Using the internet for enhancing parental self-efficacy
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  • 1. Using the Internet for enhancing parental self-efficacy in infant care
    A quasi-experimental study among attendees of maternal education in the district of Granada, Spain
    Patricia Lima Pereira
    Student of Master in Social and Health Protection
    Institute of Public Health Jagiellonian University Medical CollegeKrakow, 15th June 2010
  • 2. CONTENT
    Introduction
    • Why focus on the internet?
    • 3. What is parental self-efficacy?
    • 4. Why maternal education as setting of this study?
    Objectivesandmethods
    Results
    Discussion 5. Conclusions
  • 5. INTRODUCTION
    Why focus on the internet?
    The Internet is an important source of health information, especially among women and men in reproductive ages
    • Larsson M. A descriptive study of the use of the Internet by women seeking pregnancy-related information. Midwifery. 2009; 25:14–20.
    • 6. InstitutoNacional de Estadística (INE). Encuestasobreequipamiento y uso de tecnologías de la información y comunicación en los hogares. [Online table generator]. 2007 [Cited: 26 March 2009].
    • 7. Fox S. Online health search 2006. Pew Internet & American Life Project. [Document online] 2006. [Cited: 30 April 2009.] Available from: http://www.pewinternet.org/ PPF/r/190/report_display.asp.
  • INTRODUCTION
    Know how to do
    What is parental self-efficacy?
    • According to Social Learning Theory, it is the parental ability to meet the demands and responsibilities of tasks relating to infant care.
    • 8. High parental self-efficacy was found to be related to positive child outcomes.
    Feel capable of doing
    • Bandura, Albert. “Social Cognitive Theory: An Agentic Perspective. Abstract.” (Annual Review of Psychology) 52 (2001): 1-26.
    • 9. Crncec, R, B Barnett, and B Matthey. “Development of an Instrument to Assess Perceived Self-Efficacy in the Parents of Infants.” (Research in Nursing & Health) 31, no. 442–453 (2008).
  • INTRODUCTION
    Why maternal education as setting of this study?
    Maternal education has been included into the offers of health care services in Andalucía (Spain) since the early ‘80.
    García Calvante, María del Mar. Evaluación de Programas de Salud Materno Infantil Andalucía 1984 - 1994. .
    Vols. Junta de Andalucía - Escuela Andaluza de Salud Pública. Granada, 1996.
  • 10. More than 40% of pregnant women in Andalucía attended this kind of classes in the public sector.
    INTRODUCTION
    García Calvante, María del Mar. Evaluación de Programas de Salud Materno Infantil Andalucía 1984 - 1994. .
    Vols. Junta de Andalucía - Escuela Andaluza de Salud Pública. Granada, 1996.
  • 11. OBJECTIVES
    To determinate if the perceived usefulness of the Internet as an information source is related to parental self-efficacy in infant care
    To determinate if midwife’s advice on how to enhance the use of the Internet could have an effect in parental self-efficacy
    To calculate the validity of the developed scale
    To characterize the maternal education in Granada, Spain
    To describe the use of the Internet as a health information source
    To identify other factors related to parental self-efficacy
  • 12. METHODS
    A quasi-experimental study on group level among attendees of maternal education in the district of Granada, Spain
    Pilot study
    32 cases
    Control groups
    Intervention groups
    2009
  • 13. The sample included
    Response rate of 89%.
  • 16. The intervention
    • verbal advice and the factsheet
    • 17. based on a quality assessment for websites developed by the APHS
    • 18. was carried on by midwifes
    • 19. 6 groups: 73 participants
    Bermúdez Tamayo C, García Mochón L, Corpas Nogales E, Moya Garrido MN. Selección y evaluación de sitios web dirigidos a pacientes referidos al campo de la salud 2.0. Granada: AETSA; 2008.
  • 20. What were
    the results?
  • 21. The median age was 32 for women
    33 for men
    87 % = first child
    Stage of pregnancy (mode) = 30 weeks
    63 % = at least two antenatal classes
  • 22. University
    59 %
    High school
    35 %
    Primary school
    6 %
  • 23. RESULT 1
    To determinate if the perceived usefulness of the Internet as an information source is related to parental self-efficacy in infant care
    To determinate if midwife’s advice on how to enhance the use of the Internet could have an effect in parental self-efficacy
    To calculate the validity of the developed scale
    To characterize the maternal education in Granada, Spain
    To describe the use of the Internet as a health information source
    To identify other factors related to parental self-efficacy
  • 24. Measuring parental self-efficacy
    A nine-items Likert scale (Ranged 9 to 90)
    • Internal reliability and construct validity were proved to be acceptable.
    Cronbach’scoefficient alpha = 0.95
    Variance explained with the model = 71.7%
  • 25. RESULT 2
    To determinate if the perceived usefulness of the Internet as an information source is related to parental self-efficacy in infant care
    To determinate if midwife’s advice on how to enhance the use of the Internet could have an effect in parental self-efficacy
    To calculate the validity of the developed scale
    To characterize the maternal education in Granada, Spain
    To describe the use of the Internet as a health information source
    To identify other factors related to parental self-efficacy
  • 26. How widespread is the use of the Internet as a health information source?
  • 27. Attendees of maternal education in Granada
    100 %
    N=207
  • 28. Users of internet
    N=195
    94.7%
    Non-users
    N=12
    5.3%
  • 29. Do not seek information on pregnancy
    N=5
    2.6%
    Have ever sought information on pregnancy
    N=190
    97.4%
  • 30. Have sought during the last month
    N=165
    84.6%
  • 31. Have sought this week
    N=121
    62%
  • 32. Have sought in the last 24 hours. N=49
    25%
  • 33. RESULT 3
    To determinate if the perceived usefulness of the Internet as an information source is related to parental self-efficacy in infant care
    To determinate if midwife’s advice on how to enhance the use of the Internet could have an effect in parental self-efficacy
    To calculate the validity of the developed scale
    To characterize the maternal education in Granada, Spain
    To describe the use of the Internet as a health information source
    To identify other factors related to parental self-efficacy
  • 34. How different were the antenatal education programmes?
  • 35. Teacher’s characteristics
    8
    new dichotomous variables
    Classes’ characteristics
    Participants’ characteristics
  • 36. RESULT 4
    To determinate if the perceived usefulness of the Internet as an information source is related to parental self-efficacy in infant care
    To determinate if midwife’s advice on how to enhance the use of the Internet could have an effect in parental self-efficacy
    To calculate the validity of the developed scale
    To characterize the maternal education in Granada, Spain
    To describe the use of the Internet as a health information source
    To identify other factors related to parental self-efficacy
  • 37. What factors were associated with self-efficacy in infant care ?
  • 38. Enhanced parental self-efficacy was clearly related to parity
    after controlling for age, gender, education, use of the internet, place of living, weeks of pregnancy
  • 39. 93 % of women who had previously given birth had high parental self-efficacy comparing with 41 % of primiparous women (p<0.001).
  • 40. Enhanced parental self-efficacy was inversely related to age
  • 41. Women older than 30 years had statistically significant lower perception of parental self-efficacy, when parity was controlled.
    (34 % vs. 52%, p=0.03)
    after controlling for gender, education, use of the internet, place of living, weeks of pregnancy. P<0.001
  • 42. No statistically significant differences
    Gender
    number of assisted antenatal classes
    features of antenatal classes:
    teacher's experience
    total hours of classes
    including physical exercise in teaching programme
    use of audiovisual support
  • 43. RESULTS 5 & 6
    To determinate if the perceived usefulness of the Internet as an information source is related to parental self-efficacy in infant care
    To determinate if midwife’s advice on how to enhance the use of the Internet could have an effect in parental self-efficacy
    To calculate the validity of the developed scale
    To characterize the maternal education in Granada, Spain
    To describe the use of the Internet as a health information source
    To identify other factors related to parental self-efficacy
  • 44. Is there a relationship between the Internet and parental self-efficacy ?
  • 45. Our hypothesis was
    “the higher the perceived usefulness of the Internet the higher would be self-efficacy in infant care score”
  • 46. Our hypothesis was
    “the higher the perceived usefulness of the Internet the higher would be self-efficacy in infant care score”
    Corelation between self-efficacy and value given to the internet.
    Total sample n=194.
    Correlation between self-efficacy and value given to the internet.
    Medline’s users n=19.
    Spearman’s coefficient 0.158, p=0.03
    Spearman’s coefficient 0.515, p=0.02
  • 47. Is the perceived usefulness of the Internet related to parental self-efficacy?
    Yes,
    if the people access good websites
  • 48. How can we encourage them to access good websites?
    Providing advice ?
  • 49. 44%
    would use it in the future
    40%
    used it and found it useful
    n =48
    Without advice
    With
    advice
    Access Medline
    6%
    18%
    (Chi squared test, p=0.007)
  • 50. Correlation between self-efficacy and value given to the internet.
    Medline’s users in interv. group n=12.
    Correlation between self-efficacy and value given to the internet.
    Medline’s users n=19.
    Spearman’s coefficient 0.52
    p=0.02
    Spearman’s coefficient 0.62
    p=0.02
  • 51. How might our results be explained?
  • 52. DISCUSSION
    Social Cognitive Theory
    Knowledge
    Functional
    use
    Self-efficacy
    Previous experience
    Vicarious experience
    Social persuasions
    Personal state
    Bandura A. Social Cognitive Theory: An agentic perspective. Annual Rev Psychol. 2001; 52:1-26.
  • 53. If people are being capable to identify what information they are lacking for performing a task…
    …they might feel capable of performing this task
    ?
    …after learning how to do it
    Active role of information seeker
  • 54. CONCLUSIONS
    • A tool for measuring parental self-efficacy within the Spanish speaker population
    • 55. Factors related to parental self-efficacy previous deliveries and age
    • 56. Many disparities in maternal education programmes. No effects of these differences have been detected
  • CONCLUSIONS
    • The internet is an important information source during pregnancy
    • 57. More than 95%
    • 58. 1 out of 5 women and 1 out of 4 men preferred it as their first source
    • 59. Positive relationship between perceived usefulness of the internet and parental self-efficacy.
  • Practical implications of the work
    Providing midwifes with materials and training related to internet search can enhance their own internet competenceand improve the patient-health professional relationship.
    “Internet prescription” is becoming a new challenge.
    Antenatal education is an invaluable setting for developing health literacy
    • McKenna L, McLelland G. Midwives' use of the Internet: an Australian study. Midwifery [abstract]. 2009. [Epub ahead of print].
    • 60. McMullan M. Patients using the Internet to obtain health information: how this affects the patient-health professional relationship. Patient EducCouns. 2006; 63(1-2):24-8.
    • 61. Wald HS, Dube CE , Anthony DC. An Untangling the Web - the impact of Internet use on health care and the physician-patient relationship. Patient EducCouns. 2007; 68(3):218-24.
    • 62. Renkert S, Nutbeam D. Opportunities to improve maternal health literacy through antenatal education: an exploratory study. Health Promot Int. 2001; 16(4):381-8.
  • Dziękujęzauwagę
    And special thanks to
    my supervisors
    Clara Bermúdezand GrazynaJasienska,
    my colleagues of Granada and Krakow,
    and especially to Rodrigo,Abriland Helena
  • 63.
  • 64. Additional slides…
  • 65. Model of external influences on information use and patient empowerment
    The information seeker
    The non-seeker
    Patient motivators Patient
    barriers
    Healthcare barriers
    Healthcare facilitators
    Supportive attitude of information seeking

    Engagement with information sources
    Management of the risk associated with information use
    The
    disempowered patient
    The non-empowered patient
    The empowered patient
    • Edwards M, Davies M and Edwards A. Review: What are the external influences on information exchange and shared decision-making in healthcare consultations: A meta-synthesis of the literatura. Patient Education and Counseling 75 (2009) 37–52
  • New dichotomous variables
    Teacher’s characteristics
    • >5 years giving classes
    • 66. Ability in use of internet
    • 67. >15 total hours of classes
    • 68. Respiration techniques
    • 69. Physical exercises
    • 70. Group’s size
    • 71. Use of audiovisual support
    Classes’ characteristics
    Participants’ characteristics
    • Educational level
  • The overall mean self-efficacy score was 56.3 (sd 17.2), the median was 56.
    For correlation analysis, we used the continuous values of the scale.
    Shapiro-Wilks Test confirmed a normal distribution (P=0.09).
    For some analysis, we transformed the scale and other factors in dichotomous variables using the median, so data were analysed with chi squared test.