Exploring factors influencing pregnant Women’s attitudes, perceived subjective norms and perceived behavior control towards male involvement in maternal services utilization: a baseline findings from a community based interventional study from Rukwa, rural Tanzania

BMC Pregnancy and Childbirth, Volume 20, No. 1, Year 2020

Interpretation

Background: Although male involvement enhances obstetric care-seeking behavior, the practice of male involvement in developing countries remains unacceptably low. Male involvement in maternal services utilization can be influenced by the attitude, subjective norm, and perceived behavior control of their female partners. Little is known about factors influencing pregnant women’s attitudes, perceived subjective norms, and perceived behavior control towards male involvement in maternal services utilization. Methods: A baseline community-based cross-sectional study whose target was pregnant women were performed from 1st June until 30th October 2017. A three-stage probability sampling technique was employed to obtain a sample of 546 pregnant women. A structured questionnaire that hinged the Theory of Planned Behavior was used. The questionnaire explored three main determinants of male involvement, which were: attitudes towards male involvement, perceived subjective norms towards male involvement, and perceived behavior control towards male involvement. Results: After adjusting for the confounders, factors influencing positive attitude towards male involvement were age at marriage [19 to 24 yrs.,(AOR = 1.568 at 95% CI =1.044–2.353), more than 24 yrs. (AOR = 2.15 at 95% CI = 1.150–1.159)]; education status [primary school (AOR = 1.713 at 95% CI = 1.137–2.58)] and economic status [earning more than one dollar per day (AOR = 1.547 at 95% CI = 1.026–2.332)]. Factors influencing perceived subjective norms was only age at marriage [19 to 24 yrs., (AOR = 1.447 at 95% CI = 0.970–2.159), more than 24 years, (AOR = 2.331 at 95% CI = 1.261–4.308)]; factors influencing perceived behavior control were age at marriage [more than 24 years (AOR = 2.331 at 95%CI = 1.261–4.308)], and the intention to be accompanied by their male partners (AOR = 1.827 at 95%CI = 1.171–2.849). Conclusion: The study revealed that women who were married at an older age were more likely to have a positive attitude, subjective norms, and perceived behavior control towards male involvement in maternal services utilization than those who were married at a young age. Pregnant women who had primary education and earn more than a dollar per day were more likely to have positive attitudes towards male involvement than poor and uneducated pregnant women. The study recommends an interventional study to evaluate the influence attitude, subjective norms, and perceived behavior control on male involvement in maternal services utilization. It was a community-based cross-sectional study done in Rukwa Region from 1st June to 30th October 2017, among pregnant women from forty-five villages. According to the national census of 2012, Rukwa had a population of 1,004,539 people; 487,311 males, and 517,228 females. The region has the lowest mean age at a marriage where male marry at the age of 23.3 years and female marry at age of 19.9 years and has a fertility rate of 7.3 [15]. Rukwa region has four administrative districts. Two districts (Sumbawanga and Kalambo Districts) were purposively selected from the four districts due to the high proportion of home birth assisted by unskilled birth attendants [16]. Three stages of sampling technique were used to obtain study participants. In the first random samplings, a simple random sampling technique was used to obtain five wards from 12 wards of Sumbawanga district and ten wards from 17 wards of Kalambo district. In the second stage random samplings, all villages in the selected wards were listed separately from each district and a simple random sampling technique using the lottery method was used to select 15 villages from Sumbawanga rural district and thirty villages from Kalambo district. A systematic sampling technique was used in the third stage sampling. Households with pregnant women of 24 weeks gestation age or less and living with a male partner were systematically selected. The first household was randomly selected; a female partner was assessed for signs and symptoms of pregnancy. For a female partner who had missed her period for 2 months was requested to test for pregnancy. For those with positive tests and consented to participate were enrolled in the study. If a selected household had no eligible participants, the household was skipped and researchers entered into the next household in the predetermined direction. The sample size was calculated using the following formula [17]. Where: n = maximum sample size. Ζα = Standard normal deviation (1.96) at 95% confidence level for this study. 2β = standard normal deviate (0.84) with a power of demonstrating a statistically significant difference before and after the intervention between the two groups at 90%. πο = Proportion at pre- intervention (Use of skilled delivery in Rukwa region 30.1%) [16]. π1= proportion after intervention (Proportion of families which would access skilled birth attendant 51%) [16]. The required sample size in the intervention group = 180 pregnant women. Intervention: control ratio = 1:2. Sample size in the control group = 360 pregnant women. Therefore the total sample size was 546 pregnant women. Data was collected using interviewer-administered questionnaires. The theory of planned behavior questionnaire guide was used to guide the development of the questionnaire [8]. The questionnaire was translated into Swahili and was pretested before actual administration. Four trained research assistants were recruited, trained, and participated in data collection. The tool had two parts; the social demographic characteristics and a Likert scale where respondents were supposed to strongly agree, agree, neutral, disagree, and strongly disagree. The Likert scale was subdivided into three subparts of the statements in the Likert scale which were; i) attitudes towards male involvement questions ii) perceived subjective norms towards male involvement iii) perceived behavior control towards male involvement in maternal services utilization. Attitudes towards male involvement had five Likert scale statements which were if my husband participates in setting apart of the skilled birth attendant, he is doing a good and beneficial thing, if my husband accompanies me during antenatal clinics, he is doing a good and beneficial thing, if my husband tests for HIV with me during pregnancy, he is doing a good and beneficial thing, if my husband accompanies me during childbirth, he is doing a good thing which is beneficial and if my husband accompanies me for postnatal checkups, he is doing a good and beneficial thing. Likert scale statements involved in measuring perceived subjective norms towards male involvement were; the eminent person to me believe my husband should participate in earmarking of the skilled birth attendant, eminent person to me believe my husband to escort me during antenatal clinics, eminent person to me believe my husband has to test for HIV with me during antenatal visits, eminent person to me believe my husband has to accompany me during childbirth and eminent person to me believe my husband has to escort me during postnatal checkups. Perceived behavior control was measured using the following Likert scale statements: my husband to participate in earmarking of the skilled birth attendant is trouble-free, for me, my husband to escort me during antenatal clinics is trouble-free, for me, my husband to test for HIV/AIDS with me during antenatal visits is trouble-free, for me, my husband to accompany me during labor and childbirth is trouble-free and for me, my husband to escort me during a postnatal checkup is trouble-free. The collected data were verified for integrity then coded and entered in to computer using statistical package IBM SPSS version 23. Descriptive statistics were used to generate frequency distribution and cross-tabulation used to describe the characteristic of the study participants. Factor analysis was done to measure attitude, subjective norms, and perceived behavior control. The normality test was tested and the mean score was established. The regression score above the mean was termed as positive and below mean negative (Table 1). Logistic regression was done to determine the factors which influence the attitude, perceived subjective norms, and perceived behavior control towards male involvement in maternal services utilization. Factor analysis Positive = above mean; Negative = below mean There were 25 different responses from five questions formulated based on the theory of planned behavior change for each predictor of intention. The responses were subjected to factor analysis and 15 statements of attitude and perceived subjective norms and 16 perceived behavior control had sample adequacy to test the three predictors of intention. To ensure the validity of the tool, a pilot study was conducted to assess the accuracy of the data collection tools. A Cronbach’s Alpha was conducted to establish the reliability of the tool. The Cronbach’s Alpha for attitude towards male involvement was 0.947, Cronbach’s Alpha for perceived subjective norms was 0.948 and a Cronbach’s Alpha for perceived behavior control was 0.938.

AI Digest

Study Justification:

This study aimed to explore the factors influencing pregnant women’s attitudes, perceived subjective norms, and perceived behavior control towards male involvement in maternal services utilization in Rukwa, rural Tanzania. The practice of male involvement in maternal services utilization is low in developing countries, and understanding the factors that influence it is crucial for improving obstetric care-seeking behavior.

Highlights:

– The study was conducted from June to October 2017 in Rukwa, rural Tanzania.
– A total of 546 pregnant women from 45 villages participated in the study.
– The study used a structured questionnaire based on the Theory of Planned Behavior to explore attitudes, perceived subjective norms, and perceived behavior control towards male involvement.
– Factors influencing positive attitudes towards male involvement included age at marriage, education status, and economic status.
– Age at marriage was the only factor influencing perceived subjective norms, while age at marriage and the intention to be accompanied by male partners influenced perceived behavior control.
– Women who married at an older age, had primary education, and earned more than one dollar per day were more likely to have positive attitudes towards male involvement.

Recommendations:

The study recommends an interventional study to evaluate the influence of attitude, subjective norms, and perceived behavior control on male involvement in maternal services utilization. This intervention could help improve male involvement and ultimately enhance obstetric care-seeking behavior.

Key Role Players:

– Researchers: Responsible for designing and implementing the interventional study.
– Healthcare providers: Involved in delivering the intervention and providing maternal services.
– Community leaders: Play a role in promoting and supporting male involvement in maternal services.
– Policy makers: Responsible for creating policies and guidelines that promote male involvement.

Cost Items for Planning Recommendations:

– Research personnel: Salaries and benefits for researchers involved in the interventional study.
– Training and capacity building: Costs associated with training researchers and healthcare providers on the intervention.
– Intervention materials: Costs for developing and distributing materials related to the intervention.
– Monitoring and evaluation: Costs for monitoring and evaluating the effectiveness of the intervention.
– Community engagement: Costs for community mobilization and awareness campaigns to promote male involvement.
– Data collection and analysis: Costs for collecting, processing, and analyzing data related to the intervention.
– Reporting and dissemination: Costs for preparing and disseminating reports on the findings and recommendations of the study.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong, but there are some areas for improvement. The study design is a community-based cross-sectional study, which provides valuable insights into factors influencing pregnant women’s attitudes, perceived subjective norms, and perceived behavior control towards male involvement in maternal services utilization. The sample size of 546 pregnant women is adequate for a study of this nature. The study also adjusts for confounders, which strengthens the validity of the findings. However, there are a few areas that could be improved. Firstly, the abstract does not provide information on the statistical methods used for data analysis, which makes it difficult to assess the robustness of the results. Secondly, the abstract does not mention any limitations of the study, which is important for understanding the generalizability of the findings. Lastly, the abstract does not provide any specific recommendations for action based on the study’s findings. To improve the evidence, it would be helpful to include information on the statistical methods used, highlight any limitations of the study, and provide actionable steps based on the findings.

Abstract

It was a community-based cross-sectional study done in Rukwa Region from 1st June to 30th October 2017, among pregnant women from forty-five villages. According to the national census of 2012, Rukwa had a population of 1,004,539 people; 487,311 males, and 517,228 females. The region has the lowest mean age at a marriage where male marry at the age of 23.3 years and female marry at age of 19.9 years and has a fertility rate of 7.3 [15]. Rukwa region has four administrative districts. Two districts (Sumbawanga and Kalambo Districts) were purposively selected from the four districts due to the high proportion of home birth assisted by unskilled birth attendants [16]. Three stages of sampling technique were used to obtain study participants. In the first random samplings, a simple random sampling technique was used to obtain five wards from 12 wards of Sumbawanga district and ten wards from 17 wards of Kalambo district. In the second stage random samplings, all villages in the selected wards were listed separately from each district and a simple random sampling technique using the lottery method was used to select 15 villages from Sumbawanga rural district and thirty villages from Kalambo district. A systematic sampling technique was used in the third stage sampling. Households with pregnant women of 24 weeks gestation age or less and living with a male partner were systematically selected. The first household was randomly selected; a female partner was assessed for signs and symptoms of pregnancy. For a female partner who had missed her period for 2 months was requested to test for pregnancy. For those with positive tests and consented to participate were enrolled in the study. If a selected household had no eligible participants, the household was skipped and researchers entered into the next household in the predetermined direction. The sample size was calculated using the following formula [17]. Where: n = maximum sample size. Ζα = Standard normal deviation (1.96) at 95% confidence level for this study. 2β = standard normal deviate (0.84) with a power of demonstrating a statistically significant difference before and after the intervention between the two groups at 90%. πο = Proportion at pre- intervention (Use of skilled delivery in Rukwa region 30.1%) [16]. π1= proportion after intervention (Proportion of families which would access skilled birth attendant 51%) [16]. The required sample size in the intervention group = 180 pregnant women. Intervention: control ratio = 1:2. Sample size in the control group = 360 pregnant women. Therefore the total sample size was 546 pregnant women. Data was collected using interviewer-administered questionnaires. The theory of planned behavior questionnaire guide was used to guide the development of the questionnaire [8]. The questionnaire was translated into Swahili and was pretested before actual administration. Four trained research assistants were recruited, trained, and participated in data collection. The tool had two parts; the social demographic characteristics and a Likert scale where respondents were supposed to strongly agree, agree, neutral, disagree, and strongly disagree. The Likert scale was subdivided into three subparts of the statements in the Likert scale which were; i) attitudes towards male involvement questions ii) perceived subjective norms towards male involvement iii) perceived behavior control towards male involvement in maternal services utilization. Attitudes towards male involvement had five Likert scale statements which were if my husband participates in setting apart of the skilled birth attendant, he is doing a good and beneficial thing, if my husband accompanies me during antenatal clinics, he is doing a good and beneficial thing, if my husband tests for HIV with me during pregnancy, he is doing a good and beneficial thing, if my husband accompanies me during childbirth, he is doing a good thing which is beneficial and if my husband accompanies me for postnatal checkups, he is doing a good and beneficial thing. Likert scale statements involved in measuring perceived subjective norms towards male involvement were; the eminent person to me believe my husband should participate in earmarking of the skilled birth attendant, eminent person to me believe my husband to escort me during antenatal clinics, eminent person to me believe my husband has to test for HIV with me during antenatal visits, eminent person to me believe my husband has to accompany me during childbirth and eminent person to me believe my husband has to escort me during postnatal checkups. Perceived behavior control was measured using the following Likert scale statements: my husband to participate in earmarking of the skilled birth attendant is trouble-free, for me, my husband to escort me during antenatal clinics is trouble-free, for me, my husband to test for HIV/AIDS with me during antenatal visits is trouble-free, for me, my husband to accompany me during labor and childbirth is trouble-free and for me, my husband to escort me during a postnatal checkup is trouble-free. The collected data were verified for integrity then coded and entered in to computer using statistical package IBM SPSS version 23. Descriptive statistics were used to generate frequency distribution and cross-tabulation used to describe the characteristic of the study participants. Factor analysis was done to measure attitude, subjective norms, and perceived behavior control. The normality test was tested and the mean score was established. The regression score above the mean was termed as positive and below mean negative (Table 1). Logistic regression was done to determine the factors which influence the attitude, perceived subjective norms, and perceived behavior control towards male involvement in maternal services utilization. Factor analysis Positive = above mean; Negative = below mean There were 25 different responses from five questions formulated based on the theory of planned behavior change for each predictor of intention. The responses were subjected to factor analysis and 15 statements of attitude and perceived subjective norms and 16 perceived behavior control had sample adequacy to test the three predictors of intention. To ensure the validity of the tool, a pilot study was conducted to assess the accuracy of the data collection tools. A Cronbach’s Alpha was conducted to establish the reliability of the tool. The Cronbach’s Alpha for attitude towards male involvement was 0.947, Cronbach’s Alpha for perceived subjective norms was 0.948 and a Cronbach’s Alpha for perceived behavior control was 0.938.

Materials

Innovations

Based on the provided information, it appears that the study focused on exploring factors influencing pregnant women’s attitudes, perceived subjective norms, and perceived behavior control towards male involvement in maternal services utilization in Rukwa, rural Tanzania. The study used a community-based cross-sectional design and employed a three-stage probability sampling technique to obtain a sample of 546 pregnant women. A structured questionnaire based on the Theory of Planned Behavior was used to collect data.

The study found that factors influencing positive attitudes towards male involvement included age at marriage, education status, and economic status. Factors influencing perceived subjective norms were age at marriage, and factors influencing perceived behavior control were age at marriage and the intention to be accompanied by male partners.

The study recommends an interventional study to evaluate the influence of attitude, subjective norms, and perceived behavior control on male involvement in maternal services utilization.

It is important to note that the information provided is a summary of the study and does not include specific innovations or recommendations for improving access to maternal health. To provide recommendations for innovations, it would be necessary to review the full study and identify potential areas for improvement based on the findings.

AI Innovations Description

The study mentioned explores factors influencing pregnant women’s attitudes, perceived subjective norms, and perceived behavior control towards male involvement in maternal services utilization in Rukwa, rural Tanzania. The goal of the study is to identify these factors in order to develop interventions that can improve access to maternal health.

The study was conducted from 1st June to 30th October 2017 in Rukwa Region, which has a population of 1,004,539 people. A total of 546 pregnant women from forty-five villages were included in the study. The participants were selected using a three-stage probability sampling technique.

Data was collected using a structured questionnaire based on the Theory of Planned Behavior. The questionnaire explored three main determinants of male involvement: attitudes towards male involvement, perceived subjective norms towards male involvement, and perceived behavior control towards male involvement.

The study found that factors influencing positive attitudes towards male involvement were age at marriage, education status, and economic status. Factors influencing perceived subjective norms were age at marriage, and factors influencing perceived behavior control were age at marriage and the intention to be accompanied by their male partners.

Based on the findings, the study recommends an interventional study to evaluate the influence of attitude, subjective norms, and perceived behavior control on male involvement in maternal services utilization. This intervention could help improve access to maternal health by addressing the identified factors and promoting male involvement in maternal care.

AI Innovations Methodology

Based on the provided information, here are some potential recommendations for improving access to maternal health:

1. Male involvement programs: Implement interventions that promote and encourage male involvement in maternal health services. This can include educational campaigns, community outreach programs, and support groups for expectant fathers.

2. Health education for pregnant women: Provide comprehensive health education to pregnant women, focusing on the importance of seeking maternal health services and involving their male partners. This can be done through antenatal care visits, community workshops, and mobile health applications.

3. Strengthening healthcare infrastructure: Improve the availability and accessibility of maternal health services by investing in healthcare infrastructure, such as building more health facilities, ensuring the availability of skilled birth attendants, and equipping healthcare facilities with necessary resources.

4. Addressing socio-cultural barriers: Address socio-cultural barriers that hinder access to maternal health services, such as gender norms, stigma, and traditional beliefs. This can be done through community engagement, sensitization programs, and involving community leaders and influencers in promoting maternal health.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Identify key indicators that measure access to maternal health, such as the percentage of pregnant women receiving antenatal care, the percentage of skilled birth attendance, and the percentage of postnatal care utilization.

2. Baseline data collection: Collect baseline data on the selected indicators before implementing the recommendations. This can be done through surveys, interviews, or analysis of existing data sources.

3. Implement the recommendations: Implement the recommended interventions, such as male involvement programs, health education initiatives, and infrastructure improvements.

4. Monitoring and evaluation: Continuously monitor and evaluate the impact of the interventions on the selected indicators. This can involve collecting data at regular intervals, conducting surveys or interviews with pregnant women and healthcare providers, and analyzing the data to assess changes in access to maternal health services.

5. Data analysis: Analyze the collected data to determine the impact of the recommendations on improving access to maternal health. This can involve comparing the baseline data with the post-intervention data and conducting statistical analysis to identify significant changes.

6. Reporting and dissemination: Prepare a report summarizing the findings of the impact assessment and disseminate the results to relevant stakeholders, including policymakers, healthcare providers, and the community. This can help inform future decision-making and guide further interventions to improve access to maternal health.

It is important to note that the specific methodology for simulating the impact may vary depending on the context and available resources.

Author

Dima Health

Statistics:

Citations: 2

Identifiers:

DOI: 10.1186/s12884-020-03321-z

Research Areas:

Community Interventions, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Workforce

Study Countries:

Mali, Multi-Countries, Tanzania

Study Design:

Cross Sectional Study, Grounded Theory, randomised-control-trial

Study Approach:

Quantitative

Participants Gender:

Male & Female