Prekonsepsiyonel Dönemdeki Kadınların Sağlık Davranışları Değişim Aşamaları (Transteoretik Model): Randomize Kontrollü Çalışma

Year 2021, Volume: 31 Issue: 4, 330 - 338, 15.12.2021

Yasemin Erkal Aksoy , Melek Gülsün Özentürk

https://doi.org/10.54005/geneltip.1036367

Cited By: 1

Abstract

Amaç: Prekonsepsiyonel bakım, gebelik planlayan ya da gebelik düşünmeyen bir kadının sağlığını, sağlık davranışlarını ve bilgilerini optimize etmek olarak tanımlanabilir. Bu çalışmanın amacı; hiç gebelik yaşamamış, gebelik düşünen kadınlara verilen eğitimin kadınlardaki sağlık davranışları değişim aşamalarına (transteoretik model) etkisinin incelenmesidir.

Gereç ve Yöntem: Araştırma, randomize kontrollü eğitim müdahale çalışmasıdır. Örneklem büyüklüğü G*Power 3.1.7 programı ile her grupta en az 88 kadın olarak hesaplanmıştır. Çalışma 180 kadın ile sonlandırılmıştır. Merkeze gelen kadınlar örneklem kriterleri açısından değerlendirilmiş ve randomize örnekleme yöntemi ile iki gruba ayrılmıştır. İlk görüşmede tüm kadınlara: Tanıtıcı Bilgi Formu, Prekonsepsiyonel Risk Değerlendirme Formu, Değişim Aşamalarını Değerlendirme Formu, Sağlıklı Yaşam Biçimi Davranışları Ölçeği-II, Genel Öz-Yeterlilik Ölçeği doldurtulmuştur. Girişim grubundaki kadınlara gebeliğe hazırlık eğitimi ve Prekonsepsiyonel Bakım Rehberi adlı bir rehber kitap verilmiştir. Kontrol grubundaki kadınlar eğitim verilmemiştir.

Bulgular: Girişim grubunda yer alan kadınların; folik asit kullanma, düzenli fiziksel aktivite uygulama, yeterli ve dengeli beslenme açısından değişim aşamaları ön-son test sonuçlarına göre aralarında bulunan farkın istatistiksel olarak da anlamlı olduğu saptanmıştır.

Sonuç: Prekonsepsiyonel dönemde verilen gebeliğe hazırlık eğitiminin, folik asit kullanımı, düzenli fiziksel aktivite, yeterli ve dengeli beslenme değişim aşamaları açısından etkili olduğu, ölçek puan ortalamalarında anlamlı artış sağladığı belirlenmiştir.

Keywords

Prekonsepsiyonel dönem, transteoretik model, eğitim, gebeliğe hazırlık, ebelik

Women's Health Behaviors Stages of Change (Transtheoretical Model) in Preconception Period: A Randomized Control Study

Abstract

Objective: Preconceptional care can be defined as optimizing the health, health behaviors and information of a woman who plans a pregnancy. The study’s aim was to investigate the effect given education women who have never had any pregnancy, considering pregnancy to stages of change of health behaviors in women.

Materials and Methods: The study is a randomized controlled education intervention trial. The sample size was calculated to be at least 88 women in each group with G*Power 3.1.7 program. The study was terminated with 180 women. The women who came to the center were evaluated in terms of sample criteria and randomized sampling was divided into two groups. In the first interview, all the women were given: Introductory Information Form, Preconceptional Risk Assessment Form, Evaluation Form of Change Stages, Healthy Lifestyle Behavior Scale-II and General Self-Efficacy Scale. Women who intervention group was training to preparation for pregnancy and was given a guide book called on Preconception Care Guide. Women in the control group were not trained.

Results: The women in intervention group between pre-post test results statistically was found to be increased significant difference that based on the effect health behaviors on the stages of change given education about use of folic acid, practice of regular physical activity, adequate and balanced nutrition.

Conclusions: Pregnancy preparation training given in the preconception period had a positive effect on the use of folic acid, regular physical activity, and change in health behaviors towards adequate and balanced nutrition, general self-efficacy level and healthy lifestyle behaviors.

Keywords

Preconception period, transtheoretical model, education, pregnancy preparation, midwifery

References

• Darmstadt GL, Bhutta ZA, Cousens S, et al. Evidence-based, cost-effective interventions: how many newborn babies can we save? Lancet 2005;365(9463):977–88.
• Bhutta ZA, Das JK, Bahl R, et al. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet 2014;384(9940):347–70.
• Doğaner G, Gölbaşı Z. Preconceptional Consultancy. STED 2011;20(5):215-21.
• WHO. Preconception care: Maximizing the gains for maternal and child health. Switzerland; 2013. Available at: https://www.who.int/maternal_child_adolescent/documents/preconception_care_policy_brief.pdf. Accessed August 27, 2020.
• Çoşkun A. The Place and Importance of Preconception Careand Counseling in Women’s Lives. Hemşirelikte Eğitim ve Araştırma Dergisi 2011;8(3):8-15.
• Witt WP, Wisk LE, Cheng ER, et al. Preconception mental health predicts pregnancy complications and adverse birth outcomes: a national population-based study. Matern Child Health J 2012;16(7):1525–41.
• Bish CL, Farr S, Johnson D, et al. Preconception health of reproductive aged women of the Mississippi River delta. Matern Child Health J 2012;16 Suppl 2:250–7.
• Stern J. Preconception Health and Care: A Window of Opportunity. BMC Pregnancy Childbirth 2015;19(12):1–72.
• Dean S V, Lassi ZS, Imam AM, et al. Preconception care: nutritional risks and interventions. Reprod Health 2014;11(Suppl(S3):1-15.
• ACOG. ACOG Committee Opinion number 313, September 2005.The Importance of Preconception Care in the Continuum of Women’s Health Care. Obstet Gynecol. 2005;106(3):665-6.
• de Weerd S, Thomas CM, Cikot RJ, et al. Preconception counseling improves folate status of women planning pregnancy. Obstet Gynecol 2002;99(1):45–50.
• Lu MC. Recommendations for preconception care. American Family Physician 2007;76(3):397–400.
• AAP, ACOG. Guidelines for Perinatal Care. 7th ed. Riley A.R. LE. S, editor. Washington: AmericanAcademy of Pediatrics; American College of Obstetricians and Gynecologists; 2012. p. 95–168.
• Freda MC, Moos MK, Curtis M. The history of preconception care: evolving guidelines and standards. Matern Child Health J 2006;10(5 Suppl):S43-52.
• Lassi ZS, Dean S V, Mallick D, et al. Preconception care: delivery strategies and packages for care. Reprod Health 2014;11(Suppl 3):S7.
• WHO. Meeting to develop a global consensus on preconception care to reduce maternal and childhood mortality and morbidity. Geneva: World Health Organization; 2013.
• Ata KK, Şahin NH. The Effect of Pregestational Body Mass Index on Prenatal And Neoanatal Outcomes. Medical Bulletin of Zeynep Kamil 2015;46(4):112-7.
• Jelsma JG, van Leeuwen KM, Oostdam N, et al. Beliefs, Barriers, and Preferences of European Overweight Women to Adopt a Healthier Lifestyle in Pregnancy to Minimize Risk of Developing Gestational Diabetes Mellitus: An Explorative Study. J Pregnancy 2016;2016:3435791.
• Karsten MDA, van Oers AM, Groen H, et al. Determinants of successful lifestyle change during a 6-month preconception lifestyle intervention in women with obesity and infertility. Eur J Nutr 2019;58:2463-75.
• Glanz K, Rimer BK, Viswanath K. Health behavior and health education: theory, research, and practice. 4th ed. Rimer BK, editor. Modelsof indidual health behavior . United States of America: John Wiley & Sons; 2008. p. 41-4.
• Velicer WF, Prochaska JO, Fava JL, et al. Using the Transtheoretical Model for Population-based Approaches to Health Promotion and Disease Prevention. Homeostasis in Health and Disease 2000;40:174-95.
• Brewer N, Rimer B. Perspectives on Health Behavior Theories That Focus on Individuals. In: Glanz K, Rimer B, Viswanath K, editors. Health Behavior and Health Education. 4th Editio. United States of America: A Wiley; 2008. p. 149-162.
• Prochaska JO, DiClemente CC. Transtheoretical therapy: toward a more integrative model of change. Psychother Theory Res Pract. 1982;19:276-88.
• WHO. Health topics. Health education. WHO; 2018. Available from: http://www.who.int/topics/health_education/en/. Accessed August 27, 2020.
• Random.Org. Random Sequence Generator. Vol. 2018. Ireland; 2018. Available from: https://www.random.org/sequences/. Accessed August 27, 2020.
• Akın B, Koçoğlu D. Randomize Kontrollü Deneyler. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi. 2017;4(1):73-92.
• Kanık EA, Taşdelen B, Erdoğan S. Klinik Denemelerde Randomizasyon. Marmara Medical Journal. 2011;24:149-55.
• Walker SN, Sechrist KR, Pender NJ. The Health-Promoting Lifestyle Profile: development and psychometric characteristics. Nurs Res 1987;36(2):76–81.
• Bahar Z, Beşer A, Gördes N, et al. Sağlıklı Yaşam Biçimi DavranışlarıÖlçeği II’nin Geçerlik ve Güvenirlik Çalışması. CÜ Hemşirelik Yüksekokulu Dergisi 2008;12(1):1–13.
• Schwarzer R, Jerusalem M. Generalized Self-Efficacy scale. Weinman J, Wright S, Johnston M, editors. Measures in health psychology: A user’s portfolio. Causal and control beliefs. UK: NFER-NELSON: Windsor; 1995. p. 35–7.
• Aypay A. The Adaptation Study of General Self-Efficacy (GSE) Scale to Turkish. Inonu University Journal of the Faculty of Education 2010;11(2):113-31.
• Arslan H, Özkan A. Evaluation of women in preconceptional period. Zeynep Kamil Tıp Bülteni 2005;36(2):65-71.
• Koyucu RG, Tosun Y, Katran B. Preconceptional counselling needs among women of reproductive age. JAREN 2017;3(3):116-21.
• Akkoca AN, Kurt RK, Karapınar OS, Özler S, Özer C. Folic acid use and knowledge about among women in reproductive age. Turkish journal of family medicine and primary care (TJFMPC) 2014;8(2):35-8.
• Hanson MA, Bardsley A, De-Regil LM, et al. The International Federation of Gynecology and Obstetrics (FIGO) recommendations on adolescent, preconception, and maternal nutrition: “Think Nutrition First.” International Journal of Gynecology & Obstetrics 2015;131:S213–53.
• Yanıkkerem E. Effects of obesity on women’s health. Journal of Health Sciences of Kocaeli University 2017;3(1):37-43.
• Joyce C, Keraka M, Njagi J. Assessment of the knowledge on preconception care among women of reproductive age in Ruiru sub-county, Kıambu County, Kenya. Global Journal of Health Science (GJHS) 2018;3(1):82-100.
• Chuang CH, Velott DL, Weisman CS. Exploring knowledge and attitudes related to pregnancy and preconception health in women with chronic medical conditions. Matern Child Health J 2010;14(5):713–9.
• TPHR. 2018 Turkish Population and Health Researches. Ankara, Turkey: Hacettepe University Institute of Population Studies, T.C. Presidential Strategy and Budget Presidency and TÜBİTAK; 2019.
• Mastroiacovo P, Nilsen RM, Leoncini E, Gastaldi P, Allegri V, Boiani A, et al. Prevalence of maternal preconception risk factors: an Italian multicenter survey. Ital J Pediatr 2014;40:91.
• Navaro M, Vezzosi L, Santagati G, et al. Knowledge, attitudes, and practice regarding medication use in pregnant women in Southern Italy. PLoS One 2018;13(6):e0198618.
• Lo WY, Friedman JM. Teratogenicity of recently introduced medications in human pregnancy. Obstet Gynecol 2002;100(3):465–73.
• Werler MM, Sheehan JE, Mitchell AA. Maternal medication use and risks of gastroschisis and small intestinal atresia. Am J Epidemiol 2002;155(1):26–31.
• Werler MM, Mitchell AA, Hernandez-Diaz S, et al. Use of over-the-counter medications during pregnancy. Am J Obstet Gynecol 2005;193(3 Pt 1):771–7.
• Tsui B, Dennehy CE, Tsourounis C. A survey of dietary supplement use during pregnancy at an academic medical center. Am J Obstet Gynecol 2001;185(2):433–7.
• Sarıkaya E, Çayırtepe Z. Gebelikte Farmakovijilans ve Teratojenisite. Ankara: Türkiye Anne, Çocuk ve Ergen Sağlığı Enstitüsü; 2018.
• Aslan S, Çoşkun AM, Oral G. Management and Care of Epilepsy During Pregnancy, Birth and Postpartum. Zeynep Kamil Tıp Bülteni. 2018;49(1):117-25.
• Coonrod D V, Jack BW, Stubblefield PG, et al. The clinical content of preconception care: infectious diseases in preconception care. Am J Obstet Gynecol 2008;199(6 Suppl 2):S296-309.
• Hibbert EJ, Chalasani S, Kozan P, et al. Preconception care and contraceptive use among Australian women with diabetes mellitus. Australian Journal of General Practice 2018;47(12):877-82.
• Shrestha BD, Ali M, Mahaini R, et al. A review of family planning policies and services in WHO Eastern Mediterranean Region Member States. Eastern Mediterranean Health Journal. 2019;25(2):127-33.
• Buldurucu S, Yazıcı S. Reasons for couples to prefer withdrawal method. HSP 2015;2(2):156-66.
• Kim J, Yon M, Kim C, et al. Preconceptional use of folic acid and knowledge about folic acidamong low-income pregnant women in Korea. Nutrition Research and Practice 2017;11(3):240-6.
• Milan JE, White AA. Impact of a stage-tailored, web-based intervention on folic acid-containing multivitamin use by college women. Am J Health Promot 2010;24(6):388–95.
• Malverdy Z, Kazemi A. Health beliefs and stages of changes to improve behaviors among obese and overweight women undergoing preconception care. Iran J Nurs Midwifery Res 2016;21(6):595–600.
• Shaye ZA, Bazzaz MM, Vakili V. A trans-theoretical approach to physical activity profile in general population of Mashhad. GJHS 2015;7(7):46-54.
• Pirzadeh A, Mostafavi F, Ghofranipour F, et al. Applying Transtheoretical Model to Promote Physical Activities Among Women. Iran J Psychiatry Behav Sci 2015;9(4):e1580.
• Velicer WF, Prochaska JO, Fava JL, et al. Interactive versus noninteractive interventions and dose-response relationships for stage-matched smoking cessation programs in a managed care setting. Health Psychol 1999;18(1):21–8.
• Aveyard P, Massey L, Parsons A, et al. The effect of Transtheoretical Model based interventions on smoking cessation. Soc Sci Med 2009;68(3):397–403.
• Handel G, Hannover W, Roske K, et al. Intention to change smoking in pregnant and postpartum women according to number of pregnancies. Eur J Public Health 2009;19(2):218–21.
• Shabani M, Omidi S, Farmanbar R, et al. Effect of preconception counseling on health promoting behaviors of reproductiveage women in Sari city. JNMS. 2016;3(2):1-10.
• Moshki M, Bahri N, Sadegh Moghadam L. Lifestyle of pregnant women living in Gonabad (Iran). J Res Health 2012;2(2):200-206.
• Tavakoli N. Examination of the relationship betweenhealth-promoting behaviors and family characteristics inhigh school girl students. J Urmia Nurs Midwifery Facul 2015;13(5):395-403.