Effectiveness of video Assisted Instructional Module on Antenatal Care on the Pregnancy outcome of pregnant women attending Maternity Hospitals, Bangalore

Dr. Pushpaveni. N. P

Professor, Govt. College of Nursing, BMCRI, Bangalore, Karnataka

*Corresponding Author Email: pushpaveni42@gmail.com

ABSTRACT:

Objectives: This study was undertaken with the aim to evaluate the effectiveness of Video assisted Instructional module on Antenatal care on the pregnancy outcome of pregnant women attending maternity hospitals, Bangalore and to find the association between the knowledge, pregnancy outcome and socio- demographic variables. The conceptual framework of the study was based on Pender’s Health Promotion model. The study was attempted to examine the hypotheses. Independent variable of the study was intervention in terms of Video assisted Instructional module on antenatal care. Dependant variable was knowledge gained by the antenatal mothers and pregnancy outcome as measured through structured interview schedule and observational check list and assessment formats. Methodology: An experimental approach with post test only control group design was used for the study. The subjects for the study were selected from Vanivilas and K. C. General maternity hospital by using purposive sampling technique. The total subjects under the study were 400 antenatal mothers. (200 for experimental group and 200 for control group) The data was collected by structured interview schedule and assessment formats which were designed to assess the knowledge of antenatal mothers regarding antenatal care and pregnancy outcome respectively. Results: Majority of subjects 92(46%) in experimental group and 88(44%) in control group were in the age group between 21- 24 years. Majority 108(54%) of experimental group 88(44%) of control group subjects have completed their high school education. About 115(57.5%) pregnant mothers of control group and 83(41%) of experimental group were home makers. Majority 181(90.5%) of experimental group and 133(66.5%) of control group pregnant women were Hindus. Majority 199 (99.5%) pregnant women of experimental group and 187(93.5%) of control group were from urban area. The overall knowledge score was 83.89% high in experimental group and compared to 41.11% in control group regarding antenatal care. The result shows that there was positive pregnancy outcome in experiment group compared to control group. There was significant association found between knowledge score and socio- demographic variables. Conclusion: The overall findings of the study revealed that there was significant increase in knowledge of antenatal mothers of experimental group regarding antenatal care after administration of Video Assisted Instructional Module and there was significant positive pregnancy outcome among experiment group antenatal mothers. Hence the Video Assisted Instructional Module was concluded as effective.

KEYWORDS:

INTRODUCTION:

Women have the right to enjoy the highest attainable standard of physical and mental health. Women are subject to particular health risks. Complications related to pregnancy and child birth are among the leading causes of mortality and morbidity in many parts of the developing world. Skilled antenatal care is necessary for the pregnant mothers who are attending antenatal OPD. Studies revealed that increased community awareness and antenatal care helps to improve maternal and new born care practices.

Women are subject to particular health risks due to inadequate responsiveness and lack of services to meet health needs related to sexual and reproduction. Complications related to pregnancy and child birth are among the leading causes of mortality and morbidity of women of reproductive age in many parts of the developing world. (Report 1997-2003). [1]

Although most pregnancies and birth are uneventful approximately 50% of pregnant women develop a potential life threatening complications that calls for skilled care during antenatal, intranatal and postnatal period. Well balanced diet ensures good health and natural beauty. Antenatal care means “care before birth”. It is systematic supervision of women during pregnancy. The objective is to ensure a normal pregnancy with delivery of a healthy baby from a healthy mother. A pregnant women herself plays a most important role in preparing for the arrival of her new baby. Pregnancy is a good time to concentrate on her health. A healthy diet and life style during pregnancy is important for the development of a healthy baby and may have long term beneficial effects on the health of the child. It is also important for all pregnant women to have regular checks with a midwife throughout pregnancy. This is to make sure that any condition that may pose a risk to the baby’s or mother’s health can be identified and treated.

The antenatal period present important opportunities for reaching pregnant women with a number of interventions that may be vital to their health and well being and that of their infants. Better understanding of fetal growth and development and its relationship to the mother’s health has resulted in increased attention to the potential of antenatal care as an intervention to improve both maternal and new born health.

Complications of child birth will more than 500,000 women each year. Postpartum hemorrhage (PPH) is the leading causing of death. Because nearly half the women who gave birth at home in developing countries are cared for by unskilled attendants (Sibley et al 2007). [2]

According to Syed U and Murray J (2006) immediate and early postnatal care for mothers and new born will reduce the maternal mortality and perinatal death. They found that increased community awareness helps to improve maternal and new born care practices. [3]

Deaths due to pregnancy and child birth are common among women in the reproductive age groups. Reduction of mortality of women has thus been an area of concern and government across the globe have set time bound target to achieve it. The international conferences on population and development in 1994 had recommended reduction in maternal mortality by at least 50% of the 1990 levels by the year 2000 and further one half by the year 2015.

Postnatal care: After child birth women may feel relieved as well as exhausted but this is not the end as more problems may tend to occur. During this period we should provide prompt care to reduce postnatal complications and to improve the mother’s and child’s health status. One should know about the possible complications and management. [4]

India accounts for more than 20% of the global maternal and child deaths, and also records 20% of births world wide. Approximately 30 million women in India experience pregnancy annually, and 27millions have live births of these, nearly 136,000 maternal deaths occur annually, most of which can be prevented. The maternal mortality ratio in India is 540 maternal deaths per 100,000 live births, rising to 619 in rural areas. States with high maternal mortality include Rajasthan, Madhya Pradesh, Jharkhand, Orissa, Uttar Pradesh and Bihar.

Given the high maternal mortality rate in India, the women who lose their lives as a result of pregnancy and childbirth remain invisible in general.

Maternal mortality is generally defined as the death of a woman during pregnancy or delivery or with in 42 days of the end of pregnancy from a pregnancy related cause. The major cause of maternal death are excessive bleeding during childbirth (Generally among home deliveries) obstructed and prolonged labor, infection, unsafe abortion, disorders related to high blood pressure and anemia. Forth seven percent of maternal deaths in rural India are attributed to excessive bleeding and anemia resulting from poor nutritional practices. Intermediate causes, which are the first and second delays in care – seeking, include the low social status of women, lack of awareness and knowledge at the household level, inadequate resources the seek care, and poor access to quality health care. Causes of third delay are untimely diagnosis and treatment, poor skills and trainees of care providers, and prolonged waiting time at the facility due to lack of trained personnel, equipment and blood. There are insufficient facilities for antenatal care and 65% of all deliveries are still conducted at home, very often by untrained.

Focused antenatal care, birth preparedness and complication readiness, skilled attendance at birth, care within first seven days and access to emergency obstetrics care are factors that can help reduce maternal mortality. At the same time knowledge also plays a vital role.

Promotion of maternal and child health has been one of the most important objectives of the family welfare program in India. The current Reproductive and Child Health Program (RCH) was launched in October 1997. The RCH Program incorporates the components covered under the child survival and safe motherhood program and included an additional component relating to reproductive tract infection and sexually transmitted infections. The need for bringing down maternal mortality and significantly and improving maternal health in general has been strongly stressed in the National Population Policy 2000. [6]

Pregnancy is the most important event in women’s life. Systematic supervision of women during pregnancy is called antenatal care. A study conducted by McPherson R. A. Khaddar, Moore JM, Sharma M (2006) showed that the birth preparedness package promotes active preparation and decision making for births, including pregnancy / postpartum periods, by pregnant women and their families.[6]

It is found that, education plays an important role in improving the maternal and child health. Nurse as an educator in the maternal and child health program, it is her responsibility to educate the antenatal mothers. Hence the investigator has selected video assisted instructional module to impart knowledge regarding antenatal, intranatal and postnatal care to the antenatal mothers, thereby complications related to pregnancy and childbirth can be prevented

THE OBJECTIVES OF THE STUDY:

1 To find out the socio–demographic profile of subjects in experiment and control group.

2 To find the effectiveness of video assisted instructional module regarding knowledge on antennal care.

3 To assess the effectiveness of video assisted instructional module on the pregnancy outcome of experiment and control group.

4 To find the association between the selected demographical variables with post-test knowledge score.

The following hypothesis were tested at 0.01 level of significance:

H₁: There will be a significant difference in knowledge of the subjects of experimental group after administration of video assisted instructional module regarding antenatal care compared to that of control group.

H₂: There will be a significant difference in pregnancy outcome of the study subjects in experimental group after administration of video assisted instructional module compared to that of control group.

H₃: There will be a significant association between the selected demographical variables and post-test knowledge score after administration of video assisted instructional module.

Conceptual framework:

adopted for this study was based on Pender’s Health promotion model. The conceptual frame work indicated that adequate knowledge and healthy life style improves the health of the mother and affect on pregnancy outcome.

METHODOLOGY:

An experimental study was conducted in two maternity hospitals. The control group was taken from Vanivilas Maternity Hospital and experiment group was taken from K.C. General Maternity Hospital in Bangalore. Both hospitals were similar in their setting, nature of patients seeking services. Four hundred pregnant mothers (200 for experimental and 200 for control group) were selected by purposive sampling technique.

An evaluative approach was adopted for this study. True experimental design with post test only control group design was used.

CRITERIA FOR SELECTION OF SAMPLES:

Inclusion criteria:

· Primigravidae with 10 – 16 weeks of gestation and seeking health services.

· Primigravidae who are willing to participate in the study.

Exclusion criteria:

· Primigravidae with multiple pregnancies.

· Primigravidae with high risk pregnancies.

The tool was developed by the investigator after reviewing the related literature and guidance from the experts in the field.

Section I: Socio demographic schedule consists of 10 items which include Age, educational status, occupation, monthly family income, religion, type of family, and previous source of information, residence, marital life and type of marriage.

Section II: Structured interview schedule regarding Knowledge on antenatal care consists of 45 items of multiple choices.

Section III: Antenatal, intranatal and postnatal care assessment formats and observational checklists, consists of 26 items on maternal and fetal/ newborn parameters which is used to assess the maternal and fetal / newborn well-being and identify the possible complications and also to assess the pregnancy outcome. The scoring was done by using checklist.

Section IV; Video Assisted Instructional module (VAIM) consists of 4 components.

· Physiological changes during pregnancy.

· Antenatal care.

· Intranatal care.

· Postnatal care.

Analysis was done by using descriptive and inferential statistics.

Pregnancy outcome findings of antenatal period regarding, Anemia, USG and Anomaly scan, fetal movements and Non stress test.

Parameters		Experiment		Control		c2 value	p value
Parameters		N	%	N	%	c2 value	p value
Anemia.	Absent	176	88.0%	115	57.5%	69.208	P<0.01*
Anemia.	Present	24	12.0%	85	42.5%	69.208	P<0.01*
Ultrasonography.	Absent	3	1.5%	58	29.0%	58.513	P<0.01*
Ultrasonography.	Present	197	98.5%	142	71.0%	58.513	P<0.01*
Anomaly scan.	Absent	6	3.0%	118	59.0%	111.823	P<0.01*
Anomaly scan.	Present	194	97.0%	82	41.0%	111.823	P<0.01*
Appreciation of Fetal movements	Absent	0	0.0%	185	92.5%	392.115	P<0.01*
Appreciation of Fetal movements	Present	200	100%	15	7.5%	392.115	P<0.01*

The result shows that, anemia was present in 85(42.5%) pregnant women in control group. and 24 (12%) in experimental group. Regarding routine ultrasonography 197(98%) women of experimental group had undergone, and 142(71%) pregnant women had in control group. Related to anomaly scan 194(97%) pregnant mothers had in experimental group and 82(41%) pregnant mothers had in control group. Related to fetal movements 200 (100%) pregnant mothers in experimental group and 15 (7.5%) mothers in control group felt the fetal movements and they have counted the movements. The difference observed was statistically significant. Regarding Non stress test 193 (96.5%) mothers in experimental group and 15 (7.5%) in control group had Non stress test procedure. It shows that the pregnant mothers in experimental group had the knowledge than the control group regarding the importance of investigations.

Association between socio-demographic variables and knowledge score of Experiment group.:

The result reveals that, there was significant association found between knowledge score and socio- demographic variables of experimental group such as, educational status, (20.929), occupation, (6.395), family monthly income, (25.466), type of family, (6.333), previous source of information about pregnancy care (14.059). Related to age, (1.368), religion, (0.177), residence, (1.253), marital life in years, (0.059) and consanguinity, the association was not observed.

Association between socio-demographic variables and knowledge score of control group.:

The result reveals that, there was significant association found between knowledge score and socio-demographic variables of control group such as, educational status (33.285), occupation (14.642), family monthly income (8.947), previous source of information about pregnancy care (9.205), and consanguinity (4.944) No association found between knowledge score and following socio- demographical variables, such as age (1.225), religion (3.481), type of family (1.262), residence (0.124) and marital life in years (2.623).

Hence the research hypothesis is accepted.

DISCUSSION:

In this study it reveals that the majority of antenatal mothers were belonged to the age group of 21-24 years similar study conducted by Pinheiro A and David Joseph (2001) had the same age group antenatal mothers. [7]

The antenatal mothers who has socio demographic and economic conditions of maternal factors such as age, parity, quality of antenatal care and previous obstetric history was influenced the risk factors during antenatal period. Similar study conducted by Nair NS, Rao RS, Chandrashekar (1994) found that the socio demographic valuables influences the quality antenatal care and found to be more at risk of having low birth basics. [8]

Education plays an important role. In this study the antenatal mothers who had high schools and above education level were able to follow recommended dietary practices during antenatal period. Pan war B and Punia D (1998) conducted a co-relational study found that the Pregnant Women who had education could able to take recommended dietary allowances with increase intake of protein, calcium and Iron. [9]

Related to number of samples in this study it was comprised of 400 samples (200 for experimental group and 200 for control group). A study conducted by Yadavas Saxena U (1997) also had selected 250 cases for study group and 400 for control group to determine the effect of hypertension. [10]

Related to socio-economic status, study evealed that there is impact of socio-economic states of knowledge, opinion and practices of antenatal mothers regarding antenatal care (Kumar R. Singh and Kaur M 1997). In this study it is found that socioeconomic status had no impact on knowledge of antenatal mothers regarding antenatal care. [11]

The effectiveness of birth-preparedness program was conducted by Mc Pherson RA, Khadka N. More J M (2006) revealed that it can positively influence knowledge and intermediate health outcomes similar report has been found in this study as there is improvement is experimental group’s perinatal outcome. [06]

In this study it is found that who had education program (experimental group) had used good delivery method and initiated breast feeding within half an hour of delivery compared to control group who had not received education. Similar study was conducted by Chien Ly; Tai CJ (2007) found the effectiveness of delivery method and timing of breast feeding initiation on breastfeeding outcomes in Taiwan. [12]

With related to impact of nutrition education in this study it is found that control group mothers had low birth weight babies. Similar study conducted by Sachdev R and Mann S K (2004) reported that who have not received the nutrition education programme their mean birth weight of new born (control group) was 2300 grams compared to experiment group’s new born weight was 2700 grams. [13]

Early detection of high risk factors among pregnant mothers is very important. This study is able to detect early complications. The study conducted by Misra PK, Takur S, Kumar A, (1997) found that who had inadequate or no antenatal care, bad obstetric history and prolonged labor attributed to 13, 20 and 27 percent of the risk respectively. [14]

The findings of the present study have several implications in the field of nursing education, nursing research, nursing practice and nursing administration.

Nursing education:

On the basis of findings there is a need to strengthen the knowledge input to nursing students and staff on components and objectives of antenatal care. Video assisted teaching module serves as a complimentary educational module should be included in the curriculum.

Nursing Research:

This study can be conducted in a large scale and the study will be reference for the researchers. In addition to Video assisted instructional module other teaching module can be tried out to find the effectiveness of the different modules.

Nursing Practice:

There is a need that the nurses in the clinical area should encourage individual conversation with the antenatal mothers as part of the basic program. Practice of antenatal mother’s involvement in antenatal intranatal and postnatal care lead to better pregnancy outcome.

Nursing Administration:

Institutions providing maternity services should review their policies and practices regarding antenatal mother’s involvement in antenatal, intranatal and postnatal care. Continuous videos programmes regarding antenatal, intranatal, postnatal and newborn care can be arranged at out patient departments. So that antenatal mothers will be aware of care to be taken during antenatal, intranatal and postnatal period.

RECOMMENDATIONS:

• The study can be replicated on larger samples, in different settings.

• The study can be conducted on family members of pregnant mothers.

• A comparative study can be done between Urban and Rural antenatal mothers.

• A study can be conducted as a longitudinal study / Retrospective study to assess the pregnancy outcome in different hospitals.

CONCLUSION:

A Video assisted instructional module was administered to the subjects in group settings. The post test assessment indicated that the effect of Video assisted instructional module is statistically significant in experiment group compared to that of control group. The overall comparison of knowledge score and pregnancy outcome of the experiment group with the control group revealed that the experiment subjects improved in knowledge regarding antenatal, intranatal and postnatal care and positive pregnancy outcome was observed.

REFERENCES:

1. World Health Organization; World Health Report: 2002; Geneva: WHO; 2005

2. Sibley L M, Blum L S, Kalim N, Hruschka D, Edmonds J K, Koblinsky M, “Women’s description of postpartum health problems, complications of child birth “Journal of midwifery women’s health, 2007, July-Aug;52 (4): 351-60

3. Syed U, Heral M S, Murray J, Asirruddin S, Immediate and early postnatal care for mothers and New born, J Health Popul Nutri.2006 Dec;24(4):508-18

4. Dutta D C, Text book of Obstetrics including Perinatology, 6^th ed. Calcutta, New central book agency ;2006.

5. National Population Policy Report: 2000

6. McPherson RA, Khadka N, Moore JM and Sharma M, “Birth preparedness programme effective”, J Health Popul Nitr 2006 Dec; 24 (4); 479-88.

7. Pinheiro A, David A, Joseph B, “Prenancy weight gain and its co-relation to birth weight” Indian J MedSci.2001. May; 55 (5):266-70

8. Nair N S, Rao R S, Chandrashekar S, Acharya D, Bhat H V, “Socio demographic and maternal determinants of lowbirth weight; a multivariate approach; Indian J Paeditr. 2000 Jan; 67 (1): 9-14

9. Panwar B, Punia D, “Nutrients intake of rural pregnant women of Haryana state, Northeren India, relationship between income and education “Int J Food Sci Nutr. 1998 Sep; 49 (5): 391-5

10. Yadav S, Saxena U, Yadav R, Gupta.” Hypertensive disorder of pregnancy and maternal and fetal outcome a case controlled study “J Indian Med Assoc.1997 Oct; 95 (10):548-51

11. Kumar R, Singh M M, Kaur M, “Impact of health centre availability on utilization of maternity care and pregnancy outcome in a rural area of Hariyana” J Indian Med Asso. 1997 Aug; 95(8)

12. Chien L Y and Tai C J, Effect of delivery method and timing of breast feeding initiation, Birth,2007, Jun;34(2):123-30

13. Shah D, Sach dev H P, “Maternal micronujtrients and fetal outcome” Indian J Paedtr. 2004 Nov; 71 (11) :985-90

14. Misra PK, Thakur S, Kumar A, Tandon S. Perinatal mortality in Rural India with special references to high risk pregnancies. J Trop Pediatr. 1993, Feb; 39 (1) :41-4.

Received on 06.02.2018 Modified on 03.07.2018

Asian J. Nursing Education and Research. 2018; 8(4):505-510.

DOI: 10.5958/2349-2996.2018.00103.9

Overall Score	Experiment		Control		c2 value	p value
Overall Score	n	%	N	%	334.369	P < 0.0001
< 50%	2	1.0	169	84.5
50-75%	27	13.5	31	15.5
> 75%	171	85.5	0	0.0
Total	200	100.0	200	100.0

	Group	n	Mean	SD	Min.	Max.	‘t’ value	‘p’ value
Weight	Experiment	200	56.7	4.542	41.0	70.0	2.700	0.0072
Weight	Control	200	55.3	5.756	35.0	65.0	2.700	0.0072
Hb%	Experiment	200	11.9	0.619	10.4	14.0	12.495	P<0.0001
Hb%	Control	200	11.0	0.809	8.9	13.0	12.495	P<0.0001