Effect of an Educational Intervention Based on Self-efficacy Theory and Health Literacy Strategies on Pregnancy Outcomes: A Randomized Clinical Trial

Document Type : Original Article

Authors

1 M.Sc. Student of Health Education and health promotion, Social Determinants of Health Research Center, Student Research Committee, School of Public Health, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Associate Professor, Department of Health Education and Health Promotion, Social Determinants of Health Research Center, School of Public Health, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Professor, Department of Biostatistics and Epidemiology, Social Determinants of Health Research Center, School of Public Health, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Introduction:Maternal health literacy during pregnancy can refer to the socio-cognitive skills, which determine the motivation and ability of mothers to understand and use beneficial information in order to maintain and promote health of themselves and their children. The present study aimed to determine the effects of an educational program based on self-efficacy theory and health literacy strategies on pregnancy outcomes at healthcare centers affiliated to Mashhad University of Medical Sciences, Mashhad, Iran.
Methods: This randomized clinical trial was performed on 76 pregnant women, who referred to the healthcare centers of Mashhad for routine pregnancy period checkups in 2015. The participants were assigned to the two groups of intervention and control. Data collection tools included a demographic questionnaire, maternal health literacy and pregnancy outcome questionnaire (MHLAPQ), and perceived dietary self-efficacy questionnaire. The questionnaires were completed by the participants, followed by implementation of the educational intervention for the test group according to a pilot study. Afterwards, the questionnaires were again completed immediately post-intervention, as well as within a three-month interval (follow-up). All the data were statistically analyzed by t-test, Chi-square, one-way analysis of variance (ANOVA), and repeated measures ANOVA using SPSS version 15. For all tests, P < 0.05 was considered as significant.
Results: The findings of this study demonstrate that no significant difference was observed between the intervention and control groups in terms of maternal health literacy, self-efficacy, and pregnancy period cares pre-intervention (P>0.001). On the other hand, we reported a significant difference post-intervention regarding the mean scores of maternal health literacy and self-efficacy in the test group (P ≥ 0.001).
Conclusion: According to the results of this study, the designed educational intervention based on self-efficacy theory might improve maternal health literacy and promote normal birth weight in newborns.

Keywords

References

  1. Banihashemi SA, Amirkhani MA, Haghdoost A, Alavian S, Asgharifard H, Baradaran H, et al. Health literacy and the influencing factors: a study in five provinces of Iran. Strid Dev Med Educ 2007; 4(1):1-9. (Persian).
  2. Renkert S, Nutbeam D. Opportunities to improve maternal health literacy through antenatal education: an exploratory study. Health Promot Int 2006; 16(14):381-8.
  3. Headley AJ, Harrigan J. Using the pregnancy perception of risk questionnaire to assess health care literacy gaps in maternal perception of prenatal risk. J Natl Med Assoc 2009; 101(10):1041-5.
  4. Ohnishi M, Nakamura K, Takano T. Improvement in maternal health literacy among pregnant women who did not complete compulsory education: policy implications for community care services. Health Policy 2005; 72(2):157-64.
  5. Kohan S, Ghasemi S, Dodangeh M. Associations between maternal health literacy and pregnancy outcome. Iran J Nurs Midwifery Res 2008; 12(4):146-52.
  6. Verbeke W, Vackier I. Individual determinants of fish consumption:application of the theory of planned behaviour. Appetite 2005; 44(1):67-82.
  7. Bastani F. The effect of education on nutrition behavioral intention and self-efficacy in women. Health Scope 2012; 1(1):12-7.
  8. Berahmandpour F, Ardestani M. Guide to selecting media and methods of health education. Tehran: Arman Berasa; 2012.
  9. Ashraf-Ganjoei T, Mirzaei F, Anari-Dokht F. Relationship between prenatal care and the outcome of pregnancy in low-risk pregnancies. Open J Obstet Gynecol 2011; 1(3):109-12.
  10. Jones J, Housman J, McAleese W. Exercise, nutrition, and weight management during pregnancy. Am J Health Stud 2010; 25(3):120-8.
  11. Szwajcer EM, Hiddink GJ, Koelen MA, Van Woerkum CM. Nutrition awareness and pregnancy: implications for the life course perspective. Eur J Obstet Gynecol Reprod Biol 2007; 135(1):58-64.
  12. Shom ER, Chunuan S, Chuntharapat S. The relationships between perceived nutritional status, perceived dietary self-efficacy and dietary behavior among bangladeshi pregnant women. The 2nd International Conference on Humanities and Social Sciences; Faculty of Liberal Arts, Prince of Songkla University, Hat Yai, Thailand; 2010.
  13. Pakniat H, Movahed F. Relationship between body mass index, weight gain during pregnancy and birth weight of infants. Alborz Univ Med J 2012; 1(3):130-6. (Persian).
  14. Nam S, Chesla C, Stotts NA, Kroon L, Janson S. Review article barriers to diabetes management: patient and provider factors. Diabetes Res Clin Pract 2011; 93(1):1-9.
  15. Khosravi A, Ahmadzadeh K, Arastoopoor S, Tahmasbi R. Health literacy levels of diabetic patients referred to shiraz health centers and its effective factors. Health Inf Manage 2015; 12(2):194-205.
  16. Bang SW, Lee SS. The factors affecting pregnancy outcomes in the second trimester pregnant women. Nutr Res Pract 2009; 3(2):134-40.
  17. Allen LH. Anemia and iron deficiency: effects on pregnancy outcome. Am J Clin Nutr 2000; 71(5):1280S-4S.
  18. Nemmati A, Refahi S, Barak M, Jafari M, Ettehad G. The Relationship between some of maternal anthropometric measurments with neonatal birth weight of Alavi Hospital, Ardebil. J Ardabil Univ Med Sci 2007; 7(1):84-9.
  19. Mohseni M, Khanjani N, Iranpour A, Tabe R, Borhaninejad V. Investigate the relationship between health literacy and health status among elderly people in Kerman. Indian J Ageing 2015; 10(2):146-55.
  20. Muthayya S. Maternal nutrition & low birth weight - what is really important? Indian J Med Res 2009; 130(5):600-8.
  21. Cho Y, Lee S, Arozullah A, Crittenden KS. Effects of health literacy on health status and health service utilization amongst the elderly. Soc Sci Med 2008; 66(8):1809-16.
  22. Sharifirad G, Rajati F, Matlabi M, Abasi MH, Shahsiah M, Mohebi S, et al. A survey of maternal weight gain during pregnancy based on recommended standards and its correlation with infant birth weight in Isfahan, Iran. Health Syst Res 2012; 8(3):493-503.
  23. Mohebi S, Sharifirad G, Rasekhi H, Matlabi M, Shahsiah M, Tabaraie Y. Effect of nutrition education program on the recommended weight gain in during pregnancy application of health belief model: a randomaized cilinical trial. Qom Univ Med Sci J 2012; 6(1):23-30.
  24. Resnick B, Jenkins LS. Testing the reliability and validity of the self-efficacy for exercise scale. Nurs Res 2000; 49(3):154-9.
  25. Mojoyinola JK. Influence of maternal health literacy on healthy pregnancy and pregnancy outcomes of women attending public hospitals in Ibadan, Oyo State, Nigeria. Afr Res Rev 2011; 5(3):28-39.
  26. Kharazi SS, Peyman N, Esmaily H. An evaluation of the validity and reliability of the maternal health literacy and pregnancy outcome questionnaire. J Health Syst Res 2016; 12(4):512-9. (Persian)
  27. Ruth M, Parker SC, Ratzan aNL. Health Literacy: A Policy Challenge For Advancing High-Quality Health Care Creating a health-literate America may not be easy, but it is the right goal for health policy. Health Affairs. 2013;22(4):147-53.
  28. Barbara Hoffman RH, Scott Roberts. Williams obstetrics. New York: McGraw-Hill Education; 2014.
  29. Tol A, Pourreza A, Rahimi Foroshani A, Tavasoli E. Assessing the effect of educational program based on small group on promoting knowledge and health literacy among women with type2 diabetes referring to selected hospitals affiliated to Tehran University of Medical Sciences Razi Journal of Medical Sciences. 2013;19(104):10-9.
  30. Ohnishia M, Nakamuraa K, Takanob T. Improvement in maternal health literacy among pregnant women who did not complete compulsory education: policy implications for community care services. Health Policy 2005; 72(2):157-64.
  31. Peyman N, Behzad F, Taghipour A, Esmaeily H. Promoting level of health literacy & self efficacy of chronic patients referred to health centers through educating health literacy for the staffs of health centers in Mashhad, 2013. Mashhad: Mashhad University of Medical Sciences School of Health; 2013.
  32. Cavanaugh K, Wallston K, Gebretsadik T, Shintani A, Huizinga M, Davis D, et al. Addressing literacy and numeracy to improve diabetes care two randomized controlled trials. Diabetes Care 2009; 32(12):2149-55.
  33. Esfandiary Nejad P, Nezamivand Chegini S, Najar S, Yaralizadeh M, Afshari P, Beiranvand S. A survey on the compatibility of prenatal care offered at the second and third trimester of pregnancy with standard guidelines of country in Ahvaz health care centers. Iran J Obstet Gynecol Infertil 2016; 19(19):1-14. (Persian).
  34. Kharazi SS, Peyman N, Esmaily H. Association between maternal health literacy level with pregnancy care and its outcomes. Iran J Obstet Gynecol Infertil 2016; 19(37):40-50. (Persian).
  35. Kandula NR, Nsiah-Kumi PA, Makoul G, Sager J, Zei CP, Glass S, et al. The relationship between health literacy and knowledge improvement after a multimedia type 2 diabete education program. Patient Educ Couns 2009; 75(3):321-7.
  36. Douglas J, Boss M, Rodney E, Timbrook RE, The Fort Wayne Medical Education Research Group. Clinical Obstetric Outcomes Related to Continuity in Prenatal Care. 14. 2001;6(418-423).
  37. Bennett I, Switzer J, Aguirre A, Evans K, Barg F. Breaking It down’: patient-clinician communication and prenatal care among african american women of low and higher literacy. Ann Fam Med 2006; 4(4):334-40.
  38. Yee L, Simon M. The role of health literacy and numeracy in contraceptive decision-making for urban Chicago women. J Community Health 2014; 39(2):394-9.
  39. Johri M, Subramanian SV, Koné GK, Dudeja S, Chandra D, Minoyan N, et al. Maternal health literacy is associated with early childhood nutritional status in India. J Nutr 2016; 146(7):1402-10.
  40. Afshari M, Khazaei S, Bahrami M, Merati H. Investigating adult health literacy in Tuyserkan city. J Educ Community Health 2014; 1(2):48-55.
  41. Nasehnezhad M, Peyman N, Esmaiely H. The effect of the education based on social-cognitive theory on level of mother’s health literacy and performance of their adolecences in protection of sunlight in city of Sabzevar 2014. Mashhad, Iran: School of Health. Mashhad University of Medical Sciences; 2015.
  42. Samiee Roudi K, Peyman N, Esmaiely H. Investigating the effect of health literacy in health providers on the self care of diabetes type 2 patient in rulal area under health centers support in Khaf: School of Health. Mashhad: Mashhad University of Medical Sciences; 2015.
  43. Tol A, Pourreza A, Tavasoli E, Rahimi Foroshani A. Determination of knowledge and health literacy among women with type 2 diabetes in teaching hospitals of TUMS. J Hosp 2012; 11(3):45-52.
  44. Javadzade H, Sharifirad G, Reisi M, Tavassoli E, Rajati F. Health Literacy among Adults in Isfahan, Iran. J Health Syst Res. 2013;9(5):540-9.
  45. Reisi M, Mostafavi F, Hasanzade A, Sharifirad G. The Relationship between Health Literacy, Health Status and Healthy Behaviors among Elderly in Isfahan, Iran. J Health Syst Res 2010; 7(4):460-80.
  46. Kooshyar H, Shoorvazi M, Dalir Z, Hosseini H. Health literacy and its relationship with medical adherence and health-related quality of life in diabetic community-residing elderly. J Mazand Univ Med Sci 2014; 24(1):134-43. (Persian).
  47. Amiresmaili M, Nekoei MM, Saberi anari S, Sadeghi A, Saber M, Taheri G, et al. Study of health literacy level of women referring to health centers-2010. J North Khorasan Univ Med Sci 2013; 5(5):1071-8. (Persian).
  48. Ghanbari S, Majlessi F, Ghaffari M, Mahmoodi Majdabadi M. Evaluation of health literacy of pregnant women in urban health centers of Shahid Beheshti Medical University. Daneshvar 2012; 19(97):1-12. (Persian).
  49. Ronnenberg A, Wang X, Xing H, al. e. Low preconception body mass index is associated withbirth outcome in a prospective co hort of Chinese women. J Nutr. 2003;133(11):3449-55.
  50. Neeman N, Isaac T, Leveille S, Dimonda C, Shin J, Aronson M, et al. Improving doctor-patient communication in the outpatient setting using a facilitation tool: a preliminary study. Int J Qual Health Care 2011; 24(4):357-64. (Persian).
  51. Nielsen BL, Panzer AM, Nielsen-Bohlman L. Health Literacy: a prescription to end confusion. Washington, DC: National Academies Press; 2004.
  52. LeVine R, LeVine SE, Rowe ML, Schnell-Anzola B. Maternal literacy and health behavior: a Nepalese case study. Soc Sci Med 2004; 58(4):863-77.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 21, Issue 5
July 2018
Pages 33-46

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