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Knowledge, Attitude, And Practices on Antenatal Care Among

Pregnant Women in Selected Health Birthing Centers in Butuan City

Liza C. Mahay, and Rosenie S. Coronado

Graduate School of Allied Health Sciences, University of the Visayas, Philippines

DOI: https://doi.org/10.51244/IJRSI.2025.120800077

Received: 05 Aug 2025; Accepted: 12 Aug 2025; Published: 06 September 2025

ABSTRACT

It is the goal of good antenatal care to ensure that the woman does not suffer any adverse effects from the

pregnancy and to maintain the health of the developing baby. Local data on the interrelationship among socio-

demographic profile, knowledge, attitude, and practice on antenatal care is scarce. This quantitative study

utilized a descriptive correlational research design to assess the interrelationship among socio-demographic

characteristics, knowledge, attitude, and practices on antenatal care among pregnant women in selected

Birthing Clinics in Butuan City for the third quarter of 2024. Findings revealed that half were 18 to 24 years

old and majority were single. Most were college level and just over half were housewives. Most had a

gravidity of one while one third had two and most had a parity of one. Majority had no abortion, majority had

an above 10,000 family monthly income, and most had a nuclear family. Respondents were knowledgeable,

had a positive attitude, and practiced antenatal care. Marital status, level of education, occupation, gravidity,

parity, family monthly income, and type of family were correlated with attitude. Age, marital status, level of

education, occupation, gravidity, parity, abortion, and type of family were correlated with attitude. Age,

marital status, level of education, occupation, gravidity, parity, abortion, and type of family were correlated

with practice. Knowledge was not correlated with attitude and practice. Attitude was correlated with practice.

An antenatal care sustenance plan was proposed.

Keywords: Antenatal care; Attitude; Descriptive, Correlational design; Knowledge; Practice; Socio-

demographic profile.

INTRODUCTION

Antenatal care is the clinical assessment of mother and fetus during pregnancy used for getting the best

possible result for the mother and child. Early observation and ongoing care during pregnancy provide more

favorable births compared to no prenatal observation. It is a key entry point for pregnant women to receive

multiple health services such as nutritional maintenance, prevention or treatment of anemia, prevention,

detection and treatment of malaria, tuberculosis, and sexually transmitted infections (Berhe et al., 2014). An

adequate use of antenatal health services is associated with improved maternal and neonatal health status.

Pregnancy care is expected to affect the development of the fetus and the baby as well as the mother. Early

booking and regular visitation of antenatal care can only achieve this (WHO, 2007). Over half a million

women die each year from complications of pregnancy or childbirth. Most maternal deaths occur during

childbirth, and the presence of trained medical staff could greatly reduce this number (UNICEF, 2008). ANC

is also an opportunity to promote skilled birth attendance and postpartum care and to counsel women about

child spacing (Reynolds et al., 2014). According to the WHO, approximately 810 people die every day due to

complications during pregnancy and childbirth. In the Philippines, Northern Mindanao had the highest teenage

pregnancy with 10.0 percent, followed by Davao Region with 8.2 percent, Central Luzon with 8.0 percent, and

Caraga with 7.7 percent. Butuan City recorded a high maternal mortality rate in 2020 with 10.5 percent. ANC

aims to avoid congenital disabilities, preterm labor, neural tube defects, anemia, and poor maternal health by

providing routine check-ups and planning appropriate treatment and nutrition.

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Reports have shown that increased knowledge and positive attitudes of pregnant mothers impact antenatal

service utilization (Okafor, 2016). Almost 90 percent of maternal deaths occur in developing countries, and

over half a million women die each year due to pregnancy and childbirth-related causes (Eram et al., 2016).

Proper antenatal care reduces maternal and child morbidity and mortality. However, appropriate levels of

knowledge, attitude, and practices are critical for maternal and neonatal outcomes, and this is not well

determined in our country and in the study site. This gap will be filled by this study to initiate further larger

studies.

This study focuses on three main variables the Knowledge, which refers to the awareness and information

pregnant women have regarding antenatal care; Attitude, which refers to their feelings and perceptions towards

seeking antenatal care services; and Practices, which refer to their actual utilization and behaviors towards

antenatal visits. Thus, the objective of this study is to evaluate the level of knowledge, attitude, and practice of

pregnant women on ANC in Butuan City. To the knowledge of the researchers, there are no similar studies

done in the study area. This study is believed to give the present image of KAP on ANC in certain health

facilities in Butuan City, which may help to initiate further studies. Lastly, this study aligns with the third

sustainable development goal of health and well-being, benefiting locally or nationally a special population the

pregnant women.

RESEARCH QUESTIONS

The study aimed to assess the interrelationship among socio-demographic characteristics, knowledge, attitude,

and practices on antenatal care among pregnant women in selected Birthing Clinics in Butuan City for the third

quarter of 2024.

Specifically, it answered the following queries:

What were the socio-demographic characteristics of the patient-respondents in terms of Age, Marital Status,

Level of Education, Occupation, Gravidity, Parity Family Monthly Income and Type of Family?

What was the knowledge on antenatal care among pregnant women?

What was the attitude on antenatal care among pregnant women?

What was the practices on antenatal care among pregnant women

Was there a significant relationship between socio-demographic characteristics and knowledge on antenatal

care; socio-demographic characteristics and attitude on antenatal care;

socio-demographic characteristics and practices on antenatal care; knowledge and attitude on antenatal care;

knowledge and practices on antenatal care; and attitude and practice on antenatal care?

Based on the findings of the study, what antennal care enhancement plan was proposed based on the findings of

the study?

Statement of Null Hypotheses

Ho1: There was no significant relationship between the socio-demographic characteristics and knowledge on

antenatal care among pregnant women.

Ho2: There was no significant relationship between the socio-demographic characteristics and attitude on

antenatal care among pregnant women.

Ho3: There was no significant relationship between the socio-demographic characteristics and practice on

antenatal care among pregnant women.

Ho4: There was no significant relationship between the level of knowledge and attitude on antenatal care

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among pregnant women.

Ho5: There was no significance relationship between the level of knowledge and practices on antenatal care

among pregnant women.

Ho6: There was no significant relationship between attitude and practices on antenatal care among pregnant

women.

REVIEW OF RELATED LITERATURE AND STUDIES

Antenatal Care. Every minute, at least one woman dies from pregnancy-related complications or childbirth,

totaling 529,000 women a year. For every woman who dies, about 20 more suffer from injuries, infections, or

illnesses affecting about 10 million women annually. Studies show maternal mortality in developing countries

is mainly due to poor access to maternal health care, poor antenatal and maternity wards, and inadequacies in

available care (Igbokwe, 2012). Every year, around 6 million women become pregnant, with 5 million

pregnancies ending in childbirth. Improved maternal and newborn health is linked to adequate utilization of

prenatal health care. Pregnancy care affects fetal, baby, and maternal development (Akhtar et al., 2018). Health

knowledge is essential for women to understand their health condition and the necessity of receiving adequate

prenatal care (English et al., 2015).

Use of antenatal care services remains inadequate compared to WHO recommendations due to low education,

poor decision-making, and low economic status. Experience of abortion and stillbirth increases ANC

utilization (Dulla et al., 2017). ANC use is associated with awareness of nutrition during pregnancy, including

intake of protein, vegetables, fruits, milk, green leafy vegetables, and organ meat to prevent anemia (Faye et

al., 2011). WHO defines antenatal care as care by skilled professionals to ensure best health conditions for

mother and baby during pregnancy, including risk identification, prevention and management of diseases,

health education, and promotion (Downe et al., 2016).

The 2016 WHO ANC model recommends a minimum of eight contacts with the first in the first trimester and

further scheduled visits up to 40 weeks. It includes maternal-fetal assessment, nutrition, prevention and

treatment of physiological problems, preventative interventions for certain contexts, counseling for intimate

partner violence, iron and folic acid supplementation, tetanus toxoid vaccination, and one ultrasound before 24

weeks for gestational age estimation and fetal anomaly detection (Tunçalp et al., 2017; Abalos et al., 2016;

WHO, 2016). WHO recommends improving quality of antenatal care to reduce stillbirths and complications

and give women a positive pregnancy experience (WHO, 2016).

In the Philippines, DOH guidelines include first prenatal visit at first trimester, at least four visits, iron and

folate supplementation, iodine, tetanus toxoid immunization, counselling on healthy lifestyle, breastfeeding,

infection management, and oral health services. Studies revealed older, poorer, and less educated women

received poorer quality prenatal care compared to younger, richer, and better educated women (Lavado et al.,

2010). Multiparous women also received poorer care. Doctors provide very good quality care, midwives and

nurses provide fair care, and traditional birth attendants provide poor care. Quality of antenatal care, social

position, and support describe gaps in care for specific groups of women (Bollini & Quack‐Lötscher, 2013).

Knowledge of Pregnant Women Regarding Antenatal Care. Based on the study of Al-Jaradi et al. (2022),

majority of pregnant women had good knowledge regarding vitamin supplements and iron-folic acid, two-

thirds had knowledge about tetanus vaccine, and less than half had poor knowledge regarding blood screening

for HIV and hepatitis B. Less than two-thirds had moderate knowledge regarding ANC visit schedules, and

most had corrected total knowledge regarding ANC. These findings agree with Akhtar et al. (2018), Kaur et al.

(2018), Mored et al. (2014), Tenaw et al. (2018), Mbada et al. (2014), and Hajela (2014) showing similar

trends in knowledge about supplements, vaccines, ANC visits, HIV screening, antenatal exercises, and spacing

in perinatal care.

As of 2022, mothers aged 25-29 made up over a quarter of new mothers in the Philippines, with ages 20-24

accounting for almost a quarter (Statista, 2024). Nearly 6 in 10 married women age 15-49 were employed

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(PSA, 2022), 99 percent were literate with 37 percent having postsecondary education. Majority of pregnant

women were from lower and upper-lower class, married between 16-25, with over a third primigravida and

majority multigravida (Bashir et al., 2023). The average annual family income is Php 307,190, with middle

class earning Php 18,000 to 109,200 per month (Divina, 2024). The unintended pregnancy rate declined while

abortion rates increased (Guttmacher Institute, 2024). The most common family structure is nuclear with tight-

knit extended family bonds (Scroope, 2017).

Attitude of Pregnant Women Regarding Antenatal Care. There a study showed that about two-thirds of

pregnant women had a positive attitude, followed by one third with a negative attitude regarding ANC,

agreeing with Kaur et al. (2018), Akhtar et al. (2018), and Tenaw et al. (2018) on knowledge and positive

attitudes towards ANC and antenatal exercise. Findings showed significant associations between knowledge

and demographic characteristics, and between practice and demographics, supported by Hajela (2014) on

correct knowledge and attitude but incorrect KAP on diet and post-delivery nutrition. Educated people were

less likely to experience mortality, while those with less financial capacity experienced mortality (Davies et al.,

2018).

DOH recommends 12 prenatal care components including weight, height, BP, abdominal exam, diet advice,

danger signs, breastfeeding, family planning, and postpartum care (Malaya, 2014). Half of women were

satisfied with care, though 86.2% waited over two hours, 63% dissatisfied with medicines, 75% lacked

complete tetanus vaccine, only 31% received antenatal instructions, 46% received exercise information, and

36% discussed fear and anxiety (Sutan et al., 2016). Dulla et al. (2017) reported half a million women die

annually from pregnancy complications, mainly in developing countries, showing weak ANC activity, while

Salehi & Kohan (2017) emphasized evaluating maternal-fetal attachment to improve bonding, highlighting the

relevance of personal profile as an important research variable.

Practice of Pregnant Women Regarding Antenatal Care. Based on the study showed that the majority of

pregnant women had good practice of vitamin supplement and iron-folic acid and calcium tablets during

pregnancy, followed by the majority of them with good practice regarding eating habits changing during

pregnancy, majority of them had good practice regarding the antenatal follow-up, while less than two-thirds of

pregnant women had moderate practice regarding the visits to ANC regularity. On the other hand, over two-

thirds of pregnant women had good performance in the total ANC practice.

Socio-demographic Characteristics and KAP. Pregnant mothers were enrolled in the study with a mean age

of 27.7 years, and most reported that high blood pressure, maternal smoking, alcohol consumption, infection,

and medicines affected fetal growth during pregnancy, with two-thirds visiting health facilities in the first three

months; majority had good knowledge and attitude but low practice, with marital status, occupation, gravidity,

and parity showing significant association to knowledge, and gravidity and parity to practice (Gebremariam et

al., 2023).

Results showed moderate knowledge, positive attitude, and good practice, with linear regression identifying

women with more than seven children had lower knowledge scores, women aged 20-24 had lower attitude

scores than 18-19, women in defacto relationships and Fijian women of Indian descent had lower attitude

scores than married and I Taukei women, and women aged 30–34 had lower practice scores than 18–19

(Imtishal et al., 2023). Respondents had majority knowledge towards ANC, with 38 percent receiving

information from health care providers and few from husbands, 80 percent accepting ANC utilization, majority

seeking permission for visits, 58 percent utilizing ANC in previous pregnancies, over one third preferring

mother and child health centers, few preferring public hospitals, and 5 percent private hospitals; multigravida,

gestational months, seeking permission, spouse accompany, and awareness significantly contributed to ANC

utilization with significant differences observed (Mohamoud et al., 2022).

Interrelationship among KAP. The highest percentage of pregnant women had a high knowledge score

regarding antenatal care, most showed a positive attitude, and the highest percentage also had good practice

scores. The level of overall knowledge had a significant direct correlation with practices towards antenatal

care, while it had an insignificant correlation with attitude (Ibrahim et al., 2014). Pregnant women had average

knowledge, positive attitudes, and good practices toward ANC, with overall knowledge positively correlated

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with practices. Age, type of family, education, and occupation had significant associations with awareness and

practices, but practice of ANC remained low despite good knowledge and attitude (Bashir et al., 2023). Almost

a quarter of respondents had good knowledge, almost a quarter had sufficient knowledge, and majority had less

knowledge. Over one third had a positive attitude towards ANC, fewer than those with a negative attitude

(Hernawati et al., 2024).

The result indicated majority had correct answers in total knowledge regarding ANC, positive attitude, and

practice towards ANC. Sociodemographic characteristics including education were significantly associated

with knowledge; transport and past obstetrical history with attitude; and monthly income with practice. There

was a statistically highly significant correlation between knowledge and attitude, knowledge and practice, and

attitude and practice (Mallick et al., 2023). Majority of mothers had good knowledge and attitude but low level

of practice, with marital status, occupation, gravidity, and parity showing significant association to knowledge,

and gravidity and parity to practice (Gebremariam et al., 2023). Majority of women had adequate knowledge,

positive attitude, and practiced ANC adequately, with age, parity, education, occupation, and type of family

significantly associated with awareness (Kaur et al., 2021). Majority knew about antenatal care, while the rest

did not; majority wanted to follow ANC, while over a quarter did not due to negative attitude, and less than

half practiced ANC follow up during pregnancy (Henok et al., 2015).

RESEARCH METHODOLOGY

Design. The study made use of a descriptive correlational design. The descriptive design was determined the

socio- demographic characteristics of the pregnant women and the level of knowledge, attitude, and practices

on antenatal care. It was correlational as it assessed the interrelationship among socio-demographic

characteristics, knowledge, attitude, and practice on antenatal care among pregnant women.

Environment. This study was conducted at the selected Health Birthing Centers in Butuan City.

Respondents. The respondents of this study were 323 pregnant women who submit for antenatal in the said

hospital and birthing clinics.

Sampling Design. A quota sampling was utilized in this study.

Inclusion Criteria and Exclusion Criteria. Respondents of the study must comply with the following

inclusion and exclusion criteria: (a) must be of legal age, regardless of marital status, educational attainment,

occupation, and religion; (b) must be pregnant residing in Butuan City Agusan del Norte who must visit in

selected health facilities and had been living at least six months in the area for their antenatal visits; (c) must be

able to read and write and must be willing to give voluntary consent. Excluded from the study were those

pregnant mothers who live outside Butuan City.

Instrument. The study made use of a four-part questionnaire as the primary tool in data collection. Part one

pertains to the socio-demographic characteristics of pregnant women. This part contains the following: Age,

marital status, level of education, occupation, gravidity, parity, family monthly income, and type of family.

Part two to four of the instrument is adopted from the study of Akhtar et al. (2018). It pertains to the

Knowledge on antenatal care (14 items), Attitude on antenatal care (10 items) and Practice on antenatal care (7

items). The knowledge aspect is answerable by yes

(2) or no (1) while the attitude and practice is answerable by a three-point Likert scale where 1 is disagree, 2 is

neutral, and 3 as agree. A means score was used to determine the level of knowledge, attitude, and practice on

antenatal care. A score of 1.00 – 1.50 is not knowledgeable, and 1.51 – 2.00 is knowledgeable. For attitude, a

score of 1.00 – 1.67 is negative attitude, 1.68 – 2.34 is neither positive nor negative attitude, and 2.34 – 3.00 is

positive attitude. For practice, a score of 1.00 – 1.67 is not practiced, 1.68 – 2.34 is moderately practiced, and

2.34 – 3.00 is practiced.

For reliability, the instrument has undergone reliability testing among 15 pregnant women and Cronbach alpha

revealed the following results: Knowledge was .630, attitude was .781, and practice was .808. The instrument's

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reliability was established using Cronbach's alpha measurement to demonstrate internal consistency. An item is

considered reliable with Cronbach's alpha score greater than 0.6, acceptable between 0.6 to 0.8, with a

corrected item-total correlation greater than 0.3 (Hajjar, 2018; Cronbach, 1951).

Data Gathering Procedures. Before data collection, the researcher submitted the study title for approval, was

assigned a research adviser, and secured approval letters from the Dean of Allied Health Sciences, Chief

Academic Officer, Chief of Hospital, and Administrators of Birthing Clinics in Butuan City. A design hearing

was conducted to ensure ethical and technical standards, after which the research paper was submitted to the

university and hospital ethics committees for approval. Upon issuance of the notice to proceed, recruitment

began, and respondents signed informed consent before completing the questionnaire. Due to the pandemic,

social distancing, face masks, and sanitization were required. Questionnaires were placed in plastic envelopes

for easy sanitization before and after use. The researcher checked each completed questionnaire to confirm all

questions were answered, continuing until the desired sample size was reached. Data were compiled, analyzed

using statistical techniques, and presented in tables with interpretations, implications, research, and supporting

literature. At the end of the study, all completed surveys were shredded.

Statistical Treatment of Data. The statistical data were analyzed. The following descriptive and inferential

statistics were used in the study: Frequency Distribution and Simple Percentage were was used to present the

socio-demographic characteristics of the respondent. Weighted Mean and standard deviation were used to

determine the knowledge, attitude, and practices on antenatal care of the pregnant women. Chi-square Test of

Independence used to assess whether or not there was a significant relationship between the socio-

demographic characteristics and the knowledge, attitude, and practice on antenatal care among pregnant

women. Cramer’s V used to assess the strength of association should there exist a significant relationship

utilizing the Chi Square. And, Pearson r used to assess the interrelationship among knowledge, attitude, and

practices on antenatal care among pregnant women.

Ethical Considerations. Ethical considerations are an essential component of any research study. The study

was submitted for ethical approval prior to data gathering.

Presentation, Analysis, And Interpretation of Data

Table 1 Profile of the Respondents

Profile

Age

18- 24 years old

50.00

25-34 years old

47.50

35-44 years old

2.50

Marital Status

Single

103

63.60

Married

36.40

Level of Education

College Graduate

34.60

High School Level

3.10

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College Level

38.90

High School Graduate

23.50

Occupation

Housewife

52.50

Government employee

22.20

Private employee

25.30

Gravidity

One (1)

34.60

Two (2)

30.20

Three (3)

25.90

Four (4)

7.40

Five (5)

1.90

Parity

Zero (0)

34.60

One (1)

35.80

Two (2)

20.40

Three (3)

9.30

Abortion

Zero (0)

150

92.60

One (1)

7.40

Income

Above 10,000

121

74.70

5,001 – 10,000

25.30

Type of Family

Nuclear

40.70

Extended

4.90

Intergenerational

19.10

Cohabitational

35.20

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Note: n=162.

The table shows that half of the respondents were 18 to 24 years old and almost half were 25 to 34 years old,

with very few aged 35 to 44. This aligns with the reproductive age group, as mothers aged 25-29 made up 27.9

percent and those aged 20-24 made up 23.7 percent of new mothers in the Philippines (Statista, 2024).

Majority were single while over one third were married, contrary to Bashor et al. (2023) finding that most

pregnant women were married between 16-25 years. Most were college level, over one third were college

graduates, almost a quarter were high school graduates, and few were at high school level only, with PSA

(2022) reporting 99 percent of women are literate and 37 percent have postsecondary or college education. Just

over half were housewives, a quarter were private employees, and almost a quarter were government

employees, reflecting the common paternal family setup where men provide and women stay at home. PSA

(2022) states nearly 6 in 10 married women aged 15-49 were employed, with 79 percent paid in cash only.

Most had a gravidity of one, one third had two, a quarter had three, and few had four or five; most had a parity

of one, over one third had zero, almost a quarter had two, and few had three, similar to Bashir et al. (2023)

who reported over one third were primigravida and majority were multi gravida of 2 to 4. Majority had no

abortion while very few had at least one; abortion is illegal in the Philippines unless therapeutic, though

unintended pregnancy rates declined while abortion rates increased (Guttmacher Institute, 2024). Majority had

family monthly income above Php 10,000, a quarter had Php 5,001-10,000, with average family income in

2021 at Php 307.19 thousand per year (Divina, 2024). Most had a nuclear family, over one third were

cohabitational, few were intergenerational, and very few extended, reflecting the common nuclear household

structure with tight-knit bonds among extended family members (Scroope, 2017).

Table 2 Knowledge on Antenatal Care

Dimensions

Mean

score

Interpretation

Segregation

1. Do pregnant women need to go for antenatal

check-up?

2.00

.000

Knowledgeable

2. If yes, is it required to go for ANC even if

there is no complication during pregnancy?

2.00

.000

Knowledgeable

3. Should first antenatal check-up be done in

the first 3 months?

2.00

.000

Knowledgeable

4. Is it necessary to give injection TT during

pregnancy?

2.00

.000

Knowledgeable

5. Does pregnant woman need vitamin supplement and iron

folic acid tablet during pregnancy?

2.00

.000

Knowledgeable

6. Regular

Blood

pressure

examination

necessary during pregnancy.

1.93

.263

Knowledgeable

7. Can high blood pressure affect the fetus growth?

1.96

.204

Knowledgeable

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8. Can high blood pressure affect the fetal growth?

1.97

.173

Knowledgeable

9. Is maternal smoking harmful to the fetus?

2.00

.000

Knowledgeable

10. Can alcohol consumption during

pregnancy affect the fetal growth?

2.00

.000

Knowledgeable

11. Are you aware that any infection during pregnancy

can cause harm to your baby?

2.00

.000

Knowledgeable

12. Are you aware that any medicines other than those

prescribed by doctor can cause harm to your baby?

1.88

.323

Knowledgeable

13. Does pregnant woman need vitamin supplement and iron

folic acid tablet during pregnancy?

2.00

.000

Knowledgeable

14. Regular Blood pressure examination is necessary

during pregnancy

2.00

.000

Knowledgeable

Grand mean

1.98

.056

Knowledgeable

Note: n=162.

Legend: A score of 1.00 – 1.50 is not knowledgeable, and 1.51 – 2.00 is knowledgeable.

Table 2 shows respondents were knowledgeable about antenatal care, knowing the need for check-ups even

without complications, first check-up in the first 3 months, injection TT, vitamin supplements, iron folic acid,

regular blood pressure checks, and effects of high BP, smoking, alcohol, infections, and non-prescribed

medicines on the fetus. Majority had gravidity of two or more, explaining their knowledge. Ibrahim et al.

(2014) found high knowledge scores, positive attitude, and good practice scores, while Hernawati et al. (2024)

found almost a quarter had good knowledge, almost a quarter sufficient, and majority less knowledge. Bashir

et al. (2023) reported average knowledge, positive attitudes, and good practices. Al-Jaradi et al. (2022) found

majority knew about vitamin supplements and iron-folic acid, two-thirds knew about tetanus vaccine, less than

half knew about HIV and hepatitis B screening, and less than two-thirds knew ANC visit schedules. Findings

agree with Akhtar et al. (2018), Kaur et al. (2018), Mored et al. (2014), Tenaw et al. (2018), Mbada et al.

(2014), and Hajela (2014). Results indicate good knowledge on antenatal care but sustaining it for first-time

pregnant women is needed.

Table 3 Attitude on Antenatal Care

Dimensions

Mean

score

Interpretation

1. Early antenatal booking is good for my pregnancy

2.27

.446

Agree

2. I will go for antenatal booking before the third month of my

pregnancy.

2.27

.446

Agree

3. I believe that vitamin supplement and iron folic

acid tablet is good for the fetus.

2.58

.495

Agree

4. Antenatal follow up is good to monitor mother’s

2.15

.356

Agree

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and fetus’ health

5. I will allow the doctor to check my blood pressure

2.72

.452

Agree

6. Do pregnant women need to go for antenatal check-up

2.72

.452

Agree

7. If yes, is it required to go for ANC even if there

is no complication during pregnancy?

2.28

.452

Agree

8. Should first antenatal check-up be done in the first 3

months?

2.27

.446

Agree

9. Does pregnant woman need vitamin supplement and iron folic

acid tablet during pregnancy?

2.56

.498

Agree

10. Regular Blood pressure examination is necessary during

pregnancy

2.72

.452

Agree

Grand mean

2.45

.282

Positive

attitude

Note: n=162.

Legend: For attitude, a score of 1.00 – 1.67 is negative attitude, 1.68 – 2.34 is neither positive nor negative

attitude, and 2.34 – 3.00 is positive attitude.

Table 3 presents data on the attitude towards antenatal care, showing that respondents had a positive attitude.

They agreed with early antenatal booking, taking vitamin supplements and iron folic acid, regular check-ups

including blood pressure monitoring, and the importance of antenatal care even without complications. Most

had prior pregnancy experience, contributing to their knowledge and positive attitude. Supporting studies also

found positive attitudes towards antenatal care (Hernawati et al., 2024; Mallick et al., 2023; Gebremariam et

al., 2023; Akhtar et al., 2018; Tenaw et al., 2018), though one study noted some women still had negative

attitudes (Henok et al., 2015). The findings indicate that respondents understand the benefits of antenatal care

for both mother and baby.

Table 4 Practice on Antenatal Care

Dimensions

Mean

score

Interpretation

1. Seek antenatal care regularly during pregnancy.

2.54

.500

Agree

2. Current pregnancy is unplanned.*

2.53

.757

Disagree

Waiting for the fetus (baby) to move before going for antenatal

care.*

2.70

.458

Disagree

4. Unable to meet the transport costs to the healthcare

facility.*

2.40

.734

Disagree

5. Feeling well and not having any serious problems,

2.43

.721

Disagree

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which need the nurse or doctor’s attention.*

power

make

decisions

your

own.

Husband/partner or family members must make the

decision for you to go for antenatal care.*

2.69

.463

Disagree

7. Take five antenatal visits during pregnancy.

2.56

.498

Agree

Grand mean

2.55

.407

Practiced

Note: n=162. * Negatively worded items.

Legend: For practice, a score of 1.00 – 1.67 is not practiced, 1.68 – 2.34 is moderately practiced, and 2.34 –

3.00 is practiced.

Table 4 is the presentation of the data on the practice on antenatal care. Antenatal care was practiced by the

respondents. They agreed that they sought antenatal care regularly during pregnancy and took five antenatal

visits during pregnancy. However, they disagreed that their current pregnancy was unplanned, they waited for

the fetus (baby) to move before going for antenatal care, they were unable to meet the transport costs to the

healthcare facility, they felt well and not having any serious problems, which needed the nurse or doctor’s

attention, and they had no power to make decisions on their own. Husband/partner or family members made

the decisions for them to go for antenatal care. Majority of the respondents had practiced antenatal care

already. And, because they greatly benefit from it as well as their baby then there is no reason for them not to

do it again.

The highest percentage of pregnant women had good practice scores (Ibrahim et al., 2014). The finding of the

study revealed that pregnant women had good practices toward antenatal care (ANC). Furthermore, the

practice of ANC in the study area was low despite good knowledge and attitude toward ANC (Bashir et al.,

2023). The result indicated that majority of participants had practice towards overall antenatal care (Mallick et

al., 2023). Majority of mothers had good knowledge and attitude, but they had low level of practice

(Gebremariam et al., 2023). Majority of women were practicing antenatal care adequately (Kaur et al., 2021).

Less than half of women practiced antenatal care follow up during their pregnancy time (Henok et al., 2015).

The findings clearly show that the respondents are really submitting themselves for antenatal care. This only

shows that they know how important it is to go through antenatal care while being pregnant because it has

positive effects to the mother and the baby. They know too well how antenatal works as most of them are

gravida two already. This is a repetition of something good and therefore mothers do not hesitate to practice

antenatal care. The antenatal care is part of the mandate on National Safe Motherhood Program (NSMP) where

it is focused on making pregnancy and childbirth safer and sought to change fundamental societal dynamics

that influence decision making on matters related to pregnancy and childbirth while it tries to bring quality

emergency obstetrics and newborn care facilities nearest to homes. this move ensures that those most in need

of quality health care by competent doctors, nurses and midwives have easy access to such care.

Also, according to Administrative Order No. 2021-0034 on National Policy on Essential Care art Primary

Level Non-specialist Birthing Centers. The order shall apply to all maternal and newborn care

providers/skilled health professionals in primary care facilities and non-specialist birthing centers in Rural

Health Units, Urban Health Centers, Local Govenrment Unit (LGU) Hospitals and similar service providers in

the private sector such as private practicing midwives, nurses and doctors (Department of Health, 2021).

Table 5 Relationship between Profile and Knowledge on Antenatal Care

Variables

Chi value

p value

Cramer’s V

Decision

Interpretation

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Age

8.557

.073

Failed to reject Ho

Not

significant

Marital status

12.330

.002

.276

Reject Ho

Significant

Level of

Education

23.291

.001

.268

Reject Ho

Significant

Occupation

28.875

.000

.299

Reject Ho

Significant

Gravidity

27.067

.001

.289

Reject Ho

Significant

Parity

33.632

.000

.322

Reject Ho

Significant

Abortion

1.722

.423

Failed to reject Ho

Not

significant

Family monthly

income

9.473

.009

.242

Reject Ho

Significant

Type of family

65.355

.000

.449

Reject Ho

Significant

Legend: Significant if p value is < .05. Dependent Variable: Knowledge. Cramer’s V: ES ≤ 0.2 - The result

is weak. Although the result is statistically significant, the fields are only weakly associated. 0.2 < ES ≤ 0.6

- The result is moderate. The fields are moderately associated. ES > 0.6 - The result is strong. The fields are

strongly associated.

The table shows that the p values for the independent variables of marital status, level of education,

occupation, gravidity, parity, family monthly income, and type of family were lesser than the significant value

of .05. These values were interpreted as significant which led to the decision of rejecting the null hypothesis.

Thus, marital status, level of education, occupation, gravidity, parity, family monthly income, and type of

family were significantly correlated with knowledge on antenatal care. The correlations were moderate

positive. A very high knowledge is influenced by, a marital status of being single, a higher education, being a

housewife, higher gravidity and parity, higher family monthly income, and having a nuclear family.

Being married means that they have support from their partners and with the support this tends to allow the

respondents to strive to get more information about antenatal care. Their partners may push them to gain more

knowledge. Similarly, with higher education means that they become more knowledgeable and this being

knowledgeable is also applied to antenatal care. The more education, the more initiatives to research about

antenatal care in online resources. Being a housewife would only mean that they will have time for antenatal

care. Because there is no conflict of schedule between work and antenatal check-ups. With gravidity and

parity, it means that they gained experience on pregnancy already and therefore this experience allowed them

to gain knowledge already. In terms of family monthly income, the higher the income means the more

resources that the person has in accessing information about antenatal care.

Supporting the findings, marital status, occupation, gravidity, and parity had showed statistically significant

association to their comprehensive knowledge. And their gravidity and parity had also showed statistically

significant association to their level of practice (Gebremariam et al., 2023).

However, the p value for the independent variable of age and abortion were greater than the significant value

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of .05. These values were interpreted as not significant which led to the decision of failing to reject the null

hypothesis. Thus, age and abortion were not significantly correlated with knowledge on antenatal care. This

means that a very high knowledge is highly attainable no matter what age and whether there was an abortion or

not. Contrary to the findings, it was found that almost all the variables such as age, parity, level of education,

occupation and type of family had a significant association with awareness about ANC (Kaur et al., 2021).

Table 6 Relationship between Profile and Attitude on Antenatal Care

Variables

Chi value

p value

Cramer’s V

Decision

Interpretation

Age

26.267

.003

.285

Reject Ho

Significant

Marital status

17.205

.004

.326

Reject Ho

Significant

Level of

Education

27.400

.026

.237

Reject Ho

Significant

Occupation

23.518

.009

.269

Reject Ho

Significant

Gravidity

94.591

.000

.382

Reject Ho

Significant

Parity

78.858

.000

.403

Reject Ho

Significant

Abortion

23.330

.000

.371

Reject Ho

Significant

Family monthly

income

5.633

.344

Failed to reject Ho

Not

significant

Type of family

68.312

.000

.375

Reject Ho

Significant

Legend: Significant if p value is < .05. Dependent Variable: Attitude. Cramer’s V: ES ≤ 0.2 - The result is

weak. Although the result is statistically significant, the fields are only weakly associated. 0.2 < ES ≤ 0.6 - The

result is moderate. The fields are moderately associated. ES > 0.6 - The result is strong. The fields are strongly

associated.

The table shows that the p values for the independent variables of age, marital status, level of education,

occupation, gravidity, parity, abortion, and type of family were lesser than the significant value of .05. These

values were interpreted as significant which led to the decision of rejecting the null hypothesis. Thus, age,

marital status, level of education, occupation, gravidity, parity, abortion, and type of family were significantly

correlated with attitude on ante natal care.

The correlations were moderate positive. A very positive attitude is influenced by increasing age, a marital

status of being single, a higher education, being a housewife, higher gravidity and parity, having no abortion,

and having a nuclear family. With increasing age there is development of maturity and development of

wisdom. With this people develop and gain better understanding of the importance of antenatal care to the

mother and baby, thus embracing and providing a positive attitude towards it. With being married, this means

that the person has a support system who will provide support all the way to the antenatal care process, and

thus the person can gain positive attitude towards antenatal care. With higher levels of education, means that

ther is also higher levels of knowledge, with better knowledge there is better appreciation of the importance of

antenatal care and thus will be able to provide positive attitude towards it. Being a housewife means that there

are no competitions in complying with antenatal care. They can accomplish natal care as they are only at

home. With this they can better appreciate its importance and benefits, thus they will be able to place positive

attitude towards it. With increasing gravidity and parity, it means that they already gained experience on

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antenatal and because it is very helpful, they normally place a positive attitude towards it. Having no abortion

means that they are greatly benefitting from the effects of antenatal care and therefore they place a positive

attitude towards it. Lastly, having a nuclear family is typical family. Members of the family can provide

support towards achieving antenatal care.

Supporting the findings, some sociodemographic characteristics including education were significantly

associated with knowledge; transport and past obstetrical history of complication was significantly associated

with attitude; monthly income was significantly associated with practice (Mallick et al., 2023). However, the p

value for the independent variable of family income was greater than the significant value of .05. This value

was interpreted as not significant which led to the decision of failing to reject the null hypothesis. Thus, family

income was not significantly correlated with attitude on antenatal care. This means that a very positive attitude

is highly attainable no matter what the family income is. Linear regression identified that women in de facto

relationships had a 2.12 lower attitude score compared to the married category (Imtishal et al., 2023). Also, the

study showed that, multigravida, gestational months, seeking permission and spouse accompany to the

antenatal care visit and level of awareness significantly contributed to the utilization of ANC by pregnant

women in this study. Significant difference was strongly observed (Mohamoud et al., 2022).

Table 7 Relationship between Profile and Practice on Antenatal Care

Variables

Chi value

p value

Cramer’s V

Decision

Interpretation

Age

34.131

.000

.325

Reject Ho

Significant

Marital status

12.545

.014

.278

Reject Ho

Significant

Level of

Education

27.446

.007

.238

Reject Ho

Significant

Occupation

18.605

.017

.240

Reject Ho

Significant

Gravidity

1.204E2

.000

.431

Reject Ho

Significant

Parity

99.405

.000

.452

Reject Ho

Significant

Abortion

18.354

.001

.337

Reject Ho

Significant

Family monthly

income

8.396

.078

Failed to reject Ho

Not

significant

Type of family

60.839

.000

.354

Reject Ho

Significant

Legend: Significant if p value is < .05. Dependent Variable: Practice. Cramer’s V: ES ≤ 0.2 - The result is

weak. Although the result is statistically significant, the fields are only weakly associated. 0.2 < ES ≤ 0.6 - The

result is moderate. The fields are moderately associated. ES > 0.6 - The result is strong. The fields are strongly

associated.

The table indicates that age, marital status, level of education, occupation, gravidity, parity, abortion, and type

of family were significantly correlated with antenatal care (ANC) practices, as their p-values were less than

.05. These variables showed moderate positive correlations with ANC practice, suggesting that higher practice

levels are associated with increasing age, being single, having higher education, being a housewife, greater

gravidity and parity, no history of abortion, and being part of a nuclear family. Experience, social support,

educational attainment, and availability of time contributed to better ANC practices. Previous pregnancies and

absence of complications like abortion also positively influenced practice. The presence of a supportive

nuclear family further enhanced compliance with ANC.

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Supporting literature showed that age, type of family, education, and occupation were significantly associated

with ANC awareness and practices (Bashir et al., 2023). Despite good knowledge and attitude, ANC practice

remained low in the study area. Family income, however, had a p-value greater than .05, indicating no

significant correlation with ANC practice. Therefore, high ANC practice is achievable regardless of income

level. Linear regression analysis showed that those aged 30–34 had lower ANC practice scores than those aged

18–19 (Imtishal et al., 2023).

Table 8 Relationship between Profile and Practice on Antenatal Care

Variables

r value

p value

Decision

Interpretation

Knowledge and Attitude on antenatal

care

.131

.096

Failed to reject

Not significant

Knowledge vs. Practice on antenatal

.140

.076

Failed to reject

Not significant

Attitude vs. Practice on antenatal

.555

.000

Reject Ho

Significant

Legend: Significant if p value is < .05. Pearson r value interpretation: .00 to .30 (.00 to -.30) is negligible

correlation; .30 to .50 (-.30 to -.50) is low positive negative) correlation; .50 to .70 (-.50 to -.70) is moderate

positive (negative) correlation; .70 to .90 (-.70 to -.90) is high positive (negative) correlation; and .90 to 1.00 (-

.90 to -1.00) is very high positive (negative) correlation.

The correlation between knowledge and attitude on antenatal care was found to be not significant (p > .05),

meaning knowledge did not significantly influence attitude. A positive attitude can still exist despite low

knowledge. This contrasts with theoretical expectations from the Health Belief Model and KAP model, which

suggest knowledge should impact attitude. Supporting literature (Ibrahim et al., 2014) similarly found

knowledge correlated with practice but not attitude.

The correlation between knowledge and practice was also not significant (p > .05), indicating that high

antenatal care practices can occur even with low knowledge. This contradicts the assumptions of both the

Health Belief Model and KAP model. Despite this, Bashir et al. (2023) reported a positive relationship

between knowledge and ANC practices.

In contrast, the correlation between attitude and practice was significant (p < .05), with a moderate positive

relationship. This means that a more positive attitude is associated with higher antenatal care practice, aligning

with the theoretical frameworks and supporting literature (Mallick et al., 2023; Ibrahim et al., 2014). A noted

limitation was the use of a dichotomous knowledge instrument, which may have influenced the insignificant

findings for knowledge correlations. A Likert-scale format, like those used for attitude and practice, may have

produced different results.

CONCLUSION AND RECOMMENDATIONS

Conclusion. In conclusion, knowledge on antenatal care do not influence attitude and practice. However,

attitude influences practice on antenatal care. This means that a very positive attitude and very high levels of

practice on antenatal care can be achieved despite the low level of knowledge on antenatal care. However, a

high level of practice can be achieved through a very positive attitude on antenatal care. The findings of the

study partially proved the Health Belief Model and KAP Model as it was only attitude that influences practice

while knowledge did not influence attitude and practice. To address the findings of the study an antennal care

enhancement plan was proposed.

Recommendations. The results of this study guide the following suggestions are offered:

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Practice. A part of the research utilization of the output, the antenatal care sustenance plan is recommended

for use in the birthing centers where the study was conducted to aid in the practice of antenatal care among

pregnant women at the brangay level. Other birthing centers and hospitals in the region may also adopt the said

plan as applicable to them. Also, a special meeting shall be called for to discuss the findings of the study among

birth center administrators.

Policy. The study findings can support the crafting or strengthen the issued policies and guidelines in the strict

compliance of antenatal care and related laws or mandates among pregnant women identifying specific

measures to have massive information dissemination and practice on antenatal care.

Education. The research study can serve as a reference to studies relating to knowledge, attitude, and practice

on antenatal care and the interrelationship among socio- demographic profiles, knowledge, attitude, and

practice on antenatal care. Further, the study can be used as an educational material in research referencing the

methodology used. It can also serve as a reference in terms of the statistical treatments used and in research in

ethics. The output can also be used in educating women of reproductive age, including men, to gain

knowledge, positive attitude and high levels of practice on antenatal care.

Nursing Research. art of research utilization is the posting of the abstract of the study in the bulletin of the

hospital. The paper will also be submitted for publication in a refereed journal.

Antenatal Care Sustenance Plan

Rationale

It is the goal of good prenatal care to ensure that the woman does not suffer any adverse effects from the

pregnancy and to maintain the health of the developing baby. Furthermore, this is the opportunity for the

physician and other healthcare experts to educate both the moms and their partners about the importance of

maintaining a healthy lifestyle. Micronutrient supplements, treatment for hypertension to prevent eclampsia,

and immunization against tetanus are all options that are available to pregnant women who are receiving

antenatal care. For the purpose of preventing the transfer of HIV from mother to child, antenatal care may also

include the provision of HIV testing and medication. Findings of the study revealed the need to sustain the

knowledgeable result on antenatal care. Also, there is a need to sustain the positive attitude on antenatal care

and sustain the practice level on antenatal care. Other findings revealed a correlation between attitude and

practice on antenatal care. Thus, this antenatal plan was created mainly to sustain such finding.

General Objectives

The primary purpose of this antenatal care sustenance plan is to sustain the high levels of knowledge, very

positive attitude, and high level of practice on antenatal care among pregnant women.

Specific Objectives

a. To sustain the knowledgeable level on antenatal care among pregnant women;

b. To sustain the very positive attitude on antenatal care among pregnant women;

c. To sustain the practiced level on antenatal care among pregnant women; and

d. To sustain the high levels of knowledge, very positive attitude, and high level of practice on antenatal care

among pregnant women.

Areas of

Concern

Specific

Objectives

Activities

Persons

Responsible

Resources

Needed

Time

Frame

Success

Indicators

Knowledge -

To sustain

Personally-

Pregnant

Internet

Saved articles

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the need to

sustain the

knowledgeab

le result on

antenatal

care.

the

knowledgea

ble level on

antenatal

care among

pregnant

women.

initiated

activities:

•Read articles

and view

videos on

antenatal care.

•Attend

seminars and

webinars on

antenatal care.

Hospital-

initiated

activities:

Provide

education

program at the

barangay level

coordination

with the

barangay

health workers.

women,

Doctors,

Nurses, and

Midwives,

Hospital

Administrat

ors,

Barangay

Health

Officials.

connection

, Desktop,

laptop,

tablets, or

android

phones.

Budget for

the

creation of

leaflet.

Infographi

Quarter

of the

Year

and videos.

Certificates

of attendance

and

participation.

Update

Facebook and

official

website.

Survey

results

Attitude -

The need to

sustain the

positive

attitude on

antenatal

care.

To sustain

the very

positive

attitude on

antenatal

care among

pregnant

women.

Personally-

initiated

activities:

•Read articles

and view

videos on

antenatal care.

•Attend

seminars and

webinars on

antenatal care.

Hospital-

initiated

activities:

Encourage

involvement

husbands or

parents in the

antenatal care.

Pregnant

women,

Doctors,

Nurses, and

Midwives,

Hospital

Administrat

ors,

Barangay

Health

Officials.

Internet

connection

, Desktop,

laptop,

tablets, or

android

phones.

Budget for

the

creation of

leaflet.

Infographi

Quarter

of the

Year

Saved articles

and videos.

Certificates

of attendance

and

participation.

Update

Facebook and

official

website.

Survey

results

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Page 912

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REFERENCES

1. Abalos, E., Chamillard, M., Diaz, V., Tuncalp, Ӧ., & Gulmezoglu, A. M. (2016). Antenatal care for

healthy pregnant women: a mapping of interventions from existing guidelines to inform the

development of new WHO guidance on antenatal care. BJOG, 123, 519–28.

Practice -

The need to

sustain the

practice

level on

antenatal care

To sustain

the

practiced

level on

antenatal

Care among

pregnant

women.

Personally-

initiated

activities:

•Read articles

and view

videos on

antenatal care.

•Attend

seminars and

webinars on

antenatal care.

Hospital-

initiated

activities:

• Obtain

permission to

take email or

cellphone

number of the

pregnant

mother to be

used for

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next scheduled

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visits.

Pregnant

women,

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Hospital

Administrat

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Barangay

Health

Officials.

Internet

connection

, Desktop,

laptop,

tablets, or

android

phones.

Budget for

the

creation of

leaflet.

Infographi

Quarter

of the

Year

Saved articles

and videos.

Certificates

of attendance

and

participation.

Update

Facebook and

official

website.

Survey

results

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between

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antenatal

care.

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the high

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care

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Note: All

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here.

Pregnant

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Doctors,

Nurses, and

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Hospital

Administrat

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Health

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Note: All

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in the first,

second,

and third

concerns

are

applicable

here.

quarter of

2024.

Note: All

success

indicators

mentioned in

the first,

second, and

third concerns

Are

applicable

here.

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