EVALUATION OF MATERNAL HEALTHCARE COMMUNICATION CHANNELS IN DELTA STATE
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
1.2 Statement of Problem - - - - - - 8
1.3 Objective of the Study - - - - - - 10
1.4 Research Questions- - - - - - - 11
1.5 Statement of the Hypothesis - - - - - 12
1.6 Significance of Study - - - - - - 13
1.7 Scope of the Study - - - - - - 14
1.8 Definition of Key Terms - - - - - 15
CHAPTER TWO: LITERATURE REVIEW
2.1 Introduction - - - - - - - - 18
2.2 Conceptual Framework - - - - - - 33
2.3 Theoretical Framework - - - - - - 45
2.4 Empirical Review - - - - - - - 50
CHAPTER THREE: RESEARCH METHODOLOGY
3.1 Research Design - - - - - - 56
3.2 Population of the Study - - - - - - 57
3.3 Sample Size - - - - - - - - 57
3.4Sampling Technique - - - - - - 58
3.5 Method of Data Collection - - - - - 58
3.6 Technique for Data Analysis - - - - - 59
3.7 Model Specification and Variable Definition - - 59
3.8 Measurement of Variables - - - - - 59
CHAPTER FOUR: PRESENTATION AND ANALYSIS OF DATA
4.1 Presentation of Data - - - - - - 60
4.2 Discussion of Findings - - - - - - 79
CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS
5.1 Summary - - - - - - - - 80
5.2 Conclusion - - - - - - - 80
5.3 Recommendations - - - - - - - 93
References - - - - - - - - 95
Appendix - - - - - - - - 98
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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