Abstract:
Health-related Quality of Life (HRQoL) of primigravidas is linked to maternal
mortality. Nigeria ranks high among the countries with high maternal mortality rate.
Previous studies in Nigeria have largely focused on the influence of anxiety on
HRQoL. However, little empirical attention has been given to the specific role of
psychological factors (health-care seeking behaviour−HCSB, sleep quality,
pregnancy-specific stress and coping styles) on HRQoL among primigravidas. This
study therefore, investigated psychological factors (HCSB, sleep quality components,
pregnancy-specific stress and coping styles domains) predicting HRQoL
(psychological, physical health, social relationships and environment) and the efficacy
of psychoeducation to improve HRQoL among primigravidas in Ibadan, Nigeria.
The Health Belief Model and HRQoL Theory guided the study. A mixed methods
design consisting cross-sectional survey and pretest-posttest experimental group were
adopted. The first phase conducted at Jericho Nursing Home, Ibadan involved two
focus group discussions, eight in-depth interviews with primigravidas, and three key
informant interviews with health professionals guided development of a Pregnant
Women Health-care Seeking Behaviour (PWHSB) Scale. In the second phase, two
tertiary hospitals, four basic health centres were purposively selected, while three state
hospitals were randomly selected. Seven hundred and sixty-eight primigravidas were
purposively selected from antenatal care clinic in nine public hospitals in Ibadan. The
participants completed a 119-item questionnaire comprising demographic variables,
World Health Organization Quality of Life (WHOQL-BREF) Scale (α=0.89), Pregnant
Women Health-care Seeking Behaviour Scale (α=0.99), Pittsburgh Sleep Quality
Index (α=0.85), Revised Prenatal Distress Questionnaire (α=0.87) and Revised
Prenatal Coping Inventory (α=0.91). A six weeks intervention study was conducted in
the third phase among 30 primigravidas who scored below 50% on WHOQL-BREF
screening test. The participants were randomly assigned to Psychoeducation for
Primigravidas −PEP (15) and control (15) groups. Qualitative data were contentanalysed, while quantitative data were analysed using stepwise Multiple regression,
ANOVA, and t-test at p<0.05.
The participants’ age was 26.82±6.08 years. The HCSB, sleep quality, pregnancyspecific stress and coping styles emerged as overarching theme. The HCSB, sleep
quality components, pregnancy-specific stress and coping styles domains jointly
predicted HRQoL (R2=0.11; F(4;694)=21.34). The HCSB (β꞊0.21), sleep disturbance
(β꞊0.08), daytime dysfunction (β꞊-0.08), pregnancy-specific stress (β꞊-0.11) and
positive/spiritual coping (β꞊0.22) independently predicted HRQoL. The age groups
(F(5;762)=2.64), educational qualification (F(4;762)=7.04) and marital status (F(3;763)=3.59)
significantly differentiated HRQoL of primigravidas, while pregnancy trimesters did
not. There was a significant difference in HRQoL in PEP (x̄ =264.93) compared to those
in the control (x̄ =219.60) groups (t(28) =2.18). The HRQoL domains of physical health
(t(28)=7.41), psychological (t(28) =6.48), social relationships (t(28) =6.13), and
environment (t(28) =7.34) were significantly improved by PEP after intervention.
Health-care seeking behaviour, sleep quality, pregnancy-specific stress, and coping
styles influenced health-related quality of life while psychoeducation provided an
evidence-based strategy for improving health-related quality of life among
primigravidas in Ibadan, Nigeria. Health professionals could adopt Psychoeducation
for Primigravidas for use among primigravidas with low health-related quality of life.
