| ObjectivesFetal health status can be self-monitored by fetal movement counting (FMC)conveniently and easily. Fetal movement self-monitoring may reduce stillbirth or morbidity of other adverse pregnant outcomes. Pregnant women are recommended by guidelines to implement daily FMC from the 28th gestational week to delivery,and to visit a clinic no more than 24 hours if any abnormal movements were indicated. However,limited studies about FMC behavior among pregnant women in China showed poor compliance of fetal movement self-monitoring with unclear reasons. The primary objectives of this study were to investigate current status of FMC behaviors among pregnant women and to explore factors influencing their behavior based on a combined conceptual framework of Theory of Planned Behavior (TPB) and the Health Belief Model (HBM). Further aims were to provide evidence for healthcare professionals to develop intervention campaigns to irmprove the compliance of fetal movement self-monitoring among pregnant women and further to reduce adverse pregnant outcomes.MethodsThe study was designed according to the combined conceptual framework of TPB and HJBM, including two parts.Part one: The establishment of the Questionnaire of Fetal MovementSelf-monitoring. Salient beliefs extracted by qualitative study were used as a source of items in questionnaire, which constituted the initial questionnaire together with the results of theoretical study and literature review. The initial questionnaire was sent to 10 professionals to assess its content validity and 227 women to test its reliability and construct validity using item analysis,Cronbach’s a coefficient,test-retest reliability analysis and exploratory factor analysis.Part two: The investigation of the behavior of fetal movementself-monitoring and its influencing factors. Totla 310 postpartum women recruited from 2 tertiary hospitals in Shanghai were investigated using the convenience sampling method. The fetal movement self-monitoring behavior of pregnant women was analyzed using descriptive analysis,and influencing factors were analyzed using univariate analysis, multiple regression and non-conditional logistic regression.ResultsA total of 21 salient beliefs in 6 categories were extracted from the data of structured individual interviews and used to develop the questionnaire. The questionnaire included demographic data, fetal movementself-monitoring behavior, knowledge related to FMC,and health experience and health beliefs about FMC. The item-content validity indexes were above 0.78, scale-content validity indexes were above 0.80, suggesting good content validity of the questionnaire. The item discrimination ability was good.Exploratory factor analysis of the part of health belief showed 5 factors, including subjective norm, perceived behavior control, positive attitudes, negative attitudes and disease threat perception, and explained 62.55% of the variance. Items belonged to the exact dimension as the theory showed except 2 items. The Cronbach’s a coefficient of different parts of the questionnaire ranged from 0.601 to 0.860, and the test-retest reliability ranged from 0.900 to 0.960, indicating good reliability.Totally 310 postpartum women returned valid questionnaires. Among them, 78.7%showed good FMC intention, but the standardized score of FMC behavior was(-0.187±2.80),suggesting poor behavior level. Among 257 participants who never experienced abnormal fetal movements, 86.5% of them reported intention to seek medical help when they felt abnormal fetal movements. Although the participants reported lots of cues to action, their past behavior seemed not good enough. The average knowledge score related to FMC was (6.62±2.371) out of 10, and the main sources of knowledge were healthcare professionals and the internet. The average subjective norm score was (16.13±0.168) out of 20, positive attitudes score was (16.69±0.133) out of 20,negative attitudes score was (8.42±2.212) out of 15, perceived behavior control score was(25.85±3.680) out of 35, and disease threat perception score was (10.08±2.221) out of 15.The variables which showed significant difference in behavior of FMC or the health seeking behavior after abnormal fetal movements in the univariate analysis were introduced to the multi-factor analysis. The results showed that permanent residence,positive attitudes, subjective norm and perceived susceptibility entered logistic regression model of FMC intention. Women who were urban residents, or had higher level of positive attitudes, subjective norm and perceived susceptibility were more likely to possess the FMC intention. The FMC intention, perceived severity, perceived power and subjective norm entered multiple regression model of behavior of FMC gradually.Women with higher level of these varibles might have higher behavior level of FMC. And the perceived behavior control and perceived susceptibility entered logistic regression model of intention to seek medical advice after abnormal fetal movements. Women with higher level of these varibles were more likely to have the intention of seeking medical advice on the right day of perceived abnormal fetal movements.ConclusionThe validity and reliability of the questionnaire was good,and it could be used as an instrument in studies exploring FMC behaviors among pregnant women and influencing factors. This study suggested that FMC intention of pregnant women was fine, but their FMC behaviors were suboptimal and were influenced by their FMC intention, subjective norm, perceived power and perceived severity. Our findings indicated healthcare professionals should pay more attention to pregnant women lived in rural area. Health education about FMC and its importance to fetus safety should be targeted and focused in order to develop women ’s positive cognition and threat perception of FMC behavior. And family members should also be involved in education so that they can supervise and participate in FMC behavior. |
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