KNOWLEDGE, ATTITUDE AND PRACTICE OF PREGNANT MOTHERS TOWARDS THIER APPROPRIATE

RECOMMENDED SPECIFIC EXERCISES ATTENDING ANTENATAL CARE AT KIUTH

CHAPTER ONE

1.0 Introduction

This chapter presents the general introduction to this research study, it has

background, problem statement, objectives, research questions and justifications

for carrying out this research study.

1.1 Background of the study.

The need for exercise among pregnant women is rising in relation to increasing risks of gestation
diabetes mellitus, gestation hypertension, pre-eclampsia , weak pelvic floor muscles, prenatal and
postnatal depression , obesity during pregnancy and improving sleep.(Davenport et Al.,2018)

In developed countries like Iraq; The majority of the study sample had poor overall knowledge regarding
antenatal exercises (93%), Interest in attending antenatal exercise classes 80%, the barrier to attend
antenatal exercise 79% during pregnancy (Abdullah WH et Al.,2019).

In Saudi Arabia, 41.62% of pregnant women had high level of physical activity (PA) awareness and
practice and 58.37% had a low level of awareness and practice.(Chan CWH.,2019).

In Africa, In Nigeria: The majority of the study sample had poor overall knowledge regarding antenatal
exercises (93%), Interest in attending antenatal exercise classes 80%, the barrier to attend antenatal
exercise 79% during pregnancy. There was very highly significant relationship between the pregnant
women’s educational level and overall knowledge regarding exercise during pregnancy.(Abdullah WH et
Al.,2019).

In Ethiopia, a study was done in Hawasa city sidama region In this study, 25.5% of pregnant women had
an adequate practice of antenatal physical exercise while 43.7% of pregnant women had an adequate
level of knowledge on antenatal physical exercise(Belachew.,2023)

In east Africa, a study in Uganda to determine how Knowledgeable pregnant Women attending
Antenatal Care at Lira Regional Referral Hospital are regarding the benefits and contraindications of
Physical Activity during Pregnancy. Results were :Decreasing the risk of swelling of extremities (65%),
back pain (73%), and high blood pressure (80%), and promoting a better ability to cope with labor and
delivery (72%) were the most commonly known benefits of PA in pregnancy and vaginal bleeding (80%),
chest pain (70%), difficulty in breathing (77%), abdominal pain (72%), premature labor (73%), muscle
weakness and migraine headache (73%) were perceived contraindications of physical activity during
pregnancy. 46% had adequate knowledge about physical activity in pregnancy.(okori F et Al.,2022)
 Nurses are responsible for promotion of exercise to pregnant mothers ,it is also

arole of the nurses to evaluate the use of practice of exercise in pregnant mothers through heath
education as well as provide medical assessment expertise and have a critical role

for success of exercise among pregnant mothers. (Okori F et Al.,2022)

However, what hinders pregnant mothers towards exercise include: The attitude is associated with
marital status, the number of children they had to care for, a busy schedule, fear of PA, and lack of
information were the principal reasons not to do Physical Activity. (Okori et Al.,2022).

Therefore, health care providers who work on maternal health (Gynecologists, Midwives, Nurses, Health
extension workers and other community workers) should provide counseling and health education on
antenatal exercise.(Okori F et Al.,2022).

1.2 Problem statement:

In Uganda, studies that were done found out that most of the pregnant mothers are less
knowledgeable, have poor attitude and practice towards exercise. For example a study was done at lira
regional referral hospital regarding the benefits of physical exercise among pregnant mothers. Most of
them said have barriers to physical exercise due to marital status where some of them who were single
mothers had no support from husbands, those who had to take care of many children, busy schedules,
fear of physical activities and also necessary information about physical activity (okori F et al.,2022).

And if these is not met, the pregnant mothers are at risk of developing gestational diabetes, over weight
during pregnancy, pre eclampsia, post partum depression.(Davenport et Al.,2018)

1.3Purpose of the study

1.3.1Main objective

The main objective of this study is to assess knowledge, attitude and practice of specific
appreciate pregnant exercises among antenatal mothers at Kampala International University

Western Campus, Bushenyi District how it can be improved.

1.3.2Specific objectives
i.To find out the individual knowledge, attitude and practice of specified antenatal mother exercises
among pregnant mothers at Kampala International University Western Campus,

Bushenyi District

ii.To find out the barriers to exercise among pregnant mothers at Kampala International University
Western Campus, Bushenyi District and how to reduce on those barriers.

III. How to promote exercise in pregnant mothers.

1.4Research questions

1.What are the attitudes, knowledge and practice of exercise among pregnant mothers

at Kampala International University Western Campus,

Bushenyi District?

2.What are barriers to practicing exercise among pregnant mothers

at Kampala International University Western

Campus, Bushenyi District?.

3.How to promote on the exercises that are meant for pregnant women.

1.5Justification

In Africa, there is a high need for specified exercises among pregnant mothers due to gestational
diabetes mellitus, gestational hypertension, pre eclampsia, obesity, depression, weak pelvic muscles
related to sendantry lifestyle during pregnancy.

Therefore, this study will be beneficial in the following ways

Nursing education

Findings of this research study may help nursing educators with necessary

knowledge package that they need to pass on to pregnant mothers regarding specific pregnant mother
exercises hence improving on exercise practices among pregnant mothers.

Nursing research

Findings of this study may act as source of literature to other scholars interested in
studying attitude, knowledge and practice of pregnant mother specified exercises.

Conceptual framework:

CHAPTER TWO

LITERATURE REVIEW

2.0Introduction

This chapter presents the literature in order of specific objectives of this study

2.1. Knowledge, attitude and practice of specific recommend pregnant mother exercise among pregnant
mothers.

A study was done in Ethiopia at Health centers of Mekelle, Tigray Region, 2020. Among the study
participants of pregnant women 51%, 56% and 16.6% had good knowledge, positive attitude and
practice towards antenatal exercise respectively. Among those 38.8%, 45.9% and 49.8% were expressed
as antenatal exercise can decrease back pain, prevents excessive weight gain and increase energy and
stamina during pregnancy respectively. Among those who practiced antenatal exercise, 95% and 83.4%
was practicing with frequency ≥ three times per week and ≥20 minutes of the duration of exercise per
session respectively.(sitot et al.,2022).

So in this study, it was good to also asses other benefits of exercise among pregnant women like
reducing on the risk of gestational diabetes mellitus, pre eclampsia, strengthening pelvic muscles .

A study was done in Jazan, Saudi Arabia Concerning Pelvic Floor Muscle Exercises assessing
knowledge, attitude and practice of exercise among pregnant mothers. Weaknesses of the pelvic floor
muscles in females can lead to pelvic floor dysfunction thus increasing the risk of urinary and fecal
incontinence.Furthermore, its weakness can lead to reproductive organ prolapse and sexual
dysfunction, and influence sexual arousal and orgasm. There is limited evidence concerning the
awareness of Saudi women regarding the importance of physical activity in the prevention and
treatment of pelvic floor dysfunction.Results A total of 183 pregnant women were recruited. The mean
age of the participants was 27.4 years. The majority of pregnant women complained of lower abdomen
pain with variable degrees. Nearly half of the sample complained of having either urinary or fecal
incontinence with variable degrees of severity. The mean score of knowledge was 5 out of 12 and the
scores varied between 1 and 11. Only 71 women (38.8%) were confident that pregnant women can
exercise pelvic floor muscles. Furthermore, knowledge of the recruited mothers concerning the nature
of the pelvic floor muscle exercise was relatively low in comparison to other items. Nearly one-third of
the sample either believed that the exercise had no effect or had a worsening effect. Half the sample
reported not performing any pelvic floor exercises. Only the practice of the exercise was statistically
associated with the level of knowledge, indicating a higher proportion of women with a higher level of
knowledge among those who regularly or occasionally perform the exercise. This may suggest that
women with a higher level of knowledge are more motivated to exercise (<0.001). Conclusion Several
deficiencies in knowledge about pelvic floor muscle exercise were detected among the recruited sample.
Though the majority of the sample had an attitude favoring pelvic floor muscle exercise, nearly one-third
did not believe pelvic floor muscle exercise can be beneficial. Finally, less than 10% of the sample
indicated regular practice of pelvic floor muscle exercise. These findings indicate a need to increase the
awareness and adherence of women in Jazan.(Derrar et al.,2022).

In this study, it was basically focused on pelvic muscle exercises, next time the researcher should asses
other form of exercises recommend for women like brisk walks, swimming.

Many pregnant youths have appropriate knowledge about healthy behaviors during pregnancy,
but face many youth-specific barriers to achieving these behaviors. Interventions should address
logistical challenges (eg, food access, cost, transportation) to healthy behaviors in pregnancy to make
healthy diet and exercise more convenient for pregnant youth.(Morrison et all.,2022).

In this study, assessment was focused more on the youths who were pregnant, next time the researcher
should also asses older women who are pregnant. This will provide the knowledge, attitude and practice
of exercise among pregnant women in older women between the age of 25 years to 45 years since they
are the ones who have a high number of pregnances.

A study was done in Arba Minch town, Southern Ethiopia: A community-based cross-sectional
study.The findings of this study indicated that adequate practice of antenatal exercise was found to be
low. Appropriate measures should be taken to improve the husband's educational level, mother's
occupation, knowledge, and attitudes towards antenatal exercise. Special consideration should be given
to those with a history of miscarriage and women should be encouraged to practice regular exercise
before pregnancy.(Beyene et Al.,2022).

In this study, findings of those who had less practice towards exercise was found to be low. They should
also asses for the knowledge level and attitude towards exercise before assessing for the practice.

2.2. Barriers to exercises that are meant for pregnant mothers.

Many pregnant youths have appropriate knowledge about healthy behaviors during pregnancy,
but face many youth-specific barriers to achieving these behaviors. Interventions should address
logistical challenges (eg, food access, cost, transportation) to healthy behaviors in pregnancy to make
healthy diet and exercise more convenient for pregnant youth.(Morrison et al.,2020).
Also should asses their attitude because they may be knowledgeable but don't have interest in doing the
exercise.

Mother-child safety concerns, lack of advice/information and lack of social support were also
important emphasized pregnancy-related barriers to be targeted in future interventions(collect et
al.,2017). It should also be assessed to find out why they lack information like maybe no access to
information so as to be able to address the root cause of knowledge deficit.

Intrapersonal barriers to physical activity were fatigue and lack of energy, pain and swelling, lack
of childcare, medical restrictions and safety concerns, lack of knowledge about exercise safety, and lack
of time. Interpersonal barriers included concerns and lack of support from partners and families,
conflicting advice from friends and neighbors, and lack of advice on safe exercise from physicians.
Women in all four groups suggested a community-based intervention where they can mingle with each
other and share their challenges and concerns. Other suggestions to interventions differed among
groups and reflected the women's experiences and backgrounds.(Koceilate et all.,2021). It should asses
also for other medical conditions that maybe the major reason for fatigue, pain and swelling of the
body. As this may also be the cause of restrictions to exercise.

Factors negatively associated with an adequate antenatal exercise were husband's primary
school level, history of miscarriage, inadequate knowledge, and unfavorable attitude. Whereas, factors
positively associated with an adequate antenatal exercise were employment status of women and a
practice of regular exercise before current pregnancy.(Beyene et Al.,2022).

2.3. How to promote practice, knowledge and attitude on exercises that are meant for pregnant women.

Health care providers who work on maternal health (Gynecologists, Midwives, Nurses, Health
extension workers and other community workers) should provide counseling and health education on
antenatal exercise.(Okori F et Al.,2022).

Appropriate measures should be taken to improve the husband's educational level, mother's
occupation, knowledge, and attitudes towards antenatal exercise. Special consideration should be given
to those with a history of miscarriage and women should be encouraged to practice regular exercise
before pregnancy.(Beyene et Al.,2022).

Interventions should address logistical challenges (eg, food access, cost, transportation) to
healthy behaviors in pregnancy to make healthy diet and exercise more convenient for pregnant youth.
(Morrison et al.,2020)
 Women in all four groups suggested a community-based intervention where they can mingle
with each other and share their challenges and concerns. Other suggestions to interventions differed
among groups and reflected the women's experiences and backgrounds.(Koceilate et all.,2021).

CHAPTER THREE

METHODOLOGY

3.0Introduction

This chapter presentsthe methods employed by the researcher before and during

data collection. It presents Study designand rationale,Study setting and rationale,

Study population and rationale, Sample size determination, Sampling procedure,

Inclusion criteria, Definition of variables, Research,instrument, Data collection

procedures, Data management, Data analysis, Ethical considerations, Limitations

of the study, Dissemination of the study findings

3.1Study design and rationale

A quantitative descriptive cross-sectional study design that will be used to generate

the data for this research study. It is across-sectional because it will be assessing

only pregnant mothers present at the hospital. It is also quantitative because data

Will be presented in descriptive quantifiable figures representing each study

variable.

3.2Study setting and rationale

The study will be carried out at Kampala International University hospital in the antenatal ward.

This is because is of easy reach to the hospital.

3.3Study population and rationale

The respondents econsist of pregnant mothers at Kampala International

University teaching hospitals in the maternity ward. These have been chosen based on reports

that have showed many pregnant mother complications that come up due to sedentary lifestyle like
over weight, gestational diabetes mellitus and pre-eclampsia in the hospital.

3.4.1Sample size determination

The sample size will be determined using the formula for simple random sampling

using single proportion given by Yamane 1999 formula for calculating sample

size .

n=(

1+N(e2)

Where n=sample size

N= Gross population of pregnant mothers expected at KIUTH at time of research

study.

E= Level of precision estimated to be 0.1at 90% confidence level.

n=

2000

1+2000(O.1)2

12

n=95.2

Therefore, the number of pregnant mothers will be determined during the study.

3.4.2Sampling procedure

The participants will be selected through simple random sampling where papers

written on S representing a sample and N representing non-representative will be

written, S number of papers is equal to the strata determined, and the same
number of non-representative papers will be used in order to have equal chances for

a participant to choose S or N.

These will be a turn up for pregnant mothers knowledge, attitude and practice on their specified
exercise activities whenever there's an assessment.

3.4.3Inclusion criteria

3.4.3.1Inclusion criteria

The study will include all pregnant mothers at maternity ward Kampala international university teaching
hospitals who will be willing to participate in the study.

3.4.3.2Exclusion criteria.

Those who will not be willing to consent at the time of data collection will not be

included in the study.

3.5Definition of variables

Dependent variables

Pregnant mothers

Independent variables

Exercise for pregnant mothers.

3.6Research instrument

The instruments that will be used in collecting data will be questionnaires.

The questionnaire will be containing open and close ended questions .

The questionnaire will be given to pregnant mothers by the research himself since all may not be able
to read and write and therefore, questions will be first read and interpreted by the researcher to the
pregnant mothers who are unable.

The questionnaire will be divided into 3 sub sections section: Questions related to the socio-
demographic characteristics

Questions related to physical activity and exercise practice.

Questions related to knowledge, benefits, and barriers of physical activity.

3.6.1Reliability and Validity of Instruments

In order to ensure the validity and reliability of instruments, the researcher will

ensure that questionnaire is first gone through by the supervisor for comments

and amendments to be made while as observation and the written documents will first

be analyzed to ensure that they are consistent with what the researcher intend to

collect.

3.6.2Pre-visiting and pre testing

No pre-visiting will be reequired for this study as the researcher is a student of the

institution has been their during ward placements hence sure about possibility to get desired
population at the time of data collection.

3.6.3Pre-testing

Pretesting of the questionnaire will be done from other hospital from Ishaka

Adventist hospital to ensure validity and reliability of the instrument.

3.7Data collection procedures

The researcher will get an introductory letter from research ethics committee of

Kampala International University School of Nursing to introduce him to the respective ward in charge of
maternity ward at KIUTHin order to obtain permission to collect data from pregnant mothers at KIUTH.

Ward in charge.

After obtaining the permission, it will be taken to the ward in charge where I will ask him or her
permission into the ward.

She or he will allow me into the ward.

After obtaining all necessary permissions from all authorities, a consent form will be read

read to pregnant mothers to obtain their consent to take part in this research study.

After obtaining consent, I will destribute the questionnaires and ask those who are unable to read and
interprete so that I myself will ask their relative or any friend of theirs to do it for them. I leave them to
read, interpret and answer questions without my presence to reduce the bias related to researcher's
presence. After the participants have independently answered questionnaires, they will be ollected by
the researcher who first checks completeness and ensure that all questions in questionnaire are
answered.

After research participants have fully answered all questions, questionnaires will be

collected from the respondents, checked for completeness, and stored in an

envelope for analysis and presentation.

3.8Data management and analysis

3.8.1Data management.

I collected the data by myself to ensure no intrusion by unauthorized personal.

Collected data waskept under lock and key to avoid intrusion by unauthorized

personnel

3.8.2Data analysis

Data obtained will be recorded and checked for completeness then compiled, coded

and analyzed using SPSS version 20.0 statistical results then will be transferred to

Microsoft Excel where they wereconverted to frequency tables, charts and graphs

3.9Ethical considerations

Code of research ethics and integrity willbbe ensured throughout the study in the

following ways.

The researcher will obtain an introductory letter from the research ethics

committee, faculty of nursing sciences of KIU-WC.

Also the researcher will seek for permission from the participants by introducing

himself before carrying out the data collection processes.

The participants will be assured that all the information they will give will be

confidential and their participation are very important.

Participation will be by voluntary consent

3.10Limitations of the study

Financial constraints. The cost of surfing on the internet,

typing and printing of the research work is very high. However if I do my savings and the help from
parents it will be successful.

Also limited time is available as there are a lot of other academic assignments like courseworks,
presentations. However through proper time management, it will go successfully.

3.11Dissemination of the study findings. Two copies will be printed and submitted to:

Kampala international University school of nursing for approval.

Kampala international University teaching hospital library for other scholars

reading.

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