FACTORS AFFECTING THE EXTENT OF COMPLIANCE OF ADOLESCENT

PREGNANT MOTHERS ON PRENATAL CARE SERVICES

 CHAPTER I

THE PROBLEM AND ITS SETTING

Background of the Study

Adolescent pregnancy and childbearing entail a high risk of maternal death for the

adolescent, and the children of young mothers have higher levels of morbidity and mortality .

These adolescents and their children may experience repercussions in the present, as well as far

into the future. Pregnancy and childbearing may cut short an adolescent’s education and threaten

her economic prospects, employment opportunities and overall well-being. Adolescent mothers

may pass on to their children a legacy of poor health, substandard education and subsistence

living, creating a cycle of poverty that is hard to break ( United Nations, 2002)

In addition, teen pregnancy is a critical public health issue that affects the health and

educational, social, and economic future of the mother and child. It is also a significant factor in

numerous other important social issues, welfare dependency, out-of-wedlock births, responsible

fatherhood, and workforce development are all of particular concern. Adolescents are less likely

to seek out prenatal care because they afraid, embarrassed, or unaware of the resources available

to them. This lack of prenatal care, coupled with the mother’s usually immature physical

development, result in higher rates of low birth weight babies than in other age groups. As the

offspring of adolescent mothers grow, they are more apt than other children to have and

cognitive problems and to be the victims of neglect or abuse (www.cdc.gov/nchs/births.htm).

Moreover, the birth rate for teenagers 15- 20 years is rising for the first time since 1991. The

adolescent birth rate had been dropping steadily since a high of 61.8 births per 1, 000 in 1991 to
a low of 40.5 births per 1,000 in 2005. But between 2005 and 2006 there was a 3% increase in

births to adolescents. According to data from National Vital statistics Reports, 435,427 births

occurred to mothers aged 15-20 in 2006, correlating to a birth rate of 41.9 live births per 1,000

women in this age group (Hamilton BE, et al, 2007). Thus, adolescent pregnancy continues to

have major medical, social, and economic impact in the United States, with an adolescent birth

rate ranking the highest of developed countries. Overall, 47.8 % of high school students reported

having ever engaged in sexual intercourse, with 7.1 % stating that their age at first intercourse

occurred before the age of 13 (http://apps.nccd.cdc.gov/yrbss).

Pregnant adolescents vary greatly in their circumstances and behaviour, and consequently

their healthcare needs. Lack of information about pregnant adolescents’ needs means that service

providers are ill equipped to deal with them. Failure on the part of communities to acknowledge

and address the issues related to and stemming from adolescent pregnancy further complicates

the situation. There are major barriers that preclude adolescents’ access to maternal health-care

services. Failure to address these barriers and needs seriously threatens a healthy outcome for

these young mothers and their newborns, further compromising the already unacceptably high

maternal mortality ratio and pregnancy-related morbidities (Barker, 2002).

Prenatal Care, also known as antepartum or antenatal care, refers to the health services

that a pregnant woman receives before a baby’s birth. Health care providers know from

numerous studies that prenatal care is important because potential problems that may endanger

that mother or her baby may be discovered and treated prior to birth

(http://www.mchb.hrsa.gov/programs/womeninfants/prenatal.htm). It is composed of screening

for health conditions that are likely to increase the possibility of adverse pregnancy outcomes,

providing therapeutic interventions and educating pregnant women about planning for safe child
birth. Its importance on maternal and infant health is ascertained by different medical literature

(DOH, 2009). Thus, prenatal care is one of the most effective health interventions for preventing

maternal morbidity and mortality particularly in places where the general health status of women

is poor. The antenatal period presents an important opportunity for identifying threats to the

mother and unborn baby’s health, as well as for counselling on nutrition, birth preparedness,

delivery care and family planning options after the birth ( WHO, 2005).

In the Philippines, prenatal care is a widely accepted practice. Almost 96% of mothers

had visited a health provider for their prenatal care (NSO and Macro International, 2010).

Despite the high prenatal care coverage, morbidity and mortality related to pregnancy are still

high. Infant and maternal mortalities are still major problems, where 26 infants in every 1000

live births die and 162 women per 100,000 die due to childbirth. These put the Philippines Infant

Mortality Rate(IMR) still above its Millennium Development Goal target of 19/1000 live births

and its Maternal Mortality Rate(MMR) way above the target of 52/100,000 live births in 2015

(NSCB,2010).

Prenatal care quality is an important indicator for maternal and infant health status.

However, quantity of prenatal care visit is the most commonly used indicator while the quality of

prenatal care is seldom used (Alexander,2001;Alexander and Kotelchuck,1996; Barber and

Bertozzi,2007). To date, no existing standard protocol is used to measure quality of prenatal care.

Some popular studies have used contents of prenatal care (e.g tetanus toxoid or doctor’s advice)

to measure the overall quality (Alexander et al,2001; Victoria,2001). This practice, however,

may pose a possible problem especially when important features or components of prenatal care

are not taken into account.

 With these above mentioned conditions, this study will be conducted to look into the

factors affecting the extent of compliance of pregnant adolescents on prenatal care services and

how they affect the compliance of the pregnant adolescent on prenatal care services.

Theoretical Framework

The Health Belief Model (HBM) is a psychological model that attempts to explain and

predict health behaviors. This is done by focusing on the attitudes and beliefs of individuals. The

Health Belief Model has been applied to a broad range of health behaviors and subject

populations. Three broad areas can be identified (Conner & Norman, 1996): 1) Preventive health

behaviors, which include health-promoting (e.g. diet, exercise) and health-risk (e.g. smoking)

behaviors as well as vaccination and contraceptive practices. 2) Sick role behaviors, which refer

to compliance with recommended medical regimens, usually following professional diagnosis of

illness. 3) Clinic use, which includes physician visits for a variety of reasons.

(http://www.utwente.nl/cw/theorieenoverzicht/theory%20clusters/health%20communication/heal

th_belief_model.doc/ )

Factors affecting the extent of the compliance of adolescent pregnancy on mothers on

prenatal services can be based on the HBM. It is where HBM talks about the attitude of an

individual. One of the problems of an adolescent individual is not attending prenatal services.

One of the reasons of pregnant women is low- socio economics why they can’t send themselves

in the prenatal services. In congruent with low- socio economics is the not enough knowledge of

pregnant adolescents due to less information dissemination and maybe they are not interested

about it or maybe lack of time. In cases these are the problems that our young mothers
encountered, explain to them the importance of sending themselves in pre-natal services and on

how it affect the child and the mother.

It is the responsibility of the mother to attend prenatal services. Delayed entry into the

prenatal care may be the result of late recognition of pregnancy, denial of pregnancy, or

confusion about the services that are available. Such a delay in care may leave an inadequate

time before birth to attend to correctable problems. The very young pregnant adolescent is at

higher risk for each of the confounding variables associated with poor pregnancy outcomes and

for those conditions associated with a first pregnancy regardless of age. However, when prenatal

care is initiated early and consistently, and confounding variables are controlled, very young

pregnant adolescents are at no greater risk for an adverse outcome than older pregnant women.

(Maternal Child Nursing Vol. 1 Third Edition, 2009 by Wong et. al)

Conceptual Framework

This study will aim to determine the extent of compliance of adolescent mother on prenatal

services. It sought to gather information regarding to the respondent profile as to their age, civil

status, educational attainment, monthly income and location of the respondent. The study also

includes the level of knowledge of the respondent on the prenatal care services on the extent of

their compliance.
Statement of the Problem

This study will sought to determine the factors affecting the compliance of adolescent

pregnant mothers on prenatal care services.

Specifically, the study will answer the following questions:

1. What are the socio- demographic profile of the respondents as to:

1.1.Age

1.2. Civil status

1.3.Educational attainment

1.4.Monthly Family Income

1.5.Location of residence

2. What is the level of knowledge of the respondents on the prenatal care services as to:

2.1. Immunizations

2.2.Scheduled check up

2.3.Nutrition

2.4.Health education on prenatal care

3. What is the extent of compliance of the respondents on prenatal care services?

4. Is there a significant relationship between the socio- demographic profile and the level of

knowledge from the different prenatal care services to the extent of compliance?
Significance of the Study

Maternal Mortality worldwide, about half a million die every year in connection with

pregnancy and childbirth, 99% of which occur in developing countries like the Philippines.

Antenatal care provides an opportunity to deliver different services which are important in

improving maternal survival. Unfortunately, our country’s pregnancy related situation had not

changed in the last 5-10 years.

This study therefore will help in contribution in the improvement of the maternal

situation and will benefit the following:

Respondents. This will give them deeper insights to assess and motivate adolescents and

find times to comply in maternal and child health care services and for them to prepare and safe

with pregnancy.

Health Workers. This will provide a closer look on prenatal health services and enhance

their involvement to promote safe motherhood; and an opportunity to practice and develop their

skills.

Policy Makers. This will serve as an insight for strengthening and making of plans,

programs and policies for future development regarding maternal health care.

General Public. This will be a way to inform them of maternal and child health

situations in the country and help them recognize and participate in promoting safe maternal

services.

Researchers. The study will provide a springboard for a continued and developed study

in relation to maternal and child care.

Scope and Delimitation of the Study

The study will focus on the determination of factors affecting the extent of compliance of

adolescent pregnant mothers to prenatal care services. The prenatal care services such as

immunization, scheduled check-up, nutrition, and health education will be established. The

respondents of the study will include adolescent pregnant mothers who are first time mothers in

their 2nd or 3rd trimester of pregnancy. It is further delimited to high school and college students

of Laoag City with the age bracket 15- 20 years old because research shows that adolescent

pregnancy is not simply the result of girl’s failure to obtain and use contraception, but is instead

inexorably linked to many social, cultural, educational, and economic factors influencing

adolescent risk- taking behaviours

(http://www.glowm.com/index.html?p=glowm.cml/section_view & articleid=413). Information

regarding the adolescent pregnant mothers will be taken from the Rural Health Unit (RHU) of

Marcos, Ilocos Norte with proper protocol and ethical considerations. A structured questionnaire

will be used in gathering data and it will also utilized a descriptive correlational design. This will

also allow for greater flexibility in pursuing new information as it emerges. The study will be

conducted on November 2012 – March 2013.

Operational Definition of Terms

To promote a better and clearer understanding of the study the following terms are herein

listed with their corresponding meanings and definitions.

Danger Signs. This pertains to the sign and/or symptoms like vaginal bleeding, edema on

the face and hands, headache, dizziness, blurred visions, and pallor that may threaten the life of

the mother or the baby during pregnancy.

Extent of Compliance on the different prenatal care services. This pertains to the

level of compliance or fulfilment of the different prenatal care services whereas;

Highly Complied. Follows prenatal care services regularly.

Moderately Complied. Follows prenatal care services rarely.

Did Not Comply. Not submitting one’s self to any prenatal care services.

Health Education. This is defined as the principle by which the adolescent pregnant

mother learns from the health care provider to behave in a manner conducive to the promotion,

maintenance or restoration of health during pregnancy.

Immunization of Pregnant Mothers. This refers to the tetanus toxoid immunization

given to pregnant mothers in order to fortify their body against tetanus during their terms to

avoid any disabilities on the growing fetus.

Knowledge on the different prenatal care services. This refers to the amount of

information the pregnant adolescent mother knows on the different prenatal care services such as

immunizations, scheduled check up, nutrition and health education whereas;

Highly Knowledgeable. Fully aware on the prenatal care service(s).

Moderately Knowledgeable. Knows only some aspect of the prenatal care services.

Not Knowledgeable. Does not know anything about the prenatal care services.
 Nutrition. This refers to the provision of nutrients needed by the body of adolescent

pregnant mother to promote and maintain health during pregnancy.

Calcium Supplement. This refers to the supplementation of extra calcium by either

increasing the usual intake of foods rich in calcium or in a form of drug supplements.

Iron (Fe) Supplement. This refers to the supplementation of extra iron during second

and third trimester of pregnancy, generally in association with folic acid by either or both

increasing the intake of foods rich in iron or/and have it in a form of drug supplement.

Protein Supplement. This refers to increase in protein rich food intake during pregnancy.

Vitamin C Supplement. This refers to the supplementation of extra Vitamin C by

increasing the usual intake of foods rich in Vitamin C.

Prenatal Care Services. This refers to the care render to adolescent pregnant mothers by

the Health care providers such as immunization, scheduled check-up, nutrition and health

education.

Scheduled Check up. It refers to the number of check-ups scheduled for pregnant

women during the 2nd, 3rd trimester of pregnancy.

Socio- Demographic Profile. This term refers to the age, civil status, place of residence,

religion, number of households and educational attainment.

Civil Status. This refers to the marital status of the individual whether single,

married, or widowed.

Educational Attainment. This refers to the highest education attained by the

adolescent pregnant mothers.

Location. It refers to the distance of residence from the nearest government

health provider.
 Monthly Family Income. It refers to the amount earned by the family in a month

regardless of its source.

 CHAPTER II

REVIEW OF RELATED LITERATURE AND STUDIES

This chapter contains the different information gathered from books, journals, health

statistics records/documents and internet discussing the socio – demographic factors and other

related concepts affecting the extent of compliance of prenatal health services.

Related Literature

Adolescent Period

Adolescence is an important transition into adulthood marked by numerous

developmental, academic, and social challenges. While the exact age of adolescence is somewhat

varied in the literature, many researchers define this period as beginning around age 12 and

ending between ages 18 to 20 (Tanti et al., 2010; Engels et al., 2002). Adolescence has been

commonly regarded as a critical period for the development of self and identity. During this

stage, adolescents typically experience significant changes in their physical, cognitive, and social

domain functioning (Tanti, Stukas, Halloran, & Foddy, 2010). Because of the numerous changes

occurring during this time period, it is important to consider the sources of support that are

available to adolescents and can help them navigate the difficult transition into adulthood.

During all period, adolescence is defined not so much by chronologic age as by physiologic,

psychological, and sociological factors. The drastic change in physical appearance and the

change in expectation of others that occur during the period may lead to both emotional and

physical health problems (Pilliteri, 2007).

 Research involving adolescence has documented the shift in importance of peers during

this stage, as peers often become equally as important as parents. The period of adolescence has

been described as involving a transformation of social relationships, as adolescents spend

increasing amounts of time in activities with peers relative to the time spent with their parents

(Ryan, 2001). These friendships become more intimate and begin to involve more self disclosure

of personal thoughts and feelings as well as greater provision of support (Engels, Dekovic, &

Meeus, 2002). Because adolescents’ peer relationships become closer and more intimate, they

also become more influential in a variety of social domains, particularly with risk taking

behaviors such as smoking, drinking, drug use, and sexual activity (Ryan, 2001).

Teenage Pregnancy

Teenage pregnancy is not a new phenomenon. In the 18th century, it was common for

women to marry at an early age.

In today’s society, however, marriage and childbearing during the teenage years are not

encouraged. New educational programs on the importance of delaying pregnancy have decreased

the number of birth in the United States to girls under 18 years from the rate of 117/1,000 to

41/1,000 but this number is still higher than that of other industrialized countries (Davis, 2003) .
Danger Signs

1. Vaginal Bleeding

During a pregnancy, vaginal bleeding is not necessarily a bad thing. Many women

continue to have a period for several months after conceiving. It is also the case that bleeding

very late in the pregnancy can indicate the loss of the mucus plug. Unfortunately, vaginal

bleeding is also one of the largest danger signs in pregnancy. Vaginal bleeding during pregnancy

can point to miscarriage, ectopic pregnancy, separation of the placenta, or placenta previa.

2. Headache

While headaches are common for many people, they can actually be a sign of danger

during a pregnancy. An occasional headache alone is seldom any cause for concern. Headache

accompanied with blurred vision and swelling of the hands and face are common symptoms of

preeclampsia or hypertension, which can both lead to eclampsia. This can be a deadly condition

for an infant if it is not detected before the birth.

3. Swelling

Most women notice a little swelling in their legs and ankles during pregnancy, but severe

swelling, especially in the face or fingers, is cause for alarm. Severe swelling, often accompanied

by blurred vision and headaches, may indicate pregnancy-induced hypertension, which is usually

treated through an IV and bed rest and may require early delivery.

(http://www.ehow.com/about_5394810_danger-signs-pregnancy.html)
 4. High Blood Pressure

High blood pressure is a sign of toxemia, also known as preeclampsia. It is a condition

occurring after 20 weeks of pregnancy and its most common symptoms include high blood

pressure, blurred vision, headaches and stomach pain. In most cases, the only treatment is

delivery of the baby. This is not a problem if the mother is closer to 37 weeks; however, if she is

still too early in her pregnancy, the doctor may choose to treat with bed rest and medication to

lower her blood pressure. (http://www.livestrong.com/article/81166-danger-signs-

pregnancy/#ixzz2GugAfRZE)

5. Dizziness

Pregnancy can cause low blood sugar and a change in your blood pressure, which can

cause dizziness and even fainting. (http://www.teenbreaks.com/pregnancy/mightbepregnant.cfm)

What is Prenatal Care?

As to the presented data above, Prenatal Care, also known as antepartum or antenatal care,

refers to the health services that a pregnant woman receives before a baby’s birth. Health care

providers know from numerous studies that prenatal care is important because potential problems

that may endanger that mother or her baby may be discovered and treated prior to birth

(http://www.mchb.hrsa.gov/programs/womeninfants/prenatal.htm). It is composed of screening

for health conditions that are likely to increase the possibility of adverse pregnancy outcomes,
providing therapeutic interventions and educating pregnant women about planning for safe child

birth.

Childhood Immunizations

Haemophilus influenza B (Hib), chickenpox, diphtheria, hepatitis B, measles, mumps,

pertussis (whooping cough), polio, rubella (German Measles), tetanus, and pneumococcal

disease are among the diseases mostly related to childhood (Lieber et al, 2003).

Nutrition

Good nutrition is a major problem during adolescent pregnancy because girls enter

pregnancy with poor nutritional stores from years of eating a less than the optimal diet. Lack of

good nutrition can result in low birth weight newborns and preterm birth. The younger the girl is,

the more likely she is to have a low- birth weight infant. To prevent these complications, the

girl’s diet must be sufficient to allow for the need of her own growing body. This means she may

need to gain more weight than the mature woman does during pregnancy. Protein, iron, folic acid,

and vitamin A and C deficiency may become acute. Besides eating larger amount of food, a

pregnant adolescent should be sure to eat proper foods, possibly abandoning the food fads she

has been following.

Adolescent traditionally do not take medicine conscientiously, so they may need

frequent reminders that vitamin and iron supplements during pregnancy must not only be

purchased but also must be taken.(Pillitteri, 2006)

Schedule Check-up

A prenatal Check-up Schedule is often prescribed to a pregnant woman. There can be an

alteration in the schedule in case of any emergencies. The first prenatal check-up is usually done

in the between 8-12 weeks of pregnancy. After the first prenatal check-up, the next one is

planned after 4-6 weeks. After the 30th weeks the test are done every 2-3 weeks once. Once you

reach the 36th week, a check-up is done every week or once in 15 days till the time of labor.

Importance of first prenatal check-up: The first thing that is determined in this stage is exactly

how many days have it been since you have conceived. An ultrasound is carried on to determine

this. A blood test is done to determine the blood group, Rh factor and HIV infection. The

gynecologist then goes through your medical and family history to note any genetic disorders

that may cause problems to the child. Important vitamins like folic acid are prescribed to help

growth of the child. During the next prenatal check-up schedules your weight, blood pressure

and the baby’s heartbeat will be monitored. Usually an ultrasound scan is done during the 20 th

week to check if the baby is growing normally. During the third trimester, check-ups are more

frequent. This is because many women might have many problems. Sometimes there might be a

need to perform early premature delivery. All these things are noted towards the en of the

pregnancy. (http://www.boldsky.com/pregnancy-parenting/prenatal/2011/prenatal-check-up-

schedule-060711-aid0165.html)
Factors Contributing to Lack of Prenatal Care of Adolescent Pregnancy

Adolescent do not seek prenatal care until late in their pregnancies. This may due to a

girl’s denial of pregnancy. Not seeking prenatal care is also a way of protecting the pregnancy, if

she doesn’t tell anyone no one can suggest she terminate pregnancy. After 6 months, abortion is

no longer a possibility so she can feel free to come for care without being subjected to this

pressure.

Other factors contributing to the lack of prenatal care are lack of knowledge of the

importance of prenatal care. The girl may feel awkward in the prenatal setting and frightened

about her first pelvic examination. Ideally, every community should have facility that is designed

especially for adolescents; if this is not possible, all settings should accommodate adolescents’

needs so this last reason for poor prenatal care can be eliminated. Lack of adequate facilities for

pregnant adolescents is denial for the existence of adolescent pregnancy on the part of health

care providers and the community. (Pillitteri, 2006)

Low income women are among those at risk for delivering low birth weight babies.

These women tend to use prenatal care less often due now to lack of resources such as money to

have some consultation during their pregnancy.

(http://www.jstor.org/discover/10.2307/3427801?uid=3738824&uid=2133&uid=2&uid=70&uid

=4&sid=21101518651903)
Prenatal Health Teaching

Adolescents need a great deal of health teaching during pregnancy because they do not

know many common measures of care that an older woman has learned from experience. They

are often unwilling to follow health advice; however, that makes them different in any ways from

their peers. On the other hand, adolescents do not have well- established health practices, so they

are adoptable.

Adolescents girl may respond to health teaching that is directed to their own health more

than to that of a fetus inside them: “Eat a high-protein diet because protein makes your hair

shiny ( or prevent split fingernails)” often leads to a better adherence than a statement such as

Protein is good for your baby”. “Taking the iron supplement make you feel less tired” is better

than “ it will help the baby’s blood supply,” for the same reason. There are truthful statements

and they appeal to an adolescent’s pre-occupation with self. In addition, this type of health

teaching is the only form to which adolescents who is denying her pregnancy can respond.

Be certain to include information on the effect of drugs on fetal welfare, including over-

the-counter medications, herbal preparations, and recreational drugs. Pregnancy can become an

important growth experience if it provides the motivation some adolescents need ti withdraw

from recreational drug use.

Adolescents need instructions about possible discomforts and changes associated with

pregnancy, and measures to relieve them. Many adolescents develop hemorrhoids during

pregnancy because the disp4roportion of their body to a fetus puts extra pressure on the pelvic

vessels, causing a blood to pool in rectal veins. Reassure girls that this is a pregnancy-related

phenomenon that will resolve when pregnancy is over. ( Pillitteri, 2006)

 CHAPTER III

METHODOLOGY

This chapter discusses the methods and procedures used in the conduct of this study

which is inclusive of the research design, locale of the study, sample and sampling procedure,

data gathering instrument, data gathering procedure, and the statistical methods used in analyzing

data.

Research Design

The researchers employ the descriptive- co relational research design in gathering the

needed data for the study. It is a descriptive study because it seeks to determine the extent of

compliance of adolescent mother on the prenatal care services. Descriptive studies literally

describes the phenomenon of interest and observe association in order to estimate estimate

certain population parameters, to test hypothesis and to generate hypothesis about possible cause

and effect association between variables ( Bowling,2005)

In co- relation study it is a scientific study in which a researcher investigates associations

between variables.( http://www.psychologyandsociety.com/correlationalstudy.html)

Locale of the Study

The research study will be conducted in the 20 Baraggays of Laoag City.

Sample and Sampling Procedure

The population of the study will include pregnant adolescents belonging to the age

bracket 15- 20 years old who are first time mothers in her 2nd and 3rd trimester of pregnancy.

Data Gathering Instrument

A structured questionnaire will be use in gathering of information from the respondents.

The contents of the questionnaire were formulated based from the different resources materials

which include textbooks, journals, and articles from the internet. It is written in English and was

translated into the local dialect to ensure that accurate responses were elicited from the

respondents. The structured questionnaire which is in the form of a checklist will be composed of

three parts. Part I deals with the socio- demographic profile of the pregnant adolescent mothers

which include civil status, educational attainment, monthly family income and location of

residence. Part II consist of questions on the knowledge on the different prenatal care services.

The given answers in the checklist have corresponding meaning as to how the respondents aware

and comply on it. The numerical number of 3 with a descriptive evaluation of “ Highly

Knowledgeable” means that it fully aware on the prenatal care service(s). The numerical number

of 2 with a descriptive evaluation of “Moderately Knowledgeable” means that it knows only

some aspect of the prenatal care service(s). The numerical number of 1 with a descriptive

evaluation of “Not Knowledgeable” means that it does not know anything about the prenatal care

service(s). Part III includes questions on the compliance on the different prenatal care services.

The numerical number 3 with a descriptive evaluation of “Highly Complied” means that it

follows prenatal care services regularly. The numerical number 2 with a descriptive evaluation of

“Moderately Complied” means that it follows prenatal care services rarely. The numerical
number 1 with a descriptive evaluation of “Did Not Comply” means that did not submit one’s

self to any prenatal care services.

The instrument is subject for pre- testing among adolescent pregnant mothers belonging

to the age bracket 15- 20 years old who are first time mothers in her 2nd and 3rd trimester of

pregnancy. These adolescents will no longer be included as a respondent of the study. The result

of the pre-test will not form part of the study. All comments, suggestions will be incorporated to

improve its construction and content as well as to ensure its validity and reliability. Likewise,

any suggestion from the experts and thesis committee regarding the improvement of the

instrument shall be highly considered.

Data Gathering Procedure

Before gathering the data, permission to conduct the study will be sought from the

adviser, the Municipal Mayor or the Municipal Health Officer and the Barangay Chairman of the

said Barangays of Laoag City. Upon approval, list of adolescent pregnant mothers belonging to

the age bracket 15- 20 years old who are first time mothers in her 2nd and 3rd trimester of

pregnancy will be taken from the Rural Health Unit. Subsequently, the respondents of the study

shall be chosen purposively. After interview schedule will then prepared and finalized. Then,

structured questionnaire will be distributed by the researcher to the respondents. In the

administration of the questionnaire, the respondents shall be informed of the purpose of the study

to be conducted and required to personally answer the questionnaire. To ensure complete and

immediate retrieval and validity of the answers, the questionnaire will be distributed personally

by the researcher to the respondents. Anonymity and confidentiality will be assured in order to

ensure that all items will be answered correctly.

Statistical Treatment

Descriptive analysis such as frequency counts and percentages will be used in describing

the socio- demographic profile of the respondents. The percentage distribution will be

determined using the following formula:

Percentage (%) = ( f / N) x 100

Where: f = frequency

N = number of respondents

The Weighted Average Mean (WAM) will be used in describing the level of knowledge

and compliance on the different prenatal care services. This will be determined using the

following formula:

WAM = F1(3) + F2(2) + F3(1)

Total Number of Respondents

Where:
F1,F2,F3 are the frequencies in each column

The mean level of knowledge will be rated as follows:

2.50- 3.00 (Highly Knowledgeable)

1.50 – 2.49 ( Moderately Knowledgeable)

1.00 – 1.49 ( Not Knowledgeable)

The mean level of compliance will be rated as follows:

2.50- 3.00 (Highly Complied)

1.50 – 2.49 ( Moderately Complied)

1.00 – 1.49 ( Did Not Comply)

 In addition, the Pearson Product Moment Coefficient of Correlation (Pearson r) will be

used in determining the relationship of the respondents’ socio- demographic profile and their

level of knowledge , and the extent of compliance on prenatal care services. This will be

computed using the following formula:

r= (Nxy) – (x)(y)

√ [ N𝑥 2 - (𝑥)2 ][N𝑦 2 - (𝑦)2]

Where:

N= number of respondents

x= raw of scores of independent variables

y= raw scores of dependent variables

xy= sum of the products of the dependent and independent variables

FACTORS AFFECTING THE EXTENT OF COMPLIANCE OF ADOLESCENT
PREGNANT MOTHERS ON PRENATAL CARE SERVICES

QUESTIONNAIRE

PART I. Socio- Demographic Profile of Respondents

Direction: Please provide the necessary information needed by filling up or putting a

check mark (√) on the space beside the item that corresponds to your answer.

1. Name ( Optional): ____________________________________

2. Age: __________________

3. Civil Status:

_____ Single _______ Married ____ Widowed

4. Location:

______ Urban ____ Rural

5. Educational Attainment:

____ Elementary Undergraduate

____ Elementary Graduate
____ High School Undergraduate
____ High School Graduate
____ College Undergraduate
____ College Graduate

6. Monthly Family Income

___ Php 21,000 and above

___ Php 16,000 –Php 20,999
___Php 11,000 – Php 15, 999
___Php 6,000 – Php 10,999
___Php 5,999 and below
PART II. Prenatal Care Services

Direction: Below are statements that determine the facts about the different prenatal care
services known by adolescent pregnant mothers. Please check the column that corresponds to
your answer using the scale below.

3 Highly Knowledgeable ( if you are fully aware on the prenatal care services)
2 Moderately Knowledgeable ( if you know only some aspect of the prenatal care
services)
1 Not Knowledgeable ( if you do not know the prenatal care services)

A. Immunization (Tetanus Toxoid) 3 2 1

1. It protects both mother and baby against tetanus and neonatal
tetanus.
2. It should be given in a certain period for each dose.
3. It is considered that mother is fully immunized after
completing the five doses of tetanus toxoid.
4. It gives five(5) months guarantee of immunity to the infant
after the mother had completed all the doses of tetanus toxoid.
5. It is considered as first and second dose of tetanus toxoid if
the mother had received 3 doses of DPT in infancy.

B. Scheduled Check Ups 3 2 1

1. It is composed of at least five prenatal check ups in specific
period of pregnancy.
2. It is done early and regularly by trained medical personnel
(Doctor or midwife).
3. It assesses the risk factors as early as possible.
4. It monitors blood pressure.
5. It refers mother to another facility if there are problems that
need further investigation.
6. It provides the estimated date of delivery.

C. Nutrition 3 2 1
A. Iron Supplementation
1. It should be taken starting in the 5th month of pregnancy up to
2 months after delivery.
2. It decreases risk for pre – eclampsia (high blood, convulsion).
3. It prevents anemia.
4. It is best found in meat, fish and poultry.
5. It is best absorbed when taken with foods rich in Vitamin C
(e.g. citrus fruits).
6. It causes dark colored stool.
7. It causes nusea.
8. It causes constipation.
9. Its absorption is inhibited when taken with foods like tea and
red wine.
B. Calcium Supplementation
1. It prevents risks of pregnancy induced hypertension.
2. It decreases risk for impaired fetal skeletal growth.
3. It maintains normal blood pressure.
4. It is available in cheese, dilis, and shellfish.
5. It is being absorbed in the body by foods rich in Vitamin D
(dairy products).
C. Protein Supplementation
1. It helps in baby’s proper brain development.
2. It is found in animal products and dairy products.
3. It is available in cheese, eggs, fish, chicken, beef, lamb, and
yogurt.
D. Vitamin C
1. It reduces risk for premature births.
2. It is critical to the maintenance of the fetal sac membrane.
3. It can be found in citrus fruits (e.g. orange), papaya, potatoes,
and tomatoes.

D. Health Education by the Members of the Health Team 3 2 1

(doctors, nurses, and midwives)
A. Common discomforts experience during pregnancy
1. Development of haemorrhoids and managed by a high fiber
diet and regular bowel habit.
2. May cause striae across the sides of their abdomen that will
fade after pregnancy.
3. Development of varicose veins and managed by wearing
supportive pantyhose (not elastic bandages).
4. Development of excess pigment deposition on the face and
neck (Choloasma).
5. May have nausea and vomiting and managed by eating breads
or crackers before getting up in the morning and sucking ice
chips.
6. May have indigestion or heartburn and managed by limiting
spicy and greasy foods as well as avoiding lying down right
after eating.
B. Danger signs of pregnancy
1. Vaginal bleeding
2. Edema of the face and hands
3. Headache
4. Dizziness
5. Blurred vision
6. Pallor
 C. It discusses the effects of smoking, alcohol and drugs to the
fetus.

PART III. COMPLIANCE OF PREGNANT ADOLESCENT MOTHERS ON THE

DIFFERENT PRENATAL SERVICES.

Direction: Please rate your compliance on the different prenatal care services using the scale
below.

3 Highly Complied ( if you follow prenatal care services regularly)

2 Moderately Complied ( if you follow prenatal care services rarely)
1 Did Not Comply ( if you do not submit yourself to any prenatal care services)

Prenatal Care Services 3 2 1

A. Immunizations
B. Scheduled Check Up
C. Nutrition
a. Iron Supplementation
b. Calcium Supplementation
c. Protein Supplementation
d. Vitamin C
D. Health Education
a. Does not smoke, drink and take in drugs during
pregnancy.