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Language barriers to accessing health info during pregnancy in Jaffna

26 Apr 2021

In the case of pregnant women accessing health-related information during the gestation period, the language barrier due to the insufficient availability of information in their mother tongue and the unavailability of certain health-related information were the major barriers restricting the access of information by pregnant women attending the antenatal clinics of the Teaching Hospital, Jaffna, according to a study.  The study, therefore, suggested that small booklets in their mother tongue, covering commonly needed important health information, be compiled and distributed among all pregnant mothers. These observations and recommendations were made by K. Murugathas (the Senior Assistant Librarian of the Medical Library of the University of Jaffna), T. Sritharan (the Senior Assistant Librarian of the University of Colombo), and S. Santharooban (the Senior Assistant Librarian of the Faculty of Health Care Sciences of the Eastern University) in an article titled “Health information needs and information seeking behaviour of pregnant women attending the antenatal clinics of the Jaffna Teaching Hospital”, published recently in the Journal of the University Librarians Association of Sri Lanka Pregnancy is a vital transition and period in any women’s life. Pregnant women undergo physiological, psychological, and social changes throughout the pregnancy period. As a potential mother, she may experience differed changes in her physical behaviours, health-related needs , health information needs, as well as in the level of nutrition of the food for her and the unborn foetus. The health of a baby starts from the womb of the mother. Health care of a pregnant woman directly reflects the healthiness of her baby. Self-care of a pregnant woman is very important to make decisions for the health of the mother and the foetus. The maternal mortality rate and infant mortality rate are included among the health indicators when measuring the development of a country. In order to face all these challenges, proper information sources are very essential during pregnancy. During this period, health-related information is vital since the decisions and changes would affect the mother as well as the unborn foetus. One of the healthcare programmes delivered to pregnant mothers is the provision of pregnancy-related information. In order to ensure the safe delivery of the baby and to live a healthy life during and after the pregnancy, pregnant women must be provided with the necessary information. Nowadays, people are exposed to a wide variety of information sources. It is very important to make available or accessible, the timely and reliable information that pregnant women need. Furthermore, the researchers pointed out, it will be helpful to organise proper information services for pregnant women which would in turn help to improve maternal and infant health. The descriptive survey research method was used in this study. The study was conducted in the antenatal clinics of the Jaffna Teaching Hospital. The population of the study was pregnant women attending the said antenatal clinics. There were three clinics per week. Based on the records available at the hospital, there are about 80 pregnant women attending each clinic per day. A sample size of 384 pregnant women was calculated. A systematic sampling of 400 pregnant women was selected for the study. Every fourth woman was selected for the study from the registration number of the clinic on the day. If the mother refused to participate in the study, the next mother was considered.  An interviewer-administered questionnaire was used as the research instrument to collect the data. The questionnaire consisted of both structured and a few open-ended questions. The questionnaire had four parts mainly covering the demographic information of pregnant women and their information needs, the information sources that they were using, and the barriers they faced in accessing the information sources. The data was collected during the period from February 2019 to June 2019. The age of the majority of the respondents in the study was in the range of 26-35 years (222 – 55%). About 9% (37) of the participants were less than 20 years and 3% (12) of the participants were above 40 years. The majority of the participants (54% – 216) had attained at least the General Certificate of Education Advanced Level (GCE A/L) education or above (graduate). The majority (60% – 239) of the study participants were housewives. It was reported that the average monthly household income of the majority (65.3%– 261) of the study participants was less than Rs. 50,000. The majority of the selected study sample (87% – 348) comprised of a first or second pregnancy. Only 12.8% (51) was a third pregnancy or above. And 33% (130) of the mothers were experiencing the first trimester whereas 45.5% (182) of them were in their third trimester of pregnancy. The study revealed that 38.6% (152) of mothers always needed information, whereas 36% (142) needed information only sometimes. And 20% (76) needed information often while 5.6% reported that they rarely needed information. Therefore, the majority of the participants indicated that they needed information either always or often. It clearly indicates, the researchers noted, that pregnant women are in need of health information during their pregnancy period. The study also shows that pregnant women attending the antenatal clinics of the Jaffna Teaching Hospital actively search for health-related information during the pregnancy period. Two-thirds of the participants in the study reported that they searched for information either always or often. The participants were asked to choose from 20 types of information with regard to pregnancy and child birth which are needed by pregnant mothers during pregnancy. These included information about pregnancy-related complications, delivery-related complications, methods of child delivery, special tests, the taking of medicines, vaccination, the symptoms of pregnancy, nutrition, the development and growth of the foetus, the care of the newborn, items to be taken to the hospital for child birth, family planning, sexual activity, postpartum care of the mother, breastfeeding, carrying out daily activities, physical and psychological changes after delivery, and exercise. They could select more than one answer. In addition, there was one option for any other as an open answer. Participants were given the opportunity to select the types of information they were in need of, primarily with regard to pregnancy and child birth. The most needed types of information among the participants were about pregnancy-related complications (55.8% – 223), delivery-related complications (54% – 216), the methods of child delivery (52% – 208), and the special tests required and conducted during pregnancy (48 5% – 193). The least important type of information as indicated by the respondents was the exercise required during pregnancy (17% – 69). It may be due to, the researchers opined, their lack of knowledge that they were not aware of the importance of exercise during pregnancy. This indicates, the researchers noted, that the importance of exercise during pregnancy must be emphasised among the pregnant mothers in the local community. Also, they had less interest in the topics of physical and psychological changes after delivery (18% – 71) and on the carrying out of daily activities (18% – 72). The participants were requested to select the sources of information they used when there was a need for information. The set of information sources to be selected included family members and friends, midwives, doctors, other pregnant mothers, the internet, newspapers, books and journals, television and radio, and health programmes. The study considered the main sources of information that pregnant women relied on. They used various different types of sources of information in order to acquire information. The results revealed that the main source of information that was used most often by the majority of the participants was family members and friends, which is considered a traditional source. It clearly showed that the educational level of the family members and friends will directly affect the health information-related needs of mothers. According to the researchers, overdependence on family members and friends is not a healthy indicator in terms of providing information sources. Furthermore, traditional practices and beliefs with regard to pregnancy and child birth, the researchers pointed out, have shown a mismatch with the practices of health professionals. It was followed by midwives (61% – 243), then doctors (49%), and other pregnant women (49%). Midwives played a major role in providing health-related information to pregnant mothers. Professional support by the public health midwives with regard to providing information was well appreciated by the pregnant mothers. As midwives were the direct mediators in providing information to the mothers in this study, they should, the researchers explained, be well educated with current updates on pregnancy-related health information. Regular training programmes should be conducted to update their knowledge, the researchers added. The internet was also identified as one of the sources of information used by one-third of the participants. A total of 29 (29%) of the respondents reported that they used the internet as one of the sources to get pregnancy-related information. The study revealed that mothers did not show much interest in mass media in order to obtain health-related information among the given information sources. Television and radio and health programmes played the least role in providing information to pregnant women in this study. Only 15% of the participants used books and journals. The study was planned to identify the barriers encountered by pregnant mothers in accessing information, in order to break down the barriers with a view to improving the accessibility of information. The barriers included language, financial status, the educational level, the availability of information, the attitude of health professionals, the ignorance of existing sources, and the availability of time. The results of the study with regard to the barriers they experienced revealed that the non-availability of the relevant information was the main barrier in accessing information. It was followed by language (57.5% – 230), the financial status of the family (43% – 172), and the educational level of the pregnant mother (35.8% – 142). Language and the unavailability of information were the main barriers in accessing information as pointed out by the participants, since the most commonly available books and journals, and web-based information are published in the English language. There is, the researchers observed, an urgent need therefore, to publish books in their native language in order for them to easily access information. The attitude of the health professionals was the least-affecting barrier (about 6%) in accessing information. The findings, the researchers pointed out, clearly show that pregnant mothers have a positive attitude towards health professionals, especially doctors and midwives, regarding the accessing of health-related information. In analysing the association between the age group of the pregnant mother (below 20 years, 21-25 years, 26-30 years, 31-35 years, 36-40 years, and above 40 years) and the information sources they preferred, the results revealed that there was a significant association between the age group and the information sources they preferred. Furthermore, the results revealed that the age groups of 21-25 years and 26-30 years, and information sources such as the internet, books, television, newspaper, and health programmes were significant and strongly associated. The age group of 21-25 years was, however, weakly associated with health programmes and newspapers and negatively associated with books. The age group of 26-30 years was mostly associated with health programmes and newspapers but was weakly associated with the internet, books and journals, and radio and television. The age group of 36-40 years was closely associated with midwives and negatively associated with the television and radio, and the internet. The analysis also showed that there was a significant association between the educational level of the mothers and the information sources they preferred and used to obtain information during the pregnancy period. The results revealed that the association between educational levels such as primary education (below grade five), up to GCE A/L and graduates, and information sources such as the internet, newspapers, books and journals, doctors, television and radio, and health programmes, was significant. It was found that primary education less than grade five was strongly associated with doctors, but negatively associated with books and journals, the internet, and newspapers. An educational level up to GCE A/L was associated with the internet, health programmes, and television and radio. Graduates were negatively associated with health programme, and television and radio, and weakly associated with books and journals, newspapers, doctors, and the internet. However, there was no significant relationship between the family structure and the information sources they often used. The results of the analysis, the researchers explained, reflected that the pregnant mothers cannot be considered as a homogenous group when it comes to accessing different information sources. Different age groups and educational levels have different orientations towards information sources. For example, youngsters are heavily oriented towards web-based content, while older persons are associated with midwives. Therefore, the health programmes alone, the researchers observed, are insufficient in order to provide better information. Thus, parallel to such programmes, it is vital to publish health-related information connected to pregnancy, in different media, the researchers noted. In conclusion, it is noted that demographic factors such as the age group of participants and the maximum educational level of participants were significantly associated with the types of information sources they used in order to obtain health-related information during their pregnancy.  As the internet was identified as an important source of information for the pregnant mothers, websites, the researchers proposed, can be developed by the responsible authorities such as universities and the regional divisions of the health services so as to satisfy the information-related needs of the pregnant mothers, especially in those regions, in the Sinhala and Tamil languages. Information can be given in the form of frequently asked questions and answers, which makes it easy to find the solutions for their problems. There can be online forums to freely leave their questions, to be in turn replied to, within a period of 24 hours. These questions can be regularly attended to and reliable information could be provided as answers. The researchers also recommended that informative health educational videos can be displayed in the antenatal clinics so that the pregnant women can watch them during the time they wait to consult the doctors. Also, the pregnant mothers could read the useful health-related books and journals in the clinics, if, as the researchers suggested, there is a book cupboard or bookshelf organised in these clinics.  

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