Facilitation of behaviour change communication process for maternal, newborn, and child health at primary health care level of midwifey practice in Kaduna State, Nigeria.

Abstract

Background: Nigeria’s unacceptably high maternal and child mortality rates are related, among other things, to the people’s lack of access to appropriate information to assist them in making decisions about their health, and to promote their utilization of available services. Midwives’ skills for result-oriented client education and friendly services are fundamental to women’s behaviour change for favourable maternal and child outcomes. Aim: The purpose of the study was to appraise and facilitate behaviour change communication (BCC) by midwives at primary health care level of maternal, newborn, and child care.

Methods: Action research, with concurrent transformative mixed method data collection strategy, was adopted for the study, and the maximum variation sampling technique was employed to recruit participants. Fifteen, representing sixty-eight percent of the twenty-two recruited midwives continued through the three phases of the study. The diagnostic, intervention, and monitoring phases of the study were arranged in line with the objectives of the study, and each succeeding phase built on the findings of the previous one. At the diagnostic phase, the strengths and weaknesses in behaviour change communication by midwives in the facilities, and the appropriate solution to bridge the gaps were identified at a three-day search conference. At the intervention phase, a training manual was developed. A capacity building programme, made up of a training component for the midwives, and an interactive session between the government and the midwives, was designed and implemented at a three-day workshop. The monitoring phase comprised the midwives’ hands-on practice, using the developed training manual, core messages, and interpersonal communication (IPC) observation checklist for three months. The implementation of the

midwives’ action plans in their respective work places was also monitored. Both qualitative and quantitative data collection and analysis methods were utilized at each phase of the study.

Results: The diagnostic phase revealed that midwives lacked the essential knowledge, skills and attitudes for effective behaviour change communication activities in the facilities. Health talks were seen as midwives’ responsibility, however, they were unplanned, difficult, and given routinely, providing inadequate information, and without focus on behaviour change. Socio-cultural and environmental factors such as inadequate staff, material and time were barriers. The midwives’ knowledge, attitudes, and skills responded positively and significantly to the training, to hands-on practice, and to the use of reminders at their workplaces. In addition, midwives were able to network for support from the community and other workers in the facilities, to implement their action plans. Through exhibition of innovative behaviour in the implementation of their action plans, the midwives in most of the facilities were able to effect changes to facilitate utilization of maternal and child health (MCH) services. The gross shortage of staff, staff transfers, lack of drugs and supplies, heavy workload, and midwives’ lack of trust in their employers, however, hindered optimum implementation of some of the plans.

Conclusion: The women living in the communities where the midwives worked, desired to know more about the role of midwives and to have competent ones; while the midwives were willing to assist their clients to adopt desired health and health-seeking behaviours, because they were duly recognized and empowered during the project. The study showed that the grave disconnection between the midwives and the government policies / programmes to facilitate behaviour change, and promote maternal and child health, can be corrected. The findings and recommendations have implications for practice, education, research and policymaking in Kaduna State and similar settings.