Knowledge, Attitudes and Practices (KAP) on Anemia in Pregnant Women

Abstract

• Name: Knowledge, Attitudes and Practices (KAP) On Anemia in Pregnant Women
• Purpose: To understand the prevalent knowledge, attitudes and practices (KAP) on anemia and iron/folate supplements for pregnant women by carrying out in-depth interviews, focus groups and iron/folate supplementation trials (trials of improved practices, TIPs). Results enable program planners to design culturally appropriate and more effective IDA control programs responding to women's needs and expectations.
• Type of Design: Descriptive/cross-sectional
• Sample Size: The instrument is used with samples of pregnant women and local health providers. While statistically representative samples of pregnant women may be selected, more often convenience samples are used for interviews, and relatively small groups of women from different localities are involved in supplementation trials and focus group discussions. The results are used for program planning, particularly for decisions regarding the type, quality and distribution systems for iron supplements, as well as the design of an information, education and communication (IEC) strategy and work plan in support of iron/folate supplementation.
• Where Used: Bolivia

To survey tool

Basic Information

Name: Knowledge, Attitudes and Practices (KAP) On Anemia in Pregnant Women

Origin: Developed jointly by OMNI, the Bolivian Ministry of Health (Integrated Program for Anemia Prevention and Control), CCH and MotherCare.

Source: OMNI, CCH, Bolivian MOH, and MotherCare.

Basic Description: The tool and manual guide data collection from pregnant women and their partners, mothers, local health care personnel and influential community members. Data are gathered on knowledge, attitudes and practices related to anemia and iron/folate supplementation. Trained interviewers conduct in-depth interviews, focus group discussions and implement iron/folate supplementation trials (TIPs).

Country Applications: Prototype tool developed, field-tested and used in Bolivia, India, Sri Lanka.

Languages: Spanish. English versions used in India and Sri Lanka.

Technical Scope: Knowledge, attitudes and practices regarding anemia, the use of iron supplements and the availability and quality of services, including supplement distribution, counseling and education on anemia, and preferred communication channels.

Purpose: Program design/planning and, eventually, program monitoring and evaluation.

Type of Methods: Semi-quantitative and qualitative information to be gathered at the community.

Design: Descriptive, cross sectional

Frequency of Administration: At the program design/planning stage and subsequently during program implementation for monitoring and evaluation.

Key Users of Information

Primary Users: Anemia prevention/control and IEC program planners and implementers.

Secondary Users: NGOs/PVOs, community development agencies and projects.

Objectives and Scope of Tool

Objective: To gather information on knowledge, attitudes and practices (KAP) on anemia during pregnancy from pregnant women and health personnel particularly on iron/folate supplementation and IEC components of anemia control programs.

Scope: The instrument includes information to be collected in two phases: a) in depth interviews with pregnant women with and without experience in the use of iron supplements and their partners, influential women from the community, local health care personnel, traditional healers and birth attendants, and community leaders and local authorities, as well as focus group discussions with influential women in the community; and b) supplementation trials (TIPs) with pregnant women followed by additional focus group discussions.

Key Monitoring Needs and Evaluation Questions Tool Seeks to Address

• Knowledge and concepts of pregnant women regarding definition and recognition of anemia in general and anemia during pregnancy, its signs and symptoms, its health and functional implications, and means to prevent and control it.
• Attitudes, practices and experience of pregnant women on the use of iron supplements during pregnancy, acceptance, positive and negative reactions, side effects, and willingness to use them.
• Channels of distribution and availability of different types of iron supplements at health services and the commercial sector.
• Knowledge, attitudes and practices on anemia, its identification, prevention and control methods and the use of iron supplements among institutional and traditional health care providers.
• Sources of information, counseling and advise on anemia and iron/folate supplements available to pregnant women, including health care providers and influential persons in the family and the community.

Key Indicators

• Most frequent definitions of anemia by pregnant women, types of anemia, signs and symptoms, implications for mother and child, most frequently reported causes and means to prevent and treat anemia.
• Proportion of pregnant women with and without previous experience in using iron supplements during pregnancy, recognized benefits, most frequent complaints, type and frequency of supplement use, sources of supply, most frequently reported side effects.
• Availability of iron/folate supplements in the community, women's willingness to buy them, stock of iron/folate supplements in households.
• Most frequent sources of health and nutrition advise during pregnancy.
• Availability and use of radio and TV, frequency, preferred programs, other communication channels.
• Most prevalent views on pregnancy and anemia by women's partners; types of anemia, signs and symptoms; causes and implications of anemia; knowledge and experience with iron/folate supplements; sources of advise and information channels.
• Most prevalent views on pregnancy and anemia by influential persons in the family and the community; types of anemia, signs and symptoms; causes and implications of anemia; knowledge and experience with about iron/folate supplements; sources of advise and information channels.
• Most prevalent views on pregnancy and anemia by community leaders and authorities; types of anemia, signs and symptoms; causes and implications of anemia; knowledge and experience with iron/folate supplements; sources of advise and information channels.
• Knowledge of health care providers on anemia, signs and symptoms; magnitude of the problem in the community; causes and consequences; type of iron/folate supplements available at health services and other sources of supply; iron/folate supplementation protocols; most frequent complaints by pregnant women; prevention and control of side effects; other type of medicines or supplements frequently used by pregnant women; type of advise to be given to them.
• Most prevalent views on pregnancy and anemia by traditional health care providers and birth attendants (TBAs); types of anemia, signs and symptoms; causes and implications of anemia; knowledge and experience with iron/folate supplements; sources of advise and information channels.
• Experience of pregnant mothers with use of iron/supplements in ten-day period supplementation trials (TIPs); most frequent complaints; perceived benefits and side effects; willingness to continue using the supplement.

Research Design

Information collected is mostly qualitative. It is collected mainly through personal interviews using a standardized questionnaire from convenience samples of pregnant women, influential persons in the family and community, public health care providers, traditional health care providers, including traditional birth attendants (TBAs), and community leaders. Persons to be interviewed are selected by or in collaboration with local health services in different types of communities in the target area, ideally by geographic region. Data collection questionnaires are previously field-tested. Supplementation trials (TIPs) are conducted in small groups of pregnant women. Focus group discussions are held with small groups of pregnant women, and influential women in the family.

Implementation

Data collection is usually made by primary health care personnel especially trained in the use of the different instruments for KAP surveys, focus group discussion and supplementation trials. A study in six health districts in Bolivia, covering 130 interviews, 17 focus group discussions and a ten-day supplementation trial in a group of 30 pregnant women was completed in three months by 24 interviewers (four per district) and two supervisors.

Analysis

Data analysis is relatively simple, and it is facilitated by a series of analytical instruments provided as part of the field manual.

Reporting

The report is specifically used as a basis for development of an information, education and communication (IEC) strategy and work plan, including the design of specific messages and materials, and selection of communication channels for promoting increased use and compliance with iron/folate supplements by pregnant women.

Dissemination of Results

Although there is often some dissemination of the results to a larger audience, the primary users of the information are program planners and implementers responsible for IEC activities.

Manuals and Guidelines

A manual (in Spanish) provides specific guidance on the use of the instruments for interviews, focus group discussions and supplementation trials, as well as some guidelines for interviewers profile and training.

References

OMNI. Conocimientos, actitudes y practicas de las embarazadas en relacion a sus embarazos, el problema de las anemias, sus consecuencias y sus motodos de control. Investigacion cualitativa en Servicios de Salud y la Comunidad de 6 Distritos del Altiplano, Valle y Llanos de Bolivia. OMNI, Proyecto de Salud Infantil Communitaria (CCI), MotherCare, Secretaria Nacional de Salud. La Paz, 1997.