Contextual Effect of the Community Health Center on the Use of Antenatal Care: A Multilevel Analysis Evidence from Semarang, Central Java

Widyawati Widyawati, Eti Poncorini Pamungkasari, Bhisma Murti


Background:  The completeness of antenatal care is an effort to reduce prenatal mortality. This study aimed to analyze the contextual effect of the community health center on the use of an­te­na­tal care.

Subjects and Method: This study was an analytical observational study with a cross-sec­tio­nal approach. This study was conducted from June to August 2020. The sample con­sis­ted of 250 study subjects that were selected by simple ran­dom sampling. The dependent va­riable was an­tenatal care. The independent va­riables were husband support, knowledge, atti­tude, antenatal information, self-efficacy, cues to action, per­cei­v­ed seriousness, perceived sus­ceptibility, perceiv­ed benefits, perceived barriers, and complete faci­lities. This study used questionnaires to collect the data with multilevel analysis through a logistic regression approach in STATA 13.

Results: Complete antenatal care visits in­cre­a­s­ed with strong support (b= 4.36; 95% CI= 0.92 to 7.81; p= 0.013), high knowledge (b= 3.59; 95% CI= 0.67 to 6.51; p= 0.016), positive attitude (b= 4.07; 95% CI= 0.65 to 7.50; p= 0.020), much antenatal information (b= 4.20; 95% CI= 0.94 to 7.46; p= 0.012), high self-efficacy (b= 3.05; 95% CI= 0.20 to 5.90; p= 0.036), high cues to action (b= 3.41; 95%CI= 0.62 to 6.20; p= 0.017), high perceived seriousness (b= 4.48; 95% CI= 1.20 to 7.76; p=0 .007), high perceived susceptibility (b= 3.35; 95% CI= 0.31 to 6.38; p= 0.031), high perceived benefit (b= 3.82; 95% CI =0.49 to 7.16; p= 0.025), high perceived barrier (b= -3.13; 95% CI= -6.10 to -0.16; p= 0.039), and complete faci­lities (b= 4.97; 95% CI= 0.59 to 9.34; p= 0.026). The variation at the commu­ni­ty health center level showed a contextual effect on antenatal care with an intraclass correlation (ICC) = 51.09%.

Conclusion: Complete antenatal care is affected by husband support, knowledge, atti­tude, ante­na­tal information, self-efficacy, cues to action, per­ceiv­ed seriousness, perceived sus­cep­tibility, per­cei­ved benefits, perceived barriers, complete faci­li­ties, and community health center.

Keywords: Antenatal care, community health cent­er, multilevel analysis

Correspondence: Widyawati. Masters Prog­ram in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: widya­wati­ Mo­bile­: +62­85­742919076.

Journal of Maternal and Child Health (2020), 05(06): 663-672

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