A cross-sectional study design was conducted on 422 pregnant women aged above 18 years and attending ANC follow-up from June 1, 2023, to September 30, 2023, at Abebech Gobena MCH Hospital, Addis Abeba, Ethiopia. Ethical clearance was obtained from the Institutional Review Committee of Yekatit 12 Hospital Medical College. After the purpose and objective of the study had been informed, verbal consent was obtained from each study participant. All participants were also informed that participation was voluntary and they could withdraw from the study at any time if they were not comfortable with the questionnaire.
Source and study population
The study recruited all pregnant women aged over 18 and attending ANC follow-up at Abebech Gobena MCH Hospital during the study period. The study took place between June 1, 2023, and September 30, 2023.
Sample size determination
The sample size was determined by using a single population proportion formula with the following statistical assumptions: P (50%, proportion of pregnant women who had pregnancy-related worries since there was no previous study), d (the permissible margin of error of 5%), and Zα/2 (the value of the standard normal curve score corresponding to the given confidence interval = 1.96) corresponding to a 95% confidence level.
n = n = \(\:\frac{\left(\mathbf{Z}\varvec{\alpha\:}∕2\right)2\:\mathbf{x}\:\mathbf{p}(1-\mathbf{p})}{\left(\mathbf{d}\right)2}\)
n = \(\:\frac{\left(1.96\right)2\:\mathbf{x}\:\left(0.5\mathbf{x}0.5\right)}{\left(0.05\right)2}\:\) = 384
After adjusting for the total study population and 10% of the potential non-response rate, the final sample was 422. The sample size employing factors would not be computed because there were no studies carried out in Ethiopia or other related locations.
Sampling procedures
A study participant was selected using a systematic random sampling method. Based on the ANC registration, on average, every month, about 1033 pregnant women attended ANC follow-up at Abebech Gobena MCH Hospital. In the present study, the data collection took place over four months. As a result, the sampling interval “K” value was calculated as K = N/n, considering N = the expected number of pregnant women attending ANC at Abebech Gobena MCH Hospital per four months = 4132 and n = sample size = 422; K = 4132/422 ≈ 10, and this gives a sampling interval of ten. Thus, study subjects were selected at ten intervals, and the first participant was selected by the lottery method.
Variables of the study
Pregnancy-related worries are our dependent variable, while socio-demographic factors (age, sex, marital status, residence, income, educational status, and occupational status), obstetric-related factors (gravity, trimester, history of abortion, stillbirth (IUFD), complications in previous pregnancies), health service factors (accessibility of service, health worker behaviour, and health service quality), healthcare service utilization (ANC use, counselling during ANC, information given at counselling), and behavioural factors (social support)
Data collection procedures
The data was collected using an interview-administered, pretested, and structured questionnaire prepared by the investigator after reviewing different literature (3, 6, 9, 35). The data collection tool was prepared in English and translated into the local language, Amharic, by the language expert, and then translated back to English by language experts to check for consistency. The translated Amharic tool was used for data collection.
The questionnaire was composed of seven sections, including socio-demographics of the participants, obstetric-related history, health service utilization and related factors, behavioural factors, sources of information, and the Cambridge worry scale. Four BSc midwives and two physicians took part in data collection and supervision, respectively. Two days of intensive training were given on the overall objective of the study, ethical issues (getting consent, privacy, confidentiality, and voluntary participation), interview techniques, and the objective of each question and related probes. During the training, the data collector performed a small demo. A pre-test was done on 5% of the total sample size at St. Peter Hospital.
Operational definitions
Pregnancy
the period in which a foetus develops within the female body or uterus.
Pregnancy-related worries are measured using the summation of 17 items on the Cambridge worry scale and taking the mean value as the cut-off point for determining low or high pregnancy-related worries.
Pregnancy-related information
are information sources used by women during pregnancy to meet their information needs regarding pregnancy.
Pattern of information source
classified as professional and informal (conventional and digital) sources of information.
Professional sources
midwives, obstetricians, general practitioners, leaflets from care providers, websites from midwives and hospitals, and information meetings organized by midwives and hospitals.
Informal sources are divided into conventional sources (family and friends, peers, books, and journals) and digital sources (apps, websites about pregnancy and childbirth, forums and blogs, social media, and TV programs) (15).
The Cambridge Worry Scale (CWS) is a validated instrument for measuring women’s concerns or worries during pregnancy. The instrument consists of 17 items, and the woman estimates each aspect of worry on a scale ranging from 0 to 5, where zero is no worry and five is major worry (12).
Data quality assurance
To ensure the quality of the data, two-day training was given to the whole research team before the actual fieldwork with adequate practice, during which the final refinement of the tools was made. In addition, a pre-test was done at St. Peter Hospital on 5% (21 subjects) of the sample size before actual data collection. A necessary amendment was made upon identification of the ambiguity of the questionnaire.
Data analysis procedures
Data was entered into Statistical Package for Social Sciences (SPSS) version 26, and then data cleaning and coding were done to make it ready for analysis. Descriptive statistics were used to see the frequency distribution, mean, and standard deviation. Multi-collinearity was checked using variance inflation factors (VIF). Bivariate logistic regression analysis was computed, and all independent variables with a p-value less than 0.25 were entered into multivariate logistic regression. Multivariate logistic regression was fitted to identify the factors associated with pregnancy-related worries. Variables with a p-value less than 0.05 at a 95% confidence interval were considered statistically significant.