Pregnant Women’s Intentions to Deliver at a Health Facility in the Pastoralist Communities of Afar, Ethiopia: An Application of the Health Belief Model

Abstract

Despite the significant benefits of giving birth at a health facility to improve maternal and child health, the practice remains lower than expected in pastoralist communities of Ethiopia. Understanding the intentions of pregnant women to use health facilities for delivery predicts the adoption of the behavior, yet documented evidence of intention in the context of pastoralist populations remains scarce. The current study aimed to assess pregnant women’s intentions to use a health facility for delivery in the Afar region of Ethiopia using the framework of the health belief model (HBM). A community-based, cross sectional survey was conducted from April 1 to April 30 2016 among 357 randomly sampled pregnant women using an interviewer-administered, semi-structured questionnaire. Data were entered into EpiData and exported to SPSS version 20.0 for analysis. Principal component factor analysis was done to extract relevant constructs of the model, and the reliability of items in each construct was assessed for acceptability. Multivariate logistic regressions were applied to identify predictors of pregnant women’s intentions to give birth at a health facility. The odds ratio was reported, and statistical significance was declared at 95% CI and 0.05 p value. Three hundred fifty seven pregnant women participated in the study (104.6% response rate indicating above the minimum sample size required). Among the respondents, only 108 (30.3%) participants intended to use a health facility for the delivery for their current pregnancy. Higher household average monthly income [AOR = 1.23, 95% CI = (1.10 − 2.90), antenatal clinic (ANC) attendance for their current pregnancy [AOR = 1.41, 95% CI = (1.31 − 2.10), perceived susceptibility to delivery-related complications [AOR = 1.52, 95% CI = (1.30 − 2.70), and perceived severity of the delivery complications [AOR = 1.66, 95% CI = (1.12 − 2.31) were positively associated with pregnant women’s intentions to deliver at a health facility. Intention was negatively associated with participants’ perceived barriers to accessing a health facility [AOR = 0.62, 95% CI = (0.36 − 0.85). Conclusions: A low proportion of pregnant women in the sampled community intended to deliver at a health facility. Pastoralist communities may have special needs in this regard, with household income, antenatal care attendance, perceived risk of complications, and perceived barriers to accessing a health facility largely explaining the variance in intention. Community-based interventions providing counseling and messaging on danger signs in the perinatal period and emphasizing benefits of delivering at a facility are recommended, alongside improving access.

Antenatal care and skilled delivery service utilisation in Somali pastoral communities of Eastern Ethiopia

“…There is a need for awareness creation in the community at large, to achieve the Ethiopia reproductive health programme goal by 2020. Our study is in line with the findings from other pastoral communities showing that pastoral women prefer traditional birth attendants and healers and only travel to health facilities for complicated cases . Lack of privacy is mentioned as one of the most underreported but most important reasons for not using skilled delivery service (27% (95%CI 22.8–31.1%).…”

Individual and healthcare system factors influencing antenatal care attendance in Saudi Arabia

“…Notably, perceived susceptibility/severity of potential pregnancy complications was not associated with attendance. Although in one study in Ethiopia, women who did perceive potential complications to be more severe were more likely to attend [36], a number of studies have shown that fear does not necessarily lead to positive health behaviours [37]. Fear can lead to individuals avoiding thinking about their health issue rather than tackling it, which is one reason why fear-based health promotion campaigns often do not work [38].…”

Examining Users’ Adoption of Precision Medicine: The Moderating Role of Medical Technical Knowledge

“…Social influence included four items based on Venkatesh et al [18] and Macedo [35]. Perceived threat of disease included three items drawn from Kahsay, Hiluf, Shamie, Tadesse, and Bazzano [65] and Restivo et al [66]. User's medical technical knowledge included three items derived from Hairong Li, Daugherty, and Biocca [67].…”