Social Networks, Decision Making and Use of Skilled Birth Attendants to Prevent Maternal Mortality in Matlab, Bangladesh 公开
Edmonds, Joyce Katherine (2010)
Published
Abstract
Social Networks, Decision Making and Use of Skilled Birth Attendants to Prevent Maternal Mortality in Matlab, Bangladesh
By Joyce Katherine Edmonds
Background: Worldwide an estimated 529,000 women die annually from pregnancy-and childbirth-related complications. Use of a skilled birth attendant (SBA) is an effective means to reduce maternal mortality. However, SBA services remain underused even in settings where SBAs are available.
Purpose: This retrospective, cross sectional, two-phased study employed ethnographic decision tree modeling (EDM) and social network analysis to: 1) test the utility of the Network-Episode Model (NEM) in explaining women's health service utilization decisions in uncomplicated pregnancy and childbirth, and 2) examine the predictive power of women's self-identified decision-making criteria on choice of birth attendant.
Sample: A representative sample of 246 Bangladeshi women, 18-45 years of age, disproportionately stratified by place of birth, residing in the Matlab Health Service Area, who had an uncomplicated pregnancy and delivery resulting in a live birth in the 3 months prior to data collection participated in the main phase. A purposive sample of 25 women participated in the preliminary phase.
Method: In-depth and structured interviews using survey and social network techniques were conducted. Descriptive statistics were used to categorize individual and pregnancy episode attributes. The association between the structure and content of women's discussion networks and place of birth was assessed with logistic regression. The association between the decision criteria and place of birth was assessed with ethnographic decision models and logistic regression.
Findings: Network content was more strongly associated with place of birth than a woman's individual attributes. Indicators of network structure were not associated with place of birth nor did they modify the relationship between network content and place of birth. A women's intention during pregnancy, her perception of time in labor, transportation availability and dai availability were the decision criteria predictive of SBA use along with marital age.
Discussion: The NEM together with the EDM has utility in the study of decision processes that result in preventive health seeking behaviors. Yet, the effect of network structure may be overestimated in certain cultural contexts. Findings can inform future research and public health practice.
Table of Contents
CHAPTER
1. Introduction
Statement of the Problem 1
Specific Aims 3
Conceptual Framework 4
Rationale for Selecting the Conceptual Framework 6
Conceptual Domains of the NEM 10
Decision Criteria and Ethnographic Decision Modeling 12
Network-Episode Model Hypotheses 13
Modified Network-Episode Model 15
Relevance of the NEM in the Broader Context of Maternal Health 18
Relevance of the Proposed Study 20
Summary 21
References 23
2. Background and Significance: A Review of the Literature
Section One
Maternal Mortality 28
Skilled Birth Attendants, a Global Strategy to Reduce Maternal Mortality 29
Maternal Mortality and Skilled Birth Attendant Use in Bangladesh 32
Maternal Mortality and Skilled Birth Attendant Use in Matlab 33
The Paradox of Decreasing Maternal Mortality & Low SBA Use in Bangladesh 36
Section Two
Factors Influencing the Use of Skilled Birth Attendants in Bangladesh 38
Section Three
Social Networks and Health Service Utilization 46
Empirical Evidence: Social Networks and Health Utilization Decision-Making 47
Decision Task and Use of Skilled Birth Attendants in Bangladesh 53
Decision Makers and Use of Skilled Birth Attendants in Bangladesh 58
Interaction Among Decision Makers and Use of Skilled Birth Attendants in Bangladesh 59
Summary 61
References 63
3. Research Design and Methodology
Study Overview 77
Description of the Study Area-Matlab, Bangladesh 78
Preliminary Phase of Study 81
Design 81
Approach 81
Sample 83
Instrument 84
Recruitment, Selection and Training of Research Team 85
Recruitment, Screening and Informed Consent of Subjects 85
Data Collection 86
Analysis 87
Main Phase of Study 88
Specific Aims 88
Design 89
Sample 92
Instrument 93
Translation, Back-Translation and Pretesting 99
Recruitment, Selection and Training of Research Team 99
Recruitment, Screening and Informed Consent of Subjects 101
Data Collection 102
Analysis 103
Protection of Human Subjects 112
Assumptions, Challenges and Limitations 113
Summary 120
References 122
4. Results
Preliminary Study Data Analysis 128
Social and Demographic Characteristics of Participants 128
Results for Preliminary Study Aim 1 131
Results for Preliminary Study Aim 2 132
Main Study Phase Data Analysis 135
Social and Demographic Characteristics of Participants 135
Differences in Social and Demographic Characteristics by Place of Delivery 140
Results for Main Study Specific Aim 1 141
Results for Main Study Specific Aim 2 157
Results Summary 182
Social and Demographic Characteristics 182
Differences in Social and Demographic Characteristics by Place of Delivery 182
Network Variables 182
Specific Aim 1 183
Post-Hoc Analysis Specific Aim 1 184
Specific Aim 2 184
Comparison of RQ1 and RQ2 Results 185
Post-Hoc Analysis Specific Aim 2 185
Chapter Summary 185
References 187
5. Discussion
Social and Demographic Characteristics 188
Discussion of Findings 190
Specific Aim 1 190
Specific Aim 2 198
Summary of Findings 207
Validity of the Ethnographic Decision Model 208
Implications for Theory and the Conceptual Framework 209
Study Limitations and Challenges 211
Study Strengths 212
Recommendations 212
Chapter Summary 215
References 216
About this Dissertation
| School | |
|---|---|
| Department | |
| Degree | |
| Submission | |
| Language |
|
| Research Field | |
| 关键词 | |
| Committee Chair / Thesis Advisor | |
| Committee Members |
Primary PDF
| Thumbnail | Title | Date Uploaded | Actions |
|---|---|---|---|
|
|
Social Networks, Decision Making and Use of Skilled Birth Attendants to Prevent Maternal Mortality in Matlab, Bangladesh () | 2018-08-28 15:02:34 -0400 |
|
Supplemental Files
| Thumbnail | Title | Date Uploaded | Actions |
|---|