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Using the Internet for enhancing parental self-efficacy in infant care<br />A quasi-experimental study among attendees of ...
CONTENT<br /> Introduction<br /><ul><li>Why focus on the internet?
What is parental self-efficacy?
Why maternal education as setting of this study?</li></ul>Objectivesandmethods<br />Results<br />Discussion			5. Conclusio...
INTRODUCTION<br />Why focus on the internet?<br />	The Internet is an important source of health information, especially a...
InstitutoNacional de Estadística (INE). Encuestasobreequipamiento y uso de tecnologías de la información y comunicación en...
Fox S. Online health search 2006. Pew Internet & American Life Project. [Document online] 2006. [Cited: 30 April 2009.] Av...
High parental self-efficacy was found to be related to positive child outcomes. </li></ul>Feel capable of doing<br /><ul><...
Crncec, R, B Barnett, and B Matthey. “Development of an Instrument to Assess Perceived Self-Efficacy in the Parents of Inf...
	More than 40% of pregnant women in Andalucía attended this kind of classes in the public sector. <br />INTRODUCTION<br />...
OBJECTIVES<br /> To determinate if the perceived usefulness of the Internet as an information source is related to parenta...
METHODS<br />	A quasi-experimental study on group level among attendees of maternal education in the district of Granada, ...
The sample included<br /><ul><li>8 centres
16 groups
169 women and 34 men</li></ul> 	Response rate of 89%. <br />
The intervention<br /><ul><li>verbal advice and the factsheet
based on a quality assessment for websites developed by the APHS
was carried on by midwifes
6 groups: 73 participants </li></ul>Bermúdez Tamayo C, García Mochón L, Corpas Nogales E, Moya Garrido MN. Selección y eva...
What were <br />the results?<br />
	The median age was 32 for women<br />33 for men<br />87 % = first child <br />Stage of pregnancy  (mode) = 30 weeks<br />...
University<br />59 %<br />High school<br />35 %<br />Primary school<br />6 %<br />
RESULT 1<br /> To determinate if the perceived usefulness of the Internet as an information source is related to parental ...
Measuring parental self-efficacy <br />A nine-items Likert scale  (Ranged 9 to 90)<br /><ul><li>Internal reliability and c...
RESULT 2<br /> To determinate if the perceived usefulness of the Internet as an information source is related to parental ...
How widespread is the use of the Internet as a health information source?<br />
Attendees of maternal education in Granada<br />100 %<br />N=207<br />
Users of internet<br />N=195<br />94.7%<br />Non-users <br />N=12<br />5.3%<br />
Do not seek information on pregnancy<br />N=5<br />2.6%<br />Have ever sought information on pregnancy<br />N=190<br />97....
Have sought during the last month<br />N=165<br />84.6%<br />
Have sought this week<br />N=121<br />62%<br />
Have sought in the last 24 hours. N=49<br />25%<br />
RESULT 3<br /> To determinate if the perceived usefulness of the Internet as an information source is related to parental ...
How different were the antenatal education programmes?<br />
Teacher’s characteristics<br />8<br />new dichotomous variables<br />Classes’ characteristics<br />Participants’ character...
RESULT 4<br /> To determinate if the perceived usefulness of the Internet as an information source is related to parental ...
What factors were associated with self-efficacy in infant care ?<br />
Enhanced parental self-efficacy was clearly related to parity<br />after controlling for age, gender, education, use of th...
93 % of women who had previously given birth had high parental self-efficacy comparing with 41 % of primiparous women (p<0...
Enhanced parental self-efficacy was inversely related to age<br />
Women older than 30 years had statistically significant lower perception of parental self-efficacy, when parity was contro...
No statistically significant differences <br />Gender<br />number of assisted antenatal classes<br />features of antenatal...
RESULTS 5 & 6 <br /> To determinate if the perceived usefulness of the Internet as an information source is related to par...
Is there a relationship between the Internet and parental self-efficacy ?<br />
Our hypothesis was <br />“the higher the perceived usefulness of the Internet the higher would be self-efficacy in infant ...
Our hypothesis was <br />“the higher the perceived usefulness of the Internet the higher would be self-efficacy in infant ...
Is the perceived usefulness of the Internet related to parental self-efficacy?<br />Yes, <br />if the people access good w...
How can we encourage them to  access good websites?<br />Providing advice ?<br />
44%<br />would use it in the future<br />40%<br />used it and found it useful<br />n =48<br />Without advice <br />With<br...
Correlation between self-efficacy and value given to the internet. <br />Medline’s users in interv. group n=12.<br />Corre...
How might our results be explained?<br />
DISCUSSION<br />Social Cognitive Theory<br />Knowledge<br />Functional <br />use<br />Self-efficacy<br />Previous experien...
If people are being capable to identify what information they are lacking for performing a task… <br />…they might feel ca...
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  1. 1. Using the Internet for enhancing parental self-efficacy in infant care<br />A quasi-experimental study among attendees of maternal education in the district of Granada, Spain<br />Patricia Lima Pereira<br />Student of Master in Social and Health Protection<br />Institute of Public Health Jagiellonian University Medical CollegeKrakow, 15th June 2010<br />
  2. 2. CONTENT<br /> Introduction<br /><ul><li>Why focus on the internet?
  3. 3. What is parental self-efficacy?
  4. 4. Why maternal education as setting of this study?</li></ul>Objectivesandmethods<br />Results<br />Discussion 5. Conclusions<br />
  5. 5. INTRODUCTION<br />Why focus on the internet?<br /> The Internet is an important source of health information, especially among women and men in reproductive ages<br /><ul><li> Larsson M. A descriptive study of the use of the Internet by women seeking pregnancy-related information. Midwifery. 2009; 25:14–20.
  6. 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. 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.</li></li></ul><li>INTRODUCTION<br />Know how to do<br />What is parental self-efficacy?<br /><ul><li>According to Social Learning Theory, it is the parental ability to meet the demands and responsibilities of tasks relating to infant care.
  8. 8. High parental self-efficacy was found to be related to positive child outcomes. </li></ul>Feel capable of doing<br /><ul><li>Bandura, Albert. “Social Cognitive Theory: An Agentic Perspective. Abstract.” (Annual Review of Psychology) 52 (2001): 1-26.
  9. 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).</li></li></ul><li>INTRODUCTION<br />Why maternal education as setting of this study?<br />Maternal education has been included into the offers of health care services in Andalucía (Spain) since the early ‘80. <br />García Calvante, María del Mar. Evaluación de Programas de Salud Materno Infantil Andalucía 1984 - 1994. .<br />Vols. Junta de Andalucía - Escuela Andaluza de Salud Pública. Granada, 1996.<br />
  10. 10. More than 40% of pregnant women in Andalucía attended this kind of classes in the public sector. <br />INTRODUCTION<br />García Calvante, María del Mar. Evaluación de Programas de Salud Materno Infantil Andalucía 1984 - 1994. .<br />Vols. Junta de Andalucía - Escuela Andaluza de Salud Pública. Granada, 1996.<br />
  11. 11. OBJECTIVES<br /> To determinate if the perceived usefulness of the Internet as an information source is related to parental self-efficacy in infant care<br />To determinate if midwife’s advice on how to enhance the use of the Internet could have an effect in parental self-efficacy<br />To calculate the validity of the developed scale<br />To characterize the maternal education in Granada, Spain<br />To describe the use of the Internet as a health information source<br />To identify other factors related to parental self-efficacy<br />
  12. 12. METHODS<br /> A quasi-experimental study on group level among attendees of maternal education in the district of Granada, Spain<br />Pilot study<br />32 cases<br />Control groups <br />Intervention groups <br />2009<br />
  13. 13. The sample included<br /><ul><li>8 centres
  14. 14. 16 groups
  15. 15. 169 women and 34 men</li></ul> Response rate of 89%. <br />
  16. 16. The intervention<br /><ul><li>verbal advice and the factsheet
  17. 17. based on a quality assessment for websites developed by the APHS
  18. 18. was carried on by midwifes
  19. 19. 6 groups: 73 participants </li></ul>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.<br />
  20. 20. What were <br />the results?<br />
  21. 21. The median age was 32 for women<br />33 for men<br />87 % = first child <br />Stage of pregnancy (mode) = 30 weeks<br />63 % = at least two antenatal classes<br />
  22. 22. University<br />59 %<br />High school<br />35 %<br />Primary school<br />6 %<br />
  23. 23. RESULT 1<br /> To determinate if the perceived usefulness of the Internet as an information source is related to parental self-efficacy in infant care<br />To determinate if midwife’s advice on how to enhance the use of the Internet could have an effect in parental self-efficacy<br />To calculate the validity of the developed scale<br />To characterize the maternal education in Granada, Spain<br />To describe the use of the Internet as a health information source<br />To identify other factors related to parental self-efficacy<br />
  24. 24. Measuring parental self-efficacy <br />A nine-items Likert scale (Ranged 9 to 90)<br /><ul><li>Internal reliability and construct validity were proved to be acceptable. </li></ul>Cronbach’scoefficient alpha = 0.95<br />Variance explained with the model = 71.7%<br />
  25. 25. RESULT 2<br /> To determinate if the perceived usefulness of the Internet as an information source is related to parental self-efficacy in infant care<br />To determinate if midwife’s advice on how to enhance the use of the Internet could have an effect in parental self-efficacy<br />To calculate the validity of the developed scale<br />To characterize the maternal education in Granada, Spain<br />To describe the use of the Internet as a health information source<br />To identify other factors related to parental self-efficacy<br />
  26. 26. How widespread is the use of the Internet as a health information source?<br />
  27. 27. Attendees of maternal education in Granada<br />100 %<br />N=207<br />
  28. 28. Users of internet<br />N=195<br />94.7%<br />Non-users <br />N=12<br />5.3%<br />
  29. 29. Do not seek information on pregnancy<br />N=5<br />2.6%<br />Have ever sought information on pregnancy<br />N=190<br />97.4%<br />
  30. 30. Have sought during the last month<br />N=165<br />84.6%<br />
  31. 31. Have sought this week<br />N=121<br />62%<br />
  32. 32. Have sought in the last 24 hours. N=49<br />25%<br />
  33. 33. RESULT 3<br /> To determinate if the perceived usefulness of the Internet as an information source is related to parental self-efficacy in infant care<br />To determinate if midwife’s advice on how to enhance the use of the Internet could have an effect in parental self-efficacy<br />To calculate the validity of the developed scale<br />To characterize the maternal education in Granada, Spain<br />To describe the use of the Internet as a health information source<br />To identify other factors related to parental self-efficacy<br />
  34. 34. How different were the antenatal education programmes?<br />
  35. 35. Teacher’s characteristics<br />8<br />new dichotomous variables<br />Classes’ characteristics<br />Participants’ characteristics<br />
  36. 36. RESULT 4<br /> To determinate if the perceived usefulness of the Internet as an information source is related to parental self-efficacy in infant care<br />To determinate if midwife’s advice on how to enhance the use of the Internet could have an effect in parental self-efficacy<br />To calculate the validity of the developed scale<br />To characterize the maternal education in Granada, Spain<br />To describe the use of the Internet as a health information source<br />To identify other factors related to parental self-efficacy<br />
  37. 37. What factors were associated with self-efficacy in infant care ?<br />
  38. 38. Enhanced parental self-efficacy was clearly related to parity<br />after controlling for age, gender, education, use of the internet, place of living, weeks of pregnancy<br />
  39. 39. 93 % of women who had previously given birth had high parental self-efficacy comparing with 41 % of primiparous women (p<0.001). <br />
  40. 40. Enhanced parental self-efficacy was inversely related to age<br />
  41. 41. Women older than 30 years had statistically significant lower perception of parental self-efficacy, when parity was controlled. <br />(34 % vs. 52%, p=0.03)<br />after controlling for gender, education, use of the internet, place of living, weeks of pregnancy. P<0.001<br />
  42. 42. No statistically significant differences <br />Gender<br />number of assisted antenatal classes<br />features of antenatal classes: <br />teacher's experience<br /> total hours of classes<br /> including physical exercise in teaching programme <br />use of audiovisual support<br />
  43. 43. RESULTS 5 & 6 <br /> To determinate if the perceived usefulness of the Internet as an information source is related to parental self-efficacy in infant care<br />To determinate if midwife’s advice on how to enhance the use of the Internet could have an effect in parental self-efficacy<br />To calculate the validity of the developed scale<br />To characterize the maternal education in Granada, Spain<br />To describe the use of the Internet as a health information source<br />To identify other factors related to parental self-efficacy<br />
  44. 44. Is there a relationship between the Internet and parental self-efficacy ?<br />
  45. 45. Our hypothesis was <br />“the higher the perceived usefulness of the Internet the higher would be self-efficacy in infant care score”<br />
  46. 46. Our hypothesis was <br />“the higher the perceived usefulness of the Internet the higher would be self-efficacy in infant care score”<br />Corelation between self-efficacy and value given to the internet. <br />Total sample n=194.<br />Correlation between self-efficacy and value given to the internet. <br />Medline’s users n=19.<br />Spearman’s coefficient 0.158, p=0.03<br />Spearman’s coefficient 0.515, p=0.02<br />
  47. 47. Is the perceived usefulness of the Internet related to parental self-efficacy?<br />Yes, <br />if the people access good websites<br />
  48. 48. How can we encourage them to access good websites?<br />Providing advice ?<br />
  49. 49. 44%<br />would use it in the future<br />40%<br />used it and found it useful<br />n =48<br />Without advice <br />With<br />advice <br />Access Medline<br />6% <br />18%<br />(Chi squared test, p=0.007)<br />
  50. 50. Correlation between self-efficacy and value given to the internet. <br />Medline’s users in interv. group n=12.<br />Correlation between self-efficacy and value given to the internet. <br />Medline’s users n=19.<br />Spearman’s coefficient 0.52<br />p=0.02<br />Spearman’s coefficient 0.62<br />p=0.02 <br />
  51. 51. How might our results be explained?<br />
  52. 52. DISCUSSION<br />Social Cognitive Theory<br />Knowledge<br />Functional <br />use<br />Self-efficacy<br />Previous experience<br />Vicarious experience<br />Social persuasions<br />Personal state<br />Bandura A. Social Cognitive Theory: An agentic perspective. Annual Rev Psychol. 2001; 52:1-26.<br />
  53. 53. If people are being capable to identify what information they are lacking for performing a task… <br />…they might feel capable of performing this task<br />?<br />…after learning how to do it<br />Active role of information seeker<br />
  54. 54. CONCLUSIONS<br /><ul><li>A tool for measuring parental self-efficacy within the Spanish speaker population
  55. 55. Factors related to parental self-efficacy previous deliveries and age
  56. 56. Many disparities in maternal education programmes. No effects of these differences have been detected</li></li></ul><li>CONCLUSIONS<br /><ul><li> The internet is an important information source during pregnancy
  57. 57. More than 95%
  58. 58. 1 out of 5 women and 1 out of 4 men preferred it as their first source
  59. 59. Positive relationship between perceived usefulness of the internet and parental self-efficacy.</li></li></ul><li>Practical implications of the work<br />Providing midwifes with materials and training related to internet search can enhance their own internet competenceand improve the patient-health professional relationship. <br />“Internet prescription” is becoming a new challenge. <br />Antenatal education is an invaluable setting for developing health literacy<br /><ul><li>McKenna L, McLelland G. Midwives' use of the Internet: an Australian study. Midwifery [abstract]. 2009. [Epub ahead of print].
  60. 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. 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. 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. </li></li></ul><li>Dziękujęzauwagę<br />And special thanks to<br />my supervisors <br />Clara Bermúdezand GrazynaJasienska, <br />my colleagues of Granada and Krakow, <br />and especially to Rodrigo,Abriland Helena <br />
  63. 63.
  64. 64. Additional slides…<br />
  65. 65. Model of external influences on information use and patient empowerment<br />The information seeker<br />The non-seeker<br />Patient motivators Patient <br />barriers<br />Healthcare barriers<br />Healthcare facilitators<br />Supportive attitude of information seeking<br />…<br />Engagement with information sources<br />Management of the risk associated with information use<br />The<br />disempowered patient<br />The non-empowered patient<br />The empowered patient<br /><ul><li>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</li></li></ul><li>New dichotomous variables<br />Teacher’s characteristics<br /><ul><li> >5 years giving classes
  66. 66. Ability in use of internet
  67. 67. >15 total hours of classes
  68. 68. Respiration techniques
  69. 69. Physical exercises
  70. 70. Group’s size
  71. 71. Use of audiovisual support </li></ul>Classes’ characteristics<br />Participants’ characteristics<br /><ul><li> Educational level</li></li></ul><li> The overall mean self-efficacy score was 56.3 (sd 17.2), the median was 56. <br />For correlation analysis, we used the continuous values of the scale.<br />Shapiro-Wilks Test confirmed a normal distribution (P=0.09).<br />For some analysis, we transformed the scale and other factors in dichotomous variables using the median, so data were analysed with chi squared test. <br />
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