Epuitai Joshua, Woolley Katherine E, Nabirye Rose Chalo, Wandabwa Julius N, Odula Joseph, Lyagoba Ivan, Thomas G Neil
Department of Nursing, Faculty of Health Sciences, Busitema University, Mbale, Uganda.
Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.
PLOS Glob Public Health. 2025 Sep 15;5(9):e0003973. doi: 10.1371/journal.pgph.0003973. eCollection 2025.
In Uganda, pregnant women do not routinely receive health education during antenatal care regarding exposure to household air pollution (HAP). The study was conducted to explore perceptions regarding what would be needed to incorporate HAP as a routine topic for health education during antenatal care. The study was based on the capability, motivation, opportunity-behavior (COM-B) model. Qualitative interviews were conducted among healthcare workers and pregnant women attending antenatal care at Mbale Regional Referral Hospital in Uganda. Thematic analysis was used to identify key themes. Capability to provide health education on HAP emanated from health system factors (e.g., lack of capacity, workload, time constraints) and behavioral factors (e.g., HAP not seen as a major risk factor for adverse pregnancy outcomes). Capability to adopt cleaner fuels following health education was thought to be affected by willingness to adopt short-term interventions ahead of cleaner fuels alternatives, cost/affordability constraints, unwillingness to change, and socio-cultural concerns. Socio-economic constraints, weather and safety concerns were thought to affect women's capability to open doors/windows and cook outdoors following health education. Participants were motivated to provide/receive antenatal health education because of their need to reduce adverse birth outcomes caused by HAP, acceptability of HAP as a topic for education, and the perception of healthcare workers as role models. Training midwives about HAP, using innovative teaching aids, including prompts on HAP in the antenatal card to remind healthcare workers to talk about HAP, giving incentives to healthcare workers and involving them when designing health education about HAP were suggested to enable integration of HAP as routine topic. Our study highlights an opportunity to empower and create demand among pregnant people to adopt behaviors that could reduce exposure to HAP during ANC. Integration of HAP into antenatal care could help transition households from precontemplation and contemplation stage in the uptake of cleaner fuels.
在乌干达，孕妇在产前护理期间通常不会接受关于接触家庭空气污染（HAP）的健康教育。本研究旨在探讨将HAP纳入产前护理健康教育常规主题所需的相关观念。该研究基于能力、动机、机会 - 行为（COM - B）模型。对乌干达姆巴莱地区转诊医院的医护人员和参加产前护理的孕妇进行了定性访谈。采用主题分析法确定关键主题。提供HAP健康教育的能力受到卫生系统因素（如能力不足、工作量、时间限制）和行为因素（如HAP未被视为不良妊娠结局的主要危险因素）的影响。人们认为，健康教育后采用更清洁燃料的能力会受到在采用更清洁燃料替代品之前愿意采用短期干预措施的意愿、成本/可承受性限制、不愿改变以及社会文化担忧的影响。社会经济限制、天气和安全担忧被认为会影响女性在健康教育后打开门窗和在户外做饭的能力。由于需要减少HAP导致的不良出生结局、HAP作为教育主题的可接受性以及将医护人员视为榜样，参与者有动力提供/接受产前健康教育。建议对助产士进行关于HAP的培训，使用创新教具，包括在产前卡片上设置HAP提示以提醒医护人员谈论HAP，给予医护人员激励并让他们参与设计关于HAP的健康教育，以使HAP能够纳入常规主题。我们的研究凸显了一个机会，即增强孕妇的能力并激发她们的需求，促使她们采取能够减少产前护理期间接触HAP的行为。将HAP纳入产前护理有助于家庭在采用更清洁燃料方面从无行动意向和思考阶段过渡。
