A Cross-Sectional Study to Assess the Perceived Risk and Covid Appropriate behavior among women attending Antenatal Clinic during Covid-19 Pandemic in A Tertiary Care Hospital in Ernakulam District, Kerala
Nini Babu1, Rinu Abraham2, Megha Johnson M3, Megha Mariya Mathew3, Megha Prasad3
1Assistant Professor, Dept of Obstertics and Gynaecological Nursing, M.O.S.C College of Nursing,
Kolenchery, Ernakulam, Kerala, India.
2Assistant Professor, Dept of Obstertics and Gynaecological Nursing, M.O.S.C College of Nursing,
Kolenchery, Ernakulam, Kerala, India.
3Final Year B.Sc Nursing Students (2018-2022). M.O.S.C College of Nursing,
Kolenchery, Ernakulam, Kerala, India.
*Corresponding Author E-mail: ninibabu15@gmail.com
ABSTRACT:
Aim: This descriptive study is conducted to assess the perceived risk and covid appropriate behavior among women attending antenatal clinic during Covid -19. Objective: To assess the perceived risk and covid appropriate behavior of antenatal women. To find the relation between perceived risk and covid appropriate behavior of antenatal women. To find the association of perceived risk and covid appropriate behavior of antenatal women with their selected socio-demographic and clinical variables. Methods: Descriptive study is employed. Data is collected from 84 antenatal women attending antenatal clinic during Covid-19 pandemic in a selected tertiary care centre in Ernakulam district, Kerala. Study participants are asked to complete a structured socio-demographic and clinical proforma and a structured rating scale to assess the perceived risk of antenatal women during Covid-19 pandemic and a structured rating scale to assess covid appropriate behavior of antenatal women during Covid-19 pandemic. The data is analyzed using R software. Results: The present study is intended to assess the perceived risk and covid appropriate behavior among women attending antenatal clinic during Covid-19. There is a weak positive correlation between the perceived risk and covid appropriate behavior of antenatal women during Covid 19 pandemic as the Spearman’s correlation coefficient value (ρ) is 0.132. The variables such as age, education, religion, family structure, employment status, economical status, pregnancy status, period of gestation, regular antenatal visits, pregnancy planning, history of covid infection, comorbidities, source of information, training sessions attended are found to be not statistically significant (p >0.05) with covid appropriate behavior of antenatal women during Covid-19 pandemic.
KEYWORDS: Perceived Risk, Covid Appropriate Behavior.
INTRODUCTION:
Pregnant women and their fetuses are at high risk during the outbreak of infectious diseases1. Physiological and mechanical changes during pregnancy increase susceptibility to infections. Researchers have shown that emerging infections have a significant impact on pregnant women and their fetuses2. Antenatal care is an important indicator globally and nationally to assess the health care of the country3.
In pandemic diseases, perceived risk encourages people to engage in protective behaviors to reduce potential risks4. Measuring the level of risk perception as well as its determinants in pregnant women is essential for the transmission of information and health protocols. Despite the vulnerability of pregnant women during the COVID-19 pandemic, few studies have been conducted on their risk perception and protective behaviors.5
In the study of Ackerman et al. on the Iranian pregnant women, the higher fear of COVID-19 was associated with higher preventive behaviors. COVID-19 pandemic is the most intense and emotional experience of pregnant women’s lives. In this regard, health care providers should pay more attention to pregnant women who have health concerns at the same time about themselves and their fetuses. Currently, the mortality rate from COVID-19 is lower than previous epidemics such as SARS and MERS. However, stress and anxiety may be the most important challenge in the COVID-19 pandemic.6
Individual behavior and risk perception are two interrelated aspects of a disease outbreak. Higher perceived risk can increase an individual’s adherence to preventive measures7. Although some living guidelines on COVID-19 target the pregnancy population, several clinical questions regarding pregnancy and childbirth remain unanswered8.
The rate of COVID-19 in pregnant and recently pregnant women attending or admitted to hospital for any reason is around 10%. Pregnancy, in general, does not significantly increase the risk of being infected by SARS-CoV-29. Risk perception in relation to pregnancy is a complex process influenced by personal, psychological and societal factors10.
During the corona pandemic, it is recommended that pregnant women take care of personal and social hygiene and avoid unnecessary trips, crowded places, public transportation, and contact with sick people11.
A cross-sectional study to assess the perceived risk and covid appropriate behavior among antenatal women attending Gynecology OPD during Covid 19 pandemic in a selected tertiary care centre in Ernakulam district, Kerala.
1. To assess the perceived risk and covid appropriate behavior of antenatal women.
2. To find the relation between perceived risk and covid appropriate behavior of antenatal women.
3. To find the association of perceived risk and covid appropriate behavior of antenatal women with their selected socio-demographic and clinical variables.
Outcome variable:
Perceived risk and covid appropriate behavior.
Socio-Demographic Variables:
Age, education, religion, family structure, employment status, economical status.
Clinical variables:
Pregnancy status, period of gestation, regular antenatal visits, pregnancy planning, history of covid infection, comorbidities, source of information, training sessions attended
MATERIALS AND METHODS:
Source of data:
The data was collected from women attending antenatal clinic during Covid-19 pandemic in M.O.S.C Medical mission hospital, Kolenchery.
Methods of Data Collection:
Research Approach:
The research approach used for the study was quantitative approach.
Research design:
The research design used for the study was cross sectional analytical design.
Population:
Antenatal women in Ernakulam district, Kerala.
Accessible Population:
Women attending antenatal clinic of M.O.S.C Medical College Hospital, Kolenchery.
Setting of the study:
The setting was antenatal OPD of M.O.S.C Medical College Hospital, Kolenchery, Ernakulam district, Kerala.
Sample, Sampling size and Sampling Technique: Women attending antenatal clinic of M.O.S.C Medical College Hospital, Kolenchery, Ernakulam district. 84 subjects attending antenatal clinic were selected for the study. Sampling technique used for the study was convenience sampling technique.
Inclusion Criteria:
Antenatal women who are able to read and write Malayalam or English.
Section A: Sociodemographic and Clinical Proform:
It consist of 15 questions for collecting demographic data such as age, education, religion, family structure, employment status, economical status and clinical variables such as pregnancy status, period of gestation, regular antenatal visits, pregnancy planning, history of covid infection, comorbidities, source of information, training sessions attended.
Section B: Tool 1: Structured rating scale to assess perceived risk of antenatal women during Covid -19 pandemic:
Structured rating scale consist of 8 items. It consist of series of statements on perceived risk of antenatal women during Covid- 19 pandemic. Each item has 3 alternatives: High, Moderate, Low.
Section C: Tool 2: Structured rating scale to assess covid appropriate behavior of antenatal women during Covid-19 pandemic:
Structured rating scale consist of 18 items. It consist of series of statements that were intended to assess the covid appropriate behavior of antenatal women during Covid-19 pandemic. Each item has 3 alternatives Never, Sometimes, always.
The prepared tools sociodemographic and clinical proforma, perceived risk and covid appropriate behavior of antenatal women during Covid-19 pandemic were submitted to five experts. They were requested to judge the items for its relevance, appropriateness and degree of agreement for the study. Modifications were made in the tools as per the suggestions given by them. Content validity index was calculated. Items with a content validity index more than 0.8 is included in the tool. Reliability of perceived risk was assessed by Cronbach’s alpha and the tool was found to be highly reliable (r=.886). Reliability of covid appropriate behavior was calculated by Cronbach’s alpha and the tool was found to be highly reliable (r=.886).
After obtaining ethical clearance from the Institutional Ethical Committee, MOSC Medical College Hospital, Kolenchery, Ernakulam, administrative permission was obtained from concerned college and hospital authorities. Women attending antenatal clinic was approached individually and the purpose of the study is explained. Their concerns were clarified to the level of satisfaction. Data was collected after obtaining informed consent from the subjects.
Section 1: Analysis and interpretation of socio-demographic variables of antenatal women
Table 1: Frequency and percentage distribution of socio-demographic variables of antenatal women. n=84
|
Sl no |
Demographic characteristics |
Frequency (f) |
Percentage (%) |
|
1 |
Age in years |
|
|
|
|
18-25 years |
36.00 |
42.86 |
|
|
26-30 years |
38.00 |
45.24 |
|
|
31-35 years |
9.00 |
10.71 |
|
|
36 and above |
1.00 |
1.19 |
|
2 |
Highest level of education |
|
|
|
|
School |
0 |
0 |
|
|
Diploma |
11 |
13.10 |
|
|
Degree |
60 |
71.43 |
|
|
Post graduate |
13 |
15.48 |
|
3 |
Religion |
|
|
|
|
Christian |
52 |
61.90 |
|
|
Hindu |
22 |
26.19 |
|
|
Muslim |
10 |
11.90 |
|
|
Others |
0 |
0 |
|
4 |
Family Structure |
|
|
|
|
Joint Family |
22 |
26.19 |
|
|
Nuclear Family |
62 |
73.81 |
|
5 |
Working |
|
|
|
|
Yes |
38 |
45.24 |
|
|
No |
46 |
54.76 |
|
6. |
If yes, health professional |
|
|
|
|
Yes |
63 |
75 |
|
|
No |
21 |
25 |
|
7 |
Economic status |
|
|
|
|
APL |
62 |
73.81 |
|
|
BPL |
22 |
26.19 |
|
8 |
Pregnancy status |
|
|
|
|
1 |
41 |
48.81 |
|
|
2 |
34 |
40.48 |
|
|
3 |
9 |
10.71 |
|
|
More than 3 |
0 |
0 |
|
9 |
Period of gestation |
|
|
|
|
Less than 12 weeks |
16 |
19.05 |
|
|
12-28 weeks |
37 |
44.05 |
|
|
28 to 36 weeks |
24 |
28.57 |
|
|
36 to 40 weeks |
7 |
8.33 |
|
10 |
Regular antenatal visits |
|
|
|
|
Yes |
82 |
97.62 |
|
|
No |
2 |
2.38 |
|
11 |
Pregnancy planning |
|
|
|
|
Yes |
72 |
85.71 |
|
|
No |
12 |
14.29 |
|
12 |
History of covid infection |
|
|
|
|
Yes |
29 |
34.52 |
|
|
No |
55 |
65.48 |
|
12.1 |
If yes, during pregnancy |
|
|
|
|
Yes |
21 |
25 |
|
|
No |
63 |
75 |
|
13 |
Any comorbidities |
|
|
|
|
Yes |
5 |
5.95 |
|
|
No |
79 |
94.05 |
|
13.1 |
If yes, specify |
|
|
|
|
Diabetes |
1 |
20 |
|
|
Gestational diabetes |
2 |
40 |
|
|
Gestational hypertension |
1 |
20 |
|
|
Hypothyroidism |
1 |
20 |
|
14 |
Source of information |
|
|
|
|
Media |
43 |
51.19 |
|
|
Health care worker |
35 |
41.67 |
|
|
Other people |
6 |
7.14 |
|
15 |
Attending training session or awareness class related to COVID-19 |
|
|
|
|
Yes |
56 |
66.67 |
|
|
No |
28 |
33.33 |
Table 1 shows that one third of antenatal women belong to the age group of 26-30 years (45.24%), (71.43%) completed their degree, (61.90%) belongs to Christian religion. (73.81%) belongs to a nuclear family, most of them are working (53.76%), out of that (25%) are healthcare professionals. (73.81%) belong to APL category, half of them have pregnancy status one (48.81%). (44.05%) period of gestation in between 12-28 weeks. (97.62 %) had undergone regular antenatal visits. (85.71%) adopted a family planning method. (65.48%) had a history of covid infection. (75%) infection occurs during the time of pregnancy. (94.05%) had no any comorbidities, (51.19%) gathered information from media, (66.67%) attended training sessions related to Covid 19.
Section 2: Relationship between perceived risk and covid appropriate behavior of antenatal women during Covid-19 pandemic:
Table 2. Relation between perceived risk and covid appropriate behavior
|
Variables |
Median |
Q1 |
Q3 |
Spearman’s correlation |
p value |
|
Perceived risk |
7 |
3.50 |
8 |
|
|
|
Covid appropriate behavior |
22 |
19 |
26 |
0.132 |
0.231 |
Figure 2 shows a scatter diagram showing weak positive correlation between perceived risk and covid appropriate behavior of antenatal women during Covid-19 pandemic.
Section 3: Association of perceived risk with sociodemographic variables and clinical proforma of antenatal women during Covid-19 pandemic:
There is no association of perceived risk with sociodemographic variables and clinical proforma of antenatal women during Covid-19 pandemic.
Section 4: Association of covid appropriate behavior with socio-demographic variables and clinical variables of antenatal women during Covid-19 pandemic:
There is no association of covid appropriate behavior with socio-demographic variables and clinical variables of antenatal women during Covid-19 pandemic
The purpose of the study was to assess the perceived risk and covid appropriate behavior among women attending antenatal clinic during Covid-19 pandemic in a selected tertiary care center in Ernakulam district, Kerala. The study findings are discussed in this chapter with reference in the objectives, hypothesis stated and findings of other similar studies.
Findings related to relationship between perceived risk and covid appropriate behavior of antenatal women during Covid - 19 pandemic:
In the present study was to assess relationship between perceived risk and covid appropriate behavior of antenatal women is estimated by calculating mean and standard deviations for data which follow the normality and median and IQR which do not follow normality. Median and Q1, Q2, Q3 for perceived risk is 7+-3.50, 8. Median and Q1, Q3 for covid appropriate behavior was 22+-19,26. Their p value is .231.
Similar studies were obtained by Hamadan, Iran showed risk perception is an independent predictor of protective behaviors related to Covid -19 (p<0.05). No contradictory studies were found.
Findings related to association between perceived risk and socio-demographic variable:
In the present study, there was no association between perceived risk and socio-demographic variable. Contradictory findings were obtained showing high economic level, and nulliparity were associated with higher levels of knowledge, protective behaviors and risk perception respectively. Risk perception of pregnant women regarding Covid-19 can predict their protective behaviors.
CONCLUSIONS:
The findings of the study revealed that, there was a weak positive correlation between perceived risk and covid appropriate behavior among antenatal women. There was no association between sociodemographic variable and covid appropriate behavior with sociodemographic variable and clinical variables.
Nursing Practice:
Aim of the study should be a healthy mother, avoiding risk factors, determine socio-demographic and clinical proforma of perceived risk and covid appropriate behavior among antenatal women.
Nursing Education:
Nurse educators use the findings while teaching about the perceived risk and covid appropriate behavior among antenatal women. The need of shifting of curriculum from medical intervention to holistic approach and providing a positive approach towards pregnancy.
Nursing Research:
Further study in these areas will help health care workers to prepare interventions based on the need of antenatal women during pandemics. This result gives an insight into perceived risk and covid appropriate behavior among antenatal women which is essential for the prevention from Covid-19 pandemic.
Nursing Administration:
Health care professionals have the ability and skills to care of antenatal women. Nurse administrator can incorporate the findings of the study in-service education programs organized for the midwives.
RECOMMENDATIONS FOR FUTURE RESEARCH:
Sample size should be much more, so that the study can provide further more relevant information.
Ethical permission was obtained from the Institutional Ethics Committee of M.O.S.C Medical College Hospital, Kolenchery, Ernakulam. Formal permission was obtained from concerned college and hospital authorities. Informed consent was obtained from the subjects. Confidentiality and anonymity was ensured using the subject coding system.
The authors declare no conflict of interest.
1. Dashraath P, Wong JL, Lim MX, Lim LM, Li S, Biswas A, Choolani M, Mattar C, Su LL. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. American Journal of Obstetrics and Gynecology. 2020 Jun 1; 222(6): 521-31.
2. Rasmussen SA, Hayes EB. Public health approach to emerging infections among pregnant women. American Journal of Public Health. 2005 Nov; 95(11): 1942-4.
3. National Health Policy 2017. New Delhi: Ministry of Health and Family Welfare. Available at: https://www.nhp.gov.in/health-policies_pg. Accessed on 4 January 2017.
4. National COVID-19 Clinical Evidence Taskforce. Australian guidelines for the clinical care of people with COVID-19. 2020 [version 33]. 2020 [01/23/2021].
5. Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ (Clinical research ed). 2020; 370: m3320.
6. White O, McCorry NK, Scott‐Heyes G, Dempster M, Manderson J. Maternal appraisals of risk, coping and prenatal attachment among women hospitalized with pregnancy complications. Journal of Reproductive and Infant Psychology. 2008 May 1; 26(2): 74-85.
7. Brewer, N. T., Chapman, G. B., Gibbons, F. X., Gerrard, M., McCaul, K. D., and Weinstein, N. D. Meta-analysis of the relationship between risk perception and health behavior: the example of vaccination. Health Psychol. 2007; 26, 136–145. doi: 10.1037/0278-613 unanswered.
8. Wang SS, Zhou X, Lin XG et al. Experience of clinical management for pregnant women and newborns with novel coronavirus pneumonia in Tongji Hospital, China. Curr Med Sci. 2020; 40(2): 285–289
9. Mosby LG, Rasmussen SA, Jamieson DJ. 2009 pandemic influenza A (H1N1) in pregnancy: a systematic review of the literature. Am J Obstet Gynecol. 2011; 205: 10–8.
10. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2010; 382(8):727–733
|
Received on 18.07.2025 Revised on 05.08.2025 Accepted on 22.08.2025 Published on 03.11.2025 Available online from November 15, 2025 A and V Pub Int. J. of Nursing and Med. Res. 2025; 4(4):209-213. DOI: 10.52711/ijnmr.2025.39 ©A and V Publications All right reserved
|
|
|
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License. |
|