Postnatal Care Service Perceptions and Utilisation: Association with “Wheel of Life Saving Practices” Interpersonal Communication Tool in Dowa District, Malawi

Abstract

Background The Wheel of Life-saving Practices (a.k.a. "Wheel") is an integrated Social and Behaviour Change Communication (SBCC) tool that was designed for interpersonal communication (IPC) campaign at health facility, community, and household levels in Malawi. The IPC was used to promote 22 different priority health behaviours/actions, including attending scheduled postnatal care (PNC) visits among others, targeting period from pregnancy to caregiver’s life stage (first 1000 days of a child’s life). Despite the campaign, no studies had evaluated the Wheel’s effectiveness in influencing PNC visit perceptions nor measured the association of PNC visit perceptions with actual PNC visits in Malawi. The study was conducted to assess if exposure to the Wheel was associated with a more positive PNC visit perceptions and PNC visits among newborn caregivers in Dowa district, Malawi from May 2022 to May 2024. Methods The research employed a cross-sectional survey, conducted in Dowa from 19 to 25 May 2024. A sample of 255 adults (18 years and older) were interviewed from two rural Traditional Authorities (TAs) of Chakhaza and Dzoole, which used a multi-stage sampling technique. Collected data were cleaned using Microsoft Excel and analysed using STATA. The study sample, PNC perceptions, Wheel exposure and PNC visit behaviours were characterised by descriptive statistics. Tests of association were used to test associations between Wheel exposure and PNC visit perceptions and PNC visit perceptions and PNC visit behaviours. v Pearson Chi-square tests were used for categorical variables, while Fisher’s Exact Chi-squared and Chi-squared trending tests were used for ordered variable categories. Results Overall, 90% of the sampled population reported positive PNC visit perceptions. Socio- demographic variables associated with PNC visit perception were occupation (p-value = 0.001), income (p-value = 0.003) and PNC knowledge levels (p-value=0.003). Exposure to the Wheel was generally high, with 62% of the respondents reporting high exposure. with significant differences by education level (p-value=0.007), occupation (p-value=0.033) and income (p-value=0.045). Gender differences were also suggestive, with 58.56% of female caregivers exposed to the Wheel compared with 71.62 % of males, though not statistically significant (p=0.05). The results indicated no association of Wheel exposure with PNC perceptions, while significant association of positive PNC visit perceptions with PNC visit behaviour (p-value=0.001). Conclusion The study found an adequate IPC campaign reach in Dowa, and a very strong and positive relationship of PNC visit perceptions with adoption of PNC visit behaviours as hypothesized by the IPC campaign. However, against expectations, exposure to the Wheel was not associated with PNC perceptions. This suggests the need for critical look at the campaign’s theory of change that may need to be reviewed by the campaign designers. In the end, the study contributes health promotion campaigns and risk communication knowledge and scholarship as it has shown factors associated with IPC campaign reach and with PNC visit perceptions in Malawi, where such literature is scant.