title: Understanding the psychosocial and environmental factors and barriers affecting utilization of maternal healthcare services in Kalomo, Zambia: a qualitative study.
abstract: This qualitative study aimed to identify psychosocial and environmental factors contributing to low utilization of maternal healthcare services in Kalomo, Zambia. Twelve focus group discussions (n = 141) and 35 in-depth interviews were conducted in six health centre catchment areas. Focus group discussions comprised women of reproductive age (15-45 years), who gave birth within the last year; in-depth interviews comprised traditional leaders, mothers, fathers, community health workers and nurse-midwives. Perspectives on maternal health complications, health-seeking behaviour and barriers to utilization of maternal healthcare were explored. Most women showed insight into maternal health complications. Nevertheless, they started antenatal care visits late and did not complete the recommended schedule. Moreover, most women gave birth at home and did not use postnatal care. The main reasons for the low utilization were the low perceived quality of maternal healthcare services in clinics (negative attitude), negative opinion of important referents (subjective norms), physical and economic barriers such as long distances, high transport and indirect costs including money for baby clothes and other requirements. To improve, our findings suggest need for an integrated intervention to mitigate these barriers. Our findings also suggest need for further research to measure the elicited beliefs and determine their relevance and changeability.
authors.affiliation: Ministry of Health, Monze District Medical Office, PO Box 660144, Monze, Zambia, Department of Work and Social Psychology, Maastricht University, PO Box 616, 6200MD Maastricht, The Netherlands, Zambia Centre for Applied Health Research and Development, PO Box 30910, Lusaka, Zambia, Centre for Global Health and Development Boston University, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118, USA and Department of International Health, Boston University School of Public Health, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118, USAMinistry of Health, Monze District Medical Office, PO Box 660144, Monze, Zambia, Department of Work and Social Psychology, Maastricht University, PO Box 616, 6200MD Maastricht, The Netherlands, Zambia Centre for Applied Health Research and Development, PO Box 30910, Lusaka, Zambia, Centre for Global Health and Development Boston University, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118, USA and Department of International Health, Boston University School of Public Health, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118, USA csialubanje@yahoo.com.
authors.forename: Cephas
authors.initials: C
authors.lastname: Sialubanje
authors.affiliation: Ministry of Health, Monze District Medical Office, PO Box 660144, Monze, Zambia, Department of Work and Social Psychology, Maastricht University, PO Box 616, 6200MD Maastricht, The Netherlands, Zambia Centre for Applied Health Research and Development, PO Box 30910, Lusaka, Zambia, Centre for Global Health and Development Boston University, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118, USA and Department of International Health, Boston University School of Public Health, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118, USA.
authors.forename: Karlijn
authors.initials: K
authors.lastname: Massar
authors.affiliation: Ministry of Health, Monze District Medical Office, PO Box 660144, Monze, Zambia, Department of Work and Social Psychology, Maastricht University, PO Box 616, 6200MD Maastricht, The Netherlands, Zambia Centre for Applied Health Research and Development, PO Box 30910, Lusaka, Zambia, Centre for Global Health and Development Boston University, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118, USA and Department of International Health, Boston University School of Public Health, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118, USAMinistry of Health, Monze District Medical Office, PO Box 660144, Monze, Zambia, Department of Work and Social Psychology, Maastricht University, PO Box 616, 6200MD Maastricht, The Netherlands, Zambia Centre for Applied Health Research and Development, PO Box 30910, Lusaka, Zambia, Centre for Global Health and Development Boston University, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118, USA and Department of International Health, Boston University School of Public Health, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118, USAMinistry of Health, Monze District Medical Office, PO Box 660144, Monze, Zambia, Department of Work and Social Psychology, Maastricht University, PO Box 616, 6200MD Maastricht, The Netherlands, Zambia Centre for Applied Health Research and Development, PO Box 30910, Lusaka, Zambia, Centre for Global Health and Development Boston University, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118, USA and Department of International Health, Boston University School of Public Health, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118, USA.
authors.forename: Davidson H
authors.initials: DH
authors.lastname: Hamer
authors.affiliation: Ministry of Health, Monze District Medical Office, PO Box 660144, Monze, Zambia, Department of Work and Social Psychology, Maastricht University, PO Box 616, 6200MD Maastricht, The Netherlands, Zambia Centre for Applied Health Research and Development, PO Box 30910, Lusaka, Zambia, Centre for Global Health and Development Boston University, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118, USA and Department of International Health, Boston University School of Public Health, Crosstown 3rd Floor, 801 Massachusetts Avenue, Boston, MA 02118, USA.
authors.forename: Robert A C
authors.initials: RA
authors.lastname: Ruiter
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D011584:Psychology; D036301:Qualitative Research; D055815:Young Adult; D015024:Zambia / Q000453:epidemiology