Professional Documents
Culture Documents
May 1, 2010
FERTILITY AWARENESS PROJECT 2
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Table of Contents
I. Abstract....................................................................................................................3
II. Introduction..............................................................................................................4
A. Background Description.....................................................................................4
B. Institutional Structure..........................................................................................5
A. Purpose Statement...............................................................................................7
B. Subjects...............................................................................................................8
V. Section V. – Evaluation
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VIII. References..................................................................................................................
Abstract
A communication audit provides insight into a Christian liberal arts university community. The
audit consisted of quantitative and qualitative data collection methods based on the 12 culture
factors found in Hunt (2005) and an additional web-based communication audit. Six individuals
were purposively selected representing three different institutional levels, as well as the
traditional and non-traditional educational approaches within the university. Four factors
emerged with mixed responses. These four factors are discussed and recommendations are
identified. Analysis of the data indicates primarily positive support for the university
communication processes.
Fertility awareness methods provide women with the ability to monitor their own
personal signs of fertility and infertility, which is useful in terms of either achieving or
preventing pregnancy. The methods include detecting changes in cervical mucus and positioning
patterns and by charting basal body temperatures. Although almost a quarter of the world’s
married women report using fertility awareness methods, research indicates that many women
Lundgren, Arevalo & Jennings, 2006). The purpose of this project is to increase knowledge of
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fertility awareness methods for the prevention or achievement of pregnancy among people who
have Internet access. This will be accomplished by creating a Web site about fertility awareness
methods and by encouraging people to participate in a pretest before touring the Web site and a
post-test after touring the Web site in order to assess whether their knowledge of fertility
Section I – Assessment
methods is generally not a part of yearly gynecological visits. According to Jennings and Landy
(2006), one reason why fertility awareness methods are not taught during routine exams may be
due to gynecologists seldom receiving proper training about fertility awareness methods in
medical school or during residency training (p. 49). The fact that few women are taught the most
basic signs and symptoms that should alert them to their fertile and infertile periods may explain
why according to Becker, Koenig, Kim, Cardona, and Sonenstein (2007), approximately 48% of
pregnancies that occur in the United States are unplanned. The prevention of unwanted
pregnancy is a problem not limited to the United States. The World Health Organization (2008),
reports that there is an unmet need for fertility awareness methods in developing nations in order
to facilitate the prevention of pregnancy to achieve the goal of child spacing, for limiting the
number of overall births, and for decreasing the rate of abortions (pp. 1-3).
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Non-hormonal Birth Control. Discussions with acquaintances of the writer have
encouraged the writer to promote further education of fertility awareness methods for the
prevention of pregnancy through the use of the proposed fertility project. Specifically,
acquaintances of the writer have voiced the desire to learn more about ways that are independent
of hormones (which they have noticed cause unwanted side effects such as weight gain) in order
to control their fertility. Not all women are good candidates for chemical forms of birth control
due to health concerns. Health concerns related to hormonal contraception usually fall into one
of two categories -those who dislike the side effects of chemical birth control and those whose
health is put into danger by taking chemical birth control. Singer (2006) mentions the health
problems associated with hormonal birth control pills and shots such as increasing the risk for a
woman to develop hypothyroidism, bone loss, breast cancer, blood clots, and insulin resistance
(p. 48). Furthermore, she notes that some woman develop a decreased interest in sex while
taking birth control pills. Ultimately, there is a great need for a safe, effective, and ethically
sound means of birth control for all women of reproductive age despite the paucity of
fertility awareness may be an acceptable means of limiting family size and child spacing. fertility
awareness methods related to religious considerations may include couples choosing abstinence
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during their fertile times. According to Stanford (as cited by Liu, 2003), 60 percent of women
who follow Natural Family Planning are Catholic while the remaining 40 percent are non-
Catholic. Within the Catholic population it is estimated by Toohill (2009) that only two percent
fertile days in order to facilitate conception. Many women are surprised to learn that they can
easily note their personal signs of fertility by using the same awareness methods that are used to
prevent pregnancy. The writer has been asked by acquaintances about methods that can be used
to achieve pregnancy by simply observing their own bodies which can consequently assist
Schneider, and Raviel (2006), realizing the individual variability in the fertility window is very
important for couples who are struggling to achieve pregnancy (p. 376).
Furthermore, according to Barron (2004), daily charting of basal body temperatures and
cervical mucous patterns can be used to recognize problems in a woman’s cycle that could
decrease her chances of conceiving (pp. 81-82). Once a cycle abnormality is detected, the
woman, along with her health care provider, can make informed decisions in order to correct
infertility conditions that may be present. Therefore, fertility awareness is a critical component
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in terms of successfully identifying fertile periods in a woman’s menstrual cycle and in
cycle of change, it has been documented that it is best if the male partner is involved in the
monitoring process. According to Murphy (1994), studies have shown that Fertility Awareness
Methods are just as effective as oral contraceptives when women and men work together to
determine the woman's peak fertile time. Furthermore, Murphy (1994) describes that men are
often inspired to take greater responsibility for intercourse because by monitoring fertile and
non-fertile patterns, men have tangible evidence of changes in their partner's cycle.
Health Promotion. Women who have intimate knowledge of their menstrual cycles
have greater self-awareness about their bodies. Fertility Awareness methods, as described by
Murphy (1994), give women responsibility and respect about their menstrual cycles. Women
can more easily detect variations and changes in their cycles that may indicate that a disease
process is taking place. Women who are unaware of their hormonal cycles may not be tuned in
Cost Effective. Since Fertility Awareness Methods involve the direct observation of
bodily functions such as cervical mucous and positioning patterns in combination with
monitoring basal body temperature, Fertility Awareness Methods are typically inexpensive
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compared with the monthly cost of hormonal birth control, surgery, or hardware. Price ranges
are dependent on how many predictors of a woman's fertile period that a woman wants to rely
on.
Health Promotion Model. Nola Pender's, health promotion model, was selected as the
theoretical model for the fertility awareness project. Pender's health promotion model was a
choice selection for the fertility project because of the strong emphasis on education as a means
to promote health and well-being using natural, instead of pharmacological means of birth
Pender's health promotion model is congruent with the methods of fertility awareness which
encourage women to listen to their own bodies in order to determine their times of infertility and
infertility. Accordingly, women who are taught to actively reflect and act upon their own self-
awareness will have the ability to modify their environments to promote health and well-being.
Section II – Plan
Setting. A multipage Web site was developed for the fertility awareness project using
Web-building software. The setting for the project is the World Wide Web. The home page for
the Web site is located at http://speculativespeculum.ipage.com. The Internet was chosen as the
medium of teaching because a wide range of people can be reached. Not only would the
minimum of 15 women benefit from touring the Web site, but also all of those throughout the
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world who have access to the Internet. Furthermore, participants were able to access fertility
awareness information at their own convenience and within the privacy of their own homes or at
coffee shops, libraries, or other public places. Privacy was an important factor in determining
the medium for education since fertility awareness is often excluded from polite conversation
and since many women may be too embarrassed to converse with their peers or physicians about
monitoring their fertility naturally. The Internet allows for the necessary privacy.
Demographics. The focus population of the project included those who are interested in
learning about preventing pregnancy without the use of hormonal contraception or who wish to
become pregnant, those who want to understand more about personal fertility patterns, and those
who want to learn more about fertility awareness methods for increased health benefits for
themselves or others. The minimum age of 18 was also chosen because avoided legal
complications that might ensue from minors taking the pretest and post-test. No upper age limit
was chosen for the project because the writer feels that the more people should be aware that
fertility awareness methods exist. Furthermore there was no discrimination between those who
are not fertile anymore or by gender or sexual orientation. By having increased understanding of
what fertility awareness methods are and why they are important may be beneficial to all of
human society.
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A minimum of 50 people who have voiced to the author the desire to learn more about
either how to achieve or how to prevent pregnancy using natural methods were selected. The
participants were acquaintances of the writer through church, school, or personal contacts made
over the Internet. Except for one Canadian female, all participants selected were Americans.
Since no formal institution was used to increase knowledge about fertility awareness methods for
either a teaching base or to locate a focus population for the project, no institutional
fertility awareness for both the prevention and the achievement of pregnancy. Participation in
the fertility awareness project was a self-study endeavor, and it was the participant’s
responsibility to adequately peruse the Web site to attain information on fertility awareness
methods. Furthermore, through the use of a contact page found within the Web site, the
participants had the ability to ask the writer questions when they found it necessary. Moreover,
an E-mail address of the writer was included for further contact information.
The information on the site covered an overview of fertility awareness methods as well as
prediction kits, and trying to conceive while breastfeeding. These topics are essential to having a
basic understanding of how fertility awareness methods can be used in the achievement of
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pregnancy, the prevention of pregnancy, and for gynecological health. The fact that the majority
of information provided through the Web site is evidence-based is what sets aside the proposed
Web site from others now found on the Internet. Citations for the information used on the Web
site are located on the bottom of each page for easy reference. Attempts were made to provide
reference materials that were as current as possible. Specific topics and questions answered
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• When is charting not a good option?
• Commonly used acronyms
Cervical Monitoring • What does the cervix look like?
• What does cervical mucous look like?
• How does the cervix change over a woman’s cycle?
• How does a woman check her cervix?
• How does a couple avoid or achieve pregnancy using cervical
monitoring?
• What can influence cervical mucous?
• Where can a person find more pictures of cervices?
• When should a woman not check her cervix?
Ecological Breastfeeding • How can breastfeeding keep me infertile?
• What are the seven standards of using breastfeeding as birth
control?
• What are my chances of becoming pregnant while
breastfeeding?
• Ovulation Prediction • How expensive are OPKs?
Kits • On what cycle day (CD) should I start testing?
• What time of day should I test?
• What does a negative OPK look like? What does a positive
OPK look like?
• I always see two lines. Is this normal?
• How long will an OPK be positive for?
• Does having a positive OPK always mean that I will ovulate?
• What if I never see a positive OPK?
• When should we have intercourse?
Trying to Conceive While • What are the easiest ways to promote ovulation while
Breastfeeding nursing?
• Can every mother conceive while breastfeeding?
• Is it safe to breastfeed during pregnancy?
Links • Fertility Awareness Methods
• Cervix Pictures
• Menstruation
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• Breastfeeding
• Childbirth
• Ovulation Prediction Kits
Handouts • Fertility Awareness Quiz Pre-test/post-test printouts
Products • Amazon books
Educators • Links to Fertility Awareness educators in the United States
About • About the Web Site
• About the writer
Contact • Contact the writer
Legal Disclaimer • Liability
• Link disclaimer
• Web site terms of use
Printable fertility awareness handouts for distribution were offered, and links to other
fertility awareness Web sites were provided. Additionally, photographs taken and images made
by the writer using graphic editing software and images from the public domain were included to
enhance the Web site’s appearance and to provide visual representation of fertility awareness
methods. For legal purposes, a medical, Web site terms of use, liability, and link disclaimer for
Timeliness and Resources. Timeliness for the implementation of the Web site was
dependent on multiple factors. Initially, time was needed to learn about Web site design, using
graphic editing software, using web-building software, and using cascading style sheets for the
format of the Web site. Preparation for the Web site began in October 2009 with the viewing of
online movies about how to create a Web site and multiple trips to the library to view books on
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the basics of Web site design. Over 24 hours were spent researching information. Moreover, the
ability of the writer to maintain a time schedule relied on the writer's capacity to research
evidence-based information on fertility awareness, create or find images, develop the Web pages,
upload the individual Web pages, formulate the online pretest and posttest, and test links within
the site.
Actual construction of the Web site began in December 2009 where the site took on
multiple appearances in an attempt to become visually appealing, inviting, and easy to maneuver.
It was challenging to design a fertility awareness site that clearly delineated whether a person
wanted to focus on fertility methods that prevented pregnancy or achieved pregnancy. Different
Web site templates were trialed with the most orderly design remaining. A site name of
“Speculative Speculum” was chosen to represent the material found in the fertility awareness
project. When choosing a name for the site, the writer wanted to confer the feeling of the desire
Two basic template designs were created with the Web-building software. The first page
created was a home page or index page. On the index page, the Web site invited participants to
“know thyself by learning more about your fertility.” The name “Speculative Speculum” was
clearly displayed in the upper right hand corner of the site with links to “home,” “news,” “links,”
“handouts,” “books,” “fun,” “educators,” “about,” and “contact” were located in the upper left
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hand corner of the page. The design of the index page is two-columned, meaning that the page is
separated into two parts. On the left column, a quote on fertility from the writer was displayed to
inspire the participants to think more about reproductive well-being. Underneath the quote, the
index page is divided into two separate areas of links that are demarcated by whether the
participant desires to learn more about either the prevention of pregnancy or the achievement of
pregnancy. On the right column of the index page, a link to the pretest and post-test is provided.
Below the link for the participants to take their pretests and post-tests is an area for fertility
awareness polls and for the monthly news of the Web site. Located on the bottom of the fertility
awareness Web site is copyright information, a link to the legal disclaimers, and a link to the
Web site’s E-mail address. The second template created was very similar to the first, however,
After the two templates were created using web-building software images for the Web
site were sought after using public domain and stock photo resources. Images that the writer
could not find easily on the Internet were produced by the writer using graphic-editing software.
After images were collected and placed in the Web site, the individual pages of the entire site
was uploaded or "put" on a server so that the Web site could be viewed by the general public.
Lastly, the writer tested links throughout the Web site and imbedded the third party survey,
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Project Mentor. The project mentor was Shannon Mcquaide, who was the writer’s
obstetrical nurse during the writer’s second pregnancy and is the current nursing supervisor at the
writer’s place of employment (see Appendix A). Shannon served as a resource for insuring that
information on the Web site was cogent, attractive, and free of grammatical and syntax errors.
Shannon Mcquaide has viewed the writer’s Web sites in the past and has offered invaluable
advice. One of the suggestions that Shannon made concerning the Web site included changing
the font of the headings to all the subjects. The writer agreed with Shannon that the headings
would look better if the font were changed, however the writer had to learn how to change the
cascading style sheets for the entire Web site in order to improve the Web site.
Project Invitation. An invitation was created using computer software to attract people
who would be interested in learning more about fertility awareness methods. The invitation or
flyer was modeled after several leaflets seen at the University of Michigan for their research
studies. The flyer included the name of the project in bold, information regarding who was
eligible to participate, and the steps to be part of the project (see appendix B). Each flyer
provided a password of "cervix" (in order to limit access to the online tests only to participants)
and a random four-digit number for the pretest and post-test log-in.
Pre/Post Tests. The site was accessible to the public and the participants of the project in
April 2010. At that time, invitations were sent to approximately 50 acquaintances of the writer
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either by a letter or by electronic mail. The instructions given to potential participants advise the
participant to, first take demographic questionnaire and pretest without touring the Web site, then
tour the Web site at their own leisure, and then take the post-test without using the Web site to
look for answers to the questions. The participants were allowed one week from April 10 to
April 18, 2010 to respond to the invitation to tour the Web site by taking a multiple-choice
An online quiz maker was used to generate pretest and post-test questions. A link to both
the pretest and post-test questions was electronically embedded within the Web site. Anonymity
while maintaining congruency between pretest and post-test questions was preserved by having
the participants log-in to take the test by using a four-digit number located on the back of the
fertility awareness invitation flyer. The four-digit number was the same one used to log-in to the
pretest and post-test. It was unknown to the writer about who received what four-digit number.
Only those selected to participate in the project were permitted to take the pretest and post-test
because the questions were closed to the general public. The password of “cervix” was used by
The multiple-choice pretest consisted of the same ten questions that were on the post-test.
The ten questions were directly related to commonly known methods of fertility awareness that
most people who utilize fertility awareness methods would easily recognize and for which they
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would know the answers. Questions for the pretest and post-test were loosely based on Katie
Singer’s (2006) “How well do you know Natural Family Planning?” (pp. 66-72). Participants
were required to choose from four possible answers with only one answer being correct. Results
of the pretest and post-test were available immediately after completing the post-test questions so
that participants would become aware of what questions were answered correctly or incorrectly.
Survey. An online survey maker was used to create a means to gather demographic
information regarding gender, age, race, education level, occupation, income level, marital
status, whether or not that they have ever heard of fertility awareness methods before, and
whether or not that they enjoy learning about health information over the Internet. The
demographic survey was limited to ten questions because the service was free of charge (see
Appendix M). Additional questions would have been too expensive for the writer. A link to the
survey was provided in the Web site for the participants to take the survey. In order to track
which demographic survey went with which pre-test and post-test, the participant was required to
entire the same four-digit number that they used for taking the pretest and post-test. In order to
limit the survey to only the participants, the password of "cervix" was again required to enter the
survey.
Pilot Study. A pilot was conducted at the end of March 2010 for the pretest and post-test
questions as a way to predict complications. A total of four acquaintances of the writer were
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selected to take the pretest, tour the Web site, and take the post-test. Multiple problems were
discovered in the process. These barriers included broken links inside the Web site, failure of the
imbedded pretest and posttest to initiate testing, inability to log-in to take the tests, slowness in
new questions to appear, and marketing ads that made the testing environment appear cluttered.
As a result of the pilot study, multiple online quiz makers were trialed. The four acquaintances
voiced to the writer with the most favored or user friendly online quiz maker, and the one most
preferred remained embedded in the Web site and was used for the project. A pilot study was
not completed using the online survey maker for acquisition of demographic information because
the survey was added to the Web site immediately prior to the participants.
Cost. The cost of the fertility awareness project was more than initially expected. The
library system local to the writer does not have information regarding fertility awareness
methods. The writer preferred to purchase her own fertility awareness books and Web design
books for future reference which amounted to be approximated $100. The approximate amount
for the rights to use some of the images found on the Web site was $20. To replace the writer's
hard drive so the project continue cost $100, and to replace the computer software lost when the
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Demographic Survey. The participant's demographic information was obtained through
an online questionnaire consisting of nine questions concerning gender, age, race, education
level, occupation, income level, marital status, whether or not that they have ever heard of
fertility awareness methods before, and whether or not that they enjoy learning about health
information over the Internet. Additionally, the internet protocol (IP) addresses obtained from
the online pretests and post-tests allowed the writer to determine where in the world participants
were responding from. All participants came from southeastern Michigan except for one who
came from Canada, all participants were female except for one male, and all participants were
In general, the 18 participants who responded out of the 50 project invitations were
between the ages of 18-30, married, had a Bachelor's degree, were a type of health care worker,
and had an income level of $50,000-100,000 (see Figures 1-5). Furthermore 68.8 % of the
participants responded that they had never heard of fertility awareness methods before, and 81.3
% of the participants responded that they enjoyed reading about health information over the
Internet.
Figure 1. Age.
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Figure 2. Marital Status.
Figure 5. Occupation
survey did not complete the pretest and post-test, and these scores were removed from the
project. Overall, post-test scores were higher after touring the Web site (see Figures 6-7). The
time to take the pretest was 141 seconds, and the time to take the post-test was 78 seconds.
Moreover, a relationship was seen between the pretest and post-test score, and the correlation
coefficient of pre-test and post-test scores was r=.51. Thus, there was a moderately strong
positive correlation between participants who took the pretest, viewed the Web site, and took the
post-test. The post-test outcomes indicate that additional teaching is needed concerning
ovulation prediction kits, basal body temperatures, and defining different fertility awareness
methods because these were the most frequent questions answered incorrectly (see Figure 8).
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Figure 6. Average Pretest and Post-test Scores.
Section IV – Analysis
Revisions. There were two major revisions that occurred to make the fertility awareness
project occur. The foremost revision was the actual project proposal statement which changed
from “increasing knowledge of fertility awareness methods among women of childbearing age
with Internet access” to simply "increasing knowledge of fertility awareness methods for the
prevention or achievement of pregnancy among people who have Internet access." This way,
more people could participate in the project, and the project would not be limited to just females
or just those who are most likely fertile. The writer wanted to include any males who might be
interested in natural methods to obtain or prevent pregnancy for their wives or significant others.
Likewise, the writer wanted to include any females who are older who may have the desire to
learn more about fertility awareness methods for their children or friend's benefit. The second
major revision of the project consisted of adding a demographic survey to the Web site so that
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information could be gathered regarding who was responding. The writer felt that it would be
interesting to analyze how people with differing backgrounds did on the pretests and post-tests.
Limitations. There were unforeseen factors that limited the success and timeliness of the
fertility awareness project. The limitation that impacted the writer the most during the
implementation of the project was related to the writer’s personal health problems. The writer
became pregnant after the fertility awareness project was proposed. Hyperemesis, a condition of
severe nausea and vomiting in pregnancy, prevented the writer from continuing with the project,
and the writer was ultimately hospitalized during the months October and November of 2009.
Continued rehabilitation extending into December of 2009 and January of 2010 inhibited rapid
completion of the Web site. Specifically, the writer experienced difficulties with vision,
memory, mood, weakness, and ambulation secondary to starvation, alternative nutrition, and
medications that made researching information of fertility awareness methods and learning how
completion of the Web site. During that time, the folder containing the site was not located
permanently on the Web hosting server. Instead, the folder containing the Web site was located
on a refurbished computer, and the computer’s hard drive became corrupted. All information
regarding the fertility awareness project become irretrievable, and a new hard drive was required
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to continue with the project. Time was needed to purchase a new hard drive, install the new hard
drive, install all computer software, recreate the Web site’s overall design, create new images
using graphic-editing software, and rewrite the information found on the individual Web pages.
implementation of the demographic surveys, pretests, and posts. Some people who were not as
adept at browsing the Internet and found it difficult to go back to the home page of the Web site
after taking the survey and tests. As a consequence, one participant only did the demographic
survey and did not attempt the pretest and post-test. About 50 % of the participants who
responded contacted the writer in order to obtain assistance in what the next step of the project
was for them. This problem was not adequately detected during the pilot study and may have
been due to the fact the four trial participants use the Internet heavily and are very
Facilitator. There were no barriers or limitations after the implementation of the project.
Alternatively, the major facilitator of the project was using an online survey maker and quiz
maker for collecting the demographic information and pretest and post-test results. The online
programs automatically tallied the number of participants who took the survey and tests and gave
statistics as to which questions were answered incorrectly and correctly. Furthermore, the time
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taken to complete the pretests and post-tests was recorded. Graphs could be viewed on the Web
site, however only members who pay additional fees have access to copy and print the
information from their site. Despite not being able to copy and paste some of the information
that the quiz-making Web sites displayed, the collection and analysis of data took little effort.
Feasibility. The creation of a Web site for such a broad topic as fertility awareness was
an enormous task similar in comparison to writing and editing a small book, and the writer found
the time line to plan and implement the Web site tight. The writer feels like she could have used
more time to research and write about fertility awareness methods. Overall, however, the plan
was realistic and the demographic survey, pretest, and post-test reflected the type and amount of
information expected. Furthermore, the writer would have benefited from greater expertise in
Web site design, and having a person more adept at designing Web sites to communicate with
would have made the formulation of the Web site easier. In retrospect, it would have been
Section V – Evaluation
Outcomes Met. The purpose of the fertility awareness project was to increase knowledge
knowledge was gained from the touring the Web site as evidenced by participants scoring higher
taking the post-test than when they took the pretest. However, not all knowledge could be
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accounted for from only from viewing the Web site before taking the post-test. This is due to the
fact that approximately 50 % of the participants need assistance in navigating back to the home
page after taking the survey or the pre-test, and the writer needed to visit the participants in order
to show them how to move on to the next step. The participants, in general, showed great
interest in learning about fertility awareness methods and had many questions for the writer.
Consequently, approximately 15-20 minutes were spent discussing fertility awareness methods
to the participants who had difficulty with Web site navigation. This was an unintended,
increasing knowledge for any subject matter would include saving the entire Web site in multiple
locations in the event of hardware or server failure occurs. In this way, loss of data in one
location would not result in an overall total loss of information. Another recommendation for the
creation a Web site would include learning a programming language that could be used to
manually generate a survey and test into the Web site without having to rely on third party online
quiz makers. Thus a tailor-made survey and test could be combined, and navigation problems
Expansion of the Web site to include additional topics related to fertility awareness
methods and gynecological issues would enhance the Web site’s content. Additions to the Web
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site may include an overview of the menstrual cycle, how to perform a breast exam, nutrition for
increased fertility, barrier methods of birth control, sexually transmitted diseases, transcultural
practices regarding the menstrual cycle and sexual intercourse, menopause, infertility, and
increasing the odds of having a baby of a certain sex. Furthermore, adds for the Web site could
be made so that more people would be drawn to the site and learn more about fertility awareness
methods. Moreover a forum and a blog can be added to the Web site in order create open
A future-related project may include evaluating what is the best method for teaching
about fertility awareness methods. Since there are many modalities of teaching, it would be
nurse midwife, instruction from a brochure, instruction from an online source, or instruction in a
group setting would provide the greatest gain in knowledge concerning fertility awareness
methods. Furthermore, it would be interesting to study who is more likely to practice fertility
awareness methods regularly such as whether they are more or less religious, more or less
Section VI – Conclusion
Knowledge Gained. The knowledge gained from completing the fertility awareness
project is multi-fold. Firstly, the writer’s knowledge on the basics of creating multi-page Web
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sites and the intricacies of using Web-building and photo-editing software was expanded.
Secondly, the writer's knowledge of fertility awareness methods has broadened. Thirdly, the
writer has learned that it is best to save digital information in several locations and to never
assume that just because a person is younger, they will understand how to navigate around a
Web site.
Applicability. The writer benefits from the data generated by the fertility project as she
prepares herself to become a certified nurse midwife and women’s health nurse practitioner. She
will be able to use the Web site and the information gathered from the fertility project to enhance
the teaching methods about fertility awareness when she is a practicing midwife in the clinical
setting. Additionally, the writer can refer patients to the Web site for additional information
Perhaps the most significant benefit of creating a Web site for the fertility awareness
project is the continued effect that it will have on women around the world who are interested in
natural methods of fertility awareness who have Internet access. By virtue of the fact that the
writer plans to maintain the Web site and modify it according to the data gathered from the
project, English-speaking women around the world will be able to find answers to questions that
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References
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Becker, D., Koenig, M., Kim, Y., Cardona, K., & Sonenstein, F. (December 2007).
The quality of family planning services in the United States: Findings from a literature
review. Perspectives on Sexual & Reproductive Health, 39(4), 206-215. Retrieved from
Fehring, R., Schneider, M., & Raviele, K. (2006, May). Variability in the phases of the
35(3), 376-384. Retrieved from CINAHL Plus with Full Text database.
Jennings, V., & Landy, H. (July 2006). Explaining ovulation awareness-based family
Liu, L. (2003, 2003 Jan-feb). Mind/body. Sex ed: contraception au naturel. Health 17(1), 48.,
Pender, N.J., Murdaugh, C. L., & Parsons, M.A. (2006). Health promotion in nursing practice
http://www.nursing.umich.edu/faculty/pender/HPM.pdf
FERTILITY AWARENESS PROJECT 32
Sinai, I., Lundgren, R., Arevalo, M., & Jennings, V. (June 2006). Fertility awareness-
Planning Perspectives, 32(2), 94. Retrieved from General OneFile via Gale:
http://find.galegroup.com.ezproxy.arbor.edu/gps/start.do?prodId=IPS
Singer, K. (2006). Honoring our cycles: A natural family planning workbook. Winona Lake, IN:
Toohill, B., (2009). Natural family planning: The Catholic priest's perspective. Psy. D.
dissertation, Wheaton College, United States --Illinois. from Dissertations & Theses:
reproductivehealth/publications/family_planning/fp_advocacy_tool/en/index.html
FERTILITY AWARENESS PROJECT 33
Appendix A
Mentor Agreement
FERTILITY AWARENESS PROJECT 34
2
FERTILITY AWARENESS PROJECT 35
Appendix B
2
FERTILITY AWARENESS PROJECT 37
Appendix C
Charting Basal Body Temperature (BBT) is one way of determining whether a woman is
ovulating or not. Basal Body Temperature is simply the body's resting temperature which
varies at different stages of a woman's menstrual cycle. Gynecological charting is
retrospective in nature, meaning that only after the fact will a woman know if ovulation
has occurred or not. Basal Body Temperature charting is best used in combination with
other Fertility Awareness Methods.
PREVENTING PREGNANCY
For women who are avoiding pregnancy, charting Basal Body Temperature allows women
to know when ovulation has ended and that sexual abstinence may end or that it is allowed
to have intercourse without contraception. It is difficult to determine before noticing the
drop and rise in temperatures indicating ovulation that the fertile period has ended, thus
Basal Body Temperature charting is poor at predicting ovulation.
In other words, assessing basal body temperature before the chart indicates ovulation
will not provide the information needed to absolutely know whether the fertile period
has been reached. By abstaining from intercourse or using contraception before ovulation
FERTILITY AWARENESS PROJECT 40
is indicated on the chart (by the fall and rise of temperatures), pregnancy can can avoided.
Charting for the women who desires to avoid pregnancy is important because by charting
Basal Body Temperatures patterns can be seen and women may notice that they ovulate
during the same time most months. This knowledge aides in allowing women to know when
their most fertile times are.
COST?
Basal Body Thermometers- Basal Body Thermometers are fairly inexpensive, costing around
10 USDs for a basic thermometer. More advanced Basal Body Thermometers exist that
store temperatures, light up, and beep when the temperature is finished reading.
Charting Software- Charting software varies in price from a one-time download (40 USDs)
to monthly online fees. Many women use:
• Fertility Friend
• Hormonal Forecaster
Paper Charts- There are many places online where free charts can be printed.
• Baby Hopes
• I Parenting
• Baby Center
The best time to start charting Basal Body Temperatures is on the first day of bleeding
which is also considered the first day of the menstrual period or Cycle Day 1 (CD1). Make
sure that everything you need to chart a temperature is by the bedside ready for the
morning which may include a pen or pencil, the actual chart or scrap of paper, and the
Basal Body Thermometer. Each morning at the same time before doing anything (kissing,
yawning, drinking, brushing teeth, getting out of bed) take your Basal Body Temperature
either orally, rectally, or vaginally. Record each temperature and look for a dip followed
by a quick rise in temperature (indicating ovulation). During the day, mark down any other
makers of fertility, periods of stress or sickness, and times of intercourse.
• Try to take temperature using Basal Body Thermometer at the same time every day
• Try to use the same method of taking Basal Body Temperature each day such as
orally, vaginally, or rectally
• Test for pregnancy if Basal Body Temperature remains elevated for 18 days or more
past ovulation
• illness
• alcohol
• traveling
PG Pregnant
PI Primary Infertility
PID Pelvic Inflammatory Disease
PMS Premenstrual Syndrome
Rx Prescription
SI Secondary Infertility
TL Tubal Ligation
Tx Treatment
US or u/s Ultrasound
UTI Urinary Tract Infection
V Vasectomy
RESOURCES
Barron, Mary. (2004). Proactive Management of Menstrual Cycle Abnormalities in Young
Women. Journal of Perinatal & Neonatal Nursing, 18(2), 81-92. Retrieved December 2009,
from ProQuest Nursing & Allied Health Source. (Document ID: 651576921).
Dagmar, Ehling, & Katie Singer. (1999). Gauging a women's health by fertility signals:
Integrating western with traditional Chinese medical observations. Alternative Therapies in
Health and Medicine, 5(6), 70-83. Retrieved December 2009, from ProQuest Nursing &
Allied Health Source. (Document ID: 46539625).
Fertility; Software Program Receives FDA Approval As Device to Aid Conception. (2001,
December). Medical Devices & Surgical Technology Week, 18. Retrieved December 2009,
FERTILITY AWARENESS PROJECT 47
from ProQuest Nursing & Allied Health Source. (Document ID: 197493681).
Fertility; Timing Fertility: out with the old, in with the new. (2002, December). Women's
Health Weekly, 13. Retrieved December 2009, from GenderWatch (GW). (Document ID:
270666851).
London Draper. (2006). Working Women and Contraception: History, Health, and Choices.
AAOHN Journal, 54(7), 317-24; quiz 325-6. Retrieved December 2009, from Proquest
Nursing & Allied Health Source. (Document ID: 1073061281).
Appendix D
Cervical Monitoring
FERTILITY AWARENESS PROJECT 48
Cervical monitoring involves the act of observing the cervix for changes such as how high or
low the cervix is in the vagina, how open or closed the opening of the cervix is (cervical os),
and the softness or firmness of the cervix itself in relation to periods of fertility in a woman's
menstrual cycle.
Additionally, the cervix secretes fluid in relation to changes in hormones over the menstrual
cycle. The cervical fluid that is secreted can be observed for signs of fertility and infertility.
LIKE?
The cervix is literally the area that separates the uterus and the vagina, and through its
opening or cervical os, sperm, babies, menstrual blood, infectious organisms, and
contraceptive devices can travel. It may come as a surprise to some women that the cervix
looks like a penis at the end of the vagina. Many women have not seen their own cervices, and
some may be curious to see what their individual cervix looks like or how their cervix changes
in relation to their cycle. Cervices can be very unique in their characteristics and will appear
different if a woman has had a baby vaginally (i.e., slit like) or has never given birth vaginally
(i.e., circular).
FERTILITY AWARENESS PROJECT 50
during impending and peck ovulation as "soft," "high," "open," and "wet."
Impending &
Before
Cervix During After Ovulation
Ovulation
Ovulation
firm as tip of
soft as lips or firm as tip of nose or
[S]oftness nose or
tongue, mushy "medium"
"medium"
[H]eight low in vagina High in vagina low in vagina
closed, partly
[O]pening Open closed, partly open
open
egg white,
[W]etness dry stretchy, like sticky, creamy
snot
• antihistamines
• cough syrup
FERTILITY AWARENESS PROJECT 56
• vaginal infections
• breastfeeding
Billings LIFE: The Behaviour of the Cervix over the Phases of the Ovulatory Cycle-shows
animation of the cervix as it changes throughout a cycle
RESOURCES
Hennell, E. (1992). The Billings Ovulation Method and breastfeeding. Breastfeeding Review,
2(6), 260-262. Retrieved from CINAHL Plus with Full Text database.
Pallone, S., & Bergus, G. (2009). Fertility awareness-based methods: another option for family
planning. Journal of the American Board of Family Medicine, 22(2), 147-157. Retrieved from
CINAHL Plus with Full Text database.
FERTILITY AWARENESS PROJECT 58
Appendix E
Ecological Breastfeeding
Breastfeeding has been known for hundreds of years to prevent pregnancy, and it is how mothers in
other underdeveloped countries space their children.
2
pregnancies especially when a mother nurses less often and introduces food or formula into the baby's
diet.
4. Keep your baby close to you when sleeping during the night
5. Keep your baby close to you when sleeping during the day
6. Nurse frequently
7. Do not separate yourself from your baby for long periods of time
2
Women have a two percent chance of becoming pregnant in the first six months after giving birth if
they have not had a return of the menstrual periods and if they breastfeed almost or nearly full time
(Blincoe, 2005).
RESOURCES
Blincoe, A. (2005). The health benefits of breastfeeding for mothers. British Journal of Midwifery.
13(6), 398-401. Retrieved from CINAHL Plus with Full Text Database.
Hale R. (2007). Choices in contraception. British Journal of Midwifery, 15(5), 305. Retrieved from
CINAHL Plus with Full Text Database.
Too, S. (2003). Breastfeeding and contraception. British Journal of Midwifery, 11(2), 88-93. Retrieved
from CINAHL Plus with Full Text Database.
FERTILITY AWARENESS PROJECT 61
Appendix F
Ovulation prediction kits or OPKs are tests that assess for the luteinizing hormone (LH) which is found
right before ovulation. Many tests come in the form of strips (like as the ones seen below) that are
similar to pregnancy tests. A woman urinates either directly on the end of the test strip or urinates in a
cup and then dips the test strip into the urine to find out whether ovulation is approaching. Ovulation
will most likely occur within 36 hours of a luteinizing hormone (LH) surge.
2
• On what cycle day (CD) should I start testing?
2
Use the chart below to determine on what day to begin testing. If you have variable cycles or very long
cycles, use your shortest cycle length over the past 6-12 months to determine which day you should
begin testing using OPKs.
2
A positive OPK results in the test line that is as dark or darker than the control line. You may notice
that your OPK results seem to "fade in" meaning that they get darker in the days leading up to the
surge. This does not always happen, and your OPK can be negative even two hours before a positive
OPK. Sometimes only half of the test line shows positive, and the results are usually considered
negative unless otherwise specified by the OPK manufacturer.
2
An OPK can be positive for up to three days. If you notice your OPK to be positive all of the time, you
may have polycystic ovarian syndrome (PCOS) which will result in positive OPKs because of the
continual elevation in luteinizing hormone (LH).
RESOURCES
Hoyt, K., & Schmidt, M. (2004). Polycystic ovary (Stein-Leventhal) syndrome: etiology, complications,
and treament. Clinical Laboratory Science, 17(3), 155-163. Retrieved from CINAHL Plus Full Text
database.
Scolaro, K., Lloyd, K., & Helms, K. (2008). Devices for home evaluation of women's health concerns.
American Journal of health-System Pharmacy, 65(4), 299-314. Retrieved from CINAHL Plus with Full
Text database
FERTILITY AWARENESS PROJECT 68
2
Appendix G
Trying to become pregnant while breastfeeding can be very difficult for some couples.
2
Although rare, some women find it nearly impossible to conceive while breastfeeding and must make a
decision either to wait to try to conceive until their child weans or wean the child early.
RESOURCES
Singer, Katie. (2006). Honoring our cycles: A natural family planning workbook. New Trends Publishing:
Winona
FERTILITY AWARENESS PROJECT 70
Appendix H
Links
There are many wonderful resources on the Internet about Fertility Awareness Methods and other
women's health topics. Please speculate more!
FERTILITY AWARENESS PROJECT 71
Cycle Beads
CERVIX PICTURES
Beautiful Cervix Project: Cycles of Cervical Change -shows images of entire menstrual cycles including
images of pregnant cervices.
Billings LIFE: The Behaviour of the Cervix over the Phases of the Ovulatory Cycle
MENSTRUATION
Divacup
Ladycup
Moon Cup
BREASTFEEDING
FERTILITY AWARENESS PROJECT 73
2
Kellymom: Breastfeeding and Parenting-provides evidenced-based information on breastfeeding,
exclusively pumping, and relactation
La Leche League
CHILDBIRTH
Orgasmic Birth
Appendix I
Educators
Fertility Awareness educators may be difficult to locate in certain areas, however many teachers may
be found among lactation consultants, herbalists, doulas, and midwives.
Appendix J
FERTILITY AWARENESS PROJECT 75
2
About
A heartfelt thanks goes to everyone who has helped me over the past two years including my wonderful
husband, coworkers, schoolmates, friends, and family.
FERTILITY AWARENESS PROJECT 76
Appendix K
Contact
Do you have any questions, comments, or concerns about Speculative Speculum or would like to
contact the author of the Web site? Please E-mail the writer at: speculativespeculum@gmail.com
FERTILITY AWARENESS PROJECT 77
Appendix L
Legal Disclaimer
Speculative Speculum is written by a registered nurse for educational purposes only. Although, the
author attempts to provide evidence-based information about fertility awareness, the content of the
web site including text and graphics are not exhaustive in nature and do not replace the advice given
by your nurse-midwife or physician. Please contact the writer at speculuativespeculum@gmail.com if
you have any questions or concerns.
FERTILITY AWARENESS PROJECT 78
LIABILITY
Speculative Speculum is not responsible or liable for any loss, damage, or claim from using information
from this web site.
If you think that you have a medical emergency, please call your doctor or 911 immediately. Do not
rely on electronic communication on this web site for urgent medical needs.
Speculative Speculum is a Fertility Awareness web site that contains medically-related materials such
as images and descriptions that some may consider sexually explicit. Do not use this web site if you
find the materials presented offensive.
LINK DISCLAIMER
Speculative Speculum provides links to other web sites not associated with Speculative Speculum.
These links are provided for convenience only and does not mean that Speculative Speculum endorses
or controls information found on third-party Internet sites.
2
Appendix M
answered question 16
skipped question 2
Response
Count
Hide replies 16
FERTILITY AWARENESS PROJECT 80
2
1. Enter your four-digit number found on the back of the Fertility Awareness flyer.
1. 1115
2. 8058
3. 9217
4. 8888
5. 7231
6. 4579
7. 1983
8. 2011
9. 1987
10. 7700
11. 8215
12. 6213
13. 1159
14. 5226
15. 2222
16. 9857
FERTILITY AWARENESS PROJECT 81
2
2. What is your gender?
answered question 18
skipped question 0
Respons
Response
e
Count
Percent
Male 5.6% 1
Female 94.4% 17
answered question 18
skipped question 0
Respons
Response
e
Count
Percent
Caucasia
94.4% 17
n
FERTILITY AWARENESS PROJECT 82
2
3. What is your ethnicity?
Black
0.0% 0
American
Hispanic 0.0% 0
Asian 5.6% 1
Other 0.0% 0
Choose
not to 0.0% 0
answer
answered question 18
skipped question 0
Respons
Response
e
Count
Percent
FERTILITY AWARENESS PROJECT 83
2
4. What is your age?
18-
66.7% 12
30
31-
16.7% 3
40
41-
11.1% 2
50
50+ 5.6% 1
answered question 18
skipped question 0
Respons
Response
e
Count
Percent
Health
care 77.8% 14
worker
FERTILITY AWARENESS PROJECT 84
2
5. What is your occupation?
Stay at
home 11.1% 2
parent
Student 0.0% 0
Other 11.1% 2
answered question 18
skipped question 0
Respons
Response
e
Count
Percent
High
5.6% 1
school
Some
5.6% 1
college
Associate's 38.9% 7
FERTILITY AWARENESS PROJECT 85
2
6. What is your educational level?
degree
Bachelor'
50.0% 9
s degree
Doctorate
0.0% 0
degree
answered question 17
skipped question 1
Respons
Response
e
Count
Percent
0-20,000 0.0% 0
20,000-
29.4% 5
50,000
FERTILITY AWARENESS PROJECT 86
2
7. What is your income level?
50,000-
52.9% 9
100,000
100,000+ 17.6% 3
answered question 18
skipped question 0
Respons
Response
e
Count
Percent
Single 5.6% 1
Dating 5.6% 1
Engaged 16.7% 3
Living
0.0% 0
together
FERTILITY AWARENESS PROJECT 87
2
8. What is your relationship status?
Married 72.2% 13
answered question 18
skipped question 0
Respons
Response
e
Count
Percent
Yes 38.9% 7
No 61.1% 11
Maybe 0.0% 0
10. Do you enjoy reading about health information over the Internet?
answered question 18
FERTILITY AWARENESS PROJECT 88
2
10. Do you enjoy reading about health information over the Internet?
skipped question 0
Respons
Response
e
Count
Percent
Yes 83.3% 15
Sometime
11.1% 2
s
No 5.6% 1
FERTILITY AWARENESS PROJECT 89
Appendix N
Before touring Speculative Speculum please take the Fertility Awareness Pre-test to
assess your knowledge of fertility awareness methods. After you are finished, please
take a look around Speculative Speculum and come back to take the Fertility
Awareness Post-test to see how much you have learned. Good luck!
Total Questions » 10
Top of Form
purplefungi 105231 fertility-aw arenes
Q.2) Which of the following is incorrect about ovulation prediction kits (OPKs)?
A. A woman may receive a positive OPK for up to 36 hours
FERTILITY AWARENESS PROJECT 90
2
B. The best time to test using an OPK is between 2-4 pm.
C. A positive OPK will always mean that ovulation has occurred.
D. A positive OPK will result in a test line that is at least as dark or dark than
the control line.
Q.3) Which of the following is incorrect about Fertility Awareness Methods (FAM)?
A. Protects against sexually transmitted diseases (STDs)
B. Requires careful observation of signs of fertility by the woman
C. Requires either abstinence or a barrier method of birth control (BC) if
pregnancy is not desirable when the woman is fertile or reaching fertility.
D. Is unforgiving to mistakes
2
A. Low, firm, and closed
B. High, soft, and open
C. Mid-level, firm, and open
D. High, firm, and slit-like
Bottom of Form
Fertility Awareness Post-test
After touring the Speculative Speculum, please take the following quiz! Good luck!
Total Questions » 10
Top of Form
purplefungi 105231 fertility-aw arenes
Q.2) Which of the following is incorrect about ovulation prediction kits (OPKs)?
A. A woman may receive a positive OPK for up to 36 hours
B. The best time to test using an OPK is between 2-4 pm.
C. A positive OPK will always mean that ovulation has occurred.
D.
A positive OPK will result in a test line that is at least as dark or dark than
FERTILITY AWARENESS PROJECT 93
2
the control line.
Q.3) Which of the following is incorrect about Fertility Awareness Methods (FAM)?
A. Protects against sexually transmitted diseases (STDs)
B. Requires careful observation of signs of fertility by the woman
C. Requires either abstinence or a barrier method of birth control (BC) if
pregnancy is not desirable when the woman is fertile or reaching fertility.
D. Is unforgiving to mistakes
2
D. High, firm, and slit-like
2
C. A positive OPK
D. A negative OPK
Bottom of Form
FERTILITY AWARENESS PROJECT 96
Appendix P
2
5226 Michigan 40 100 532 72
2222 Michigan 100 100 110 91
Averages 70.66666667 96.66666667 141.7333333 78.46666667
Appendix Q