@2024 Afarand., IRAN

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ISSN: 2383-2150    Journal of Education and Community Health 2015;1(4):11-21

Background
Nutrition is a vital factor during pregnancy which has effects on bothfetus and mother`s health as well as the outcome of pregnancy[1].
Previous Studies
... [2-12]. Inappropriate consumption of food groups in pregnant women has been reported in previous studies (8). One of the most effective theories used to predict and explain nutritional behavior is Albert Bandura's Social Cognitive Theory[13]. Social cognitive theory states that individual and environmental characteristics affect behavior; this theory believes in mutual interactions of the individual, the behavior and environment [14]. ... [15-28].
Aim(s)
This study aimed to investigate predictive factors of nutritional behaviors among pregnant women in Tabriz based on the social cognitive theory.
Research type
This study is analytical.
Research society, place and time
This study was carried out on 380 pregnant women who had referred to health centers of Tabriz in 2014.
Sampling method and number
Among the health centers of Tabriz, 10 of them were selected as the research sample which had the largest population of pregnant women. Sampling in this study was through a multi-stage random method; thus considering that the city of Tabriz consists of 9 geographical areas, 10 urban health centers with the largest population of covered pregnant women were selected as the research society and were randomly included in the study based on having the criteria for entering the study. These criteria included the age range of 15 to 45, not having any acute and chronic physical and mental diseases, having health records in the health center, referring to these centers for services and completing letters of consent by pregnant women. Exclusion criteria were regarded as refusing to continue the participation in the study by the participants, the inability to respond to the questions, and people with severe disease.
Used devices&materials
Data collection instruments consisted of three parts in this study: demographic characteristics, the researcher-made questionnaire containing questions related to social cognitive theory constructs and the questionnaire of nutritional behavior of which their reliability and validity have been confirmed in previous studies (16).The questionnaire of social cognitive theory was prepared after reading books and articles on the topic and its reliability was achieved by reviewing the opinions of a few specialists on health education and health improvement,and through CVR and CVI evaluation. In the preliminary survey, the CVR index for the entire instruments was above0.8. After applying the recommended amendments, content validity index (CVI) for all the measures was calculated higher than 0.9. The reliability of the questionnaire was achieved through interviewing 30 pregnant women in the form of a preliminary study and Cronbach's alpha coefficient was examined. Internal correlation for knowledge, outcome expectations, outcome expectancies, self-efficacy, social support and self-regulation was 0.71, 0.82, 0.89, 0.83, 0.70 and 0.76, respectively. Demographic characteristics were evaluated through 15 questions. Social cognitive theory constructs comprised of 7 questions of nutritional knowledge with “yes, no, or I do not know” answers. Grading was in the form of zero and one for each question, so the maximum attainable score was7. The minimum and maximum scores for 9 questions of outcome expectations, 9 outcome expectancies questions, 7 questions of self-efficacy, 9 social support questions, and 7 questions of self-regulation all with the answers of completely agree (5) to strongly disagree (1)were considered 9 - 45, 9 - 45, 7 - 35, 9 - 45, and 7 – 35, respectively. Nutritional behavior questions consisted of two parts: the first part contained 16 questions of nutritional behavior in pregnant women and in dealing with common problems during this time. The second part had5 questions about food stocks which were completed by pregnant women after explaining the instructions for completing the questionnaires. Anthropometric data such as weight and height was measured and BMI was also performed during pregnancy. The purpose of adequate consumption of food groups was receiving enough proportions from each of the food groups, based on the amounts recommended in the food pyramid.Moreover, the purpose of suitable nutritional behavior for preventing and treating common pregnancy problems like constipation, heartburn, swelling of hands and feet, anemia and urinary tract infection, was using a variety of foods including increased consumption of fruits, vegetables, liquids, the number of meals and other approaches to nutritional behavior which was mentioned in the answers. Questions of nutritional behavior varied from 2 to 6 options and people were asked to choose one or more options for each question. Therefore, to match the scores, all the questions became standard according to a study by Mohammad Alizadeh et al (16) in a way that in case of selecting all the correct options for each question, it gets the score of 100 and in case of selecting no correct options, the question is scored zero and if some of the options are selected correctly, a score range of 0 to 100 is given based on the selected correct options of all the options for each question. Finally, the general nutritional behavior scores were calculated by dividing the total points earned from all the questions to the total number of questions. Classification of the questions was as follows: the meanscores from 0 to 33.33, 33.34- 66.67, and greater than 66.67 were in low, average and good levels, respectively. Statistical analysis: Data were analyzed through SPSS statistical software (version 20) and by using linear regression and Pearson correlation tests. The level of significance was considered less than 0.05 for all tests.
Findings by Text
Almost half of women (46.1%) were pregnant for the first time. Most of the participants (32.9%) aged between 26 to 30 with the mean and standard deviation of 27.56 ± 5.52, and in the range of 15 to 43 years in the study. Most of the participants were housewives (87.6%) and (44.7%) had Diplomas. 39.7% of women participated in the study were fat (with a body index of 29.9 and more). Most of the subjects` income (47.6%) was between 400 and 700 thousand Tomans. Most of the participants in the study (63.4%) were pregnant intendedly. The demographic characteristics frequency of the participants is presented in Table 1. According to the results of figure1, insufficient consumption of bread and cereal, meat and beans, fruits, and vegetables was reported in 207 (54.5%), 278 (73.2%), 210 (55.3%), and 268 patients (70.5%), respectively. The use of milk and dairy products in 218 patients (57.4%) was reported favorable. Food proportions of 93 women (24.5%) had decreased compared to before pregnancy and 248 women (65.3%) had also reduced the intake of dairy products. The majority of people (90%) had an appropriate consumption of folic acid, iron (82.89%) and multivitamin (78.16%).According to Table 2, the nutritional behaviors in the prevention of constipation, heartburn, swelling in hands and feet,anemia, and urinary tract infection were on the average level and below in 159 (41.8%), 226 (59.5%), 241 (63.4%) 85 patients (22.4%), and 260 patients (68.4%), respectively.Descriptive statistics and correlation coefficient matrix between the constructs of social cognitive theory are presented in Table 3. According to statistical test results, knowledge had a positive and significant correlation with outcome expectancies, self-efficacy, social support and self-regulation. Furthermore, the correlation of outcome expectancies with self-efficacy, social support and self-regulation was positive and significant. The same correlation existed in self-efficacy construct with social support and self-regulation constructs; so did the social support with self –regulation construct (p<0.05).Linear regression test analysis showed that different constructs of social cognitive theory explain 16% of nutritional behaviors ` variance in pregnant women who had been studied in general. Among the constructs studied, outcome expectations (p=0.039),the outcome expectancies (p=0.046), knowledge (p=0.043) and self-regulation (p<0.001) had a significant proportion in explaining the variance of nutritional behaviors among pregnant women (Table 4).
Main comparison to the similar studies
The results of the study by Fowles et al. illustrated a strong positive correlation between the inner belief and its desirable eating habits [29] ... [30]. The results of this study showed a significant relationship between the education and self-efficacy for applying nutritional behaviors. In the study by Rojas et al., father`s education has had an influence on the consumption of vegetables and fruits andthe calcium amount of foods for adolescents such that students whose fathers had higher education consume vegetables and fruits more[27].... [31-34]. These findings are in line with previous studies in the use of social cognitive theory in predicting of different nutritional behaviors that report the amount of prediction less than 30%[35].
Suggestions
Non-declared
Limitations
Using questionnaires and self-reporting methodwere the limitation of the study.
Conclusions
Knowledge, outcome expectations, outcome expectancies and self-regulation can be effective for designing educational interventions to achieve healthy nutritional behaviors in pregnant women.
Acknowledgments
Many thanks are addressed to the authorities of The University of Medical Science, personnel of the health centers of Tabriz, and pregnant women who participated in this study.
Conflict of interest
The personal interests of authors have not been associated with the results of this study.
Ethical Permissions
Letters of consent were intentionally completed by pregnant women.
Funding Sources
This article is taken from approved projects by University of Medical Sciences and Health Services of Hamadan (under the registration number of 9306253121) and is financially supported by Vice Chancellor for Research and Technology (Social Determinants of Health Research Center)

TABLES and CHARTS

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