Data collection

Data collection included a number of sources that have been explained as in the following sections.

3.4.1. Secondary data collection

It was done firstly in September 2018. Although the topic of interest, utilization of antenatal health care was developed, and the study area was identified, the information about the current on-ground situation was unknown. Therefore, the researcher visited South Okkalapa township and observed the condition of provision of antenatal care services in the hospital and collected the required secondary data from the medical records of hospital after achieving the authorization permit from the medical superintendent of South Okkalapa Maternal and Child Hospital. The catchment population (number of pregnant women) who received antenatal care Figure 3.1: Map of Yangon Districts and

Townships

Figure 3.2: Map of South Okkalapa Township

Table 3.1: Maternal healthcare services in public health facilities of South Okkalapa Township (2018)

Month

Total number of (new) pregnancies

registered

Number of (newly) registered pregnant women coming for a checkup at around

12 weeks of pregnancy

January 244 142

February 240 146

March 244 166

April 242 143

May 262 185

June 257 160

July 267 183

August 261 189

September 266 219

October 266 185

November 252 165

December 253 184

Total 3054 2067

Source: Data from Urban Health Center, population proportion (2018)

Table 3.2: The catchment population of public health centers (number of pregnant women who took antenatal care) and total number of women in child-bearing age in South Okkalapa Township in 2018

Ward

No. of women in the age of 15-49

No. of women who received antenatal care in public health centers

3 902 65

4 4,557 351

5 4,848 317

6 3,784 205

7 5,011 346

8 560 52

9 2,779 205

10 2,930 240

11 1,748 141

12 3,122 251

13 4,659 371

14 4,338 379

15 1,483 131

Total 40,721 3,054

Source: Data from Urban Health Center, population proportion (2018)

3.4.1. Sample size calculation

Total number of pregnant women who took first ANC visits at public health facilities during July, August and September was 794 according to the collected secondary data as shown in Table 3.1. Therefore, 260 women were interviewed based on the Krejcie and Morgan table (Educational and Psychological Measurement, 1970) for sample size determination for a given population (attached in Appendix).

3.4.2. Questionnaire preparation

Two sets of questionnaires were used in this study. One was self-prepared based on the literature review and existing previous studies. It is to assess the socio-demographic characteristics, knowledge on ANC and its services, satisfaction and the expectation for future usage and recommendation to others about ANC. The QPCQ questionnaire has been used to collect information about women’s perception on the quality of the provided antenatal care services.

3.4.3. Assessment of variables

In this study, the outcome variable was utilization of antenatal care according to recommendation which was defined as the participants receiving at least four or more antenatal visits, and the first visit within the first trimester (first 4 months) of pregnancy. For analysis, the outcome responses were dichotomized into the women who visited less than four antenatal visits or initiate antenatal visits from the second trimester onwards = 0 and those who received four or more antenatal visits and the first visit within the first trimester = 1.

The independent variables measured were as follows: socio-demographic variables, for instance, age of respondents, parity, education level, employment, education of partners and

affordability of expense. Moreover, variables concerning the current pregnancy, for instance, planned pregnancy or not, knowledge of antenatal care in recommended timing and frequency, its importance and services and tests received during the antenatal care visits.

Furthermore, the respondents’ perception on the quality of antenatal care services were assessed using the preformed questionnaire, “Quality of Prenatal Care Questionnaire” (QPCQ) after receiving the permission from the authorized personnel. Finally, women’s satisfaction, prospective usage in their future pregnancies and their potentials for recommending antenatal care to their friends, relatives or neighbors for their pregnancies were also examined.

3.4.4. “Quality of Prenatal Care” Questionnaire

The “Quality of Prenatal Care” Questionnaire (QPCQ) is a self-report instrument with 46-item was developed by Heaman, Sword, Akhtar-Danesh, Bradfort, Tough, Janssen, Young, Kingston, Hutton and Helena in 2014. It aims to measure prenatal care quality in monitoring the provision and pros of prenatal healthcare services. Grounding upon the statement of Donabedian, the critical role of consumers in the assessment of quality of care, this developed questionnaire is to be completed by women receiving prenatal care (Heaman et. al., 2014). It consists of 46 items with six factors. Each item is rated on a 5-point scale, within the range of 1 (strongly disagree) to 5 (strongly agree). 5 items are in the reversed score to reduce responder bias of choosing all positives. The six factors or subscales with different number of items are as follows:

1) Information Sharing has nine items and focuses on providers’ information sharing and confidentiality and educating patient about reasons for doing tests and results.

2) Anticipatory Guidance with 11 items measures information provided to women to make self-decision about their care and how their providers prepare for it

3) Sufficient Time has 4 items that measure the time the providers spend for appointments and responding women’s questions

4) Approachability to healthcare providers by woman is measured with 4 items.

5) Availability assess the availability of health providers to tackle women’s concerns and needs and how to reach them

6) Support and Respect with 12 items measure whether women are respected or supported accordingly based on their concerns and decisions

Total score is calculated by the sum of all items, the score can range from 46-230, where higher scores means higher rating of quality of prenatal care. The instrument had been validated for construct validity and reliability. It can be used in research to evaluate women’s perceptions of quality of prenatal care (Heaman et al., 2014). Permission to use the QPCQ in this research had already received from the corresponding personnel.

3.4.5. Primary data collection

Primary data collection was done in March 2019 with two trained interviewers in the selected hospital. The researcher paid a prior-visit to the Out-patient clinic of Obstetric department of the hospital to inform the staff about data collection. The self-prepared questionnaire was developed in English and used in individual interview. The translated version of QPCQ in Myanmar was used for survey. The total time taken was about 30 minutes. Stratified sampling was used to recruit the pregnant women attending ANC in the age of 15-49 in their third trimester attending antenatal care with at least 3 visits and then was followed by simple random sampling to reach the desired sample size of N=260. The respondents could ask the interviewers about the questions if they did not understand the question properly. Permission to use the QPCQ in this research had received from the corresponding personnel. The