Application of the salutogenic theory in the perinatal period: A systematic mixed studies review

Perceptions of game-based education among parents during the perinatal period: A mixed studies review

BACKGROUND

Experiential education, particularly through game-based approaches, has gained recognition for effectively addressing the myriad challenges faced by expectant parents.

AIM

To consolidate and synthesize the available evidence regarding expectant parents' experiences of game-based perinatal education.

DESIGN

A mixed studies review.

DATA SOURCES

Six electronic databases were searched from their inception until March 2024: PubMed, Embase, CINAHL, Web of Science, Scopus, ProQuest Dissertations and Theses Global.

METHODS

This review observed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was guided by Pluye and Hong's (2014) framework for mixed studies review. Quality appraisal of included studies was conducted using the Mixed Methods Appraisal Tool. A convergent qualitative synthesis design for mixed studies review was adopted to analyse all findings and thematic analysis was conducted.

FINDINGS

Three themes and 10 subthemes were generated from the eight included studies. The main themes were: (1) Exploring novel frontiers to deliver perinatal education, (2) Empowerment through play: Unveiling key insights and (3) Insights and recommendations.

CONCLUSION

The findings suggest that game-based education holds promise as a valuable tool for equipping expectant parents with the necessary knowledge and skills in an engaging and immersive manner to navigate the challenging perinatal period.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The findings suggest that game-based education holds promise as a valuable tool for equipping expectant parents with the necessary knowledge and skills to navigate the challenging perinatal period. Nurses should consider incorporating or developing a game-based curriculum to supplement current educational classes to encourage parental participation and enhance learning for perinatal education.

REPORTING METHOD

This study adhered to the PRISMA reporting guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

TRIAL AND PROTOCOL REGISTRATION

A protocol was submitted to PROSPERO (CRD42023447527).

Maternal experiences of women who had received salutary childbirth education: A descriptive qualitative study

BACKGROUND

Childbirth education, underpinned by Salutogenesis, presents a paradigm shift in maternal care. There was no present information about the maternal experiences of women who had received Salutary childbirth education.

OBJECTIVE

The present study aimed to deeply explore women's pregnancy, birth and postnatal experiences who attended the 'Salutary Childbirth Education Program' and shed light on the mechanisms of Salutogenesis on maternal health promotion.

METHODS

A descriptive qualitative study was conducted with 15 mothers. The study was conducted during April-October 2023. Data were obtained through semi-structured, in-depth individual longitudinal interviews to cover all maternal periods. A thematic analysis was performed.

RESULTS

Women stated that they 'acquired normality oriented perspective' which provides 'attribution of positive meanings to the period' and 'freedom from their risk focus concerns'. Women experienced the naturality of the process and were in the flow. They described that they became 'aware of their internal resources', and gained 'skills for the construction of resources' and 'ability to manage the period'. The 'emotional strength' and 'Investment ability for themselves' in addition to obtained autonomy provided them a feeling of strength to actively engage in their experience.

PRACTICE IMPLICATIONS

This study explores the experiences of women who participated in the Salutary Childbirth Education Program and describes the mechanisms of the program's components on their experiences. By doing so, it aims to enhance understanding of how healthcare professionals can present effective childbirth education through the use of the Salutogenesis Model.

PATIENT OR PUBLIC CONTRIBUTION

The authors would like to acknowledge and thank the women who attended the education program and were willing to interview.

The Childbearing sense of coherence scale (CSOC-scale): development and validation

BACKGROUND

the salutogenic theory is essential to explain an individual's ability to maintain health during the perinatal period. While previous studies mainly focused on the perspectives from a family-level orientation and a global orientation, the purpose of the present study was to develop and validate a scale, the childbearing sense of coherence scale (CSOC-scale) from the individual's perceptions of the stresses, resources, and meaningfulness of childbearing.

METHODS

A total of 3 separate studies contributed to the development of the CSOC-scale between July 2022 and February 2023. In study 1, the initial item pool based on the conceptual framework of the childbearing sense of coherence and the salutogenic theory was developed. Delphi expert consultation was conducted to revise and improve items. Studies 2 and 3 were cross-sectional studies. In study 2, item analysis and explore factor analysis (EFA) (N = 351 for women, N = 256 for men) were used to screen items. In study 3, confirmatory factor analysis (CFA) and reliability analysis (N = 366 for women, N = 308 for men) were used to test the fit indices and reliability of the final scale.

RESULTS

final analysis suggested the CSOC-scale includes three factors, consisting of 13 items. Confirmatory factor analysis demonstrated good model fit (χ2 = 157.448, df = 62, χ2/ df = 2.539, RMSEA = 0.065, CFI = 0.974, TLI = 0.968, SRMR = 0.029 for women; χ2 = 181.363, df = 62, χ2/ df = 2.925, RMSEA = 0.079, CFI = 0.968, TLI = 0.960, SRMR = 0.033 for men) and high factor loadings (from 0.751 to 0.929 for women; from 0.746 to 0.947 for men). Internal consistency (Cronbach's α ranging from 0.895 to 0.933 for women and 0.881 to 0.945 for men in three dimensions; Cronbach's α was 0.919 for women and 0.821 for men in the entire instrument) and split-half reliability (Spearman-Brown coefficients ranging from 0.876 to 0.921 for women and 0.841 to 0.937 for men in three dimensions; Spearman-Brown coefficient was 0.744 for women and 0.785 for men in the entire instrument) were excellent.

CONCLUSIONS

the CSOC-scale has robust psychometric properties. It is reliable and valid in evaluating the childbearing sense of coherence in women and men during pregnancy. Utilisation of this scale can help healthcare professionals understand the health maintenance competencies of couples during the transition of parenthood and provide health promotion services from a salutogenic perspective.

The perception of childbearing sense of coherence among Chinese couples: a qualitative study

BACKGROUND

Although childbearing health care is wellness-based and promotes normal physiology, it is in a medical model and focuses on risk aversion and disease prevention. The salutogenic theory might provide an alternative perspective to health care concerning childbearing, supporting health-promoting factors, not solely on avoiding adverse events. However, there is a dearth of qualitative research exploring couples' perceptions of childbearing from the salutogenic lens. This study aimed to explore perceptions and experiences concerning childbearing among couples in the perinatal period and identify salutogenic aspects of it.

METHODS

The qualitative descriptive study adopted a directed content analysis to analyse data from a semi-structured and individual interview with 25 purposively selected Chinese couples between July 2022 and December 2022. The concepts of the sense of coherence (SOC) from the salutogenic theory were used as the theory framework for coding.

RESULTS

Definitions and content for the salutogenic aspects of Chinese couples' perception of childbearing sense of coherence were developed. For comprehensibility of childbearing, four subthemes were extracted (the challenge to health and endurance; transition to and identification with the new role; conflict and reconciliation in relationships; resistance and compromise between social culture and personal development). For manageability of childbearing, two subthemes were extracted (helplessness and hope of childbearing; self-doubt and self-assurance of childbearing). For meaningfulness of childbearing, three subthemes were extracted (personal realisation; family bonding and harmony; the continuation of life).

CONCLUSIONS

The findings of this study could give a greater understanding in maintaining couples' health in the perinatal period from the salutogenic lens and provide a guide to further research that the salutogenic theory could bring a health and wellness-focused agenda in practice and policy-making in the perinatal period.

Case-based learning interventions for undergraduate nursing students in a theoretical course: A review of design, implementation, and outcomes

BACKGROUND

Case-based learning (CBL) is a contextualized learning and teaching method that can facilitate active and reflective learning to develop critical thinking and problem-solving skills. However, nursing educators have some difficulty in creating a CBL environment that matches the diverse professional nursing curriculum and students' needs, including developing relevant cases and appropriate CBL implementation processes.

OBJECTIVE

To summarize the case design, implementation process, and their relationship with CBL effectiveness.

METHODS

Electronic databases of PubMed, Embase, Web of Science, CINAHL, China National Knowledge Infrastructure (CNKI) and Wanfang Data (a Chinese database) were searched from inception until January 2022. Study quality was assessed using the Mixed Methods Appraisal Tool. A qualitative synthesis was then conducted to summarize the study findings.

RESULTS

The systematic mixed studies review included twenty-one quantitative studies, five qualitative studies and two mixed methods studies. The case design and implementation process were indispensable parts of each study, but the application process of CBL in each study was slightly different, basically including case design, preparation, small-group interaction and exploration, collaborative efforts, teacher summary, assignment and teacher feedback. There were three themes in this review that indicate the effect of CBL on students, namely, knowledge, competence and attitude.

CONCLUSION

The present review analyzes the available literature and suggests that there is no common format for the case design and CBL implementation process, but demonstrates that they are an indispensable part of each study. This review provides conceptual procedures for nurse educators to design and implement CBL in nursing theoretical courses to improve the effectiveness of CBL.

Parental experiences with changes in maternity care during the Covid-19 pandemic: A mixed-studies systematic review

BACKGROUND

During the COVID-19 pandemic, pregnant women were identified as a high-risk and vulnerable group. To reduce risk of transmission, maternity healthcare services were modified to limit exposure but maintain services for pregnant women. However, the change in hospital practice may have compromised quality maternal care standards. Therefore, this review aims to explore parental experiences and views with maternity care received from healthcare institutions during the COVID-19 pandemic.

METHODS

A mixed studies systematic review was conducted. Six electronic databases (Medline, CINAHL, Embase, PsycInfo, Web of Science, and Maternity and Infant Care) were searched for qualitative, observational, and mixed method studies from the year 2019 to February 2022. Study quality was appraised using the Mixed Methods Appraisal Tool. Quantitative findings were converted to narrative findings. Data was synthesised thematically using a convergent synthesis design.

RESULTS

Fifty-eight articles were included. Four themes were generated: (1) Distress associated with COVID-19 regulations (perception of hospital restrictions, confusion with ever changing policies), (2) adaptability with maternity services (prenatal: changes in birth plans, prenatal: altered antenatal appointments, education, and care, intrapartum: medicalization of birth, postpartum: varied views on care received and Breastfeeding woes, postpartum: skin-to-skin contact and mother infant bonding) (3) importance of support persons, and (4) future direction for maternity services.

CONCLUSIONS

Parental experiences highlighted how maternity care during the COVID-19 pandemic did not adhere to WHO standards of quality maternity care. This calls for healthcare institutions to continuously appraise the implementation of restrictive practices that deviate from evidence-based frameworks underpinning quality care.

Developmental trajectories of health-promoting behaviours among pregnant women: A longitudinal study

AIMS AND OBJECTIVES

The aim of this study is to estimate differences in health-promoting behaviour levels throughout the pregnancy trimesters, to identify distinct patterns of health-promoting behaviour trajectories during pregnancy and to evaluate predictors of these trajectory group memberships.

BACKGROUND

Promoting healthy lifestyle behaviours during pregnancy could decrease devastating outcomes for the mother and foetus. However, there is currently limited insight into the dynamics of health-promoting behaviours during pregnancy.

DESIGN

An observational longitudinal study.

METHODS

158 pregnant women were recruited from June 2020 to June 2021 in Qingdao, China. The Health-Promoting Lifestyle Profile was used to assess health-promoting behaviours. Latent growth model was performed to compare health-promoting behaviours at different time points. Group-based trajectory model was applied to identify health-promoting behaviour trajectories. Multinomial logistic regression was adopted to determine the predictors of trajectory group memberships. We used the STROBE checklist to report this study.

RESULTS

The entire sample of pregnant women experienced a significant increase in health-promoting behaviours during pregnancy. Three trajectories were identified including a 'low-increase behaviour trajectory (20.1% of sample)', a 'moderate-increase behaviour trajectory (58.0% of sample)' and a 'stable then increased behaviour trajectory (21.9% of sample)'. Low maternal sense of coherence, lack of pre-pregnancy exercise habit, artificial insemination and low monthly family income were significantly associated with the low-increase behaviour trajectory. High self-efficacy and pre-pregnancy exercise habit were significantly associated with the stable then increased behaviour trajectory.

CONCLUSIONS

Pregnant women exhibit different health-promoting behaviours throughout the pregnancy trimesters. Meanwhile, three trajectories were identified among pregnant women. Thus, more attentions should be paid on early identification and targeted intervention in a future study.

RELEVANCE OF CLINICAL PRACTICE

Healthcare providers should pay closer and earlier attention to identify women in the low-increase trajectory subgroup at the outset of pregnancy. Similarly, increased efforts should be made to improve maternal self-efficacy and develop good pre-pregnancy exercise habit in future study.

An educational programme based on salutogenesis theory on childbirth fear and delivery method among nulliparous women: A mixed methods research protocol

AIM

Designing, executing and testing a training intervention based on enhanced concepts of salutogenesis theory for managing fear of childbirth and choice of delivery method among nulliparous women.

DESIGN

A Sequential-Exploratory Mixed Methods Research.

METHODS

In the first phase (qualitative approach), the determinants of childbirth fear among nulliparous women will be explored. In the second phase (systematic review), the factors of childbirth fear among them will be summarized. In the third phase, the content of the educational intervention is developed based on the common factors of childbirth fear obtained from the previous two phases of the study. In the fourth phase (randomized controlled trial), two intervention and the control groups will be compared based on primary and secondary outcomes.

DISCUSSION

Using salutogenesis theory in a few interventional studies on various health areas has produced promising results. Based on the evidence, women had less sense of coherence with a strong childbirth fear. Therefore, developing an effective intervention based on this theory can probably help manage childbirth fear and reduce the costs of any potential consequences.

Coaching interventions among healthcare students in tertiary education to improve mental well-being: A mixed studies review

OBJECTIVES

To consolidate the available evidence regarding healthcare students' experiences of coaching interventions' effect on their mental well-being in tertiary educational institutions.

DESIGN

A mixed studies review.

DATA SOURCES

Seven electronic databases were searched for relevant studies from their inception dates until July 2021: PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus and ProQuest Dissertations and Theses Global.

REVIEW METHODS

This review observed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and was guided by Pluye and Hong's (2014) framework for mixed studies review. Quality appraisal of included studies was conducted using the Mixed Methods Appraisal Tool. A convergent qualitative synthesis design for mixed studies reviews was adopted to analyze all findings and thematic analysis was conducted according to Braun and Clarke's (2006) framework.

RESULTS

Three themes and seven subthemes are generated from the 12 included studies. The main themes are: 1) Receiving much-needed help, 2) Unlocking the secrets of success, and 3) Way forward for coaching in healthcare education.

CONCLUSIONS

Many students benefited from the coaching interventions in terms of academic, emotional and psychological support and received guidance in professional development. However, careful preparation of both coaches and students is needed to improve the success of coaching interventions. Future coaching interventions could incorporate both group and individual sessions, assign students to coaches based on their clinical interests and consider conducting online coaching sessions using video calls. Improvement of study rigor would be required to achieve more accurate results. Lastly, future studies should be conducted on healthcare students of more diverse disciplines and cultures to increase results' generalizability.

Application of the OMAHA System in the education of nursing students: A systematic review and narrative synthesis

AIM

The aim of this systematic review was to synthesize evidence on the application of the Omaha System in the education of nursing students and to provide advice for educators to apply the Omaha System to practice and research effectively and meaningfully.

BACKGROUND

It is a necessary part of nursing education to provide students with informatics experience. The Omaha System is a standardized nursing terminology designed to enhance practice, documentation, and information management.

DESIGN

A systematic review and narrative synthesis.

METHODS

Studies from eight databases (PubMed, Web of Science, Embase, CINAHL, PsycINFO, China Biology Medicine disc, CNKI, Wanfang Data) were systematically retrieved. Twenty-three articles were found and synthesized.

RESULTS

Existing studies showed that the Omaha System was mainly applied in student community practice as a tool for guiding practice and collecting information, and the practice data were used by educators to analyse the outcomes of nursing education. Recently, the Omaha System was introduced into the classroom environment and achieved positive results in terms of teaching. Students' feedback on the use of the Omaha System was generally positive.

CONCLUSIONS

The Omaha System can be an active teaching and learning tool for nursing education, and further research is needed to explore and realize its potential in the field of education.

Strengthening Antenatal Care towards a Salutogenic Approach: A Meta-Ethnography

The aim was to explore how midwives, public health nurses and nurses view caring in antenatal care (ANC) as provided for mothers and fathers/partners. Based on Noblit and Hare (1988), meta-ethnography was used to address meaning by synthesizing knowledge and understanding inductively through selected qualitative studies (n = 16). Four core themes were identified: (1) supporting the parents to awaken to parenthood and creating a firm foundation for early parenting and their new life situation; (2) guiding parents on the path to parenthood and new responsibility; (3) ensuring normality and the bond between baby and parents while protecting life; and (4) promoting the health and wellbeing of the family today and in the future. The overarching theme can be expressed as "helping the woman and her partner prepare for their new life with the child by providing individualized, shared care, firmly grounded and with a view of the future". Caring in antenatal care (ANC) is being totally present, listening and using multidimensional professional competence but also being open-minded to new aspects and knowledge. The health promotion and positive health aspects should be considered an important part of supporting parents and the whole family now and in the future. A more conscious salutogenic approach to ANC would lead to more favorable results and could be a fruitful research topic in the future. There is a need to provide midwives/nurses with enough time to allow them to concentrate on specific needs and support for different kind of families in ANC but also training for midwives to make them more familiar with online and other options.