Cues to action to prevent mother-to-child transmission of HIV

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CHAPTER 2 Conceptual framework of the study

INTRODUCTION

This chapter discusses the conceptual framework used in the study. A conceptual framework broadly presents an understanding of the phenomenon of interest, and reflects the assumptions and philosophic views of the model’s designer (Polit & Beck 2008:141). A model “is frequently described as a symbolic depiction of reality. It provides a schematic representation of certain relationships among phenomena, and it uses symbols or diagrams to represent an idea” (Brink et al 2006:23). The phenomena under study were factors affecting HIV-positive pregnant women’s utilisation of prevention of mother-to-child transmission services. The conceptual framework enabled the researcher to discover what was known or not known about the topic of interest in order to conduct research that added to the body of knowledge and also lay the foundation of the study (Polit & Beck 2006:88). The researcher used the Health Belief Model (HBM) as the conceptual framework for this study.

HEALTH BELIEF MODEL (HBM)

The HBM was developed to provide a framework for understanding why some people take specific actions to avoid illness, whereas others fail to protect themselves (Dennill et al 1999:156; Stanhope & Lancaster 2000:271). In addition, the HBM postulates that health-seeking behaviour is influenced by a health problem and the value associated with actions aimed at reducing the threat (Polit & Beck 2008:150). The HBM is beneficial in assessing health protection or disease prevention behaviours.It is also useful in organising information about clients’ views on the state of health and what factors may influence them to change their behaviour. When used appropriately,the model provides organised assessment data about clients’ abilities and motivation to change their health status. Health education programmes can be developed to better fit the needs of clients/patients (Salazar 1991 in Stanhope & Lancaster 2000:271-272).The HBM is considered one of the most influential models in health promotion
(Hochbaum 1956:107; Strecher & Rosenstock 1997:227). It is a useful tool for health care professionals to help clients and manage illness prevention or to address health problems and has been used by nurses in different practice areas (Roden 2004:1). The researcher used the HBM in this study to better understand why some HIV-positive pregnant women do not utilise prevention of mother-to-child transmission intervention services.

Origin and development of the HBM

The HBM is a psychological model introduced in the 1950s by social psychologists,Godfrey Hochbaum, Irwin Rosenstock and Stephen Kegels working in the United States of America (USA) Public Health Service (Edelman & Mandle 1995:228). The HBM
attempts to explain and predict health behaviours by focusing on individuals’ attitudes and beliefs. The model was developed to describe why people fail to participate in programmes to detect and prevent disease, particularly a free and conveniently located
tuberculosis (TB) screening programme. The question thus was why, despite the fact that this service was offered without charge in several convenient locations, the programme only had limited success (Edelman & Mandle 2006:222; National Cancer Institute [NCI] 2005:13; Stanhope & Lancaster 2000:271). Hochbaum identified the main components of the HBM in 1958 (Dennill et al 1999:157). Subsequent amendments were made to the model as late as 1988. The key variables of the HBM are (FHI 1996:2; Polit & Beck 2008:150):
• Perceived threat: The perceived susceptibility and perceived severity of a health condition.
 Perceived susceptibility: An individual’s subjective perception of the risk of contracting a health condition (in this study, transmitting the infection),
 Perceived severity: Feelings about the seriousness of contracting an illness or of leaving it untreated (including evaluations of both medical and clinical consequences and possible social consequences).
• Perceived benefits: The believed effectiveness of strategies designed to reduce the threat of illness (using the interventions in place to prevent mother-to-child transmission of HIV).
• Perceived barriers: The potential negative consequences that may result from taking particular health actions, including physical, psychological, and financial demands (such as social stigma, fear of rejection by spouse).
• Cues to action: Events, either bodily (e.g., physical symptoms of a health condition) or environmental (e.g., media publicity), that motivate individuals to take action.
• Other variables: Diverse demographic, socio-psychological and structural variables that affect an individual’s perceptions and thus indirectly influence health-related behaviour.
• Self-efficacy: The belief of being able to successfully accomplish the behaviour required to produce the desired outcomes (Bandura 1977:212).Self-efficacy is a relatively new concept added to the HBM (Campbell 2004:28).
The HBM changed when applied to problems concerning immunization and more broadly to people’s different responses to public health measures and their use of health services. In these wider applications, the model substituted a belief in susceptibility to a disease or health problem for the more specific belief that one could have a disease and not know it, which had featured in Hochbaum’s original study as the most important belief accounting for seeking screening examinations (Becker1974:293).
In 1974, Becker (1974:470) described the model’s history and experience and its wideranging applications. In 1977, Maiman, Becker and Kirscht (1977:215) reviewed the standardised scales for measuring its several dimensions. The model continued to evolve into the 1980s, largely due to Becker’s work at Johns Hopkins University and later at the University of Michigan School in the USA (Becker, 1974:475; Janz & Becker,1984:1-47;Edelman & Mandle 2006:222). Since then, the HBM has been adapted to
explore a variety of long- and short-term behaviours, including sexual risk behaviours and the transmission of HIV/AIDS (Beaudoin 2009:1; Rosenstock, Strecher & Becker
1994:5).

Chapter 1 Background to the study
1.1 INTRODUCTION
1.2 BACKGROUND TO THE STUDY 
1.3 PURPOSE OF THE STUDY 
1.3.1 Research questions
1.3.2 Objectives of the research
1.4 SIGNIFICANCE OF THE RESEARCH 
1.5 THEORETICAL FRAMEWORK 
1.6 DEMARCATION OF THE STUDY FIELD
1.6.1 Brief discussion of Nigeria
1.6.2 Description of the area and hospitals under study
1.7 RESEARCH METHODOLOGY
1.7.1 Population
1.7.2 Sampling and sample size
1.7.3 Data collection
1.7.4 Data analysis
1.7.5 Validity and reliability
1.8 DEFINITION OF KEY TERMS 
1.9 ETHICAL CONSIDERATIONS 
1.10 LIMITATIONS OF THE STUDY 
1.11 OUTLINE OF THE STUDY
1.12 CONCLUSION 
Chapter 2 Conceptual framework
2.1 INTRODUCTION
2.2 HEALTH BELIEF MODEL (HBM)
2.2.1 Origin and development of the HBM
2.2.2 Core assumptions and statements
2.2.3 Scope and application of the HBM
2.3 COMPONENTS OF THE HBM APPLIED TO PMTCT OF HIV
2.3.1 Individual perceptions
2.3.2 Modifying factors
2.3.2.1 Demographic
2.3.2.2 Socio-psychological
2.3.2.3 Structural
2.3.3 Variables affecting the likelihood of actions
2.4 SUMMARY OF THE HBM COMPONENTS
2.4.1 Perceived susceptibility
2.4.2 Perceived severity
2.4.3 Perceived benefits
2.4.4 Perceived barriers
2.4.5 Cues for action
2.4.6 Self-efficacy
2.5 LIMITATIONS OF THE HBM
2.6 CONCLUSION
CHAPTER 3 LITERATURE REVIEW
3.1 INTRODUCTION
3.2 PURPOSE OF A LITERATURE REVIEW 
3.3 SCOPE OF THE LITERATURE REVIEW 
3.3.1 Overview of HIV/AIDS
3.3.2 Mother–to-child transmission of HIV globally
3.3.3 Mother-to-child transmission in Nigeria
3.4 THEORETICAL FRAMEWORK
3.4.1 Individuals’ perceptions of HIV
3.4.1.1 Perceived susceptibility (risk) of mother-to-child transmission of HIV
3.4.1.2 Perceived severity of mother-to-child transmission of HIV
3.4.1.3 Perceived benefits of PMTCT of HIV
3.4.1.4 Perceived barriers to utilizing PMTCT services
3.4.1.5 Cues to action to prevent mother-to-child transmission of HIV
3.4.1.6 Self efficacy to prevent mother-to-child transmission of HIV
3.4.2 Modifying factors
3.4.2.1 Demographic
3.4.2.2 Socio-psychological
3.4.2.3 Structural
3.4.2.3.1 Knowledge of HIV transmission
3.4.2.3.2 HIV counselling and testing services
3.4.2.3.3 Antiretroviral therapy
3.4.2.3.4 Infant feeding in PMTCT of HIV
3.4.3 Variables affecting likelihood of taking action to prevent mother-to-child transmission of HIV
3.4.3.1 Sources of information on mother-to-child transmission of HIV accessible to pregnant woman
3.4.3.1.1 Health facility
3.4.3.1.2 Radio
3.4.3.1.3 Magazines/newspapers
3.4.3.1.4 Other sources
3.4.3.1.5 Peer support
3.5 CONCLUSION 
CHAPTER 4 RESEARCH DESIGN AND METHODOLOGY
4.1 INTRODUCTION
4.2 RESEARCH SETTING
4.3 RESEARCH METHODOLOGY
4.3.1 Research design
4.3.1.1 Non-experimental
4.3.1.2 Quantitative
4.3.1.3 Descriptive
4.3.1.4 Cross-sectional
4.3.1.5 Exploratory
4.3.2 Research method
4.3.2.1 Population
4.3.2.2 Sampling frame
4.3.2.3 Sample and sampling
4.3.2.4 Number of respondents
4.3.3 Data collection
4.3.3.1 Characteristics of structured data collection
4.3.3.2 The research instrument
4.3.3.3 Development of the data collection instrument
4.3.3.4 Structure of the instrument
4.4 MEASURES TO ENSURE RELIABILITY AND VALIDITY 
4.4.1 Reliability
4.4.2 Validity
4.4.2.1 Internal validity
4.4.2.2 External validity
4.4.2.3 Content validity
4.4.2.4 Construct validity
4.4.2.5 Face validity
4.4.3 Pre-Test
4.5 ETHICAL CONSIDERATIONS
4.5.1 Permission to conduct the study
4.5.2 Protection of human rights
4.5.3 Beneficence
4.5.4 Respect
4.5.5 Privacy and confidentiality
4.5.6 The right to fair treatment
4.5.7 The right to informed consent
4.6 DATA ANALYSIS
4.7 LIMITATIONS OF THE STUDY 
4.8 CONCLUSION 
Chapter 5 Data analysis and discussion of research result
5.1 INTRODUCTION
5.2 DATA COLLECTION
5.3 PRESENTATION AND DISCUSSION
5.3.1 Section 1: Demographic data
5.3.1.1 Item 1.1: Respondents’ age
5.3.1.2 Item 1.2: Respondents’ marital status
5.3.1.3 Item 1.3: Living with spouse/partner
5.3.1.4 Item 1.4: Reason for not living with spouse/partner
5.3.1.5 Item 1.5: Respondents’ educational level
5.3.1.6 Item 1.6: Respondents’ employment status
5.3.1.7 Item 1.7: Respondents’ number of living children
5.3.2 Section 2: Knowledge of HIV and PMTCT of HIV
5.3.2.1 Item 2.1: Ways HIV can be transmitted
5.3.2.2 Item 2.2: Heard about mother-to-child transmission of HIV
5.3.2.3 Item 2.3: Where first heard about mother-to-child transmission of HIV
5.3.2.4 Item 2.4: Can a pregnant woman be HIV positive and look healthy?
5.3.2.5 Item 2.5: Transmission of HIV to baby during pregnancy
5.3.2.6 Item 2.6: Transmission of HIV to baby during delivery
5.3.2.7 Item 2.7: Transmission of HIV to baby during breastfeeding
5.3.2.8 Item 2.8: Babies born to HIV-positive women become HIV infected
5.3.2.9 Item 2.9: Ways a woman can prevent MTCT of HIV
5.3.2.10 Item 2.10: Awareness of interventions that can prevent MTCT of HIV
5.3.2.11 Item 2.11: Use of anti-HIV drugs to prevent MTCT of HIV
5.3.2.12 Item 2.12: Pregnant woman’s knowledge of HIV status
5.3.2.13 Item 2.13: Reasons for wanting to know HIV status
5.3.2.14 Item 2.14: Breastfeeding by HIV positive women
5.3.2.15 Item 2.15: Breastfeed own baby by HIV-positive women
5.3.2.16 Item 2.16: Reason for wanting to breastfeed
5.3.2.17 Item 2.17: If spouses/partners should know their HIV status
5.3.2.18 Item 2.18: If both partners can have different HIV test results
5.3.3 Section 3: Perceived threat – susceptibility and severity
5.3.3.1 Item 3.1: HIV/AIDS as a problem/threat in Nigeria
5.3.3.2 Item 3.2: HIV/AIDS as a problem/threat in Anambra State
5.3.3.3 Item 3.3: Who can become infected with HIV?
5.3.3.4 Item 3.4: Can pregnant women become infected with HIV?
5.3.3.5 Item 3.5: Can married women become infected with HIV?
5.3.3.6 Item 3.6: If they need their spouse’s/partner’s permission to undergo test
5.3.4 Section 4: Barriers to utilisation of PMTCT services
5.3.4.1 Item 4.1: How people living with HIV/AIDS are treated in the community
5.3.4.2 Item 4.2: Willingness to use services if near their home if they are HIV positive
5.3.4.3 Item 4.3: Reason for not wanting to do so
5.3.4.4 Item 4.4: If transportation cost will be a problem
5.3.4.5 Item 4.5: Disclosure to spouse/partner if positive
5.3.4.6 Item 4.6: Reasons for not disclosing test result to spouse/partner.
5.3.4.7 Item 4.7: If HIV positive result will affect marriage
5.3.4.8 Item 4.8: How it will affect the marriage
5.3.4.9 Item 4.9: Disclosure to other family members/friends if HIV positive
5.3.4.10 Item 4.10: Reasons for not disclosing HIV status
5.3.4.11 Item 4.11: Return to hospital for delivery
5.3.4.12 Item 4.12: Reasons for not wanting to come back
5.3.4.13 Item 4.13: Reasons why some HIV positive women do not return for delivery
5.3.4.14 Item 4.14: Where they go to deliver
5.3.4.15 Item 4.15: Can attitude of health care workers’ attitude make some pregnant women not come back to hospital for delivery
5.3.4.16 Item 4.16: Some negative attitudes of health workers
5.3.5 Section 5: Cue to action and self-efficacy
5.3.5.1 Item 5.1: Do you personally know someone (adult/child) with HIV/AIDS?
5.3.5.2 Item 5.2: Have your spouse/partner tested for HIV?
5.3.5.3 Item 5.3: Has someone ever told you about implications of not utilising PMTCT services
5.3.5.4 Item 5.4: Return to hospital for follow-up/postnatal visit
5.3.5.5 Item 5.5: Reasons for not returning
5.3.5.6 Item 5.6: Any additional information shared
5.3.5.7 Item 5.7: Suggested ways to help more HIV positive women to use PMTCT in the health facility
5.4 CONCLUSION
Chapter 6 CONCLUSIONS, LIMITATIONS AND RECOMMENDATIONS
6.1 INTRODUCTION
6.2 FINDINGS
6.2.1 Respondents’ demographic profile
6.2.2 Respondents’ knowledge of HIV and PMTCT of HIV
6.2.3 Respondents’ perceived threat including the severity and susceptibility of HIV and if the respondents wanted to know their HIV status
6.2.4 Respondents’ perceived barriers to the utilisation of PMTCT services
6.2.5 Cues for action and self-efficacy
6.3 LIMITATIONS
6.4 RECOMMENDATIONS
6.4.1 Knowledge of HIV transmission and PMTCT
6.4.2 Barriers to utilising PMTCT services
6.4.3 Further research
6.5 CONCLUSION 
BIBLIOGRAPHY 

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