Table 1 Health Belief Model constructs including the main themes with quotes from the participants, Palestine
Model constructs | Description of the themes | Example excerpts |
|---|---|---|
Perceived susceptibility | Knowledge: Susceptibility is perceived as higher among women who know the complications that can develop in pregnancy | “I don’t know about the disease, so how can I know if I am susceptible to it or not.” - a primigravida |
Self-care: Women perceive lower susceptibility as they engage in preventive self-care (e.g. healthy diets) and follow recommendations of care providers (e.g. ANC and screening) | “No, because I came to the clinic every time, and they [healthcare providers] reassured me that I didn’t have anything worrying. Also, in fact, I do not like sweets and sugar.” - a primigravida “I do not think so, because I am eating a good diet. As long as you have a good diet and milk and your hemoglobin is 12 and you are at the end of your pregnancy…” - a low risk woman | |
Pregnancy history: Women with complications in previous pregnancies perceive themselves as more susceptible | “Yes, I had it [hypertension] in my first pregnancy and I recovered after delivery. Yes, I am susceptible because…” - a woman who had a history of hypertension | |
Family history: Women with a family history of pregnancy complications or chronic conditions perceive themselves as more susceptible | “No I don’t worry, and there is nobody in my family who has diabetes” - a hypertensive woman “I don’t know exactly, my parents don’t have hypertension and my husband’s parents have hypertension, so may be my children will have hypertension in the future.” - a pregnant woman who had miscarried five times | |
Perceived severity | Chronic conditions, not pregnancy complications. Women relate their perception of severity to the conditions as chronic conditions, but not their potential for complicating pregnancy | “I know that diabetes delays healing of the wound and this may cause amputation of limbs…” - a woman attending a high-risk clinic “Heart problems and increase heart rate, dizziness and loss of consciousness” - a low-risk woman “I do not know if it affects [the baby]” - a primigravida with moderate anemia |
History of friends/relatives: Women who know friends/family with a history of pregnancy complications perceive complications as more severe | “…hypertension is dangerous for pregnant women and leads to preeclampsia, I know a friend who had eclampsia at the end of the eighth month” - a multigravida “My sister had anemia and her hemoglobin became 5, and she needed two units of blood…” - a grand multipara | |
Being affected by a complication: Women diagnosed with a high risk condition, often articulate clearly the potentially severe consequences of the condition | “Premature baby, low birth weight or IUGR” - a pregnant woman in a high-risk clinic “It can cause early labor, bleeding and thrombosis” - a woman with coagulation disorder | |
Perceived benefit | Expectations to care content: Advance knowledge of purpose and what tests each scheduled visit would include, affects the women’s perception of benefit | “I found that [private] doctor and [public] clinic providing the same services, such as weight, height, blood pressure measurements, so I decided to follow up in the [public] clinic” - a pregnant woman at low-risk clinic trying out services in Gaza “I have to come. It is my duty to come for ANC visit” - a primigravida |
Being affected by a complication: Women diagnosed with a high risk condition perceive the importance of visiting the clinics according to the schedule, but only for the specific condition they are diagnosed with | “…examine the level of sugar and control…” - a woman attending a high-risk clinic “I follow my periodic check-ups every month …I receive the anticoagulant injections…” - a woman with coagulation disorder “Of course it is beneficial, since I get the anti-hypertensive drugs, iron and vitamins” - a woman diagnosed with HDP | |
Perceived barrier | Perception of benefits: The better the perceived benefit the woman have, the less perceived barrier to attend the scheduled visits | “I think that there are no obstacles, and I should follow the right things for my benefit.” - a primigravida “I think, there are no difficulties, and the most important thing is having personal will” - a grand multipara |
Family logistics: Women with small children and little family support, report this as a barrier to attend ANC | “In the first and second pregnancies, I attended regularly, but when the number of my children increased, it became less often than before.” - a mother of three “…my children are small and my husband works in military and he comes back at night…” - a multipara |