The Role Of Interpersonal Communication On Maternal Health Of Expectant Mothers (A Case Study Of Selected Hospitals In Owerri)

Project and Seminar Material for Mass Communication

The Role Of Interpersonal Communication On Maternal Health Of Expectant Mothers (A Case Study Of Selected Hospitals In Owerri)


Abstract


This project is a survey on the interpersonal communication on maternal Health of Expectants mothers: a case study of selected Hospitals in Owerri.

Study design Metareview of published and unpublished systematic reviews and meta-analyses conducted between January 2000 and March 2013 in any language. Assessment of Multiple Systematic Reviews (AMSTAR) is used to assess the methodological quality of systematic reviews.

Settings Health systems of all states. Study outcome: QoC measured using surrogate indicators––effective, efficient, accessible, acceptable/patient centred, equitable and safe.

Analysis Conducted in two phases (1) qualitative synthesis of extracted data to identify and group the facilitators and barriers to improving QoC, for each of the three population groups, into the six domains of WHO’s framework and explore new domains and (2) an analysis grid to map the common facilitators and barriers.

Results We included 98 systematic reviews with 110 interventions to improve QoC from countries globally. The facilitators and barriers identified fitted the six domains of WHO’s framework––information, patient–population engagement, leadership, regulations and standards, organisational capacity and models of care. Two new domains, ‘communication’ and ‘satisfaction’, were generated.

Facilitators included active and regular interpersonal communication between users and providers; respect, confidentiality, comfort and support during care provision; engaging users in decision-making; continuity of care and effective audit and feedback mechanisms. Key barriers identified were language barriers in information and communication; power difference between users and providers; health systems not accounting for user satisfaction; variable standards of implementation of standard guidelines; shortage of resources in health facilities and lack of studies assessing the role of leadership in improving QoC. These were common across the three population groups.

Conclusions The barriers to good-quality healthcare are common for pregnant women, newborns and children; thus, interventions targeted to address them will have uniform beneficial effects. Adopting the identified facilitators would help countries strengthen their health systems and ensure high-quality care for all.


Table Of Contents


Preliminary Page(s)

  • Title Page
  • Approval page
  • Dedication
  • Acknowledgment
  • Abstract
  • Table of Contents

Chapter One

1.0 Introduction

  • 1.1 Background of the Study
  • 1.2 Statement of the Problem
  • 1.3 Objective of the Study
  • 1.4 Significance of the Study
  • 1.5 Research question and Hypothesis
  • 1.6 Definition of Terms
  • 1.7 Limitation of Study

Chapter Two

2.0 Literature Review

  • 2.1 Theoretical Frame Work
  • 2.2 The Review
  • 2.3 Summary of Literature Review

Chapter Three

3.1 Research Design and Methodology

  • 3.2 Research Design
  • 3.3 Area of the Study
  • 3.4 Population of the Study
  • 3.5 Sample and Sampling Procedure
  • 3.6 Sources of Data
  • 3.7 Instrument of Data Collection
  • 3.8 Validity and Reliability of Instrument
  • 3.9 Administration of Instrument –
  • 3.10 Method of Data Analysis

Chapter Four

4.0 Data Presentation and Analysis

  • 4.1 Introduction
  • 4.2 Data analysis
  • 4.3 interpretation of results

Chapter Five

5.0 Summary, Conclusion and Recommendation

  • 5.1 Summary of Finding
  • 5.2 Conclusion
  • 5.3 Recommendation
  • Questionnaire

Chapter One


Introduction

1.1 Background Of The Study

The persistent rise in maternal health of expectant, infant and child morbidity and mortality demand improved healthcare which does not pertain to coverage of health services alone. Recently, there is a growing interest in the quality of healthcare services provided.

The health issues of pregnant women, mothers, infants and children cannot be addressed without due attention to quality of care (QoC) for the simple reason that the healthcare services will not be effective, efficient, acceptable and safe. However, it is not easy to conceptualise QoC and there are several definitions. Avedis Donabedian, a pioneer in introducing QoC into the health system, defined QoC as: that kind of care which is expected to maximise an inclusive measure of patient welfare, after one has taken account of the balance of expected gains and losses that attend the process of care in all its parts.

The WHO provides a framework of organisational management strategies to improve QoC in order to help the healthcare system achieve its desired goals. This is a general framework which suggests that overall the health systems should focus on improving six domains of organisational management strategies to improve QoC—information, leadership, engagement with patients and population, use of regulation and standards, developing organisational capacity and models of care.

However, it is not known to what extent the current global issues in improving QoC for maternal, newborn and child health fit into the WHO framework. The objective of this study was to conduct a global situational analysis to identify the current facilitators and barriers to improving QoC for pregnant women, newborns and children with respect to the WHO’s quality improvement framework.

Simply by their presence, the interpersonal communication have the nature of societal communication norms. Large audiences have been created, that expect the media to provide continuous flow of news, entertainment, political commentary, and other types of messages.

The people depend on the media for various forms of gratification based on content. If denied such communication, they will feel deprived (Berelson 1950:889). Even in relatively underdeveloped societies, population quickly develops media related habits, once mass communication becomes available in a form they understand.

Initially, the United Nations Organization (UNO) through its agency the World Health Organization (WHO) has championed the publicity and propaganda campaign for the introduction and acceptance of the modern agitations and clamoring against it.


1.2 Statement Of The Problem

Although it is truism that the term “maternal health” is not unknown to many Nigerians, there is still need to clearly define the concept. So the problems this project sets out to study will focus on:

  1. Leadership is considered to underpin the other five domains. While the framework suggests the requirement of effective leadership at all levels that is external and internal to the health system, this metareview focused only on ‘leadership’ within the healthcare system.
  2. Information includes an information system in any shape and form (papers, checklists to computer-aided prompts) that enables service providers to deliver standard best practices and help patients and communities to manage their own health.
  3. Patient and population engagement is described as central to quality improvement strategies because, ‘either directly or indirectly, they will be financing care, they will be working in partnership with health workers to manage their own care and they will sometimes be the final arbiter of what is acceptable and what is not across all the dimensions of quality’. etc.
  4. Regulations and standards based on evidence of best practices are required to be adhered to in order to improve the performance of the health system. They are the means for checking the credibility of the healthcare system and thus are usually monitored by an agency external to the health system. These agencies could be governmental or non-governmental, but their role is to inspect and accredit the healthcare systems.
  5. Organisational capacity is the fifth domain and ‘issues of quality within this domain apply throughout the health system’ from the organisation and structure of the healthcare system to the knowledge and capacity of the service providers. This is suggested to be the interface at which providers and users interact and directly experience QoC-related issues.

1.3 Objective Of The Study

The primary aims of this study are:

  1. To examine the extent to which interpersonal communication helps in maternal health of expectant mothers in Owerri.
  2. To know the ability to improve the health care of pregnant women in owerri.
  3. To induce couples to change their behavior to expectant mothers.
  4. To help them know more about change in their system and suggest ways of it practice.
  5. To find out if they are really getting information (exposure) at their level of education.

1.4 Research Questions

  1. To what extent does interpersonal communication helps in maternal health of expectant mothers in Owerri?
  2. Can health care of pregnant women in owerri be improved through interpersonal communication?
  3. Do couples have negative attitude towards expectant mothers?
  4. Are they are really getting information (exposure) at their level of education?

1.5 Significance Of The Study

It is envisaged (imagined) that the outcome of this study will alert the parents’ population on dangers inherent in misinformation based on expectant mothers and equally contribute to existing write-ups (literature) in the area of interpersonal communication.

Also, the study will help the ministry of health in Nigeria to determine which media to employ in dissemination of pregnant mothers health care information. Above all, it is hoped that the study will further equip media practioners, communication experts and researchers to come up with a more concrete approach to covering all manners of campaigns without much ado (delay) in Nigeria.


1.6 Scope Of The Study

The research is basically concerned with the role of interpersonal communication on maternal Health of expectant mothers in Owerri, Imo state, Nigeria. Many selected Hospitals in Owerri west, Municipals and Owerri North were used as case study.


1.7 Limitation Of The Study

Collecting information about this particular study has not been an easy task. The most frustrating among others are;

  1. Accessibility to hospitals; in the average situation of things, an average young woman is viewed by some parents with suspicious and skepticism.
  2. This makes it near impossible for the researcher to get at peoples homes when he wanted to.
  3. Finance has been seen to be a major set back the researchers encountered.
  4. Enough time was not available for the researches.

Chapter Five


5.0 Summary, Conclusion And Recommendations

5.1 Summary Of Findings

This study examined the logistical and perceived barriers women confront when accessing maternal health services within the cultural context of Matagalpa, Nicaragua. The study has identified a range of logistical barriers to seeking care that have also been shown to be important in other countries and cultural contexts (9, 11, 16, 20). The findings indicate that financial obstacles, especially in relation to transportation, time constraints, and availability of health care staff and services influence women’s utilization of prenatal and delivery services. While previous studies in Matagalpa have addressed logistical barriers, specifically at the health facility level, no study has previously addressed the underlying social and cultural perceptions influencing women’s utilization of services in this region.
Women who perceive prenatal and delivery care to be relevant overcome the logistical barriers with the support of family members, most notably their husbands and mothers or mothers-in-law. Various factors facilitate women’s utilization of institutional-based maternal health services, including establishing financial savings, most often with the support of their husbands; timely preparation for delivery, including staying at the casa materna; and arranging for a family member or friend to accompany them, or to care for their other children. However, women’s utilization of prenatal care does not necessarily translate to use of institutional delivery care. While it appears that parity may affect a woman’s use of delivery services, the themes identified in the study did not clearly vary by women’s age or parity. It is possible that low-parity women face fewer opportunity costs in relation to caring for additional children when seeking delivery services. Some women’s intentions to seek delivery care may be thwarted by their failure to access or pay for emergency transportation or their inability to travel due to extremely rapid labor. However, these barriers do not completely explain the discrepancy between the use of prenatal services and the use of delivery services. The data show that a range of sociocultural factors may explain this disconnect between women’s utilization of prenatal and delivery services.

Logistical barriers, which are a product of the political and economic environment, are easier to surmount than the intergenerational cultural influences in this region. Women’s utilization of services is affected by the varying degree to which they receive information about health care through formal and informal sources, including other women in the community, health workers, and partners. Furthermore, the level of encouragement and promotion of healthy maternal health care–seeking behaviors provided by those information resources influences a woman’s ability to overcome the cultural barriers to seeking care.

In the study setting, cohesive women’s networks within families and communities link women and disseminate their knowledge and experiences. The data reveal that women’s disclosure of past experiences, traditional practices, and prevailing fears and misconceptions influence their attitudes toward prenatal and delivery care as well as their utilization of services. Women often rely on the knowledge and advice of older, more experienced authority figures within their network to direct their health care– seeking behaviors. Women’s perceptions of prenatal and delivery care is enhanced through positive personal experiences; an established sense of security in health facilities; shared positive experiences; and direct, comprehensive communication with health workers. The disconnect between utilization of prenatal care and delivery services may be attributed to women’s collective comfort with receiving prenatal care at well-known rural health clinics versus their apprehension at receiving delivery services at the larger and better equipped yet unfamiliar health centers.

Women’s utilization of prenatal and delivery services is influenced by communal and individual perceptions regarding maternal care. This study reveals the shared cultural belief that a woman’s role is to be the caretaker of her children. Women’s acceptance of their prescribed gender role as the passive caretaker of the family heightens the perceived opportunity costs of seeking care. For women, prenatal care is considered necessary primarily to ensure the health of a child rather than to protect one’s own health. There is a disconnect in how women view prenatal and delivery care in relation to the health and security of their child, which may result in the difference in their utilization of antenatal and delivery services. Further research is warranted to examine the external and internal construction of this caretaker role and the degree to which it extends to the unborn child. Better understanding of how the expectations of other women, and husbands, influence women’s perceptions of their duties as a caretaker may shed light on women’s use of institutional delivery services and its influence on neonatal survival and overall child health.

Nicaragua is a country in which machismo is manifested within the political, social, and cultural environment and may be exhibited in the behaviors of individual men (33). According to Sternberg (33), machismo is a dominant, dynamic component of a value system that justifies the subordination of women and governs the relationships among men in which women are considered “a form of currency.” Women’s acceptance of an idealized notion of motherhood and serving the family leaves them economically dependent on men. This dependence grants men the authority, both in the workplace and in the home, to dictate women’s mobility and autonomy in accessing maternal health care services. A husband’s perception of the relevance of accessing maternal health services is an important factor influencing a woman’s health care–seeking behavior. While a previous study in Nicaragua revealed that men believe they have the right to decide when a woman should have children, further research regarding husbands’ perceptions and interpersonal communication regarding maternal health care is necessary for understanding women’s health care–seeking behaviors (33).

The study results should be considered within the scope of the limitations. Interviews were only conducted with mothers seeking care for their child at a health clinic, thus the results are not necessarily representative of women who never seek care at health facilities. An additional limitation of this study is the effect of a three-month-long health workers’ strike five months prior to beginning the research on prenatal and delivery care practices. In addition, as with all research involving self-reported interview responses, there was a potential for recall bias, particularly in reporting number of prenatal visits. Furthermore, women who were accompanied by their husbands to the health facilities on the days of the interviews may have been hesitant to disclose details about their relationships with their husbands. As a result, gender power dynamics at the household level, which may not have been completely understood, may have affected the study outcome.


5.2 Conclusion

This study highlights the logistical and socio-cultural barriers impeding women’s utilization of maternal health services. Enhanced health care infrastructure and human resource capacity would improve overall access to services and would likely increase service utilization. As demonstrated in this study, better understanding of community and individual perceptions about prenatal care, the quality of services, and women’s health needs may improve the efficacy of public health interventions and contribute to increased utilization and effectiveness of maternal health services. Women’s ability to convene and communicate is a powerful force that—if better understood by researchers—could be used as a tool for public health interventions. Future public health research should therefore target women’s networks and the information being communicated via those interpersonal relationships.

Investigating women’s concerns regarding quality of care and lack of communication between health workers and patients may improve services and increase consumer confidence. The high level of utilization of prenatal care services provides an opportunity to improve the content and effectiveness of prenatal care while encouraging healthy maternal care practices, including delivering in health facilities. Incorporating prenatal and delivery education and counseling into standard prenatal visits will allow health workers to address women’s questions and misconceptions regarding care and delivery. Discussions about pregnancy and postpartum danger signs, adequate nutrition during pregnancy, delivery care services, casa materna utilization, and postpartum care could inform women about appropriate care and the types of services available while initiating a dialogue about concerns women may have regarding these issues. Alleviating misconceptions and fears and reducing the gap in maternal health knowledge during prenatal care may contribute to an increase in the utilization of delivery services.

Communication with women about their expectations and perceptions of health facility deliveries, along with other issues, could improve community awareness of the importance of delivery services in regard to the health of their unborn children. Prenatal care visits should also be used to educate women on how to avoid logistical barriers at the time of delivery. Human resources at rural health facilities, which are often understaffed, could be supplemented by trained local community health workers to reduce the workload of physicians or nurses, introduce effective education and counseling, and encourage repeat use of services.

This study highlights how men’s financial power and women’s acceptance of their passive gender role limits women’s agency in their own health care. To maximize community understanding and acceptance of maternal health services, public health interventions must target men, who often control women’s health-seeking practices. As the inclusion of men in maternal health programs has proven controversial, more research and comprehensive monitoring and evaluation of programs involving men are needed to ascertain the male influence on women’s utilization of maternal health services.


5.3 Recommendation

  1. A study should be carried out on men on the adoption of interpersonal communication because most women complain that men are the main constraints to adoptions in many homes. If it is true actions should be taken on how to reserve the trend.
  2. A study should be done on rural community where there is no elasticity, where posters are used as a means of information dissemination.
  3. Expectant mother’s health clinics should be forced but people should not be persuaded to visit. The posters should be pasted tothe clinics and adoption should be measured seven months after the commencement of the poster campaign.
  4. The rest should be compared with the study. Study should be on lowest income earners living in the rural communities. The focus should be on media use, considering that most of them own television and radio set. Their attitude towards government development policies, messages should be the main focus of study.

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