Using the theory of planned behavior to explain birth in health facility intention among expecting couples in a rural setting Rukwa Tanzania: a cross-sectional survey

BACKGROUND: According to the theory of planned behavior, an intention to carry out a certain behavior facilitates action. In the context of birth in health facility, the intention to use health facilities for childbirth may better ensure better maternal and neonatal survival. Little is known on the influence of the domains of theory of planned behavior on birth in health facility intention. The study aimed to determine the influence of the domains of theory of planned behavior on birth in health facility intention among expecting couples in the rural Southern Highlands of Tanzania. METHODS: A community based cross-sectional study targeting pregnant women and their partners was performed from June until October 2017. A three-stage probability sampling technique was employed to obtain a sample of 546 couples (making a total of 1092 study participants). A structured questionnaire based upon the Theory of Planned Behavior was used. The questionnaire explored three main domains of birth in health facility intentions. These three domains included; 1) attitudes towards maternal services utilization, 2) perceived subjective norms towards maternal services utilization and 3) perceived behavior control towards maternal services utilization. RESULTS: The vast majority of study participants had birth in health facility intention. This included 499(91.2%) of pregnant women and 488(89.7%%) of their male partners partner. Only perceived subjective norms showed a significant higher mean score among pregnant women (M = 30.21, SD = 3.928) compared to their male partners (M = 29.72, SD = 4.349) t (1090) = − 1.965 at 95% CI = -0.985 to − 0.002; p < 0.049. After adjusting for the confounders, no intention to use health facility for childbirth decreased as the attitude [pregnant women (B = − 0.091; p = 0.453); male partners (B = − 0.084; p = 0.489)] and perceived behavior control [pregnant women (B = − 0.138; p = 0.244); male partners (B = − 0.155; p = 0.205)] scores increase among both pregnant women and their male partners. CONCLUSION: Despite the fact that majority of study respondents had birth in health facility intention, the likelihood of this intention resulting into practice is weak because none of the domains of theory of planned behavior showed a significant influence. Innovative interventional strategies geared towards improving domains of intention is highly recommended in order to elicit strong intention to use health facilities for childbirth.