Introduction

Health information(HI) is the content that can be conveyed using health communication strategies to improve health outcomes through behavioral changes1,2. Having access to relevant health messages is advantageous for a global community’s health status as well as quality of life3. The World Health Organization indicated communication as one aspect of effective care for mothers and newborns, which should be successful and fulfill mothers’ needs4,5. Practices of effective communication are the main principle that supports mothers during maternity periods, which can add value to their positive health outcomes6,7. The Ethiopian health policy underscored health education as one of the methods for changing people’s attitudes, actions, and health status8.

The life of the first 1000 days (the baby’s life from conception to the child’s two-year birthday) is a once-in-a-lifetime opportunity to develop a lifelong healthy status. A child’s problems during this period can cause short-term as well as long-term physical, mental, and social dysfunctions9. Factors that influence a child’s life, like the mother’s health, breastfeeding behavior, the child’s additional feed, and social and economic issues, can be prevented through maternal education10. According to past studies, more informed people are more likely to cope with illness, make informed treatment decisions, manage chronic diseases, and maintain their and their loved ones’ health11.

The international community has acknowledged the seriousness of mother and child health issues and has pledged to reduce maternal fatalities by planning good health (SDG 3) in the Sustainable Development Agenda12. Although there have been considerable improvements, there are still significant maternal and under-five health problems, particularly in developing countries13. Recent data in Ethiopia shows a 401/100,000/live birth ratio of maternal mortality, 35/1000/live births infant mortality, and 37% of under-five-year-old children were stunted14. In addition, various investigations found undesirable practices such as food prohibitions, discarding colostrum, applying substances to the cord stump, delayed breastfeeding, pre-lacteal eating, and early bathing during the maternity period15.

Over 80% of community homes around the world, notably in Sub-Saharan Africa, have insufficient access to reliable and efficient maternity related health information16. Women in developing countries hardly access adequate, accurate information that meets their needs17,18. Although there is no clear data in Ethiopia on mothers’ health information access from different sources, the 2016 mini-Demographic Ethiopian health survey showed that a high proportion (three-fourths) of women had no access to one of three mass media (TV, radio, and newspaper) at least once per week, and only 4% of reproductive-age women had used the Internet in 201619.

Previous studies conducted on mothers’ knowledge, attitudes, and practices underscored lack of knowledge as major predictors of maternal health problems20,21,22,23. The study performed in Butajira indicates monetary and social empowerment of girls will increase their gaining access to the media24. According to Jonson et al., demographic variables like gender, occupation, and education, and an individual’s previous exposure to health problems shape the individual’s health information utility25. Although previous studies pointed out knowledge gaps as major predictors of maternal and child health problems, there are few studies that addressed the extent of health information utility and associated factors in Ethiopia. Knowing the level of health information access and its associated factors is important to guide the work of maternal health educators and practitioners. Therefore, this study aims to assess unmet health information needs and associated factors among lactating mothers in the Gedeo zone.

Methods

Study setting and period

The survey was done in the Gedeo zone, southern Ethiopia, from November to December 2023. It was carried out in randomly selected districts and kebeles (the smallest administrative unit in Ethiopia). The capital of the Gedeo zone, Dilla, is located 377 km south of Addis Ababa. A total of 1,247,812 people live in the research area, which is divided into eight districts (Bule, Gedeb, Wonago, Rappe, Chorso, Kochore, Dilla Zuriya, and Yirgachefe) and four town administrations (Dilla, Gedeb, Chelelektu, and Yirgachefe). There are also accessible national and regional mass media (radio and television) that use different languages. In addition, there is also access to Dilla University community radio programs.

Study design

A community-based cross-sectional survey was conducted aiming to assess the proportion of unmet health information needs among lactating mothers in the Gedeo zone. All methods were carried out in accordance with relevant guidelines and regulations. In this research, the investigators are interested in assessing maternity-related health information access and factors affecting it.

Population

All lactating mothers who had a child less than 2 years of age in Gedeo zone were a source population. The study population was lactating mothers who lived in selected districts and kebeles of Gedeo zone for 6 months. The number of lactating mothers from selected kebeles was used as a sampling frame. A randomly selected mother from a list of lactating mothers who have children less than 2 years old was included in the study. However, mothers who were unable to hear and speak were excluded from the study.

Sample size

The required sample size was computed by using a single population proportion formula based on the following assumptions: a 95% confidence interval, a 5% margin of error, and 28.60% of health information gaps among lactating mothers from the study done in Tanzania26.

$${\text{n }}=\frac{{({{\text{Z}}^{\text{2}}}{\text{P }}\left( {{\text{1}} - {\text{P}}} \right)}}{{{{\text{d}}^{\text{2}}}}}=\frac{{{{\left( {{\text{1}}.{\text{96}}} \right)}^{\text{2}}}\left( {0.{\text{286}}} \right)\left( {{\text{ }}0.{\text{714}}} \right)}}{{{{\left( {0.0{\text{5}}} \right)}^{\text{2}}}}}=314$$

The representative sample with a 2 design effect was 628, and considering a 10% non-response rate, the final sample size was 628/1-0.1 = 698.

Sampling technique

The sampling technique was conducted as follows: From the total (8 districts and 4 town administrations), 2 districts (Bule and Gedeb) and 1 town administration (Yirgachefe) were selected from the total districts. After districts were known, 8 kebeles (20% of their respective kebeles) were chosen using simple random selection, and the overall sample size for each kebele was proportionally scattered. Then, using a simple random sampling technique, the study units were picked by computer-generated random numbers (Supplementary file 1).

Variables of the study

Dependent variable

Unmet health information need.

Independent variables

  • Socio-demographic variables: age, marital status, educational status, place of residence, occupation, and family income.

  • Distance from nearest health facility.

  • Level of health service utilization.

  • History of maternity related health problems.

  • Health information characteristics (availability of health information sources, accessibility of health information).

Data collection tools and measurements

The study is guided by a comprehensive health information seeking model, and the data collection tool is adapted from previous similar studies27,28,29,30,31. The content validity of the questionnaire was assessed by seven experts from the reproductive health and health education field areas. Feedback was given in relation to the relevancy and clarity of items. The consistency between items of ‘mothers’ unmet health information needs’ was assessed using Cronbach’s alpha test, which was 0.75.

The questionnaire contains four parts: Socio-demographic information of respondents was assessed using 8 questions. Reproductive characteristics of mothers were assessed using 6 items. History of maternity-related health problems was assessed using 4 yes/no questions. A characteristic of health information was assessed using 6 items, and health information access was assessed using 4 yes/no questions.

The dependent variable was assessed as follows: Mothers’ unmet health information needs were assessed based on the utility of available health information. The respondents’ responses were measured using 6 items that used a 5-point Likert scale extending from1 (strongly agree) to5 (strongly disagree). The mean of the total score was computed to categorize for binary logistic regression analysis.

Operational definitions

Unmet needs of maternity-related health information: the mother’s unsatisfied need for adequate, understandable, and timely maternity-related health information32. It is categorized as “unmet health information needs” if the respondents scored less than the mean for total maternity-related health information needs questions, whereas it is “met health information needs” if the respondents scored above the mean for the questions33,34.

Data collection procedures and quality management

The data was gathered in a structured Gede’uffa and Amharic version of questionnaires administered by an interviewer. Before being utilized in the main data collection, it was pretested on 35 (5% of sample size) of mothers. Data was collected through face-to-face interviews using the EPIcollect5 platform. Before the actual data collection, data collectors and supervisors received enough training on the study’s goal, data collection tool, and processes used to complete the questionnaires. Eight data collectors and three supervisors were hired, all of whom are health professionals with prior data collection experience. Following sufficient training on the pre-tested questionnaires, the data was collected under the close supervision of investigators, with supervisors monitoring the process. On a daily basis, the investigator and supervisors checked the completion of the questionnaire and the overall quality of data collection. Before leaving the area, each kebele’s data was rechecked after the data collection was completed.

Data analysis procedures

The data was collected by EPIcollect5 and exported to the STATA 17 software suite. Descriptive statistics, such as frequency and percentages, were computed. The binary logistic regression was done to discover if there was an individual association between independent variables and unmet health information need. The model fitness was assessed by the Hosmer-Lemeshow test, and the value was 0.79. Before running multivariable logistic regression, the normality distribution of data was tested by the Shapiro-wilk test, and the results were non-significant (p-value > 0.05), which indicates normally distributed data.

The variance inflation factor (VIF) was used to check the absence of multicollinearity, which resulted in the VIF value for all variables being less than two, which indicates the absence of multicollinearity. To find features that significantly predict dependent variables, all components that were significant in bi-variable logistic regression analysis at a P-value less than 0.25 were combined into the multivariable logistic regression model. To establish the degree of association between the independent and dependent variables, an odds ratio with a 95% confidence interval and a P-value of less than 0.05 was considered as statistically significant.

Results

Respondents socio-demographic characteristics

A total of 687 respondents, with a response rate of 98.42%, participated. The mean age of the mothers was 28.4 years, with a standard deviation of 5.5 years. The majority (59.50%) of mothers’ occupation is housewives, and about 43.38% of mothers have a monthly income between 1001 and 3000 ETB (Table 1).

Table 1 Socio-demographic characteristics of respondents in Gedeo zone, Southern ethiopia.
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Previous experiences and health services utilization in Gedeo zone, Southern Ethiopia

About 89.22% of respondents have perceived their health status as ‘healthy,’ and 296 (43.10%) have a previous history of maternity-related health problems. More than half (51.90%) of respondents have good health services utilization, like ANC follow-up, health facility delivery, postnatal care, and child vaccination services (Fig. 1).

Fig. 1
figure 1

Respondents’ history of maternity-related health problems and health services utilization.

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Access to health information sources in Gedeo zone, Southern Ethiopia

Of the total, about 77.58% of respondents received health information (HI) related to infant/child care and health-related problems. The major health information sources were health professionals & health extension workers, while the least was the internet, followed by the Health Development Army (HDA) (Fig. 2).

Fig. 2
figure 2

Respondents health information sources in Gedeo zone southern Ethiopia.

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Adequacy, understandability, and usefulness of obtained health information

Of the total, 282 (41.05%) respondents have unmet health information needs based on the adequacy, understandability, and usefulness of received health information (Fig. 3). About two-fifths of the study participants disagree with the easy understandability of available maternity-related health information (Supplementary file 2).

Fig. 3
figure 3

Health information utility among lactating mothers in Gedeo zone, Southern Ethiopia (N = 687).

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Factors associated with unmet health information needs among lactating mothers

In bi-variable analysis, 8 variables (age of mother, educational status, monthly income, place of residence, distance from the nearest health facility, having communication media, level of health service utilization, and history of maternity-related health problems) were taken to multivariable logistic regression analysis based on their P-value < 0.25.

In multivariable logistic regression analysis, 5 variables (age of mother, educational status, distance from the nearest health facility, having communication media, and level of health service utilization) were significantly associated with unmet health information needs. In this analysis, the odds of having no formal education are 4.30 times more likely to have an unmet need for health information than those who have college and above educational status (AOR = 4.30, 95% CI = 1.90–9.74). The results of the multivariable model also show mothers who have poor health service utilization were 1.54 times more likely to have an unmet need for health information than those who have good health service utilization (AOR = 1.54, 95% CI = 1.02–2.33) (Table 2).

Table 2 Bi-variable and multi-variable logistic regression analysis of factors associated with unmet health information needs among lactating mothers in Gedeo zone, Southern Ethiopia (N = 687).
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Discussion

This study assessed unmet health information needs among lactating mothers in dimensions of the adequacy, understandability, and usefulness of information according to the comprehensive health information seeking model. The findings of this study showed that about 41% of mothers have an unmet need for health information on maternal and child issues. This is comparable with the study done in Monroe County, Indiana, which shows about 44% of participants reported at least one postpartum health information gap35. This study finds that about two-fifths of the study participants disagree with the easy understandability of available maternity-related health information. The reason behind the poor understandability of available health information is factors like the use of technical/medical words by health professionals, language differences between health information senders and receivers, the health information provider’s quality of communications, etc36.

This study found out more than two-fifths of respondents did not agree with the adequacy of obtained health information regarding child care. The causes of inadequacy of obtained health information could be due to incomplete content of the health messages and lack of consistency of delivering health information from various sources. This study’s finding on the adequacy of health information is higher than the finding from the study done in Melbourne, Australia, which shows one-third of pregnant women indicated that they felt they received inadequate information37. The difference could be due to a difference in study population and variation in socioeconomic status. The study also revealed that one-third of respondents did not agree with the usefulness of the obtained health information. This may be attributed to the failure of obtained health information to answer the mothers’ questions, the inappropriateness of the time to deliver health information, and the like.

The finding of this study shows that more than three-fourths of respondents have gotten health information related to infant/child care and health-related problems. The major health information sources were health professionals & health extension workers, and the least common health information source was the internet through a smartphone. The finding is comparable with the study done in Jimma Zone, which shows participants primarily favored face-to-face/interpersonal communication channels, followed by mass media and traditional approaches like community conversation, traditional songs, and role play38. Regarding receiving health information from mass media, this study’s findings are comparable with the study done in eastern Ethiopia, which shows one in every four rural communities had access to health messages through mass media39. The finding from Makete District, Tanzania, shows nurses were ranked high as sources of nutrition information that was used by nearly three-fourths of the study respondents, following about 30% of the respondents also indicating they consult their friends for various nutrition-related information40.

Regarding factors that affect unmet health information needs, variables like age, educational status, level of health service utilization, availability of communication media, and distance from health facilities were significantly associated factors. The finding from the current study shows respondents who don’t have at least one communication media were nearly three times more likely to have unmet health information needs than their counterparts. This is supported by the study from Jimma Zone, which indicates that perceived easiness, perceived acceptability, and perceived feasibility were significantly associated with the intention to use mobile phone-based messages of maternal and child health41. The study’s finding also shows respondents who go more than one hour’s distance from the health facility were double times more likely to have unmet health information needs than those who go less than 15 min. This is slightly consistent with the finding from Makate district, Tanzania, which shows the nature of the health facility around which the respondents reside may contribute to the women’s access to the needed nutrition information40.

Strengths and limitations of the study

Regarding the strengths of this study, it covered a wide study area and adequate sample size. Whereas, the study used a quantitative study design, which limited our capacity to explore the subjective experience of mothers obtaining health information. The inclusion of qualitative research in this research may provide a complete understanding about lactating mothers’ health information utility and its impacts on health outcomes. Furthermore, recall bias in the study variables might occur because a self-reporting questionnaire was used in the study.

Conclusion and recommendations

The study finding shows that about two-fifths of mothers have unmet needs for health information on maternal and child issues. The desire for respondents’ health information during the lactation period was affected by factors like age, educational status, level of health service utilization, availability of communication media, and distance from the health facility. Therefore, the study suggests that health extension workers, health professionals, and concerned stakeholders should strengthen the delivery of health messages to satisfy mothers’ health information needs. Health sectors and concerned stakeholders should also work to strengthen health service utilization, which indirectly gives opportunity for health information access.