From need to neglect: Exploring psychological barriers to preventive interventions in pregnancy

To effectively reduce the impact of hepatitis B and malaria during pregnancy, consistent adherence to key preventive interventions such as vaccination, the use of long-lasting insecticidal nets (LLINs), and the administration of Sulfadoxine-Pyrimethamine (SP) is essential. Achieving high coverage of these interventions, however, requires a clear understanding of the factors that hinder compliance. Therefore, this study investigated the psychological determinants of non-compliance with these interventions among pregnant women in the Bono East Region. A prospective cross-sectional mixed-method study was conducted among 1,430 pregnant women. Data were collected through serological screening, questionnaires, in-depth interviews, and focus group discussions. Quantitative analysis included descriptive statistics, Chi-square tests, and logistic regression with results shown as crude and adjusted odds ratios at 95% confidence intervals. The quantitative analysis involved a four-step thematic analysis with a focus on transcription, profiling, coding, and thematic framework. The study revealed a series of psychological barriers to compliance. The fear of side effects (AOR = 2.17; 95% CI: 1.78 - 4.06), forgetfulness (AOR = 6.02; 95% CI: 2.13 - 9.91), and pain (AOR = 2.95; 95% CI: 1.97 - 4.94) increased the odds of hepatitis B infection. Likewise, fear of side effects (AOR = 2.07; 95% CI: 1.66 - 3.72), absence of symptoms (AOR = 1.82; 95% CI: 1.53 - 2.26), forgetfulness (AOR = 2.41; 95% CI: 1.48 - 3.90), perceived efficacy of herbs (AOR = 2.35; 95% CI: 1.49 - 3.68), pain (AOR = 2.52; 95% CI: 1.48 - 4.27), uncertainty (AOR = 2.38; 95% CI: 1.48 - 3.84), and prolonged adherence (AOR = 1.71; 95% CI: 1.10 - 2.66) increased the odds of malaria. The identified barriers and their strong association with increased odds of infections call for a groundbreaking and policy-driven public health response. Consequently, integrating psychosocial support and mental health services into antenatal care could play a crucial role in overcoming these barriers.