Discussion
BLIND
This cluster-randomized trial revealed that health education provided to couples significantly improved male partners’ knowledge of and attitude towards MWHs in rural Ethiopia. The couples in the intervention group received health education on the importance of MWHs including paternal support whereas those in the control group received the usual standard care. The health education was provided to the couples at three contact points (first at group health education and then during the two home visits) by the health extension workers who were already working in the health system. The outcome measurements were taken before and after the intervention at 6 months interval.The male partners’ knowledge about MWH was significantly increased in the intervention group compared to those in the control group. The net effect of the intervention on improving male partners’ knowledge about MWH was 35.6%. Besides, male partners in the intervention group were nearly 6 times more likely to have good knowledge about MWH compared to those in control group. This implies that providing health education to couples can improve male partners’ awareness about the maternal health services including MWHs. In observational studies, male partners’ awareness was mentioned as one of the key factors positively associated with their involvement in maternal health services including antenatal care, health facility delivery, and MWHsFurthermore, male partners’ attitude towards MWH was significantly improved in the intervention group as compared to those in the control group. The net effect of the intervention on improving favorable attitudes toward MWH was 36.2% among the male partners. In addition, male partners in the intervention group were nearly 6 times more likely to have favorable attitude towards MWH compared to their counterparts. This indicates that giving health education to couples can improve male partners’ attitude towards maternal health services including MWHs. In literature, male partners attitude was mentioned to be associated with their involvement in maternal health services and women’s access to maternal health services such as antenatal care, health facility birth, postnatal care, and utilization of MWHsThis study had several strengths. The response rate was high with zero dropouts. The data collection tools were adopted from the validated national Ethiopian Demographic Health Survey documentsThis study had also some limitations. First, only outcome assessors were blinded (i.e., the allocation was concealed from the outcome assessors). We could not blind the study participants due to the nature of the study. This might have introduced the social desirability bias in the outcomes. Second, the outcomes were assessed through self-report. This might have introduced a recall bias into the study; though any threats to validity related to the precise estimation of the outcomes distributed equally over control and intervention groups since we randomized the clusters.