Abstract
Background and Objectives: Preconception care involves health promotion, screening, and interventions for women and men to reduce the risk factors with the potential effect on their future pregnancies; the present research is aimed at investigating the effect of planned behavior theory on the knowledge, attitude, subjective norms, perceived behavior, self-control, intention, and practices of preconception care.
Methods: This is a controlled randomized trial study to examine the impacts on the intentions and conductance of the preconception care among the women referring to a marriage consulting center. To this end, 110 women referring to the marriage counseling centers of Asad Abad city in Iran were selected and then divided into two groups. The educational sessions were held twice a week in four 60-minute sessions for the intervention group, while the control group received no intervention. Wilcoxon and Mann-Whitney and ϰ2 were employed for data analysis at the significance level of 0.05. The reliability of the tools was evaluated using Cronbach Alpha.
Findings: The results indicated a significant difference between the two groups in terms of awareness (14.27 ± 1.53 vs. 5.32 ± 2.95), attitudes (45.89 ± 3.52 vs. 36.36 ± 6.77), subjective norms (30.01 ± 3.34 vs. 26.38 ± 4.10), and perceived behavioral control (23.10 ± 2.06 vs. 18.87 ± 4.61) for the intervention and control groups, respectively (P = 0.001). Also, 89% of the intervention group (vs. 4% of the controls) tried to make the record for preconception care.
Conclusion: The theory of planned behavior can effectively improve awareness, attitude, and perceived behavioral control in women. This theory also improved the behavioral intention of women toward preconception care. The midwives and physicians are recommended to use this educational method in health centers to motivate the women to take preconception counseling with the help of health providers.
Keywords: Reproductive health, women health, preconception care, prenatal care, cronbach alpha, preterm birth.
Graphical Abstract
[1]
Johnson, K.; Posner, S.F.; Biermann, J.; Cordero, J.F.; Atrash, H.K.; Parker, C.S.; Boulet, S.; Curtis, M.G. Recommendations to improve preconception health and health care--United States. A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR Recomm. Rep., 2006, 55(RR-6), 1-23.
[PMID: 16617292]
[PMID: 16617292]
[2]
Ayalew, Y.; Mulat, A.; Dile, M.; Simegn, A. Women’s knowledge and associated factors in preconception care in adet, West Gojjam, Northwest Ethiopia: A community based cross sectional study. Reprod. Health, 2017, 14(1), 15.
[http://dx.doi.org/10.1186/s12978-017-0279-4] [PMID: 28122628]
[http://dx.doi.org/10.1186/s12978-017-0279-4] [PMID: 28122628]
[3]
Khorsandi, M.; Valayi Aziz, M.; Ranjbaran, M.; Vakilian, K. Predicting the intention to preconception care on the basis of planning behavior theory in women referred to the marriage counseling centers in Asadabad in 2015. Curr. Womens Health Rev., 2021, 17(3), 218-223.
[http://dx.doi.org/10.2174/1573404816999201005213601]
[http://dx.doi.org/10.2174/1573404816999201005213601]
[4]
Dadipoor, S.; Mehraban, M.; Ziapour, A.; Safari Moradabadi, A. Causes of maternal mortality in Iran: A systematic review. Int. J. Pediatr., 2017, 5(12), 6757-5770.
[http://dx.doi.org/10.22038/ijp.2017.26983.2325]
[http://dx.doi.org/10.22038/ijp.2017.26983.2325]
[5]
Beigi, M.; Jahanian Sadatmahaleh, S.; Changizi, N.; Mohammadi, E.; Kazemi, A. Analysis of the Iranian maternal mortality surveillance system and providing system improvement strategies: Study protocol for strategy formulation. Reprod. Health, 2020, 17(1), 111.
[http://dx.doi.org/10.1186/s12978-020-00963-2] [PMID: 32703296]
[http://dx.doi.org/10.1186/s12978-020-00963-2] [PMID: 32703296]
[6]
World health organization:. Maternal mortality in 2000-2017. Internationally comparable MMR estimates by the Maternal Mortality Estimation Inter-Agency Group (MMEIG) WHO, UNICEF, UNFPA, World bank group and the united nations population division. Available from: https://www.who.int/gho/maternal_health/countries/irn.pdf
[7]
Alkema, L.; Chou, D.; Hogan, D.; Zhang, S.; Moller, A-B.; Gemmill, A.; Fat, D.M.; Boerma, T.; Temmerman, M.; Mathers, C.; Say, L. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: A systematic analysis by the UN maternal mortality estimation inter-agency group. Lancet, 2016, 387(10017), 462-474.
[http://dx.doi.org/10.1016/S0140-6736(15)00838-7] [PMID: 26584737]
[http://dx.doi.org/10.1016/S0140-6736(15)00838-7] [PMID: 26584737]
[8]
Daemi, A.; Ravaghi, H.; Jafari, M. Risk factors of neonatal mortality in Iran: A systematic review. Med. J. Islam. Repub. Iran, 2019, 33, 87.
[http://dx.doi.org/10.47176/mjiri.33.87] [PMID: 31696081]
[http://dx.doi.org/10.47176/mjiri.33.87] [PMID: 31696081]
[9]
Frederick, I.O.; Rudra, C.B.; Miller, R.S.; Foster, J.C.; Williams, M.A. Adult weight change, weight cycling, and prepregnancy obesity in relation to risk of preeclampsia. Epidemiology, 2006, 17(4), 428-434.
[http://dx.doi.org/10.1097/01.ede.0000221028.33245.0b] [PMID: 16755262]
[http://dx.doi.org/10.1097/01.ede.0000221028.33245.0b] [PMID: 16755262]
[10]
Atrash, H.; Jack, B. Preconception care to improve pregnancy outcomes: Clinical practice guidelines. J. Hum. Growth Dev., 2020, 30(3), 407-416.
[http://dx.doi.org/10.7322/jhgd.v30.11075]
[http://dx.doi.org/10.7322/jhgd.v30.11075]
[11]
Tamura, N.; Hanaoka, T.; Ito, K.; Araki, A.; Miyashita, C.; Ito, S.; Minakami, H.; Cho, K.; Endo, T.; Sengoku, K.; Ogasawara, K.; Kishi, R. Different risk factors for very low birth weight, term-small-for-gestational-age, or preterm birth in Japan. Int. J. Environ. Res. Public Health, 2018, 15(2), 369.
[http://dx.doi.org/10.3390/ijerph15020369] [PMID: 29466290]
[http://dx.doi.org/10.3390/ijerph15020369] [PMID: 29466290]
[12]
He, Z.; Bishwajit, G.; Yaya, S.; Cheng, Z.; Zou, D.; Zhou, Y. Prevalence of low birth weight and its association with maternal body weight status in selected countries in Africa: A cross-sectional study. BMJ Open, 2018, 8(8), e020410.
[http://dx.doi.org/10.1136/bmjopen-2017-020410] [PMID: 30158218]
[http://dx.doi.org/10.1136/bmjopen-2017-020410] [PMID: 30158218]
[13]
World Health Organization. World Health Organization: Meeting to develop a global consensus on preconception care to reduce maternal and childhood mortality and morbidity: World Health Organization Headquarters, Geneva, 6–7 February 2012: meeting report. 2013.
[14]
Habte, A.; Dessu, S.; Haile, D. Determinants of practice of preconception care among women of reproductive age group in Southern Ethiopia, 2020: Content analysis. Reprod. Health, 2021, 18(1), 100.
[http://dx.doi.org/10.1186/s12978-021-01154-3] [PMID: 34020669]
[http://dx.doi.org/10.1186/s12978-021-01154-3] [PMID: 34020669]
[15]
Catalao, R.; Mann, S.; Wilson, C.; Howard, L.M. Preconception care in mental health services: Planning for a better future. Br. J. Psychiatry, 2020, 216(4), 180-181.
[http://dx.doi.org/10.1192/bjp.2019.209] [PMID: 31685038]
[http://dx.doi.org/10.1192/bjp.2019.209] [PMID: 31685038]
[16]
Chivers, B.R.; Boyle, J.A.; Lang, A.Y.; Teede, H.J.; Moran, L.J.; Harrison, C.L. Preconception health and lifestyle behaviours of women planning a pregnancy: A cross-sectional study. J. Clin. Med., 2020, 9(6), 1701.
[http://dx.doi.org/10.3390/jcm9061701] [PMID: 32498329]
[http://dx.doi.org/10.3390/jcm9061701] [PMID: 32498329]
[17]
Goshu, Y.A.; Liyeh, T.M.; Ayele, A.S.; Zeleke, L.B.; Kassie, Y.T. Women’s awareness and associated factors on preconception folic acid supplementation in Adet, Northwestern Ethiopia, 2016: Implication of reproductive health. J. Nutr. Metab., 2018, 2018, 4936080.
[http://dx.doi.org/10.1155/2018/4936080] [PMID: 30116639]
[http://dx.doi.org/10.1155/2018/4936080] [PMID: 30116639]
[18]
Ganganna, A.; Devishree, G. Opinion of dentists and gynecologists on the link between oral health and preterm low birth weight: “Preconception care - treat beyond the box”. J. Indian Soc. Pedod. Prev. Dent., 2017, 35(1), 47-50.
[http://dx.doi.org/10.4103/0970-4388.199231] [PMID: 28139482]
[http://dx.doi.org/10.4103/0970-4388.199231] [PMID: 28139482]
[19]
Khayeri, A.; Mahmoodi, Z.; Rahimzadeh, M.; Salehi, L.; Moghadam, Z.B.; Saeieh, S.E. Effect of the theory of planned behavior education on nutritional behaviors of overweight and obese women before pregnancy. Int. J. Women’s Health Reprod. Sci., 2019, 7(4), 471-477.
[http://dx.doi.org/10.15296/ijwhr.2019.78]
[http://dx.doi.org/10.15296/ijwhr.2019.78]
[20]
Hamilton, K.; Fleig, L.; Henderson, J.; Hagger, M.S. Being active in pregnancy: Theory-based factors associated with physical activity among pregnant women. Women Health, 2018, 59(2), 1-16.
[http://dx.doi.org/10.1080/03630242.2018.1452835] [PMID: 30040597]
[http://dx.doi.org/10.1080/03630242.2018.1452835] [PMID: 30040597]
[21]
Kang, S.Y.; Kim, H.W. Comparison of awareness about alcohol use during pregnancy among female college students by drinking levels: Using the theory of planned behavior. J. Korean Acad. Nurs., 2019, 49(6), 690-700.
[http://dx.doi.org/10.4040/jkan.2019.49.6.690] [PMID: 31932564]
[http://dx.doi.org/10.4040/jkan.2019.49.6.690] [PMID: 31932564]
[22]
Alami, A.; Tavakoly Sany, S.B.; Lael-Monfared, E.; Ferns, G.A.; Tatari, M.; Hosseini, Z.; Jafari, A. Factors that influence dietary behavior toward iron and vitamin D consumption based on the theory of planned behavior in Iranian adolescent girls. Nutr. J., 2019, 18(1), 8.
[http://dx.doi.org/10.1186/s12937-019-0433-7] [PMID: 30728026]
[http://dx.doi.org/10.1186/s12937-019-0433-7] [PMID: 30728026]
[23]
Ghaffari, M.; Rakhshanderou, S.; Harooni, J.; Mehrabi, Y.; Ebrahimi, A. Prenatal interventional program about mothers’ behavior related to exclusive breast feeding: Findings of planned behavior theory-based research. J. Lifestyle Med., 2019, 9(2), 143-149.
[http://dx.doi.org/10.15280/jlm.2019.9.2.143] [PMID: 31828034]
[http://dx.doi.org/10.15280/jlm.2019.9.2.143] [PMID: 31828034]
[24]
Sharma, M.; Romas, J.A. Theoretical Foundations of HEALTH Education and Health Promotion; Jones & Bartlett Publishers: Sudbury, MA, 2011.
[25]
Ajzen, I. The theory of planned behavior. Organ. Behav. Hum. Decis. Process., 1991, 50(2), 179-211.
[http://dx.doi.org/10.1016/0749-5978(91)90020-T]
[http://dx.doi.org/10.1016/0749-5978(91)90020-T]
[26]
Ajzen, I. Perceived behavioral control, self‐efficacy, locus of control, and the theory of planned behavior 1. J. Appl. Soc. Psychol., 2002, 32(4), 665-683.
[http://dx.doi.org/10.1111/j.1559-1816.2002.tb00236.x]
[http://dx.doi.org/10.1111/j.1559-1816.2002.tb00236.x]
[27]
Ghaffari, F.; Jahani Shourab, N.; Jafarnejad, F.; Esmaily, H. Application of Donabedian quality-of-care framework to assess the outcomes of preconception care in urban health centers, Mashhad, Iran in 2012. JMRH, 2014, 2, 50-59.
[28]
Oluka, O.C.; Nie, S.; Sun, Y. Quality assessment of TPB-based questionnaires: A systematic review. PLoS One, 2014, 9(4), e94419.
[http://dx.doi.org/10.1371/journal.pone.0094419] [PMID: 24722323]
[http://dx.doi.org/10.1371/journal.pone.0094419] [PMID: 24722323]
[29]
Fazeli, N.; Moradi, M.; Khadivzadeh, T.; Esmaily, H. Effect of preconception care education by health volunteers on knowledge and attitudes of women: Application of the health belief model. EBCJ, 2018, 8, 76-81.
[http://dx.doi.org/10.22038/ebcj.2018.28654.1709]
[http://dx.doi.org/10.22038/ebcj.2018.28654.1709]
[30]
Curtis, M.G. Preconception care: Clinical and policy implications of the preconception agenda. J. Clin. Outcomes Manag., 2010, 17, 30-38.
[31]
Gautan, P.; Dhakal, R. Knowledge on preconception care among reproductive age women. Saudi J. Med. Pharm. Sci., 2016, 2, 6.
[32]
Kassa, A.; Yohannes, Z. Women’s knowledge and associated factors on preconception care at Public Health Institution in Hawassa City, South Ethiopia. BMC Res. Notes, 2018, 11(1), 841.
[http://dx.doi.org/10.1186/s13104-018-3951-z] [PMID: 30486891]
[http://dx.doi.org/10.1186/s13104-018-3951-z] [PMID: 30486891]
[33]
Frayne, D.J. Preconception care is primary care: A call to action. Am. Fam. Physician, 2017, 96(8), 492-494.
[PMID: 29094899]
[PMID: 29094899]
[34]
Kizirian, N.V.; Black, K.I.; Musgrave, L.; Hespe, C.; Gordon, A. Understanding and provision of preconception care by general practitioners. ANZJOG, 2019, 59, 799-804.
[http://dx.doi.org/10.1111/ajo.12962]
[http://dx.doi.org/10.1111/ajo.12962]
[35]
Hussein, N.; Kai, J.; Qureshi, N. The effects of preconception interventions on improving reproductive health and pregnancy outcomes in primary care: A systematic review. Eur. J. Gen. Pract., 2016, 22(1), 42-52.
[http://dx.doi.org/10.3109/13814788.2015.1099039] [PMID: 26610260]
[http://dx.doi.org/10.3109/13814788.2015.1099039] [PMID: 26610260]
[36]
de Jong-Potjer, L.C.; de Bock, G.H.; Zaadstra, B.M.; de Jong, O.R.; Verloove-Vanhorick, S.P.; Springer, M.P. Women’s interest in GP-initiated pre-conception counselling in The Netherlands. Fam. Pract., 2003, 20(2), 142-146.
[http://dx.doi.org/10.1093/fampra/20.2.142] [PMID: 12651787]
[http://dx.doi.org/10.1093/fampra/20.2.142] [PMID: 12651787]
Article Metrics
4