew133.
Martin, S. P. (2000). Diverging fertility among U.S. women who delay childbearing past age 30. Demography, 37, 523–533. https://doi.org/10.1353/dem.2000.0007.
Martins, M. V. M., Basto-Pereira, M., Pedro, J., Peterson, B., Almeida, V., Schmidt, L., & Costa, M. E. M. E. (2016). Male psychological adaptation to unsuccessful medically assisted reproduction treatments: A systematic review. Human Reproduction Update, 22, 466–478. https://doi.org/10.1093/humupd/dmw009.
McQueen, A., Vernon, S. W., Rothman, A. J., Norman, G. J., Myers, R. E., & Tilley, B. C. (2010). Examining the role of perceived susceptibility on colorectal cancer screening intention and behavior. Annals of Behavioral Medicine, 40, 205–217. https://doi.org/10.1007/s12160-010-9215-3.
Mills, M., Rindfuss, R. R., McDonald, P., & te Velde, E. (2011). Why do people postpone parenthood? Reasons and social policy incentives. Human Reproduction Update, 17, 848–860. https://doi.org/10.1093/humupd/dmr026.
Mogilevkina, I., Stern, J., Melnik, D., Getsko, E., & Tydén, T. (2016). Ukrainian medical students’ attitudes to parenthood and knowledge of fertility. European Journal of Contraception & Reproductive Health Care, 21, 189–194. https://doi.org/10.3109/13625187.2015.1130221.
Mortensen, L. L., Hegaard, H. K., Andersen, A. N., & Bentzen, J. G. (2012). Attitudes towards motherhood and fertility awareness among 20-40-year-old female healthcare professionals. The European Journal of Contraception & Reproductive Health Care: The Official Journal of The European Society of Contraception, 17, 468–481. https://doi.org/10.3109/13625187.2012.728015.
Noorbakhsh, A., Mostafavi, F., & Shahnazi, H. (2017). Effects of the educational intervention on some health belief model constructs regarding the prevention of obesity in students. International Journal of Pediatrics, 5, 5561–5570. https://doi.org/10.22038/ijp.2017.24632.2077.
Orji, R., Vassileva, J., & Mandryk, R. (2012). Towards an effective health interventions design: An extension of the health belief model. Online Journal of Public Health Informatics, 4, e9. https://doi.org/10.5210/ojphi.v4i3.4321.
Pedro, J., Brandão, T., Schmidt, L., Costa, M. E., & Martins, M. V. (2018). What do people know about fertility? A systematic review on fertility awareness and its associated factors. Upsala Journal of Medical Sciences, 123, 71–81. https://doi.org/10.1080/03009734.2018.1480186.
Petersen, K. B., Hvidman, H. W., Sylvest, R., Pinborg, A., Larsen, E. C., Macklon, K. T., …, Schmidt, L. (2015). Family intentions and personal considerations on postponing childbearing in childless cohabiting and single women aged 35 – 43 seeking fertility assessment and counselling. Human Reproduction, 30, 2563–2574. https://doi.org/10.1093/humrep/dev237.
Peterson, B., Pirritano, M., Tucker, L., & Lampic, C. (2012). Fertility awareness and parenting attitudes among American male and female undergraduate university students. Human Reproduction, 27, 1375–1382. https://doi.org/10.1093/humrep/des011.
Pordata. (2016). Mean age of women at childbirth. Retrieved September 22, 2018, from https://www.pordata.pt/en/Europe/Mean+age+of+women+at+childbirth-2408.
Pordata. (2017). Total fertility rate. Retrieved September 22, 2018, from https://www.pordata.pt/en/Europe/Total+fertility+rate-1251.
Rosenstock, I. M. (1974). Historical origins of the health belief model. Health and Behaviour, 2, 328–335. https://doi.org/10.1177/109019817400200403.
Sharma, V., Allgar, V., & Rajkhowa, M. (2002). Factors influencing the cumulative conception rate and discontinuation of in vitro fertilization treatment for infertility. Fertility and Sterility, 78, 40–46. https://doi.org/10.1016/S0015-0282(02)03160-6.
Sheeran, P. (2002). Intention—Behavior relations: A conceptual and empirical review. European Review of Social Psychology, 12, 1–36. https://doi.org/10.1080/14792772143000003.
Sniehotta, F. F., Scholz, U., & Schwarzer, R. (2005). Bridging the intention-behaviour gap: Planning, self-efficacy, and action control in the adoption and maintenance of physical exercise. Psychology and Health, 20, 143–160. https://doi.org/10.1080/08870440512331317670.
Sørensen, N. O., Marcussen, S., Backhausen, M. G., Juhl, M., Schmidt, L., Tydén, T., & Hegaard, H. K. (2016). Fertility awareness and attitudes towards parenthood among Danish university college students. Reproductive Health, 13, 146. https://doi.org/10.1186/s12978-016-0258-1.
Stern, J., Larsson, M., Kristiansson, P., & Tydén, T. (2013). Introducing reproductive life plan-based information in contraceptive counselling: An RCT. Human Reproduction, 28, 2450–2461. https://doi.org/10.1093/humrep/det279.
ter Keurst, A., Boivin, J., & Gameiro, S. (2016). Women’s intentions to use fertility preservation to prevent age-related fertility decline. Reproductive BioMedicine Online, 32, 121–131. https://doi.org/10.1016/j.rbmo.2015.10.007.
Verhaak, C., Smeenk, J. M. J., Evers, A. W. M., Kremer, J. A. M., Kraaimaat, F. W., & Braat, D. D. M. (2007). Women’s emotional adjustment to IVF: A systematic review of 25 years of research. Human Reproduction Update, 13, 27–36. https://doi.org/10.1093/humupd/dml040.
Virtala, A., Kunttu, K., Huttunen, T., & Virjo, I. (2006). Childbearing and the desire to have children among university students in Finland. Acta Obstetricia et Gynecologica Scandinavica, 85, 312–316. https://doi.org/10.1080/00016340600555975.
Von Ah, D., Ebert, S., Ngamvitroj, A., Park, N., & Kang, D.-H. (2004). Predictors of health behaviours in college students. Journal of Advanced Nursing, 48, 463–474. https://doi.org/10.1111/j.1365-2648.2004.03229.x.
Williamson, L. E. A., Lawson, K. L., Downe, P. J., & Pierson, R. A. (2014). Informed reproductive decision-making: The impact of providing fertility information on fertility knowledge and intentions to delay childbearing. Journal of Obstetrics and Gynaecology Canada, 36, 400. https://doi.org/10.1016/S1701-2163(15)30585-5.
Wojcieszek, A. M., & Thompson, R. (2013). Conceiving of change: A brief intervention increases young adults’ knowledge of fertility and the effectiveness of in vitro fertilization. Fertility and Sterility, 100, 523–529. https://doi.org/10.1016/j.fertnstert.2013.03.050.
Yu, L., Peterson, B., Inhorn, M. C., Boehm, J. K., & Patrizio, P. (2016). Knowledge, attitudes, and intentions toward fertility awareness and oocyte cryopreservation among obstetrics and gynecology resident physicians. Human Reproduction, 31, 403–411. https://doi.org/10.1093/humrep/dev308.
Acknowledgements
We would like to thank all private clinics (Centro de Genética da Reprodução Prof. Alberto Barros, Porto, Portugal; PortoClínica, Porto, Portugal; Centros de Estudos de Esterilidade e Infertilidade, Porto, Portugal) and leaders from the pre-marital courses who allowed us to invite the participants. We would also like to thank all participants.
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This study was supported by the Portuguese Foundation for Science and Technology, under the individual doctoral grant SFRH/BD/103234/2014 attributed to the first author.
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Juliana Pedro, Tânia Brandão, Joana Fernandes, Alberto Barros, Pedro Xavier, Lone Schmidt, Maria E. Costa, and Mariana V. Martins declare that they have no conflict of interest.
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Pedro, J., Brandão, T., Fernandes, J. et al. Perceived Threat of Infertility and Women’s Intention to Anticipate Childbearing: The Mediating Role of Personally Perceived Barriers and Facilitators. J Clin Psychol Med Settings 28, 457–467 (2021). https://doi.org/10.1007/s10880-020-09743-3
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DOI: https://doi.org/10.1007/s10880-020-09743-3