2.1. Study Area and Period.
The study was conducted in Jabitehnan District, West Gojjam zone, Amhara region, northwest Ethiopia. Jabitenhnan is bordered on the southwest by Dembech, on the west by Bure, on the northwest by Sekela, on the north by Kuarit, and on the east of Degadamot districts. It is located 387 km from Addis Ababa in the northwest part of Ethiopia. According to the report from the district in 2016, it has 39 kebeles with a total population of 218,447 and 125,323 adults. In the district, there are 11 health centers and 39 health posts. The health centers give different clinical services such as family planning, antenatal care, delivery, testing of HIV, etc. for the nearby community. All health centers provide ANC service for the nearby community The majority of the inhabitants practiced Orthodox Christianity(97.96%) while 2.02% were Muslim (23, 24). This study was conducted from April 01, 2021, to April 30, 2021
2.2. Study Design.
The institutional-based cross-sectional study design was conducted.
2.3. Source and Study Population.
Source population of this study was all pregnant women coming to antenatal care service in Jabitehnan district health centers and the study population was all pregnant women attending to antenatal care service in Jabitehnan district health centers during the data collection period
2.4. Sample Size Determination.
The sample size was calculated using the single population proportions formula by considering 50% of the population has good pregnancy risk perception. The size of the sample was calculated as follows:
Then by adding a 10% non-response rate, the total sample size was 424
2.5. Sampling Technique and Procedure.
There are eleven health centers in the Jabitehnan district. All health centers were included in the study and a systematic sampling technique was used to collect data. The total number of pregnant women attending ANC per month for the previous three consecutive months in each health center was taken from the ANC tally record book. The average number of pregnant women attending ANC per month was calculated. Based on the total number of pregnant women attending antenatal care in Jabitehnan district health center the total sample was divided to each health center proportionally. P=n/N then P times by total antenatal care attendant per month in each health center (Fig 1).
2.6. Inclusion and Exclusion Criteria
2.6.1. Inclusion Criteria.
Pregnant women coming to antenatal care service in Jabitehnan district health centers
2.6.2. Exclusion Criteria.
Women who were critically ill during the data collection period
2.7. Study Variables.
2.7.1. Dependent Variables
Pregnancy risk perception (poor/good)
2.7.2. Independent Variables
√ Socio-demographic factors (age, marital status, education, occupation, religion, place of residence, income, partner education)
√ Knowing a woman who died due to pregnancy-related complications
√ Obstetric factors (gravidity, parity, history of obstetric complications, having pregnancy danger signs, number of ANC visit, bad obstetric history)
√ Knowledge of pregnancy danger signs
2.8. Data Collection Tools.
The tool has four parts. These are socio-demographic characteristics, obstetric characteristics, Knowledge of pregnancy danger signs, and pregnancy risk perception using the two constructs of health belief model. These tools were first prepared in English and later translated into Amharic (local language) and back to English again to maintain its consistency. The socio-demographic variables, obstetric characteristics, and knowledge of pregnancy danger sign was assessed as a factor for pregnancy risk perception using two constructs of health belief model.
The client’s knowledge of pregnancy danger signs was assessed as a factor for their perception of pregnancy risk. Knowledge about pregnancy danger signs (yes or no options for being familiar with each pregnancy danger sign). This tool consists of 11 questions, which focus on general knowledge of pregnancy danger signs.
The client’s pregnancy risk perception using health belief model constructs was assessed. Clients are asked question of two constructs of health belief model that ranges from five to twenty-five score for perceived susceptibility and seven to thirty-five score for perceived severity. The total scores were calculated from the combined questions ranges from twelve to sixty. The questions has five options ( 1=strongly disagree,2=disagree, 3=neutral, 4=agree, 5=strongly agree)(25).
2.9. Data Collection Procedure.
Eleven trained midwives collected the data through a face-to-face interview. The data collectors and supervisors had taken training on the objective of the study, methods of data collection procedures, and tool of data collection for one day by the researcher
2.10. Data Quality Control.
To ensure the data quality training was given to data collectors and supervisors by the principal investigator on how to conduct client interviews. A pre-test was conducted in 5 % of the sample on March 2021 Finote Selam health center. Cronbach’s alphas (0.89 up to 0.90) were calculated to check the internal consistency and reliability of the item. The necessary modification was made for any ambiguity, confusion, and difficult words based on pre-test data analysis. Each data collector and supervisor checked before and immediately after collection for the completeness and consistency of the questionnaire.
2.11. Data processing and Analysis.
The data was cleaned, coded and entered, and analyzed using Statistical Package for social sciences (SPSS) version 20. Descriptive statistics such as frequency, percentage, standard deviation, and mean were used to characterize the participants in terms of socio-demographic variables, obstetric variables, and knowledge of pregnancy danger signs. A logistic regression model was fitted to assess the association between dependent and independent variables with a P-value of 0.25 or less in the bivariable analysis will be included in the multivariable analysis. The adjusted odds ratio together with 95% confidence intervals was computed and, results with P-value <0.05 were considered to declare a result as significantly associated.