@2024 Afarand., IRAN

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ISSN: 2383-2150    Journal of Education and Community Health 2019;6(2):119-125

Background
Due to the high sensitivity of pregnancy and the vulnerability of mothers during this period, their participation in clinical decisions is very important.
Previous Studies
... [4-12]. Active collaboration between physician and patient has recently been considered by shared decision making (SDM) studies. ... [13-32]. According to the Ethics and Reproductive Health committee the International Confederation of Midwives (ICM), the pregnant women have the right to be informed about benefits and disadvantages of different treatments and to participate in the decision-making process of treatment and care. Another right for pregnant women is that the treatment team provide them with all the information necessary to make diagnostic and therapeutic decisions, including the benefits and complications of the selected treatment [33]. Educational intervention in pregnant mothers has reduced hospital stay, increased natural childbirth, decreased prenatal problems and increased satisfaction in pregnant mothers [34]. Patient participation is described as a continuum from the customer-oriented approach to demographic-oriented approach and four types are outlined to make patient able for making healthcare decisions: 1) giving information to the patient, 2) consulting, 3) engaging the patient in decision-making, and 4) make patient able in decision-making [35]. Training and counseling are two of the key roles of the health team; however, it is less addressed [36]. … [37].
Aim(s)
This study aimed to investigate the effect of individual counseling on the participation of pregnant mothers in decision making on the treatment process.
Research type
This research is a randomized clinical trial with control group.
Research society, place and time
This study was carried out on pregnant women who referred to Kosar medical-education center in Qazvin in 2018.
Sampling method and number
Pregnant mothers who met the inclusion criteria were selected through purposive sampling. Inclusion criteria included 10 to 36 weeks gestation, willingness to participate in research, and no history of neuropsychiatric disorders (self-report) and the exclusion criteria included pregnant mothers requiring immediate referral, pregnant mothers complaining of labor pain, and pregnant mothers without needed consciousness. Sample size was estimated 86 patients for each group according to the Hillary Becker (2004) [38] and with respect to the mean obtained in control and test groups (3.94 ± 0.36 and 3.77 ± 0.43) and α = 0.05 and β = 0.2 and the final sample size was estimated to be 172 subjects and due to the 10% sample loss 190 subjects were considered. 95 patients were included in the study for each group.
Used devices&materials
The data collection tool was a checklist consisting of two sections: demographic information and pregnancy information. The SDM-Q-9 questionnaire was also used to assess the patients' participation in decision making [39-41]. The intervention was done in a personal consultation with the clinic coordinator in a room of the clinic prepared for consultation. Counseling for the test group was done in a session of up to 60 minutes after examination by an expert. At the consultation session, the researcher identified the topic at the beginning of the session and after providing understandable information on the topic, by asking questions, the patient entered the discussion and thereby identified his or her needs and problems. Then, with the active cooperation and involvement of the patient, they explained about the performance and the right method for problem solving and also the necessary corrections, so that the patient could make the right decision. The decision-making areas for mothers were fetal health tests and pregnancy screening and ultrasound. Prior to the intervention, both control and test groups completed the participation in decision making questionnaire. The control group received a routine counseling session and counseling on prenatal nutrition (placebo). The experimental group, in addition to receiving routine care and prenatal nutrition counseling, participated in a counseling session after examination by a specialist. Immediately after the intervention, the decision-making questionnaire was completed by both groups to evaluate the results. The data were analyzed by SPSS 23 software using descriptive statistics methods for providing general information, independent t-test for comparison between the experimental and control groups before intervention, paired T-test for comparison between the experimental and control groups after the intervention and Chi-square test to compare the qualitative variables.
Findings by Text
The mean age of pregnant women in the experimental group was 28.6± 5.9 and in the control group was 27.5 ± 5.3 years and the mean gestational age in the experimental and control groups was 23.6 ± 0.8 and 22.5±7.3 weeks, which there was no significant difference between the groups (p> 0.05). In terms of demographic characteristics, both groups were similar and did not have significant differences (p> 0.05; Table 1).There was a significant difference between the mean scores of mothers 'participation before and after the intervention in the experimental group, but in the control group there was no significant difference between the mean scores of mothers' participation before and after the intervention. In addition, before intervention, the mean level of participation between the experimental and control groups was not statistically significant, but after the intervention, this difference was statistically significant (Table 2).Mothers' participation in the experimental and control groups was almost the same before the intervention and did not show a statistically significant difference, but after the intervention this difference was significant (Table 3).
Main comparison to the similar studies
Becker et al. conducted a study using decision analysis to facilitate informed decision making in the UK and concluded that counseling with a decision analysis approach could give women more knowledge about prenatal diagnosis decisions. Professionals will need training to use this effective technique. In addition, receiving a decision-making aid package in women with positive screening results made them less anxious than those in the routine group. Those in the decision-making analysis group were less conflicted in their decision making, but in the routine counseling group there was a great deal of concern about these decisions [38]. Ghiasvandiani et al. conducted a study aimed at investigating the impact of decision-making aid package on treatment selected by patients with breast cancer and its consequences. The results showed that intervention in decision making, by involving patients in their own therapeutic decision making improves patients' awareness, and results in confidence in initiating treatment and choosing treatment options in accordance with their values and priorities [42]. These two studies are in line with the present study. [43]. ... [44, 45].
Suggestions
Further studies on the effect of different counseling models on pregnant mothers' attitudes towards participation in decision making are suggested.
Limitations
One of the limitations of this study was the limited number of Iranian and International studies, so we tried to use similar studies.
Conclusions
Individual counseling is an effective and appropriate intervention to increase the participation rate of pregnant mothers in decision making in the treatment process.
Acknowledgments
The staff of the Kosar medical-education center, Qazvin who assisted us in this study are appreciated.
Conflict of interest
None declared.
Ethical Permissions
This study was conducted after obtaining permission from the Ethics Committee of Qazvin University of Medical Sciences (IR.QUMS.REC.1397.042) and registered at the Iranian Registry for Clinical Trial (IRCT20180508039583N1).
Funding Sources
This study is extracted from a Master's thesis in Midwifery Counseling.

TABLES and CHARTS

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