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Using the Internet for enhancing parental self-efficacy in infant care
A quasi-experimental study among attendees of maternal education in the district of Granada, Spain
Patricia Lima PereiraStudent of Master in Social and Health Protection
Institute of Public Health Jagiellonian University Medical College Krakow, 15th June 2010
CONTENT1. Introduction
• Why focus on the internet?• What is parental self-efficacy?• Why maternal education as setting of this study?
2. Objectives and methods3. Results4. Discussion 5. Conclusions
INTRODUCTION
The Internet is an important source of health information, especially among women and men in reproductive ages
• Larsson M. A descriptive study of the use of the Internet by women seeking pregnancy-related information. Midwifery. 2009; 25:14–20.
• Instituto Nacional de Estadística (INE). Encuesta sobre equipamiento y uso de tecnologías de la información y comunicación en los hogares. [Online table generator]. 2007 [Cited: 26 March 2009].
• Fox S. Online health search 2006. Pew Internet & American Life Project. [Document online] 2006. [Cited: 30 April 2009.] Available from: http://www.pewinternet.org/ PPF/r/190/report_display.asp.
Why focus on the internet?
What is parental self-efficacy?
• According to Social Learning Theory, it is the parental ability to meet the demands and responsibilities of tasks relating to infant care.
• High parental self-efficacy was found to be related to positive child outcomes.
• Bandura, Albert. “Social Cognitive Theory: An Agentic Perspective. Abstract.” (Annual Review of Psychology) 52 (2001): 1-26.
• Crncec, R, B Barnett, and B Matthey. “Development of an Instrument to Assess Perceived Self-Efficacy in the Parents of Infants.” (Research in Nursing & Health) 31, no. 442–453 (2008).
INTRODUCTION Know
how to do
Feel capable of
doing
INTRODUCTION
Maternal education has been included into the offers of health care services in Andalucía (Spain) since the early ‘80.
García Calvante, María del Mar. Evaluación de Programas de Salud Materno Infantil Andalucía 1984 - 1994. . Vols. Junta de Andalucía - Escuela Andaluza de Salud Pública. Granada, 1996.
Why maternal education as setting of this study?
More than 40% of pregnant women in Andalucía attended this kind of classes in the public sector.
INTRODUCTION
García Calvante, María del Mar. Evaluación de Programas de Salud Materno Infantil Andalucía 1984 - 1994. . Vols. Junta de Andalucía - Escuela Andaluza de Salud Pública. Granada, 1996.
OBJECTIVES To determinate if the
perceived usefulness of the Internet as an
information source is related to parental self-efficacy in infant care
To determinate if midwife’s advice on how
to enhance the use of the Internet could have
an effect in parental self-efficacy
To characterize the maternal education in Granada, Spain
To describe the use of the Internet as a health information
source
To calculate the validity of the
developed scale
To identify other factors related to
parental self-efficacy
METHODS
A quasi-experimental study on group level among attendees of maternal education in the district of Granada, Spain
2009
Pilot study32 cases Control groups Intervention groups
The sample included• 8 centres• 16 groups• 169 women and 34 men Response rate of 89%.
The intervention• verbal advice and the factsheet• based on a quality assessment for
websites developed by the APHS
• was carried on by midwifes• 6 groups: 73 participants
Bermúdez Tamayo C, García Mochón L, Corpas Nogales E, Moya Garrido MN. Selección y evaluación de sitios web dirigidos a pacientes referidos al campo de la salud 2.0. Granada: AETSA; 2008.
What were the results?
The median age was 32 for women
33 for men
87 % = first child
Stage of pregnancy (mode) = 30 weeks
63 % = at least two antenatal classes
University59 %
High school35 %
Primary school6 %
To determinate if the perceived usefulness of
the Internet as an information source is
related to parental self-efficacy in infant care
To determinate if midwife’s advice on how
to enhance the use of the Internet could have
an effect in parental self-efficacy
To characterize the maternal education in Granada, Spain
To describe the use of the Internet as a health information
source
To calculate the validity of the
developed scale
To identify other factors related to
parental self-efficacy
RESULT 1
Measuring parental self-efficacy
• Internal reliability and construct validity were proved to be acceptable.
Cronbach’s coefficient alpha = 0.95Variance explained with the model = 71.7%
A nine-items Likert scale (Ranged 9 to 90)
To determinate if the perceived usefulness of
the Internet as an information source is
related to parental self-efficacy in infant care
To determinate if midwife’s advice on how
to enhance the use of the Internet could have
an effect in parental self-efficacy
To characterize the maternal education in Granada, Spain
To describe the use of the Internet as a health information
source
To calculate the validity of the
developed scale
To identify other factors related to
parental self-efficacy
RESULT 2
How widespread is the use of the
Internet as a health information source?
Attendees of maternal education in Granada
100 %N=207
Users of internetN=195
94.7%
Non-users N=12
5.3%
Have ever sought information on pregnancy
N=190
97.4%
Do not seek information on
pregnancyN=5
2.6%
Have sought during the last month
N=165
84.6%
Have sought this weekN=121
62%
Have sought in the last 24 hours. N=49
25%
To determinate if the perceived usefulness of
the Internet as an information source is
related to parental self-efficacy in infant care
To determinate if midwife’s advice on how
to enhance the use of the Internet could have
an effect in parental self-efficacy
To characterize the maternal education in Granada, Spain
To describe the use of the Internet as a health information
source
To calculate the validity of the
developed scale
To identify other factors related to
parental self-efficacy
RESULT 3
How different were the antenatal
education programmes?
Teacher’s characteristics
Classes’ characteristics
Participants’ characteristics
8new
dichotomous variables
To determinate if the perceived usefulness of
the Internet as an information source is
related to parental self-efficacy in infant care
To determinate if midwife’s advice on how
to enhance the use of the Internet could have
an effect in parental self-efficacy
To characterize the maternal education in Granada, Spain
To describe the use of the Internet as a health information
source
To calculate the validity of the
developed scale
To identify other factors related to
parental self-efficacy
RESULT 4
What factors were associated with self-efficacy in infant care ?
Enhanced parental self-efficacy was
clearly related to parity
after controlling for age, gender, education, use of the internet, place of living, weeks of pregnancy
93 % of women who had previously given birth had high parental self-efficacy comparing with 41 %
of primiparous women (p<0.001).
Enhanced parental self-efficacy was
inversely related to age
Women older than 30 years had statistically significant lower perception of parental self-
efficacy, when parity was controlled. (34 % vs. 52%, p=0.03)
after controlling for gender, education, use of the internet, place of living, weeks of pregnancy. P<0.001
No statistically significant differences
• Gender• number of assisted antenatal classes• features of antenatal classes:
• teacher's experience• total hours of classes• including physical exercise in teaching programme • use of audiovisual support
To determinate if the perceived usefulness of
the Internet as an information source is
related to parental self-efficacy in infant care
To determinate if midwife’s advice on how
to enhance the use of the Internet could have
an effect in parental self-efficacy
To characterize the maternal education in Granada, Spain
To describe the use of the Internet as a health information
source
To calculate the validity of the
developed scale
To identify other factors related to
parental self-efficacy
RESULTS 5 & 6
Is there a relationship between the Internet and
parental self-efficacy ?
Our hypothesis was
“the higher the perceived usefulness of the Internet the higher would be self-efficacy in infant care score”
Corelation between self-efficacy and value given to the internet.
Total sample n=194.
Spearman’s coefficient
0.158, p=0.03
Correlation between self-efficacy and value given to the internet.
Medline’s users n=19.
Spearman’s coefficient
0.515, p=0.02
Our hypothesis was
“the higher the perceived usefulness of the Internet the higher would be self-efficacy in infant care score”
Is the perceived usefulness of the Internet related to parental self-
efficacy?
Yes, if the people access
good websites
How can we encourage them to access good websites?
Providing advice ?
44%would use it
in the future
40%used it and
found it useful
n =48
(Chi squared test, p=0.007)
Access Medline6%
Without advice
18%
Withadvice
Correlation between self-efficacy and value given to the internet.
Medline’s users n=19.
Spearman’s coefficient
0.52 p=0.02
Correlation between self-efficacy and value given to the internet.
Medline’s users in interv. group n=12.
Spearman’s coefficient
0.62p=0.02
How might our results be
explained?
DISCUSSIONSocial Cognitive Theory
Knowledge Functional use
Self-efficacy
Previous experience
Vicarious experience
Social persuasions
Personal state
Bandura A. Social Cognitive Theory: An agentic perspective. Annual Rev Psychol. 2001; 52:1-26.
…they might feel capable of performing this
task
If people are being capable to identify what information they are lacking for performing a task…
?
…after learning how to do it
Active role of information seeker
• A tool for measuring parental self-efficacy within the Spanish speaker population
• Factors related to parental self-efficacy previous deliveries and age
• Many disparities in maternal education programmes. No effects of these differences have been detected
CONCLUSIONS
• The internet is an important information source during pregnancy • More than 95%• 1 out of 5 women and 1 out of 4 men
preferred it as their first source
• Positive relationship between perceived usefulness of the internet and parental self-efficacy.
CONCLUSIONS
Practical implications of the work
Providing midwifes with materials and training related to internet search can enhance their own internet competence and improve the patient-health professional relationship.
“Internet prescription” is becoming a new challenge.
Antenatal education is an invaluable setting for developing health literacy
• McKenna L, McLelland G. Midwives' use of the Internet: an Australian study. Midwifery [abstract]. 2009. [Epub ahead of print]. • McMullan M. Patients using the Internet to obtain health information: how this affects the patient-health professional relationship. Patient Educ Couns. 2006; 63(1-2):24-8.• Wald HS, Dube CE , Anthony DC. An Untangling the Web - the impact of Internet use on health care and the physician-patient relationship. Patient Educ Couns. 2007; 68(3):218-24.• Renkert S, Nutbeam D. Opportunities to improve maternal health literacy through antenatal education: an exploratory study. Health Promot Int. 2001; 16(4):381-8.
Dziękuję za uwagęAnd special thanks to
my supervisors
Clara Bermúdez and Grazyna Jasienska,
my colleagues of Granada and Krakow,
and especially to Rodrigo, Abril and Helena
Additional slides…
The non-seeker
The information
seeker
Patient motivators
Patient barriers
Healthcare barriers
Healthcare facilitators
Supportive attitude of information seeking
…
Engagement with information sources
Management of the risk associated with
information use
The non-empowered
patient
The empowered
patient
Thedisempowered
patient
• Edwards M, Davies M and Edwards A. Review: What are the external influences on information exchange and shared decision-making in healthcare consultations: A meta-synthesis of the literatura. Patient Education and Counseling 75 (2009) 37–52
Model of external influences on information use and patient empowerment
Teacher’s characteristics
Classes’ characteristics
Participants’ characteristics
• >5 years giving classes• Ability in use of internet
• >15 total hours of classes• Respiration techniques• Physical exercises• Group’s size• Use of audiovisual
support
• Educational level
New dichotomous variables
The overall mean self-efficacy score was 56.3 (sd 17.2), the median was 56.
Parental Self-Efficacy Score
Fre
cu
en
cy
20
10
0
Desv. típ. = 17,21
Media = 56,3
N = 109,00
For some analysis, we transformed the scale and other factors in dichotomous variables using the median, so data were analysed with chi squared test.
For correlation analysis, we used the continuous values of the scale.
Shapiro-Wilks Test confirmed a normal distribution (P=0.09).