ABSTRACT
Child mortality remains a major
concern of public health because high rate of child mortality persists in
developing and under-developed countries. The introduction of child-survival
interventions has caused substantial reduction in child mortality. Inadequate
implementation seems to be attributed to healthcare workers’ attitude and
communication skills. This research work was undertaken at Adeoyo Maternity
Hospital, Ibadan to determine the perception of mothers regarding how the
attitude and communication skills of healthcare workers have influenced their
readiness to adopt child-survival strategies.
The study adopted a cross-sectional
design and employed a 37-item questionnaire. One hundred and forty three
mothers participated in the study after seeking their consent for
participation. Systematic random sampling was the sampling technique employed.
Rating scales were computed for the variables while ANOVA and regression
analysis were applied for the test of significance and independence
respectively.
The mean age of mothers who
participated in the study was 29 ± 5.70. The proportion of married women that
participated in the study was higher (87.4%) than single (8.4%) and
widowed/divorced (4.2%) women. Christian respondents had higher proportion
(62.2%) compared to Muslim affiliated participants. Majority of the
participants (78.3%) attained tertiary level of education, 15.4% had secondary
level of education while 6.3% had primary level of education. High proportions
(86.7%) of the respondents are of Yoruba ethnic origin followed by Igbo
(13.3%). There were 37.8% of the respondents who have a single child, while
23.8% have more than two children and 28% have two children. Majority of the
respondents were attending the clinic for more than two times (72.7%) while
19.6% reported for the second time and 7.7% of the respondent attending for the
first time at the time of the study. Perceived attitude of healthcare workers
towards child-survival on a 30-point rating scale had a mean score of 20.49 ±
3.77 while perceived communication skills of healthcare workers in
disseminating child-survival messages on a 30-point rating scale had a mean
score of 19.99 ± 3.29. Readiness of mothers to adopt child-survival strategies
was measured on a 30-point rating scale and had a mean score of 19.32 ± 4.13.
There was significant association between perceived attitude towards
child-survival and mothers’ readiness to adopt child-survival strategies (R =
0.527; R2 = 0.278; p <0.05).
Significant association was observed between perceived communication skills of
healthcare workers to motivate mothers’ adoption of child-survival strategies
and mothers’ readiness to adopt the strategies (R = 0.639; R2 = 0.394; p <0.05). Perceived attitude and
communication skills had 40.8% contribution to mothers’ readiness (df = 2; R2
= 0.408; p < 0.05) where communication skills had more contribution (β =
0.510; t = 5.548; p < 0.05).
Findings from the study showed that
mothers’ readiness to adopt child-survival strategies was above average.
Mothers made claims that there was poor comprehension due to poor
communication.
The study recommends review of
communication methods and approach to cause improved motivation in mothers to
implement child-survival strategies.
CHAPTER
ONE
INTRODUCTION
1.1
Background to the Study
Child mortality constitute a major
concern of public health as shown by records few years back that the rate of
newborn mortality is unacceptably high in developing and under-developed
countries (USAID, 2009). A recent report by World Health Organization showed
that the mortality rate of under-five children persists in low and
middle-income countries, posing threat to public health. The leading causes of
death among this group of children were recorded to be pre-term birth
complications, pneumonia, birth asphyxia (impaired breathing at birth),
diarrhoea and malaria (WHO, 2015). The World Health Organization also reported
that 45% of child mortality is caused by malnutrition which makes children
vulnerable to severe diseases (WHO, 2002). Most of these causes of child
mortality could be prevented through simple and cost-effective interventions
known as child-survival interventions.
The efforts of global organizations
have been aimed at reducing child mortality by incorporating the use of these
interventions in primary healthcare services, training healthcare workers on
applying them, and providing facilities to ensure appropriate applications;
still the rate of child mortality in Sub-Saharan Africa has not met the desired
targets of two-third reduction; currently, it stands at 109 per 1000 live
births as at 2015 in Nigeria (IGME report, 2015). Possible causes of child
mortality persistence in areas such as Nigeria are still bases for study and it
involves various sectors of public health.
Recent findings have shown that the
attitude and communication skills of healthcare workers could be contributing
factors to the high rate of child mortality, although reports have not shown
that these factors are the major reason for the high level of persistence in
the Sub-Sahara (Anand & Bärnighausen, 2004). It is important to note that
these factors are influential in building up the clients’ efficacy and
acquisition of necessary skills to implement child-survival strategies. When a
baby is safely delivered and has survived the first week after birth, it is the
mother’s responsibility to ensure the survival of her child through
breastfeeding, seeking postnatal care services when required such as
immunization, growth monitoring and so on (Barros, Ronsman, Axelson, Loaiza,
Bertoldi, Franca et al., 2012). Therefore,
mothers are meant to understand the importance of child-survival strategies and
how to carry them out.
With experience and improved
technical skills, healthcare workers are capable of inculcating healthy
behaviours in their clients through practical explanation of health issues. A
Bangladeshi study reported that client’s satisfaction and willingness to
practice healthy behaviours was dependent on health worker’s behaviour
especially respect and politeness (Jorge, Herga & Ahmed, 2001). On this note,
it is reasonable to admit that healthcare workers are important instruments in
the course of reducing child mortality rate in areas where persistence remain.
It should be noted that
communication is an important aspect of healthcare service delivery and it is
influential in such a way that could transform bad healthy habits to positive
ones if properly carried out and monitored. Good communication could motivate
an individual to change from bad to good habits otherwise it becomes worse and
eventually results in situations as worse as death. The sole reason of
communication is to derive response in terms of change in attitude and since
communication does not only involve informative explanations, it involves
inculcation of practical skills and the efficacy to perform them therefore it
takes time to create change in the target audience (Bertrand & Kincaid,
1996).
Although it is inappropriate to
make conclusions that healthcare workers are responsible for the persistence of
child mortality in Nigeria and other sub Saharan localities, but it is highly
essential to note that mothers reflect the quality of healthcare services they
have received during their course of attending a healthcare centre. A recent
report by UNICEF which gave a general overview of the implementation of
child-survival strategies in Nigeria showed that child-survival strategies are
not fully implemented by mothers and caregivers in Nigeria and this was
attributed to poor provider-patient relationship of which communication is a
major component. The report gave an estimation that only 17 percent of mothers
in Nigeria practice exclusive breastfeeding, 6 percent of babies sleep under
insecticide-treated nets to prevent mosquito bites that causes malaria, 18
percent of children under 2 years are considered to be fully immunized
according to the recommended guidelines, and some mothers still engage in
unhygienic practices which are dangerous to the health of the child (UNICEF,
2015).
In the course of this study, it
will be determined the perception of mothers on the efforts of healthcare
workers to cause willingness and readiness to implement child-survival
strategies through their attitude and communication skills.
1.2
Statement of the Problem
The persistence of child mortality
in low and middle-income countries has raised the concern of public health.
Major reasons for this persistence has not been readily established which has
led to further studies and diverse research designs to categorize the causes of
persistence in child mortality. Therefore, the findings will pave way for
necessary intervention by pinpointing the source of the problem for adequate
implementation of preventive measures in line with the health problem (Black,
Morris & Bryce, 2003). Child mortality rate in the world has declined since
the inception of Millennium Development Goals (MDGs) as records show; per annum
12.7 million deaths in 1990 have been reduced to 5.9 million deaths as at 2015.
Sub-Saharan Africa still has the highest rate of under-five mortality in all
the regions of the world, although there was improvement in attaining reduction
in mortality rate. Under-five mortality rate decreased from 180 deaths per 1000
live births in 1990 to 83 deaths per 1000 live births in 2015. In Nigeria, a
decrease in child mortality has been experienced over the years. The
improvement was recorded as a reduction from under-five mortality rate of 213
deaths per 1000 live births in 1990 to 109 deaths per 1000 live births in 2015
(UN IGME, 2015).
The persistence of child mortality
has been attributed to various factors among which are inadequate
implementation of child-survival strategies by mothers and caregivers,
socio-economic factors under which lack of necessary resources for care-giving
can be categorized, level of comprehension or efficacy of mothers in order to
take practical steps of the information given, and most importantly, the
process of communication from the health provider to care recipients (Fishbein
& Cappella, 2006).
Inadequate implementation of
child-survival strategies is a major cause of the child mortality as it is
reported that child deaths occur more frequently at the neonatal stage of birth
(WHO, 2015). The inadequacy of implementation could be linked to mothers’
demographic characteristics such as level of education, socio-economic status,
experiences of childbirth and more factors that are attitudinal such as
lackadaisical attitudes, introverted personality, lack of trust and so on
(Alcalde& Elster, 2002). Since mothers are eventual caregivers to the
child, the onus of child-survival is placed on them, thus the responsibility of
implementing child-survival strategies through appropriate decision making (Gilmore & McAuliffe, 2013).
Although mothers are capable of
making decisions of ensuring their child’s survival, the appraisal of
healthcare workers’ influence on mothers’ actions and inactions cannot be
overlooked. Considering this fact, it has been discovered in recent findings
that some healthcare workers exhibit hostile and rude attitudes which often
times demotivate their clients which in case of child healthcare services could
be a result of the inadequate implementation of child-survival strategies (Jorge, Herga & Ahmed, 2001).
Such negative attitudes are responsible for poor service delivery, and in turn
clients are unable to develop self efficacy to perform the required behaviour
necessary for their child’s survival (Mathole, Lindmark, Majoko & Alhberg,
2004).
At this juncture, it is important
to state that the attitude and communication skills of healthcare workers are
important factors to motivate mothers in implementing child-survival
strategies. This study, therefore, aims to determine the perception of mothers
about healthcare workers’ attitude and communication skills. How influential
are healthcare workers in motivating mothers to implement child-survival
strategies? Do they carefully deal with their clients to develop their self
efficacy for the desired behaviour change? These are some of the questions that
will be treated in the course of this study.
1.3
Research Questions
The following research questions
have been raised to be answered in the course of the study and include:
1. What
is the perception of mothers regarding the attitude of healthcare workers
towards child-survival interventions?
2. What
is the perception of mothers regarding how the healthcare workers have
communicated health messages about their children?
3. What
is the perceived readiness of mothers to implement child-survival strategies?
4. What
is the association between the perception of mothers regarding healthcare
workers’ attitude towards them and the readiness of mothers to implement
child-survival interventions?
5. What
is the association between the perception of mothers regarding communication
skills of healthcare workers and mother’s readiness to implement child-survival
strategies?
1.4
Objective
of the Study
The main objective of this study is
to determine mothers’ perception regarding healthcare workers’ attitude and
communication skills towards the dissemination of health messages to motivate
mothers for child-survival strategies adoption. The specific objectives are to:
1. determine
the perception of mothers on attitude of healthcare workers towards
child-survival interventions;
2. determine
the perception of mothers regarding communication skills of health care workers
in disseminating motivational health messages on child-survival interventions;
3. determine
the perceived readiness of mothers to implement child-survival strategies;
4. determine
the association between perceived attitude of healthcare workers and the
readiness of mothers to implement child-survival strategies and
5. determine
the association between perceived communication skills of healthcare workers
and the readiness of mothers to implement child-survival strategies.
1.5
Hypotheses
The study proposes the following
research hypotheses:
H1: There will be a
significant association between mothers’ perception of healthcare workers’
attitude towards child-survival and mothers’ readiness to implement survival
strategies.
H1: There will be a significant
association between mothers’ perception of healthcare workers’ communication
skills of disseminating health messages and mother’s readiness to implement
child-survival strategies.
1.6
Scope
of the Study
The coverage of the study does not
exceed Adeoyo Maternity Hospital, Ibadan which is located in Ibadan North Local
Government Area of the Oyo State. The study will target pregnant and nursing
mothers to determine their relationship with health providers in the facility
and how their relationship has helped to motivate them in implementing
child-survival strategies. The aspect of patient-provider relationship that
this study focuses on is the attitude and communication skills of healthcare
workers and the recipients of the healthcare services would be in a suitable
position to provide answers to the intended question of the study.
1.7 Significance
of the Study
As child mortality persists,
various research findings are pointing to different directions to determine the
main cause of persistence so that the cause could be focused on for
intervention. As a result of diversity in research findings, it is important
that the attitude and communication skills of healthcare workers are assessed
to balance all loose ends. The study determines the perception of mothers
regarding how the attitude and communication skills of healthcare workers have
influenced their readiness to implement child-survival strategies; it also
benefits healthcare workers on how to restructure their behavioural and
communication approach to mothers regarding child survival strategies. This
study can also be referred to for further researches on mothers’ readiness to
implement child survival strategies and healthcare workers’ attitude and
communication skills towards clients on issues regarding child survival.
1.8 Justification
for the Study
This study is
important because it seeks to find out mother’s perception of healthcare
workers’ attitude with regards to infant-survival and communication skills of
healthcare workers to successfully prompt them to take necessary steps in
ensuring their child’s survival. This study investigated the attitude and
communication skills of healthcare workers towards child healthcare services
from the mothers’ perspective because it is suspected that negative attitudes
are exhibited by health providers in Nigeria and this may be responsible for
the high rate of child mortality in the country. This study took a dimension of
focusing on mothers’ concern about healthcare workers’ attitude and
communication skills towards dissemination of child-survival messages because
it has been observed that most studies focus on the output of healthcare
workers which has clouded answers surrounding persistence of child mortality.
It is necessary to determine the feedback of communication processes and
attitudinal display of healthcare workers and the care recipients are best
positioned to grant such answers. With the use of structured research
instrument, this study determined mothers’ position regarding healthcare
workers’ output towards child-survival intervention. Questions that will be
answered with the help of the research instrument for this study include: “Are
mothers yearning for more expertise from healthcare workers?” “Are they
satisfied with the provider-patient relationship?” these are some of the
questions to be revealed in the course of this study.
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