Knowledge, attitude and practice of physical exercises among pregnant women attending prenatal care clinics of public health institutions in Hawassa city, Sidama, Ethiopia, in 2021: descriptive cross-sectional study | BMC Women’s Health

Study area

The study was conducted in public health centers in Hawassa city, which is located 273 km from Addis Ababa, the capital city of Ethiopia. According to report of Hawassa city health department, the total population of town was estimated to be 369,908 in 2017 [20].

Hawassa has an elevation of 1,708 m above sea level. Administratively, the city is structured into 7 urban sub-cities and 21 Kebeles. Publically, there is 1 comprehensive specialized referral and teaching hospital, 1 public general hospital, 1 public primary hospital, 3 private primary hospitals, 11 public health centers, 1 private health centers, and 17 health posts. Antenatal care is provided in all of these health institutions.

Study design and period

Facility based descriptive cross sectional study design was conducted in public health facilities in Hawassa city, Sidama, Ethiopia from July to December 2021.

Population

Source population

All pregnant women who attended antepartum in public health institutions of Hawassa city were the target population in this study.

Study population

Pregnant women who attended antenatal care during the data collection period and presented at a randomly selected public health centers in Hawassa city during the study period were considered as study population.

Eligibility criteria

All pregnant women who visited antenatal care follow up were included in this study. Pregnant women who came for medical or other purpose, pregnant mothers who had been diagnosed with gait disturbances, and serious psychiatric illness were excluded from this study.

Sample size determination and procedure

Sample size was determined using single population proportion formula. The sample size was computed using the following assumptions: Proportion of attitude towards physical exercise among pregnant women from previous study conducted in Gondar (P = 55.3%) [15], 95% confidence interval, and 5% marginal error. Where, n = number of samples, Z α/2 = the value of under standard normal value of confidence (1.96), and α = level of significance. Standard Cochrane formula was used to compute sample size, n= (Z α/2)² P (1-P)/d²).

Therefore, plugging these values into formula, n = (1.96)² 0.55* (0.45)/ (0.05)², the initial sample size was calculated to be 384. On the contrary, pregnant women in public health institutions in Hawassa city was reported as less than 10,000 (N = 1784) within the past 3 months before this study. Thus, a reduction formula (n = n/1 + n/N) have been applied making initial sample size of 313. Finally, we have added 10% non-response rate as the compensation for non-respondents making final sample size of 344.

All health centers were included in this study. Each pregnant woman was selected using systematic sampling technique during antepartum visits. Each K-value was determined by using formula (K = N/n). Therefore, based on the client flow in the selected health centers, we have used different K-values to select samples. The first study participant was chosen among clients came for antenatal care service using lottery method.

Data collection method, tools and procedure

This descriptive cross-sectional study explored pregnant women knowledge, practice and attitude of pregnant women. Interview administered survey was applied to collect data in this study. Data were collected using semi-structured and pre-tested questionnaire. The tool was adapted from various literatures [18, 19, 21]. It includes information about socio-demographic, health care seeking, and reproductive health charactestics of the study subjects. Information on socio-demographic factors includes age, educational status, income and occupation. Obstetrics factors include number of birth, gestational age, mode of last delivery and history of abortion. Furthermore, these studies include attitude, practice and knowledge of physical exercise. Data were collected by 4 BSc midwives and supervised by two MSc clinical midwives. Overall supervision was conducted by principal investigator.

Data quality control

Questionnaire was first prepared in English and translated to Amharic and Sidaamu Afoo (local languages) and re-translated back to English to keep its consistency. Pre-test was done on 18 (5%) study participants on outside of the study area (Shashemenie). Training was given for 4 data collectors and 2 supervisors for one day. Training was focused on objective of the study, data collection tool, and methods of data collection, checking the completeness questionnaires and maintains confidentiality. Two supervisors monitored data collection process. Questionnaire was checked for completeness before data entry. Any problem which was occurred during data collection was discussed and solved each day after data collection together with principal investigator and co-investigator.

Data analysis

The purpose of analysis of this study was to describe the prevalence of knowledge, attitude and practice of physical exercise among pregnant women. Data were cleaned and entered in Epi-data version 4.6 and exported to SPSS version 25 for analysis. Descriptive statistics was performed using frequency, mean, standard deviation and percentage. Data was presented and reported using text, table, graph and figure.

Ethical consideration

Ethical approval

and clearance was obtained from Hawassa University, college of medicine and health sciences, health Ethical Review Board/IRB/. The purpose of the study was explained for the study participants, and written informed consent was obtained. The right to withdraw from the study at any time was assured before the start of data collection. Coding was used to eliminate any personal identification. Confidentiality was assured throughout the study.

Operational definitions

Knowledge: Women’s knowledge about physical exercise was measured based on the individual study participant’s correct response of 9items measuring their knowledge about exercise. Each question had one correct answer and three options: Yes, No and ‘I do not know’. Those who scored above the mean of the items are labeled as women with “adequate knowledge”, otherwise, ‘in adequate knowledge’.

Attitude

Attitude was measured using 8 questions with possible three responses. Those participants who scored above the mean were considered as having ‘positive attitude’ towards physical exercise, otherwise, they were considered as having ‘negative attitude’.

Practice

If pregnant women perform any type of antenatal physical exercise in the current pregnancy at least 3 times per week from a total of 6 exercises, they were regarded as doing ‘good practice’; otherwise, ‘poor practice’.