The Role of Interpersonal Communication on Maternal Health of Expectant Mothers (a Case Study of Selected Hospitals in Owerri)
CHAPTER ONE
General Objective
The main objective of the study was to investigate how interpersonal communication has been used as a tool for maternal health in Owerri.
Specific Objectives
The study was guided by the following research objectives:
- To investigate forms of interpersonal communication that have been used by health promoters to convey messages aimed at maternal health in Owerri
- To determine the factors that have influenced the choice of forms of interpersonal communication that have been used in promoting maternal health in Owerri
- To investigate the perceptions of the Owerri community on the various forms of interpersonal communication used in passing messages aimed at maternal health in Owerri
CHAPTER TWO
LITERATURE REVIEW
Overview
This chapter presents a review of existing literature on interpersonal communication. It covers the global trends on maternal health, various communication strategies used in health, which include interpersonal communication and participatory communication. It further discusses theories relevant to the study including behaviour change communication, theory of diffusion of innovation, theory of convergence and conceptual framework. The chapter finally identifies the research gaps that this study sought to fill.
Global Trends on Maternal health
A total of 189 countries, including Nigeria, have adopted MDGs now Sustainable Development Goals (SGDs), by September 2000. Most of these countries have defined and established various interventions to try and achieve the targeted goals (GOK, 2013). Among the goals that have received high attention has been maternal and child health. In 2013, it was reported that there was an improvement of maternal and child health care with a reduction in the number of maternal and child mortality rate worldwide. The report indicates that the number of women who die each year from causes related to pregnancy or child birth dropped from 543,000 deaths in 1990 to around 287,000 deaths in 2010 (WHO, 2013).
The WHO (2013) report attributes this improvement to campaign’s effort and other support by various governments. Among the efforts by these governments and other stakeholders in health sectors include using various communication strategies targeting both the policy makers and communities to promote behaviour change. These agencies have used mass media, advocacy, celebrities, sport stars, religious and civic leaders to promote maternal and child health care in various countries worldwide, especially in the developing countries where it records high maternal and child mortality rate
According to the WHO (2013), countdown profile reports, 30 countries, achieved reduction of maternal mortality rate of 50% between 1990 and 2010 while three countries of Equatorial Guinea, Nepal and Vietnam attained 75%. Over fifty countries reported reduced mortality rate during the period between 2000 and 2010, faster than during the previous decade.
In East Africa, maternal mortality rate has also improved with Uganda recording 310 per 100,000 live births, followed by Rwanda with 340, Nigeria 362, Tanzania 460 while Burundi has 800 mortality rate per 100,000 live births. Regarding under five (5) child mortality rate, the report records improvement with Rwanda leading with 54 per 1000 births, Tanzania 68, Nigeria 73, Uganda 96 and Burundi has 139 per 1000 births (UN, 2017, WHO, 2013; GOK, 2017).
In 2006, the Nigeria government established a strategy to try and empower families, households and communities to be at the forefront in enhancing health. The strategy targeted every household with health messages, especially on the health of expectant mothers and children under five years who are normally vulnerable to various ailments. The government, through community strategy, aimed at prevention and management of common maternal and childhood illnesses at the community level with the main objective of attaining universal coverage of cost-effective child survival interventions and hence reduction of maternal and child mortality rate (MOH, 2007). Despite this campaign effort aimed at maternal health rates, the statistics are still high as shown by a KDHS report of 2014.
Owerri has been recorded as one of the counties with the highest maternal mortality rate of 488 per 100, 000 live births (GOK, 2013). In child health, the State has recorded low immunization rate with 43.2% of children under one year, having fully undergone immunization as required (CRA, 2013). This poor state of affairs has come about despite spirited attempts to increase health education.
Maternal health Messages in the Nigeria Context
The Community Health Workers (CHWs) and the Health Workers based at health facilities across Nigeria are charged with the responsibility of educating expectant mothers through interpersonal communication on key maternal health messages. This is normally done by CHWs when they visit their respective households and at health facility during clinic days. In such occasions, the health workers at the health facility have sessions reserved for health education every clinic days for those community members who have gone to seek for Antenatal care (ANC) and immunization services (MOH, 2007). These maternal health messages are passed by the health workers using different forms of interpersonal communication and these forms include one-on-one talks, small group discussions that have personal touch amongst the stakeholders like role of relevant examples. Other forms of interpersonal communication used include; lectures or teaching with demonstrations/role of teaching aids or pictures, counselling, video viewing coupled with discussions (MOH, 2014).
The Ministry of Health guidelines, (MOH 2017, MOH, 2007), outlines the following as the main maternal health messages that should be passed to the community members by health workers:
- Identifying the early signs during pregnancy such as anaemia, swelling of legs, arms or face, spotting or vaginal bleeding or profuse or persistent bleeding after delivery, severe headaches or abdominal pains, severe or persistent vomiting, high fever, the water breaks before due time of delivery, convulsions and prolonged Women who identify any of these signs are normally advised to quickly seek medical assistance from the nearest health facility that offers maternal and child health services.
- Encouraging pregnant women to attend ANC for at least four times during every pregnancy so that they are checked by a clinical officer, nurse or a
- Encourage all pregnant mothers to sleep under insecticide-treated nets (ITN) as pregnant women are susceptible to malaria which cause sickness for both the mother and unborn
CHAPTER THREE
RESEARCH METHODOLOGY
Research Design
Kothari (2010) defines a research design as a conceptual structure or the blue print for the collection, measurement and analysis of data. It assists the researcher to set up a framework for a study. This research employed a cross-sectional research design in this study targeting to describe the state of affairs as it exists. Kombo and Tromp (2009) note that this design suits collection of information about people’s attitude, opinions, habits or other social issues. According to Oso and Onen (2016), cross- sectional design describes and explains events as they are and involves collecting data from cross section of respondents chosen to represent a large population. This design was found appropriate for this study as it allowed the investigation of relationship among various variables as they interacting with each. Again, the design was relevant for this study as it helped explore attitude and opinions of resident of Owerri on the role of interpersonal communication in promoting maternal health.
Research Approach
The study adopted a mixed methods research approach, where both quantitative and qualitative approach were used. By using both methods, the study benefited from the strengths of each, which helped to increase the reliability and validity of the results (Creswell, 2009). The quantitative approach builds directly on the results from qualitative phase in most cases and it gives a voice to the study participants and ensure that findings are grounded in participants’ experiences (Wisdom & Creswell, 2013). Ndati (2011) and Nachmias and Nachmias (2001) concur that data produced by combined methods enhance validity and reliability of research findings and in addition confirming the findings through convergence of different perspectives.
Quantitative Approach
Through quantitative approach the research studied phenomena within their natural settings and described the situation of maternal health campaign as it is in Owerri.
Abagi (1995) argues that a descriptive research attempts to describe what is in a social system such as a community living in particular area of research.
This approach was appropriate for this study because it provided a great deal of information, which was accurate (Kerlinger, 1983). In this approach, questionnaire was used to collect data from the respondents spread Owerri and Manion (2000) note that the intention of a survey research is to gather data at a particular point in time and use it to describe the nature of existing conditions. This method was relevant to this study as the researcher was able to obtain information on the current situation on how interpersonal communication was being used in the study area to promote maternal health.
Qualitative Approach
Qualitative research approach was also important for this study because it allowed the research to go beyond the statistical results obtained through quantitative and explore the community beliefs, attitude and interactions. The role of qualitative approach permitted an understanding on establish how participants interpreted their situations and related among they understood themselves, as explained by Jwan and Ong’ondo (2011). Qualitative data was obtained using key informant interviews and focus group discussions.
Through the mixed methods approach, the researcher was able to obtain information on the current situation and understand well on how interpersonal communication was being used in the study area, the perceptions and attitudes of the community in the role of interpersonal communication in promoting maternal health.
Target Population
The study targeted the residents of Owerri. Most of the respondents who were selected to participate in the study were aged 15-49, which are in the reproductive age (GOK, 2013).
The respondents for the survey comprised women who had children aged under five years, women who had had difficulty during child delivery (such as still births), expectant mothers, the Community Health Extension Workers (CHEWs), Community Health Workers (CHWs), and Community Health Committees (CHCs), who are also opinion leaders. Others included State Ministry of Health officials and coordinators/directors of non-governmental organizations working in the health sector in the State. These officials gave relevant information on how they had been using interpersonal communication in promoting maternal health in the State. The total sample was drawn from a target population of 21,001 for the survey and 11,644 for FGDs and key informant interviews.
CHAPTER FOUR
DATA PRESENTATION, ANALYSIS AND INTERPRETATION
Socio-demographic Characteristics
The study sought to document various socio-demographic characteristics of the respondents in relation to their responses on maternal health messages using interpersonal communication approaches used.
The demographic parameters sought were: age, marital status, education level, distance between households and health facility, means of transport and cost of transport to health facility, knowledge of maternal health services offered at health facility, religious affiliation and occupation. These parameters were investigated and presented in tables and interpreted appropriately.
Age of Respondents
Age of respondents was taken as very important variable in this study because it sheds light on the maturity and ability of the subjects to interpret the health care messages and take appropriate actions or response. Again, mature respondents, are able to conceptualise issues concerning maternal health, and subsequently undertake corresponding decision and action appropriately. The findings on the ages of respondents were as presented in Table 4.1.
CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATIONS
Overview
This chapter presents the summary, conclusion and recommendations. It begins with an over view of the study, the summary of the findings, conclusions of the study based on the research findings. Recommendations for both policy makers and practitioners are presented based on the findings of the study.
The General Overview of the Study
The purpose of this study was to find out the role of interpersonal communication in promoting maternal health in Owerri in Nigeria. The study was guided by three questions namely: Which forms of interpersonal communication have been used to convey messages aimed at maternal health in Owerri? What factors have influenced the choice of the forms of interpersonal communication used in communicating maternal health messages? What are the perceptions of the community on the various forms of interpersonal communication that have been used for maternal health in Owerri? Three hundred and ninety (390) respondents from Owerri were selected plus four key informants’ interviewers and four Focus Group discussions which were held. Three hundred and ninety (390) questionnaires were filled and returned to the researcher for coding, analysis, interpretation and discussions and were triangulated with the results from FDGs and KIIs. From the results of the study, conclusion and recommendations to both the policy makers and practitioners were made.
Forms of interpersonal communication used by health promoters to convey maternal health messages
The study showed that face to face was ranked the highest used form of interpersonal communication that have been used to the benefit of the target group with majority agreeing that this form has been used to their benefit, while mobile phones was rated the least used form of interpersonal communication.
The results therefore revealed that the role of mobile phone in Owerri is very low among the CHWs and this could be attributed to lack of creation and implementation of mobile phone software programmes for CHWs and other health workers. The monthly reporting of CHWs is still manual. This corroborates with the observations made by Schiavo (2007), that technology-mediated interpersonal communication are more widespread in developed countries than in many countries in the developing world, where more conventional ways of communications like word of mouth may still be dominant.
The respondents interviewed stated that mobile phones had not been incorporated by the government as the strategies of reaching the community with maternal health messages. The initiative of using mobile phones to boost the campaigns have not been adopted as the government has not developed software to be used by the community health workers (CHWs) as in other parts of the World. Mobile phones are usually used to send messages (SMS) to pregnant mothers and lactating ones and inform them of the clinic days not as like in Rwanda.
In Rwanda, for example, the health management information systems have been incorporated in various electronic health records and software programmes, web-based platform such as mobile phones. Mobile phone technology resources have improved availability and quality health information systems needed for prevention, management and monitoring and evaluation of programmes through an alert system known as rapid short messages services-SMS (Musafili, 2015; WHO, 2013).
On the first sources of information on Antenatal Care (ANC), majority of the respondents indicated that their first source of information on ANC services were hospital followed by friends while others reported getting their first information from school and finally community meeting among other sources.
Factors that influence the choice of forms of interpersonal communication used in promoting maternal health in Owerri
On the factors that influence the role of interpersonal communication in conveying maternal health, it was found out that government policies and guidelines, which urges the health workers at the health facilities to carry out maternal health education, during or when offering maternal and child immunizations, and other services related to maternal and child health were noted among the important factors that influences the choice of forms of interpersonal communication used by the health workers to convey maternal and child health messages. Again, through the community health strategy guidelines, the CHW/Vs and CHEWs are tasked to move within their designated households and educate the members of the households on the need to adhere to maternal health messages.
Another factor that was revealed by the respondents as having influence on the forms of interpersonal communication used was pointed out as periodical campaigns conducted by the national government from time to time on foreseeing danger that require immunizations of either that of children under 5 years or expectant mothers. One of the key informant explained that in such a case the government normally planned and announced the massive campaigns spearheaded by the Ministry of Health officials in conjunction with other government officials including local leaders like chiefs and their assistants.
Conclusion
The summary of the major findings and discussions of the study according to the three objectives which initially formed the basis for the study are as follows; the study established that face-to-face interpersonal communication was found to be the most popular mode of conveying maternal health messages while the mobile phone was rated the least used form of interpersonal communication.
On the factors that influence the role of interpersonal communication in conveying maternal health, it was found that government policies and guidelines, which urges the health workers at the health facilities to carry out maternal health education, during or when offering maternal and child immunizations, and other services was noted among the important factors that influences the choice of interpersonal communication forms. Secondly, through the community health strategy guidelines, the CHW/Vs and CHEWs are tasked to move within their designated households and educate the members of the households on the need to adhere to maternal health messages.
It was further found that there are normally periodic maternal health campaigns plans and led by the government and during such campaigns role of various combination of interpersonal communication among other strategies used to convey maternal health campaigns. In addition, it was further revealed that there are health indicators which shows the progress on the adherence of maternal health messages in the target areas. These health indicators are compared with the ideal situation as recommended by WHO standard and this factor guide the CHWs and health workers at their respective health facilities on the choice of interpersonal communication to be used to conveying maternal health messages.
The perception of the community on the role of interpersonal communication in promoting maternal health, was rated fairly well at 53.8% by the community members who are the beneficiaries of services offered by the health workers.
In final conclusion, the study found out that technology has permeated every sphere of life and has played a significant role in revolutionising communication strategies in general. But still, face-to-face interpersonal communication reigns supreme in a situation where action or behaviour change is required of the receptions. Psychologists assert that when two or more people talk to one another through face-to-face, their brains synchronise and collective action undertaken thereafter.
Recommendations
This study generated evidence to enable making of suggestions and recommendations on three areas, namely: formulation of the health policies that will target to enhance maternal health and secondly, the recommendations for practitioners and finally, suggestions or recommendations for further research.
Recommendations on Policy
Based on the results of this research, the following recommendations are made for policy makers:
- From the findings of this study, the major stakeholders in maternal health, namely the national and State government together with non- governmental organizations working in health sector in the State of this study, should make deliberate efforts to formulate policies to guide the design and dissemination of maternal health messages to promote women’s reproductive health. The policy to be designed should take into considerations the current situations of the community and their inputs should also be sought in order to ensure that the policy should be inclusive of all the factors like cultural, current situation plus inputs of beneficiaries of this important services as this will enable the community to own all the process of maternal health campaigns. This is because through this study, it emerged that in the current policy, it has not taken into considerations cultural factors, current situation and the input from the recipients of the services hence the gaps or limitations of the policy can be filled by the additions of these aspects in order to make the campaign yield the desired
- The national and State governments should formulate policies that incorporate health management information systems with software programs that can be integrated into web-based and mobile These tools should be used by CHWs in prevention, management and monitoring of maternal and child health. This will assist the CHWs to notify and remind the respective clients on when to visit health facility for ANC and immunizations. Also, this format may be used by CHWs while filling monthly or quarterly report. This is because through this study, it was made known that the mobile telephone has not be used to enhance the maternal health campaigns as has been done in other developing countries like Rwanda for maternal health rate.
- The policy on health campaigns based on gender should be formulated to include both genders because this is likely to help develop men’s awareness that might help communities find culturally appropriate ways to change existing beliefs, attitudes and social norms that restrict gender equity and There is therefore need for development of the framework for communication that takes into consideration the gender-related factors that influence positively the upholding of maternal health messages. The planning and execution of the health extension program should be based on identifiable purposes by the community members in order for them to be accepted and implemented as recommended. The results obtained from this study shows that the maternal and child health has been left to the women yet men are decision makers of their respective households and are economically endowed than women hence the need to have gender inclusive campaigns on maternal health campaigns to achieve the desired results.
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