Abstract
This study examined the adequacy of communication
channels available for maternal healthcare in Delta State. Rationalized by the
agenda setting theory, the quantitative and qualitative research designs, the
questionnaire was used to extract relevant information from a sample size of
399 respondents. The study found that the level of awareness of the programmes
was encouraging for FMHCP and HeFAD. The majority of respondents acknowledged
that the communication channels were adequate, and more than half thought they
were effective in influencing participation in the maternal healthcare
programmes. The stakeholders acknowledged the use of multiple
communication channels in spreading awareness of the maternal healthcare
programmes. Therefore, the study recommends the continuous usage of
communication channels to spread awareness of maternal healthcare programmes.
Keywords: Adequacy, Communication,
Channels, Maternal and Healthcare
TABLE
OF CONTENTS
TITLE PAGE - - - - - - ii
DECLARATION - - - - - - iii
CERTIFICATION - - - - - - iv
DEDICATION - - - - - - v
ACKNOWLEDGEMENTS - - - - - vi
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
1.2
Statement of the Problem:
1.3 Objectives
of the Study
1.4 Research Questions:
1.5 Significance of the Study
1.6 Scope of the Study
1.7 Limitations of the Study
1.8 Operational Definition of Terms
CHAPTER TWO
LITERATURE REVIEW
2.1 Introduction:
2.2 Review
of Concepts:
2.2.1 Evaluation:
2.2.2 Health Communication:
2.2.3 Health Communication Channels:
2.2.4
Maternal Healthcare:
2.2.5 Delta State Maternal Healthcare:
2.2.6 Behaviour Change Communication (BCC):
2.3 Review
of Related Literature:
2.3.1 Communication and Maternal
Healthcare:
2.3.2.
Communication Channels and Maternal Healthcare:
2.4 Review of Empirical Studies:
2.5 Theoretical Framework:
CHAPTER THREE
RESEARCH METHODS
3.1 Research Design
3.2 Population
of the Study
3.3 Sample
Size
3.4 Sampling
Technique
3.5 Description
of Research Instrument:
3.6 Validity
of Research Instrument
3.7 Reliability
of Research Instrument
3.8 Method
of Data Collection
3.9 Method
of Data Analysis
CHAPTER
FOUR
DATA
PRESENTATION AND ANALYSIS
4.1 Preamble
4.2 Data Presentation
4.2.1 Socio Demographic Variables
4.2.2 Awareness of Maternal Healthcare Programmes
4.2.3
Participation in Maternal Healthcare Programmes
4.2 .4 Communication Channels of
Respondents
4.2.5 Communication channel that influenced
participation
4.2.6 Perception of Communication Channels
4.3 Qualitative
Data Presentation
4.4 Answering
Research Questions and Discussion of Findings
CHAPTER
FIVE
SUMMARY,
CONCLUSION AND RECOMMENDATION
5.1 Summary
5.2
Conclusion
5.3
Recommendations
5.4 Suggestions
for Further Studies
5.5
Contribution to Knowledge
References
Appendix: Questionnaire
CHAPTER
ONE
INTRODUCTION
1.1
Background
to the Study
In developing countries
of the world, maternal healthcare has become a major part of health programmes
because of the population of women who are in their reproductive age (21
percent), the high maternal mortality rates, insufficient care during pregnancy
and delivery, poorly spaced/unwanted pregnancy, diseases, nutritional problems,
delivery in the hands of untrained persons, among others, (Ethiopia Public
Health Training Initiative, 2003).
As part of its concern
for maternal healthcare, the Nigerian government had at national and states
levels introduced programmes with the intent of reducing maternal mortality
rates (MMR) and encouraging safe motherhood. As listed by Nwagbara (2017), some
of those programmes include Safe Motherhood
Initiative in 1987,
the National Integrated Maternal,
New-born and Child
Health Strategy in
2007, the Nigerian
Midwives Service Scheme
in 2009, the Millennium
Development Goals numbers
4 and 5. Presently, it has also keyed into the
United Nations Sustainable Development Goals (SDGs) 3 which is on maternal
health.
Most of the programmes were interventions aimed at encouraging
healthy life styles and proper utilization of healthcare facilities during
pregnancy, delivery and post partum. While some recorded minimal success,
others failed. However, some factors that inhibit participation or positive response to such interventions have been identified to include: cultural
beliefs and practices; state of government health facilities, attitude of
healthcare providers to pregnant women, poor communication flow, poor health
behaviour of pregnant women, poverty, poor access roads to health facilities,
religious belief and unskilled birth attendants.
Atakiti and
Ojomo (2015, p.170) citing United
Nations Fund for
Population Activities (UNFPA),
also listed the following factors: "negligence to family
planning, HIV and
AIDS, unwanted pregnancy,
finance, lack of
education and ignorance". Other factors are poor
response on the part of pregnant women to intervention programmes, cost of
maternal healthcare services, among others. These factors can be duly handled
through adequate provision of needed facilities and manpower, reduction in the
cost of services, strategic flow of relevant information through available and
accessible channels and introduction of health policies that are people
oriented. The point of interest here is
the aspect of information spread.
Information has been identified as one of the
instruments of sustained development in any society. According to Famulusi and
Owoeye (2014), information sustains development because of its ability to
reduce uncertainty and provision of needed awareness for people to take right
decisions. These decisions cut across health, social, economic, political and
educational aspects of life. They added that circumstances determine the
information needs, accessibility and utilization because people are bound to
seek information to take decisions when things seem to go well or wrong within
and around them.
One major outcome of accessibility and utilization of
information provided is the willingness to respond positively to information
received. In the area of maternal healthcare, it is evident by the increase in
the number of those who deliver at health facilities, consciousness of the
wellbeing of mother and child, continuous patronage of trained healthcare
providers even when the Programmes have ended and reduction in maternal
mortality.
Health communication is the aspect of communication
that is basically concerned with the provision of information that is strong
enough to create awareness, deal with ignorance and boost health knowledge,
improve or change the attitude and behaviour of targets towards a particular
health issue. It is geared towards
reawakening the consciousness of people to adopting a healthy lifestyle and
also to encourage people to take control of their health, participate in
healthcare programmes and utilize new or existing healthcare services.
Since the 1960s till date, health communication has
passed through four major eras. According to O’Suillivan, Yorkler, Morgan and
Merritt (2003)) citing Rimon (2001), they are: the Medical era (1960s)
characterised by “we build, they will come”, the Field era (1970s) “let’s meet
them”, the Social Marketing (1980s) ”they demand, we give them” and the
Strategic era (1990s till date). They
explained that the present Strategic era is majorly characterised with the use
of multiple channels for health communication, integration of health services,
increased attention on evaluation of communication strategies while senders and
receivers now share messages together. This is however made possible when
available and accessible health communication channels are effectively used by
healthcare providers.
Additionally, Famulusi and Owoeye (2014) had noted
that information in itself is not mobile but it needs a vehicle of dissemination
from one man to another and from one distance to another. The vehicles that
move information from one place to the other are referred to as channels. They
could be mass, traditional or social media. Their importance cannot be
overemphasized as they are capable of reaching the targets with information
that could help them take right decisions.
The information is presented in different formats like news, drama,
documentary, songs, jingles, adverts, among others. They are all meant to
attract and reach more persons at the same time.
Abana (2017,p.5) had noted that “adequate flow
of information is
required for knowledge
to be shared by
those who have
more of it
and those who
have less of
it on any
given subject”. Any healthcare
Programmes not backed up with adequate flow of information is bound to hit the
rock or not see the light of the day. Maternal healthcare programmes well
promoted using the right communication channels are powerful enough to provide
the needed knowledge to change the decisions not to participate or use the
available maternal healthcare services. The flow of communication using the
right channels and the right message, to a large extent, can help in reducing
maternal healthcare issues.
Nkanunye and
Obiechina (2017) believe that communication channels can disseminate
information that are strong enough to change whatever negative behaviour,
attitude or ignorance is shown by the people and also achieve set
objectives. They believe that health
communication help people to understand the effect of some practices on their
health and also change the perspective from which certain behaviours and
attitudes are formed. They therefore encourage the dissemination of information
that is strong enough to change people through the communication channels that
are accessible and used by the people.
Contextually, health communication channels are the
means through which awareness and knowledge of the maternal healthcare
programmes are disseminated to the targets with the intent of influencing their
participation and subsequent achievement of the set objectives. In all
healthcare programmes, communication channels play vital roles in promoting and
spreading its awareness and knowledge that could elicit the desired response
from the targets. As observed by Bishwajite, Jose, Junior, Sarker and Sandeep
(2016), the communication media are what bring people together and they have
the capability to cause or influence physical, mental and social change.
Communication channels abound and their effectiveness
varies from society to society. While some are effective in a particular
environment, others are less effective depending on the type that is employed
by the health providers or communicators. They must be perceived by the targets
to be credible, accessible, adequate, culturally inclined and acceptable, among
others. It is of utmost importance that the health communicators employ or use
more than one communication channel. O’Suillivan et al (2003) had suggested
that more than one should be used because the more they are employed, the
better the messages and programmes are understood and responded to. This same
view was also shared by Bishwajite et al (2016, p.4) that “media-mix approach
integrates a synergy effect which produces much more and better results than a
single medium”. Besides, it also enables the targets that are usually from
different background get the needed information.
Furthermore,
health communicators must ensure they employ sound communication strategies at
all times because of their ability to influence the success of the health
Programmes. In line with this, O’Suillivan et al (2003) had noted that sound
communication strategies provide coherence and power needed for the success of
a health Programmes. Therefore, the place of communication channels should not
be overlooked by healthcare providers, communicators and the society at large.
Communication channels choice depends on the nature of
the message to be disseminated and the targets. Imoh,(2013) had mentioned some
communication channels that are often used to include: Mass Media,
interpersonal and intermediate channels and traditional media. While the Centre
for Rural Health (2015) as cited by Nkanuye et al (2017) listed radio,
television, newspaper, flyers, brochure, internet and social media as health
communication channels that are usually adopted by healthcare providers.
As part of its efforts at reducing maternal mortality,
ensuring equitable access to maternal healthcare, the Delta State government
had introduced two major programmes namely the Free Maternal Healthcare Program
(FMHCP) which was launched in November 2007 by the Dr Emmanuel Ewetan Uduaghan
led administration and also the Health for All Deltans (HeFAD) by the
administration of Senator Dr Ifeanyi Okowa in 2016.
As part of its strategies of eliciting positive
response and participation in the maternal healthcare programmes, communication
channels such as radio, television, newspapers, churches, town halls, market
places, posters, town criers and billboards, among others were used to create
awareness and spread knowledge of the programmes. They are assumed to have
created adequate awareness and spread the needed knowledge that influenced the
women of child bearing age to respond positively to the programmes. This is
because of the belief that the set objectives of the programmes were achieved.
The point of interest of this study is to evaluate
some of the communication channels used and to ascertain the extent to which
they influenced the achievement of the maternal healthcare programmes in Delta
State.
1.2
Statement of the Problem:
Adequate provision and utilization of maternal
healthcare result in reduction of mortality and morbidity rates. Hence, it has
become needful for governments and international organizations like the United
Nations (UN) and World Health Organisation (WHO) to introduce maternal
healthcare programmes at reduced or free costs.
In line with the above, the Delta State government had
in 2007 and 2016 introduced two major maternal healthcare programmes, the FMHCP
(2007-2015) during the regime of Dr
Emmanuel Ewetan Uduaghan and HeFAD by the government of Senator Dr Ifeanyi
Okowa (2016 till date). The main objectives of the programmes were basically to
give pregnant women access to adequate healthcare during and after delivery and
also encourage continuous utilization of the health facilities where there are
trained or skilled healthcare providers.
. While the FMHCP was 100 percent free with such
services as : free antenatal, delivery,
caesarean sections and other health needs of pregnant women in 54 designated
government hospitals in the state, the HeFAD is a contributory health
scheme targeted at Deltans, by
implication, it is not totally free compared with the FMHCP.
The two maternal healthcare programmes, though
targeted at pregnant women are people oriented because the safety of a pregnant
woman is beneficial to the larger society. Information about the programmes was
spread by government and some members of the society who had participated or
heard about them. Babatola and Uriri (2013) had suggested that for maternal
healthcare programmes to yield the desired results, government must do a lot on
communication so as to persuade the targets on the genuineness of the
programmes. Besides the issue of genuineness, communication needs a vehicle
through which knowledge and information that are strong enough to encourage
active participation are taken to the targets. Similarly, Sokey,Adjei and
Ankrah (2018) had reiterated that provision of information guarantees the
acceptance of new ideas and also creates the interest to participate.
It is based on the above that Delta State government
deemed it fit to use the radio, television, newspaper, posters, billboards,
State Ministry of Health, State Ministry of Information, community leaders,
churches, among others as communication channels to reach its targets for the
programmes.
Abana (2017) had observed that mobilization is only
possible when the targets are adequately informed and guided to make right
decisions which in turn lead to active participation. Therefore, the place of
communication cannot be overlooked as it is what guides decision making as
regards why, when, how and where to go for antenatal, delivery and post natal
services.
However, Akpomuvie (2010, p.165) had observed that in
Africa, “many people participate in programmes because they
have been asked
to, not because they
understand the very essence of the programmes”. It is here believed that when
there is adequate spread of information through communication channels that are
accepted and accessible by the targets, they are bound to develop the basic
understanding of its benefits to their lives. This understanding in turn
informs their acceptance and participation in such programmes. It is based on
this that the study seeks to evaluate the communication channels and to
ascertain how they were able to influence participation and achievement of the
set objectives.
1.3
Objectives of the Study
The objectives of this study therefore are to:
1.
Determine the awareness of the maternal
healthcare programmes in Delta State.
2.
Ascertain the adequacy of the communication
channels in spreading awareness of the maternal healthcare programmes in Delta
State.
3.
Ascertain the adequacy of the communication
channels in influencing the participation of women of reproductive age in the
two maternal healthcare programmes.
4.
Assess the effectiveness of the communication
channels in achieving the objectives of the two maternal healthcare programmes.
5.
Ascertain women perception of the
communication channels used in the two maternal healthcare programmes.
1.4 Research
Questions:
The research questions that
guide this study are as follows:
1.
What is the level of awareness of the maternal
healthcare programmes among Deltans?
2.
How adequate were the communication
channels in spreading awareness of the maternal healthcare programmes?
3.
How adequate were the communication
channels in influencing participation by women of reproductive age in the two
maternal healthcare programmes?
4.
How effective were the communication
channels in the achievement of the objectives of the two maternal healthcare
programmes?
5.
What is the perception of the women of
reproductive age of the communication channels used in the two maternal
healthcare programmes?
1.5 Significance of the Study
The study is significant to
health communicators, government and pregnant women not only in Delta State,
but in any society or State where maternal healthcare programmes will be
carried out. It would provide better understanding of the relevance of
communication channels in achieving the objectives of maternal healthcare
programmes. The data will also help provide understanding of the communication
channels that are powerful enough to attract targets of maternal healthcare
programmes.
Data from this study will
further help government, healthcare providers and health communicators to see
the need for the evaluation of communication channels used at the end of any
Programme so as to plan better and achieve set objectives. This is because most
maternal healthcare programmes are evaluated based on the number of persons who
participated, the MMR, amount spent and areas covered but little or not much
attention is paid to the specific communication channels that helped to achieve
the set objectives.
1.6 Scope of the Study
The study was limited to
evaluating the communication channels used in achieving the objectives of two
maternal healthcare programmes in Delta State. The targets were women of child
bearing age who are between 18 and 49 years. They are believed to have
participated in the two maternal healthcare programmes at one time or the
other. They are the major targets of the programmes. The study is limited to
evaluating the communication channels that were used in the two maternal
healthcare programmes, effectiveness of the communication channels in achieving
the objectives of the two programmes and perception of the communication
channels by the women that participated.
1.7 Limitations of the Study
As with studies of this
nature, there are bound to be some limitations which could be considered in
future research. First was the issue of data collection which was a herculean
task to reach out to those that participated in the FMCP. This difficulty has
to do with the fact that the programme was carried out about six years before
this study. However, the researcher had to use respondents with children within
the age of 0-10 years. This took care of those that participated in the HeFAD
also.
Secondly, there was dearth
of research materials specifically carried out on evaluation of maternal
healthcare communication channels. The researcher had to use related materials
on previous health programmes.
Thirdly, another limitation
in this study was on time constraints. It would have been possible to spend
more time in the field to reach more respondents.
1.8 Operational Definition of Terms
Maternal Healthcare: In this
study, this refers to care provided and received by women of child bearing age.
It is inclusive of antenatal visits, delivery and postnatal care as provided by
government. It also refers to the care and medical attention given to a woman
during delivery by trained healthcare providers such as doctors, nurses,
matrons, gynaecologists or trained birth attendants. It also extends to the
care she receives up to six weeks after delivery.
Communication Channels: Contextually,
this refers to the channels or means through which the targets of maternal
healthcare programmes are reached with information that are strong enough to
elicit needed response (participation in the maternal healthcare programmes).
They are the means through which information flow from the government (sender)
to the receiver (women of child bearing age). They are accessible by the
targets and must be able to elicit the needed response to the maternal
healthcare programmes. They include radio, television, posters, and
interpersonal communication channels.
Health Communication: In this study, this has to do with the sharing of
maternal healthcare information with women of child bearing age with the intent
of changing their attitude, behaviour and influencing them to participate in
the maternal healthcare programmes. It
also has to do with the reawakening of the health consciousness of women of
child bearing age.
Healthcare Programmes: Healthcare programmes are activities or services put
together to meet a specific health target in any given society. In this study,
the focus was on two maternal healthcare programmes introduced by the Delta
State government to basically take care of the health needs of women of child
bearing age. While one of them (FMHCP) was free, the other (HeFAD) is a
contributory health scheme.
Evaluation: This has to do with the assessment of the communication
channels used in the two maternal healthcare programmes. The evaluation will
help to show if communication channels actually influenced the achievement of
the programmes objectives.
Awareness: This refers to the information that women of child bearing age have about
the two maternal healthcare programmes. The information is based on what they
specifically got through the communication channels used for the two programmes
and not from other sources.
Knowledge: This has to do with what the women of child bearing
age know about the programmes and their health. It goes beyond just getting
informed but it extends to having the basic facts about the programmes that
helped them change attitude and behaviour by embracing or participating.
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