PSYCHOLOGICAL PREDICTORS OF HEALTH-RELATED QUALITY OF LIFE AND THE EFFICACY OF PSYCHOEDUCATION AMONG PRIMIGRAVIDAS IN IBADAN, NIGERIA

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.