Determination of contraceptive knowledge, attitude, and behavior among nursing students in Northern Cyprus: A cross-sectional study

Determination of contraceptive knowledge, attitude, and behavior among nursing students in Northern Cyprus: A cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Determination of contraceptive knowledge, attitude, and behavior among nursing students in Northern Cyprus: A cross-sectional study Jonathan NICIZA, Kemal ELYELI, Ümran Dal YILMAZ, Dilay NECIPOĞLU This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7199486/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 26 Dec, 2025 Read the published version in BMC Nursing → Version 1 posted 13 You are reading this latest preprint version Abstract Aim: This study aims to assess the level of knowledge, attitude and behavior on contraceptive method among international nursing student. Design : A cross sectional study Methods: This study applied a convenience sampling and 297 students participated. The study was conducted from January to May 2025.The data was collected with the Student Information form, the Contraceptive Knowledge Assessment (CKA), the Contraceptive Attitude Scale (CAS), and the Contraceptive Behavior Scale (CBS). Data were analyzed using SPSS version 27. Results: The CKA scores, with a mean of 8.39 (SD = 4.93) and a median of 8.00 and the interquartile range was 7. The findings reveal a limited to moderate understanding of contraception among the participants. The Nursing students CAS scores, with a mean of 106.11 (SD = 16.86) and a median of 101.00. The interquartile range was 21, suggesting a moderate variability in attitudes about contraception. The findings suggest that students predominantly expressed positive attitude regarding contraceptive use. The scores on the CBS yielding a mean of 7.56 (SD = 6.92) and a median of 8.00. The interquartile range was 12; indicating significant variability in reported contraceptive practices, these low average score showed respondents exhibited minimal utilization of contraceptive procedures. Conclusions: The result of this study indicate low level of knowledge in contraceptive procedure moderate variability in attitude about contraception and minimal utilization of contraceptive procedures. It is important to elaborate a training program tailored to this category of students to enhance their understanding and positive behavior regarding contraceptive method use. Implication for the professional: Contraceptive exploration in young population has substantial public health implications in terms of health risks. Patient or Public Contribution : Questionnaires completed by nurses were used to explore levels of contraceptive knowledge, contraceptive attitude and contraceptive behavior in this context. Clinical trial number : Not applicable Attitude Behavior Contraceptive Method Nursing Students Knowledge Introduction According to the National Cancer Institute (NCI), contraception encompasses the use of pharmacological agents, devices, or surgical interventions to prevent pregnancy( 1 ). The importance of contraception is cited in its efficacy in reducing unintended pregnancy rates, mitigating the incidence of unsafe abortions, and limiting the transmission of infections( 2 ). The World Health Organization (WHO, 2021) reported that 164 million women of reproductive age lacked access to contraception. Among the estimated 1.9 billion women aged 15 to 49 worldwide, 9% had unmet contraceptive needs, and 270 million women lacked access to modern birth control( 3 ). In 2022, approximately 874 million women globally, representing 77.5% of women in their reproductive years, used modern contraception. This figure reflects a 10-percentage-point increase from 1990, when the prevalence was 67%. Furthermore, the WHO indicates that annually, 74 million women in low- and middle-income countries experience unintended pregnancies ( 4 ). Sexually transmitted infections (STIs) exert a substantial impact on sexual and reproductive health worldwide, with over one million new curable infections acquired daily ( 5 ). In 2020, the WHO estimated 374 million new infections of the four most common STIs: chlamydia (129 million), gonorrhea (82 million), syphilis (7.1 million), and trichomoniasis (152 million) (Sexually Transmitted Infections (STIs), 2024) ( 5 ). STIs pose significant international challenges with repercussions for society, the economy, and public health ( 6 ). These infections have affected humanity for centuries and continue to do so, transcending geographical and cultural boundaries. HIV/AIDS is considered a global crisis, affecting over 38 million individuals ( 7 ). Bacterial infections such as chlamydia, gonorrhea, and syphilis remain problematic, with millions of new cases reported daily worldwide ( 8 ) Elevated fertility rates contribute to maternal mortality and morbidity, posing health risks for both mothers and offspring ( 9 ). Newborns may be born into families unprepared for their arrival or unable to provide adequate care ( 10 ). Parenthood entails significant demands, including financial obligations, and can affect families, communities, and societies ( 11 ). Limited access to education can restrict opportunities for young people growing up in families facing such challenges. Parents may experience increased emotional and psychological distress ( 12 ). The gap between existing literature and this study is that, recent research measure single variable such as contraceptive knowledge ( 13 , 14 ). General contraceptive attitude( 15 , 16 ), and for other categories of people such as women ( 17 , 18 ), men and women or community members not specifically for university students ( 2 ). The contribution of this study is not only to conduct the study to university student but also to measure the entire three variable at the same time: knowledge, attitude and behavior. It is significant that this study evaluate how one variable affects the other given that this category of people are exposed to enormous health risks since they are among the sexually active people and they need to be informed and fight against risk factors for a good future of society. In addition, these students are future health providers whom will be playing valuable role as educators, counselors, and influencers in their specific communities. It is better to increase their knowledge to save them from sexually transmitted disease, unplanned pregnancies, unsafe abortion and later premature death. The aim of this study is to measure the level of knowledge, attitudes, and practices of international nursing students regarding contraceptive methods. The study will address the following research questions: What is the average score of students on the 'Contraceptive Knowledge Assessment Form'? What is the average score of students on the ‘Contraceptive Attitude Scale’? What is the average score of students on the ‘Contraceptive Behavior Scale’? Materials and Methods Research Design This is a descriptive and a cross sectional study Place and time The study was conducted at Near East University, in Nursing Faculty, located in Northern Cyprus, from January to June 2025. Feature of the place of the study Target population is international students in Nursing Faculty. However, Near East University has 21 Faculties comprising of 220 departments and programs, 5 graduate schools with around 200 graduate and postgraduate programs, 28 research institutes. Population and sample In this study, a convenience sampling method was used. As the Faculty of Nursing of Near East University, counts N = 349 active international students from different countries, all 349 Nursing Students were asked to participate in this study. Hence the study population size (N) equal to the sample size (n). As participation was voluntary, only n = 297 students were able to complete and submit the questionnaire. The researcher distributed the questionnaire and collected after the participants had completed it. Data Collection Instruments/Materials Data for this study was collected for two weeks from 6 to 20th of January 2025. Participants completed a questionnaire face to face approximately 20 minutes, and submit it to the researcher. The data collection instruments are: Student Information Form The Student Information Form used to gather demographic data had 12 questions, including age, gender, religion, sexual activity, marital status, contraceptive method use, having children, etc… Contraceptive Knowledge Assessment (CKA) The CKA is a 25-item multiple-choice instrument. Each correct response was scored as 1 point, and each incorrect response as 0 points. A total knowledge score was calculated by summing the scores across the 25 items. Higher scores indicated greater knowledge, while lower scores indicated poorer knowledge. Total possible scores range from 0 to 25 ( 14 ). Contraceptive Attitude Scale (CAS) The CAS is a 32-item self-report instrument. Items are rated on a 5-point Likert scale. For positively worded statements, a rating is (strongly disagree = 1and strongly agree = 5). For negatively worded statements, scores will be reversed, such that "strongly disagree" receives a score of 5, and "strongly agree" receives a score of 1. The total attitude score will be the sum of the responses to each item. Lower scores will indicate more attitudes that are negative while the higher scores will indicate positive attitudes toward contraceptive use. Total possible scores range from 32 to 160 ( 15 ). Contraceptive Behavior Scale (CBS) The CBS is a 5-item scale employing a five-point rating system. Participants will indicate the degree of correspondence between their actual practices and the presented statements, with ratings ranging from 0 (totally no correspondence) to 4 (total correspondence). Higher scores will indicate more favorable contraceptive behaviors, while lower scores will indicate less favorable or negative behaviors. Total possible scores range from 0 to 20 ( 19 ). Data Analysis The data obtained from this study were analyzed using Statistical Package for the Social Sciences (SPSS), version 27. Kolmogorov-Smirnoff was applied to measure the normality of distribution of the participants. Descriptive statistics tests (frequency, percentage, mean, median and SD) were used to assess the level of knowledge, attitude and behavior among participants. Kruskal Wallis Test, Mann-WhitneyU Test and Pearson were the final inferential statistics used to compare the sociodemographic and variables (knowledge, attitude and behavior). Criteria of the study Inclusion criteria are , International Nursing Students English speakers Exclusion criteria Those who do not agree to participate in the study Variables of the study Dependent variables Contraceptive Knowledge Assessment, Contraceptive Attitude Scale and Contraceptive Behavior Scale Independent variables Socio-demographic characteristics of participants Ethical Considerations Ethical approval was obtained from the Institutional Review Board (IRB) of the Near East University, with reference number (1891/2024/127). Permission was also obtained from the Nursing Faculty. All procedures were carried out in compliance with the ethical standards outlined in the Declaration of Helsinki and relevant institutional guidelines. All participants provided oral informed consent after receiving comprehensive details about the study’s objectives, methodologies, and confidentiality measures. Participation was entirely voluntary, with individuals having the freedom to withdraw from the study at any point without facing any consequences. Results Table 1 Distribution of the students according to socio-demographic variables (n = 297) Variable Mean Minimum Maximum Age 23.22 17 37 Variable Categories Frequency (f) Percentage (%) Gender Female 215 72.4 Male 78 26.3 Prefer not to mention 4 1.3 Religion Protestants 97 32.7 Muslims 91 30.6 Catholics 93 31.3 Others specify 16 5.4 Sexual activity Sexually active 103 34.7 Not sexual active 194 65.3 Marital status Single 247 83.2 Married 14 4.7 Had a relationship 36 12.1 Contraceptive method use No 256 86.2 Yes 41 13.8 If yes, which method Condom 26 63.5 IUD 2 4.8 Pills 2 4.8 Others 11 26.9 Having children No 280 94.3 Yes 17 5.7 If yes, how many 1 12 70.6 2 3 17.6 3 1 5.9 4 1 5.9 Have you or your partner had an unwanted pregnancy or curettage? No 289 97.3 Yes 8 2.7 Have you received any training or consultancy on this subject? No 162 54.5 Yes 135 45.5 If your answer is yes, who did you get it from? School 96 71.1 Friends 5 3.7 Parents or family members 8 5.9 Media 15 11.1 Others 11 8.2 Table one show that the average age of the responders was 23.22 years, with a minimum age of 17 and a maximum age of 37. Participants in the study 72.4% was female, Ninety-seven respondents (32.7%) identified as Protestants and 30.6% Muslims. Among the respondents, 34.7% indicated they were sexually active. The majority of respondents were single, with 247 individuals (83.2%) indicating this status. A significant proportion of respondents 86.2% said that they do not utilize any contraceptive methods. Only 41 respondents (13.8%) reported using a contraceptive technique. Twenty-six respondents (63.5%) utilized condoms, eleven respondents (26.9%) adopted alternative techniques. Most respondents, 94.3%, were childless, whilst 17 respondents (5.7%) had offspring. A total of 289 respondents (97.3%) indicated they had not encountered an unplanned pregnancy or curettage, whereas 8 respondents (2.7%) claimed having had such an event. Approximately 45.5% of respondents, indicated they had received training or consulting on the issue, whereas 54.5% had not. Of the individuals who underwent training or consultancy, 96 respondents (71.1%) reported receiving it from educational institutions. Table 2 Contraceptive Knowledge Assessment Correct and wrong response (n = 297) Variables Correct Response (%) Wrong Response (%) Total (%) 1. When during a woman's cycle is she most likely to become pregnant? 42.8 57.2 100 2. How long can sperm stay alive in a woman's body? 50.5 49.5 100 3. Which of the following choices is TRUE about pregnancy? 62.3 37.7 100 4. Which of the following choices is TRUE about withdrawal, or the “pull-out” method? 49.5 50.5 100 5. Which birth control method guarantees you will not become pregnant? 33.0 67.0 100 6. Which is the only birth control method that helps prevent infections? 56.6 43.4 100 7. All of the following are TRUE about using male condoms EXCEPT: 41.1 58.9 100 8. Hormonal birth control comes in which of the following forms? 41.4 58.6 100 9. Which one is NOT a benefit of hormonal birth control? 22.9 77.1 100 10. How long should the vaginal ring (NuvaRing) stay in place before changing it? 19.5 80.5 100 11. Which of the following can make hormonal birth control less effective? 24.6 75.4 100 12. What is the main way that birth control pills work? 37.7 62.3 100 13. Birth control pills can have which of the following ingredients? 38.7 61.3 100 14. You should NOT use the birth control pill if you have any of the following: 15.2 84.8 100 15. How long after a woman stops using birth control can she become pregnant? 22.6 77.4 100 16. If you forget to take one birth control pill and remember the next day, what should you do? 12.5 87.5 100 17. Which of the following is FALSE about Depo-Provera (the “shot”)? 18.9 81.1 100 18. Which of the following birth control methods may be reversed if you decide you want to become pregnant? 43.8 56.2 100 19. Which birth control method is not easily noticed by a partner? 43.4 56.6 100 20. A doctor places an IUD (intrauterine device) in what part of the body? 32.7 67.3 100 21. Which method of birth control is the best at preventing pregnancy? 33.3 66.7 100 22. Which choice is FALSE about IUDs (intrauterine devices)? 17.2 82.8 100 23. A doctor places the birth control implant (Nexplanon) in what part of the body? 40.1 59.9 100 24. How soon after sex must the “morning after pill” (or Plan B) be used to be effective? 12.8 87.2 100 25. How can you get the emergency contraceptive pill called Plan B (or “the morning-after pill”)? 25.9 74.1 100 The response of the participants on the correct response varied between 12.5% and 62.3% indicating a low to moderate knowledge of contraception. The question with highest (62.3%) correct response is (which of the following choices is true about pregnancy?). The question that received the least accurate responses was “If you forget to take one birth control pill and remember the next day, what should you do?” with merely 12.5% of participants answering correctly. The question that have low response rate below 30% include question that pertain; vaginal ring usage (19.5%), contraindications of using birth control pill (15.2%), questions regarding IUDs (17.2%), and timing of emergency contraception (12.8%). The findings showed knowledge deficiencies among respondents especially on hormonal contraceptives, emergency contraception and the appropriate guidelines for use. Table 3 Descriptive statistics of the nursing students’ scores on CKA, CAS and CBS (n = 297) Variable Minimum Maximum Mean Median SD Int. Range CKA 0 22 8.39 8.00 4.93 7 CAS 62 156 106.11 101.00 16.86 21 CBS 0 20 7.56 8.00 6.92 12 In Table 3 the descriptive statistics of nursing students' scores on the CKA, CAS and CBS are given. The CKA scores, with a mean of 8.39 (SD = 4.93) and a median of 8.00 and the interquartile range was 7. The findings reveal a limited to moderate understanding of contraception among the participants. The findings reveal a limited to moderate understanding of contraception among the participants. The Nursing students CAS scores, with a mean of 106.11 (SD = 16.86) and a median of 101.00. The interquartile range was 21, suggesting a moderate variability in attitudes about contraception. The findings suggest that students predominantly expressed positive attitude regarding contraceptive use. The scores on the CBS yielding a mean of 7.56 (SD = 6.92) and a median of 8.00. The interquartile range was 12; indicating significant variability in reported contraceptive practices, these low average score showed respondents exhibited minimal utilization of contraceptive procedures. Table 4 Spearman’s Correlations between Age, Contraceptive Knowledge, Attitude, and Behavior (N = 297) Correlations Age CKA_Total CAS TOTAL CBS_Total Spearman's rho Age Correlation Coefficient 1.000 .154 ** − .019 .092 Sig. (2-tailed) . .008 .750 .115 N 297 297 297 297 CKA Total Correlation Coefficient .154 ** 1.000 .501 ** .281 ** Sig. (2-tailed) .008 . .000 .000 N 297 297 297 297 CAS Total Correlation Coefficient − .019 .501 ** 1.000 .302 ** Sig. (2-tailed) .750 .000 . .000 N 297 297 297 297 CBS Total Correlation Coefficient .092 .281 ** .302 ** 1.000 Sig. (2-tailed) .115 .000 .000 . N 297 297 297 297 **. Correlation is significant at the 0.01 level (2-tailed). A Spearman's rank-order correlation between age, CKA, CAS, and CBS was conducted to determine the relationship between the variables among the nursing students’ respondents (n = 297). The results in the table indicate a statistically significant weak positive correlation between age and contraceptive knowledge score (r s =.154, p = .008); no statistically significant relationships were found between age and contraceptive attitudes (r s = − .019, p = .750) or between age and contraceptive behavior (r s =.092,p = .115). The findings also showed a moderate positive relation between contraceptive knowledge and attitude scores, and the association is statistically significant (r s =.501, p < .001). Furthermore, a weak statistically significant relationship was found between contraceptive knowledge and behavior (r s =.281, p < .001) and between contraceptive attitudes and behavior (r s =.302, p < .001). In summary, the findings indicate age is related to contraceptive knowledge; knowledge and attitude are positively associated with contraceptive behavior among the study sample. Discussion This study investigated contraceptive knowledge, attitudes, and behaviors among international nursing students, utilizing the Contraceptive Knowledge Assessment (CKA), Contraceptive Attitude Scale (CAS), and Contraceptive Behavior Scale (CBS). The findings provide critical insights into the current state of these variables within this population and highlight areas for targeted intervention. Contraceptive Knowledge Assessment (CKA) Findings The overall CKA score indicated a significant knowledge deficit among the nursing student participants. The mean CKA score of 8.39 (SD = 4.93), representing only 33.56% of the total possible score (Table 3 ), reveals a predominantly poor understanding of contraception. This finding aligns with existing literature, where studies among young women and those at risk of unintended pregnancy also reported low contraceptive knowledge ( 17 , 20 ). Our results contrast sharply with other cohorts, such as that in Hayes et al. (2017), where respondents demonstrated substantially higher knowledge (mean score of 19.4, or 77.6%). Specific areas of acute knowledge deficiency were identified through questions with notably low correct response rates (below 30%). These included the mechanism and use of the vaginal ring (19.5%), contraindications of oral contraceptive pills (15.2%), details regarding intrauterine devices (IUDs) (17.2%), and the precise timing for emergency contraception (12.8%) (Table 2 ). These specific knowledge gaps suggest a fundamental lack of comprehensive understanding, particularly concerning hormonal contraceptives, emergency contraception, and their appropriate usage guidelines, side effects, or contraindications. This mirrors the observations of Hylton-Kong et al. (2021), where a significant portion of respondents frequently selected "do not know" for various contraception-related questions. Such deficiencies are critical, as they can directly lead to misunderstandings, improper use, or avoidance of effective contraceptive methods, thereby highlighting an urgent need for focused educational initiatives. A statistically significant, albeit weak, positive correlation was observed between age and CKA scores (rs​=.154, p = .008) (Table 4 ). This suggests that slightly older nursing students in our sample tended to possess marginally greater contraceptive knowledge, a finding consistent with Eryilmaz et al. (2022) ( 13 ). However, this modest correlation indicates that age alone does not fully account for knowledge levels, pointing to other influential factors. Contraceptive Attitude Scale (CAS) Findings In stark contrast to the identified knowledge deficits, participants largely expressed positive attitudes towards contraceptive use. The mean CAS score of 106.11 (SD = 16.86), representing 66.3% of the total possible score (Table 3 ), supports this conclusion. This widespread positive attitudinal stance is consistent with numerous prior studies, which also reported favorable attitudes toward contraception across diverse populations( 16 , 21 , 22 ). This suggests that while practical knowledge may be lacking, nursing students generally perceive contraception favorably, indicating an openness to its benefits. Contraceptive Behavior Scale (CBS) Findings Despite the observed positive attitudes, the scores on the Contraceptive Behavior Scale (CBS) indicated poor contraceptive practices among the respondents. The mean CBS score was 7.56 (SD = 6.92), accounting for only 37.58% of the total possible score (Table 3 ). This low average score points to minimal utilization of contraceptive methods and aligns with findings from Wang et al. (2013) ( 19 ), who also reported a low global mean CBS score of 2.72. This discrepancy between positive attitudes and suboptimal behaviors highlights a significant knowledge-practice gap, where favorable intentions do not consistently translate into effective or consistent contraceptive actions. The CBS demonstrated neither floor nor ceiling effects, confirming its suitability for capturing the range of behaviors in this population. Factors Influencing Contraceptive Outcomes Impact of Contraceptive Training A robust finding of this study is the significant positive influence of contraceptive training on all three measured variables. Students who reported receiving training demonstrated statistically significantly higher CKA scores (U = 5.994, p < .001) compared to their untrained counterparts. This result aligns with systematic reviews, such as Pazol et al. (2018) ( 23 ), which consistently show an increase in contraceptive knowledge following educational interventions. Similarly, trained students exhibited more positive CAS scores (U = 3.579, p < .001) and significantly improved CBS scores. These comprehensive findings strongly suggest that contraceptive education is crucial for enhancing knowledge, fostering positive attitudes, and improving practical contraceptive behaviors among nursing students. This is further supported by broader meta-analytic findings on the efficacy of health education in improving contraceptive knowledge, attitude, and utilization among women of reproductive age ( 24 ). Furthermore, the source of contraceptive training specifically impacted CBS scores, though not CKA or CAS. Students who received training from "others" (implying non-traditional or informal programs) had the highest mean rank for CBS, followed by those informed by media, educational institutions, parents/family, and friends. This nuanced finding suggests that while formal education provides foundational knowledge, less traditional or informal sources might be more influential in shaping actual contraceptive practices. This highlights the potential benefit of exploring diverse and perhaps more relatable educational avenues to complement formal curricula. Sexual Activity Status and Contraceptive Behavior Sexual activity status significantly affected CBS scores, with a statistically significant difference between sexually active and non-sexually active students (Z = − 4.407, p = .001). Sexually active students exhibited more proactive contraceptive behaviors, likely driven by the personal imperative to prevent unintended pregnancies or STIs. In contrast, sexual activity status had no substantial influence on CKA or CAS scores. While our finding on attitudes contrasts with Thao et al. (2020) ( 22 ), who reported more positive attitudes among sexually active participants, the lack of significant difference in CAS scores aligns with Gnimpieba and Sarpkaya (2024) ( 16 ). This implies that while basic contraceptive information is important for all students, sexually active individuals particularly benefit from behavior-oriented interventions that address the practical aspects of contraception. The observation that the majority of respondents were not sexually active, diverging from cohorts like Thao et al. (2020), further contextualizes the overall low contraceptive behavior observed in this sample. Contraceptive Use Status When comparing students who utilized contraceptives with those who did not, a statistically significant difference was observed in both CKA (Z = − 2.681, p < .007) and CBS scores (Z = − 5.351, p < .001). The data indicate that the utilization of contraceptive methods correlated with elevated scores on both the CKA and CBS scales. This finding aligns with Eryilmaz et al. (2022) ( 13 ), who also reported significant differences in contraceptive knowledge between users and non-users. Interestingly, no significant difference was found in CAS scores between these two groups (Z = − .641, p < .522), suggesting that a positive attitude towards contraception may be broadly held, regardless of actual usage. Condoms were the most frequently reported method among users, likely due to their convenience and accessibility, consistent with prior research (Eryilmaz et al., 2022) ( 13 ). Gender Influence Gender did not yield statistically significant differences across any of the three measured variables. For CKA scores, no significant difference was found (χ2( 2 ) = 2.28, p = .320), despite female students having a slightly higher mean rank. This finding contrasts with some studies ( 13 , 18 ) that reported significant gender differences in contraceptive knowledge. For CAS scores, the results approached statistical significance (χ2( 2 ) = 5.72, p = .057), with a trend toward more positive attitudes among females, aligning with Gnimpieba & Sarpkaya (2024) ( 16 ) but contrasting Thao et al. (2020). Similarly, no significant difference was observed in CBS scores across gender groups (χ2( 2 ) = 0.90, p = .637), differing from Arias et al. (2018) ( 25 ). The overall lack of significant gender influence suggests that while reproductive health services traditionally centered on women, contemporary contexts may reflect a more balanced engagement and perceived importance of contraception across genders, supporting calls for increased male involvement in contraceptive decision-making ( 26 ). Religious Affiliation and Marital Status Religious affiliation significantly influenced CKA scores, with Muslim students demonstrating lower scores compared to other religious groups. This suggests that religious beliefs or cultural contexts tied to religion may impact access to or acceptance of contraceptive information. However, religious affiliation did not show a statistically significant association with CAS or CBS scores, aligning with Thao et al. (2020) ( 22 ) and Gnimpieba & Sarpkaya (2024) ( 16 ). This indicates that while knowledge may be influenced, attitudes and behaviors might be shaped by a broader array of factors beyond religious background alone. Similarly, marital status did not show statistically significant differences across any of the CKA, CAS, or CBS scores. This finding contrasts with Eryilmaz et al. (2022) ( 13 ) regarding CKA, and Gnimpieba and Sarpkaya (2024) ( 16 ) regarding marital status impacting group differences in attitudes and behaviors. However, the lack of significant association between marital status and attitudes or behaviors aligns with Thao et al. (2020) ( 22 ), suggesting that marital status might not be a primary determinant of contraceptive outcomes in this specific nursing student cohort. The majority of respondents being single and not utilizing contraceptives (Table 1 ) could be partly influenced by cultural and religious values prevalent in their African home countries, where fear of societal consequences might lead to under-reporting of sexual engagement or contraceptive use. Parenthood and Type of Contraceptive Method The analysis demonstrated that parenthood status and the number of children did not substantially influence nursing students' CKA, CAS, or CBS scores. While some variability was noted, it did not reach statistical significance, potentially due to small sample sizes in certain subgroups. This contrasts with Eryilmaz et al. (2022) ( 13 ), who reported significant differences based on parenthood. Furthermore, no statistically significant differences were observed in CKA, CAS, or CBS scores when comparing them by the type of contraceptive method used. This could indicate a relatively uniform exposure to information and attitudes toward contraception, irrespective of the specific method chosen. However, it is crucial to consider the potential limitation of statistical power due to the small sample sizes within certain contraceptive method subgroups (e.g., IUD and pill users). As Polit and Beck (2024) ( 27 ) emphasize, small subgroup sizes can limit the ability of statistical tests to detect true differences, increasing the risk of a Type II error. Therefore, while the findings might suggest homogeneity across different users, caution is warranted in interpreting these results definitively. Conclusion In conclusion, this study reveals a critical paradox among international nursing students: while they generally hold positive attitudes toward contraception, their actual knowledge and behavior demonstrate significant deficiencies. The pivotal role of contraceptive training is unequivocally highlighted, as it positively influences knowledge, attitudes, and behaviors. The findings also underscore the importance of sexual activity status in shaping contraceptive behavior, with sexually active students demonstrating more pragmatic practices. While some sociodemographic factors, like age and religious affiliation, showed limited associations with knowledge, broader factors appear to drive attitudes and behaviors. These insights collectively emphasize a pressing need for enhanced and tailored contraceptive education for nursing students, focusing on improving specific knowledge areas and bridging the gap between positive attitudes and effective contraceptive practices to safeguard their sexual and reproductive health and prepare them for their future roles as health providers and educators. Declarations Acknowledgment The author acknowledge gratitude to all the staff who participated in the study. Author Contributions Conceptualization: JN, KE, UDY and DN; investigation: JN and KE; methodology: JN, KE, UDY and DN; validation: JN, KE, UDY and DN; writing original draft: JN and KE; writing review and editing: JN, KE, UDY and DN; visualization: JN, KE, UDY and DN. Funding The current research is not funded by any institutional or government body. Data availability The datasets generated and/or analyzed during the present study are not publicly available because the authors are currently working on them in order to prepare the final version of this manuscript. However, they are available from the corresponding author upon reasonable request. Ethical approval was obtained from the Institutional Review Board (IRB) of the Near East University, with reference number(1891/2024/127). Permission was also obtained from the Nursing Faculty. All procedures were carried out in compliance with the ethical standards outlined in the Declaration of Helsinki and relevant institutional guidelines. All participants provided oral informed consent after receiving comprehensive details about the study’s objectives, methodologies, and confidentiality measures. Participation was entirely voluntary, with individuals having the freedom to withdraw from the study at any point without facing any consequences. Consent for publication : Not applicable. 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Knowledge, attitudes and practices of contraceptive methods among students in public and private high schools in Cameroon. Women Health. 2024;64(3):274–82. Hylton-Kong T, Bailey,Althea, Steiner, Markus J, Gallo MF. Contraceptive knowledge among women at risk of unintended pregnancy in Kingston, Jamaica. Women Health. 2021;61(3):294–302. Melbostad HS, Badger,Gary J, Rey, Catalina N, MacAfee, Lauren K, Dougherty, Anne K, Sigmon, Stacey C, et al. Contraceptive Knowledge among Females and Males Receiving Medication Treatment for Opioid Use Disorder Compared to Those Seeking Primary Care. Subst Use Misuse. 2020;55(14):2403–8. Wang RH, Jian SY, Yang YM. Psychometric testing of the Chinese version of the Contraceptive Behavior Scale: a preliminary study. J Clin Nurs. 2013;22(7–8):1066–72. Gallo M, Scholarly Project. Sugammadex and Hormonal Birth Control Education [Internet] [D.N.P.]. [United States -- North Carolina]: The University of North Carolina at Charlotte; 2023 [cited 2025 Jul 5]. Available from: https://www.proquest.com/docview/2956479588/abstract/9182DF7E6B81421CPQ/1 Nosheen I, Jami H. Translation, Adaptation, and Validation of Contraceptive Attitude Scale. Thao C, Perez MA, Thao T, Vue K. Contraceptive attitudes among hmong young adults in rural california. Rev Fac Med Humana. 2020;20(2):201–8. Pazol K, Zapata LB, Dehlendorf C, Malcolm NM, Rosmarin RB, Frederiksen BN. Impact of Contraceptive Education on Knowledge and Decision Making: An Updated Systematic Review. Am J Prev Med. 2018;55(5):703–15. Gelgelo D, Abeya SG, Hailu D, Edin A, Gelchu S. Effectiveness of Health Education Interventions Methods to Improve Contraceptive Knowledge, Attitude, and Uptake Among Women of Reproductive Age, Ethiopia: A Systematic Review and Meta-Analysis. Health Serv Res Manag Epidemiol. 2023;10:23333928221149264. Arias MLF, Champion JD, Soto NES, Navarro VN, Caudillo Ortega L. Adaptation of the Contraceptive Behavior Scale for Mexican Heterosexual Populations. Hisp Health Care Int. 2018;16(2):56–61. Stewart M, Ritter T, Bateson D, McGeechan K, Weisberg E. Contraception – what about the men? Experience, knowledge and attitudes: a survey of 2438 heterosexual men using an online dating service. Sex Health. 2017;14(6):533–9. Flanagan J, Beck CT. Polit & Beck’s Nursing Research: Generating and Assessing Evidence for Nursing Practice. Lippincott Williams & Wilkins; 2024. p. 1773. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 26 Dec, 2025 Read the published version in BMC Nursing → Version 1 posted Editorial decision: Revision requested 24 Nov, 2025 Reviews received at journal 20 Nov, 2025 Reviews received at journal 20 Nov, 2025 Reviewers agreed at journal 06 Nov, 2025 Reviewers agreed at journal 04 Nov, 2025 Reviews received at journal 13 Aug, 2025 Reviewers agreed at journal 09 Aug, 2025 Reviewers agreed at journal 03 Aug, 2025 Reviewers invited by journal 02 Aug, 2025 Editor invited by journal 25 Jul, 2025 Editor assigned by journal 24 Jul, 2025 Submission checks completed at journal 24 Jul, 2025 First submitted to journal 23 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7199486","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":496740663,"identity":"38f3acfd-8a71-43d2-bb09-2caa3b9060f2","order_by":0,"name":"Jonathan NICIZA","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuklEQVRIiWNgGAWjYBACxgbGBoYEBgY5EOfAA1K0GIO1JJBiW2IDiCRKC/Ps5sYPD/7Ypc8PO/wQaIudnG4DIYfNOdgskcCTnLvxdpoBUEuysdkBQlpmJLYxJEgw526cnQDSciBxG3FaDOrTDWenfyBFS8LhBHnpHOJtAfrlwHHDDdI5BQcSDIjwi+GM9Icff/yplpefnb75w4cKOznCWhqgDAOwSgMCykFAHs5owKNqFIyCUTAKRjYAAK4zR3cexFn6AAAAAElFTkSuQmCC","orcid":"","institution":"Near East University, TRNC Mersin 10","correspondingAuthor":true,"prefix":"","firstName":"Jonathan","middleName":"","lastName":"NICIZA","suffix":""},{"id":496740664,"identity":"95b42767-ace0-427e-94c7-0b12b64af872","order_by":1,"name":"Kemal ELYELI","email":"","orcid":"","institution":"Near East University, TRNC Mersin 10","correspondingAuthor":false,"prefix":"","firstName":"Kemal","middleName":"","lastName":"ELYELI","suffix":""},{"id":496740665,"identity":"6427b713-f77a-45c2-965d-85a8f22342f9","order_by":2,"name":"Ümran Dal YILMAZ","email":"","orcid":"","institution":"Near East University, TRNC Mersin 10","correspondingAuthor":false,"prefix":"","firstName":"Ümran","middleName":"Dal","lastName":"YILMAZ","suffix":""},{"id":496740666,"identity":"779a8bdf-3d44-4252-83d5-9cd3af296819","order_by":3,"name":"Dilay NECIPOĞLU","email":"","orcid":"","institution":"Near East University, TRNC Mersin 10","correspondingAuthor":false,"prefix":"","firstName":"Dilay","middleName":"","lastName":"NECIPOĞLU","suffix":""}],"badges":[],"createdAt":"2025-07-23 20:08:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7199486/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7199486/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12912-025-04257-5","type":"published","date":"2025-12-26T15:58:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":99172884,"identity":"20ed848a-870c-4a65-b1ca-5f92c829314b","added_by":"auto","created_at":"2025-12-29 16:11:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1070991,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7199486/v1/5e4398e0-ffc9-4765-93f7-38c6329d1129.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Determination of contraceptive knowledge, attitude, and behavior among nursing students in Northern Cyprus: A cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAccording to the National Cancer Institute (NCI), contraception encompasses the use of pharmacological agents, devices, or surgical interventions to prevent pregnancy(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The importance of contraception is cited in its efficacy in reducing unintended pregnancy rates, mitigating the incidence of unsafe abortions, and limiting the transmission of infections(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe World Health Organization (WHO, 2021) reported that 164\u0026nbsp;million women of reproductive age lacked access to contraception. Among the estimated 1.9\u0026nbsp;billion women aged 15 to 49 worldwide, 9% had unmet contraceptive needs, and 270\u0026nbsp;million women lacked access to modern birth control(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In 2022, approximately 874\u0026nbsp;million women globally, representing 77.5% of women in their reproductive years, used modern contraception. This figure reflects a 10-percentage-point increase from 1990, when the prevalence was 67%. Furthermore, the WHO indicates that annually, 74\u0026nbsp;million women in low- and middle-income countries experience unintended pregnancies (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSexually transmitted infections (STIs) exert a substantial impact on sexual and reproductive health worldwide, with over one million new curable infections acquired daily (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In 2020, the WHO estimated 374\u0026nbsp;million new infections of the four most common STIs: chlamydia (129\u0026nbsp;million), gonorrhea (82\u0026nbsp;million), syphilis (7.1\u0026nbsp;million), and trichomoniasis (152\u0026nbsp;million) (Sexually Transmitted Infections (STIs), 2024) (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSTIs pose significant international challenges with repercussions for society, the economy, and public health (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). These infections have affected humanity for centuries and continue to do so, transcending geographical and cultural boundaries. HIV/AIDS is considered a global crisis, affecting over 38\u0026nbsp;million individuals (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Bacterial infections such as chlamydia, gonorrhea, and syphilis remain problematic, with millions of new cases reported daily worldwide (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eElevated fertility rates contribute to maternal mortality and morbidity, posing health risks for both mothers and offspring (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Newborns may be born into families unprepared for their arrival or unable to provide adequate care (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Parenthood entails significant demands, including financial obligations, and can affect families, communities, and societies (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Limited access to education can restrict opportunities for young people growing up in families facing such challenges. Parents may experience increased emotional and psychological distress (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe gap between existing literature and this study is that, recent research measure single variable such as contraceptive knowledge (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). General contraceptive attitude(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), and for other categories of people such as women (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), men and women or community members not specifically for university students (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The contribution of this study is not only to conduct the study to university student but also to measure the entire three variable at the same time: knowledge, attitude and behavior. It is significant that this study evaluate how one variable affects the other given that this category of people are exposed to enormous health risks since they are among the sexually active people and they need to be informed and fight against risk factors for a good future of society. In addition, these students are future health providers whom will be playing valuable role as educators, counselors, and influencers in their specific communities. It is better to increase their knowledge to save them from sexually transmitted disease, unplanned pregnancies, unsafe abortion and later premature death.\u003c/p\u003e\u003cp\u003eThe aim of this study is to measure the level of knowledge, attitudes, and practices of international nursing students regarding contraceptive methods. The study will address the following research questions:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eWhat is the average score of students on the 'Contraceptive Knowledge Assessment Form'?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eWhat is the average score of students on the \u0026lsquo;Contraceptive Attitude Scale\u0026rsquo;?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eWhat is the average score of students on the \u0026lsquo;Contraceptive Behavior Scale\u0026rsquo;?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cb\u003eResearch Design\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis is a descriptive and a cross sectional study\u003c/p\u003e\u003cp\u003e\u003cb\u003ePlace and time\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study was conducted at Near East University, in Nursing Faculty, located in Northern Cyprus, from January to June 2025.\u003c/p\u003e\u003cp\u003e\u003cb\u003eFeature of the place of the study\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTarget population is international students in Nursing Faculty. However, Near East University has 21 Faculties comprising of 220 departments and programs, 5 graduate schools with around 200 graduate and postgraduate programs, 28 research institutes.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePopulation and sample\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn this study, a convenience sampling method was used. As the Faculty of Nursing of Near East University, counts N\u0026thinsp;=\u0026thinsp;349 active international students from different countries, all 349 Nursing Students were asked to participate in this study. Hence the study population size (N) equal to the sample size (n). As participation was voluntary, only n\u0026thinsp;=\u0026thinsp;297 students were able to complete and submit the questionnaire. The researcher distributed the questionnaire and collected after the participants had completed it.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData Collection Instruments/Materials\u003c/b\u003e\u003c/p\u003e\u003cp\u003eData for this study was collected for two weeks from 6 to 20th of January 2025. Participants completed a questionnaire face to face approximately 20 minutes, and submit it to the researcher. The data collection instruments are:\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudent Information Form\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe Student Information Form used to gather demographic data had 12 questions, including age, gender, religion, sexual activity, marital status, contraceptive method use, having children, etc\u0026hellip;\u003c/p\u003e\u003cp\u003e\u003cb\u003eContraceptive Knowledge Assessment (CKA)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe CKA is a 25-item multiple-choice instrument. Each correct response was scored as 1 point, and each incorrect response as 0 points. A total knowledge score was calculated by summing the scores across the 25 items. Higher scores indicated greater knowledge, while lower scores indicated poorer knowledge. Total possible scores range from 0 to 25 (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eContraceptive Attitude Scale (CAS)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe CAS is a 32-item self-report instrument. Items are rated on a 5-point Likert scale. For positively worded statements, a rating is (strongly disagree\u0026thinsp;=\u0026thinsp;1and strongly agree\u0026thinsp;=\u0026thinsp;5). For negatively worded statements, scores will be reversed, such that \"strongly disagree\" receives a score of 5, and \"strongly agree\" receives a score of 1. The total attitude score will be the sum of the responses to each item. Lower scores will indicate more attitudes that are negative while the higher scores will indicate positive attitudes toward contraceptive use. Total possible scores range from 32 to 160 (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eContraceptive Behavior Scale (CBS)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe CBS is a 5-item scale employing a five-point rating system. Participants will indicate the degree of correspondence between their actual practices and the presented statements, with ratings ranging from 0 (totally no correspondence) to 4 (total correspondence). Higher scores will indicate more favorable contraceptive behaviors, while lower scores will indicate less favorable or negative behaviors. Total possible scores range from 0 to 20 (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003e The data obtained from this study were analyzed using Statistical Package for the Social Sciences (SPSS), version 27. Kolmogorov-Smirnoff was applied to measure the normality of distribution of the participants. Descriptive statistics tests (frequency, percentage, mean, median and SD) were used to assess the level of knowledge, attitude and behavior among participants. Kruskal Wallis Test, Mann-WhitneyU Test and Pearson were the final inferential statistics used to compare the sociodemographic and variables (knowledge, attitude and behavior).\u003c/p\u003e\u003cp\u003e\u003cb\u003eCriteria of the study\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eInclusion criteria are\u003c/b\u003e,\u003c/p\u003e\u003cp\u003eInternational Nursing Students\u003c/p\u003e\u003cp\u003eEnglish speakers\u003c/p\u003e\u003cp\u003e\u003cb\u003eExclusion criteria\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThose who do not agree to participate in the study\u003c/p\u003e\u003cp\u003e\u003cb\u003eVariables of the study\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eDependent variables\u003c/b\u003e\u003c/p\u003e\u003cp\u003eContraceptive Knowledge Assessment, Contraceptive Attitude Scale and Contraceptive Behavior Scale\u003c/p\u003e\u003cp\u003e\u003cb\u003eIndependent variables\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSocio-demographic characteristics of participants\u003c/p\u003e\u003cp\u003e\u003cb\u003eEthical Considerations\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003cp\u003ewas obtained from the Institutional Review Board (IRB) of the Near East University, with reference number (1891/2024/127). Permission was also obtained from the Nursing Faculty. All procedures were carried out in compliance with the ethical standards outlined in the Declaration of Helsinki and relevant institutional guidelines. All participants provided oral informed consent after receiving comprehensive details about the study\u0026rsquo;s objectives, methodologies, and confidentiality measures. Participation was entirely voluntary, with individuals having the freedom to withdraw from the study at any point without facing any consequences.\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of the students according to socio-demographic variables (n\u0026thinsp;=\u0026thinsp;297)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMinimum\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMaximum\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategories\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency (f)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e215\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e72.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrefer not to mention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eReligion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProtestants\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMuslims\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCatholics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOthers specify\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSexual activity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSexually active\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e103\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot sexual active\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e194\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e65.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e247\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e83.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHad a relationship\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eContraceptive method use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e256\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e86.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eIf yes,\u003c/p\u003e\u003cp\u003ewhich method\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCondom\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e63.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIUD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eHaving children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e280\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e94.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eIf yes, how many\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eHave you or your partner had an unwanted pregnancy or curettage?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e289\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e97.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eHave you received any training or consultancy on this subject?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e162\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e54.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e135\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eIf your answer is yes, who did you get it from?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSchool\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e71.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFriends\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eParents or family members\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable one show that the average age of the responders was 23.22 years, with a minimum age of 17 and a maximum age of 37. Participants in the study 72.4% was female, Ninety-seven respondents (32.7%) identified as Protestants and 30.6% Muslims. Among the respondents, 34.7% indicated they were sexually active. The majority of respondents were single, with 247 individuals (83.2%) indicating this status. A significant proportion of respondents 86.2% said that they do not utilize any contraceptive methods. Only 41 respondents (13.8%) reported using a contraceptive technique.\u003c/p\u003e\u003cp\u003eTwenty-six respondents (63.5%) utilized condoms, eleven respondents (26.9%) adopted alternative techniques. Most respondents, 94.3%, were childless, whilst 17 respondents (5.7%) had offspring. A total of 289 respondents (97.3%) indicated they had not encountered an unplanned pregnancy or curettage, whereas 8 respondents (2.7%) claimed having had such an event. Approximately 45.5% of respondents, indicated they had received training or consulting on the issue, whereas 54.5% had not. Of the individuals who underwent training or consultancy, 96 respondents (71.1%) reported receiving it from educational institutions.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eContraceptive Knowledge Assessment Correct and wrong response (n\u0026thinsp;=\u0026thinsp;297)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCorrect Response\u003c/p\u003e\u003cp\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWrong Response\u003c/p\u003e\u003cp\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. When during a woman's cycle is she most likely to become pregnant?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e42.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e57.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. How long can sperm stay alive in a woman's body?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e49.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. Which of the following choices is TRUE about pregnancy?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e62.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. Which of the following choices is TRUE about withdrawal, or the \u0026ldquo;pull-out\u0026rdquo; method?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e49.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5. Which birth control method guarantees you will not become pregnant?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e67.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6. Which is the only birth control method that helps prevent infections?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e56.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e43.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7. All of the following are TRUE about using male condoms EXCEPT:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e41.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e58.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8. Hormonal birth control comes in which of the following forms?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e41.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e58.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9. Which one is NOT a benefit of hormonal birth control?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e22.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e77.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10. How long should the vaginal ring (NuvaRing) stay in place before changing it?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e80.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11. Which of the following can make hormonal birth control less effective?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e75.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12. What is the main way that birth control pills work?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e37.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e62.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13. Birth control pills can have which of the following ingredients?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e38.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e61.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e14. You should NOT use the birth control pill if you have any of the following:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e84.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15. How long after a woman stops using birth control can she become pregnant?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e22.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e77.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16. If you forget to take one birth control pill and remember the next day, what should you do?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e87.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e17. Which of the following is FALSE about Depo-Provera (the \u0026ldquo;shot\u0026rdquo;)?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e81.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18. Which of the following birth control methods may be reversed if you decide you want to become pregnant?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e43.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e56.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e19. Which birth control method is not easily noticed by a partner?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e43.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e56.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20. A doctor places an IUD (intrauterine device) in what part of the body?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e32.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e67.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21. Which method of birth control is the best at preventing pregnancy?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e66.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e22. Which choice is FALSE about IUDs (intrauterine devices)?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e82.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e23. A doctor places the birth control implant (Nexplanon) in what part of the body?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e59.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e24. How soon after sex must the \u0026ldquo;morning after pill\u0026rdquo; (or Plan B) be used to be effective?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e87.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25. How can you get the emergency contraceptive pill called Plan B (or \u0026ldquo;the morning-after pill\u0026rdquo;)?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e74.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe response of the participants on the correct response varied between 12.5% and 62.3% indicating a low to moderate knowledge of contraception. The question with highest (62.3%) correct response is (which of the following choices is true about pregnancy?). The question that received the least accurate responses was \u0026ldquo;If you forget to take one birth control pill and remember the next day, what should you do?\u0026rdquo; with merely 12.5% of participants answering correctly. The question that have low response rate below 30% include question that pertain; vaginal ring usage (19.5%), contraindications of using birth control pill (15.2%), questions regarding IUDs (17.2%), and timing of emergency contraception (12.8%). The findings showed knowledge deficiencies among respondents especially on hormonal contraceptives, emergency contraception and the appropriate guidelines for use.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptive statistics of the nursing students\u0026rsquo; scores on CKA, CAS and CBS (n\u0026thinsp;=\u0026thinsp;297)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMinimum\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMaximum\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMedian\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eInt. Range\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCKA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e8.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e4.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCAS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e156\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e106.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e101.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e16.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCBS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e8.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e6.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e the descriptive statistics of nursing students' scores on the CKA, CAS and CBS are given. The CKA scores, with a mean of 8.39 (SD\u0026thinsp;=\u0026thinsp;4.93) and a median of 8.00 and the interquartile range was 7. The findings reveal a limited to moderate understanding of contraception among the participants. The findings reveal a limited to moderate understanding of contraception among the participants. The Nursing students CAS scores, with a mean of 106.11 (SD\u0026thinsp;=\u0026thinsp;16.86) and a median of 101.00. The interquartile range was 21, suggesting a moderate variability in attitudes about contraception. The findings suggest that students predominantly expressed positive attitude regarding contraceptive use. The scores on the CBS yielding a mean of 7.56 (SD\u0026thinsp;=\u0026thinsp;6.92) and a median of 8.00. The interquartile range was 12; indicating significant variability in reported contraceptive practices, these low average score showed respondents exhibited minimal utilization of contraceptive procedures.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSpearman\u0026rsquo;s Correlations between Age, Contraceptive Knowledge, Attitude, and Behavior (N\u0026thinsp;=\u0026thinsp;297)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eCorrelations\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCKA_Total\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCAS TOTAL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eCBS_Total\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"11\" rowspan=\"12\"\u003e\u003cp\u003eSpearman's rho\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCorrelation Coefficient\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.154\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.092\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSig. (2-tailed)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e.008\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.750\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.115\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e297\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eCKA Total\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCorrelation Coefficient\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.154\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.501\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.281\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSig. (2-tailed)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e.008\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e297\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eCAS Total\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCorrelation Coefficient\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.501\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.302\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSig. (2-tailed)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.750\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e297\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eCBS Total\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCorrelation Coefficient\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.092\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.281\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.302\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSig. (2-tailed)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e297\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e**. Correlation is significant at the 0.01 level (2-tailed).\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eA Spearman's rank-order correlation between age, CKA, CAS, and CBS was conducted to determine the relationship between the variables among the nursing students\u0026rsquo; respondents (n\u0026thinsp;=\u0026thinsp;297). The results in the table indicate a statistically significant weak positive correlation between age and contraceptive knowledge score (r\u003csub\u003es\u003c/sub\u003e=.154, p\u0026thinsp;=\u0026thinsp;.008); no statistically significant relationships were found between age and contraceptive attitudes (r\u003csub\u003es\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.019, p\u0026thinsp;=\u0026thinsp;.750) or between age and contraceptive behavior (r\u003csub\u003es\u003c/sub\u003e=.092,p\u0026thinsp;=\u0026thinsp;.115). The findings also showed a moderate positive relation between contraceptive knowledge and attitude scores, and the association is statistically significant (r\u003csub\u003es\u003c/sub\u003e=.501, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). Furthermore, a weak statistically significant relationship was found between contraceptive knowledge and behavior (r\u003csub\u003es\u003c/sub\u003e=.281, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) and between contraceptive attitudes and behavior (r\u003csub\u003es\u003c/sub\u003e=.302, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). In summary, the findings indicate age is related to contraceptive knowledge; knowledge and attitude are positively associated with contraceptive behavior among the study sample.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study investigated contraceptive knowledge, attitudes, and behaviors among international nursing students, utilizing the Contraceptive Knowledge Assessment (CKA), Contraceptive Attitude Scale (CAS), and Contraceptive Behavior Scale (CBS). The findings provide critical insights into the current state of these variables within this population and highlight areas for targeted intervention.\u003c/p\u003e\u003cp\u003e\u003cb\u003eContraceptive Knowledge Assessment (CKA) Findings\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe overall CKA score indicated a significant knowledge deficit among the nursing student participants. The mean CKA score of 8.39 (SD\u0026thinsp;=\u0026thinsp;4.93), representing only 33.56% of the total possible score (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), reveals a predominantly poor understanding of contraception. This finding aligns with existing literature, where studies among young women and those at risk of unintended pregnancy also reported low contraceptive knowledge (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Our results contrast sharply with other cohorts, such as that in Hayes et al. (2017), where respondents demonstrated substantially higher knowledge (mean score of 19.4, or 77.6%).\u003c/p\u003e\u003cp\u003eSpecific areas of acute knowledge deficiency were identified through questions with notably low correct response rates (below 30%). These included the mechanism and use of the vaginal ring (19.5%), contraindications of oral contraceptive pills (15.2%), details regarding intrauterine devices (IUDs) (17.2%), and the precise timing for emergency contraception (12.8%) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). These specific knowledge gaps suggest a fundamental lack of comprehensive understanding, particularly concerning hormonal contraceptives, emergency contraception, and their appropriate usage guidelines, side effects, or contraindications. This mirrors the observations of Hylton-Kong et al. (2021), where a significant portion of respondents frequently selected \"do not know\" for various contraception-related questions. Such deficiencies are critical, as they can directly lead to misunderstandings, improper use, or avoidance of effective contraceptive methods, thereby highlighting an urgent need for focused educational initiatives.\u003c/p\u003e\u003cp\u003eA statistically significant, albeit weak, positive correlation was observed between age and CKA scores (rs​=.154, p\u0026thinsp;=\u0026thinsp;.008) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). This suggests that slightly older nursing students in our sample tended to possess marginally greater contraceptive knowledge, a finding consistent with Eryilmaz et al. (2022) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). However, this modest correlation indicates that age alone does not fully account for knowledge levels, pointing to other influential factors.\u003c/p\u003e\u003cp\u003e\u003cb\u003eContraceptive Attitude Scale (CAS) Findings\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn stark contrast to the identified knowledge deficits, participants largely expressed positive attitudes towards contraceptive use. The mean CAS score of 106.11 (SD\u0026thinsp;=\u0026thinsp;16.86), representing 66.3% of the total possible score (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), supports this conclusion. This widespread positive attitudinal stance is consistent with numerous prior studies, which also reported favorable attitudes toward contraception across diverse populations(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). This suggests that while practical knowledge may be lacking, nursing students generally perceive contraception favorably, indicating an openness to its benefits.\u003c/p\u003e\u003cp\u003e\u003cb\u003eContraceptive Behavior Scale (CBS) Findings\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDespite the observed positive attitudes, the scores on the Contraceptive Behavior Scale (CBS) indicated poor contraceptive practices among the respondents. The mean CBS score was 7.56 (SD\u0026thinsp;=\u0026thinsp;6.92), accounting for only 37.58% of the total possible score (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). This low average score points to minimal utilization of contraceptive methods and aligns with findings from Wang et al. (2013) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), who also reported a low global mean CBS score of 2.72. This discrepancy between positive attitudes and suboptimal behaviors highlights a significant knowledge-practice gap, where favorable intentions do not consistently translate into effective or consistent contraceptive actions. The CBS demonstrated neither floor nor ceiling effects, confirming its suitability for capturing the range of behaviors in this population.\u003c/p\u003e\u003cp\u003e\u003cb\u003eFactors Influencing Contraceptive Outcomes\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eImpact of Contraceptive Training\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA robust finding of this study is the significant positive influence of contraceptive training on all three measured variables. Students who reported receiving training demonstrated statistically significantly higher CKA scores (U\u0026thinsp;=\u0026thinsp;5.994, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) compared to their untrained counterparts. This result aligns with systematic reviews, such as Pazol et al. (2018) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), which consistently show an increase in contraceptive knowledge following educational interventions. Similarly, trained students exhibited more positive CAS scores (U\u0026thinsp;=\u0026thinsp;3.579, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) and significantly improved CBS scores. These comprehensive findings strongly suggest that contraceptive education is crucial for enhancing knowledge, fostering positive attitudes, and improving practical contraceptive behaviors among nursing students. This is further supported by broader meta-analytic findings on the efficacy of health education in improving contraceptive knowledge, attitude, and utilization among women of reproductive age (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFurthermore, the source of contraceptive training specifically impacted CBS scores, though not CKA or CAS. Students who received training from \"others\" (implying non-traditional or informal programs) had the highest mean rank for CBS, followed by those informed by media, educational institutions, parents/family, and friends. This nuanced finding suggests that while formal education provides foundational knowledge, less traditional or informal sources might be more influential in shaping actual contraceptive practices. This highlights the potential benefit of exploring diverse and perhaps more relatable educational avenues to complement formal curricula.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSexual Activity Status and Contraceptive Behavior\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSexual activity status significantly affected CBS scores, with a statistically significant difference between sexually active and non-sexually active students (Z\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;4.407, p\u0026thinsp;=\u0026thinsp;.001). Sexually active students exhibited more proactive contraceptive behaviors, likely driven by the personal imperative to prevent unintended pregnancies or STIs. In contrast, sexual activity status had no substantial influence on CKA or CAS scores. While our finding on attitudes contrasts with Thao et al. (2020) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), who reported more positive attitudes among sexually active participants, the lack of significant difference in CAS scores aligns with Gnimpieba and Sarpkaya (2024) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). This implies that while basic contraceptive information is important for all students, sexually active individuals particularly benefit from behavior-oriented interventions that address the practical aspects of contraception. The observation that the majority of respondents were not sexually active, diverging from cohorts like Thao et al. (2020), further contextualizes the overall low contraceptive behavior observed in this sample.\u003c/p\u003e\u003cp\u003e\u003cb\u003eContraceptive Use Status\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWhen comparing students who utilized contraceptives with those who did not, a statistically significant difference was observed in both CKA (Z\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;2.681, p\u0026thinsp;\u0026lt;\u0026thinsp;.007) and CBS scores (Z\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;5.351, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). The data indicate that the utilization of contraceptive methods correlated with elevated scores on both the CKA and CBS scales. This finding aligns with Eryilmaz et al. (2022) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), who also reported significant differences in contraceptive knowledge between users and non-users. Interestingly, no significant difference was found in CAS scores between these two groups (Z\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.641, p\u0026thinsp;\u0026lt;\u0026thinsp;.522), suggesting that a positive attitude towards contraception may be broadly held, regardless of actual usage. Condoms were the most frequently reported method among users, likely due to their convenience and accessibility, consistent with prior research (Eryilmaz et al., 2022) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eGender Influence\u003c/b\u003e\u003c/p\u003e\u003cp\u003eGender did not yield statistically significant differences across any of the three measured variables. For CKA scores, no significant difference was found (χ2(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;2.28, p\u0026thinsp;=\u0026thinsp;.320), despite female students having a slightly higher mean rank. This finding contrasts with some studies (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) that reported significant gender differences in contraceptive knowledge. For CAS scores, the results approached statistical significance (χ2(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;5.72, p\u0026thinsp;=\u0026thinsp;.057), with a trend toward more positive attitudes among females, aligning with Gnimpieba \u0026amp; Sarpkaya (2024) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) but contrasting Thao et al. (2020). Similarly, no significant difference was observed in CBS scores across gender groups (χ2(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;0.90, p\u0026thinsp;=\u0026thinsp;.637), differing from Arias et al. (2018) (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The overall lack of significant gender influence suggests that while reproductive health services traditionally centered on women, contemporary contexts may reflect a more balanced engagement and perceived importance of contraception across genders, supporting calls for increased male involvement in contraceptive decision-making (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eReligious Affiliation and Marital Status\u003c/b\u003e\u003c/p\u003e\u003cp\u003eReligious affiliation significantly influenced CKA scores, with Muslim students demonstrating lower scores compared to other religious groups. This suggests that religious beliefs or cultural contexts tied to religion may impact access to or acceptance of contraceptive information. However, religious affiliation did not show a statistically significant association with CAS or CBS scores, aligning with Thao et al. (2020) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) and Gnimpieba \u0026amp; Sarpkaya (2024) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). This indicates that while knowledge may be influenced, attitudes and behaviors might be shaped by a broader array of factors beyond religious background alone.\u003c/p\u003e\u003cp\u003eSimilarly, marital status did not show statistically significant differences across any of the CKA, CAS, or CBS scores. This finding contrasts with Eryilmaz et al. (2022) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) regarding CKA, and Gnimpieba and Sarpkaya (2024) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) regarding marital status impacting group differences in attitudes and behaviors. However, the lack of significant association between marital status and attitudes or behaviors aligns with Thao et al. (2020) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), suggesting that marital status might not be a primary determinant of contraceptive outcomes in this specific nursing student cohort. The majority of respondents being single and not utilizing contraceptives (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) could be partly influenced by cultural and religious values prevalent in their African home countries, where fear of societal consequences might lead to under-reporting of sexual engagement or contraceptive use.\u003c/p\u003e\u003cp\u003e\u003cb\u003eParenthood and Type of Contraceptive Method\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe analysis demonstrated that parenthood status and the number of children did not substantially influence nursing students' CKA, CAS, or CBS scores. While some variability was noted, it did not reach statistical significance, potentially due to small sample sizes in certain subgroups. This contrasts with Eryilmaz et al. (2022) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), who reported significant differences based on parenthood.\u003c/p\u003e\u003cp\u003eFurthermore, no statistically significant differences were observed in CKA, CAS, or CBS scores when comparing them by the type of contraceptive method used. This could indicate a relatively uniform exposure to information and attitudes toward contraception, irrespective of the specific method chosen. However, it is crucial to consider the potential limitation of statistical power due to the small sample sizes within certain contraceptive method subgroups (e.g., IUD and pill users). As Polit and Beck (2024) (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) emphasize, small subgroup sizes can limit the ability of statistical tests to detect true differences, increasing the risk of a Type II error. Therefore, while the findings might suggest homogeneity across different users, caution is warranted in interpreting these results definitively.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, this study reveals a critical paradox among international nursing students: while they generally hold positive attitudes toward contraception, their actual knowledge and behavior demonstrate significant deficiencies. The pivotal role of contraceptive training is unequivocally highlighted, as it positively influences knowledge, attitudes, and behaviors. The findings also underscore the importance of sexual activity status in shaping contraceptive behavior, with sexually active students demonstrating more pragmatic practices. While some sociodemographic factors, like age and religious affiliation, showed limited associations with knowledge, broader factors appear to drive attitudes and behaviors. These insights collectively emphasize a pressing need for enhanced and tailored contraceptive education for nursing students, focusing on improving specific knowledge areas and bridging the gap between positive attitudes and effective contraceptive practices to safeguard their sexual and reproductive health and prepare them for their future roles as health providers and educators.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author acknowledge gratitude to all the staff who participated in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: JN, KE, UDY and DN; investigation: JN and KE; methodology: JN, KE, UDY and DN; validation: JN, KE, UDY and DN; writing original draft: JN and KE; writing review and editing: JN, KE, UDY and DN; visualization: JN, KE, UDY and DN.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe current research is not funded by any institutional or government body.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the present study are not publicly available because the authors are currently working on them in order to prepare the final version of this manuscript. However, they are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Institutional Review Board (IRB) of the Near East University, with reference number(1891/2024/127). Permission was also obtained from the Nursing Faculty.\u0026nbsp;All procedures were carried out in compliance with the ethical standards outlined in the Declaration of Helsinki and relevant institutional guidelines. All participants provided oral informed consent after receiving comprehensive details about the study\u0026rsquo;s objectives, methodologies, and confidentiality measures. Participation was entirely voluntary, with individuals having the freedom to withdraw from the study at any point without facing any consequences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e: Not applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: The authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDefinition of contraception - NCI Dictionary of Cancer Terms - NCI [Internet]. 2011 [cited 2025 Apr 2]. 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Sex Health. 2017;14(6):533\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFlanagan J, Beck CT. Polit \u0026amp; Beck\u0026rsquo;s Nursing Research: Generating and Assessing Evidence for Nursing Practice. Lippincott Williams \u0026amp; Wilkins; 2024. p. 1773.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Attitude, Behavior, Contraceptive Method, Nursing Students, Knowledge","lastPublishedDoi":"10.21203/rs.3.rs-7199486/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7199486/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eAim: \u003c/strong\u003eThis study aims to assess the level of knowledge, attitude and behavior on contraceptive method among international nursing student.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDesign\u003c/strong\u003e: A cross sectional study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This study applied a convenience sampling and 297 students participated. The study was conducted from January to May 2025.The data was collected with the Student Information form, the Contraceptive Knowledge Assessment (CKA), the Contraceptive Attitude Scale (CAS), and the Contraceptive Behavior Scale (CBS). Data were analyzed using SPSS version 27.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe CKA scores, with a mean of 8.39 (SD = 4.93) and a median of 8.00 and the interquartile range was 7. The findings reveal a limited to moderate understanding of contraception among the participants. The Nursing students CAS scores, with a mean of 106.11 (SD = 16.86) and a median of 101.00. The interquartile range was 21, suggesting a moderate variability in attitudes about contraception. The findings suggest that students predominantly expressed positive attitude regarding contraceptive use. The scores on the CBS yielding a mean of 7.56 (SD = 6.92) and a median of 8.00. The interquartile range was 12; indicating significant variability in reported contraceptive practices, these low average score showed respondents exhibited minimal utilization of contraceptive procedures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe result of this study indicate low level of knowledge in contraceptive procedure moderate variability in attitude about contraception and minimal utilization of contraceptive procedures. It is important to elaborate a training program tailored to this category of students to enhance their understanding and positive behavior regarding contraceptive method use.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplication for the professional:\u003c/strong\u003e Contraceptive exploration in young population has substantial public health implications in terms of health risks.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient or Public Contribution\u003c/strong\u003e: Questionnaires completed by nurses were used to explore levels of contraceptive knowledge, contraceptive attitude and contraceptive behavior in this context.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e: Not applicable\u003c/p\u003e","manuscriptTitle":"Determination of contraceptive knowledge, attitude, and behavior among nursing students in Northern Cyprus: A cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-08 20:27:42","doi":"10.21203/rs.3.rs-7199486/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-24T06:30:46+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-20T21:22:23+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-20T13:33:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"336485212578627562441648972830314479212","date":"2025-11-06T18:47:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"212703354390033583436936070672518843951","date":"2025-11-04T14:42:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-13T15:16:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"218385804424422839311902485906025937408","date":"2025-08-10T02:01:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"164079822301019632886314442808065329454","date":"2025-08-03T06:10:23+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-02T17:21:37+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-25T15:31:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-25T01:57:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-25T01:56:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-07-23T19:55:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6ce9a241-e292-442b-b0af-d7ff1dbfda2d","owner":[],"postedDate":"August 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-29T16:09:40+00:00","versionOfRecord":{"articleIdentity":"rs-7199486","link":"https://doi.org/10.1186/s12912-025-04257-5","journal":{"identity":"bmc-nursing","isVorOnly":false,"title":"BMC Nursing"},"publishedOn":"2025-12-26 15:58:00","publishedOnDateReadable":"December 26th, 2025"},"versionCreatedAt":"2025-08-08 20:27:42","video":"","vorDoi":"10.1186/s12912-025-04257-5","vorDoiUrl":"https://doi.org/10.1186/s12912-025-04257-5","workflowStages":[]},"version":"v1","identity":"rs-7199486","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7199486","identity":"rs-7199486","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}