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SELECTION OF THE TOOL

According to Nieswiadomy, research instrument also called research tools, are the devices used to collect
data. The instrument facilitates the observation and measurement of the variable under the study. The type of
instrument used in a study is determined by data collection method(s) selected. Great care should be taken to
select the most appropriate instrument or instruments. The most common data collection methods used in
survey research is interviews and questionnaires.

For the present study, the technique for data collection was a structured interview schedule consisting of
components relating to preparation of birth process and readiness against any untoward complication.

DEVELOPMENT OF THE TOOL

Steps taken in the development of tool were:

 Extensive review of research and non- research literature was done to opt for appropriate tool.

 Consultation with guide and co-guide.

 Selection of tool after checking its validity and reliability.

DATA COLLECTION TOOLS AND TECHNIQUE

Polit stated that the type of data collection instrument required depends upon the nature of the data to be
gathered to answer the research question.

On the basis of the objectives of the study and the conceptual framework, data collection tool was prepared.
The tool for data collection was Structured Interview Schedule to assess Birth Preparedness and
Complication Readiness status of antenatal mothers.

Developement of the Data Collection Tool

Tool has been developed using various sources-

 Extensive review of research and non-research literature to develop the needed items and scoring
technique for the tool.

 Consultation with Guide, Co-guide and experts in related fields was sought.
 Knowledge of the researcher.

 The items were organised by compliling information from all the above sources.

Description of the tool


In order to achieve the following objectives, the following tool is prepared-
 Part A- Structured Demographic tool to attain demographic characterstics of antenatal mothers.
 Part B- Structured Interview Schedule to assess birth preparedness and complication readiness status of
antenatal mothers.
Part A:- Description of demographic characteristics of 200 antenatal mothers

This part describes the frequency and percentage distribution of demographic characteristics of 200 antenatal
mothers in terms of demographic data of study subjects, that is age of the mother (in years), marital status of
the mother, education of the mother, parity, type of family, residential area, occupation of the husband,
occupation of the mother and religion.

Part B:- Consist of 3 sections related to findings related to BPACR score and its relationships with various
demographic variables.

Section I:- Birth Preparedness and Complication Readiness (BPACR ) score of 200 antenatal mothers
obtained.

Section II:- Birth Preparedness and Complication Readiness (BPACR ) status of 200 antenatal mothers.

Section III:- Relationship of Birth preparedness and Complication Readiness (BPACR) in antenatal mothers
with selected demographic variables

TOOL FOR DATA COLLECTION

 Structured validated Interview Schedule.

This tool has two sections.

Section A - It has demographic characteristics of the antenatal mother.

Section B-It has questions to assess Birth preparedness and Complication Readiness (BPACR tool has been
given by Johns Hopkins Program for International Education in Gynaecology and Obstetrics (JHPIEGO).
Establishing Content Validity and Reliability of the Tool

According to Nieswiadomy, “validity is the ability of an instrument to measure the variable that it is
intended to, measure”.

According to Polit and Beck, “the reliability of an instrument is the degree of consistency with which it
measures the attributes it is supposed to be measuring”

Tools were submitted to seven experts for validation. Among the evaluators one is Director at RHTC center
New Delhi, one doctor from Shri Dada dev Matri avum Shishu Chikitsalaya and rest are experts from OBG.
Experts were asked to review and verify the items for adequacy, clarity, accuracy and meaningfulness.
Minor changes were made on care guide according to the opinion of experts.

Reliability of structured interview schedule (behavior scale) was calculated using cronbach’s alpha formula.
The value was found to be 0.81, indicating high reliability of the tool. Thus the tool was established to be
reliable for the study.

Pilot study

According to Polit and Beck, “pilot study is a small scale version, or trial run, done in preparation for a
major study. People selected for the pilot study were similar in characteristics to the sample that will be used
for the actual study. After obtaining formal permission from the concerned authority, pilot study was
conducted in PHC, Palam, New Delhi on 20 antenatal mothers attending antenatal clinics of primary health
center on 19th of October, 2017. The data were collected from the study subjects us In-depth interviews
guided by trigger questions were conducted in Hindi, later transcribed and translated into English. The pilot
study helped the researcher to get acquainted with the interview techniques. It was found that the research
questions were comprehensive to fulfill the objectives of the study. The pilot study was conducted on 19
October 2017. The purpose of the pilot study was to find out the feasibility of undertaking the study, to
assess the availability of study subjects to decide a plan on statistical analysis.

Trustworthiness of the Data

A key caution in the conduct and analysis of all research data is error. Error may occur anywhere in the
research process and can compromise the outcome and limits the utility of data. (Morse)

An outcome or finding is considered valid if it represents in an accurate and consistent way the phenomenon
that is intended to describe, explain or theorize (Burns and Groove)

Credibility: The Credibility in this research was ensured by the audio-recordings of the in-depth interviews
followed by listening and re-listening to the recordings and writing the transcripts.

Auditability: It includes the clear presentation of all the study elements from the development of the research
questions to the analysis and interpretation of the findings, such that the researcher can follow the steps of
the research process.

Auditability of the present study was ensured by the development of the appropriate research questions and
clear, unbiased and accurate analysis, interpretation and presentation of the data related to the phenomenon
under study.

Fittingness: Fittingness in the quantiitative research is what external validity is to quantitative studies. It is
vivid description of the experiences and problems faced by study subjects.
Fittingness of the present study was ensured by listening and re-listening to the audio recordings of the
phenomenon under study, that is, individual in-depth interviews and writing the transcripts, as well as review
of the translation of the transcripts from Hindi to English by an editor or a language translation expert.

Conformability: It establishes the accuracy of data information and the soundness of the decisions and
judgments in the sequence of the research process from the beginning to the end.

To ensure the conformability, the collected data were transcribed, analyzed, interpreted and presented
accurately without any personal biasness.

Data Analysis

According to Polit and Beck, Data Analysis is the systematic organization and synthesis of research data.
Qualitative analysis is a labor-intensive activity that requires creativity, conceptual sensitivity, and sheer
hard work.

The thematic aspects of the experience can be uncovered from the participants’ descriptions of the
experience by three methods.

-Holistic approach: The researchers view the text as a whole and try to capture its meaning.
-Selective/ highlighting approach: The researchers highlight or pull out statements or phrases that seem
essential to the experience under study.
-Detailed approach: the researcher analyses every statement.

From this study, the selective approach is used. It consists of four major steps:

Searching for “structure of experience”.


Describing how structures are thematic.
Searching for essential and incidental themes.
Explaining and interpreting essential and incidental themes.

Data analysis was done through thematic analysis:

-Editing and re-organization of the transcripts.


-Hindi verbatim was translated into English and edited by a language expert.
-Re-reading and reducing the transcripts into English and edited by a language expert.
-Identified the naming of the themes in the identified statements.
-Identified the essential structure of the phenomenon in the transcribed data.
-Providing insightful interpretations of problems faced with in a social framework.

Procedure for Data Collection

Formal administrative approval was obtained from the concerned authority to conduct final study. The final
study was conducted at RHTC , Najafgargh, New Delhi-110075 from 25 October to 3 November 2017.
Antenatal mothers who met the inclusion criteria were selected using simple random sampling technique.
The purpose of the study was explained to the participants. Confidentiality of their response was assured.
After obtaining their willingness to participate in the study the data were collected from the sample subjects
using a structured interview schedule. The average time taken to administer the tool was 20-30 minutes.

Plan for Data Analysis


According to Parahoo, “data collection is an integrated part of the research design, and involves presenting
the data in an understandable manner”. The data were collected from patients, family members and health
care provider. It was planned to use descriptive and inferential statistics for data analysis. The following plan
for analysis was developed with expert opinion.

Part A:- Description of demographic characteristics of 200 antenatal mothers

This part describes the frequency and percentage distribution of demographic characteristics of 200 antenatal
mothers in terms of demographic data of study subjects, that is age of the mother (in years), marital status of
the mother, education of the mother, parity, type of family, residential area, occupation of the husband,
occupation of the mother and religion.

Part B:- Consist of 3 sections related to findings related to BPACR score and its relationships with various
demographic variables.

Section I:- Birth Preparedness and Complication Readiness (BPACR ) score of 200 antenatal mothers
obtained.

Section II:- Birth Preparedness and Complication Readiness (BPACR ) status of 200 antenatal mothers.

Section III:- Relationship of Birth preparedness and Complication Readiness (BPACR) in antenatal mothers
with selected demographic variables

Summary

Chapter III dealt with methodology adopted for the study. It includes the research design, approach and
description of settings, variables under study, population, sample and sampling technique, development and
description of tool, pilot study, procedure for data collection and a plan for data analysis.

The following chapter 4 provides information on the data collected along with the analysis and the
interpretation of the assessing BPACR of antenatal mothers.

CHAPTER 4
ANALYSIS AND INTERPRETATION

This chapter deals with the analysis and interpretation of data collected from 200 study participants for
quantitative data analysis . The present study was to assess assess Birth Preparedness and Complication
Readiness (BPACR) status in antenatal mothers of Selected Primary Health Centre of New Delhi.

Analysis refers to the method of organizing data in such a way that research questions can be answered. The
analysis of quantitative data deals with information collected during research study, which can be quantified
and statistical calculations, can be computed.

Analysis and interpretation of data were based on structured interview schedule a related to behavior and
attitude by using descriptive and inferential statistics.

Interpretation involves making sense of study results and examining their implications. It also involves
envisioning how the new evidence can be used in clinical practice, and what further research is needed.
ORGANIZATION OF THE DATA

Part A:- Description of demographic characteristics of 200 antenatal mothers

This part describes the frequency and percentage distribution of demographic characteristics of 200 antenatal
mothers in terms of demographic data of study subjects, that is age of the mother (in years), marital status of
the mother, education of the mother, parity, type of family, residential area, occupation of the husband,
occupation of the mother and religion.

Part B:- Consist of 3 sections related to findings related to BPACR score and its relationships with various
demographic variables.

Section I:- Birth Preparedness and Complication Readiness (BPACR ) score of 200 antenatal mothers
obtained.

Section II:- Birth Preparedness and Complication Readiness (BPACR ) status of 200 antenatal mothers.

Section III:- Relationship of Birth preparedness and Complication Readiness (BPACR) in antenatal mothers
with selected demographic variables

PART - A : Description of demographic characteristics of 200 antenatal mothers


This part describes the demographic characteristics of 200 antenatal mothers in terms of demographic data of
study subjects, that is age of the mother (in years), marital status of the mother, education of the mother,
parity, type of family, residential area, occupation of the husband, occupation of the mother and religion.

The data were compiled and presented in form of table and graphs.

Table 1: Frequency percentage distribution of antenatal mothers by their socio- demographic profile (age of
the mother, marital status of the mother, education of the mother, parity, type of family, residential
area, occupation of the husband, occupation of the mother and religion)

(n=200)

Demographic Variables Frequency Percentage Cummula


tive
( n = 200 ) ( in%) percentag
e ( in%)

1. Age of the mother

a) <20 34 17.0 17.0

b) 20-24 24 12.0 29.0

c) 25-29 63 31.5 60.5

d) 30-34 64 32.0 92.5

e) ≥35 15 7.5 100.0

2.Marital status of the mother

a) Married 196 98.0 98.0

b) Unmarried 1 0.5 98.5

c) Widowed 1 0.5 99.0

d) Separated 0 0 99.0

e) Divorcee 2 1.0 100.0

Demographic Variables Frequency Percentage Cummula


tive
( n = 200 ) ( in%) percentag
e ( in%)
Education of the mother

a) Illiterate 23 11.5 11.5

b) Primary Education 18 9.0 20.5

c) Secondary Education 50 25.0 45.5

d) Senior Secondary 40 20.0 65.5


Education

e) Graduate 69 34.5 100.0

a) Post graduate 0 0 100.0

4.Parity

a) Nulliparous 20 10.0 10.0

b) Para 1 65 32.5 42.5

c) Para 2 99 49.5 92.0

d) Para <2 16 8.0 100.0

5. Type of family

a) Nuclear 94 47.0 47.0

b) Joint 94 47.0 94.0

c) Extended 12 6.0 100.0

6. Residential Area

a) Urban area 43 21.5 21.5

b) Rural area 28 14.0 35.5

c) Suburban area 126 63.0 100.0

Frequency Percentage Cummula


tive
Demographic Variables ( n = 200 ) ( in%) percentag
e ( in%)

7. Occupation of the Husband

a) Unemployed 1 0.5 .5

b) Self-employed 68 34.0 34.5

c) Government service 46 23.0 57.5

d) Private service 85 42.5 100.0

8 . Previous Still birth n*= 180

a) Yes 5 2.5 2.5

b) No 175 97.5 100.0

9.Occupation of the mother

a) Housewife 147 73.5 73.5

b) Laborer 8 4.0 77.5

c) Self-employed 30 15.0 92.5

d) Government service 0 0.0 92.5

e) Private service 15 7.5 100.0

10.Religion

a) Hindu 190 95.0 95.0

b) Muslim 10 5.0 100.0

c) Christian 0 0.0 100.0

d) Sikhism 0 0.0 100.0

e) Budhism 0 0.0 100.0

f) Jainism 0 0.0 100.0

g) Other religion 0 0.0 100.0

Table 1 shows that most of the antenatal mother were in the age group of 30-34 i.e. 32%, followed by 31.5%
of them were in the age group of 25-29, 17% were <20, 12% were in the age group of 20-24 and only 7.5%
were ≥35.

Majority of the antenatal mothers were married i.e. 98% (196) and only 0.5% were unmarried and widowed
and 1% were divorced.
Table shows that most of the antenatal mothers 34.5%(69) were graduate while 40(20%) subjects had
completed senior secondary education. 50 (25.0%) had completed secondary education. 23 antenatal mothers
were found to be illiterate (11.5%).
Majority of the antenatal mothers (49.5%) were para 2. 65 (32.5%) were para 1 and only 20 were nulliparous
i.e. 10%.

There were evident that antenatal mothers were equally distributed in terms of the type of family they belong
to i.e. 47% to nuclear and joint family, while only 6% were in extended family.

Most of the antenatal mothers (63%) resides in suburban area and (21.5%) resides in urban area while
merely 14% resides in rural area.

Table also shows that most of the participant’s husband ( 42.5%) were in private service. More than one-
third were self-employed while 23% were in government service and 0.5% were unemployed.

Majority of antenatal mothers did not experience still birth previously i.e. 97.5% (195) while 2.5%(5) have
had a still birth previously.

Most of the antenatal mothers 73.5% (147) were housewives, 15% were self-employed , 7.5% were in
private service and 4% were laborers.

Majority of antenatal mothers were hindu i.e 95%(195) and only 5% were muslims.

PART - B : Section I:- Findings related to BPACR Score


This section displays the results related to Birth preparedness and Complication Readiness status of antenatal
mothers as calculate by various BPACR indicators provide by JHPIEGO. Maternal and Neonatal health
(MNH) Program, Birth preparedness and complication readiness. A matrix of shared responsibilities.
Maternal and Neonatal Health. 2001.

Table 2 : BPACR score of antenatal mothers


n =200

BPACR score Frequency Percent Cumulative Percent

0 18 9.0 9.0

1 11 5.5 14.5

2 14 7.0 21.5

3 37 18.5 40.0

4 42 21.0 61.0

5 28 14.0 75.0
6 27 13.5 88.5
7 23 11.5 100.0
Total 200 100.0

Table 2 depicts that most of the antenatal mothers out of 7 scored 4 i.e 21%(42), 18.5%(37) scored 3,
14%(28) scored 5, 13.5% scored 6/7, 11.5% (23) scored 7, 9% scored 0, 7% scored 2 and 5.5% scored 1 out
of 7.

Section II :- Findings related to BPACR status of antenatal mothers


Table 3 : BPACR status of antenatal mothers

n = 200

BPACR Std
status Frequency Percent Mean Median Mode Deviation

Inadequate 44 22.0 3.91 4.00 4 2.031

Adequate 156 78.0

Total 200 100.0

Table 3 depicts that BPACR status of 156 antenatal mothers i.e. 78% was adequate and 22% (44) was found
to be inadequate.(JHPIEGO. Maternal and Neonatal health (MNH) Program, Birth preparedness and
complication readiness. A matrix of shared responsibilities. Maternal and Neonatal Health. 2001)

Table 4 : Frequency percentage distribution of BPACR indicators of antenatal mothers.


N = 200

BPACR Indicators Frequency Percentage

Awareness about > 8 danger signs of pregnancy 52 26

Awareness about>3 essential ANC care 193 96.5


Identified skilled birth attendant for delivery 162 81

Identified mode of transportation 118 59

Awareness about transportation provided by government in Janani 55 27.5


Shishu Suraksh Karyakram (JSSK)

Awareness about financial assistance provided by government in 41 20.5


Janani Suraksh Yojana (JSY)

Saved money to pay for expenses during pregnancy. 85 42.5

BPACR index was calculated as Σ Indicator/7, which was 50.4%. Table 4 shows BPACR indicators among
study participants. After all the seven indicators calculated with their respective percentages BPACR was
50.4%.

Section III:- Findings related to relationship of Birth preparedness and


Complication Readiness (BPACR) in antenatal mothers with selected
demographic variables

The chi-square test for independence, also called Pearson's chi-square test or the chi-square
test of association, is used to discover if there is a relationship between two categorical
variables.

Fisher's exact test is a statistical significance test used in the analysis of contingency tables.

The test is useful for categorical data that result from classifying objects in two different
ways; it is used to examine the significance of the association (contingency) between the two
kinds of classification.

Table-5 : Relationship between age of the participants and their BPACR status

n = 200

BPACR status Total

Inadequa Statistical
Demographic Variables te Adequate value p value

Age of the <20 12 22 34 X2 = 5.934 0.043*


participants 20-24 4 20 24 (5)

25-29 11 52 63

30-34 12 52 64

≥ 35 5 10 15

Total 44 156 200

*significant at 0.05 level of significance as p ≤ 0.05

Table 5 shows the relationship of age of the participants and BPACR status. Fishers exact was used to test
the relationship. There was a higher proportion of birth preparedness and complication readiness among
those whose age is between 30-34 than those whose age is ≥35. There was a statistically significant
association between age of the participants and their BPACR status as X2 (5) = 5.934, p value- 0.043 which
is less than 0.05 level of significance.

Relationship between age of the participants and their BPACR status


n = 200
60 52 52
50
40
Frequency

30 22 20
20 12 12
11 10
10 4 5

0
<20 20-24 25-29 30-34 ≥ 35
Age of the participants

BPACR status Inadequate BPACR status Adequate

Figure 1 : Relationship between age of the participants and their BPACR status n = 200

Table-6: Relationship between marital status of the mother and their BPACR status
n = 200

BPACR status
Statistical
Demographic Variables inadequate adequate Total value P value

Marital married 44 152 196 x2 = 1.106 1.000


Status of (5)
the mother Unmarri 0 1 1
ed
widowed 0 1 1

divorcee 0 2 2

Separate 0 0 0
d

Total 44 156 200

Not significant at 0.05 level of significance as p > 0.05

Table 6 shows the relationship of age of the marital status and BPACR status. Fisher exact test was used to
test the relationship. There was a higher proportion of birth preparedness and complication readiness among
those who are married. There was no statistically significant association between age of the marital status
and their BPACR status as x2 (5) = 1.106, p value- 1.000 which is more than 0.05 level of significance.

Relationship between marital status of the mother and


their BPACR status n = 200
160 152

140
120
Frequency

100
80
60 44
40
20 1 1 2
0 0 0 0 0
0
married Unmarried widowed divorcee Separated
Marital Status of the mother

BPACR status inadequate BPACR status adequate

Figure 2:- Relationship between marital status of the mother and their BPACR status
n = 200

Table- 7: Relationship between education of the mother and their BPACR status
n = 200

BPACR status

Demographic Inadequ Statistical


Variables ate Adequate Total Value P value

Educatio Illiterate 5 8 13 X 2 = 1.652 0.037*


n of the Primary 6 22 28
mother Education

Secondary 10 40 50
Education

Senior 8 32 40
Secondary
Education

graduate 15 54 69

Post- 0 0 0
graduate

Total 44 156 200

*significant at 0.05 level of significance as p < 0.05


Table 7 shows the relationship of education of the mother and BPACR status. Fishers exact was used to test
the relationship. There was a higher proportion of birth preparedness and complication readiness among
those who were graduate. There was a statistically significant association between education of the mother
and their BPACR status as x2 (5) = 1.652 , p value- 0.037 which is less than 0.05 level of significance.

Relationship between education of the mother and their


BPACR status n = 200
60 54
50
40
Frequency

40 32
30 22
20 15
8 10 8
10 5 6

Education of the mother

BPACR status Inadequate BPACR status Adequate

Figure 3 :- Relationship between education of the mother and their BPACR status
n = 200

Table-8: Relationship between parity of the mother and their BPACR score
n = 200

BPACR status Statistical


value
Demographic inadequ
Variables ate adequate Total P value

Parity Nullipar 13 7 20 X2 = 3.538 0.027*


ous
Para 1 13 52 65 (5)

Para 2 19 80 99

Para > 2 5 11 16

Total 44 156 200

*significant at 0.05 level of significance as p ≤ 0.05

Table 8 shows the relationship of parity of the antenatal mothers and BPACR status. Pearson chi-square was
used to test the relationship. There was a higher proportion of birth preparedness and complication readiness
among those who were para 2 than those who were nulliparous. There was a statistically significant
association between age of the participants and their BPACR status as x2 (5) = 3.538, p value- 0.027 which is
less than 0.05 level of significance with the degree of freedom 3.

Relationship between parity of the mother and their


BPACR score n = 200
90
80
80
70
60 52
Frequency

50
40
30
19
20 13 13 11
7 5
10
0
Nulliparous Para 1 Para 2 Para > 2
Parity

BPACR status inadequate BPACR status adequate

Figure 4 : Relationship between parity of the mother and their BPACR score
n = 200
Table-9: Relationship between type of family of the mother and their BPACR status
n = 200

BPACR status

Demographic inadequ Statistical


Variables ate adequate Total value P value

Type of Nuclear 23 71 94 x2 = 2.265 0.738


family
Joint 17 77 94 (5)

Extende 4 8 12
d

Total 44 156 200

Not significant at 0.05 level of significance as p > 0.05

Table 9 shows the relationship of type of family of the antenatal mothers and BPACR status. Fishers exact
was used to test the relationship. There was a higher proportion of birth preparedness and complication
readiness among those who were in joint family those who were nuclear family. There was no statistically
significant association between type of family of antenatal mothers and their BPACR status as x2 (5) = 2.265
, p value- 0.738 which is more than 0.05 level of significance.

Relationship between type of family of the mother and


their BPACR status n = 200
90
77
80 71
70
60
Frequency

50
40
30 23
17
20 8
10 4
0
Nuclear Joint Extended
Type of family

BPACR status inadequate BPACR status adequate

Figure 5 :- Relationship between type of family of the mother and their BPACR status
n = 200
Table- 10 : Relationship between residential area of the mother and their BPACR status
n = 200

BPACR status

Demographic Inadequat Adequat Statistical


Variables e e Total Value p value

Residential Urban 13 30 43 x2 = 2.894 0.420


Area Area
(5)
Rural 5 23 28
Area

Sub 26 103 129


urban
area

Total 44 156 200

Not significant at 0.05 level of significance as p > 0.05

Table 10 shows the relationship of residential area of the antenatal mothers and BPACR status. Fisher exact
test was used to test the relationship. There was a higher proportion of birth preparedness and complication
readiness among those who were residing in suburban area. There was no statistically significant association
between type of family of antenatal mothers and their BPACR status as x2 (5) = 2.894 , p value- 0.420 which
is more than 0.05 level of significance.

Relationship between residential area of the mother and


their BPACR status n = 200
120
103
100

80
Frequency

60

40 30 26
23
20 13
5
0
Urban Area Rural Area Sub urban area
Residential Area

BPACR status inadequate BPACR status adequate

Figure 6:- Relationship between residential area of the mother and their BPACR status
n = 200

Table- 11: Relationship between occupation of the husband and their BPACR status
n = 200
BPACR Status
Total
Demographic Inadequ Statistical
Variables ate Adequate value p value

Occupation Unempl 1 0 1 x2 = 5.838 0.105


of the oyed
Husband
Self- 15 53 68
employe
d

Govern 6 40 46
ment
service

Private 22 63 85
service

Total 44 156 200

Not significant at 0.05 level of significance as p > 0.05

Table 11 shows the relationship of occupation of husbands of the antenatal mothers and BPACR status.
Fishers exact was used to test the relationship. There was a higher proportion of birth preparedness and
complication readiness among those who were in private service. There was no statistically significant
association between occupation of husbands of antenatal mothers and their BPACR status as x2 (5) = 5.838 ,
p value- 0.105 which is more than 0.05 level of significance

Relationship between occupation of the husband and their BPACR


status n = 200
70
60
50
40
30
20
10
0
Unemployed Self-employed Government service Private service
Occupation of the Husband

Inadequate adequate

Figure 7: Relationship between occupation of the husband and their BPACR status
n = 200

Table-12: Relationship between previous still birth of the mother and their BPACR status
n = 1801
BPACR Status

Demographic inadequa Statistical


Variables te adequate Total value p value

Previous yes 1 4 5 x2 = 4.518 0.165


still birth

No 41 134 175

Total 44 156 180

Not significant at 0.05 level of significance as p > 0.05

Table 12 shows the relationship of the antenatal mothers having previous still birth and BPACR status.
Fishers exact was used to test the relationship. There was a higher proportion of birth preparedness and
complication readiness among those who did not have had any previous still birth. There was no statistically
significant association between previous still birth and their BPACR status as x2 (5) = 4.518 , p value- 0.165
which is more than 0.05 level of significance.

Relationship between previous still birth of the mother


and their BPACR status n = 200
180
154
160
140
120
Frequency

100
80
60 41
40
20 1 4
0
yes No
Previous still birth

inadequate adequate

Figure 8 : Relationship between previous still birth of the mother and their BPACR status
n = 200

Table-13: Relationship between occupation of the mother and their BPACR status
n = 200
BPACR Status

Demographic inadequ Statistical


Variables ate adequate Total value p value

Occupati Housewife 31 116 147 x2 = 1.796


on of the
Labourer 3 5 8 0.480
mother
Self- 6 24 30
employed

Governme 0 0 0
nt service

Private 4 11 15
service

Total 44 156 200

Not significant at 0.05 level of significance as p > 0.05

Table 13 shows the relationship of occupation of the mothers and their BPACR status. Fishers exact was
used to test the relationship. There was a higher proportion of birth preparedness and complication readiness
among those who were housewives. There was no statistically significant association between occupation of
the mother and their BPACR status as x2 (5) = 1.796 , p value- 0.480 which is more than 0.05 level of
significance.

Relationship between occupation of the mother and


their BPACR status n = 200
140
116
120
100
Frequency

80
60
40 31
24
20 6 11
3 5 0 0 4
0
Housewife Labourer Self-employed Government Private service
service
Occupation of the mother

BPACR Status inadequate BPACR Status adequate

Figure 9:- Relationship between occupation of the mother and their BPACR status
n = 200

Table- 14 : Relationship between religion of the mother and their BPACR status
n = 200
Demographic BPACR Status
Variables
Inadequ Adequat Statistical
ate e Total value p value

Religion Hindu 41 149 190

Muslim 7 3 10 x2 = 0.393 0.531

Christian 0 0 0

Sikhism 0 0 0

Budhism 0 0 0

Jainism 0 0 0

Other 0 0 0
religion

Total 44 156 200

Not significant at 0.05 level of significance as p > 0.05

Table 14 shows the relationship of religion of the mothers and their BPACR status. Fishers exact was used to
test the relationship. There was a higher proportion of birth preparedness and complication readiness among
those who were hindu. There was no statistically significant association between religion of the mother and
their BPACR status as x2 (5) = 0.393 , p value- 0.531 which is more than 0.05 level of significance.

Relationship between religion of the mother and their


BPACR status n = 200
160 149
140
120
Frequencyl

100
80
60 41
40
20 7 3 0 0 0 0 0 0 0 0 0 0
0
Hindu Muslim Christian Sikhism Budhism Jainism Other religion
Religion

BPACR Status Inadequate BPACR Status Adequate

Figure 10:- Relationship between religion of the mother and their BPACR status
n = 200

DISCUSSION
PART - A
Findings related to demographic characteristics of 200 antenatal mothers.
A total of 200 women participated in our study with no refusals. Table 1 depicts that the mean age of the
respondents was 24.2 years (standard deviation, SD 2.031) with nearly equal numbers in age group 30-34
and 25-29. One third (1/3rd) of the study participants belongs to the age group 30-34 i.e. 32 % and 25-29 i.e.
31.5%. 17%(34) of antenatal mothers belongs to the age group <20 and 12%(24) belongs to the age group of
20-24 while merely 7.5% belongs to the age group ≥35.
Majority of the antenatal mothers were married i.e. 98% (196).

Almost 1/3rd(34.5%) subjects were graduate while 1/5 th (20%) subjects had completed senior secondary
education. One-fourth (25.0%) had completed secondary education. 23 antenatal mothers were found to be
illiterate (11.5%).

Almost half of the antenatal mothers (49.5%) were para 2. More than one third (32.5%) were para 1 and only
20 were nulliparous i.e. 10%.

There were evident that antenatal mothers were equally distributed in terms of the type of family they belong
to i.e. 47% to nuclear and joint family.

More than half 63% antenatal mothers resides in suburban area and more than 1/4 th (21.5%) resides in urban
area while merely 14% resides in rural area.

Table also shows that nearly half of the participant’s husband ( 42.5%) were in private service. More than
one-third were self-employed(34%) while 23% were in government service.

Majority of antenatal mothers did not experience still birth previously i.e. 97.5% (195) while 2.5%(5) have
had a still birth previously.

Most of the antenatal mothers 73.5% (147) were housewives, 15% were self-employed , 7.5% were in
private service and 4% were laborers.

Majority of antenatal mothers were hindu i.e 95%(195) and only 5% were muslims.

PART - B
Section I:- Findings related to BPACR Score
Results shows that most of the antenatal mothers out of 7 scored 4 i.e 21%(42), 18.5%(37) scored 3,
14%(28) scored 5, 13.5% scored 6/7, 11.5% (23) scored 7, 9% scored 0, 7% scored 2 and 5.5% scored 1 out
of 7. It could be inferred by the following data that one-fourth of the antenatal mothers had scored 4 out of 7.

PART - B
Section II:- Findings related to BPACR status

BPACR status of 156 antenatal mothers i.e. 78% was adequate and 22% (44) was found to be inadequate.
(JHPIEGO. Maternal and Neonatal health (MNH) Program, Birth preparedness and complication readiness.
A matrix of shared responsibilities. Maternal and Neonatal Health. 2001)

In present study BPACR status of 156 antenatal mothers i.e. 78% was adequate and 22% (44) was found to
be inadequate. Studies conducted in India have highlighted poor levels of preparedness among women. In a
study conducted among 312 recently delivered women in 11 slums of Indore, it was reported that less than
half of the mothers (47.8%) were well-prepared.

BPACR index was calculated as Σ Indicator/7, which was 50.4%. Table 4 shows BPACR indicators among
study participants. After all the seven indicators calculated with their respective percentages BPACR was
50.4%. n our study, BPACR was very low which is similar to a study conducted in Ethiopia, poor
comprehensive knowledge and practices of

Birth preparation and complication readiness were reported. Out of 534 women included in the study, only
(47.2%) of the respondents were prepared for birth and its complications. In multivariate analysis,
preparation for birth and its complication was higher among literate mothers, women with parity range of 2
to 4, women with history of still birth and those who were advised about birth preparedness during their
antenatal care follow-up.(7)

PART - B
Section III:- Findings related to relationship of Birth preparedness and
Complication Readiness (BPACR) in antenatal mothers with selected
demographic variables
Relationship between age of the participants and their BPACR status

There was a higher proportion of birth preparedness and complication readiness among those whose age is
between 30-34 than those whose age is ≥35. There was a statistically significant association between age of
the participants and their BPACR status as X2 (5) = 5.934, p value- 0.043 which is less than 0.05 level of
significance.

Relationship between marital status of the mother and their BPACR status

There was a higher proportion of birth preparedness and complication readiness among those who are
married. There was no statistically significant association between age of the marital status and their BPACR
status as x2 (5) = 1.106, p value- 1.000 which is more than 0.05 level of significance.
Relationship between education of the mother and their BPACR status

There was a higher proportion of birth preparedness and complication readiness among those who were
graduate. There was a statistically significant association between education of the mother and their BPACR
status as x2 (5) = 1.652 , p value- 0.037 which is less than 0.05 level of significance.
Relationship between parity of the mother and their BPACR score

There was a higher proportion of birth preparedness and complication readiness among those who were para
2 than those who were nulliparous. There was a statistically significant association between parity and their
BPACR status as x2 (5) = 3.538, p value- 0.027 which is less than 0.05 level of significance with the degree
of freedom 3.

Relationship between type of family of the mother and their BPACR status

There was a higher proportion of birth preparedness and complication readiness among those who were in
joint family those who were nuclear family. There was no statistically significant association between type
of family of antenatal mothers and their BPACR status as x2 (5) = 2.265 , p value- 0.738 which is more than
0.05 level of significance..

Relationship between residential area of the mother and their BPACR status

There was a higher proportion of birth preparedness and complication readiness among those who were
residing in suburban area. There was no statistically significant association between type of family of
antenatal mothers and their BPACR status as x2 (5) = 2.894 , p value- 0.420 which is more than 0.05 level of
significance.
Relationship between occupation of the husband and their BPACR status

There was a higher proportion of birth preparedness and complication readiness among those who were in
private service. There was no statistically significant association between occupation of husbands of
antenatal mothers and their BPACR status as x2 (5) = 5.838 , p value- 0.105 which is more than 0.05 level of
significance.
Relationship between previous still birth of the mother and their BPACR status

There was a higher proportion of birth preparedness and complication readiness among those who did not
have had any previous still birth. There was no statistically significant association between previous still
birth and their BPACR status as x2 (5) = 4.518 , p value- 0.165 which is more than 0.05 level of significance.
Relationship between occupation of the mother and their BPACR status

There was a higher proportion of birth preparedness and complication readiness among those who were
housewives. There was no statistically significant association between occupation of the mother and their
BPACR status as x2 (5) = 1.796 , p value- 0.480 which is more than 0.05 level of significance.
Relationship between religion of the mother and their BPACR status
here was a higher proportion of birth preparedness and complication readiness among those who were hindu.
There was no statistically significant association between religion of the mother and their BPACR status as
x2 (5) = 0.393 , p value- 0.531 which is more than 0.05 level of significance.

Hence, we partially accept the research hypothesis.

CHAPTER - 5

DISCUSSION
This chapter deals with the summary of major findings of the study, conclusion, discussion of the findings,
implication for nursing education, nursing practice and nursing administrations, followed by its limitations
and recommendations for future research in this field.

BPACR is a strategy to promote the timely use of skilled maternal and neonatal care, especially during
childbirth, based on the theory that preparing for childbirth reduces delays in obtaining this care. Despite the
great potential of BPACR in reducing the maternal and newborn deaths its status is not known. In this study
the proportion of women who were prepared for birth was 20.3% in a group of 345 women that had
delivered within two years prior to the survey. This proportion is lower than findings in a study in Indore
city, India by Siddaharth et al. (2010) that found it to be at 47.8%, though they had only assessed three
instead of the six aspects of birth preparedness. The other reason for the difference could be the setting of the
study where Indore is a city with more access to information and the transport network could be better than
Tharaka.

The facilities of delivery could also be near. Deoki (2009) found a higher proportion of preparedness (47.5).
Almost the same level of preparedness was found in Adrigat, Ethiopia (22%) (Mihret et al., 2006). The
setting of the current study was similar to Adrigat in many in that it is rural and has few health facilities.
This could examine explain the similarity of the findings. Jerome et al., (2012) in Mbarara district in Uganda
found a higher level of preparedness (35%) though they studied only four aspects of birth preparedness.

The variables are independently associated with birth plan. Factors like age and religion shows no positive
association with BPACR. While SES class IV shows a positive association. Secondary level of education of
study participants shows a three times positive association with BPACR, similarly husbands who are
educated to secondary or graduate level shows a positive association. Immunization against tetanus only
shows a positive association among antenatal care.

In another study done in Nigeria [8], similar results regarding poor awareness of danger signs (28.3%) were
reported. A study conducted among pregnant and recently delivered mothers in Rewa district of Madhya
Pradesh also highlighted similar findings where BPACR index was found to be 41% [9]. This study revealed
poor level of knowledge about key danger signs and transportation services among mothers. Knowledge
about financial assistance was high. The study showed that majority of the women had planned for skilled
provider and transport but less than half (44.2%) of the mothers planned for saving money which is nearly
similar to our study results. A field trial conducted in the neighboring country of Nepal [4] concluded that
birth preparedness programs could positively influence knowledge and intermediate health outcomes, such
as household practices and use of some health services. It was recommended that such programs can be
implemented by government health services with minimal outside assistance but should be comprehensively
integrated into the safe motherhood program rather than implemented as a separate intervention. In a study
conducted in 11 slums of Indore [10], it was reported that less than half of the mothers (47.8%) were well-
prepared. Although awareness of the mothers about at least one danger-sign of pregnancy and delivery was
not low, being 79.2% and 78.5%, respectively; however, nearly three-fourths of the deliveries took place in
the home. Overall, only 32% of the deliveries were attended by skilled birth attendants. In a study conducted
in PHC of Delhi [11], the results are similar to our study where BPACR was 44%, but in few aspects like
awareness about danger signals, husbands role our study shown better results. Our study showed that SES
class IV, education, husband’s education and immunization against tetanus were associated with having a
birth plan. Woman’s education (P = 0.001) and her spouse’s education (P = 0.02) up to graduate and above
were strong predictors of BPACR which is similar to a study done in rural Uganda where women’s
education and her spouse’s education are significantly associated with BPACR [12]and astudy done in
Kenya [13] also reported women’s education having positive influence on birth preparedness. The finding of
low preference for the government health facilities during obstetric emergencies in the present study
highlights the need for making efforts to improve the quality of care in the government facilities.

Due to better health information Educated women have better pregnancy outcome compared with
uneducated women, are likely to make better choices, develop and implement a birth plan, and are more
socially or financially empowered to make the necessary decisions in case of obstetric emergencies [14]. Our
findings are in agreement with others [15] that many patients are admitted when they already have life
threatening complications. This is a reflection of the quality of antenatal care at peripheral units, the quality
of obstetric care at the referring units and the efficiency of the referral system. The finding that many of the
referrals were in critical condition at admission suggests possible delays in making the decision to refer
(possibly due to difficulty in diagnosis), delays in reaching the referral hospital or poor quality of care at the
referring health facility. Indeed, diagnostic delays and misdiagnosis are responsible for many of the near-
miss mortality and are common among emergency obstetric referrals [16,17].

CONCLUSION

As the level of awareness regarding BPACR is low i.e. 55.7%. in 200 antenatal mothers need to be
empowered to contribute positively to make pregnancy safer. There are many strategies that have been
devised to reduce maternal mortality in India and one has been implementation of birth preparedness
strategy. Studies have shown that birth preparedness has positive influence in reduction of maternal
mortality.The main objective of this study was to assess the Birth preparedness and Complication Readiness
status among antenatal mothers who are attending ANC clinic of primary health centers of New Delhi.This
can be done by raising awareness towards improving education for women.Antenatal care provides a golden
opportunity to all the pregnant women to provide information, education and communication so that they
along with their families can make the correct choices especially in event of any complications arising
during delivery, childbirth or post-partum. This opportunity is missed many a times due to a number of
reasons which should be addressed at the individual, family, community and the health provider’s level.
Repeated IEC awareness programs may be initiated at the PHC towards community participation so that
BPACR status improves for these women. This will be a positive step toward achieving the millennium
development goal 5 of safe motherhood and reduction in maternal mortality.

This study also revealed high level of health facility deliveries among respondents. The high health facility
deliveries and skilled attendant present at birth in this study is in contrast to the Nigeria National averages
from previous surveys [2,35] which had health facilities deliveries (35%) and skilled attendant present at
birth (39%) respectively. In addition other studies, in Enugu, South Eastern Nigeria [27], Southern Ethiopia
[24] and rural Uganda [36] equally showed low level of birth preparedness among nursing mothers and
pregnant women resulting in low health facility deliveries. These studies showed that inadequate preparation
was a key factor influencing the level of birth preparedness as most of the respondents had poor plans
towards birth preparedness; majority of them had not identified skilled care providers or health facility for
delivery or emergencies, made no transportation plan, or made savings nor identified potential blood donor
during emergency situations.Majority of pregnant women in this study did not make plans for potential
blood donor, inadequate plans in relation to identifying potential blood donors can result in serious
morbidity and mortality during emergency situation such as from severe vaginal bleeding during pregnancy,
delivery and even post-delivery. Bleeding events have been reported to contribute significantly to maternal
mortality globally4-5. These unpredictable emergency events can occur in locations were laboratory
facilities may not be readily available to assess blood group and having this information can minimize time
delays in accessing safe and appropriate blood for transfusion needed under such circumstances to save life.

IMPLICATION

NURSING RESEARCH

Nurses are very well into the research but mixed approaches research remains an area less explored by them
and for real and ground level understanding of some important issues of human life.
Similar studies can be replicated in another setting with another group of clients so as to generate more valid
and reliable data.The low level of birth preparedness identified in this study is discouraging and should be
improved by stepping up health education interventions.

This further reinforces the importance of adequate planning and making basic preparations towards delivery
and emergency situation which are usually unpredictable; this study showed that respondents who made
saving plans, registered for ANC and identified skilled attendant towards had higher rates of health facility
deliveries than those who did not. This is the essence of the birth preparedness and complication readiness
strategy to empower women with basic information to plan better, recognize early warning signs and take
necessary steps that will minimize delays in accessing appropriate care from skilled hands and thus
enhancing health facilities deliveries and improve maternal and child health outcomes.

Nursing Education

 Encourage the students to provide Health education in the community regarding Birth preparedness and
complication readiness by communicating with antenatal mothers attending antenatal clinics of PHCs or
during home visitsthrough a teaching or counselling session regarding:

 Importance of BPACR,

 Components of BPACR,

 Essential ANC care.

 Danger signs during pregnancy

 Educate the students regarding the importance of nursing interventions in reducing the maternal
mortality and morbidity.

Nursing Administration

 The finding of the study could serve as a basis for administration to organize in-service education for
nursing personnel and teaching programmes fro nursing students to emphasize the importance of
BPACR for antenatal mothers.
 The nurse administrations are in the pivotal position to formulate policies regarding enhancing the
health education programmed at remote community level and also includes the nursing interventions or
counselling session for mothers coming to antenatal clinics.

 They can also encourage further researches as per the recommendation.

LIMITATIONS

Time duration was less to study the phenomenon for a long period of time.

-Generalization cannot be made as the sample size is small.


-Obtaining the desired sample within a limited time period was a little difficult for the researcher.
-Difficulty in getting the time of subjects as they were busy with their antenatal checkup and investigations.

Strong points of the study

-Study was conducted in natural setting.


-In-depth interview schedule was developed with a number of trigger so as to prevent data loss.
-Considerable sample size for the study.
-Various initiatives were taken to ensure the trustworthiness of data e.g. data were collected by interview
schedules.
-Information Booklet was disseminated related to Birth Preparedness and Complication Readiness in
antenatal mothers.

RECOMMENDATIONS

Based on the results of this study the following recommendations have been made;

1. The ministry of health should do a sensitization on birth preparedness among


women of reproductive age.

2. The ministry of health should improve the level of birth preparedness through

quality ante natal care.

3. The government through all relevant ministries should put in place strategies

to increase the average income of the women and households.

4. The ministry of health should upscale the attendance of ante natal care to a

minimum of four visits per pregnancy.

5.The study can be replicated in different settings with larger samples.

6.A comparative study can be done with different setting.

7.A longitudinal study can be done for a longer span of time so as to understand the phenomenon with more
holistic approach.

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