@2024 Afarand., IRAN
ISSN: 2383-2150 Journal of Education and Community Health 2019;6(3):169-176
ISSN: 2383-2150 Journal of Education and Community Health 2019;6(3):169-176
Factors Affecting the Intention to Choose the Natural vaginal delivery based on the Theory of Planned Behavior among Primigravidae
ARTICLE INFO
Article Type
Descriptive & Survey StudyAuthors
Yaghobi Z. (1)Mohaddes Hakkak H. (*2)
Tavakoli Ghoochani H. (2)
Joveini H. (1)
Maheri M. (3)
Taherpour M. (4)
Hosseini S.H. (5)
(1) Health Education & Health Promotion Department, Public Health Faculty, Sabzevar University of Medical Sciences, Sabzevar, Iran
(2) Health Education & Health Promotion Department, Public Health Faculty, North Khorasan University of Medical Sciences, Bojnurd, Iran
(3) “Reproductive Health Research Center” and “Public Health Department, Health Faculty”, Urmia University of Medical Sciences, Urmia, Iran
(4) Biostatistics Department, Public Health Faculty, North Khorasan University of Medical Sciences, Bojnurd, Iran
(5) “Carrier Transmitted Disease Research Center”,“Health Education & Health Promotion Department, Public Health Faculty”, North Khorasan University of Medical Sciences, Bojnurd, Iran
Correspondence
Address: Health Education & Health Promotion Department, Public Health Faculty, North Khorasan University of Medical Sciences, Bojnurd, Iran.Phone: +98 (58) 32240571
Fax: +98 (58) 32247281
mohaddes76@gmail.com
Article History
Received: February 18, 2019Accepted: April 7, 2019
ePublished: September 21, 2019
BRIEF TEXT
In the recent years, with regard to the uncontrolled growth of cesarean section (C-section) and the emphasis on increasing the indicator of Natural vaginal delivery (NVD) in Iran's Health System Transformation Plan, identifying the individual and social factors affecting this indicator have been necessary.
… [1-10]. Unnecessary C-section has many complications, such as wound infection, endometritis, increased mortality, pulmonary embolism, aspiration, preterm birth, neonatal respiratory problems, etc. for mother and infant compared to normal delivery. [2, 11]. One of the major consequences of cesarean delivery is excessive bleeding, which can be an important cause of threat to the mother's life, so that the first cause of death for pregnant women is postpartum hemorrhage [12, 13]. … [14-25]. Studies show that the constructs of theory of planned behavior (TPB) are good predictors of intention and subsequent behavior. … [26-37].
The aim of the present study was to determine the effective factors with the intention of choosing NVD based on the TPB among primigravidae in Neyshabour city.
This cross-sectional study is descriptive-analytical research
It was done on 340 primigravidae with the age of 18-35 years old women referred to comprehensive urban health care centers of Neyshabour city, in 2018.
Due to 95% confidence and 5% accuracy, the required sample size was estimated to be 340 subjects. According to previous studies, the variance of consciousness was considered to be 4.7 [38]. Inclusion criteria included consent to participate in the study, the first week to thirty weeks of pregnancy, age range of 18-35 years, and having an appropriate body mass index (18.5 to 29.9 kg/m2). Exclusion criteria included multiple births, indications for cesarean section (placenta previa, pelvic stenosis, genital herpes, microcephalus or macrosomia, Breech, etc.) and being in the high-risk pregnancy group (having heart disease, urinary tract infections, epilepsy, hypertension, preeclampsia and eclampsia).
Data collection tool was a two-part questionnaire; the first section included demographic information of subjects, including age, gestational age, employment status, spouse's job status and education and the second part was a researcher-made questionnaire based on the constructs of the TPB. Cronbach's alpha coefficient was used to determine the reliability of the questionnaire and it was completed by 25 pregnant mothers who met the inclusion criteria. Cronbach's alpha coefficient for attitude (behavioral beliefs + behavioral outcomes) was 0.82, for abstract norms (normative beliefs + motivation to comply) was 0.84, for perceived behavioral control (control beliefs + perceived power) was 0.82 and for behavioral intention obtained 0.76. Finally, data were analyzed by SPSS 17 software using descriptive statistics (mean, standard deviation, percent and frequency), Kolmogorov-Smirnov statistical tests (to check the normal distribution of data), Kruskal Wallis, Spearman correlation coefficient and multiple linear regression.
The mean age of participants was 24.3 ± 4.47 years and the mean gestational age was 4.93 ± 1.89 months. 83.5% of the participants were housewives and 55.9% reported their spouse's job non-governmental. 47.4% had a college education and 38.5% had diploma. There was a statistically significant relationship between the mean score of behavioral intention for NVD and participants' education (p = 0.04), however, no significant relationship was found between mean behavioral intention score and other demographic variables (p> 0.05; Table 1). 44.6% of participants intended to have cesarean delivery, 38.3% normal delivery and 17.0% did not have any idea about the type of delivery.The mean scores of the constructs of the TPB are presented in Table 2.Behavioral intention to perform NVD was positively and significantly correlated with all constructs of TPB (except for motivation to comply), as the score of these constructs increased, the behavioral intention score for natural delivery increased and vice versa (Table 3).
The results of this study showed that the attitude of pregnant mothers is one of the important predictors of choosing the type of delivery and there was a positive and significant correlation between these two constructs, as negative attitude towards vaginal delivery increases one's intention to have cesarean section and as the attitude toward natural childbirth improves, one's intention to choose this type of childbirth increases. Shahraki et al. [2] and Rahmati et al. [13] also stated in their studies that misconceptions about cesarean delivery outcomes were among the factors influencing the choice of this type of delivery. … [38-57]
It is suggested that future studies be done on patients referring to the private and rural centers.
Sampling from patients of comprehensive health services centers was one of the limitations of the present study.
The theory of planned behavior is suitable and useful for identifying the factors influencing the intention to perform NVD as well as designing and implementing educational interventions aimed at promoting NVD.
We are grateful to the Vice Chancellor for Education and Research of North Khorasan University of Medical Sciences, the pregnant women participating in the study, and all those who contributed to the design and implementation of this study.
None declared.
Data collection questionnaire did not contain any name and surname and exclusion and inclusion were voluntarily.
This study was funded by North Khorasan University of Medical Sciences.
TABLES and CHARTS
Show attach fileCITIATION LINKS
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[5]Yilmaz SD, Bal MD, Beji NK, Uludag S. Women’s preferences of method of delivery and influencing factors. Iran Red Crescent Med J. 2013;15(8):683-9.
[6]Montoya-Williams D, Lemas DJ, Spiryda L, Patel K, Neu J, Carson TL. What are optimal cesarean section rates in the U.S. and how do we get there? a review of evidence-based recommendations and interventions. J Womens Health. 2017;26(12):1285-91.
[7]Dadipoor S, Aghamolaei T, Ramezankhani A, Safari Moradabadi A. Comparison of health belief model constructs based on birth type among primiparous pregnant women in Bandar Abbas, Iran. J Educ Community Health. 2017;4(1):59-65. [Persian]
[8]Liu NH, Mazzoni A, Zamberlin N, Colomar M, Chang OH, Arnaud L, et al. Preferences for mode of delivery in nulliparous Argentinean women: a qualitative study. Reprod Health. 2013;10(1):2.
[9]Piroozi B, Moradi G, Esmailnasab N, Ghasri H, Farshadi S, Farhadifar F. Evaluating the effect of health sector evolution plan on cesarean rate and the average costs paid by mothers: A case study in Kurdistan province between 2013-2015. J Hayat. 2016;22(3):245-54. [Persian]
[10]Rezaei M, Dakhesh S, Fazli H. Comparison of frequency of cesarean section and its causes before and after implementation of the health system reform plan in Jahrom, Iran. Pars J Med Sci. 2017;15(4):36-45. [Persian]
[11]Hamzekhani M, Hamidzade A, Vasegh Rahimparvar SF, Montazeri AS. Effect of computerized educational program on self-efficacy of pregnant women to cope with childbirth. J Knowledge Health. 2014 ;9(1):13-20. [Persian]
[12]Saccone G, Caissutti C, Ciardulli A, Berghella V. Uterine massage for preventing postpartum hemorrhage at cesarean delivery: Which evidence? Eur J Obstet Gynecol Reprod Biol. 2018; 223:64-7.
[13]Rahmati Najarkolaei F , Eshraghi T , Dopeykar N , Zamani O. Determinants of delivery type selection by using theory of planned behaviors (TPB). J Urmia Nurs Midwifery Fac. 2015;12(12):1062-70. [Persian]
[14]Carvalho FA, Tenorio SB. Comparative study between doses of intrathecal morphine for analgesia after caesarean. Braz J Anesthesiol .2013;63(6):492-9.
[15]Sammour RN, Ohel G, Cohen M, Gonen R. Oral naproxen versus oral tramadol for analgesia after cesarean delivery. Int J Gynecol Obstet .2011;113(2):144-7.
[16]Karimy M, Niknami S, Hidarnia AR, Hajizadeh I Intention to start cigarette smoking among Iranian male adolescents: usefulness of an extended version of the theory of planned behaviour. Heart Asia.2012;4(1):120-4.
[17]Mohammaditabar S, Rahnama P, Mohammadi K. Cesarean section on maternal request in Tehran 2010-2011: incidence and predisposing factors. J Mazandaran Univ Med Sci. 2014;24(114):74-82. [Persian]
[18]Rahimi T, Dehdari T, Faryabi R, Ghazvinian L. The applicability of the theory of planned-behavior in predicting the intention to exclusive breast-feeding among pregnant women in Qom in 2014. J Rafsanjan Univ Med Sci. 2015;14(4):299-310. [Persian]
[19]Zakerihamidi M, Roudsari RL, Khoei EM, Kazemnejad A. Decision-making for vaginal delivery in the North of Iran: A focused ethnography. Iran J Nurs Midwifery Res. 2014;19(7 Suppl 1):S37-44.
[20]Latifnejad Roudsari R, Zakeri Hamidi M, Merghati Khoei E, Kazemnejad A. Comparing the cultural beliefs related to mode of delivery among pregnant women and women with childbirth experiences as vaginal delivery or cesarean section (Tonekabon, 2014). J Mazandaran Univ Med Sci. 2015;24(120):54-68. [Persian]
[21]McGrath P, Phillips E, Vaughan G. Vaginal birth after caesarean risk decision‐making: Australian findings on the mothers' perspective. Int J Nurs Pract .2010;16(3):274-81.
[22]Kasai KE, Nomura RM, Benute GR, de Lucia MC, Zugaib M. Women's opinions about mode of birth in Brazil: a qualitative study in a public teaching hospital. Midwifery 2010;26(3):319-26.
[23]Roostai Shalmaii M, Rakhshani F, Ramezankhani A, Soori H. Effect of education based on the theory of planned behavior on preventive behaviors of aggression. J Saf Promot Inj Prev. 2016;4(1):39-46. [Persian]
[24]Javadzade H, Sharifirad G, Reisi M, Nasr Esfahani M, Mahaki B, Mostafavi F. Applying the theory of planned behavior to predicting nurse’s intention and behavior in using health literacy strategies in patient education. Iran J Nurs. 2015;28(97):23-33. [Persian]
[25]Hosseini F, Farshidi H, Aghamolaei T, Madani A, Ghanbarnejad A. The impact of an educational intervention based on PRECEDE - PROCEED model on lifestyle changes among hypertension patients. Iran J Health Educ Health Promot. 2014;2(1):17-27. [Persian]
[26]Vafaei Najar A, Masihabadi M, Moshki M, Ebrahimipour H, Tehrani H, Esmaili H, et al. Determining the theory of planned behavior's predictive power on adolescents' dependence on computer games. Iran J Health Educ Health Promot. 2015;2(4):303-11. [Persian]
[27]Kanani S, Allahverdipour H, AsghariJafarabadi M. Modeling the intention to choose natural vaginal delivery: using reasoned action and social cognitive theories. Health Promot Perspect. 2015;5(1):24-33.
[28]Moeini B, Allahverdipour H, Mahjoub H, Bashirian S. Evaluation of beliefs, behavioral intention and predictive of cesarean section from the perspective of pregnant women in Hamedan. Iran J Obstet Gynecol Infertil. 2011;14(3):37-44. [Persian]
[29]Hamilton K, Daniels L, White KM, Murray N, Walsh A. Predicting mothers' decisions to introduce complementary feeding at 6 months. An investigation using an extended theory of planned behavior. Appetite .2011;56(3):674-81.
[30]Saisto T, Halmesmaki E. Fear of child birth: a neglected dilemma. Acta Obstet Gynecol Scand. 2003;82(3):201-8.
[31]Ashoogh M, Aghamolaei T, Ghanbarnejad A, Tajvar A. Utilizing the theory of planned behavior to Prediction the safety driving behaviors in truck drivers in Bandar Abbas 1392. Iran J Health Educ Health Promot. 2013;1(3):5-14. [Persian]
[32]Yosefvand M, Khorsandi M, Roozbahani N, Ranjbaran M. Affecting factors fear of childbirth based on the theory of planned behavior in pregnant women in Aleshstar in 2015. Avicenna J Nurs Midwifery care. 2017;25(4):114-20. [Persian]
[33]Araban M, Karimy M, Taher M, Bayati S, Bakhtiari A, Abrehdari H, et al . Predictors of tobacco use among medical students of Ahvaz University: a study based on theory of planned behavior. J Educ Community Health. 2015;2(1):10-8. [Persian]
[34]Karimy M, Niknami S, Heidarnia AR, Hajizadeh I, Montazeri A. Prevalence and determinants of male adolescents’ smoking in Iran: An explana-tion based on the theory of planned behavior. Iran Red Crescent Med J. 2013;15(3):187-93.
[35]Karimy M, Niknami S, Heidarnia AR, Hajizadeh I. Measuring constructs of Theory of Planned Behavior (TPB) regarding cigarette use among adolescents. J Kermanshah Univ Med Sci .2013;16(8):617-25. [Persian]
[36]Rahnama P, Mohammadi K. Behavioral beliefs about cesarean section according to the theory of planned behavior in pregnant women. J Mazandaran Univ Med Sci. 2015;24(122):169-78. [Persian]
[37]Armitage CJ. Can the theory of planned behavior predict the maintenance of physical activity? Health Psychol. 2005;24(3):235-45.
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