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Conceptual and conceptual framework
Theoretical Framework
This section dealt with theories that support the literature under the study and other frameworks for
easier verification and suggestions. The theories to be looked at are: the health model theory and
stakeholder theory, which are deemed to be relevant to the study.
The Health Model Theory
This is a psychological model that attempts to explain and predict health
behaviours by focusing on the attitudes and beliefs of individuals. It was developed in the 1950s as
part of an effort by social psychologists in the United States Public Health Service to explain the
lack of public participation in health screening and prevention programs. (example,
maternal health care). This theory looks at various aspect of health treatment with regard to the patient.
The aspects are;
Perceived Threat contains two parts: perceived susceptibility and perceived severity of a health
condition-Perceived Susceptibility is one's subjective perception of the risk of contracting a health
condition-Perceived Severity are feelings concerning the seriousness of contracting an illness or of
leaving it untreated (including evaluations of both medical and clinical on sequences and possible
social consequences)-Perceived Benefits are the believed effectiveness of strategies designed to reduce
the threat of illness-Perceived Barriers is the potential negative consequences that may result from
taking particular health actions, including physical, psychological, and financial demands. Cues to
Action is the events, either bodily (e.g., physical symptoms of a health condition) or environmental
(e.g., media publicity) that motivate people to take action. Cues to actions are an aspect of the HBM
that has not been systematically studied. Other Variables - Diverse demographic, socio-psychological,
and structural variables that affect an individual's perceptions and thus indirectly influence health-
related behavior. Self-Efficacy is the belief in being able to successfully execute the
behavior required to produce the desired outcomes. One of the first things one can do is
determine the respondent's preconceived notions about the role of health behavior change in illness
prevention. The simplest technique a person can use is to assess the patient's perceived barriers and
benefits to engaging in the behavior change. The health educator can engage in this process by
discussing with the patient his/her perception of the pros and cons for engaging in the behavior.
During a discussion of the barriers, the patient can begin addressing how to overcome some of the
obstacles to the performance of the behavior, thereby increasing self-efficacy for its performance. Cues
to action also influence whether a person will be motivated for lifestyle change.
Cues can include illness in other family members, information from the media, and concurrent
symptoms experienced by the individual. Health educators can elicit from the target group or person
the potential cues he/she is exposed to on a daily basis and then use these cues as reminders of the
potential consequences of failing to change unhealthy behavior practices.
This theory is most relevant to this current study on community participation on maternal health
projects, since many of the mothers have a negative notion regarding visiting various health cares
across the county due to perceived aspects. The community’s traditional healers and mid-wives
have got an influence in the people’s minds and their choices of what to do. HBM research has
been used to explore a variety of health behaviors in diverse populations. For instance, researchers
have applied the HBM to studies that attempt to explain and predict individual participation in
programs for influenza inoculations, high blood pressure screening, smoking cessation, seatbelt usage,
exercise, nutrition, and breast self-examination. With the advent of HIV/ AIDS, the model also has
been used to gain a better understanding of sexual risk behaviors. Perceived barriers are the most
influential variable for predicting and explaining health-related behaviors. Other
significant HBM dimensions are perceived benefits and perceived susceptibility, with perceived
severity identified as the least significant variable. More recently, though, researchers are
suggesting that an individual's perceived ability to successfully carry out a "health" strategy, such as
going for maternal health care, using a condom consistently, greatly influences his/her decision and
ability to enact and sustain a changed behavior.
General limitations of the HBM include: a) most HBM-based research to date has incorporated only
selected components of the HBM, thereby not testing the usefulness of the model as whole.
b) as a psychological model it does not take into consideration other factors, such as
environmental or economic factors, that may influence health behaviors; and c) the model does not
incorporate the influence of social norms and peer influences on people's decisions regarding their
health behaviors (a point to consider especially when working with adolescents on HIV/AIDS
issues, adolescent birth).
Stakeholder Theory
Stakeholder theory came from four major academic fields: economics, politics, sociology, and ethics
(Wagner Mainardes, Alves &Raposo, 2011). It was highly influenced by many concepts that were
raised in the planning department of the Lockheed Company. These ideas were developed from the
research done by Igor Ansoff and Robert Steward in this company (MacIntosh& Maclean, 2014).
Muchlinski (2011) viewed the stakeholder theory from different perspectives. There is the Normative
Stakeholder theory, which contains theories of how managers or stakeholders ought to act and view the
method of reasoning of organization on some moral guideline (Koschmann, 2008). The other point of
view is the unmistakable partner hypothesis that is worried with how administrators and partners act
and how they see their duties and activities. The aim here is to know how supervisors manage partners
and how they remain for their interests. The partnership is viewed as an accumulation of interests, at
some point aggressive and different times helpful. Instrumental stakeholder theory majors on the
hierarchical consequences of considering partners in administration by analyzing the relations between
the act of partner administration and the achievement of different corporate administration targets. It
concentrates on how administrators ought to do in the event that they need work for their own great. In
some writing their own particular intrigue is acknowledged as the interests of the association, which
is to get the most out of benefit or to boost shareholder esteem.
This demonstrates if supervisors treat partners in accordance with the partner idea the projects was
more fruitful over the long haul (Freeman, Harrison, Wicks, Parmar, and DeColle, 2010). Freeman
defines stakeholders as those groups who are fundamental to the survival of the organization (Bailur,
2006). There is concern for mapping the stakeholders, provision of comprehensive list of the specific
groups associated with each category of stakeholders, and an equivalent list of interests. How does
each stakeholder affect us? What are their interests? Who are our current and potential stakeholders?
How do we affect every stakeholder? How do we measure these variables and their impact and how do
we maintain score with our stakeholders?
Freeman, Harrison, Wicks, Parmar and De Colle, (2010) incorporates in this list of stakeholders
employees, stockholders, suppliers, and the organizations local community. This list, though similar
to list given by stakeholder theorists, is not uncontroversial. The stakeholder concept itself has its
critics. Those critics imply that the stakeholder approach is not capable of guiding essential
enhancements in corporate government in that numerous lines of accountability inferred by
acknowledging a multiplicity of stakeholders, minimizes efficiency and that the idea of stakeholders
as ethically important undermines the morally significant relations between community and
stakeholders.
25
Figure 2.1: Conceptual Framework
Conceptual Framework
The conceptual framework for this study was researcher based framework depicted in figure 1.1
below. In the framework the researcher intended to determine how effective level of awareness,
cultural factors, referral mechanisms and cost of health influences community participation in
community projects.
Independent Variables
Dependent Variable
Level of Awareness
Education level
Mobilization
Facilitation
Capacity Building
Motivation
Intervening Variables
Ministry of health policy on
community maternal health,
Poverty and
Level of community literacy
Cultural Factors
Religion – Kabonokia
attitudes and beliefs
Referral Mechanism
Governmental, NGOs and
international
organizations
Mobile outreach clinics or
peripheral health facilities
Community participation
Number of people
accessing maternal
health
Capacity building
Communities access to
their own situation
Minimize dependence
on the state
Improve maternal
health care
Reduces maternal
mortality rate
Cost of Health care
Patient costs
Transport Costs
Accommodation costs
Out of pocket spending
Moderating Variables
CU/ CEHW knowledge
of Maternal health care
and
Level of education of OP
on maternal health.
Figure2: Conceptual Framework
2.5 Summary of Literature Review
In this chapter the researcher introduced the research topic, defined it, discussed in details
the objectives using dependent, independent, moderating variable and intervening variables.
Researcher also put theoretical framework and conceptual framework which were explained.
The literature review above indicated a lot of misgivings and many issues about community
participation on maternal health project. It’s acknowledged that many studies have been
done on the issue of community participation pointing out why communities do not
participate fully in a given project yet an immediate attention need to be put in place to
understand this in view of the growth of maternal health problems day in and day out.
Clearly there is a glaring importance in finding a lasting solution to this gap once and for all
by researching on other areas like influence of community participation on health which is
the back born of this study.
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