Applying the Health Belief Model to Maternal Health Care Seeking Behavior of Women in Low Income Urban Areas in Ghana.

1. Dr. Patricia Anafi
SOEPS Seminar
SUNY Potsdam
10/22/2014

2.  Brief Background Information
 Research Questions & Objectives
 Health Belief Model and its usefulness to the topic
 Findings
 Conclusions

3.  Ghana’s MMR is estimated at 451 per 100,000 live
births (GMHS, 2008).
 Ghana has committed to the Safe Motherhood
Initiative since the 1980s & MDG-5 (Witter et al.,
2007).
 Since 2001, the gov’t has embarked on specific
programs to improve maternal health.

4.  2008 GDHS indicates that deliveries with MPs only
increased slightly for the poorest: 19% in 2003 to
23.5% in 2008.
 The big question is:
What forms of health care are received my these poor
pregnant women since many are not showing up at
clinics to receive delivery care with skilled medical
professionals?

6.  Pop ~ 250, 000
 Ga Indigenous people & migrant workers.
 Ga: Men are fishermen & women fishmonger.
 The migrants: traders, some sell on the street of
Accra, “kayaye.”
 Poorest maternal health outcome in Accra with ~
80% of girls become pregnant before age 22.
 Has one polyclinic & maternity home.
 Private clinics

7.  Use of ANC during the 1st trimester remain low (43%) in
urban slums and poor communities.
 Women seek untrained TBAs and spiritualist care
and15% use their services during delivery.
 ANC and preparation cost towards delivery is still a
barrier to seeking medical care.

8.  What are mothers’ and other community members’
perceptions and knowledge about pregnancy, childbirth
and the existing care?
 What forms of health care do women use during
pregnancy and delivery?
 Why do poor urban pregnant women fail to seek
medical care?

9.  To examine the health care decisions and choices that
poor urban pregnant mothers make and make
recommendations to improve maternal health
outcomes in the study area.

10.  Describe mothers’ and community members’
perception and knowledge about pregnancy &
childbirth
 Describe the forms of health care available to mothers
during pregnancy and childbirth.
 Examine the factors that influence care preference

11.  A Qualitative Study
 Data was collected in 2007 and 2010
 In-depths interviews with Midwives, TBAs, Social
workers and mothers (n= 17) (n=5, 12)
 13 focus groups with mothers (n=82) (n 52, 30)

12.  Health Belief Model (Hochbaum, 1958; Rosenstock,
1966)
 Developed in 1950s and most widely used model in
Public Health research and intervention.
 Provides a framework to explain individual health
behavior

13. Perceived
Susceptibility
Behavior

14.  Perceived Susceptibility- how individually personally
feels at risk of a health condition.
Perceived Severity- has to do with a person’s belief about
how serious a health condition will be if no protective
health action is taken

15.  Perceived Benefits: degree to which a person believe
that taking certain protective health action will be
effective in reducing the threat.
 Perceived Barriers: a belief about impediments
(tangible & physiological cost) for the
recommended behavior.

16.  Guided the data collection
 Analysis and interpretation of data
 For example:
Measure pregnant women’s or participants risk
perceptions of pregnancy

17.  Examples of Questions:
1.Are you personally vulnerable to low birth weight if you do not seek
timely or appropriate antenatal care?
2.Are you personally vulnerable to pre-term birth if you do not seek
appropriate antenatal care?
3. What makes a woman more susceptible to pregnancy and delivery
complications?
4. What are the benefits of seeking skilled care during pregnancy &
delivery?
5. What are benefits of seeking other forms of care during pregnancy
& delivery?
6.What are the cost of or barriers to seeking midwifery care or any
other forms of care

18. Medical Care
Traditional
Birth
Attendance
Spiritual
Churches

19.  Threat Perceptions/Knowledge (Perceived
Susceptibility and Severity)
- Pre-existing ill health condition ( e.g. malaria, HIV/AIDS)
-Hypertension, anemia, bleeding (Magadi, 2006, WHO, 2004).
-Lack of exercise during pregnancy
-Infections, pre-eclampsia, eclampsia, induced abortion
-Delay in the delivery of after birth or placenta
-Sleeping on back
-Poor nutrition
- “Asram”
-Curse spell

20.  Perceived Threat- Perceived Susceptibility/Severity to
pregnancy and delivery complications.
 Women who seek professional midwifery care believe
they could have negative pregnancy and delivery
outcomes if they do not seek timely and appropriate
care
 Those who seek TBAs and Spiritual care believe that
they could have pregnancy or delivery complication if a
curse spell is cast on them or evil eye transfers disease
the unborn.

21.  Perceived/Actual Benefits and Barriers influence health care
decisions and preference
Medical care/Midwifery care
- Quality care to manage or avert pregnancy and delivery
complications.
- It worked for close relatives
- Cost associated with seeking medical/midwifery care as a
barrier (Buabeng et al., 2007)
- Negative attitude of medical staff/midwives (Muturi, 2005)
- Fear of C-section
- Long wait time at antenatal clinic

22.  Perceived/Actual Benefits and Barriers influence health
care decisions and preference
TBA/Spiritual care
-Spiritual protection from complication or death during
delivery
- Affectionate care/use of herbal medicine (Wulandari &
Whelan, 2010)
-Cost can be paid in kind or cost of care can be paid later
after delivery
-Worked for close relatives.

23.  The HBM was relevant to understanding why
pregnant women make certain health decision and
what motivate them to take action to maintain
healthy pregnancy and safe delivery.
 However, there are factors such a person’s cultural
and spiritual beliefs and value of social networks
that directly affect maternal heath care seeking
decisions and behavior the original model fails to
recognize.

24.  It also fails to address beliefs that disease like
“asram” caused by evil spirit and complications due
to curse spell-biomedical care is not a treatment
option- such beliefs influence decisions to seek
TBA and spiritual care.
 Social networks such as TBAs, and parents play
important roles regarding making health care
seeking decisions and behavior.

26.  The original study of this presentation was funded by
DANIDA Health Sector Support, Accra. Ghana, and
 The Compton Foundations International Fellowship
 Thanks to Ghana Health Service Greater Accra Regional
Directorate for the Technical Support.