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Impact of Antenatal Group Education on Birth Preparedness Knowledge among Pregnant Women in Nigeria

Abstract

Birth preparedness is an important component of maternal health and involves planning for childbirth, recognizing potential danger signs, identifying a skilled birth attendant and appropriate place of delivery, arranging transportation, preparing necessary resources, identifying a support person, and planning for emergencies. In Nigeria, inadequate knowledge and poor preparation for childbirth may contribute to delays in seeking, reaching, and receiving appropriate maternal healthcare, particularly in settings where access to skilled maternity services is limited. Antenatal group education provides an opportunity to improve pregnant women's knowledge and understanding of birth preparedness through structured health education delivered to groups of women during antenatal care. Group sessions can provide information on pregnancy and childbirth, maternal danger signs, delivery planning, emergency preparedness, facility-based delivery, skilled birth attendance, transportation arrangements, and the importance of timely healthcare-seeking. However, inadequate antenatal education, limited staffing, irregular attendance, large group sizes, language barriers, low health literacy, and insufficient educational materials may limit the effectiveness of antenatal group education in Nigeria. Against this background, this study investigates the impact of antenatal group education on birth preparedness knowledge among pregnant women in Nigeria. The study will be anchored on the Health Belief Model, Social Cognitive Theory, and the Health Systems Framework. The Health Belief Model explains how pregnant women's perceptions of the risks and severity of pregnancy complications, perceived benefits of birth preparedness, perceived barriers, and cues to action may influence their participation in antenatal group education and adoption of recommended preparedness practices. Social Cognitive Theory emphasizes learning through observation, interaction, self-efficacy, reinforcement, and social support, making it relevant to group-based antenatal education where pregnant women can learn from healthcare providers and from one another. The Health Systems Framework emphasizes service delivery, health workforce, health information, availability of educational resources, and accessibility as important components of effective antenatal education programmes. Collectively, these theoretical perspectives provide a suitable framework for explaining how antenatal group education may influence birth preparedness knowledge among pregnant women in Nigeria. The study will adopt a quantitative cross-sectional analytical or quasi-experimental research design. The study population will comprise pregnant women attending selected public and private antenatal clinics across Nigeria. A multistage sampling technique will be used to select states, local government areas, healthcare facilities, antenatal clinics, and eligible pregnant women. Antenatal group education will be measured using indicators such as participation in group education sessions, frequency of sessions attended, duration of educational exposure, content coverage, educator competence, use of educational materials, opportunities for questions and discussion, and participation in interactive group activities. Birth preparedness knowledge will be assessed using indicators such as knowledge of expected delivery planning, identification of skilled birth attendants, knowledge of appropriate delivery locations, recognition of maternal danger signs, emergency transportation planning, financial preparation, identification of a birth companion or support person, knowledge of essential items for delivery, and knowledge of appropriate actions when complications occur. Data will be collected using structured questionnaires, antenatal attendance records, group education registers, and relevant maternal health programme documents. Descriptive statistics will be used to summarize participants' demographic and obstetric characteristics, antenatal education exposure, and levels of birth preparedness knowledge. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis, will be used to determine the impact of antenatal group education on birth preparedness knowledge. Where appropriate, knowledge scores before and after participation in antenatal group education may be compared to determine changes associated with the educational intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that antenatal group education has a significant positive impact on birth preparedness knowledge among pregnant women in Nigeria. Pregnant women who participate regularly in structured antenatal group education are expected to demonstrate better knowledge of childbirth preparation, maternal danger signs, skilled birth attendance, appropriate delivery facilities, emergency transportation, financial planning, and appropriate responses to pregnancy and childbirth complications than women with limited or no exposure to group education. Group-based learning may provide opportunities for women to interact with healthcare providers, ask questions, share experiences, and learn from other pregnant women, thereby improving understanding and confidence in preparing for childbirth. Improved knowledge may encourage women and their families to make practical arrangements before labour and recognize the need for timely professional care when complications arise. Conversely, irregular antenatal attendance, inadequate educational materials, limited healthcare personnel, language barriers, low health literacy, and insufficient time for interactive education may reduce the effectiveness of antenatal group education. The study therefore expects accessible and well-structured antenatal group education to contribute significantly to improved birth preparedness knowledge among pregnant women in Nigeria. The study is expected to contribute to the literature on antenatal group education, birth preparedness knowledge, maternal health education, antenatal care, pregnancy health, maternal health promotion, health education, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, public and private healthcare facilities, midwives, nurses, community health workers, maternal health programme managers, development partners, and policymakers regarding strategies for strengthening antenatal education. The study will also provide evidence-based recommendations for expanding structured antenatal group education, improving the quality and consistency of educational content, strengthening healthcare workers' health-education skills, increasing the availability of culturally and linguistically appropriate educational materials, encouraging regular antenatal attendance, promoting interactive learning, and integrating comprehensive birth preparedness education into routine antenatal care programmes across Nigeria.

Keywords: Antenatal group education, birth preparedness knowledge, pregnant women, antenatal care, maternal health education, childbirth preparation, skilled birth attendance, maternal health promotion, pregnancy health, Nigeria, public health.