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Tao Y, Zhang Y, Chen J, Wang L, Zhu N, Hu H. Effect of oral health education on improving knowledge, attitude, practice, and oral health status of patients with liver cancer: A quasi-experimental study. Eur J Oncol Nurs 2024; 71:102660. [PMID: 38968670 DOI: 10.1016/j.ejon.2024.102660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 06/06/2024] [Accepted: 06/30/2024] [Indexed: 07/07/2024]
Abstract
PURPOSE To evaluate the effectiveness of the PRECEDE-PROCEED model (PPM) in helping patients with liver cancer be aware of their knowledge, skills, and abilities in self-oral health behaviors and improve their oral health status. METHODS This is a quasi-experimental study of 90 patients with liver cancer assigned to an oral health education or a control group. The intervention group was educated with the PRECEDE-PROCEED model. A brief oral scale and the knowledge, attitude, and practice oral health questionnaire were employed to measure the oral health status and cognitive behavioral ability to seek oral health in patients. RESULTS Among 102 eligible patients, 90 (88.23%) agreed to participate in the present study and were divided to intervention (n = 45) or control (n = 45) groups. After the intervention and one month after discharge, the oral health scores of patients in the Intervention group were lower than those of the control group (P < 0.05). In addition, after the intervention and one month after discharge, the patients in the test group had higher scores on knowledge, beliefs, and behaviors of oral health than the control group (P < 0.05). One month after discharge, the mean knowledge and skills scores were significantly higher in the intervention group than in the control group. CONCLUSIONS Our findings suggest that oral health education may be a useful health intervention for patients with liver cancer. It may also improve the knowledge and beliefs of liver cancer patients seeking oral health. Larger long-term investigations are necessary to provide more support for these preliminary conclusions.
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Affiliation(s)
- Yue Tao
- Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Jiangnan University, 1000 Hefeng Rd, Binhu District, Wuxi, Jiangsu Province, 214122, China; School of Medicine, Jiangnan University, Wuxi, 214122, China.
| | - Yan Zhang
- Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Jiangnan University, 1000 Hefeng Rd, Binhu District, Wuxi, Jiangsu Province, 214122, China.
| | - Jie Chen
- Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Jiangnan University, 1000 Hefeng Rd, Binhu District, Wuxi, Jiangsu Province, 214122, China.
| | - Leisheng Wang
- Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Jiangnan University, 1000 Hefeng Rd, Binhu District, Wuxi, Jiangsu Province, 214122, China; School of Medicine, Jiangnan University, Wuxi, 214122, China.
| | - Na Zhu
- School of Medicine, Jiangnan University, Wuxi, 214122, China.
| | - Hao Hu
- Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Jiangnan University, 1000 Hefeng Rd, Binhu District, Wuxi, Jiangsu Province, 214122, China; School of Medicine, Jiangnan University, Wuxi, 214122, China; Hepatobiliary and Pancreatic Surgery, The Third Hospital Affiliated to Nantong University, Wuxi, 214041, China; Medical School, Nantong University, Nantong, 226001, China; Wuxi Institute of Hepatobiliary Surgery, Wuxi, 214122, China.
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Nijagal MA, Odiase OJ, Bell AJ, El Ayadi AM, Williams S, Nicolaisen C, Jacobs G, Mack B, LaSerre M, Stewart C, Crockett K, Afulani PA. The Family and Pregnancy Pop-Up Village: Developing a one-stop shop of services to reduce pregnancy care-related inequities in San Francisco. Birth 2024. [PMID: 38887141 DOI: 10.1111/birt.12839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/22/2024] [Accepted: 05/02/2024] [Indexed: 06/20/2024]
Abstract
INTRODUCTION Centering affected individuals and forming equitable institutional-community partnerships are necessary to meaningfully transform care delivery systems. We describe our use of the PRECEDE-PROCEED framework to design, plan, and implement a novel care delivery system to address perinatal inequities in San Francisco. METHODS Community engagement (PRECEDE phases 1-2) informed the "Pregnancy Village" prototype, which would unite key organizations to deliver valuable services alongside one another, as a recurring "one-stop-shop" community-based event, delivered in an uplifting, celebratory, and healing environment. Semi-structured interviews with key partners identified participation facilitators and barriers (PRECEDE phases 3-4) and findings informed our implementation roadmap. We measured feasibility through the number of events successfully produced and attended, and organizational engagement through meeting attendance and surveys. RESULTS The goals of Pregnancy Village resonated with key partners. Most organizations identified resource constraints and other participation barriers; all committed to the requested 12-month pilot. During its first year, 10 pilot events were held with consistent organizational participation and high provider engagement. CONCLUSION Through deep engagement and equitable partnerships between community and institutional stakeholders, novel systems of care delivery can be implemented to better meet comprehensive community needs.
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Affiliation(s)
- Malini A Nijagal
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, USA
| | - Osamuedeme J Odiase
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | - April J Bell
- Department of Family and Community Medicine, University of California, San Francisco, California, USA
| | - Alison M El Ayadi
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA
| | - Schyneida Williams
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, USA
| | - Chloe Nicolaisen
- Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, USA
| | - Garrett Jacobs
- Designing Justice + Designing Spaces (DJDS), Oakland, California, USA
| | - Brandi Mack
- Designing Justice + Designing Spaces (DJDS), Oakland, California, USA
| | - Monique LaSerre
- Rafiki Coalition for Health and Wellness, San Francisco, California, USA
| | - Chelsea Stewart
- Rafiki Coalition for Health and Wellness, San Francisco, California, USA
| | | | - Patience A Afulani
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA
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Uçakcı Asalıoğlu C, Yaman Sözbir Ş. Effect of online health training/counseling and progressive muscle relaxation exercise on postpartum depression and maternal attachment: A randomized controlled trial. Int J Gynaecol Obstet 2024; 165:1218-1228. [PMID: 38294240 DOI: 10.1002/ijgo.15359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/15/2023] [Accepted: 12/26/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVE To evaluate the effect of online health training/counseling and a progressive muscle relaxation exercise (PMRE) program on postpartum depression and maternal attachment. METHODS The present study was a randomized, controlled, experimental trial. Participants were asked to complete the Prenatal Attachment Inventory (PAI) and the Edinburgh Postpartum Depression Scale (EPDS) at 35 weeks of pregnancy. Group assignment was done by stratified block randomization according to EPDS score (0-9, 10-30) and parity. Women in the experimental group received training in progressive muscle relaxation, postpartum depression, and maternal attachment via online video calls twice a week starting at 36-37 weeks of pregnancy. They were asked to complete the PMRE program from 36 weeks of pregnancy until 6 months postpartum, and online counseling was provided throughout this period. Participants completed the Maternal Postpartum Attachment Scale (MPAS) and the EPDS at 6 weeks postpartum. RESULTS Mean PAI score was 64.24 ± 9.61 in the experimental group before the intervention and 62.14 ± 10.13 in the control group. The mean EPDS score of the experimental group was 9.12 ± 5.05 and the mean score of the control group was 9.77 ± 6.30 (P > 0.05). The mean MPAS score after the intervention was 13.92 ± 5.54 in the experimental group and 17.51 ± 6.12 in the control group. The mean EPDS score of the experimental group was 3.40 ± 3.00 and the mean score of the control group was 11.40 ± 5.91 (P < 0.05). CONCLUSION Online health training/counseling and PMRE reduce the risk of postpartum depression and increase maternal attachment.
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Affiliation(s)
| | - Şengül Yaman Sözbir
- Department of Nursing, Gazi University Faculty of Nursing, Çankaya, Ankara, Turkey
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Jajarmi H, Tavakoli Sani SB, Pourtaheri A, Gholian-Aval M, Esmaily H, Hosseini SH, Rajabzadeh R, Tehrani H. A community based intervention to modify preventive behaviors of cutaneous leishmaniasis in children: a randomized controlled trial based on PRECEDE PROCEED model. BMC Public Health 2024; 24:1304. [PMID: 38741099 DOI: 10.1186/s12889-024-18810-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 05/09/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVES Iran ranks among the top six countries globally with a significant incidence of Cutaneous Leishmaniasis (CL). Using planning models is one community-based intervention to promote preventive behaviors. The purpose of our study was to evaluate the effectiveness of the PRECEDE-PROCEED model (PPM) in modifying preventive behaviors related to CL in children through mother training in a community intervention. METHODS A randomized controlled trial based on the PPM model was conducted on 168 mothers (intervention (n = 84) and control group (n = 84) with 10 years old children in the rural areas of Iran. Mothers from 7 village areas were randomly allocated to the intervention (2 village) and control groups (5 village). The intervention group received a program comprising eight 90-minute training sessions and environmental interventions. In this study, we utilized the PPM as a framework to design the questionnaires on Leishmaniosis prevention behavior. Participants in both groups completed the questionnaires at baseline (before the intervention), immediately after the intervention, and at the 2-month follow-up. Analysis of the data was conducted utilizing SPSS20, with statistical significance set at p < 0.05. RESULTS Compared to the control group, the intervention group showed significant increases in knowledge, enabling factors, reinforcing factors, attitude, and preventive behaviors related to Cutaneous Leishmaniasis over time from baseline to follow-up (P < 0.001). No significant differences (P > 0.05) were observed in the alterations of the PPM construct, knowledge, and preventive behaviors within the control group from pre-intervention to follow-up. CONCLUSIONS Community (education and environmental) intervention based on PPM is feasible and acceptable to modify preventive behaviors of Cutaneous Leishmaniasis in children by increasing a mother's knowledge and attitude as well as changing enabling and reinforcing factors. TRIAL REGISTRATION IRCT20160619028529N8.
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Affiliation(s)
- Hossein Jajarmi
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyedeh Belin Tavakoli Sani
- Department of Health, Safety, and environment, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
- Social Determinants of Health research center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Asma Pourtaheri
- Instructor of Health Education, School of Public Health, Bam University of Medical Sciences, Bam, Iran
| | - Mahdi Gholian-Aval
- Department of Health Education and Health Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
- Social Determinants of Health research center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Habibollah Esmaily
- Department of Biostatistics, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
- Social Determinants of Health research center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Hamid Hosseini
- Health Education and Promotion, Vector-borne Diseases Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Rezvan Rajabzadeh
- Epidemiology, Vector-borne Diseases Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Hadi Tehrani
- Department of Health, Safety, and environment, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
- Social Determinants of Health research center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Pillai L, Srivastava S, Ajin A, Rana SS, Mathkor DM, Haque S, M Tambuwala M, Ahmad F. Etiology and incidence of postpartum depression among birthing women in the scenario of pandemics, geopolitical conflicts and natural disasters: a systematic review. J Psychosom Obstet Gynaecol 2023; 44:2278016. [PMID: 38050938 DOI: 10.1080/0167482x.2023.2278016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/27/2023] [Indexed: 12/07/2023] Open
Abstract
Postpartum depression (PPD) is classified under postpartum psychiatric disorders and initiates soon after birthing, eliciting neuropsychological and behavioral deficits in mothers and offspring. Globally, PPD is estimated to be associated with 130-190 per 1000 birthing. The severity and incidences of PPD have aggravated in the recent years due to the several unfavorable environmental and geopolitical circumstances. The purpose of this systematic review hence is to explore the contributions of recent circumstances on the pathogenesis and incidence of PPD. The search, selection and retrieval of the articles published during the last three years were systematically performed. The results from the primary studies indicate that unfavorable contemporary socio-geopolitical and environmental circumstances (e.g. Covid-19 pandemic, political conflicts/wars, and natural calamities; such as floods and earthquakes) detrimentally affect PPD etiology. A combination of socio-economic and psychological factors, including perceived lack of support and anxiousness about the future may contribute to drastic aggravation of PPD incidences. Finally, we outline some of the potential treatment regimens (e.g. inter-personal psycho- and art-based therapies) that may prove to be effective in amelioration of PPD-linked symptoms in birthing women, either alone or in complementation with traditional pharmacological interventions. We propose these psychological and art-based intervention strategies may beneficially counteract the negative influences of the unfortunate recent events across multiple cultures, societies and geographical regions.
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Affiliation(s)
- Lakshmi Pillai
- Department of Biotechnology, School of Bio Sciences and Technology (SBST), Vellore Institute of Technology, Vellore, India
| | - Shayna Srivastava
- Department of Biotechnology, School of Bio Sciences and Technology (SBST), Vellore Institute of Technology, Vellore, India
| | - Akhil Ajin
- Department of Biotechnology, School of Bio Sciences and Technology (SBST), Vellore Institute of Technology, Vellore, India
| | - Sandeep Singh Rana
- Department of Biosciences, School of Bio Sciences and Technology (SBST), Vellore Institute of Technology, Vellore, India
| | - Darin Mansor Mathkor
- Research and Scientific Studies Unit, College of Nursing and Allied Health Sciences, Jazan University, Jazan, Saudi Arabia
| | - Shafiul Haque
- Research and Scientific Studies Unit, College of Nursing and Allied Health Sciences, Jazan University, Jazan, Saudi Arabia
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Murtaza M Tambuwala
- Lincoln Medical School, University of Lincoln, Brayford Pool Campus, Lincoln, UK
| | - Faraz Ahmad
- Department of Biotechnology, School of Bio Sciences and Technology (SBST), Vellore Institute of Technology, Vellore, India
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Alizadeh-Dibazari Z, Abdolalipour S, Mirghafourvand M. The effect of prenatal education on fear of childbirth, pain intensity during labour and childbirth experience: a scoping review using systematic approach and meta-analysis. BMC Pregnancy Childbirth 2023; 23:541. [PMID: 37501120 PMCID: PMC10373291 DOI: 10.1186/s12884-023-05867-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/22/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Antenatal education provides parents with strategies for pregnancy, childbirth, and parenthood. There is not enough evidence of the positive effect of prenatal education on childbirth and maternal outcomes. The present scoping review using a systematic approach, evaluates the effectiveness of prenatal education on fear of childbirth, pain intensity during labour, childbirth experience, and postpartum psychological health. METHODS We used Google Scholar and systematically reviewed databases such as PubMed, Web of Science, Cochrane, Scopus, and SID (Scientific Information Database). Randomized controlled and quasi-experimental trials examining the effect of structured antenatal education and routine prenatal care compared to routine prenatal care were reviewed. The participants included pregnant women preferring a normal vaginal delivery and had no history of maternal or foetal problems. The outcomes considered in this study included fear of childbirth, pain intensity during labour, childbirth experience (as primary outcomes) and postpartum psychological health (as secondary outcomes). The grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence. RESULTS Overall, 3242 studies were examined, of which 18 were qualified for the final analysis. The meta-analysis showed that providing prenatal education and routine care compared to only routine care may decrease the fear of childbirth, postpartum depression, and pain intensity during labour. However, we found no study examining the outcome of the childbirth experience. In addition, the inconsistency of included studies prevented conducting a meta-analysis on the rest of the outcomes. CONCLUSIONS Our investigations showed that there are very few or no studies on the effect of prenatal education on outcomes such as childbirth experience, postpartum anxiety, and maternal attachment, and the existing studies on the effect of prenatal education on outcomes such as the fear of childbirth, postpartum depression, and pain intensity during labour lack sufficient quality to make definitive conclusions. Therefore, high-quality, randomized trials with a more extensive sample size are suggested to provide clear reports to make definitive decisions. PROSPERO ID CRD42022376895.
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Affiliation(s)
- Zohreh Alizadeh-Dibazari
- Midwifery Department, Faculty of Nursing and Midwifery, Students' Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Somayeh Abdolalipour
- Midwifery Department, Faculty of Nursing and Midwifery, Students' Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
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Han L, Zhang J, Yang J, Yang X, Bai H. Between Personality Traits and Postpartum Depression: The Mediated Role of Maternal Self-Efficacy. Neuropsychiatr Dis Treat 2022; 18:597-609. [PMID: 35342292 PMCID: PMC8942121 DOI: 10.2147/ndt.s346327] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/09/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Postpartum depression is related to many factors, which affect the health of mothers and infants. The purpose of this study is to test the mediated effect of self-efficacy in the relationship between vulnerable personality and postpartum depression. PATIENTS AND METHODS A cross-sectional survey was conducted with pregnant women aged ≥20 years from February to April 2021 in Zhengzhou, China. We recruited 587 pregnant women, and 429 pieces of data were available. The demographic characteristics questionnaire, General Self efficacy Scale (GSES) and Vulnerable Personality Style Questionnaire (VPSQ) were distributed in the prenatal survey. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen postpartum depression symptoms at one month through WeChat and telephone follow-up. A mediated model was constructed to explain the relationship of variables and test the mediated effect of self-efficacy. RESULTS The valid questionnaires were 429 (effective response rate: 90.7%). The vulnerable personality and low self-efficacy were related to postpartum depression (all P< 0.01). The self-efficacy of pregnant women was inversely associated with vulnerable personality (β= -0.415) and postpartum depression (β= -0.216). The vulnerable personality and self-efficacy can explain 29.0% of the variation in postpartum depression. It was confirmed that a partial mediating effect of self-efficacy accounted for 18.0% (0.090/0.501) of the total effect. CONCLUSION Maternal self-efficacy partly mediates the relationship between vulnerable personality traits and postpartum depression. The study implies the importance of targeted interventions to improve self-efficacy for women with vulnerable personality traits to reduce the risk of postpartum depression.
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Affiliation(s)
- Lingli Han
- The Third Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Ji Zhang
- Zhengzhou Maternal and Child Health Hospital, Zhengzhou, Henan, People's Republic of China
| | - Jingxuan Yang
- The Third Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Xiaoyu Yang
- The Third Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Hua Bai
- The Third Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
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Beydokhti TB, Dehnoalian A, Moshki M, Akbary A. Effect of educational- counseling program based on precede-proceed model during Pregnancy on postpartum depression. Nurs Open 2021; 8:1578-1586. [PMID: 33438825 PMCID: PMC8186680 DOI: 10.1002/nop2.770] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/27/2020] [Accepted: 11/05/2020] [Indexed: 12/19/2022] Open
Abstract
AIM To explore the effects of an educational- counselling programme based on the precede-proceed model during pregnancy on preventing post-partum depression. DESIGN A randomized clinical trial (RCT) study. METHOD 130 pregnant women were selected and randomly assigned to intervention and control groups. Data collection was carried out using questionnaires of predisposing, reinforcing and enabling factors, GHQ and Edinburgh Postnatal Depression Scale (EPDS). The Education programme was designed and performed in each group in a given weekday through four 60-minute sessions. The whole intervention lasted for one month in all groups. The participants in the control group were given routine pregnancy care. Data were gathered before and after the intervention in both groups. RESULTS Independent t test showed a significant difference between the two groups in terms of the mean score of predisposing, reinforcing, enabling factors and post-partum depression (p < .05). Regression tests indicated predisposing, reinforcing, enabling factors and general health as the most important factors associated with post-partum depression (p < .05). The results supported the effectiveness of the educational intervention on reducing post-partum depression and showed that implementing these training during pregnancy leads to a reduced level of post-partum depression.
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Affiliation(s)
- Tahereh Baloochi Beydokhti
- Department of Emergency MedicineSchool of Nursing; Social Development & Health Promotion Research CentreGonabad University of Medical SciencesGonabadIran
| | - Atefeh Dehnoalian
- Department of NursingNeyshabur University of Medical SciencesNeyshaburIran
| | - Mahdi Moshki
- Department of Health Education & Health PromotionSchool of Health Sciences; and Social Development & Health Promotion Research CenterGonabad University of Medical SciencesGonabadIran
| | - Ali Akbary
- Department of PsychiatryFaculty of MedicineGonabad University of Medical SciencesGonabadIran
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