Background
Methods
Research setting
Study design
Researcher characteristics and reflexivity
Study informants and sampling
Data collection
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knowledge on postnatal period
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utilization of postnatal care (how many, when, where)
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content of postnatal care received (e.g. physical examination, education/counseling)
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the role of the family during the postnatal period
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beliefs and traditional practice related to the postnatal period.
Data processing and analysis
Meaning Unit | Code | Sub-category | Category |
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I visited the midwife’s clinic only after I got infection, not before that (Mother 8). | Knowledge on danger signs | Knowledge | Mother and family members’ health literacy |
Many mothers believe in food taboo...They are also afraid to do self-wound care...(Midwife 1). | Attitude to food taboo Lacking confidence to do self-wound care | Awareness and confidence | |
The midwife gave the advice to visit the village health clinic before 7 days, but I did it after 10 days (Mother 6). | Delay to conduct postnatal care visit | Practice | |
I informed my daughters about the traditional rules. She is submissive to my suggestions. She should not eat peanuts and fish if her wound has not dry enough unless she will get an infection. When I delivered my daughter a long time ago, I eat fish and then my daughter’s cord got infection (Family 1). | Feeling afraid to against parents/grandmothers’ advice | Social power | Social power, cultural belief and practices |
Food taboo | Cultural belief and practice | ||
I am aware that it should be home visit but in case that I felt that the patients visited me at the clinic, I perceived that that was a home visit (Midwife 3). | Inconsistent home visit | Provider work load and capacity | Health service responses |
I received only wound care...Maybe because my condition was good. My blood pressure was high only when I delivered the baby, after that my blood pressure was normal (Mother 7). | Selective care | Perceived low quality of postnatal care | |
I did not understand what the the widwife said. She said some sentences in the Javanese language, the high-level Javanese level that I did not really understand (Mother 1). | Language barrier | Suboptimal patient-centered care |
Trustworthiness
Research ethics
Results
Categories | Mother and family members’ health literacy | Social power, cultural belief and practices | Health service response | |||||
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Sub-categories | Knowledge | Practice | Awareness and confidence | Social power | Cultural belief and practices | Working load and capacity of midwives | Perceived low quality of postnatal care | Suboptimal patient-centered care |
Codes | Knowledge on postnatal period; Knowledge of danger signs; Lack of knowledge on safe self-treatment. | Lack of hygiene; Delay to conduct postnatal care visit; Lack skills to do wound-care. | Lack of confidence to do self-wound care; Attitude to food taboo; Submissive to the midwife’s advice. | Information from family; Information from neighbors; Information from parents; Submissive to what parents said; Feeling afraid of parents/ grandmothers; Feeling afraid to disobey parents/grandmothers’ advice; Living with parents. | Traditional rules; Intergeneration practice; Cultural self-treatment practice; Practices from grandmothers; Food taboo; Herbal potion; Breastfeeding booster potion; Unseen hazards. | Working load; Collaboration between village midwives and health cadres; Knowledge of midwives; Education on food taboo. | Timely service; Availability of midwives; Insuficient time to educate patients; Lack of education on breastfeeding; No information for next visit; No education to family; Perceived quality of service; Inconsistent home-visit; Selective care; Inadequate education for wound care; Indirect communication between midwives and mothers. | Lack of interactive communication; Lack of frank communication; Language barrier; Inconvenient treatment. |
Mother and family member’s health literacy on postnatal care
“I did a health check up once at the hospital. I also went to our local midwife’s practice twice. I did the first visit because I got a headache. I did the second visit when my kid got diarrhea.” (Mother 1, primipara, 26 years old).
“... A week after the delivery I was suggested to check up to the doctor at the health center. But I missed that. I forgot.” (Mother 2, multipara, 40 years old).
Sociocultural beliefs and practices
Culture-related myths and rules
" ... I must not eat fish. I must not eat chicken and salted fish.... I am afraid to get itchy on my stitches. My neighbors said that it would make my stitches worse." (Mother 4, primipara, 23 years old)
“There is a traditional rule that during postnatal period mothers should only eat green vegetables, no chili, not fried, no meats. Mothers should limit the amount of water to drink because it will make their babies have a cold.” (Midwife 5, 46 years old)
Self-treatment and traditional care
Social power
“I do not know the reasons for the rules. I just obey my parents.” (Family member 1, female, 72 years old)
“Culture-related myths and rules still exist among a small proportion of population particularly among pregnant women and mothers who lived with their parents and grandparents. I discussed this issue in the education class for pregnant women. However, it is difficult to change the knowledge of mothers who live with grandparents. They do not believe it, but they are afraid to violate the rules from their parents.” (Midwife 2, 32 years old).
Health services responses
Perceived low quality of postnatal care
"After 1 week, I did check myself up. After that, I did not consult again. I thought once was enough. I was suggested to have my stitches checked if necessary ... I did go to the midwife because I got a headache, one month after delivery." (Mother 1, primipara, 26 years old)
Suboptimal patient-centered care
Workload and capacity of midwives
“I know that I should conduct a home visit for pregnant women, do postnatal care, and monitor high-risk neonates. However, the population which I should serve is too large. There are 500 under five children, more than 100 pregnant women per year, 114 infants... I also have other tasks for dengue control program, helminthiasis control program... I have limitations to conducting a home visit. I am aware that my works are suboptimal.” (Midwife 3, 43 years old)