Knowledge, Attitude, and Practice of Midwives Toward Intrapartum and Postpartum Management of COVID-19 Patients: A Cross-sectional Analysis

Abstract

Background: The COVID-19 pandemic significantly affected maternal healthcare delivery, with midwifery personnel serving on the front line. Understanding the knowledge, attitudes, and practices (KAP) of midwives is essential for optimizing healthcare preparedness and response strategies. However, KAP studies specifically assessing midwives’ preparedness for the intrapartum and postpartum care of mothers with COVID-19 in Iran remain scarce, particularly those examining associations with individual sociodemographic and professional characteristics. This gap limits the development of targeted educational interventions. Objectives: This study aimed to assess KAP levels among midwifery personnel regarding intrapartum and postpartum care for mothers diagnosed with COVID-19 and to identify sociodemographic and professional factors associated with these outcomes in hospitals affiliated with Ahvaz Jundishapur University of Medical Sciences, Iran. Methods: A descriptive-analytical cross-sectional study was conducted between March and June 2021 among 162 midwifery personnel from four COVID-19-designated hospitals in Ahvaz, Iran. Data were collected using a validated researcher-developed questionnaire comprising 21 knowledge items, 28 attitude items, and 40 practice items. Attitude and practice items were scored on a 0 - 4 Likert scale, and the reported scores were transformed to 0 - 28 and 0 - 40 scales, respectively, to facilitate interpretation. Multivariable linear regression and hierarchical cluster analysis were used to examine associations between KAP domains and participant characteristics. Results: Mean scores were 11.92 ± 3.83 (56.8%) for knowledge, 19.39 ± 3.98 (69.3%) for attitudes, and 33.34 ± 5.72 (83.4%) for practices. Hierarchical cluster analysis identified three KAP profiles: "high performers with moderate knowledge" (58.6%), "knowledgeable but hesitant" (22.8%), and "low overall engagement" (18.5%). Employment status (P = 0.007) and specialized COVID-19 maternal care training (P = 0.007) significantly predicted knowledge scores, whereas educational level strongly influenced both attitudes and practices (P < 0.001). In a model examining interrelationships among KAP domains, attitudes emerged as the strongest predictor of practices (β = 0.48, P < 0.001), and the model explained 23.2% of the variance in practice scores (R2 = 0.232, P < 0.001). However, the low R2 indicates that unmeasured factors likely play substantial roles in determining practice behaviors. Conclusions: Although midwifery personnel demonstrated good levels of practice, knowledge and attitudes remained suboptimal, particularly among project-based and less experienced staff. These findings underscore the critical need for targeted educational interventions focused on improving attitudes and strengthening practical skills to enhance maternal healthcare resilience during public health emergencies. The identification of distinct KAP profiles through cluster analysis represents a novel contribution, enabling differentiated interventions tailored to specific provider subgroups.