تأثیر اختصاصی کردن پیامهای آموزشی بر انتخاب نوع زایمان در زنان باردار: کارآزمایی بالینی

نوع مقاله: اصیل پژوهشی

نویسندگان

1 دانشجوی کارشناسی ارشد آموزش بهداشت، کمیته تحقیقات دانشجویی، دانشکده بهداشت، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران.

2 استادیار گروه آموزش بهداشت و ارتقاء سلامت، مرکز تحقیقات عوامل اجتماعی مؤثر بر سلامت، دانشکده بهداشت، دانشگاه علوم پزشکی جندی شاپور، اهواز، ایران.

3 مربی گروه آمار، دانشکده بهداشت، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران.

4 دانشیار گروه آموزش بهداشت و ارتقاء سلامت، دانشکده بهداشت، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران.

چکیده

مقدمه: زایمان به روش سزارین نسبت به زایمان طبیعی عوارض بیشتری دارد، اما شیوع آن بیشتر از نرخ توصیه شده سازمان جهانی بهداشت است. مطالعه حاضر با هدف تعیین تأثیر اختصاصی کردن پیام­های آموزشی بر انتخاب نوع زایمان در زنان باردار انجام شد.
روش‌کار: این مطالعه کارآزمایی بالینی تصادفی شده دو گروهه در سال 1395 بر روی ۷۲ زن در هفته ۲۵-۲۰ بارداری در شهر اصفهان انجام شد. افراد به دو گروه ۳۶ نفره آزمون و کنترل تقسیم شد. پیش‌آزمون به‌وسیله پرسشنامه متغیرهای آگاهی، نگرش، خودکارآمدی درک شده، حمایت اجتماعی درک شده و قصد زایمان در هر دو گروه انجام شد. سپس در گروه آزمون به هر زن و همسرش بر اساس نمره هر قسمت از پیش‌آزمون، پیام­های آموزشی اختصاصی در فایل کامپیوتری داده شد. در هفته 37 بارداری، پس‌آزمون انجام شد و بعد از زایمان، نوع زایمان در پرسشنامه ثبت شد. تجزیه و تحلیل داده­ها با استفاده از نرم‌افزار آماری SPSS (نسخه 22) و آزمون‌های تی مستقل، تی زوجی، من‌ویتنی و کای اسکوئر انجام شد. میزانp  کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته‌ها: قبل از مداخله آگاهی، نگرش، خودکارآمدی، حمایت اجتماعی و قصد نوع زایمان بین دو گروه تفاوت معناداری نداشت (05/0<p)، اما بعد از مداخله میانگین آنها در گروه آزمون بیشتر از گروه کنترل بود (001/0>p). تغییر تصمیم قطعی زایمان واژینال در گروه آزمون از 6/30% به 3/58% و در گروه کنترل از 16/30% به 1/۳۶% رسید که در گروه آزمون به‌طور معناداری بیشتر بود (۰۳/۰=p). نسبت زایمان طبیعی در گروه آزمون (2/72%) بیشتر از گروه کنترل (8/52%) بود (۰۴/۰=p).
نتیجه‌گیری: پیام­های اختصاصی مبتنی بر آگاهی، خودکارآمدی، نگرش و حمایت اجتماعی درک شده باعث افزایش انتخاب روش زایمان طبیعی در زنان باردار می‌شود. برنامه­های آموزشی بر اساس این عوامل روان‌شناختی برای هدایت مداخلات آموزشی در بارداری پیشنهاد می­شود.

کلیدواژه‌ها


عنوان مقاله [English]

Implementation of Targeted Education to Promote Normal Vaginal Delivery: A Randomized Controlled Trial

نویسندگان [English]

  • Khadijeh Mohammadali Makhouli 1
  • Marzieh Araban 2
  • Akbar Hassanzadeh 3
  • Zamani Alavijeh 4
1 M.Sc. Student of Health Education, Student Research Committee, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
2 Assistant Professor, Department of Health Education and Health Promotion, Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
3 Instructor, Department of Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
4 Associate Professor, Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
چکیده [English]

Introduction: It is widely reported that the complications of Caesarean-section (C- section) delivery are much more than the normal vaginal delivery (NVD) in Iran. The purpose of this study was to determine the effect of targeted education on the mode of delivery in pregnant women.
Methods: A randomized controlled trial was conducted among 72 primiparous women at their 20-25 weeks of gestational age in Isfahan, Iran, during 2015. The sample was randomized into two groups of 36 people. A pre-test was performed using a questionnaire on knowledge, attitude, perceived self-efficacy, perceived social support, and intention to choose the delivery mode. The experimental group (including the women and their spouses) received specialized educational messages in a form of a computer file based on their scores obtained from each part of the pre-test data. At 37 weeks of pregnancy, post-test was administered to both study groups using the questionnaire and the mode of delivery was recorded in the questionnaire after the birth. The analysis of data was conducted using SPSS through the Chi-square test, independent t-test، and paired t-test.
Results: Before the intervention, no significant difference was observed in terms of the studied variables between two the groups (P=0.71). However, the mean score in the experimental group was higher than that of the control group after the intervention (P<0.001). The definite decision to choose NVD in the experimental group also increased from 30.6% to 58.3% which was significantly more than that of the control group (P=0.03). The frequency of NVD was significantly higher in the experimental group, compared to the control group (P=0.04).
Conclusion: The utilization of targeted educational messages through computer based on knowledge, self-efficacy, attitude, and perceived social support could result in NVD selection. Therefore, it is suggested to provide new strategies to offer educational messages, such as targeting education in community health centers.

کلیدواژه‌ها [English]

  • Mode of Delivery
  • Normal vaginal delivery
  • Education
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