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ATTITUDE OF PREGNANT WOMEN TOWARDS GROUP HEALTH TALK DURING ANTENATAL CARE VISIT IN A NIGERIAN CITY
Date Posted: 23/Feb/2015

INTERNATIONAL PROFESSIONAL NURSING JOURNAL

January 2015
Volume 13 NO.1
Pages:64 - 67

AUTHORS: 

MARAGRET OMOWALEOLA AKINWAARE. 

RN, RM, RPHN, BNSc, MSc. (Nursing) Awaiting
Department of Nursing, 
College of Medicine, 
University of Ibadan, Ibadan. 
Oyo State, Nigeria.
E-mail: omoakinayaakin@gmail.com 
Mobile phone: 08034242253

Abstract 
Antenatal care is widely established and provides an opportunity to inform and educate pregnant women about pregnancy, childbirth and care of the newborn. It is expected that this would assist the women in making choices that would contribute to good pregnancy outcome. This study examined the attitude of pregnant women towards group health talk during antenatal care visit.  The study was descriptive study. The participants were selected by systematic random sampling technique. A total number of 100 pregnant women participated in the study. A self-developed and well validated questionnaire was used for data collection. Data were analysed using frequency and percentages. The median age of the respondents was 28years, 57 (57%) of them had secondary school education, 62 (62%) of them are traders, 70 (70%) of them are multigravida. Majority, 68 (68%) of them see health talk during antenatal care visit as what benefit them during pregnancy, most 62 (62%) of them see it as a learning forum, while few 17(17%) of them believed that it is meant to keep them busy while waiting for the doctors' consultation. The study suggests that nurses should endeavour to let the pregnant women know the essence of the health talk being given at each visit. When the clients are aware of the need for health information and health education, they will have the right attitude towards it.

Introduction  
The aim of Antenatal care (ANC) is to assist women to remain healthy, finding and correcting adverse conditions when present, and thus aid the health of the unborn1. ANC should also provide support and guidance to the woman and her partner or family, to help them in their transition to parenthood. This implies that both health care and health education are required from health services. This broad definition of ANC is endorsed by evidence-based clinical guideline2. Moreover, it introduces the needed holistic approach (biological care and concern with intellectual, emotional, social and cultural needs of women, babies and families) during pregnancy. Care during pregnancy should enable a woman to make informed decisions, based on her needs, after discussing matters fully with the professionals involved.  Antenatal care provides an opportunity to inform and educate pregnant women on a variety of issues related to pregnancy, birth and parenthood. The aim of this exercise is to equip them to make appropriate choices that will contribute to optimum pregnancy outcome and care of the newborn3. This concept has made antenatal education programmes a standard component of antenatal care worldwide4.  There has been controversy about the impact of antenatal education on pregnancy outcome. However, a recent synthesis of experience with information, education and communication (IEC) makes the point that it works1. In other words, an appropriate strategy of IEC leads to or reinforces desirable attitudes and behaviour. The "Three Phases of Delay Model" highlights the importance of IEC in the prevention of maternal death by describing the sequence of events from late recognition of danger signs to maternal death. Therefore, an appropriate programme of health literacy or behaviour change communication is highly desirable. The IEC strategy was first articulated in the early 1990s but has undergone revisions in line with emerging needs. The strategy is to inform and educate pregnant women on a variety of topics including nutrition, malaria, STIs/HIV/AIDS, danger signs of pregnancy and delivery, and care of the newborn5.
Antenatal care provides a key entry point for a broad range of health promotion and disease prevention services. It is essential for healthcare providers and women to talk about important issues affecting the woman's health and her pregnancy. 
During the antenatal period, the health care provider can promote the health of the women and the health of their babies before and after birth, by educating mothers about the benefits of good nutrition, adequate rest, good hygiene, family planning and exclusive breastfeeding, and immunization and other disease prevention measures. The aim is to develop women's knowledge of these issues so they can make better informed decisions affecting their pregnancy outcome.
Studies of childbirth education have universally failed to take into account the quality of the education provided to women and their families and whether its style of delivery meets women's preferences and needs.
In recent years in the United Kingdom, there has been a considerable cutback in the provision of antenatal education by the National Health Service. This is of concern not only to midwives and to childbirth educators trained by the National Childbirth Trust, the largest charitable organization in Europe providing prenatal and postnatal education to parents, but also to parents themselves. A recent documentary on British television6 interviewed women who expressed disappointment and concern that they had not been offered any antenatal classes in their first pregnancies, although the U.K.'s prestigious National Perinatal Epidemiology Unit claimed that 88.5% of primiparous women were offered classes at their local hospital or clinic in 20067.
Education to promote maternal and fetal health and safety is a significant component of antenatal care. Topics that should be discussed at first antenatal visit include promotion of healthy behaviours, dental care, nutrition, wearing a seat belt, continued exercise, avoiding substance and hazardous-chemical exposure, and minimal use of hot tubs or saunas or potential domestic violence exposure. Sexual activity may also be discussed. If women use tobacco products, smoking cessation should be encouraged and support provided. If the patient has had a prior caesarean delivery, the risks and benefits of a trial of labour versus repeat caesarean delivery should be reviewed. 
· Specific issues to consider: 
o Breastfeeding: throughout antenatal care, healthcare providers should provide information about the benefits of breastfeeding and breastfeeding support should be provided. 
O Working: most women with an uncomplicated pregnancy can typically continue working until the onset of labour. However, if women have medical complications or other pregnancy complications, or the occupation involves physical work, prolonged standing, or significant stress, some adjustments may need to be made.
o Air travel: women with uncomplicated pregnancies can fly safely until 36 weeks' gestation. Pregnant women who are planning to fly should be informed about the increased risks of venous thromboembolism from the combination of ,,pregnancy and venous stasis, and instructed to take appropriate precautions (support stockings, movement of lower extremities, hydration). 
o Exercise: women should be encouraged to continue or begin a moderate aerobic exercise program during pregnancy. Potential risks from contact sports, high-impact sports, activities with risk of abdominal trauma, and scuba diving should also be discussed.
o Childbirth education: attendance in childbirth education classes should be encouraged. Classes teach expectant mothers about labour and delivery, pain relief options, potential obstetric complications and procedures, normal newborn care, and postpartum adjustment. Supportive information should be provided regarding the benefits of breastfeeding.
o Miscellaneous: other educational issues to discuss during the antepartum period include postpartum contraception and circumcision of male infants.
The Safe Motherhood Initiative currently advocates the provision of advice during antenatal care about potential pregnancy complications, and specifically about how to seek medical care for pregnant women and their families. This is viewed as central to the strategy to reduce delays in seeking skilled care. Although antenatal care does not diminish the likelihood of complications, the number of visits is a predictor of institutional delivery8 and these visits provide a natural opportunity for conveying this critical health information.
Aims
The aims of the study were as follows:
1. To examine the attitude of pregnant women towards the group health talk given during the antenatal care visit.
2. To establish relationship between literacy level of pregnant women and their attitude towards health talk during antenatal care visit.
3. To determine relationship between parity and  participation during health talk.
4. To determine whether the health talk  influences the clients' health behaviour
Methodology.
The study was descriptive cross-sectional by design. It was delimited to selected health institutions in Ile-Ife, including one tertiary, one secondary and one primary health institutions. The participants were selected by systematic random sampling technique. A total of 100 pregnant women participated in the study. The instrument for this study was an 18 item self-developed questionnaire based on the objectives and hypotheses of the study. The questionnaire was administered face to face to the participants by the researcher and collected on the spot. Data were analysed using frequency and percentages. Verbal consent was obtained from the participants to take part in the study.
Results The socio-demographic characteristics of the respondents are shown in table 1.
Table 1 shows that the median age of all respondents was 28 years, range 11  40 years. The majority (57%) had secondary school education and 62% were traders. However, the vast majority (70%) of the respondents had carried pregnancy before (table 2). 
 
 
Table 3 shows the respondents' participation in health talk during antenatal care visit. And the effect of the health talk on their behaviour. 
 
 
 
 
The table shows majority (92%) of the respondents participate during health talk, and the health talk given during antenatal care visit has changed the health behaviour of most (94%) of them. Meanwhile,  majority (70%) of the respondents who have positive attitude towards the health talk are those with only primary school education, while most (41%) of them who have negative attitude are those who had tertiary education (Table 4). 

Discussion

The socio-demographic characteristics of the respondents showed that teenage pregnancy has greatly reduced, which is in line with previous studies9. This study has also revealed that majority (70%) of the respondents with primary education had positive attitude towards health talk during ANC visit, while only few (29%) of the respondents with tertiary education had the positive attitude. This suggests that people with primary education will take more advantage of the health talk to learn, since they might not have opportunity to learn from reading books. Furthermore, the study revealed that the largest percentage (57%) of the study population had secondary school education, this is responsible  for many of them preferring the health talk being delivered in Yoruba language so as to understand better. 
Also, the study revealed that most (70%) of the respondents are multigravida, which is of great significance in the sense that they have learnt from the past health talk during previous pregnancy/ies, and that is why the majority (68%) believed that health talk is meant to benefit them during pregnancy. It was also noted from the study that the health talk has changed the health behaviour of most (94%) of the client, and this could be responsible for majority (98%) of them coming early to the antenatal clinic in order not to miss the health talk, and most (92%) of them participate well during the health talk.
 
Nursing Implication and Conclusion
Health talk during antenatal care visit is meant to educate pregnant women, which in turn should bring about change in their health behaviour. This study showed that only 62% of the study population knew that health talk during antenatal care visit serve as a learning forum, while few (17%) of them agreed that it was meant to keep them busy while waiting for the doctor's consultation. This poses a challenge to nursing practice in relation to essence of health education. There is need for nurses to clarify the essence of health education being given to their clients, because when the clients are aware of the need for the health talk, they will have right attitude to it.
Also, the health talk should be seen as an integral part of antenatal care, and same should be given in such a way that the clients will know why it is so important. Further research is required with a larger sample to elicit other factors that influence the attitude of pregnant women towards health education. 
The study examined the effect of health talk during antenatal care visit on pregnant women's health behaviour, their opinion about the purpose of the health talk, their preferred language for the health talk and their participation during the health talk. 
In addition, the study showed the relationship between the respondents literacy level and their attitude towards the health talk, as well as the respondents participation during health talk. 

References

World Health Organization. Information, education and communication: lessons from the past, perspectives for the future. Geneva, 2005.
Di Mario S. What is the effectiveness of antenatal care? (Supplement) Copenhagen, WHO Regional Office for Europe (Health Evidence Network report; Available in http://www.euro.who.int/Document/E87997.pdf, Accessed 28 December 2005). 
Renkert S,and Nutbeam D. Opprotunities to improve maternal health literacy through antenatal education: an exploratory study. Health Promotion International, 2001: 16:381-388.
Turan J. M, and Sale L. Community-based antenatal education in Istanbul, Turkey: effects on health behaviours. Health Policy and Planning, 2003: 18(4):391-398. 
Anya Samuel E, Abba Hydara and Lamin E.S Jaiteh. Antenatal care in The Gambia: Missed opportunity for information, education and communication, 2008.
Ahmad T.. Dispatches: Health  Undercover mother [Television broadcast]. London: Channel 4,2007.
Redshaw, Rowe. Hockley & Brocklehurst. United Kingdom National Perinatal Epidemiology Unit, 2006.
Islam et al. 2006; Gage 2007; Fotso et al. 2008 in Béatrice Nikiéma, Gervais Beninguisse and Jeannie L Haggerty. Providing information on pregnancy complications during antenatal visits: unmet educational needs in sub-Saharan AfricaHealth Policy Plan, 2009: 24 (5): 367-376. Available in doi: 10.1093/heapol/czp017 Accessed on: April 28, 2009
Mohn J.K, Tingle L.R and Finger R. “An analysis of the causes of the decline in non-marital birth and pregnancy rates for teens from 1991 to 1995,” Adolescent and Family Health, 2002:  3(1):39-47.
Abrahamsson A, Springett J, Karlsson L, Hakansson A, and Ottosson T. Some lessons from Swedish midwives' experiences of approaching women smokers in antenatal care. Midwifery 2005: 21(4):335345. 
Barber S. Does the quality of prenatal care matter in promoting skilled institutional delivery? A study in rural Mexico. Maternal and Child Health Journal, 2006: 10:419-25.
Béatrice Nikiéma, Gervais Beninguisse  and Jeannie L Haggerty. Providing information on pregnancy complications during antenatal visits: unmet educational needs in sub-Saharan AfricaHealth Policy Plan, 2009: 24 (5): 367-376. Available in doi: 10.1093/heapol/czp017 Accessed on April 28, 2009. 
Birungi H and Onyango-Ouma W. FRONTIERS Final Report. Washington, DC: Population Council.; accessed 1 November 2008. Acceptability and sustainability of the WHO focused antenatal care package in Kenya. Available in  http://www.popcouncil.org/pdfs/frontiers/FR_FinalReports/Kenya_ANC.pdf.
Chege J.N, Askew I and Mosery N. FRONTIERS Final Report. Washington, DC: Population Council.; accessed 1 November 2008. Feasibility of introducing a comprehensive integrated package of antenatal care services in rural public clinics in South Africa. Available in: http://www.popcouncil.org/pdfs/frontiers/FR_FinalReports/SA_ANC.pdf.
Mary L. Nolan. Information Giving and Education in Pregnancy: A Review of Qualitative Studies. J Perinat Educ. Fall, 2009: 18(4): 2130.
National Collaborating Centre for Women's and Children's Health. Antenatal care. Routine care for the healthy pregnant woman. Clinical guideline. London, RCOG Press. Available in http://www.rcog.org.uk/resources/Public/pdf/Antenatal_Care. Accessed 29 September 2005.
Essential antenatal, perinatal and postpartum care. Training modules. Copenhagen: WHO Regional Office for Europe, 2002; available in (http://www.euro.who.int/document/e79235.pdf,  accessed 29 September 2005).
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