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

3. What is parental self-efficacy?

4. Why maternal education as setting of this study?Objectivesandmethods Results Discussion 5. Conclusions

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].

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

14. 16 groups

15. 169 women and 34 men Response rate of 89%.

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

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

55. Factors related to parental self-efficacy previous deliveries and age

57. More than 95%

58. 1 out of 5 women and 1 out of 4 men preferred it as their first source

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.

64. Additional slides…

66. Ability in use of internet

67. >15 total hours of classes

68. Respiration techniques

69. Physical exercises

70. Group’s size