Prenata Care Thesis - Copy (1).docx

FACTORS AFFECTING THE EXTENT OF COMPLIANCE OF ADOLESCENT PREGNANT MOTHERS ON PRENATAL CARE SERVICES

CHAPTER I THE PROBLEM AND ITS SETTING

Background of the Study Adolescent pregnancy and childbearing entail a high risk of maternal death for the adolescent, and the children of young mothers have higher levels of morbidity and mortality . These adolescents and their children may experience repercussions in the present, as well as far into the future. Pregnancy and childbearing may cut short an adolescent’s education and threaten her economic prospects, employment opportunities and overall well-being. Adolescent mothers may pass on to their children a legacy of poor health, substandard education and subsistence living, creating a cycle of poverty that is hard to break ( United Nations, 2002) In addition, teen pregnancy is a critical public health issue that affects the health and educational, social, and economic future of the mother and child. It is also a significant factor in numerous other important social issues, welfare dependency, out-of-wedlock births, responsible fatherhood, and workforce development are all of particular concern. Adolescents are less likely to seek out prenatal care because they afraid, embarrassed, or unaware of the resources available to them. This lack of prenatal care, coupled with the mother’s usually immature physical development, result in higher rates of low birth weight babies than in other age groups. As the offspring of adolescent mothers grow, they are more apt than other children to have and cognitive problems and to be the victims of neglect or abuse (www.cdc.gov/nchs/births.htm). Moreover, the birth rate for teenagers 15- 20 years is rising for the first time since 1991. The adolescent birth rate had been dropping steadily since a high of 61.8 births per 1, 000 in 1991 to

a low of 40.5 births per 1,000 in 2005. But between 2005 and 2006 there was a 3% increase in births to adolescents. According to data from National Vital statistics Reports, 435,427 births occurred to mothers aged 15-20 in 2006, correlating to a birth rate of 41.9 live births per 1,000 women in this age group (Hamilton BE, et al, 2007). Thus, adolescent pregnancy continues to have major medical, social, and economic impact in the United States, with an adolescent birth rate ranking the highest of developed countries. Overall, 47.8 % of high school students reported having ever engaged in sexual intercourse, with 7.1 % stating that their age at first intercourse occurred before the age of 13 (http://apps.nccd.cdc.gov/yrbss). Pregnant adolescents vary greatly in their circumstances and behaviour, and consequently their healthcare needs. Lack of information about pregnant adolescents’ needs means that service providers are ill equipped to deal with them. Failure on the part of communities to acknowledge and address the issues related to and stemming from adolescent pregnancy further complicates the situation. There are major barriers that preclude adolescents’ access to maternal health-care services. Failure to address these barriers and needs seriously threatens a healthy outcome for these young mothers and their newborns, further compromising the already unacceptably high maternal mortality ratio and pregnancy-related morbidities (Barker, 2002). Prenatal Care, also known as antepartum or antenatal care, refers to the health services that a pregnant woman receives before a baby’s birth. Health care providers know from numerous studies that prenatal care is important because potential problems that may endanger that

mother

or

her

baby

may

be

discovered

and

treated

prior

to

birth

(http://www.mchb.hrsa.gov/programs/womeninfants/prenatal.htm). It is composed of screening for health conditions that are likely to increase the possibility of adverse pregnancy outcomes, providing therapeutic interventions and educating pregnant women about planning for safe child

birth. Its importance on maternal and infant health is ascertained by different medical literature (DOH, 2009). Thus, prenatal care is one of the most effective health interventions for preventing maternal morbidity and mortality particularly in places where the general health status of women is poor. The antenatal period presents an important opportunity for identifying threats to the mother and unborn baby’s health, as well as for counselling on nutrition, birth preparedness, delivery care and family planning options after the birth ( WHO, 2005). In the Philippines, prenatal care is a widely accepted practice. Almost 96% of mothers had visited a health provider for their prenatal care (NSO and Macro International, 2010). Despite the high prenatal care coverage, morbidity and mortality related to pregnancy are still high. Infant and maternal mortalities are still major problems, where 26 infants in every 1000 live births die and 162 women per 100,000 die due to childbirth. These put the Philippines Infant Mortality Rate(IMR) still above its Millennium Development Goal target of 19/1000 live births and its Maternal Mortality Rate(MMR) way above the target of 52/100,000 live births in 2015 (NSCB,2010). Prenatal care quality is an important indicator for maternal and infant health status. However, quantity of prenatal care visit is the most commonly used indicator while the quality of prenatal care is seldom used (Alexander,2001;Alexander and Kotelchuck,1996; Barber and Bertozzi,2007). To date, no existing standard protocol is used to measure quality of prenatal care. Some popular studies have used contents of prenatal care (e.g tetanus toxoid or doctor’s advice) to measure the overall quality (Alexander et al,2001; Victoria,2001). This practice, however, may pose a possible problem especially when important features or components of prenatal care are not taken into account.

With these above mentioned conditions, this study will be conducted to look into the factors affecting the extent of compliance of pregnant adolescents on prenatal care services and how they affect the compliance of the pregnant adolescent on prenatal care services.

Theoretical Framework The Health Belief Model (HBM) is a psychological model that attempts to explain and predict health behaviors. This is done by focusing on the attitudes and beliefs of individuals. The Health Belief Model has been applied to a broad range of health behaviors and subject populations. Three broad areas can be identified (Conner & Norman, 1996): 1) Preventive health behaviors, which include health-promoting (e.g. diet, exercise) and health-risk (e.g. smoking) behaviors as well as vaccination and contraceptive practices. 2) Sick role behaviors, which refer to compliance with recommended medical regimens, usually following professional diagnosis of illness. 3) Clinic use, which includes physician visits for a variety of reasons. (http://www.utwente.nl/cw/theorieenoverzicht/theory%20clusters/health%20communication/heal th_belief_model.doc/ ) Factors affecting the extent of the compliance of adolescent pregnancy on mothers on prenatal services can be based on the HBM. It is where HBM talks about the attitude of an individual. One of the problems of an adolescent individual is not attending prenatal services. One of the reasons of pregnant women is low- socio economics why they can’t send themselves in the prenatal services. In congruent with low- socio economics is the not enough knowledge of pregnant adolescents due to less information dissemination and maybe they are not interested about it or maybe lack of time. In cases these are the problems that our young mothers

encountered, explain to them the importance of sending themselves in pre-natal services and on how it affect the child and the mother. It is the responsibility of the mother to attend prenatal services. Delayed entry into the prenatal care may be the result of late recognition of pregnancy, denial of pregnancy, or confusion about the services that are available. Such a delay in care may leave an inadequate time before birth to attend to correctable problems. The very young pregnant adolescent is at higher risk for each of the confounding variables associated with poor pregnancy outcomes and for those conditions associated with a first pregnancy regardless of age. However, when prenatal care is initiated early and consistently, and confounding variables are controlled, very young pregnant adolescents are at no greater risk for an adverse outcome than older pregnant women. (Maternal Child Nursing Vol. 1 Third Edition, 2009 by Wong et. al)

Conceptual Framework This study will aim to determine the extent of compliance of adolescent mother on prenatal services. It sought to gather information regarding to the respondent profile as to their age, civil status, educational attainment, monthly income and location of the respondent. The study also includes the level of knowledge of the respondent on the prenatal care services on the extent of their compliance.

Statement of the Problem This study will sought to determine the factors affecting the compliance of adolescent pregnant mothers on prenatal care services. Specifically, the study will answer the following questions: 1. What are the socio- demographic profile of the respondents as to: 1.1.Age 1.2. Civil status 1.3.Educational attainment 1.4.Monthly Family Income 1.5.Location of residence 2. What is the level of knowledge of the respondents on the prenatal care services as to: 2.1. Immunizations 2.2.Scheduled check up 2.3.Nutrition 2.4.Health education on prenatal care 3. What is the extent of compliance of the respondents on prenatal care services? 4. Is there a significant relationship between the socio- demographic profile and the level of knowledge from the different prenatal care services to the extent of compliance?

Significance of the Study Maternal Mortality worldwide, about half a million die every year in connection with pregnancy and childbirth, 99% of which occur in developing countries like the Philippines. Antenatal care provides an opportunity to deliver different services which are important in improving maternal survival. Unfortunately, our country’s pregnancy related situation had not changed in the last 5-10 years. This study therefore will help in contribution in the improvement of the maternal situation and will benefit the following:

Respondents. This will give them deeper insights to assess and motivate adolescents and find times to comply in maternal and child health care services and for them to prepare and safe with pregnancy. Health Workers. This will provide a closer look on prenatal health services and enhance their involvement to promote safe motherhood; and an opportunity to practice and develop their skills. Policy Makers. This will serve as an insight for strengthening and making of plans, programs and policies for future development regarding maternal health care. General Public. This will be a way to inform them of maternal and child health situations in the country and help them recognize and participate in promoting safe maternal services. Researchers. The study will provide a springboard for a continued and developed study in relation to maternal and child care.

Scope and Delimitation of the Study The study will focus on the determination of factors affecting the extent of compliance of adolescent pregnant mothers to prenatal care services. The prenatal care services such as immunization, scheduled check-up, nutrition, and health education will be established. The respondents of the study will include adolescent pregnant mothers who are first time mothers in their 2nd or 3rd trimester of pregnancy. It is further delimited to high school and college students of Laoag City with the age bracket 15- 20 years old because research shows that adolescent pregnancy is not simply the result of girl’s failure to obtain and use contraception, but is instead inexorably linked to many social, cultural, educational, and economic factors influencing adolescent

risk-

taking

behaviours

(http://www.glowm.com/index.html?p=glowm.cml/section_view & articleid=413). Information regarding the adolescent pregnant mothers will be taken from the Rural Health Unit (RHU) of Marcos, Ilocos Norte with proper protocol and ethical considerations. A structured questionnaire will be used in gathering data and it will also utilized a descriptive correlational design. This will also allow for greater flexibility in pursuing new information as it emerges. The study will be conducted on November 2012 – March 2013.

Operational Definition of Terms To promote a better and clearer understanding of the study the following terms are herein listed with their corresponding meanings and definitions. Danger Signs. This pertains to the sign and/or symptoms like vaginal bleeding, edema on the face and hands, headache, dizziness, blurred visions, and pallor that may threaten the life of the mother or the baby during pregnancy. Extent of Compliance on the different prenatal care services. This pertains to the level of compliance or fulfilment of the different prenatal care services whereas; Highly Complied. Follows prenatal care services regularly. Moderately Complied. Follows prenatal care services rarely. Did Not Comply. Not submitting one’s self to any prenatal care services. Health Education. This is defined as the principle by which the adolescent pregnant mother learns from the health care provider to behave in a manner conducive to the promotion, maintenance or restoration of health during pregnancy. Immunization of Pregnant Mothers. This refers to the tetanus toxoid immunization given to pregnant mothers in order to fortify their body against tetanus during their terms to avoid any disabilities on the growing fetus. Knowledge on the different prenatal care services. This refers to the amount of information the pregnant adolescent mother knows on the different prenatal care services such as immunizations, scheduled check up, nutrition and health education whereas; Highly Knowledgeable. Fully aware on the prenatal care service(s). Moderately Knowledgeable. Knows only some aspect of the prenatal care services. Not Knowledgeable. Does not know anything about the prenatal care services.

Nutrition. This refers to the provision of nutrients needed by the body of adolescent pregnant mother to promote and maintain health during pregnancy. Calcium Supplement. This refers to the supplementation of extra calcium by either increasing the usual intake of foods rich in calcium or in a form of drug supplements. Iron (Fe) Supplement. This refers to the supplementation of extra iron during second and third trimester of pregnancy, generally in association with folic acid by either or both increasing the intake of foods rich in iron or/and have it in a form of drug supplement. Protein Supplement. This refers to increase in protein rich food intake during pregnancy. Vitamin C Supplement. This refers to the supplementation of extra Vitamin C by increasing the usual intake of foods rich in Vitamin C. Prenatal Care Services. This refers to the care render to adolescent pregnant mothers by the Health care providers such as immunization, scheduled check-up, nutrition and health education. Scheduled Check up. It refers to the number of check-ups scheduled for pregnant women during the 2nd, 3rd trimester of pregnancy. Socio- Demographic Profile. This term refers to the age, civil status, place of residence, religion, number of households and educational attainment. Civil Status. This refers to the marital status of the individual whether single, married, or widowed. Educational Attainment. This refers to the highest education attained by the adolescent pregnant mothers. Location. It refers to the distance of residence from the nearest government health provider.

Monthly Family Income. It refers to the amount earned by the family in a month regardless of its source.

CHAPTER II REVIEW OF RELATED LITERATURE AND STUDIES

This chapter contains the different information gathered from books, journals, health statistics records/documents and internet discussing the socio – demographic factors and other related concepts affecting the extent of compliance of prenatal health services.

Related Literature

Adolescent Period Adolescence is an important transition into adulthood marked by numerous developmental, academic, and social challenges. While the exact age of adolescence is somewhat varied in the literature, many researchers define this period as beginning around age 12 and ending between ages 18 to 20 (Tanti et al., 2010; Engels et al., 2002). Adolescence has been commonly regarded as a critical period for the development of self and identity. During this stage, adolescents typically experience significant changes in their physical, cognitive, and social domain functioning (Tanti, Stukas, Halloran, & Foddy, 2010). Because of the numerous changes occurring during this time period, it is important to consider the sources of support that are available to adolescents and can help them navigate the difficult transition into adulthood. During all period, adolescence is defined not so much by chronologic age as by physiologic, psychological, and sociological factors. The drastic change in physical appearance and the change in expectation of others that occur during the period may lead to both emotional and physical health problems (Pilliteri, 2007).

Research involving adolescence has documented the shift in importance of peers during this stage, as peers often become equally as important as parents. The period of adolescence has been described as involving a transformation of social relationships, as adolescents spend increasing amounts of time in activities with peers relative to the time spent with their parents (Ryan, 2001). These friendships become more intimate and begin to involve more self disclosure of personal thoughts and feelings as well as greater provision of support (Engels, Dekovic, & Meeus, 2002). Because adolescents’ peer relationships become closer and more intimate, they also become more influential in a variety of social domains, particularly with risk taking behaviors such as smoking, drinking, drug use, and sexual activity (Ryan, 2001).

Teenage Pregnancy Teenage pregnancy is not a new phenomenon. In the 18th century, it was common for women to marry at an early age. In today’s society, however, marriage and childbearing during the teenage years are not encouraged. New educational programs on the importance of delaying pregnancy have decreased the number of birth in the United States to girls under 18 years from the rate of 117/1,000 to 41/1,000 but this number is still higher than that of other industrialized countries (Davis, 2003) .

Danger Signs 1. Vaginal Bleeding During a pregnancy, vaginal bleeding is not necessarily a bad thing. Many women continue to have a period for several months after conceiving. It is also the case that bleeding very late in the pregnancy can indicate the loss of the mucus plug. Unfortunately, vaginal bleeding is also one of the largest danger signs in pregnancy. Vaginal bleeding during pregnancy can point to miscarriage, ectopic pregnancy, separation of the placenta, or placenta previa.

2. Headache While headaches are common for many people, they can actually be a sign of danger during a pregnancy. An occasional headache alone is seldom any cause for concern. Headache accompanied with blurred vision and swelling of the hands and face are common symptoms of preeclampsia or hypertension, which can both lead to eclampsia. This can be a deadly condition for an infant if it is not detected before the birth.

3. Swelling Most women notice a little swelling in their legs and ankles during pregnancy, but severe swelling, especially in the face or fingers, is cause for alarm. Severe swelling, often accompanied by blurred vision and headaches, may indicate pregnancy-induced hypertension, which is usually treated

through

an

IV

and

bed

rest

and

may

require

(http://www.ehow.com/about_5394810_danger-signs-pregnancy.html)

early

delivery.

4. High Blood Pressure High blood pressure is a sign of toxemia, also known as preeclampsia. It is a condition occurring after 20 weeks of pregnancy and its most common symptoms include high blood pressure, blurred vision, headaches and stomach pain. In most cases, the only treatment is delivery of the baby. This is not a problem if the mother is closer to 37 weeks; however, if she is still too early in her pregnancy, the doctor may choose to treat with bed rest and medication to lower

her

blood

pressure.

(http://www.livestrong.com/article/81166-danger-signs-

pregnancy/#ixzz2GugAfRZE)

5. Dizziness Pregnancy can cause low blood sugar and a change in your blood pressure, which can cause dizziness and even fainting. (http://www.teenbreaks.com/pregnancy/mightbepregnant.cfm)

What is Prenatal Care? As to the presented data above, Prenatal Care, also known as antepartum or antenatal care, refers to the health services that a pregnant woman receives before a baby’s birth. Health care providers know from numerous studies that prenatal care is important because potential problems that may endanger that mother or her baby may be discovered and treated prior to birth (http://www.mchb.hrsa.gov/programs/womeninfants/prenatal.htm). It is composed of screening for health conditions that are likely to increase the possibility of adverse pregnancy outcomes,

providing therapeutic interventions and educating pregnant women about planning for safe child birth.

Childhood Immunizations Haemophilus influenza B (Hib), chickenpox, diphtheria, hepatitis B, measles, mumps, pertussis (whooping cough), polio, rubella (German Measles), tetanus, and pneumococcal disease are among the diseases mostly related to childhood (Lieber et al, 2003).

Nutrition Good nutrition is a major problem during adolescent pregnancy because girls enter pregnancy with poor nutritional stores from years of eating a less than the optimal diet. Lack of good nutrition can result in low birth weight newborns and preterm birth. The younger the girl is, the more likely she is to have a low- birth weight infant. To prevent these complications, the girl’s diet must be sufficient to allow for the need of her own growing body. This means she may need to gain more weight than the mature woman does during pregnancy. Protein, iron, folic acid, and vitamin A and C deficiency may become acute. Besides eating larger amount of food, a pregnant adolescent should be sure to eat proper foods, possibly abandoning the food fads she has been following. Adolescent traditionally do not take medicine

conscientiously, so they may need

frequent reminders that vitamin and iron supplements during pregnancy must not only be purchased but also must be taken.(Pillitteri, 2006)

Schedule Check-up A prenatal Check-up Schedule is often prescribed to a pregnant woman. There can be an alteration in the schedule in case of any emergencies. The first prenatal check-up is usually done in the between 8-12 weeks of pregnancy. After the first prenatal check-up, the next one is planned after 4-6 weeks. After the 30th weeks the test are done every 2-3 weeks once. Once you reach the 36th week, a check-up is done every week or once in 15 days till the time of labor. Importance of first prenatal check-up: The first thing that is determined in this stage is exactly how many days have it been since you have conceived. An ultrasound is carried on to determine this. A blood test is done to determine the blood group, Rh factor and HIV infection. The gynecologist then goes through your medical and family history to note any genetic disorders that may cause problems to the child. Important vitamins like folic acid are prescribed to help growth of the child. During the next prenatal check-up schedules your weight, blood pressure and the baby’s heartbeat will be monitored. Usually an ultrasound scan is done during the 20 th week to check if the baby is growing normally. During the third trimester, check-ups are more frequent. This is because many women might have many problems. Sometimes there might be a need to perform early premature delivery. All these things are noted towards the en of the pregnancy.

(http://www.boldsky.com/pregnancy-parenting/prenatal/2011/prenatal-check-up-

schedule-060711-aid0165.html)

Factors Contributing to Lack of Prenatal Care of Adolescent Pregnancy Adolescent do not seek prenatal care until late in their pregnancies. This may due to a girl’s denial of pregnancy. Not seeking prenatal care is also a way of protecting the pregnancy, if she doesn’t tell anyone no one can suggest she terminate pregnancy. After 6 months, abortion is no longer a possibility so she can feel free to come for care without being subjected to this pressure. Other factors contributing to the lack of prenatal care are lack of knowledge of the importance of prenatal care. The girl may feel awkward in the prenatal setting and frightened about her first pelvic examination. Ideally, every community should have facility that is designed especially for adolescents; if this is not possible, all settings should accommodate adolescents’ needs so this last reason for poor prenatal care can be eliminated. Lack of adequate facilities for pregnant adolescents is denial for the existence of adolescent pregnancy on the part of health care providers and the community. (Pillitteri, 2006) Low income women are among those at risk for delivering low birth weight babies. These women tend to use prenatal care less often due now to lack of resources such as money to have

some

consultation

during

their

pregnancy.

(http://www.jstor.org/discover/10.2307/3427801?uid=3738824&uid=2133&uid=2&uid=70&uid

=4&sid=21101518651903)

Prenatal Health Teaching Adolescents need a great deal of health teaching during pregnancy because they do not know many common measures of care that an older woman has learned from experience. They are often unwilling to follow health advice; however, that makes them different in any ways from their peers. On the other hand, adolescents do not have well- established health practices, so they are adoptable. Adolescents girl may respond to health teaching that is directed to their own health more than to that of a fetus inside them: “Eat a high-protein diet because protein makes your hair shiny ( or prevent split fingernails)” often leads to a better adherence than a statement such as Protein is good for your baby”. “Taking the iron supplement make you feel less tired” is better than “ it will help the baby’s blood supply,” for the same reason. There are truthful statements and they appeal to an adolescent’s pre-occupation with self. In addition, this type of health teaching is the only form to which adolescents who is denying her pregnancy can respond. Be certain to include information on the effect of drugs on fetal welfare, including overthe-counter medications, herbal preparations, and recreational drugs. Pregnancy can become an important growth experience if it provides the motivation some adolescents need ti withdraw from recreational drug use. Adolescents need instructions about possible discomforts and changes associated with pregnancy, and measures to relieve them. Many adolescents develop hemorrhoids during pregnancy because the disp4roportion of their body to a fetus puts extra pressure on the pelvic vessels, causing a blood to pool in rectal veins. Reassure girls that this is a pregnancy-related phenomenon that will resolve when pregnancy is over. ( Pillitteri, 2006)

CHAPTER III METHODOLOGY

This chapter discusses the methods and procedures used in the conduct of this study which is inclusive of the research design, locale of the study, sample and sampling procedure, data gathering instrument, data gathering procedure, and the statistical methods used in analyzing data.

Research Design The researchers employ the descriptive- co relational research design in gathering the needed data for the study. It is a descriptive study because it seeks to determine the extent of compliance of adolescent mother on the prenatal care services. Descriptive studies literally describes the phenomenon of interest and observe association in order to estimate estimate certain population parameters, to test hypothesis and to generate hypothesis about possible cause and effect association between variables ( Bowling,2005) In co- relation study it is a scientific study in which a researcher investigates associations between variables.( http://www.psychologyandsociety.com/correlationalstudy.html)

Locale of the Study The research study will be conducted in the 20 Baraggays of Laoag City.

Sample and Sampling Procedure The population of the study will include pregnant adolescents belonging to the age bracket 15- 20 years old who are first time mothers in her 2nd and 3rd trimester of pregnancy.

Data Gathering Instrument A structured questionnaire will be use in gathering of information from the respondents. The contents of the questionnaire were formulated based from the different resources materials which include textbooks, journals, and articles from the internet. It is written in English and was translated into the local dialect to ensure that accurate responses were elicited from the respondents. The structured questionnaire which is in the form of a checklist will be composed of three parts. Part I deals with the socio- demographic profile of the pregnant adolescent mothers which include civil status, educational attainment, monthly family income and location of residence. Part II consist of questions on the knowledge on the different prenatal care services. The given answers in the checklist have corresponding meaning as to how the respondents aware and comply on it. The numerical number of 3 with a descriptive evaluation of “ Highly Knowledgeable” means that it fully aware on the prenatal care service(s). The numerical number of 2 with a descriptive evaluation of “Moderately Knowledgeable” means that it knows only some aspect of the prenatal care service(s). The numerical number of 1 with a descriptive evaluation of “Not Knowledgeable” means that it does not know anything about the prenatal care service(s). Part III includes questions on the compliance on the different prenatal care services. The numerical number 3 with a descriptive evaluation of “Highly Complied” means that it follows prenatal care services regularly. The numerical number 2 with a descriptive evaluation of “Moderately Complied” means that it follows prenatal care services rarely. The numerical

number 1 with a descriptive evaluation of “Did Not Comply” means that did not submit one’s self to any prenatal care services. The instrument is subject for pre- testing among adolescent pregnant mothers belonging to the age bracket 15- 20 years old who are first time mothers in her 2nd and 3rd trimester of pregnancy. These adolescents will no longer be included as a respondent of the study. The result of the pre-test will not form part of the study. All comments, suggestions will be incorporated to improve its construction and content as well as to ensure its validity and reliability. Likewise, any suggestion from the experts and thesis committee regarding the improvement of the instrument shall be highly considered.

Data Gathering Procedure Before gathering the data, permission to conduct the study will be sought from the adviser, the Municipal Mayor or the Municipal Health Officer and the Barangay Chairman of the said Barangays of Laoag City. Upon approval, list of adolescent pregnant mothers belonging to the age bracket 15- 20 years old who are first time mothers in her 2nd and 3rd trimester of pregnancy will be taken from the Rural Health Unit. Subsequently, the respondents of the study shall be chosen purposively. After interview schedule will then prepared and finalized. Then, structured questionnaire will be distributed by the researcher to the respondents. In the administration of the questionnaire, the respondents shall be informed of the purpose of the study to be conducted and required to personally answer the questionnaire. To ensure complete and immediate retrieval and validity of the answers, the questionnaire will be distributed personally by the researcher to the respondents. Anonymity and confidentiality will be assured in order to ensure that all items will be answered correctly.

Statistical Treatment Descriptive analysis such as frequency counts and percentages will be used in describing the socio- demographic profile of the respondents. The percentage distribution will be determined using the following formula:

Percentage (%) = Where:

( f / N) x 100 f = frequency N = number of respondents

The Weighted Average Mean (WAM) will be used in describing the level of knowledge and compliance on the different prenatal care services. This will be determined using the following formula:

WAM =

F1(3) + F2(2) + F3(1) Total Number of Respondents

Where: F1,F2,F3 are the frequencies in each column The mean level of knowledge will be rated as follows: 2.50- 3.00 (Highly Knowledgeable) 1.50 – 2.49 ( Moderately Knowledgeable) 1.00 – 1.49 ( Not Knowledgeable) The mean level of compliance will be rated as follows: 2.50- 3.00 (Highly Complied) 1.50 – 2.49 ( Moderately Complied) 1.00 – 1.49 ( Did Not Comply)

In addition, the Pearson Product Moment Coefficient of Correlation (Pearson r) will be used in determining the relationship of the respondents’ socio- demographic profile and their level of knowledge , and the extent of compliance on prenatal care services. This will be computed using the following formula:

r=

(Nxy) – (x)(y) √ [ N𝑥 2 - (𝑥)2 ][N𝑦 2 - (𝑦)2]

Where: N= number of respondents x= raw of scores of independent variables y= raw scores of dependent variables xy= sum of the products of the dependent and independent variables

FACTORS AFFECTING THE EXTENT OF COMPLIANCE OF ADOLESCENT PREGNANT MOTHERS ON PRENATAL CARE SERVICES

QUESTIONNAIRE

PART I. Socio- Demographic Profile of Respondents Direction: Please provide the necessary information needed by filling up or putting a check mark (√) on the space beside the item that corresponds to your answer.

1. Name ( Optional): ____________________________________ 2. Age: __________________ 3. Civil Status: _____ Single

_______ Married

4. Location: ______ Urban

____ Rural

5. Educational Attainment: ____ Elementary Undergraduate ____ Elementary Graduate ____ High School Undergraduate ____ High School Graduate ____ College Undergraduate ____ College Graduate 6. Monthly Family Income ___ Php 21,000 and above ___ Php 16,000 –Php 20,999 ___Php 11,000 – Php 15, 999 ___Php 6,000 – Php 10,999 ___Php 5,999 and below

____ Widowed

PART II. Prenatal Care Services Direction: Below are statements that determine the facts about the different prenatal care services known by adolescent pregnant mothers. Please check the column that corresponds to your answer using the scale below. 3 2 1

Highly Knowledgeable ( if you are fully aware on the prenatal care services) Moderately Knowledgeable ( if you know only some aspect of the prenatal care services) Not Knowledgeable ( if you do not know the prenatal care services)

A. Immunization (Tetanus Toxoid) 1. It protects both mother and baby against tetanus and neonatal tetanus. 2. It should be given in a certain period for each dose. 3. It is considered that mother is fully immunized after completing the five doses of tetanus toxoid. 4. It gives five(5) months guarantee of immunity to the infant after the mother had completed all the doses of tetanus toxoid. 5. It is considered as first and second dose of tetanus toxoid if the mother had received 3 doses of DPT in infancy.

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2

1

B. Scheduled Check Ups 1. It is composed of at least five prenatal check ups in specific period of pregnancy. 2. It is done early and regularly by trained medical personnel (Doctor or midwife). 3. It assesses the risk factors as early as possible. 4. It monitors blood pressure. 5. It refers mother to another facility if there are problems that need further investigation. 6. It provides the estimated date of delivery.

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1

C. Nutrition A. Iron Supplementation 1. It should be taken starting in the 5th month of pregnancy up to 2 months after delivery. 2. It decreases risk for pre – eclampsia (high blood, convulsion). 3. It prevents anemia. 4. It is best found in meat, fish and poultry. 5. It is best absorbed when taken with foods rich in Vitamin C (e.g. citrus fruits). 6. It causes dark colored stool. 7. It causes nusea.

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1

8. It causes constipation. 9. Its absorption is inhibited when taken with foods like tea and red wine. B. Calcium Supplementation 1. It prevents risks of pregnancy induced hypertension. 2. It decreases risk for impaired fetal skeletal growth. 3. It maintains normal blood pressure. 4. It is available in cheese, dilis, and shellfish. 5. It is being absorbed in the body by foods rich in Vitamin D (dairy products). C. Protein Supplementation 1. It helps in baby’s proper brain development. 2. It is found in animal products and dairy products. 3. It is available in cheese, eggs, fish, chicken, beef, lamb, and yogurt. D. Vitamin C 1. It reduces risk for premature births. 2. It is critical to the maintenance of the fetal sac membrane. 3. It can be found in citrus fruits (e.g. orange), papaya, potatoes, and tomatoes. D. Health Education by the Members of the Health Team (doctors, nurses, and midwives) A. Common discomforts experience during pregnancy 1. Development of haemorrhoids and managed by a high fiber diet and regular bowel habit. 2. May cause striae across the sides of their abdomen that will fade after pregnancy. 3. Development of varicose veins and managed by wearing supportive pantyhose (not elastic bandages). 4. Development of excess pigment deposition on the face and neck (Choloasma). 5. May have nausea and vomiting and managed by eating breads or crackers before getting up in the morning and sucking ice chips. 6. May have indigestion or heartburn and managed by limiting spicy and greasy foods as well as avoiding lying down right after eating. B. Danger signs of pregnancy 1. Vaginal bleeding 2. Edema of the face and hands 3. Headache 4. Dizziness 5. Blurred vision 6. Pallor

3

2

1

C. It discusses the effects of smoking, alcohol and drugs to the fetus.

PART III. COMPLIANCE OF PREGNANT ADOLESCENT MOTHERS ON THE DIFFERENT PRENATAL SERVICES. Direction: Please rate your compliance on the different prenatal care services using the scale below. 3 2 1

Highly Complied ( if you follow prenatal care services regularly) Moderately Complied ( if you follow prenatal care services rarely) Did Not Comply ( if you do not submit yourself to any prenatal care services)

Prenatal Care Services A. Immunizations B. Scheduled Check Up C. Nutrition a. Iron Supplementation b. Calcium Supplementation c. Protein Supplementation d. Vitamin C D. Health Education a. Does not smoke, drink and take in drugs during pregnancy.

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