| ObjectiveFetal movement is the sign of fetal life which can be accurately percervied by pregnant woman.In order to reduce the incidence of stillbirth or other adverse pregnancy outcomes,pregnant women should increase the fetal movement self-monitoring(FMSM)to immediately detect any abnormalities of fetal.However,pregnant women in China have low cognitive level and poor behavioral compliance to the FMSM,and few studies had been conducted to improve their FMSM.Some studies showed that WeChat intervention had a good effect on promoting compliance of some definite health behaviors,but it has not been applied in FMSM among pregnant women.This study aimed to develop a WeChat intervention program to improve FMSM among pregnant women in the third trimester based on 6 influencing factors of FMSM among pregnant women which had been explored in the previous study of the research team and framework of health action process approach(HAPA),and then to verify feasibility and effectiveness of this program.The findings of the study can provide evidence for improving knowledge,health belief and behavior compliance of FMSM among pregnant women in the future.MethodsThe study was divided into three parts.Part 1: Development of WeChat intervention program.Six Chinese and English databases were searched on the basis of identified retrieval strategies,and the literatures met the selection criteria and quality assessment criteria were included.Content analysis method was used and the strategies applicable to intervention of FMSM were extracted from the included articles according to the Michie’s taxonomy of behavior change techniques.Under the framework of HAPA model and focusing on the influencing factors and intervention strategies,a draft of WeChat intervention program for FMSM of pregnant women in the third trimestation was preliminarily developed.Then the content of the WeChat intervention program was evaluated using Delphi method and revised according to expert opinions.Part 2: A pilot trial of WeChat intervention program.Forty pregnant women were purposively selected from a tertiary teaching hospital of a university in Shanghai in July 2018.A series of picture-text messages were daily sent to these women via WeChat Official Account,lasting for 15 days.Pregnant women were asked to record the number of fetal movement in a WeChat clock-in and encouraged to consult health issues in a WeChat group.After 15-day intervention,the data about their message reading was collected by an online questionnaire survey,their behavior of using the program and clock-in was analyzed basing on the data of WeChat admin site,their experience and suggestion on WeChat intervention program were explored via semi-structured interview,and the content of consultations in the WeChat group was qualitatively analyzed.The WeChat intervention program was finally revised according to the above data.Part 3: A quasi-experimental study to evaluate the effect of the WeChat intervention.During August and December 2018,in the same hospital,138 pregnant women in the third trimester were selected by convenient sampling and assigned to the WeChat group(n=69)and the control group(n=69)according to the prenatal examination date.The established WeChat intervention program was used in the WeChat group,by sending 1 to 3 WeChat picture-text messages every week,lasting for 13 weeks.While the routine education with a handbook(including same knowledge as that in the WeChat intervention)was used in the control group.Before intervention,the general demographic information,knowledge level and health beliefs were investigated in both groups using questionnaire surveys at the Antenatal Clinic.After 13-week intervention,the knowledge level,health beliefs,behavioral compliance and health experience were investigated in both groups using questionnaire surveys in the Maternity Ward.And for pregnant women in the WeChat group,the satisfaction for WeChat intervention program was surveyed,and gain from intervention,evaluation and suggestion on the WeChat intervention program were collected via semi-structured interviews.ResultsPart 1: Fourteen suitable intervention techniques were extracted based on analysis of enrolled 18 literatures and 2 books related to theory.According to theoretical guidance and evidence-based guidelines and literatures about fetal movement,the definite intervention techniques were applied to FMSM,and a WeChat intervention program was drafted which including 3 stages and 15 WeChat essays.The content of WeChat essays were consulted using 2-round Delphi methods among 10 experts and revised basing on experts’ suggestion and discussion of research team.Experts’ judgement,familiar and coefficients of authority to the WeChat essays’ content were 0.950,0.980 and 0.965,respectively.Mean values of speciality and readability score to the WeChat essays were 4.7-5.0,and variation coefficient of expert opinion was 0-0.103.The final draft of WeChat intervention program was established after 4 sentences were deleted,5 sentences were adjusted and 3 sentences were added according to expert opinions.Part 2: Thirty-six pregnant women completed the questionnaire after the trial of WeChat intervention.Totally 97.2% of women reported they had read the fulltext of essays and could fully understand its meaning,91.7% could read an essay within 4 minutes,and all of them were interested in the essay.The reading rate of each essay was ranging of 41.0-92.3%.Only 25.6% of women had participated in WeChat Clock-in.Five themes were summarized from the transcripts of qualitative interview among 13 pregnant women,including complicated operation of WeChat Clock-in reduced behavior intention,difference in the understanding of picture-text messages which needed healthcare works’ support,time limitation and boring title of the essay reduced the reading behavior,picture-text messages providing practical information,and Recommending to send a message on every weekend night.According to analysis of consultation content in WeChat group,6 categories were extracted and classified into 3 themes,including confusion about rules of fetal movement,query on methods of fetal movement counting,and worried about symptoms of pregnancy discomfort.The WeChat intervention program was then revised according to the above findings.Part 3: After 13-week intervention,the WeChat group lost 7 cases and the control group lost 8,and finally 123 cases were included to analyze.There were no significant differences in demographic characteristics,knowledge level and health beliefs between the two groups before intervention(both P>0.05),indicating baseline comparability.The results included.(1)knowledge level: There was no significant difference in knowledge level between the two groups before-after intervention(P>0.05),but the knowledge level of both groups after intervention was significantly higher than before(both P<0.05).(2)health beliefs: The level of WeChat group’s health beliefs before-after intervention was significantly higher than that of the control group(P<0.05);on dimensions of health beliefs,the perceived threaten of WeChat group after intervention was significantly higher than that before(P<0.05),the subjective norm of the control group after intervention was significantly lower than that before(P<0.05).(3)behavioral compliance: there was no significant difference between two groups after intervention(P > 0.05).(4)Satisfaction: In WeChat group,95.2% of women were satisfied with WeChat intervention.(5)seven themes were summarized from the findings of interviews,including gains from WeChat intervention,advantages of WeChat intervention,suggestions to WeChat intervention,reasons for not reading WeChat picture-text messages,merits of fetal movement counting application,problems of fetal movement counting application,and reasons for not using the fetal movement counting application.ConclusionA WeChat intervention program to improve FMSM in pregnant women of the third trimester was developed based on literature content analysis,Delphi method and clinical trial,and the program included three stages and fifteen WeChat essays sending in 13-week period.The program was then evaluated using a quasi-experimental study.The findings suggested that WeChat intervention could improve the pregnant women’s health belief and knowledge level related to FMSM,however,comparing to handbook intervention,WeChat intervention didn’t show a significant advantage on improving the pregnant women’ FMSM behavioral compliance.Future studies should continue to explore the role of WeChat intervention in the FMSM after the improvement of WeChat intervention program. |
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