Heat event risk perception and care adaptation among pregnant women in Nepal: baseline assessment of a longitudinal concurrent cohort

Heat events have detrimental effects on maternal and neonatal health, increasing the risk for maternal complications, preterm birth, and neonatal mortality. There is an urgent need to explore pregnant women’s heat risk perceptions and adaptive measures. This study uses the Health Belief Model (HBM) to investigate pregnant women’s perception of heat risks and related prevention and mitigation strategies and identifies barriers to the adoption of such behaviours. Using a concurrent cohort design, a baseline assessment was conducted through semi-structured interviews with 745 pregnant women in a heat prone district in Nepal. The interviews collected socio-demographic information and assessed the five HBM constructs of heat event risk perception using a Likert scale. Heat maps were created to visualise perceptions, and Principal Component Analysis was undertaken to create a nominal scale score for each construct. Crude and adjusted linear regressions were performed to assess associations of socio-demographic characteristics and HBM constructs. Among the pregnant women, 68% perceived dehydration due to heat as a risk to their pregnancy, and 37% perceived sunburn as a risk to foetal health. In terms of perceived benefit, 34% agreed that staying in an air-conditioned environment could reduce their chances of suffering during a heat event. Adjusted linear regression showed that wealthier women perceived higher susceptibility (adj. β = 0.14, 95% CI: 0.07, 0.21; p < 0.001) and severity (adj.β = 0.16, 95% CI: 0.08, 0.23; p < 0.001), and reported more barriers (adj. β = 0.16, 95%CI: 0.08, 0.23; p < 0.001). Conversely, urban residents had significantly lower perceived susceptibility (adjusted β = -0.32, 95% CI: -0.41, -0.24; p < 0.001) and severity (adj. β = -0.34, 95%CI: -0.42, -0.25; p < 0.001), fewer barriers (adj. β = -0.34, 95%CI: -0.42,-0.25; p < 0.001) towards heat events, and perceived more benefits (adj. β = 0.31, 95%CI: 0.22, 0.39; p < 0.001) from heat stress prevention and mitigation strategies compared to their rural counterparts. To promote adaptive behaviours in this vulnerable population and strengthen maternal and foetal resilience against the growing threat of heat, we recommend focusing on closing knowledge, availability, and accessibility gaps. Maternal health considerations should be integrated into national climate change adaptation strategies to ensure that pregnant women are prioritised in policies and interventions. IBM SPSS statistic software for Windows version 26 and Stata/SE 18.0 were used for this study.