A description of midwives’ perceived roles in health educating pregnant women at primary healthcare clinics in a Sub-District of eThekwini, KwaZulu-Natal, South Africa.

Abstract

Introduction and background Antenatal care (ANC), the care preceding birth, is described as a careful, systematic assessment and follow up of pregnant women through their pregnancy, culminating in the delivery of the foetus (Al-Ateeq and Al-Rusaiess, 2015). Health education has shown it can result in better pregnancy outcomes (Al-Ateeq et al., 2015). ANC health education is frequently conducted in PHC clinics by midwives (Phillips, 2014; Susuman, 2015), but with the advent of mHealth, it is not confined to the PHC setting (Skinner et al., 2018; Susuman, 2015). Aim/Purpose The aim of the study was to describe midwives’ perceived roles in maternal health education and their acceptance of mHealth in health educating pregnant women during and between antenatal visits at Primary Healthcare clinics in a sub-district of EThekwini, KwaZulu-Natal, South Africa. Methodology A quantitative approach was used, with an explorative and descriptive design, framed within a merged model of Donnabedian’s quality framework and the Unified Theory of User Acceptance of Technology (UTAUT) model. Purposive sampling selected a sub-district of eThekwini, and the participating midwives and unit managers. Data collection occurred over three and a half weeks, in February 2020, using a self-administered questionnaire with the midwives and a researcher-developed survey of the health education landscape with the unit managers. The four-part questionnaire included two validated scales to measure health education (Aldossary et al., 2013) and mhealth (Yakubu et al., 2019). Findings were grouped according to the sections of the questionnaire, namely Section A: Demographics, Section B: Roles and perception of health education, Section C: Acceptance of technology and mHealth in the PHC clinic and Section D: Actual health education conducted. Data was entered into IBM SPSS version 24, and descriptive and inferential statistics calculated. All ethical considerations were adhered to. Results Response rate was 88.5% (n= 92) for the completion of the self-administered questionnaire and 16 surveys of the health education landscape of the PHC clinics The mean age of the respondents was 39 years, with the majority of midwives being female (87%). Responsibility of midwives (m= 18.17/24 [CI95% 17.68-18.67]) was the highest of the subscales, emphasising the important role that midwives play in health education towards pregnant women. Performance Expectancy (m= 16.61/20 [CI95% 15.92 – 17.29]) was the highest of the mHealth subscales. Significant differences were found in the midwives >50 years of age for responsibilities of midwives, and in the male midwives for responsibilities of midwives and perceptions of patient’s responses to health education and midwives perceptions of their role in delivery of health education. During the survey of the health education landscape in the PHC clinics (n=16), the midwives mainly focused on ANC care with 730 sessions conducted in PHC clinics, but less mHealth registrations (n=22, 23.9%). Maternity health policies were available in all clinics (n=16), but just over half (n=10; 62.5%) were able to provide policies on mHealth. Conclusion The study identified both structure and process related information in its description of midwives’ perceived roles in maternal health education and their acceptance of mHealth in health educating pregnant women during and between antenatal visits. Structurally, mHealth polices need greater visibility in the clinics and increased facilitating conditions, such as support for the midwives for mHealth. In particular, midwives older than 50 years and male midwives could add further resistance to the seamless implementation of health education, when utilising both digital and face-to-face approaches. However, from the process perspective of quality care, the midwives showed positive perceptions towards both their roles and responsibility in health education, with high Performance Expectancies of a mHealth application to deliver maternal health education. The level of Performance Expectancy can be drawn on in the COVID-19 pandemic, to ensure continued maternal and neonatal health, despite constraints brought about by social distancing and thereby mitigate against increased maternal mortality rates. Recommendations Studies to identify mitigating circumstances and barriers towards mHealth applications as well as further investigation towards male midwives perceptions of their roles, and responsibilities towards maternal health education. Limitations The use of one district resulted in a small number of clinics and respondents. During this study the Chronbach α scores of the highest subscale ‘responsibilities of midwives’ was low (α= 0.37), thereby affecting the generalisability of that subscale to the population of studies.