Abstract
Late initiation of antenatal care (ANC) remains a major obstetric care challenge in rural Zimbabwe, contributing to preventable maternal and neonatal complications. Although national ANC coverage is high, district records from Mangwe (2023-2024) indicate that over 90% of pregnant women initiate ANC after 20 weeks of gestation, well beyond the World Health Organization recommendation of booking within the first trimester. This study explored the lived experiences and perceptions of women who booked ANC late in Mangwe District. A descriptive phenomenological qualitative study was conducted. A target sample of 15 to 25 participants was estimated a priori; thematic saturation was achieved after in-depth interviews with 20 pregnant women who initiated ANC after 20 weeks of gestation. Five key informants (3 midwives and 2 nurses) were also interviewed to provide health system perspectives. Data were collected in May 2025 and analyzed using inductive thematic analysis. Women described delayed booking as a constrained response to poverty, distance, stigma, and health system frustrations rather than personal neglect. Many prioritized food and household survival over transport costs, concealed pregnancies to avoid community judgment, or perceived ANC as necessary only when unwell. Fear of reprimand and long waiting times further discouraged early attendance. Providers confirmed that late booking contributes to missed early diagnosis of HIV and hypertension, undetected fetal complications, and preventable stillbirths. Late ANC booking in Mangwe reflects structural vulnerability rather than maternal negligence. Interventions should strengthen respectful maternity care, community education, and physical access to promote timely ANC initiation.
Keywords
Introduction
Antenatal care (ANC) is a cornerstone of maternal health, pivotal for reducing maternal and neonatal morbidity and mortality through early detection and management of potential complications. 1 Globally, 82.6% of pregnant women attend antenatal care booking visit during the second and third trimester of pregnancy. 2 This late antenatal care booking attendance lead to ~515 000 deaths every year as a result of complications related to pregnancy and childbirth.2,3 The World Health Organization (WHO) recommends initiating ANC within the first trimester (before 12 weeks) to maximize these benefits. 4 However, in many low-resource settings, this guideline remains elusive, with a significant proportion of women presenting for their first ANC visit late in their pregnancy. 5 In this study, late ANC booking is operationally defined as the first ANC visit occurring after 20 weeks of gestation. While the World Health Organization recommends ANC initiation within the first trimester (before 12 weeks), the 20-week threshold is used in local health reporting systems to denote markedly delayed initiation and is therefore applied for programmatic and analytical consistency.
In Zimbabwe, despite high overall ANC coverage, the timeliness of initiation is a persistent concern. Studies indicate that many women, particularly in rural areas, book their first ANC visit after 14 weeks, with a national decline in early access recorded over recent years. 6 This trend is pronounced in Mangwe District, a rural and underdeveloped region where systemic, economic, and cultural barriers converge. 7 Recent district data (2023-2024) from clinics in Mangwe show consistently high rates of late bookings, with some facilities reporting over 90% of pregnant women initiating care after 20 weeks. 8
While previous research, including mixed-methods studies in the same district, has quantified the problem and identified associated factors such as low education, unemployment, and long distances, a critical gap remains. 7 The lived experiences, the deeply felt personal realities, and the decision-making processes of women who book late are not fully captured by quantitative data alone. Understanding these nuanced perspectives is essential for designing interventions that are not only effective but also empathetic and responsive to the actual needs of the population.
Therefore, this study aimed to explore the lived experiences and perceptions of pregnant women in Mangwe District who initiated antenatal care after 20 weeks of gestation. To strengthen interpretation and triangulation, the perspectives of key informants (healthcare providers) were also incorporated to reflect the health system context. Rather than merely documenting prevalence, this study seeks to generate an in-depth, contextual understanding of the social, cultural, and structural barriers shaping delayed care-seeking. Ultimately, the findings aim to inform more responsive and woman-centered obstetric care strategies to improve maternal health outcomes in rural Zimbabwe.
Methods
Study Area
The study was conducted in Mangwe District, located in the Matabeleland South Province of Zimbabwe. The district is predominantly rural, characterized by limited infrastructure, high poverty levels, and significant out-migration. 9 It has a total of 13 health facilities (3 hospitals and 10 clinics) serving a population of 65 562 people (Zimbabwe Census, 2022). This study was conducted in 5 purposefully selected clinics (Tshitshi, Murula, Madabe, Dingumuzi, and Izimnyama) due to their high recorded rates of late ANC bookings. These are rural, primary care, non-specialist facilities. The geographic dispersion of these facilities and the poor road network pose significant access challenges for residents. Mangwe District reports some of the highest rates of late ANC bookings in the province, making it a critical setting for this inquiry. A map of the study area is shown in Figure 1.

Study area map (Mangwe District).
Study Design
This study employed a qualitative phenomenological design. Phenomenology is concerned with understanding a phenomenon from the perspectives of those who have experienced it, aiming to uncover the underlying meanings and essence of their lived experiences. 10 To enrich the data and provide a systems-level perspective, the study also included a key informant component with healthcare providers. The study period spanned from August 2024 to August 2025, with the initial months dedicated to protocol development, tool refinement, and ethical approvals. Formal data collection commenced in May 2025 after ethical clearance was obtained. This approach was chosen to delve deeply into the personal and social realities of women who book ANC late, exploring the “why” and “how” behind the statistical trends.
Target Population and Sampling
The study targeted pregnant women who had initiated their first ANC visit after 20 weeks of gestation and were receiving care at 1 of the 5 selected clinics in Mangwe District. The 20-week cutoff does not originate from World Health Organization guidance, which recommends ANC initiation before 12 weeks of gestation. Instead, this threshold is used operationally by local and national health authorities in Zimbabwe for routine reporting to identify pregnancies at heightened risk due to delayed care initiation. This distinction is explicitly acknowledged in the interpretation of findings. Purposive sampling was used to identify and recruit information-rich participants. The inclusion criteria were: (1) being pregnant and having booked the first ANC visit for the current pregnancy after 20 weeks, (2) aged 18 years or older, (3) receiving services at one of the selected clinics, and (4) willingness to provide informed consent. We initially estimated that a sample of 15 to 25 participants would be needed to reach saturation, based on similar phenomenological studies. A final sample of 20 participants was determined sufficient upon reaching thematic saturation, where subsequent interviews yielded no new substantive themes. Recruitment continued until this point was achieved.
In addition, 5 key informants (3 midwives and 2 nurses) were purposively selected from the participating clinics. These healthcare professionals were chosen for their direct involvement in providing antenatal care and their familiarity with the challenges associated with late bookings. Recruitment of key informants continued until data saturation was achieved, where no new themes emerged from the interviews.
Data Collection Procedure and Tools
Data were collected through in-depth, semi-structured interviews using 2 separate guides: one for pregnant women and another for key informants. The interview guide for pregnant women included with open-ended questions exploring several domains: (1) pregnancy discovery and initial feelings, (2) decision-making process regarding when to seek ANC, (3) barriers and facilitators encountered, (4) interactions with family and community, (5) perceptions of and experiences with healthcare services, and (6) suggestions for improvement. The key informant guide focused on providers’ observations of reasons for late booking, perceived barriers (including community and spouse influences), and complications they have witnessed as a result of delayed ANC initiation (see Supplementary File 1).
Both guides were developed by the research team in accordance with the study objectives and the existing literature; they were not derived from previously validated instruments. To ensure clarity, cultural appropriateness, and relevance, the guides were pilot tested with 2 pregnant women (who were not part of the main study) and 1 midwife, after which minor adjustments were made to wording and probing questions. The final English versions were translated into isiNdebele and Shona by a bilingual research assistant and back translated to verify accuracy.
Interviews were conducted in a private room at the respective clinics by the principal investigator, lasting between 30 and 50 minutes for pregnant women and 8 and 9 minutes for key informants. They were conducted in the participants’ preferred language (isiNdebele or Shona). All interviews were audio-recorded with participant consent. In 2 instances where participants declined recording, detailed handwritten notes were taken and expanded immediately post-interview.
In addition to women’s individual narratives, a systems-level perspective was incorporated through key informant interviews with maternal health providers. Although spouses and community members were not interviewed directly, women’s accounts of partner influence, household decision-making, community norms, and health system interactions were actively probed during interviews to capture the broader socio-cultural and structural context shaping late ANC initiation.
Ethical Considerations
Ethical approval for the study was obtained from the National University of Science and Technology Institutional Review Board (Ref: NUST/IRB/2025/55). Written informed consent was obtained from all participants prior to data collection. Privacy was ensured by conducting interviews in private rooms at health facilities, and confidentiality was maintained by anonymizing transcripts and removing identifying information. Participation was voluntary, and participants were informed of their right to withdraw at any stage without consequences. Audio recordings and transcripts were securely stored and accessible only to the research team.
Data Management and Analysis
Audio recordings were transcribed verbatim, and transcripts in local languages were translated into English by a bilingual research assistant. A random selection of 20% of the transcripts was back translated to verify accuracy. Data analysis followed Braun and Clarke’s framework for thematic analysis and was facilitated by NVivo 12 software. 11 The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. 12 A completed checklist has been provided as a Supplementary File. The analysis process was iterative. First, the researchers immersed themselves in the data by repeatedly reading the transcripts. Initial codes were generated inductively from the data itself. These codes were then collated into potential themes, which were reviewed and refined to ensure they accurately reflected the dataset. The analysis integrated data from both pregnant women and key informants, with the latter used to triangulate and contextualize the themes emerging from the women’s narratives. The final thematic structure comprised 4 main themes and 8 subthemes. To ensure rigor, the research team held regular meetings to discuss and reach a consensus on the emerging themes. To enhance credibility, member checking was conducted by returning to selected participants to verify the accuracy and interpretation of their individual interview transcripts, rather than sharing aggregated findings. Participants confirmed that the recorded accounts reflected their intended meanings.
Results
Twenty pregnant women who had booked ANC late participated in the study. Their ages ranged from 18 to 37 years (median age: 26 years), with most having secondary education and being unemployed. Key demographic characteristics are summarized in Table 1. Five key informants (3 midwives and 2 nurses) with 1 to 6 years of experience also participated (Table 2).
Participant Demographic Characteristics (n = 20).
Key Informants Demographic Characteristics.
KI = key informant.
Themes That Emerged
The analysis of in-depth interviews with pregnant women and key informants revealed a complex interplay of factors leading to late antenatal care (ANC) bookings. The journey to a first clinic visit after 20 weeks was not a single decision but a process shaped by a daunting convergence of external barriers, internal fears, and systemic failures. The final analysis produced 4 main themes with associated sub-themes, as summarized in Table 3.
Emergent Themes and Sub-Themes.
Navigating Structural Hardships
The most immediate and tangible barriers described by women were the intertwined challenges of poverty and geographic isolation. The physical and financial journey to the clinic was often described as an insurmountable hurdle.
The Tyranny of Distance and Cost
Women consistently highlighted the exhausting reality of traveling long distances to reach a health facility, often on foot. This physical burden was a primary reason for postponing visits.
The clinic is very far. I have to wake up at 4 am to walk and hope to arrive before they close. Sometimes I feel too tired, or my body aches, and I decide to postpone the visit. I know it’s important, but the journey is too much. (Participant 04) The money for transport is a problem. I am not working, and my husband is a casual labourer. Sometimes we have the money for the clinic, but then there is no food at home. What do I choose? Food for my family or a clinic visit when I am still feeling strong?. (Participant 11)
Financial Preoccupation
Beyond the direct cost of travel, a pervasive preoccupation with financial survival pushed ANC down the list of immediate concerns. Women framed their delay as a necessary prioritization in a context of extreme scarcity, where the future costs of a new child overshadowed the preventive healthcare of pregnancy.
You think about the baby, yes, but you also think about how you will feed it when it comes. You need to save every dollar. Going to the clinic early means multiple trips, and that is a lot of money we do not have. (Participant 17) My husband said, ‘We have no money for the clinic today. Next month when I get paid.’ Then next month came and the same story. I just waited until I could use money from the small garden vegetables.– (Participant 08) Even the $2 for the registration card is too much sometimes. You feel ashamed to go and say you don’t have it, so you stay away until you’ve saved enough. (Participant 14)
Key informants confirmed that poverty and transport challenges frequently prevent women from accessing ANC early, particularly in remote clinic catchment areas.
Some women walk more than 10 km to reach the clinic. Without transport money, they delay until the pregnancy is advanced. (KI_4)
The Shadow of Stigma and Fear
Beyond the physical barriers, powerful social and emotional forces created a climate of fear and shame, making the clinic an intimidating and unwelcoming space.
Fear of Judgment
A recurrent and powerful sub-theme was the palpable fear of being shamed, scolded, or discriminated against by nurses and other clinic staff. This fear was particularly acute for younger women, unmarried women, and those with unplanned or multiple pregnancies.
The way the nurses look at you. . . they can count on their fingers how many months you are and then ask you why you are only coming now. Their faces are not welcoming. I waited until I was big because I was afraid of that scolding. (Participant 07) This is my third child. I know they will ask me why I am having another one, as if it is their business. It is easier to stay away until you cannot hide it anymore. (Participant 15)
Concealing the Pregnancy
For some, delaying the clinic visit was a strategic decision to keep the pregnancy a secret from the wider community for as long as possible. This was often tied to the stigma of premarital pregnancy or difficult personal circumstances.
I was not yet married to the father. I was afraid of what people would say. If I go to the clinic early, everyone in the village will know. If I wait, I can hide it for some time. (Participant 02) My family is very religious. Having a baby before marriage is a big shame. I only told my mother when I was six months, and she said we should keep it quiet. So I couldn’t go to the clinic – someone might see me there and spread rumours.– (Participant 19) I have a friend who was shouted at by the nurse in front of other patients because she was young. I did not want that for myself. (Participant 01)
Providers acknowledged that fear of reprimand contributes to delayed attendance.
Some women avoid early booking because they are afraid of being shouted at, especially if they are young or unmarried. (KI_5)
Negotiating Knowledge and Misconceptions
The decision of when to seek care was profoundly influenced by women’s understanding of the purpose of ANC, which was often shaped by personal experience, community advice, and cultural norms rather than formal health education.
Perception of ANC as Curative
A common and powerful misconception was the perception of ANC as a service exclusively for women who were experiencing problems or feeling unwell. The preventive, health-promoting aspect of early care was not well understood or valued.
I didn’t see the reason to go. I wasn’t sick. No nausea, no pain. I thought the clinic was for when you have problems. My mother and grandmother never went to clinic, and they were fine. (Participant 09) I thought I should only go when I feel the baby moving, to confirm everything is okay. Nobody ever told me I need to go before that. (Participant 13)
Conflicting Advice From Social Networks
Women often navigated a sea of conflicting information, where advice from trusted family members and friends sometimes directly contradicted official health messaging, leading to confusion and delay.
My aunt told me that if I go too early, they will do scans that can harm the baby. She said it’s better to wait until the baby is stronger. (Participant 05) In our culture, some believe that announcing a pregnancy early can invite bad spirits. So, you keep it quiet, even from the nurse, until it is obvious. (Participant 18)
Health workers noted that misconceptions about the purpose of ANC remain common and often delay early booking.
Many women think ANC is only for problems. If they feel well, they don’t see the need to come early. (KI_2)
Systemic Disillusionment
Negative perceptions and past experiences with the healthcare system itself created a deep sense of disillusionment that actively deterred timely attendance. The quality of the interaction with the health system became a barrier in itself.
Frustration With Clinic Efficiency
The experience at the clinic was frequently described as arduous, inefficient, and disrespectful of women’s time. Long waiting times for brief consultations made the opportunity cost of a clinic visit a full day’s lost labor or domestic duties exceptionally high.
You spend the whole day at the clinic for just a few minutes with the nurse. You sit on hard benches for hours. If you are lucky, you will be attended to. Sometimes they say they have run out of cards or medicines and tell you to come back next week. It is discouraging. (Participant 10) You wake up early, you walk, you wait, and sometimes they don’t even apologise when they send you away. It makes you feel like you are not important. (Participant 03)
Perceived Poor Quality of Care
Some women expressed a lack of trust in the services provided, rooted in past experiences of perceived rudeness, hurries, or a lack of communication from healthcare workers. This eroded the motivation to seek care proactively.
The last time I was pregnant, the nurse was very rude. She did not explain anything. She just shouted instructions. I thought, why should I go through that again if I am not sick?.– (Participant 06) They are always in a hurry. You don’t get to ask questions. You leave feeling more confused than when you came. (Participant 20)
Health System Perspective: Complications Associated With Late Bookings
The key informant interviews provided a critical health system perspective, corroborating the barriers identified by women and detailing the severe clinical consequences of late ANC initiation. Four key themes emerged from the key informant data:
Delayed Diagnosis of HIV and STIs Leading to Mother-to-Child Transmission
Late ANC attendance often means women miss essential tests such as HIV and STI screening during early pregnancy noted one of the key informants. As a result, some unknowingly live with infections that can be passed to the unborn child, especially when not placed on timely treatment.
Some will not have tested for HIV and STIs, ending up transmitting to children. (KI_2) The most common complication is that some woman will be HIV positive. This puts infants at a higher risk of perinatal infections, which could otherwise be prevented through early interventions like PMTCT (Prevention of Mother-To-Child Transmission). (KI_4)
Hypertension and Eclampsia Leading to Stillbirths and Maternal Death
Key informants reported that hypertension is common among women who book late for ANC, often going undetected until it causes severe complications. Conditions such as eclampsia were also frequently mentioned, contributing to stillbirths and maternal mortality.
Some have their blood pressure shooting up leading to giving birth to stillborns or some mothers losing their lives. (KI_4) Some come back with swollen legs; their blood pressure is very high. (KI_5)
High Incidence of Stillbirths Linked to Late Booking and Home Births
Delayed ANC leads some women to deliver at home without skilled birth attendants, increasing the risk of complications. Some arrive at health facilities only after complications arise, including stillbirths noted one of the key informants.
There are high numbers of stillborn babies as some do house births and come with complications. (KI_3)
However, one of the key informants emphasized that many of these stillbirths are preventable if women are monitored earlier and more regularly during pregnancy.
Mothers should do clinic visits about 8 times before giving birth and do scans so that complications be dictated earlier and take action. (KI_5)
Undetected Breech Presentations and Complicated Deliveries
Some women only arrive at clinics during labor, and complications such as breech presentations are discovered too late for safe intervention. These emergencies often require urgent referrals, but ambulance shortages worsen outcomes.
Some come for delivery only to discover their babies are bridging . . . they will have to be transferred to the main hospital hence the shortages of ambulances. (KI_1) We had a woman who arrived in labour, and the baby was in a transverse lie. She had never been to the clinic before. We tried to refer her, but the ambulance took three hours. By then it was too late – we lost the baby. (KI_4)
Discussion
This phenomenological study provides an in-depth understanding of late ANC booking in Mangwe District by foregrounding women’s lived experiences within their social and structural realities. Rather than reflecting negligence, delayed booking emerged as a rational response to poverty, stigma, misinformation, and health system constraints. The integration of key informant perspectives strengthened these findings by demonstrating how individual delays translate into preventable clinical complications.
The findings further demonstrate that late ANC initiation cannot be understood solely as an individual decision but rather as a product of intersecting system-level, household, and community influences. Women described how spousal authority over financial resources, household responsibilities, community norms surrounding pregnancy disclosure, and perceived quality of care within health facilities collectively shaped their care-seeking trajectories. These findings underscore the importance of engaging male partners, communities, and health systems in interventions aimed at improving timely ANC initiation.
The theme of Navigating Structural Hardships underscores the profound impact of poverty and geographic isolation. The findings align with the concept of “availability versus accessibility,” where even available services remain inaccessible due to economic and logistical constraints. 13 The choice between spending limited resources on transport for ANC or on family food highlights the cruel trade-offs that women in poverty must make, a reality well-documented in other low-resource settings. 13
The Shadow of Stigma and Fear reveals the critical role of the healthcare environment as either a facilitator or a barrier. The fear of judgment from healthcare providers is a powerful deterrent, corroborating studies that identify disrespectful and abusive treatment as a key reason women avoid formal health services. 14 This is particularly salient for adolescent and unmarried mothers, who face a double burden of societal stigma. Creating youth-friendly and non-judgmental services is not just a luxury but a necessity for improving early uptake.
The theme of Negotiating Knowledge and Misconceptions points to a significant gap in health education and the enduring influence of cultural norms. The perception of ANC as a curative rather than preventive service has been noted elsewhere. 15 This suggests that current health messaging may be failing to reach women effectively or to counter deeply held traditional beliefs. Community-based, peer-led education that respectfully engages with traditional knowledge is crucial.
Finally, Systemic Disillusionment highlights how the very design and delivery of health services can discourage use. Long waiting times, perceived rudeness of staff, and stock-outs of essential supplies erode trust and make the cost of seeking care (in time and dignity) too high. This echoes findings from across sub-Saharan Africa, where poor quality of care is a major driver of low health service utilization.16,17
Critically, the key informant data on complications provides a powerful rationale for addressing these barriers, as a matter of urgency. The delayed diagnosis of HIV/STIs, the high incidence of preventable stillbirths linked to hypertension and eclampsia, and the emergency complications from undetected breech presentations are direct consequences of the delays documented in this study. These findings align with regional literature, such as Ngwenya, 18 who identified severe preeclampsia and eclampsia as leading causes of maternal mortality in Zimbabwe, often exacerbated by late care-seeking.
Strengths and Limitations
This study has several strengths and limitations. Its strengths include the use of a rigorous phenomenological design, data triangulation with key informants, and adherence to the COREQ checklist. The sample, while sufficient for thematic saturation, was drawn from only 5 clinics in 1 district, which may limit the transferability of findings to other contexts. The reliance on self-reported experiences may be subject to recall bias or social desirability bias. Furthermore, while the inclusion of key informants provided a health system perspective, the study did not include the voices of spouses, partners, or community leaders, whose influence on ANC timing is significant. Future research should incorporate these perspectives. Despite these limitations, the trustworthiness of the findings is supported by methodological rigor.
Conclusion
This study has illuminated the lived reality behind the statistics of late ANC bookings in Mangwe District, a reality shaped by poverty, fear of stigma, conflicting knowledge systems, and disillusionment with healthcare delivery. The corroborating perspectives of healthcare providers highlight the severe yet preventable maternal and neonatal complications resulting from delayed care. The implications are clear: addressing late ANC booking requires multi-level interventions that prioritize respectful maternity care, community-based education, and improved access to quality services. Creating environments where early ANC is feasible, safe, and dignified is essential for improving maternal health outcomes in rural Zimbabwe.
Supplemental Material
sj-docx-1-inq-10.1177_00469580261444288 – Supplemental material for Lived Experiences of Pregnant Women Regarding Late Antenatal Care Bookings: A Phenomenological Study in Mangwe District, Zimbabwe
Supplemental material, sj-docx-1-inq-10.1177_00469580261444288 for Lived Experiences of Pregnant Women Regarding Late Antenatal Care Bookings: A Phenomenological Study in Mangwe District, Zimbabwe by Sidumisile Sibanda, Methembe Yotamu Khozah and Perez Livias Moyo in INQUIRY: The Journal of Health Care Organization, Provision, and Financing
Supplemental Material
sj-docx-2-inq-10.1177_00469580261444288 – Supplemental material for Lived Experiences of Pregnant Women Regarding Late Antenatal Care Bookings: A Phenomenological Study in Mangwe District, Zimbabwe
Supplemental material, sj-docx-2-inq-10.1177_00469580261444288 for Lived Experiences of Pregnant Women Regarding Late Antenatal Care Bookings: A Phenomenological Study in Mangwe District, Zimbabwe by Sidumisile Sibanda, Methembe Yotamu Khozah and Perez Livias Moyo in INQUIRY: The Journal of Health Care Organization, Provision, and Financing
Footnotes
Acknowledgements
The authors sincerely thank the women who shared their stories and time to make this study possible. We also extend our gratitude to the Mangwe District Health Department and the staff at the participating clinics for their support and cooperation.
Author Note
S.S. is a BSc Public Health student at the National University of Science and Technology in Zimbabwe. This paper was part of the research project that was a partial fulfilment of the BSc in Public Health. P.L.M. and M.Y.K. are a Master of Science Degree in Environmental Health holders at the National University of Science and Technology in Zimbabwe. The Authors are both Lecturers in the Department of Environmental Health in the Faculty of Environmental Science at the National University of Science and Technology.
Ethical Considerations
Ethical approval was granted by the Institutional Review Board of the National University of Science and Technology, Zimbabwe (ref: NUST/IRB/2025/55). All methods were performed in accordance with the relevant guidelines and regulations (Declaration of Helsinki).
Consent to Participate
Permission was also obtained from the Mangwe District Medical Officer and the respective clinic heads. Written informed consent was obtained from all participants.
Consent for Publication
Written informed consent for publication of anonymized data was obtained from all participants.
Author Contributions
S.S.: conceptualization, data curation, formal analysis, investigation, methodology, project administration, writing – original draft. M.Y.K. and P.L.M.: conceptualization, formal analysis, methodology, supervision, validation, visualization, writing – review and editing. All authors read and approved the final manuscript.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data Availability Statement
The datasets generated and analyzed during the current study are not publicly available to protect participant confidentiality but are available from the corresponding author on reasonable request.
Supplemental Material
Supplemental material for this article is available online.
References
Supplementary Material
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