Effects of fertility education on knowledge, desires and anxiety among the reproductive-aged population: findings from a randomized controlled trial.
What are the effects of fertility education on knowledge, childbearing desires and anxiety?



Providing fertility information contributed to greater knowledge, but increased anxiety.



Past studies have found that exposure to educational material improved fertility awareness and changed desires toward childbearing and its timing. Existing educational websites with evidence-based medical information provided in a non-judgmental manner have received favorable responses from reproductive-aged men and women.



This three-armed (one intervention and two control groups), randomized controlled trial was conducted using online social research panels (SRPs) in Japan in January 2015.



A total of 1455 participants (726 men and 729 women) between 20 and 39 years of age who hoped to have (more) children in the future were block-randomized and exposed to one of three information brochures: fertility education (intervention group), intake of folic acid during pregnancy (control group 1) or governmental financial support for pregnancy and childbirth (control group 2). Fertility knowledge was measured with the Japanese version of the Cardiff Fertility Knowledge Scale (CFKS-J). Knowledge, child-number and child-timing desires, subjective anxiety (i.e. whether participants felt anxiety [primary outcome]), and scores on the State-Trait Anxiety Inventory were assessed immediately after exposure. Non-inferiority comparisons were performed on subjective anxiety with non-inferiority declared if the upper limit of the two-sided 95% confidence interval (CI) for risk difference did not exceed a margin of 0.15. This test for non-inferiority was only performed for subjective anxiety; all the other variables were tests of superiority.



Posttest scores on the CFKS-J (mean, SD) were higher in the intervention group than that of the control groups: intervention versus Control 1 and versus Control 2: 52.8 (28.8) versus 40.9 (26.2) (P< 0.001) versus 45.1 (27.1) (P = 0.003) among men and 64.6 (26.0) versus 50.8 (26.9) (P< 0.001) versus 53.0 (26.4) (P< 0.001) among women.The percentage of participants who felt subjective anxiety after exposure to the intervention brochure was significantly higher than that of the control groups: intervention versus Control 1 and versus Control 2: 32.6 versus 17.8% (risk difference [RD] = 0.149, 95% CI: 0.073-0.225) versus 14.5% (RD = 0.182, 95% CI: 0.108-0.256) among men, and 50.2 versus 26.3% (RD = 0.239, 95% CI: 0.155-0.322) versus 14.0% (RD = 0.362, 95% CI: 0.286-0.439) among women. Non-inferiority of the intervention was inconclusive (i.e. the CI included 0.15) among men whereas inferiority was declared among women. The incidence of anxiety was higher in the intervention group than that of the control groups especially among men aged 30 and older and among women aged 25 and older. No difference existed in childbearing desires between groups after exposure.



The possibility of selection bias associated with the use of SRPs (higher socioeconomic status and education) and volunteer bias toward those more interested in fertility may limit the generalizability of these findings.



In addition to education targeting a younger generation, psychological approaches are needed to alleviate possible anxiety caused by fertility information.



This study was funded by National Center for Child Health and Development, Seiiku Medical Study Grant (24-6), the Daiwa Foundation Small Grants and Grant-in-Aid for JSPS Fellows (26-1591). No competing interest declared.



UMIN Clinical Trials Registry. Trial registration number, 000016168.



13 January 2015.



15 January 2015.
Department of Environmental Health Sciences, Akita University Graduate School of Medicine, Akita 010-8543, Japan.
E
E
Maeda
Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan.
F
F
Nakamura
Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan.
Y
Y
Kobayashi
Cardiff Fertility Studies Research Group, School of Psychology, Cardiff University, Cardiff CF10 3AT, UK.
J
J
Boivin
Department of Preventive Medicine, Graduate School of Sports and Health Sciences, Daito Bunka University, Saitama 355-8501, Japan.
H
H
Sugimori
Department of Environmental Health Sciences, Akita University Graduate School of Medicine, Akita 010-8543, Japan.
K
K
Murata
Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo 157-0074, Japan saitou-hi@ncchd.go.jp.
H
H
Saito
D001007:Anxiety / Q000523:psychology; D004644:Emotions; D005193:Family Planning Services; D005260:Female; D005298:Fertility; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007564:Japan; D008297:Male; D055815:Young Adult
anxiety; awareness; education; fertility; risk communication