Effectiveness of self-instructional module on knowledge and attitude regarding antenatal care among primigravida mothers in selected government hospital, Dehradun, Uttarakhand.
Pregnancy is a condition in which fetus is developed and nurtured within a body. "Pregnant" word originated from Latin word "pre" means before, "natus" means birth, so pregnant means before (giving) birth. 
All human life on earth is born to women, who nourishes her offspring and gives birth to child. Pregnancy links the mother and the fetus together. Pregnancy is the basis for maintaining the human existence in the earth. It is a pride for every pregnant mother to know that she is pregnant and nourishing another life within her and dreams of a healthy child. However, woman, the life giver, is vulnerable to losing her life in the process of childbirth.
A systematic analysis conducted under the WHO in which 23 studies (between 2003 and 2012) were studied. 115 countries were included in which 417 datasets comprising 60,799 deaths analyzed. Among all maternal deaths, 73% (17,71,000 of 24,43,000) occurred because of direct obstetrical causes and 27-5% (6,72,000) because of indirect obstetrical causes. The causes include hemorrhage 271% (6,61,000), hypertensive disorders 14 0% (3,43,000), sepsis 10-7% (2.61.000), abortion 79% (1,93,000), and embolism 3 2% (78.000). 
Every pregnant woman hopes for an uncomplicated pregnancy and healthy baby. Maternal mortality is a major insult for the country, especially in regard of health services. Mother plays a key role in the family. The mortality and morbidity of mother place the newborn infant at the risk of survival. The worldwide data on maternal mortality and morbidity force us to focus on the importance and acceptance of adequate antenatal care for every pregnant woman across the country.
Systemic supervision of pregnant woman during pregnancy is known as antenatal care. The care must be regular in nature and be supposed to begin soon after conception till delivery. The purpose of antenatal care is to preserve the normal physiology of pregnancy, to observe the high-risk pregnancy, prevention and treatment of complications, and improvement in the psychology of the mother. The overall goal of antenatal care is delivery of a healthy child from a healthy mother. 
According to World's Mothers annual report, 56,000 mothers die yearly and 309,000 newborns die within the first 24 h of birth in India, indicates the poor maternal and child health. 
A retrospective study was conducted on does an antenatal care makes a difference in PIMS, Jalandhar, India. The study result concluded that 58% primipara mothers were not registered among them, 37.21% of unregistered mothers suffered with anemia and 24.14% of mothers fetus developed fetal distress. They concluded that inadequate antenatal care may ahead to obstetric complications among unregistered mothers. 
A study was carried out on utilization of antenatal care services among pregnant mother in Uttarakhand state. A total of 550 pregnant women participated belonging to various rural as well as urban areas in and around Dehradun. The final result concluded in which 18.7% attended regular ANC checkup, 22% women attended ANC sometimes. 59.3% women never attended ANC earlier. The factors responsible to influence the utilization of ANC services by the pregnant women included that 44.5% women had lack of knowledge about existing ANC services. 
The study was conducted with an outlook to assess the effectiveness of self-instructional module on knowledge and attitude regarding antenatal care among primigravida mothers in selected government hospital, Dehradun, Uttarakhand. The following were the key objectives:
* To assess the knowledge and attitude regarding antenatal care among primigravida mothers.
* To assess the effectiveness of self-instructional module on knowledge and attitude regarding antenatal care among primigravida mothers.
[H.sub.1]: There is a significant difference in the mean score of knowledge level among primigravida mothers regarding antenatal care before and after implementing self-instructional module at the level of 0.05.
[H.sub.2]: There is a significant difference in the mean score of attitude among primigravida mothers regarding antenatal care before and after implementing self-instructional module at the level of 0.05.
The word conceptualization refers to the process of developing and refining abstract. It is a framing of ideas which provides outline for the study; the present study is aimed at assessing knowledge and attitude of primigravida mothers regarding antenatal care. To describe the concepts in the study, Nola J. Pender's health promotion model is used in Figure 1.
MATERIALS AND METHODS
In the present study, pre-experimental one--group pretest --post-test design was opted. 62 primigravida mothers attending antenatal clinics were selected by consecutive sampling technique. The instrument used in the study was divided into three sections--Section I--demographic variables, Section II--structured questionnaire (34 questions) to assess the knowledge, and Section III--3 points Likert scale to assess the attitude which includes 16 statements (eight positive effect statements and eight negative effect statements). Then, the intervention self-instructional module was applied. The study was conducted in District Woman Hospital, Dehradun, Uttarakhand.
Table 1 finding summarizes the pre-test mean was 12.16 and standard deviation (SD) was 4.469. The post-test mean was 23.27 and SD was 4.458. The t-paired test was used to find out the comparison between total pre-test knowledge score and total post-test knowledge score. The total mean difference was 11.113. The t = 30.930 at df 61, the tabulated value at 0.05 level was 2.000, the calculated value was greater than tabulated value; hence, the research hypothesis accepted. It observed that there was difference between pre-test and posttest knowledge score.
Table 2 findings summarize the pre-test mean was 20.50 and SD was 3.806. The post-test mean was 23.84 and SD was 3.806. The t-paired test was used to find out the comparison between total pre-test attitude score and total post-test attitude score. The total mean difference was 3.339. The t value was 11.040 at df 61, the tabulated value at 0.05 level was 2.000, the calculated value was greater than tabulated value; hence, the research hypothesis accepted. It observed that there was difference between pre-test and post-test knowledge score.
A study was conducted by Kaur et al. on self-instructional module to assess the knowledge of primigravida women about antenatal care. 60 study samples were selected by convenient sampling technique. The efficiency of intervention was calculated by t-paired test (13.423, 0.000) and unpaired t-test (13.894, 0.000) at 0.05 level. The intervention was useful in enhancing the knowledge about antenatal care. 
The similar intervention was used in the study to improve the knowledge and attitude level of mothers regarding antenatal care. The pre-intervention mean knowledge score of primigravida mothers was 12.16 and the knowledge level post-intervention was 23.27. The mean attitude score of primigravida mothers before intervention was 20.50 and the attitude level after intervention was 23.84. The t value for knowledge score was 30.930 at 0.05 levels and the t value for attitude score was 11.040 at 0.05 levels. The result findings disclose that there was an improvement in the knowledge and attitude level among primigravida regarding antenatal care.
Nursing profession present and future require qualified nurses to meet the challenges and deliver the health care in all settings. The student nurses are the growing buds of our nursing profession.
The present study would help the nursing students to understand about various aspects of antenatal care. The study finding will help the nursing personnel to incorporate the various methods of teaching while dealing with the pregnant mothers at maternity units.
Nurses have the responsibility to promote health education and teach the pregnant women regarding antenatal care. Teaching materials on antenatal care can be prepared and distributed to the pregnant mothers during their antenatal visits. The nurses should disseminate the proper information regarding antenatal care to increase the public awareness which will help to promote healthy lifestyle, positive attitude, and will increase the utilization of antenatal services provided by the health sector.
Nursing administrators play a crucial role to ensure all the dimensions of health and complete well-being. Nursing administrators should organize in-services educational programs regarding antenatal care for nurses working in the maternity unit. Appropriate teaching-learning materials regarding antenatal care need to be prepared and make available for nurses in health settings and community settings. Appropriate policies and protocols related to antenatal care should be developed by the administrative authorities, and the nursing personnel should be aware regarding the policies.
The study has tested the usefulness of self-instructional module on knowledge and attitude about antenatal care among primigravida mothers. Similar study can also be undertaken for the pregnant mothers including primigravida and multigravida.
A parallel study can be carried out on a large sample regarding all the aspects of antenatal care among primigravida mothers attending antenatal clinics in all health settings, so the result can be generalized. A comparative study can be conducted among primigravida and multigravida mothers on knowledge and attitude regarding antenatal care.
Pregnancy and childbirth are a time of great expectation and blissful anticipation. Antenatal care is systemic supervision of mother throughout pregnancy. Its endeavor is to safeguard the physiological aspect of pregnancy and labor. Various maternal and fetal complications can be prevented through proper antenatal checkups. The study findings indicated that self-instructional module was useful to improve the knowledge and attitude of primigravida mothers regarding antenatal care. Hence, the effective teaching material on antenatal care must be instituted in all communities with a view to bring awareness regarding maternal and child health.
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[7.] Kaur H, Ramanadin P, Vadivukkarasi, Bala K. A quasi experimental study on effectiveness of self-instructional module on knowledge regarding antenatal care among primigravida women attending selected hospitals of Punjab and Haryana. Int J Psychiatric Nurs 2015;1:188-94.
Department of Obstetrics and Gynecological Nursing, Government College of Nursing, Roshnabad, Haridwar, Uttarakhand, India
Correspondence to: Nidhi Jugran, E-mail: email@example.com
Received: April 15, 2018; Accepted: May 07, 2018
Caption: Figure 1: Conceptual framework--Nola J. Pender's health promotion model
Table 1: The mean, SD, mean difference, and t-value pre- and post-intervention on knowledge level of primigravida mothers regarding antenatal care (n=62) Intervention Mean [+ or -] SD Mean Df t difference Pre 12.16 [+ or -] 4.469 11.11 61 30.93* Post 23.27 [+ or -] 4.458 * Significant at 0.05 level. SD: Standard deviation Table 2: The mean, SD, mean difference, and t-value pre- and post-intervention on attitude of primigravida mothers regarding antenatal care (n=62) Intervention Mean [+ or -] SD Mean Df t-value difference Pre 20.50 [+ or -] 3.806 3.34 61 11.04* Post 23.84 [+ or -] 3.609 * Significant at 0.05 level. SD: Standard deviation
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|Title Annotation:||Research Article|
|Publication:||International Journal of Medical Science and Public Health|
|Date:||Aug 1, 2018|
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