Predictors of male partners’ behavioral intentions and cognitive readiness toward maternal health service utilization in rural Tanzania: an application of the theory of planned behavior

Abstract

BACKGROUND: Men are not only heads and decision-makers in most families, but they also heavily influence the healthcare access of their female partners and/or children. However, low male spousal accompaniment at health facilities remains a persistent public health challenge in rural Tanzania. While structural barriers are well documented, there is a lack of evidence regarding the behavioral intention factors that drive this men's physical disengagement from clinical spaces. Understanding these internal drivers is critical for designing effective targeted interventions to improve maternal service utilization in rural settings. Applying the Theory of Planned Behavior (TPB), this study assessed the predictors of male partners' behavioral intentions and cognitive readiness toward spousal accompaniment in maternal health service utilization in rural Tanzania. METHODS: A baseline community-based assessment from a longitudinal interventional study was adopted to evaluate 546 randomly selected male partners from June to October 2017 was conducted using a quantitative research approach. A multi-stage sampling technique was employed to select participants. While male accompaniment broadly encompasses emotional and domestic support, this study specifically operationalized male spousal accompaniment as men's physical accompaniment of their expectant mothers to the health facility for clinical maternal health services. Data were analyzed using IBM SPSS version 25. Bivariate and multivariable logistic regression analyses were performed to identify independent predictors (α = 0.05). RESULTS: Participants' mean age was 31 ± 7.726 years, and 71.8% were married. Findings revealed that 61.7% of male partners had never physically accompanied their spouses to health facilities for maternal services. High rates of negative behavioral constructs were observed, with 59.0%, 57.0%, and 57.0% of male partners reporting negative attitudes, demonstrating negative perceived subjective norms, and negative perceived behavior control, respectively. Multivariable analysis showed that positive attitude (AOR = 3.616; p < 0.05; 95%CI: 1.333, 6.138), positive perceived subjective norms (AOR = 2.374; p < 0.05; 95%CI: 1.669, 5.984), and positive perceived behavioral control (AOR = 1.759; p < 0.05; 95%CI: 1.004, 4.373) were significantly associated with increased prospective intention to accompany partners to care. CONCLUSION: A significant proportion of male partners in rural Tanzania remain physically disengaged from clinical maternal spaces, driven primarily by negative cognitive constructs and traditional social norms that designate pregnancy care as an exclusively female domain. Policy and programmatic actions should prioritize community-based social and behavior change communications (SBCC) that challenge restrictive subjective norms, foster joint family decision-making, and reshape male attitudes toward spousal accompaniment.