KNOWLEDGE AND PERCEPTION ABOUT MIDWIVES  AND THEIR IMPACT ON HEALTH SEEKING BEHAVIORS AMONG PREGNANT WOMEN TABLE OF CONTENT

TOPIC IS SUITABLE FOR:
1-Department of Nursing Science
2-Department of Midwifery
3-Department of Public Health
4-Department of Community Health

TOPIC: KNOWLEDGE AND PERCEPTION ABOUT MIDWIVES  AND THEIR IMPACT ON HEALTH SEEKING BEHAVIORS AMONG PREGNANT WOMEN

TABLE OF CONTENT
Abstract
CHAPTER ONE: INTRODUCTION
1.1 Background of the Study 
1.2 Statement of the Problem 
1.3 Objective of the Study
1.4 Research Questions
1.5 Scope of the Study 
1.6 Significance of the Study
1.7 Operational Definition of Terms  
CHAPTER TWO: REVIEW OF LITERATURE
2.1 Conceptual Review
2.2 Theoretical Framework 
2.3 Empirical Review 
2.4 Summary of Literature Review
CHAPTER THREE: METHODOLOGY    
3.1 Research Design    
3.2 Area of the Study        
3.3 Population  of the Study                                
3.4 Sample size 
3.5 Sampling technique    
3.6 Instruments for data collection     
3.7 Validity and Reliability of Instrument
3.8 Method of data collection 
  CHAPTER FOUR: DATA PRESENTATION AND ANALYSIS
4.0 Introduction
4.1 Demographic Analysis 
4.2 Analysis of research questions one on the level of knowledge of pregnant women towards the essentiality of midwives in the University of Port Harcourt Teaching Hospital
4.3 Analysis of research question two pregnant women’s perception of midwives in the University of Port Harcourt Teaching Hospital.
4.4 Analysis of research question three on the health-seeking behavior of pregnant women in the University of Port Harcourt Teaching Hospital
CHAPTER FIVE - DISCUSSION
5.1 Key findings    
5.2 Implications of findings to nursing                            
5.3 Summary of the study                                      
5.4 Conclusion                                    
5.5 Limitations of the study                            
5.6 Recommendations                                 
5.7 Suggestions for further studies
References
Appendix

ABSTRACT
This study investigated the knowledge and perception of pregnant women about midwives and how these factors influence their health-seeking behavior at the University of Port Harcourt Teaching Hospital (UPTH). The specific objectives were to assess the level of knowledge of pregnant women regarding the essentiality of midwives, examine their perceptions of midwives, determine how knowledge and perception affect health-seeking behavior, and identify factors shaping these perceptions. A descriptive cross-sectional survey design was adopted, targeting pregnant women attending antenatal clinics at UPTH. Using Taro Yamane’s formula, a sample size of 225 respondents was determined, and consecutive sampling was employed to select participants who met inclusion criteria and provided informed consent. Data were collected using a structured, self-administered questionnaire divided into sections on socio-demographic characteristics, knowledge, perception, health-seeking behavior, and factors influencing perceptions of midwives. The data were analyzed using SPSS version 25, employing descriptive statistics and Chi-square tests at a 5% significance level. The results indicated that 136 respondents representing 60.4% demonstrated good knowledge of midwives’ essential roles, 150 respondents representing 66.7% had positive perceptions, and 161 respondents representing 71.6% exhibited good health-seeking behavior. Chi-square analysis revealed significant relationships between knowledge and health-seeking behavior (χ² = 14.8, p < 0.05) and between perception and health-seeking behavior (χ² = 12.6, p < 0.05), indicating that higher knowledge and positive perceptions are associated with better health practices. Factors shaping perceptions included midwives’ attitude and behavior (79.1%), competence (72.0%), communication (64.4%), availability (58.7%), and hospital environment (56.4%). Based on these findings, it is recommended that UPTH should implement continuous professional development for midwives, ensure adequate staffing and resources, enhance antenatal education outreach, and establish structured feedback mechanisms to sustain positive perceptions, improve knowledge, and promote optimal maternal health-seeking behavior among pregnant women.

CHAPTER ONE
INTRODUCTION (Preview)
1.1 Background of the Study
Internationally, midwifery has been identified as one cornerstone of maternal health, playing a significant role in the delivery of safe pregnancy, birth and postnatal care. The World Health Organisation emphasises the role of midwives in maternal and neonatal mortality reduction, particularly in low- and middle-income countries, where access to skilled health care is a problem. As explained by Khomami et al. (2021), midwives don't just have to concern themselves with the clinical side of maternal care, but also with promoting healthy lifestyles in pregnancy: Similarly, Shiindi-Mbidi et al. (2023) note that the woman-midwife relationship extends beyond clinical expertise to also include emotional, social and cultural dimensions of care which contribute to maternal health outcomes. These consistent academic views highlight the role of midwives in bridging the gaps between medical institutions and pregnant women, which makes their knowledge and perception among women very significant in influencing health seeking behaviours.
The maternal health debate in sub-Saharan Africa sees midwives at the centre of health systems particularly where physicians and resources are scarce. Jaffre and Lange (2021) outline the midwifery profession in West Africa in terms of moral standards, affective constraints, and socio-technical issues that impact the provision of service as well as the experience of patients. Nwankwo and Ezenwaka (2020) believe that cultural perceptions and systemic deficiencies remain as a constraint in midwife-led ANC access to maternal healthcare. According to Ogbuabor and Okoronkwo (2021), women's perception of midwives' competency and empathy is most important in person-centred maternity care, meaning that knowledge and perception are not marginal factors in women's intention to use health facilities.
In the Nigerian setting, midwives have always been positioned as core actors in the reduction of maternal morbidity and mortality (such as postpartum haemorrhage), which are largely preventable. Kalu and Chukwurah (2022) opined that with early interventions, the midwives can contribute greatly to the reduction of maternal deaths in Eastern Nigeria in line with the Sustainable Development Goals on maternal health. In addition, Ebong et al. (2023) state that the recognition of midwives in the emergency obstetric care situation in rural health facilities has been a key factor in improving maternal and infant survival. And as Ngcobo and Bell (2022) point out, women's knowledge of midwives and their perception of midwives can enable or inhibit healthcare-seeking practises, implying that knowledge about the importance of midwives is crucial to the decision to use maternal health services.
The quality of the interpersonal care provided during antenatal and delivery care also influences the perception of pregnant women of midwives. Ige and Cele (2021) stated that the respectful maternity care has been one of the factors between returning or not returning to health facilities for subsequent care. To support this point, Daniel et al. (2023) found that women in Jos, Nigeria related positive experiences of respectful maternity care to greater trust on midwives and higher levels of satisfaction to maternal health service delivery. This finding has implications related to a similar finding of John et al. (2020) who also expressed satisfaction with midwives that exhibited caring behaviours during childbirth. It has been proven that midwives perceived as empathetic caregivers, not just technical, also have a direct effect on pregnant women's willingness to seek healthcare.
Furthermore, the factors that affect people's perceptions of midwives are multidimensional, including socio-cultural norms, institutional practises and gender roles associated with midwifery. Alhassan, et al. (2024) discuss the complexities of men in midwifery where cultural perspectives of gender may influence the way women are related to care providers during pregnancy and childbirth. In addition, Ayoade et al. (2024) in their study to explore acceptance of male midwives among pregnant women in Lagos conclude on their study that it is influenced by a variety of cultural, religious and individual factors. As Ojong et al. (2022) assert, the practise of respectful maternity care in Cross River State reveals that midwives' ownership of attitude towards respectful maternity care also affect women's perception and engagement with health services. This indicates that perception cannot be static, but the result of dynamic interactions between women and midwives, and the rest of the health care system.
As the maternal health debate has evolved, the role of midwives in influencing women's health-seeking behaviour has also been recognised. According to Ogbe et al. (2023) in Enugu State, pregnant women's use of health seeking behaviour is dependent on their past experience with midwives and availability of services. Udenigwe et al. (2023) add to this argument by situating maternal healthcare-seeking in the context of negofeminism, which prioritises women's negotiation of cultural and systemic barriers to accessing care. Similarly, Iwaola (2024) asserts that the attitudes of women on birth preparedness and complication preparedness in Ondo State is highly dependent on the level of health education and counselling that are carried out by midwives. Taken together, these findings suggest that knowledge and perception that women have about midwives is relevant for influencing women's health behaviours and outcomes in Nigeria.
Against this background, the current study situates itself within the existing debates on the role of midwives in maternal health with particular focus on the role of knowledge and perception on health-seeking behaviour among pregnant women. The case of the University of Port Harcourt Teaching Hospital is relevant in view of the diversity of maternal health experience in Rivers State. As Doering et al (2023) contend, women's lived experience of their interaction with midwives remains an important lens for the effectiveness of maternal health care systems. This is related to findings of Dede et al. (2024) which indicates the significance of women's experience of midwife-led perinatal care in Rivers State and the impact of this on their interaction with health facilities. Therefore, an understanding of the pregnant women's level of knowledge about need for midwives, perception of midwives and factors that contribute to their perceived needs will offer a pathway to scaling up MATs, improving respectful maternity care and improve health seeking behaviour in Nigeria.

1.2 Statement of the Problem
Despite the presence of midwives in Nigeria who are trained to provide comprehensive antenatal, intrapartum and postnatal care, maternal mortality and morbidity rates still remain high. According to Kalu and Chukwurah (2022), midwives have proven to be very capable in decreasing maternal deaths caused by preventable complications whereas Ebong et al (2023) validate the fact that their participation in emergency obstetric care has been very important in rural health facilities. However, there is evidence that many pregnant women under-utilise midwife-led services because of knowledge deficits pertaining to their key roles and the continued existence of negative perceptions with regards to the quality of care they provide (Ngcobo & Bell, 2022; Nwankwo & Ezenwaka, 2020). The optimal scenario would be one where pregnant women, through increased awareness and positive perception, seek care early and consistently from midwives in a manner that would optimise health. However, the present reality is characterised by inconsistent attendance to services, due to cultural attitudes, fear of disrespectful treatment and lack of proper health education (Ogbuabor & Okoronkwo, 2021; Ige & Cele, 2021) by midwives themselves.
Some studies have looked at midwives' experience of providing respectful maternity care (Daniel et al., 2023; Ojong et al., 2022), and women's perceptions of midwife-led care in other regions of Nigeria (John et al., 2020; Dede et al., 2024). However, there is little evidence on how pregnant women's knowledge and perceptions of midwives in particular affect their health-seeking behaviours in tertiary health institutions like the University of Port Harcourt Teaching Hospital. This gap is important, given that Ogbe et al. (2023) highlight that women's health-seeking behaviour is directly related to trust and previous experiences with midwives, and Udenigwe et al. (2023) emphasise that cultural negotiation further determines decisions to seek formal care. Unless we know how knowledge and perception interact to affect behaviour, interventions to improve maternal health outcomes threaten to be ineffective. Therefore, this study aims to bridge the gap by researching how pregnant women of Port Harcourt Teaching Hospital understand and perceive the role of midwives, and how these factors influence their health-seeking behaviour to give evidence for improving maternal health strategies in Nigeria.

1.3 Objectives of the Study
The main objective of this study is to examine the knowledge and perception of pregnant women about midwives and how these factors influence their health-seeking behaviors at the University of Port Harcourt Teaching Hospital. The specific objectives are to:
1. Assess the level of knowledge of pregnant women towards the essentiality of midwives in the University of Port Harcourt Teaching Hospital.
2. Examine how pregnant women perceive midwives in the University of Port Harcourt Teaching Hospital.
3. Determine how pregnant women’s knowledge and perception of midwives affect their health-seeking behavior.
4. Identify the factors that shape pregnant women’s perceptions of midwives in the University of Port Harcourt Teaching Hospital.
OTHER PARTS OF CHAPTER ONE INCLUDE:
1.4 Research Questions
1.5 Significance of the Study
1.6 Scope of the Study
1.7 Operational Definition of Terms

CHAPTER TWO
LITERATURE REVIEW (Preview)
This chapter critically examines relevant literature that would assist in explaining the research problem and, furthermore, recognizes the efforts of scholars who had previously contributed immensely to similar research. The chapter intends to deepen the understanding of the study and close the perceived gaps. This chapter, therefore, focuses on the concept of midwifery, the concept of pregnant women’s knowledge about midwives, perceptions of midwives among pregnant women, the role of midwives in maternal healthcare, and the impact of knowledge and perception about midwives on health-seeking behaviours among pregnant women. The chapter covers the following subheadings:
2.1 Conceptual Framework
2.2 Theoretical Framework
2.3 Empirical Review
2.4 Summary of Literature Review

CHAPTER THREE
RESEARCH METHODOLOGY (Preview)
Research Design: The study adopted a descriptive cross-sectional survey design.
Population of the Study: The population of the study comprises pregnant women attending antenatal clinics at the University of Port Harcourt Teaching Hospital (UPTH).
Sample Size Determination: The study adopted the Taro Yamane formula to determine a sample size of 277 participants.
Sampling Technique: The study employed a consecutive sampling technique to select the individual respondents.
Research Instrument: The study utilized a structured questionnaire as the instrument for data collection.
Methods of Data Analysis: The collected data were analyzed using frequencies, percentages, means, and standard deviations to summarize and present the socio-demographic characteristics, knowledge levels, perception scores, and health-seeking behaviours of the respondents. Inferential statistics, such as the Chi-square test, were used to determine relationships between knowledge, perception, and health-seeking behaviours.

CHAPTER FOUR: DATA PRESENTATION AND ANALYSIS
MAJOR FINDINGS (Preview)
The analysis results were presented in tables. Based on the results obtained from the analysis, the following findings are made:

i. The study found that the majority of pregnant women attending antenatal care at the University of Port Harcourt Teaching Hospital demonstrated good knowledge of the essentiality of midwives, as 176 respondents representing 78.2% had good knowledge, 39 respondents representing 17.3% had fair knowledge, while 10 respondents representing 4.5% had poor knowledge. This indicates that most pregnant women possessed adequate knowledge of the essential role of midwives in maternal healthcare.

ii. The study found that pregnant women generally had a positive perception of midwives at the University of Port Harcourt Teaching Hospital, as 187 respondents representing 83.1% demonstrated positive perceptions, while 38 respondents representing 16.9% had negative perceptions. This suggests that the majority of pregnant women viewed midwives favourably in terms of their competence, friendliness, approachability, provision of health education, respect, and empathy.

iii. The study found that the majority of pregnant women demonstrated good health-seeking behaviour, as 161 respondents representing 71.6% exhibited good health-seeking behaviour, 49 respondents representing 21.8% demonstrated fair behaviour, while 15 respondents representing 6.6% demonstrated poor behaviour. Furthermore, 63.1% of respondents reported regular antenatal attendance, 72.4% regularly took prescribed medications or supplements, and 60.9% sought medical assistance immediately when experiencing pregnancy complications. This indicates that most pregnant women demonstrated appropriate health-seeking practices.

iv. The study found that there was a statistically significant relationship between pregnant women’s knowledge of midwives and their health-seeking behaviour, with a chi-square value of 14.8 (p < 0.05). Similarly, a statistically significant relationship existed between pregnant women’s perceptions of midwives and their health-seeking behaviour, with a chi-square value of 12.6 (p < 0.05). These findings indicate that knowledge and perception of midwives were significantly associated with pregnant women’s health-seeking behaviour at the University of Port Harcourt Teaching Hospital.

v. The study found that several factors shaped pregnant women’s perceptions of midwives, with the attitude and behaviour of midwives being the most prominent factor, as reported by 178 respondents representing 79.1%. This was followed by the competence and skills of midwives, reported by 162 respondents representing 72.0%, and communication and information provided, reported by 145 respondents representing 64.4%. Furthermore, the quality of antenatal care (63.1%), opinions of family and friends (45.8%), and cleanliness and organization of the maternity ward (56.4%) also influenced perceptions. This indicates that midwives’ interpersonal relationships, professional competence, communication, and the hospital environment played important roles in shaping pregnant women’s perceptions of midwives.

CHAPTER FIVE:DISCUSSION
This chapter covers the following outline:
5.1 Implications of the Findings to Nursing Practice
5.2 Summary of the Study
5.3 Conclusion
5.4 Limitations of the Study
5.5 Recommendations
5.6 Suggestions for Further Studies

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