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).