Opportunities to improve maternal health literacy through antenatal education: an exploratory study.

This paper examines the concept of maternal health literacy, defined as the cognitive and social skills that determine the motivation and ability of women to gain access to, understand, and use information in ways that promote and maintain their health and that of their children. Specifically, it investigates the feasibility of using the concept of health literacy to guide the content and process of antenatal classes. The paper reports on the results of focus groups and interviews conducted with a range of health care providers, pregnant women and new mothers to obtain different perspectives on the issues surrounding antenatal education and parenting. The results give us a realistic look at what women are learning from existing antenatal education and how it can be improved. Comparing the results from the educators and the women, the same basic issues surface. Both recognize that there are serious time limitations in antenatal classes. These limitations, combined with natural anxiety and curiosity about childbirth, generally ensure that the content of classes is confined to pregnancy and childbirth. The limitations of time are also cited as a reason for the teaching methods being heavily weighted towards the transfer of factual information, as distinct from the development of decision-making skills, and practical skills for childbirth and parenting The results indicate clearly that antenatal classes cannot possibly cover all there is to know about pregnancy, childbirth and parenting. If the purpose of antenatal classes is to improve maternal health literacy, then women need to leave a class with the skills and confidence to take a range of actions that contribute to a successful pregnancy, childbirth and early parenting. This includes knowing where to go for further information, and the ability to analyse information critically. The authors conclude that this would represent a very challenging change in orientation for both the educators and pregnant women included in this study. Work continues on the development of the tools that will be needed to support this change.     

农民工孕妇产前保健影响因素

目的了解分析农民工孕妇产前保健情况、存在问题和影响因素,为进一步采取措施改善农民工孕妇产前保健提供信息。方法于2006年7月至2007年11月期间,对在本院产科住院的203名农民工产妇作问卷调查,对早孕检查方法、建立孕产妇联系手册、产前检查次数等产前保健状况进行了描述,并分析影响因素。结果农民工孕妇的产前保健还存在比较大的问题。调查对象中,有30．5％不在医院作早孕确定,有38．4％没有建立孕产妇联系卡,有77．3％没作产前保健或者不足3次。丈夫是否上海户籍、丈夫的经济收入及是否有准生证是影响产前保健的重要因素。结论农民工孕妇产前保健还存在较大问题,其影响因素也是多方面的,包括丈夫是否上海户籍、经济收入及是否有准生证。这些问题都迫切需要政府有专门的措施来解决。     

Prevalence and barriers to HIV testing among mothers at a tertiary care hospital in Phnom Penh,Cambodia. Barriers to HIV testing in Phnom Penh,Cambodia

Background  

One-third of all new HIV infections in Cambodia are estimated to be due to mother-to-child transmission. Although the Ministry of Health adopted a policy of provider-initiated HIV testing and counseling (PITC), nearly a quarter of pregnant mothers were not tested in 2007. Greater acceptance of HIV testing is a challenge despite Cambodia's adoption of the PITC policy.     

Engagement: an indicator of difference in the perceptions of antenatal care for pregnant women from diverse socioeconomic backgrounds

Background Socioeconomically deprived women are at greater risk of adverse pregnancy outcomes. Research tends to focus on access of services. Yet access may not equate with the equity of services for women from different socioeconomic backgrounds. Objectives To determine whether pregnant women’s perceptions of antenatal provision differed in relation to their socioeconomic deprivation ranking (determined by the Scottish Index of Multiple Deprivation 2006). Design A longitudinal, qualitative study with comparative antenatal case studies between January 2007 and April 2009. Setting/Participants Cases were primigravida women from ‘least deprived’ (n = 9) and ‘most deprived’ (n = 12) geographical areas within one local authority in Scotland. Analysis Data were analysed using case study replication analysis. Results There was little difference in access to antenatal services between the ‘least’ and ‘most’ deprived groups. Perception of care differed in relation to the level of ‘engagement’ (defined using constructs of: language and personalization of care; power and relationships; and health literacy). Engagement was evidenced in most of the ‘least deprived’ cases and almost none of the ‘most deprived’ cases. Specifically, socioeconomically deprived women described less evidence of personal connection to their own care, effective communication and the opportunity for shared decision making. Conclusion In women from socioeconomically deprived areas, access may be a less useful indicator than engagement when assessing antenatal service quality. As engagement levels may be one method by which to predict and improve health outcomes, a more equitable antenatal service may need to be developed through the early identification of those women at risk of non‐engagement.     

农村地区孕产期保健服务时间变化趋势分析

目的 了解新疆、安徽省2地农村地区孕产期保健服务时间变化情况,及时发现农村地区孕产期保健服务中存在的问题.方法 采用整群随机抽样方法,自行设计调查问卷,于2006年1月对新疆、安徽2地15～69岁有过孕产史的已婚育龄妇女进行孕产期保健服务调查.结果 随着时间的推移,新疆、安徽2地孕产期保健服务利用的各项指标均呈现增加趋势(P值均<0.05).但仍然存在产前检查开始时间较晚、产前检查次数较少等问题.2000年以来,孕早期检查比例只有52.5%,≥5次产前检查的比例也只达到54.0%,住院分娩比例只有68.1%.同时,2地区各项指标间差异有统计学意义.结论 新疆、安徽2地农村地区孕产期保健服务总利用水平不高,服务质量有待加强.     

孕产妇产前保健现状及其影响因素分析

目的了解目前孕产妇产前保健现状及其影响因素。方法采用分层随机整群的抽样方法,对2004年1月1日~12月31日在北京市5所医院进行分娩的4 000名孕产妇产前检查记录进行回顾性分析。结果①孕产妇产前检查率为88.45%,平均产前检查次数为5次;首次产前检查时间的中位数为孕22周,仅13.33%的孕产妇在孕早期开始产前检查;孕产妇各项基本产前检查项目的检查率较低,12.41%的孕产妇在孕早、中、晚期均进行了产前检查;②孕产妇首次产前检查时间和产前检查次数受年龄、职业、户口所在地、医疗付费方式、产次等社会人口学因素及孕产史的影响。结论目前研究地区产前保健服务工作存在不足,医疗保健机构应结合人群的不同特点,采取相应措施,提高产前保健质量,切实做好产前保健工作,促进母婴健康。     

Peri-urban aquatic plant culture and skin disease in Phnom Penh, Cambodia

A cross-sectional study with follow-up was done in five communities involved in aquaculture in peri-urban Phnom Penh, Cambodia, to assess the association between skin disease, particularly dermatitis and occupational wastewater exposure. From 200 selected households 650 household members aged15 years were visited and examined dermatologically three times in July 2004, January and May 2005. Overall dermatitis prevalence was 6.1%. However, all cases (116) were found in the two wastewater villages involved in aquatic plant culture. Risk factor analysis restricted to the two wastewater villages showed that involvement in wastewater-fed aquatic plant production increased the risk of dermatitis in the univariable analysis but not in the multivariable analysis. Among family members involved in wastewater-fed aquatic plant production a longer duration of daily wastewater contact did not increase the risk of dermatitis in the multivariable analysis. Wet season, older age and having a history of skin problems in the three months prior to each survey were associated significantly with dermatitis. Very few aquaculture workers applied personal protection and the factor had no significant effect on dermatitis. The present study did not show a consistent association between occupational exposure to wastewater and dermatitis, unlike similar Vietnamese studies.     

Community participation for perinatal health in Istanbul

This study aimed to evaluate the success of a project in achieving community participation in efforts to improve perinatal health. A 10-step structured process was used to work with a community in Istanbul, Turkey. To evaluate the success of the project in achieving community participation, five key indicators were selected: (i) participation of the community group in decision making; (ii) gains in knowledge and skills of the community group; (iii) continuity of the community group; (iv) continuation of the health program by the community group; and (v) initiation of new support and advocacy activities. From the beginning, community members participated in all decisions regarding the group activities. In the early months, project staff had more of a guiding role, but, over time, the community members became active decision-makers. Over the course of the project they learned how to identify community health problems, and to design, implement and evaluate interventions to address those problems. Four years later, meetings and activities of the group are continuing. The antenatal education course developed by the group continues to be offered at a local community centre. Community members are now completely responsible for promoting the course, communication with participants, planning the courses, making preparations for the sessions, as well as teaching non-technical topics. Course participants have developed ongoing support networks and have begun to advocate for better perinatal health services in the community. Working with a community is an intensive, time-consuming process. The results of this project indicate that the benefits, both in terms of health outcomes and in terms of increases in community capacity, can be well worth the effort.     

妊娠期糖尿病患者早期保健对围产结局的影响

目的探讨妊娠期糖尿病（ GDM）患者早期保健对围产结局的影响。方法将86例在海盐县妇幼保健院产检及分娩的GDM患者随机分为观察组和对照组,每组各43例。对照组采用一对一责任制分娩,对症处理出现的症状;观察组在此基础上给予饮食控制、适当运动、心理保健及药物治疗等早期围生保健措施。比较分析两组患者血糖控制情况及妊娠结局。结果产后空腹血糖、餐后2h血糖观察组患者明显低于对照组（t值分别为254,3．01,均P＜0．05）;妊娠高血压、剖宫产、产后出血及产后感染的发生率观察组显著低于对照组（χ2值分别为4．17、3．01、3．96、4．07,均P＜0．05）;与对照组比较,观察组的围生儿在胎儿窘迫、早产、巨大儿、新生儿低血糖的并发症方面均显著降低（χ2值分别为4．07、3．89、5．46、5．11,均P＜0．05）。结论 GDM与妊娠结局密切相关,加强GDM早期保健可有效降低母婴并发症,改善围生儿预后。     

Health literacy and knowledge of antenatal care among pregnant women

Health literacy has a direct impact on pregnancy from the perspectives of both the mother and the baby. This study aimed to determine the level of health literacy and assess the knowledge of antenatal care among pregnant women. From among all pregnant women who presented to the hospital's obstetric polyclinic during the study's timeline, the study group consisted of 460 women who agreed to take part (492 women were invited and a response rate of 93.5% was achieved). A questionnaire prepared based on the literature in line with the study's objectives was completed by the participants under supervision. The Turkish Health Literacy Scale (THLS-32) was used to assess health literacy. In order to determine the women's prenatal care knowledge levels, a total of 20 knowledge-testing statements prepared using the literature were applied, 14 of which were true and six of which were false. The internal consistency of antenatal information questions during pregnancy was made and the Cronbach alpha coefficient was calculated as 0.77. It was determined that 33.9% of the participants had a sufficient level of health literacy. Health literacy was sufficient in young married women (19 years and less) in their first pregnancy and those who had regular reading habits, participated in healthcare activities and received postpartum care at a family health clinic (p < 0.05 for each). While the most accurately evaluated statement about antenatal care was ‘It is normal to experience nausea/vomiting in the first trimester of pregnancy’, the least accurately evaluated statement was ‘Over 35% of women incorrectly believed it was normal to gain 20 kg of weight during pregnancy’. It was found that pregnant women with sufficient health literacy had higher levels of knowledge about antenatal care (p < 0.05). In this study, it was determined that approximately two-thirds of the participants had insufficient health literacy and the women with insufficient health literacy had low levels of knowledge about antenatal care.     

围产保健与儿童保健监测的方法与应用

目的：研究最佳围产保健与儿童保健的监测方法与应用,为母婴与儿童提供及时,系统的保健服务。方法：新婚妇女在婚前检查时建立围产保健册、随后开始月经监测,确定早孕后,定期作产前复查等监测。直到产后42d为止;新生儿应在出生42d内建立儿童保健册,然后根据监测对象的年龄 常规体检的原则,完成相应年龄段的询问,体检、实验室检查与评价。监测全程均有质量控制措施,所有的监测结果均录入计算机。实现计算机化管理。结果：该监测系统已经在我国的32个县（市）中实施,覆盖地区的总人口超过2千万,从1993年至,围产保健监测系统已成地连续运转了8年,儿童保健监测系统已成功地连续运转了4年。结论：该围产保健与儿童保健监监适合我国,国情,运转顺利,对促进和提高当地的围产保健与儿童保健工作水平,提高我国人口素质将发挥重要作用。     

国外健康素养型医疗机构建设与评价及对我国的启示

介绍了美国医学研究所(Institute of Medicine,IOM)发布《健康素养型医疗机构的10个特征(Ten Attributes of Health Literate Health Care Organizations,HLHO 10个特征)》文件的背景及健康素养型医疗机构(health literate health care organization,HLHO)概念,并以Donabedian的理论为指导综述了HLHO的特征和建设措施及HLHO评价的研究进展。提出了我国医疗机构可借鉴《HLHO 10个特征》文件与国外HLHO评价现状,从人员培训、文化、制度、物理和信息环境建设,要求员工应用健康素养策略,促进服务对象参与健康材料的开发及医务人员健康教育工作的考核等措施入手,践行《健康中国行动(2019—2030年)》提出的“医务人员在诊疗过程中主动提供健康指导”和“建立医务人员开展健康教育绩效考核机制”两项指标。     

Cohort analysis of antenatal care and delivery outcomes in pregnancy: a basis for improving maternal health

Cohort analysis has been the cornerstone of tuberculosis (TB) monitoring and evaluation for nearly two decades; these principles have been adapted for patients with the human immunodeficiency virus/acquired immune-deficiency syndrome on antiretroviral treatment and patients with diabetes mellitus and hypertension. We now make the case for using cohort analyses for monitoring pregnant women during antenatal care, up to and including childbirth. We believe that this approach would strengthen the current monitoring and evaluation systems used in antenatal care by providing more precise information at regular time intervals. Accurate real-time data on how many pregnant women are enrolled in antenatal care, their characteristics, the interventions they are receiving and the outcomes for mother and child should provide a solid basis for action to reduce maternal mortality.     

Dilemmas and paradoxes in providing and changing antenatal care: a study of nurses and midwives in rural Zimbabwe

This paper describes the experiences of caregivers in a rural district in Zimbabwe, in caring for pregnant women within a context of changing antenatal care routines. Data were generated using individual interviews with 18 nurses and midwives. The caregivers experienced their working situation as stressful and frustrating due to high staff turnover, inconsistent policies, parallel programmes and limited resources, including time. They also faced difficulties when implementing some of the proposed changes. Furthermore, the caregivers had to deal with the pressure and resistance from the pregnant women, whose reasoning and rationale for using care appeared different from those of the health professionals. In light of the above, we stress the necessity for reflecting on and including the experiences and perspectives of caregivers and the users of care, as well as their contexts and realities, when implementing change.     

安徽省农村育龄妇女孕产期保健状况分析

目的 了解安徽省不同年代农村育龄妇女孕产期保健状况.方法 采用整群随机抽样方法获得调查对象,由调查员对其进行面对面问卷调查.结果 随着时间推移,产前检查率和住院分娩率逐渐提高.至2000年以后,产前检查率和住院分娩率分别达到84.9%和80.6%,≥5次的产前检查率达到43.6%,在孕早期(12周内)产前检查比例为64.1%.在乡镇卫生院分娩比例从17.1%上升到60.2%.多因素Logistic回归分析显示,年龄、分娩时间和是否进行过产前检查与住院分娩有统计学联系.结论 近年来安徽省农村妇女孕产期保健状况不断改善.     

Eliciting individual preferences for health care: a case study of perinatal care

Objective  To demonstrate how a discrete choice experiment (DCE) can be used to elicit individuals' preferences for health care and how these preferences can be incorporated into a cost–benefit analysis.
Methods  A DCE which elicited preferences for three perinatal services: specialist nurse appointments; home visits from a trained lay visitor; and home-help. Cost was included to obtain a monetary measure of the value that individuals place on the services. In total, 292 women who had previously participated in a randomized trial of alternative forms of pre-natal care were interviewed.
Results  The most preferred service configuration consisted of three nurse appointments and two home visits before birth and 4 h of home-help per week for the first 4 weeks after birth. On average, women are willing to pay $371 for this package. A package that excluded home-help was valued at $122 whilst provision of three nurse appointments only was valued at $97. The predicted uptake of the services ranged from 37% to 93% depending on the woman's experience with the service, whether or not it was her first child and her level of education.
Conclusion  The willingness to pay values were much higher than the costs for nurse appointments, suggesting this service produces a net social benefit. The willingness to pay for the package including both the nurse appointments and home visits only just exceeded the costs of the package, suggesting there is a relatively high chance that this package produces a net social loss.     

四川省艾滋病高发区艾滋病病毒感染孕产妇卫生保健服务利用现状分析

目的了解艾滋病高发区艾滋病病毒(human immunodeficiency virus,HIV)感染孕产妇的卫生服务及围产保健服务利用现状。方法选取艾滋病高发区四川省凉山州为样本地区,对212名HIV感染孕产妇开展卫生服务利用的问卷调查。结果 HIV感染孕产妇两周患病率和两周就诊率分别为31.13%和27.27%,年住院率为1.42%,需住院未住院率为66.67%。产前检查的比例为72.17%,产后访视的比例为57.08%,住院分娩比例为82.55%。两周患病率在不同年龄、民族和是否务农间有差异,两周就诊率在不同年收入家庭间存在差异。结论 HIV感染孕产妇卫生服务需求和门诊服务利用较高,住院服务和围产保健服务利用不足。     

Promoting health literacy through the health education assessment project

BACKGROUND: The Council of Chief State School Officers' State Collaborative on Assessment and Student Standards Health Education Assessment Project (SCASS-HEAP) allows states to pool financial and human resources to develop effective ready-to-use health education assessment resources through a collaborative process. The purpose of this article is to describe the extensive ongoing development of the SCASS-HEAP and its benefits for important stakeholders in health and education. METHODS: A review of the products from the first decade of the SCASS-HEAP was undertaken. RESULTS: The SCASS-HEAP supports a comprehensive systems approach to helping educators focus effectively on the most important skills and issues in child and adolescent health and gives health education a place at the school reform table, providing visibility and credibility and promoting the essential links between health and learning. CONCLUSION: State education agencies and school districts can use SCASS-HEAP materials for assessment and, perhaps more importantly, to help teachers modify and improve instruction at the classroom level for increased student learning.     

凉山州孕产妇围产保健服务利用现状分析

目的了解凉山州艾滋病感染孕产妇与正常孕产妇围产保健服务利用现状。方法以艾滋病高发区四川省凉山州为样本地区,选取2013~2014年检测确诊并可追踪的212例人类缺陷免疫病毒(human immunodeficiency virus,HIV)感染孕产妇为研究组,随机等距抽取402例正常孕产妇作为对照组,开展围产保健服务利用的问卷调查。结果两组孕产妇在民族、文化程度和家庭年收入比较,差异有统计学意义(P0.05)。HIV感染孕产妇的住院分娩比例、产后访视比例高于对照组,产检次数低于对照组(P0.05)。文化程度和家庭年收入的差异是两组孕产妇利用围产保健服务状况不同的主要原因。结论凉山州HIV感染和正常孕产妇的围产保健服务利用受诸多因素影响,在精准扶贫中应有针对性地推行免费孕产期保健和住院分娩项目,提高边远地区孕产妇系统管理率。