Study Of Self-healthcare Management Level And Influencing Factors In Pregnant Women

Objective To develop a rating questionnaire of self-healthcare management for pregnant woman, and to investigate the self-management behaviors and their influential factors in pregnant women in providing the evidence for strategy making of health education.MethodsThe questionnaire, named Self-rating Questionnaire of Healthcare Management for Pregnancy(SQHMP), was developed based on the socio-cognitive theory, self-efficacy theory, trans-theoretical model of behavior and guidance of the primary prevention concept. With relevant literature extensively reviewed and experts'suggestions broadly consulted, the initial questionnaire was established. The preliminary scale was reviewed by 60 full-term pregnant women, and a series of statistic analyses were conducted, such as T-test, correlation analysis, factor analysis, etc. To deduce the items to 25 and then a comprehensive set of psychometric tests was performed on the final version. The reliability analysis included the test-retest reliability, Cronbach's a coefficient, split-half reliability. The validity analysis included content validity and construct validity.A convenient sample of 200 pregnant women from the Affiliated Hospital of Bengbu Medical College was taken as objects of the investigation. Self-rating anxiety scale (SAS), self-rating depression scale(SDS), social support rating scale(SSRS) and self-rating questionnaire of healthcare management for pregnancy (SQHMP) were used together to collect the data, and t-test, one way analysis of variance and multinomial logistic regression analysis were employed as data analysis by using Statistical Package for the Social Sciences(10.0). ResultsItem reduction and scale construction were carried out using principal component and the final questionnaire comprised 4 dimensions grouping 25 items. The appraisal results of reliability were as follows: The range of test-retest reliability Pearson correlation coefficient were 0.85 to 0.96, the test-retest reliability Pearson correlation coefficient of the total score was 0.96; The range of split-half reliability coefficient of 4 domains were 0.62 to 0.84, the total split-half reliability coefficient was 0.87; Cronbach'sαcoefficient, which is an index of internal consistency reliability, ranged from 0.81 to 0.87, the Cronbach'sαcoefficient of total score was 0.93; The Pearson correlation coefficient between each item and sub-scale ranged from 0.31 to 0.83, that of 4 domains ranged from 0.43 to 0.61 and the Pearson correlation coefficient between sub-scale and total scale ranged from 0.73 to 0.87. The appraisal results of validity were as fo1lows: The content validity index of the total questionnaire was 0.91 and sub-scale ranged from 0.89 to 0.92. Factor analysis(PCA) used to evaluate construct validity, the KMO statistic of 0.68 and Bart1ett's test results of spherical withχ2=697.46(P=0.000) suggested that the factor analysis could be performed appropriately. Through factor analysis, the four common factors were worked out, and the cumulative contribution rate was 62.30%. The four common factors were defined as factor 1- self-protection behavior (8 items), factor 2- fetal monitoring behavior(5 items), factor 3- medical compliance behavior(4 items) and factor 4- daily life behavior(8 items). The remaining entries in the load factors were found in line with the questionnaire structure, supporting the structural validity.The score of self-healthcare management in these pregnant women was bit low (67.83±13.00) , with a moderate average score index of 74.26%. In every domain, the maximal one was self-protection behavior(78.76%), followed by medical compliance behavior (78.50%) and daily life behavior(77.24%), while the minimal one was fetal monitoring behavior(56.50%). More than 90% of pregnant women reached middle to high level in the aspects of self-protection behavior, medical compliance behavior and daily life behavior management. 49.50% of pregnant women were at a low level in fetal monitoring behavior. Pregnant women under 24 years old have the lowest self-healthcare management level(F=5.13,P<0.01); The self-healthcare management level of pregnant women with professionals, laborers, peasants and unemployed varying in a descending order(F=13.84,P<0.001); With the improvement of families'monthly-earning, the self-healthcare management level improved as well(F=11.45,P<0.01). The self-management behavior of pregnant women with primary school or junior high school were worse than pregnant women with the educational level for high school, or institutes for higher learing(F=22.97,P<0.001). In families with a greater concern for pregnancy, the self-healthcare management level of pregnant women was higher(t=3.82,P<0.01).The results of multinomial logistic regression analysis showed that the factors influencing high level of self-healthcare management include high school education(junior high school=reference), occupation for professional and technical personnel(unemployed personnel=reference), families'monthly-earning lower from 2000 to 2999 RMB (lower than 1000 RMB=reference) and depression symptoms score for medium group(high score group=reference). Their OR were 4.15(95%CI: 1.005～17.146),5.20(95%CI: 1.240～21.807),6.49(95%CI: 1.284～32.791)and 2.84(95%CI: 1.024～7.847) respectively.Conclusions The Self-rating Questionnaire of Healthcare Management for Pergnancy (SQHMP) has been proved to be of high reliability and reached the standard of psychological measurement, the division of 4 dimensions accords with original design philosophy and it can serve as a measuring tool to evaluate the self-healthcare management level of the pregnant women. The self-healthcare management of pregnant women are influenced by social demographic factors, including occupation, educational level, family monthly income, and depression symptoms. The intervention of the self-healthcare management of pregnant women should be based on different occupation, economic and cultural background combined with psychological intervention.