Introduction
Being pregnant and supply is likely one of the most necessary experiences in girls’s lives, in addition to a chance for screening their well being and reinforcing wholesome behaviors.1 As pregnant girls undergo numerous bodily, psychological, and social adjustments, their want for info and looking for habits typically improve.2 Whereas studying about wholesome being pregnant, pregnant girls study that their well being practices straight have an effect on fetal well being and being pregnant outcomes.3
Prenatal care and training are important elements of look after sustaining maternal and fetal well being throughout being pregnant.4 This gives a chance to watch their well being and ship important training to pregnant girls and their households.4 Pregnant girls who purchase ample data and coping strategies have been proven to enhance well being practices, turn out to be assured in maternal roles, and improve their maternal-child attachment.5 Furthermore, prenatal training lowers the bodily, psychological, and social dangers throughout being pregnant, helps to construct wholesome relationships with household and neighborhood, and reduces perinatal mortality and morbidity.6
Prenatal training in South Korea is commonly supplied by medical facilities and personal companies (eg, pharmaceutical or child product corporations).7 Lots of the girls, particularly pregnant girls at work (PWW), can’t attend to those on-site classes as a result of place and time restrictions.8,9 They typically depend on pregnancy-related books, acquaintances, and the web.10 A few of this wealth of data is useful; nevertheless, some sources provide incorrect or low-evidence info resulting in considerations about what’s transmitted. Contemplating that the working pregnant girls accounted for 44.0% of whole pregnant girls in 2020,11 many ladies in South Korea could have restricted entry to on-site prenatal training. A number of research on Korean pregnant girls have described elevated antagonistic being pregnant outcomes in working pregnant girls and have advised that further assist is required for these girls.12,13
To deal with limitations of conventional prenatal training, extra acceptable instructional media are rising.11 With a rise in smartphone provide, well being training using smartphones is growing within the medical area.14,15 Smartphone-based training has benefits, together with no temporal and spatial constraints, quick access, and comfort.16 In South Korea, the speed of smartphone utilization was 94% in 2018.17 The smartphone possession was the best amongst youthful adults (ie between the age of 18 and 36) in comparison with different age teams.17 Contemplating the typical first-child start age is 31.4 years in South Korea,18 using smartphones for prenatal training is possible. Earlier research have used a web-based being pregnant administration program that confirmed a rise in pregnant healthcare data, self-efficacy, wholesome behaviors, and higher program satisfaction within the intervention group.10,19
The PWW have been reported to have many difficulties in receiving prenatal care and training. Their unmet instructional and knowledge wants typically result in nervousness and poor being pregnant administration. To deal with these wants, this research aimed to 1) develop an smartphone software to ship prenatal training and assist self-care habits for South Korean PWW and a couple of) study preliminary results and value of this system.
Supplies and Strategies
This research included two phases. In part one, the Self-care for Pregnant Ladies at Work (SPWW) cell software was designed and developed by the analysis crew. In part two, usability testing of SPWW was carried out by 31 PWW and 13 healthcare suppliers who had been acquainted with pregnant girls’s well being. The research information was collected between March and October 2019. This research complies with the Declaration of Helsinki and was carried out in line with the Chung-Ang College Institutional Evaluate Board’s approval (1041078–201905-HRSB-153-01).
Section 1. Growth of SPWW
The Orem’s Self-care Deficit Nursing Idea guided the event of SPWW.20 In line with the speculation, human have an desirous to look after oneself.21 Self-care deficit happens when one’s self-care capability and talent doesn’t meet the self-care calls for.21,22 That is when nursing turns into needed.21,22 We understood from the earlier research that the PWW are experiencing self-care deficit as a result of numerous boundaries from work that restrict girls from performing self-care.8,9 The SPWW was designed to assist nursing system that addresses the deficit.
The event course of and transient technical circulation of the SPWW are described in Figure 1. The SPWW was developed in Google Play Console23 with Amazon Net Companies backend assist for storage.24 The Firebase Might Messaging was used to ship messages to the customers.25 The contents and constructs of the SPWW had been designed based mostly on a previously-conducted systematic assessment of technology-supported intervention for pregnant girls.26 The well being matters on which the SPWW targeted on had been chosen based mostly on precedence well being practices described in a scientific assessment of the technology-supported intervention for pregnant girls.26 The parts and features of the SPWW had been chosen based mostly on the earlier research, which explored key parts of mHealth interventions.27 Essentially the most regularly used behavioral change strategies had been setting behavioral objectives, offering info, and selling self-monitoring.27 The SPWW included all of those parts.
Determine 1 Growth course of and fundamental technical circulation of Self-care for Pregnant Ladies at Work Cell Utility. |
The analysis crew members consisted of a main investigator (nursing college professor) and three registered nurses (one nurse with a Grasp of Science in Nursing, two with a Bachelor of Science in Nursing levels). The know-how crew members constituted two software program consultants with numerous expertise in growing cell functions and one software program designer. To develop an appropriate intervention program, the analysis crew and know-how crew held a number of conferences to finalize the prototype between March and July 2019. A number of methods for selling adherence to this system had been mentioned and embedded in this system. The applying was constructed for the Android platform because it permits simple launch to software shops and simple updates.
Section 2. Preliminary Results and Usability Testing of SPWW
Individuals and Settings
The usability of SPWW was examined between August and October 2019 from PWW and healthcare suppliers. Researchers sometimes suggest a pattern dimension of a pilot research to be between 10 and 40 individuals or 10% of the ultimate research dimension of the pilot research.28 The pattern dimension of the ultimate research was calculated to be 74; nevertheless, to handle attainable drop-outs and calculate reliability of the research devices, we determined to have a minimum of 30 PWW and 10 healthcare suppliers for usability checks. To attenuate the sampling bias solely inclusion standards of the PWW had been being lower than 36-week of being pregnant (contemplating the research interval) and girls who can learn and kind by way of smartphone. The healthcare suppliers with greater than 5 years of working with this inhabitants had been included within the research.
Information Assortment
The PWW had been recruited utilizing a handy sampling technique. The research was marketed on three main on-line communities the place pregnant girls typically alternate info and had separate posting sections for pregnant girls and moms who work. The research was delineated as an internet put up with a hyperlink to obtain the appliance by way of Google Play. After set up, the ladies had been requested to signal knowledgeable consent, generate a nickname, reply an inventory of questions, after which submit. The venture investigator reviewed the solutions and authorised their participation within the research. Upon approval, the push message was despatched to the individuals and requested to assessment step-by-step instruction for utilizing software and reply a pre-intervention questionnaire. After finishing the questionnaire, they had been in a position to make use of the appliance freely for 2 weeks. On the 14th day, the individuals acquired a push message that guides to reply a post-intervention questionnaire.
Contrarily, the healthcare suppliers had been recruited utilizing the snowball sampling technique. It’s an efficient technique to collect wealthy information based mostly on dependable interpersonal relationships amongst healthcare suppliers.29 The venture investigator defined the research to 2 healthcare suppliers who labored within the obstetrics and gynecology unit and had been invited to move on this research info to their colleagues. After signing the knowledgeable consent, the healthcare suppliers had been in a position to navigate the appliance freely for 2 weeks. On the 14th day, the hyperlink to the post-intervention questionnaire designed by way of SurveyMonkey for the healthcare suppliers was despatched by way of a multimedia messaging service. The individuals from each teams acquired $10 cell reward card as compensation.
Devices
The PWW acquired whole of twenty-two objects on sociodemographic, pregnancy-related, and work pattern-related questions. The healthcare suppliers acquired three questions relating to their age, occupation, and years of working. The PWW acquired questions on well being practices for wholesome being pregnant and system usability. The healthcare suppliers solely acquired questions on system usability. The applying utilization info was collected amongst PWW, together with the period of time spent on every software part, how they set their software alarm preferences, and efficiency on well being logs. The first outcomes of the research had been well being practices of pregnant girls and software usability.
The individuals’ well being practices associated to being pregnant had been assessed utilizing the Well being Practices in Being pregnant Questionnaire-II (HPQ-II),3 a 34-item questionnaire. The next summed rating indicated an individual performing extra health-promoting practices in being pregnant.3 Cronbach’s alpha of the dimensions was 0.813 and 0.90.30 Since a Korean-language model of the dimensions was unavailable, the analysis crew translated the dimensions into Korean utilizing forward-and-back translation.31 Through the translation course of, 4 objects from the dimensions had been eliminated as they had been comparatively irrelevant to South Korean tradition (eg, use of marijuana). A modified 30-item Korean model of the HPQ-II confirmed a Cronbach’s alpha of 0.86 on this research.
The usability of the SPWW cell software was evaluated utilizing the System Usability Scale (SUS),32 a 10-item scale. In line with the scoring rubric, 1 was subtracted from odd-numbered objects and scores of even-numbered objects had been subtracted from 5. The summed rating was multiplied by 2.5. This ultimate rating ranged between 0 and 100. A rating over 68 is taken into account to be a system with “good” usability.33 The Cronbach’s alpha was 0.81 in our research. Along with the SUS, we added 4 open-ended inquiries to take heed to the precise voices of the individuals on strategies to enhance the appliance.
Information Evaluation
The SPSS 25.0 statistical software program bundle was used to research the quantitative information of every group. To take care of the validity of the research, individuals who missed over 10% of the full questions had been excluded from the research.34 The lacking information from the remaining individuals’ was assessed for lacking at randomness and all analyses had been carried out with out information imputation.35 The sociodemographic information had been analyzed utilizing descriptive evaluation. The preliminary results of the SPWW on the research variables had been analyzed by way of paired t-tests. The usability of the SPWW functions was analyzed by way of calculation of the SUS rating and performing a content material evaluation of the qualitative information retrieved from 4 further open-ended questions. The ATLAS.ti 8 software program bundle was used for qualitative evaluation.
Outcomes
Section 1. Growth of SPWW
The 4 well being practices addressed by way of SPWW had been: (1) getting sufficient sleep and relaxation; (2) wholesome consuming; (3) enhancing bodily exercise; and (4) stress administration. Every subject was addressed by way of the 4 parts of SPWW (Figure 2): (1) Schooling Periods; (2) the Well being Log; (3) the Diary; and (4) the Dialogue Board. The customers might freely navigate these 4 parts by tapping on every icon fastened on the backside of the appliance.
Determine 2 4 parts of SPWW cell software (English translated model). |
Within the “Schooling Periods,” eight instructional studying supplies had been accessible from the eight totally different matters. The studying supplies focused a below-fifth-grade studying degree and developed by the analysis crew members. The supplies’ contents had been proofread and revised by two different nursing professors in girls’s well being. The size of every studying supplies was 12 to 17 PowerPoint slides, with an estimated studying time of quarter-hour. The primary 4 classes had been on the research’s focused 4 well being practices: sleep and relaxation, consuming, bodily exercise, and stress administration. Every session defined why this well being apply is necessary for pregnant girls and supplied a number of particular actions that might be performed in a piece setting. The opposite 4 classes had been well being info relating to the indicators and signs of labor onset, recommendations on hospital admission for supply, the 4 phases of labor, and labor ache administration. To maintain the individuals’ adherence to this system, the primary 4 instructional supplies had been accessible from the start of their participation within the research, however the latter 4 supplies had been accessible from day 8 of participation.
The “Well being Log” was designed to assist individuals set individualized objectives to carry out well being practices on the research’s 4 focused matters. They had been requested to sort in what sorts of particular actions they want to do for every of the 4 matters and the way typically they want to do them (eg, stretching for enhanced bodily exercise (subject 3) each 2 hours). The objective setting web page guided the individuals to check with “Schooling Periods” to assist them set objectives. As soon as they set the objective, they started receiving push alarms from the functions saying, “It’s time to do well being practices,” in line with their alarm regularity settings. The customers had been free to vary actions and the regularity of the alarm at any time. Additionally, they had been in a position to present their sleeping occasions (eg between 9 p.m. and seven a.m.) and snooze the appliance’s push alarms. Upon receiving push alarms from the appliance, the customers had been guided to decide on “carried out” or “not carried out” on every of their pre-set actions. Their efficiency was calculated in proportion and colours (blue for assembly over 70% of efficiency, yellow for assembly over 30% of efficiency, crimson for assembly lower than 30% of efficiency). This visualization of each day efficiency was one other technique for the individuals to reinforce adherence and compliance to the research program (ie, get extra inexperienced days).
The “Diary” was designed to maintain a each day message for the individuals’ unborn child. On high of the diary display screen, the day’s well being apply efficiency info was proven. This guided the individuals to replicate on their day and to plan higher for the next day.
The “Dialogue Board” was divided into two. The primary board was designed for individuals to anonymously put up their tales and write feedback to one another. The second board was a one-to-one board the place individuals might ask inquiries to analysis crew and get solutions.
Section 2. Preliminary Results and Usability Testing of SPWW
The PWW
Amongst 37 PWW recruited for the research, six individuals who missed over 10% of the full questions on the preliminary survey had been excluded from the research. The sociodemographic info is summarized in Table 1. The individuals’ imply size of working was 53.32 months (virtually 4.44 years). They labored 8.26 hours a day and labored 4.71 days per week; thus, they labored 38.90 hours per week. Over half of the individuals reported they did workplace jobs (67.7%), 12.9% reported they had been educators, and the others mentioned they work for the federal government or do service jobs.
Desk 1 Basic Traits of Individuals (Pregnant Ladies at Work; N=31) |
The common variety of views on every of the eight instructional classes ranged between 1.90 and a couple of.16 occasions per participant. Essentially the most considered session matters had been indicators and signs of labor onset and recommendations on hospital admission for supply. The individuals set their alarm to do self-care practices each 4.03 hours on common. Essentially the most profitable space of their self-care efficiency was taking prenatal nutritional vitamins, whereas the typical efficiency of every participant was 34.13%.
The consequences of the intervention on the PWW is summarized in Table 2. Statistically vital variations earlier than and after the intervention had been: “Workouts greater than thrice every week,” “Drinks ample fluid (together with water),” and “Drinks greater than two caffeinated drinks a day.” The individuals reported doing extra train (t = −2.971, p = 0.006), ingesting extra fluid (t = −3.407, p = 0.002), and ingesting much less caffeinated drinks (t = 2.065, p = 0.048). The individuals’ adjustments in general well being practices weren’t statistically vital; nevertheless, elevated from 3.65 at pre-test to three.76 at post-test (t = −1.196, p = 0.241).
Desk 2 Preliminary Results on Well being Practices (Pregnant Ladies at Work; N=31) |
The outcomes of the usability evaluation of the SPWW cell software are proven in Table 3. The very best rating was scored on the merchandise: “I might think about that most individuals would study to make use of this technique in a short time.” The bottom rating was scored on the merchandise: “I wanted to study quite a lot of issues earlier than I might get going with this technique.” The calculated rating of the dimensions was 67.82 ± 14.28.
Desk 3 Usability Evaluation of the SPWW Cell Utility |
Of the individuals, 64.5% supplied particular solutions to open-ended questions on usability, and 54.8% commented on the “Schooling Periods” part. They reported utilizing the appliance virtually daily and thought the data was simple to grasp and useful. Some requested for a printout choice for “Schooling Periods” in order that they may put up on their desks. Nevertheless, the individuals advised offering extra various prenatal info with animation and sounds.
I preferred the transient in-office stretching information and weight-reduction plan strategies. As a substitute of the weekly instructional contents, I want to have each day instructional updates with extra fun-to-read being pregnant info (PWW #15).
A majority of individuals supplied solutions in regards to the “Well being Log” part (61.3%), with many indicating that they preferred this part essentially the most. Some individuals advised having a simple alarm-off operate to make use of throughout work conferences.
I’m experiencing elevated forgetfulness throughout being pregnant. The alarm operate was very simple to set and useful. I hardly forgot about taking prenatals whereas utilizing this app. Nevertheless, an alarm-off operate might be useful when I’m within the assembly or have to give attention to my work (PWW #4).
Of the individuals, 51.6% commented on the “Diary” part, stating that it was simple to make use of and useful in reflecting on being pregnant self-care actions. Some advised having individually customizable features, comparable to various textual content font and colour choices or methods to insert photos and images.
The diary on this app was totally different from different diary apps as my each day self-care efficiency was proven within the scene in order that I might replicate on my day extra “health-wise.” I needed to embellish this diary web page with stickers (PWW #21).
The bottom variety of individuals (38.7%) commented on the “Dialogue Board” part. They answered that the one-to-one board that allowed them to ask inquiries to the analysis members was useful. Nevertheless, they had been considerably reluctant to make use of the nameless dialogue board.
There weren’t many postings on the nameless dialogue board. I felt that everybody utilizing this app is likely to be busy at her work and don’t have time to speak by way of the app. Additionally the sense of “being in a research” made me really feel reluctant to share my tales (PWW #26).
Ladies’s Healthcare Suppliers
The 13 healthcare suppliers with over 5 years of medical expertise and had been acquainted with pregnant girls’s well being points had been recruited from the medical establishments. The imply age of the individuals was 33.62 years previous. 4 individuals had been physicians and the others had been registered nurses. Their common work years had been 8.84. The very best and the bottom scored objects from the usability evaluation of the SPWW cell software was the identical because the PWW group. Nevertheless, the calculated rating on the dimensions was 51.25 ± 7.85, which was decrease than the scores from the PWW group.
All 13 individuals supplied solutions to open-ended questions on usability. The consultants’ strategies had been just like the PWW teams’ (ie, having an alarm-off operate, growing various instructional contents, growing animated training). New strategies from the consultants had been growing quiz after training classes, offering meditation music for stress administration, and having sections to maintain the customers’ bodily traits together with weights.
Dialogue
To our data, this was the primary research that has developed a cell software for PWW and examined its preliminary results and value. Our software focused 4 self-care practices, sleep and relaxation, consuming, bodily actions, and stress administration. Equally, different research that developed cell functions for pregnant girls focused wholesome consuming and train recommendation.36,37 To assist the mobile-based intervention, a research supplied Fitbit to reinforce the extent of bodily exercise38 or dietary recipes to assist their dietary decisions.39 The preliminary results and testing of usability was carried out with two teams: PWW and girls’s healthcare suppliers. Different research pilot examined the appliance with analysis employees36 or with a focused person inhabitants.38
The imply age of the PWW individuals was 32.49 years previous. Superior age in being pregnant is expounded to the next susceptibility to well being issues.40 Furthermore, over 80% of the ladies had been having their first baby; thus, could have comparatively much less data and expertise about being pregnant and baby start.41 Contemplating their imply working hours had been 38.90 hours every week, we might infer that they might have to spare further effort and time to finish their self-care practices or seek for well being info associated to their being pregnant.
The findings of preliminary results confirmed enchancment in enhancing train, ingesting ample fluid, and limiting each day caffeine consumption. The SPWW was developed to focus on 4 well being practices: getting sufficient sleep and relaxation, wholesome consuming, enhancing bodily actions, and stress administration. All of the enhancements famous on this research had been burdened in in-application training classes and well being logs. Subsequently, we might infer that the appliance contributed to bettering PWW’s self-care practices. Extra emphasis is required on different well being practices. The advantages of train in pregnant girls have been burdened in a number of research. The advantages for pregnant girls embrace enchancment in cardiovascular operate, musculoskeletal discomfort, and glucose tolerance.42 Along with these bodily advantages, common train is useful in lowering depressive signs and bettering general health-related high quality of life.43 Throughout being pregnant, fluid wants improve to keep up circulation to the fetus, to type amniotic fluid, and to assist maternal blood quantity.44 Nevertheless, pregnant girls typically expertise dehydration with out realizing their want for fluid will increase or have consciousness of their precise fluid consumption.44 Consuming 8–10 glasses of water per day is advisable for wholesome pregnant girls.44 Caffeine consumption throughout being pregnant isn’t advisable to exceed 200 mg per day.45 Extreme caffeine consumption is expounded to elevated dangers of spontaneous abortion and nonetheless start.46
The usability of SPWW was examined utilizing the SUS. Different research have used totally different devices and strategies to check the usability, together with the Cell Utility Ranking Scale (MARS)47 and the alpha check.48 Though, the professional group rated extra positively on the general objects than the PWW did, each teams reported that the appliance was acceptable and really simple to study. Troublesome to make use of functions typically turn out to be underused, misused, or deleted from customers’ telephones.49 Furthermore, to attenuate the boundaries to utilizing mobile-based intervention, the event of detailed explanations and user-friendly functions is necessary.50
Each the PWW and girls’s healthcare suppliers made a number of strategies to enhance the SPWW. Analysis crew members addressed the enhancements previous to the next randomized managed research after the pilot research. The enhancements made to “Schooling Periods” had been diversified instructional contents and the inclusion of colourful photos, in addition to an alarm-off operate for the “Well being Log” part and font change features for the “Diary” and “Dialogue Board.”
Limitations of the Examine
The research poses a number of limitations. First, the research was restricted to utilizing on-line recruitment. Sampling bias typically exists in web-based research.51 Nevertheless, contemplating the individuals had been comparatively younger adults and the ubiquity of the web and smartphones in South Korea, we count on the sampling bias to be minimal. Furthermore, authenticity of the individuals could be one other limitation to web-based research.52 Subsequently, cautious consideration is important when decoding the research’s findings. Second, the research holds a limitation of response shift bias.53 The PWW group’s pre-test and post-test responses had been collected two weeks aside. The individuals’ post-test response might have modified because of the adjustments of their inside requirements of questionnaires or efforts to fulfill the goal objectives addressed within the research intervention. To attenuate this danger, their pre-test solutions had been hidden by the appliance earlier than initiating the precise use of the cell software.
Conclusion
Pregnant girls who work typically discover it troublesome to take part in common prenatal care or carry out each day self-care associated to their being pregnant due to rigid working circumstances. This research developed a mobile-based intervention program for South Korean PWW to reinforce their self-care practices, which might contribute to a wholesome being pregnant. The SPWW was efficient in enhancing train, ingesting ample fluid, and limiting each day caffeine consumption. For using the appliance, each PWW and professional teams reported good usability of the cell software. The outcomes from this research recommend that SPWW could be an appropriate, participating, manageable, and efficient intervention for PWW. Nonetheless, there’s a want for future analysis to check the long-term results of this software on bigger pattern sizes. Nonetheless, the appliance developed on this research is promising, in that it might probably assist PWW improve their self-care practices and keep wholesome lives throughout their being pregnant in a user-friendly manner. Moreover, developmental course of and the main points of the appliance are defined on this manuscript. We count on this manuscript to offer a information for researchers who plan to develop user-friendly cell functions involving the goal inhabitants and put it to use within the intervention research.
Acknowledgments
We want to thank the 2 healthcare suppliers from the obstetrics and gynecology unit for his or her help in recruiting girls’s healthcare suppliers for the research.
Disclosure
This analysis was funded by the Nationwide Analysis Basis of Korea in 2019-2020 (2017R1C1B5075221). The funding physique performs no function within the design of the research, information assortment, evaluation, interpretation, and writing the manuscript. The authors report no conflicts of curiosity on this work. The info of this research is out there from the venture investigator upon cheap requests.
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