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="" 0.639="" adopt="" adoption="" and="" association="" between="" child-survival="" communication="" healthcare="" mothers="" motivate="" observed="" of="" perceived="" r="" readiness="" significant="" skills="" strategies="" sup="" the="" to="" was="" workers="">2
= 0.394; p <0 .05="" 40.8="" and="" attitude="" communication="" contribution="" df="2;" had="" mothers="" perceived="" r="" readiness="" skills="" sup="" to="">2 = 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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