Nursing Research

1. 1

2. Journal Club Presentation
B.P. Koirala Institute of Health
Sciences
Dharan, Nepal
Presented by:
Anju Bista
Department of Maternal Health Nursing
M.Sc. Nursing- 2021
2

3. Perception of pregnant women on barriers to
male involvement in antenatal
care in Sekondi, Ghana
Journal
• Heliyon CellPress
• Volume/Issue: 6/7 e04434
• DOI:
https://doi.org/10.1016/j.heli
yon.2020.e04434
• Received: 27 January 2019
• Accepted: 10 July 2020
• Published Online: 21July
2020
Authors
1. Yvonne Annon
2. Thomas Hormenu
3. Bright Opoku
Ahinkorah
4. Abdul-Aziz Seidu
5. Edward Kwabena
Ameyaw
6. Francis Sambah
3

4. Outlines of Presentation
• Introduction
• Objectives
• Methodology
• Results
• Discussion
• Limitations
• Conclusion
• Recommendation
• Critical Appraisal
4

5. 5
Introduction

6. Introduction (1/3)
Globally, 303,000 women died in 2015 due to
pregnancy related complications, Out of this, 99%
occurred in low and middle-income countries.
The World Health Organization 2016 ANC model
recommendations also highlight the need for
interventions that can promote male involvement
during pregnancy, intra-partum and the entire
postpartum period to ensure improvement in
maternal health of women and children .
6

7. Introduction (2/3)
Evidence from an interventional study in African
countries suggest that the three exposure indexes
consistently and significantly associated with
women's use of Skilled Birth Attendants (SBAs)
are husband's involvement in decision-making,
couple's discussion and planning within the
household, and having received counseling on
birth preparedness during ANC.
7

8. Introduction (3/3)
The prospects of getting men to be active with
ANC is a function of women's perception about
the need for them to be accompanied by their
partners. Women have a key role to play because
it is only when they are fully convinced about
the need to have their partners' company for
ANC that they will think of how best to
communicate with their partners in that regard.
9

9. Objective
• This study aimed to find out the perception of
women on the barriers to male involvement in
antenatal care in sekondi, Ghana.
10

10. 11
Methodology

11. Methodology (1/12)
• Study Design: Cross-sectional study
• Study Area: five fishing communities of
Sekondi, Ghana
• Study Population: Pregnant women in
selected fishing communities in sekondi,
Ghana.
• Study Period: 15th may to 22nd may 2017
12

12. Methodology (2/12)
• Sampling technique:
Non probability accidental sampling
technique
• Sample Size: 328
 Obtained from Krejcie and Morgan
13

13. Methodology (3/12)
• Inclusion Criteria: Pregnant women who
belongs to fishing communities and made at
least one ANC visit in the course of pregnancy.
• Exclusion Criteria: Adolescent (15-19 years)
pregnancies.
14

14. Methodology (4/12)
• Research Instrument: Pretested , Self
developed Questionnaire was used for
collecting data.
• Made up of five main section.
Section A: Socio-demographic characteristics.
Section B: Level of male involvement in ANC.
Section C: Socio-demographic barriers.
Section D: Socio- cultural barriers.
Section E : Health care environment factors.
15

15. Methodology (5/12)
• On the level of male involvement in ANC,7
questions were measured .
• Composite involvement index score was
driven, with higher index scores indicating
“high involvement” and low scores indicating
“low involvement”.
• Respondents who chose 0-3 “yes” was put in
category “low involvement”.
• Respondents who chose 4-7 “yes” in high
involvement.
16

16. Methodology (6/12)
• Instrument was developed based on
literatures on barriers to male
involvement and inspection by experts in
maternal health.
• To ensure validity of instruments, it was
tested through Construct validity, Face
validity and Content validity.
17

17. Methodology (7/12)
• Kuder - Richardson formula (KR-21) was used
for internal consistency reliability coefficient
of the items on level of male involvement in
ANC, socio cultural and health facility factors
and the values were 0.72,0.71 and 0.75
respectively.
18

18. Methodology (8/12)
• Ethical approval:
This study was approved by the Ethical
Review Board of University of Cape Coast
with the code ID: UCCIRB/A/2016/122
 All participants were ensured about the
matter of confidentiality and privacy.
Written and verbal consent was obtained
from all participants and partner’s
permission was also obtained.
19

19. Methodology (9/12)
• Data collection method:
Data collection was done in households at
convenient location far away from hearing
distance of third party.
Items on questionnaire were read to some
respondents while other were provided self
administered questionnaire depending on
literacy and competence in English
language.
20

20. Methodology (10/12)
• Data Processing and Analysis
Each completed questionnaire was checked
for accuracy and consistency of the
responses to the items on the instrument by
Bilayer Overtone Analysis Instrument
(BOA).
Statistical analysis of data was done by using
statistical products and service solutions
(SPSS), version 21
21

21. Methodology (11/12)
• Data Processing and Analysis
Use of both descriptive (frequencies and
percentages) and inferential statistics (binary
logistic regression).
The choice of this statistical technique was
influenced by the fact that, the dependent
variable (male involvement in ANC) was
categorized into two groups ‘low involvement’
and ‘high involvement’.
22

22. Methodology (12/12)
The independent variables were measured
on both categorical and continuous scales.
The results were interpreted using odds
ratio (OR) and p-values at 95% confidence
interval.
23

23. 24
Results

24. Results
• The final sample size was 300 based on
the response rate (91%).
25

25. Table 1.Socio-demographic
characteristics of the respondents
Variables Frequency Percentage
Age
20-29
30-39
40-49
106
127
67
35.3
42.3
22.3
Marital status
Married
Cohabiting
Separated/divorced
165
93
42
55.0
31.0
14.0
Educational level
Primary
Junior secondary
Senior secondary
Tertiary
No formal education
34
148
59
19
40
11.3
49.3
19.7
6.3
13.3 26

26. Table 1.Socio-demographic
characteristics of the respondents
Variables Frequency Percentage
Occupation
Unemployed
Self-employed
Civil/public servant
46
229
25
15.3
76.3
8.3
Religion
Christianity
Other
284
16
94.7
5.3
Number of children
1child
2-4children
5 or more children
79
178
43
26.3
59.3
14.3
Living with partner
No
Yes
107
193
35.7
64.3

27. Figure 2.Level of male involvement
in ANC
28

28. Table2.Socio-demographic barriers
to male involvement in ANC
variables Wald B OR P-Value 95% CI
Age of Partner
20-29
30-39
40-49
50-59
Ref
1.58
0.65
3.08
-0.53
-0.39
-0.76
0.59
0.68
0.47
0.21
0.41
0.03**
0.26 -1.35
0.26 – 1.76
0.35 – 0.86
Marital status of partner
Married
Cohabiting
Separated/divorced
Ref
1.19
4.85
-0.40
- 1.05
0.67
0.35
0.28
0.03**
0.33 – 1.38
0.14 – 0.89
Education of partner
No formal education
Primary
JHS
SHS
Tertiary
Ref
0.57
0.02
0.04
1.38
0.43
0.07
0.13
- 0.94
1.54
1.08
1.14
0.39
0.45
0.90
0.85
0.24
0.50 – 4.74
0.34 – 3.41
0.30 – 4.28
0.08 – 1.87
29

29. Table2.Socio-demographic barriers
to male involvement in ANC
variables Wald B OR P-Value 95% CI
Partner occupation
Unemployed
Self employed
Civil/public servant
Ref
1.45
0.17
- 0.98
- 0.36
0.38
0.70
0.23
0.68
0.08 - 1.85
0.13 – 3.79
Religion of partner
Christianity
other
Ref
0.13 - 0.10 0.91 0.72 0.54 – 1.53
No of children
1children
2-4 children
More than5
Ref
0.06
0.43
0.09
- 0.36
1.09
0.70
0.81
0.51
0.53 – 2.26
0.24 – 2.05
Living with partner
No
yes
Ref
6.00 0.78 2.17 0.01** 1.17 – 4.04
30

30. Socio-demographic barriers to male
involvement in ANC
Aged 50–59 years were less likely to report
high male involvement in ANC compared to
those whose partners were aged 20–29 years
(OR = 0.47, 95% CI = [0.35–0.86], p = 0.03).
Respondents whose partners were separated/
divorced were less likely to report high male
involvement in ANC compared to those whose
partners were married (OR = 0.35, 95% CI =
[0.14–0.89, p = 0.03).
31

31. Socio-demographic barriers to male
involvement in ANC
In relation to living arrangement,
respondents whose partners were living
together with them were about two times
more likely to report high male involvement
in ANC compared to those who did not live
with their partners (OR = 2.17, 95% CI =
[1.17–4.04], p= 0.01).
32

32. Table 3.Socio-cultural barriers to
male involvement in ANC
Variables Wald B OR P- Value 95 % CI
Ridicule from friends does not allow husbands to accompany their partners
for ANC
Disagree
Agree
Ref
0.65 0.31 1.36 0.42 0.64 – 2.88
It is unacceptable for a man to carry out household chores for his wife when she is
pregnant
Disagree
Agree
Ref
4.79 - 1.02 0.36 0.03** 0.15 – 0.90
33

33. Table 3.Socio-cultural barriers to
male involvement in ANC
Variables Wald B OR P-value 95% CI
In our culture, men are prohibited from escorting their wives for ANC
Disagree
Agree
Ref
3.23 1.44 4.23 0.07 0.88 – 20.3
Even if a woman is pregnant, she still has to perform her normal duties in the home
Disagree
Agree
Ref
0.13 - 0.10 0.91 0.72 0.54 – 1.53
Husbands will be seen as being controlled by their partners if they escort their wives
to ANC
Disagree
Agree
Ref
5.56 - 0.80 0.45 0.02** 0.23 – 0.88
34

34. Socio-cultural barriers to male
involvement in ANC
Respondents who agreed that it is
unacceptable for a man to carry out
household chores for his wife when she is
pregnant were less likely to report high male
involvement in ANC compared to those who
disagreed (OR = 0.36, 95% CI = [0.15–
0.90], p = 0.03).
35

35. Socio-cultural barriers to male
involvement in ANC
Respondents who agreed that husbands
will be seen as being controlled by their
partners if they escort their wives to ANC
were less likely to report high male
involvement in ANC (OR = 0.45, 95% CI
= [0.23–0.88], p = 0.02).
36

36. Table 4.Health facility barriers to
male involvement in ANC
Variables Wald B OR P- Value 95% CI
Cost of healthcare prevents husbands from accompanying their partners for
ANC
Disagree
Agree
Ref
0.03 - 0.07 0.94 0.87 0.41 – 2.12
Long waiting time at the health facility does not allow men to accompany
their partners for ANC
Disagree
Agree
Ref
7.50 - 0.57 0.57 0.01** 0.38 – 1.68
Ridicule from health workers prevents husbands from accompanying their
partners for ANC
Disagree
Agree
Ref
0.35 - 0.22 0.80 0.56 0.38 – 1.68
37

37. Table 4.Health facility barriers to
male involvement in ANC
Variable Wald B OR P-value 95% CI
Not involving husbands in anything that occurs at the health facility
during ANC makes them reluctant to accompany their partners to the
facility
Disagree
Agree
Ref
0.19 0.19 1.21 0.67 0.52-2.82
Male partners do not have enough time to accompany their partners for
repeated ANC visits
Disagree
Agree
Ref
4.22 - 0.49 0.61 0.03** 0.39 – 0.98
38

38. Table 4.Health facility barriers to
male involvement in ANC
Variable Wald B OR P-value 95% CI
Lack of space to accommodate male partners in ANC clinics
makes it difficult for them to attend ANC with their partners
Disagree
Agree
Ref
0.81 0.42 1.52 0.37 0.61- 3.75
Distance to health facilities makes it difficult for male
partners to attend ANC with their partner
Disagree
Agree
Ref
3.99 0.93 2.13 0.04** 1.19 – 6.36

39. Health facility barriers to male
involvement in ANC
Respondents who agreed that long waiting
time at the health facility is a health facility
factor that influences male involvement in
ANC were less likely to report high male
involvement in ANC compared to those
who disagreed (OR = 0.57, 95% CI =
[0.38–0.85], p = 0.01).
40

40. Health facility barriers to male
involvement in ANC
Respondents who agreed that male partners
do not have enough time to accompany
their partners for repeated ANC visits were
less likely to indicate high male
involvement in ANC (OR = 0.61, 95% CI =
[0.38–0.98], p = 0.03).
41

41. Health facility barriers to male
involvement in ANC
Respondents who agreed that distance to
health facilities is a health facility factor that
influences male involvement in ANC were less
likely to report high male involvement in ANC
compared to those who disagreed (OR = 2.13,
95% CI = [1.19–6.36], p = 0.04).
42

42. 43
Discussion

43. Discussion (1/3)
• This study found that male involvement in
ANC was high in Sekondi which was similar
with the study counducted by Bhatta et al, Doe
and Kwambai et al.
• On the other hand, the finding of the current
study was contrary to the findings of the
studies by Awasthi et al, Secka et al, Nantamu
and Craymah et al who found that male
involvement in ANC was low.
44

44. Discussion (2/3)
• On the socio-demographic barriers to male
involvement in ANC, age of partner, marital
status, religion, and living arrangement
statistically influenced the level of male
involvement in ANC.
• To a greater extent, socio-demographic traits of
an individual greatly influence his/her thinking
patterns, choices and preferences in life.
• A man’s biological and social age, marital status
and religion can immensely affect his decision to
or not to involve himself in ANC.
45

45. Discussion (3/3)
• Regarding health facility factors, long waiting
time at the health facility, not involving
husbands in anything that occurs at the health
facility during ANC, accommodative
problems and distance to health facilities are
barriers to male involvement in ANC.
• It support the findings of Nantamu, Doe,
Nanjala and Wamalwa. All researchers found
similar issues as a contributing factor to low
male involvement in ANC.
47

46. Strengths
• The decision to explore all the possible
barriers to male involvement in ANC
(socio-demographic, socio-cultural and
health facility factors) makes the study very
comprehensive.
• High response rate and the relatively large
sample size.
48

47. Limitations
• Cross-sectional study design that makes it
impossible to provide a causal relationship.
• Study relied upon husband's behavior from
the report the women gave, without including
direct observations.
• There is the possibility of social desirability
bias.
49

48. Conclusion(1/1)
• The findings revealed that there was high
male involvement in ANC in Sekondi. There
were socio-demographic, socio-cultural and
health facility barriers to male involvement in
ANC.
• Understanding various barriers to male
involvement in ANC will guide to come out
with strategies that will address these barriers
instead of trying to deal with those that have
no influence.
50

49. Conclusion(2/2)
• Further studies should be conducted to
employ qualitative or mixed method approach
to unravel the fine distinction surrounding
socio-demographic, socio-cultural and health
facility barriers to males involvement in ANC.
51

50. CRITICAL
APPRAISAL

51. Title of the Study
Strengths
Title is clear, concise and informative.
Contains 15 words.
Population: mentioned.
Outcome variable: mentioned.
Study design: mentioned.
53

52. Abstract (1/2)
Strengths
At the beginning of the article.
contains 293 words.
Purpose of the research, the principal results
and major conclusions were stated briefly.
Informative, clear, adequate, and concisely
summarized.
keywords are mentioned.
54

53. Abstract (2/2)
Limitations
Unstructured
Use of abbreviations (ANC)
55

54. Introduction (1/3)
Strengths
Adequate background information.
Concept clearly stated.
Consistent with the title of the study.
Objectives of the study specified.
56

55. Introduction (2/3)
Strengths
Relevant literature review was done.
Citation done properly.
Conceptual framework mentioned.
57

56. Introduction (3/3)
Limitations
Abbreviation of Antenatal care was
repeated
Abbreviation was not mentioned in first
use for sustainable development goals
58

57. Methodology (1/5)
Strengths
Study design: appropriate.
Study area: stated.
Study population: clearly stated.
Study period: stated.
Sample size: clearly stated.
Sampling technique: clearly stated
(accidental sampling technique).
59

58. Methodology (2/5)
Strengths
Inclusion criteria: mentioned.
Exclusion criteria: mentioned.
Research instrument: valid and reliable
tool was used.
Ethical approval: mentioned.
Data collection method: mentioned.
Data analysis: mentioned.
60

59. Methodology (3/5)
Strengths
 Both verbal and written informed consent
were taken.
Verbal consent were taken form husband as
well.
Confidentiality and privacy of participants
were mentioned
Researcher avoided information bias
61

60. Methodology (4/5)
Limitations
Study population : rational for selecting
fishing communities pregnant women was
not justifiable.
Five fishing communities were included
but sample number form each communities
were not mentioned.
62

61. Methodology (5/5)
Limitations
Research Instrument: available in English
language only , was not translated in local
language.
Data collection technique: not appropriate
63

62. Results (1/3)
Strengths
• Results were explained and well-chosen
tabulated and graphical form presentation of
results
• Complete, concise and insightful analysis
64

63. Results (2/3)
Strengths
Explanations: consistent and understandable
Use of tables: Table headings, table number
clearly stated
65

64. Results (3/3)
• Limitations:
Table number present but total number of
sample in table was not mentioned.(n = 300)
There is no any option for primi mother in
socio demographic section.
66

65. Discussion
Strengths
All major findings interpreted and discussed.
Most of the research findings are compared
with prior research and cited properly.
Possible reasons for inconsistent findings are
also clearly stated.
67

66. Discussion
Limitations :
 use of we, our study instead of this
study
Citations from studies conducted from
1970 to 2009 were used, i.e. few recent
studies included.
68

67. Limitations
Strengths
Strengths of study are mentioned
Study limitations are clearly mentioned.
69

68. Conclusion
Strengths
• Conclusion is drawn
in accordance with
the study objectives
Limitations
• Recommendation is
also included in
conclusion section.
70

69. Presentation of Report (1/2)
Strengths
Well written and organized.
Abstract adequately summarized.
Presented in sequence.
No use of jargons.
No irrelevant details
73

70. Recommendations(1/2)
Study would have been better if :
Instead of writing male involvement
,husband’s involvement could have been
written.
Sample were taken form different
communities.
74

71. Recommendations(2/2)
Study would have been better if:
Pregnant women who were not living with
their partner and divorced could be kept in
exclusion criteria.
If included primi and multiparous mother as
sample , the result could be applicable in both
pregnancy.
75

72. 76

73. 77