1. Introduction

regnancy is a crucial stage in women’s lives and due to the direct effect of maternal health on fetal health, the importance of this period is much more significant. Given the role of the health care team in improving health and teaching self-care behaviors, it is possible to identify these behaviors by planning interventions and improve the level of self-care and thus the lifestyle of pregnant women. This study aimed to compare the effects of self-care education given by focus group discussion and teach-back methods on the lifestyle of pregnant women.

In a study examined the effect of self care education based on teach-back method (4 sessions) on the promotion of self care behaviors in 70 patients with type 2 diabetes in Hamedan, Iran in two test and control groups. Their study showed a significant improvement in self-care behaviors of patients in test group after intervention compared to the controls. They concluded that teach-back method can have an important role in reducing the disease and improving the life quality of patients [1]. In other research the effect of educational booklet evaluated using focus group discussion method on 56 primary school students’ knowledge of waste pollution. Students were divided into 7 groups and were assessed before and after intervention. They reported that focus group discussion could improve the students’ knowledge of waste pollution [2].

2. Materials and Methods

This is a randomized field Trial. Participants were 90 pregnant women referred to the community health centers in Gonabad, Iran with no history of physical and psychological problems that can affect their self-care. They were randomly selected from among the three health centers and divided into three groups of focus group discussion, teach-back, and control. The first two groups received self-care education about prenatal care using focus group discussion and teach-back method, while the control group received a routine education. The data collection tools were a demographic form, and Walker’s Health-Promoting Lifestyle Profile (HPLP) questionnaire completed before and one month after the intervention.

3. Results

There was no significant difference between the three groups in terms of educational level (P=0.029), occupation (P=0.090), income (P=0.099), and gestational age (P=0.741), and they were homogeneous (Table 1).

After intervention, health responsibility, spiritual growth, physical activity, interpersonal relationships, and nutrition (aspects of health-promoting lifestyle) of teach-back (P<0.001) and focus group discussion (P<0.001) groups were significantly improved compared to the control group (P=0.66) except in stress management dimension which showed no significant difference (Table 2).

In comparing the effects of two educational methods, focus group discussion had a more significant impact on the lifestyle of pregnant women compared to the teach-back method (Table 3).

4. Conclusion

To our knowledge, there is no randomized field trial that compares the effects of self-care education using focus group discussion and teach-back method on the lifestyle of pregnant women. Based on the results, it is recommended to provide self-care education for pregnant women during pregnancy using focus group discussion method.

Ethical Considerations

Compliance with ethical guidelines

This study has ethical approval with code: IR.GMU.REC.1396.104

Funding

This study was extracted from a master thesis, and received financial support from the Deputy for Research and Technology Gonabad University of Medical Sciences (Code: 96/148).

Authors' contributions

Designing the study, Manuscript preparation: Mitra Jaras, Ali Delshad Noghabi, Mohammad Reza Mansoorian; Data analysis, data collection: Mitra Jaras, Hossein Nezami; Reading and approving the final version: All authors

Conflicts of interest

The authors declare no conflict of interest

Acknowledgements

The authors would like to thank the Deputy for Research and Technology and the School of Nursing of Gonabad University of Medical Sciences as well as all pregnant women for their support and cooperation. Teaching through focus group discussion increases the level of self-care in pregnant women due to more interaction and communication, and the use of each other’s experiences.


 

References

1. Memari A, Ramim T, Amini M, Mehran A, Ajorloo A, Shakibaei P. [Investigation of effects of aerobic exercise on pregnancy and its circumstances (Persian)]. Journal of Hayat. 2006; 12(3):35-41. http://hayat.tums.ac.ir/article-1-201-en.html
2. Sedaghati P, Ardjmand A, Sedaghati N. [Does regular ergometeric training have any effect on the pregnancy outcome? (Persian)]. Iranian Journal of Pediatrics. 2006; 16(3):325-31. https://tspace.library.utoronto.ca/handle/1807/58307
3. Moravcová M, Mareš J, Ježek S. Menopause Rating Scale-validation Czech version specific instrument for assessing health-related quality of life in postmenopausal women. Ošetřovatelství A Porodní Asistence. 2014; 5(1):36-45. https://www.researchgate.net/publication/269687724
4. Olds SB. Maternal-newborn nursing & women’s health care. Upper Saddle River, NJ: Pearson Prentice Hall; 2004. https://books.google.com/books?id=JMHjzAEACAAJ&dq
5. Heaman MI, Newburn-Cook CV, Green CG, Elliott LJ, Helewa ME. Inadequate prenatal care and its association with adverse pregnancy outcomes: A comparison of indices. BMC Pregnancy and Childbirth. 2008; 8:15. [DOI:10.1186/1471-2393-8-15] [PMID] [PMCID]
6. Wallace DA, Dodd MM, McNeil DA, Churchill AJ, Oelke ND, Arnold SL, et al. A pregnancy wellness guide to enhance care through self‐assessment, personal reflection, and self. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2009; 38(2):134-47. [DOI:10.1111/j.1552-6909.2009.01008.x] [PMID]
7. GHasemzadeh S, Dadmanesh M, Safari A, Ebrahimi S. [The Study on the knowledge, attitude and function of gestated mother’s about gestational diabetes that referred to Army Khanvadeh Hospital from 2005 to 2006 (Persian)]. 2007; 5(3):1325-30. https://www.sid.ir/fa/journal/ViewPaper.aspx?id=74778
8. Derakhshan E, Shadzi Sh, Derakhshan F, Behjatian Z. [Effects of targeted education on knowledge and attitude of pregnant women regarding eclampsia (Persian)]. 2010; 6(3):443-9. http://hsr.mui.ac.ir/index.php/jhsr/article/view/64
9. Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, et al. Williams obstetrics. New York: Mc Graw Hill Professional; 2014. https://www.worldcat.org/title/williams-obstetrics/oclc/892490452
10. Mollakhalili H, Papi A, Zare-Farashbandi F, Sharifirad GR, Hasanzadeh A. A survey on health literacy of inpatient’s educational hospitals of Isfahan University of Medical Sciences in 2012. Journal of Education and Health Promotion. 2014; 3:66. [DOI:10.4103/2277-9531.134804]
11. Downey LVA, Zun LS. Assessing adult health literacy in urban healthcare settings. Journal of the National Medical Association. 2008; 100(11):1304-8. [DOI:10.1016/S0027-9684(15)31509-1]
12. Sajjadi H, Hosseinpour N, Sharifian Sani M, Mahmoodi Z. [Association between health literacy and life style in married rural women in Izeh, Iran (Persian)]. Journal of Health. 2016; 7(4):479-89. http://healthjournal.arums.ac.ir/article-1-1056-en.html
13. Cassidy T. Stress, healthiness and health behaviours: An exploration of the role of life events, daily hassles, cognitive appraisal and the coping process. Counselling Psychology Quarterly. 2000; 13(3):293-311. [DOI:10.1080/09515070010028679]
14. Bartlett EE. The contribution of school health education to community health promotion: What can we reasonably expect? American Journal of Public Health. 1981; 71(12):1384-91. [DOI:10.2105/AJPH.71.12.1384] [PMID] [PMCID]
15. Libbus MK, Sable MR. Prenatal education in a high‐risk population: The effect on birth outcomes. Birth. 1991; 18(2):78-82. [DOI:10.1111/j.1523-536X.1991.tb00064.x] [PMID]
16. Browner C, Preloran M, Press NA. The effects of ethnicity, education and an informational video on pregnant women’s knowledge and decisions about a prenatal diagnostic screening test. Patient Education and Counseling. 1996; 27(2):135-46. [DOI:10.1016/0738-3991(95)00796-2]
17. Azadbakht L, Haghighatdoost F, Esmaillzadeh A. [Comparing the effect of teaching based on problem solving method versus lecturing method regarding first diet therapy course for students of nutritional science (Persian)]. Iranian Journal of Medical Education. 2011; 10(5):1093-101. http://ijme.mui.ac.ir/article-1-1451-en.html
18. Wong LP. Focus group discussion: A tool for health and medical research. Singapore Medical Journal. 2008; 49(3):256-60. [PMID]
19. Baghcheghi N, Kouhestani HR, Rezaei K. [Comparison of the effect of teaching through lecture and group discussion on nursing students’ communication skills with patients (Persian)]. Iranian Journal of Medical Education. 2010; 10(3):211-8. http://ijme.mui.ac.ir/article-1-1307-en.html
20. Adib hajbagheri M, Parvizi S, Salsali M. [Qualitative research methods (Persian)] Tehran: Boshra Publisher; 2012. http://www.sciepub.com/reference/150995
21. Ha Dinh TT, Bonner A, Clark R, Ramsbotham J, Hines S. The effectiveness of the teach‐back method on adherence and self‐management in health education for people with chronic disease: A systematic review. JBI Database of Systematic Reviews and Implementation Reports. 2016; 14(1):210-47. [DOI:10.11124/jbisrir-2016-2296] [PMID]
22. Wilson FL, Mayeta-Peart A, Parada-Webster L, Nordstrom C. Using the teach-back method to increase maternal immunization literacy among low-income pregnant women in Jamaica: A pilot study. Journal of Pediatric Nursing. 2012; 27(5):451-9. [DOI:10.1016/j.pedn.2011.05.004] [PMID]
23. White M, Garbez R, Carroll M, Brinker E, Howie-Esquivel J. Is “teach-back” associated with knowledge retention and hospital readmission in hospitalized heart failure patients? Journal of Cardiovascular Nursing. 2013; 28(2):137-46. [DOI:10.1097/JCN.0b013e31824987bd] [PMID]
24. Reusch A, Ströbl V, Ellgring H, Faller H. Effectiveness of small-group interactive education vs. lecture-based information-only programs on motivation to change and lifestyle behaviours. A prospective controlled trial of rehabilitation inpatients. Patient Education and Counseling. 2011; 82(2):186-92. [DOI:10.1016/j.pec.2010.04.031] [PMID]
25. Shakeri M, Fekri Sh, Shahnavaz A, Shakibazadeh E. [Effectiveness of a group-based educational program on physical activity among pregnant women (Persian)]. Journal of Hayat. 2012; 18(3):1-9. http://hayat.tums.ac.ir/article-1-18-en.html
26. Nasiri A, Poodineh Moghadam M. Effect of an educational plan based on teach-back method on hemodialysis patients’ self-care deficits. Modern Care Journal. 2012; 9(4):344-54. https://www.semanticscholar.org/paper/Effect-of-an-educational-plan-based-on-Teach-Back-Nasiri-Moghadam/e8d7061b97602ee21133970e6225b6865939f9e6
27. Oshvandi Kh, Jokar M, Khatiban M, Keyani J, Yousefzadeh MR, Sultanian AR. [The effect of self care education based on Teach Back method on promotion of self care behaviors in type II diabetic patients: A clinical trial study (Persian)]. Iranian Journal of Diabetes and Metabolism. 2014; 13(2):131-44. http://ijdld.tums.ac.ir/article-1-5109-en.html
28. Sanaati F, Mohammad Alizadeh S, Mirghafourvand M, Alizadeh Sharjabadi F, Galeshi M. [The effect of training pregnant women and their husbands on health promoting behaviors during pregnancy and postpartum period (Persian-English)]. Journal of Babol University of Medical Sciences. 2018; 20(5):38-47. http://jbums.org/article-1-7029-en.html
29. Zendehtalab HR. [Comparing the effect of face to face and group discussion teaching methods on quality of life improvement among patients suffering from multiple sclerosis (Persian)]. Iranian Journal of Medical Education. 2013; 13(9):711-20. http://ijme.mui.ac.ir/article-1-2595-fa.html
30. Borimnejad L, Assemi S, Samiei N, Haghani H. [Comparison of group and individual training on the patients’ compliance and incidence of warfarin side effects after cardiac valve replacement (Persian)]. Iranian Journal of Medical Education. 2012; 12(1):10-8. http://ijme.mui.ac.ir/article-1-1721-fa.html
31. Rahmati A, Etemadi A. [The effect of teaching coping skills on the-students attitudes towards drug abuse -using group discussion (Persian)]. Journal of Psychology. 2007; 1(4):117-41. https://www.sid.ir/fa/journal/ViewPaper.aspx?id=87879
32. Mahram M, Mahram B, Mousavinasab SN. [Comparison between the effect of teaching through student-based group discussion and lecture on learning in medical students (Persian)]. Strides in Development of Medical Education. 2009; 5(2):71-9. https://www.sid.ir/fa/journal/ViewPaper.aspx?id=89001
33. Khosravi Sh, Pazargadi M, Ashktorab T. [Nursing students` viewpoints on challenges of student assessment in clinical settings: A qualitative study (Persian)]. Iranian Journal of Medical Education. 2012; 11(7):735-48. http://ijme.mui.ac.ir/article-1-1432-en.html
34. Powell RA, Single HM. Focus groups. International Journal for Quality in Health Care. 1996; 8(5):499-504. [DOI:10.1093/intqhc/8.5.499]
35. Boger EJ, Demain SH, Latter SM. Stroke self-management: A focus group study to identify the factors influencing self-management following stroke. International Journal of Nursing Studies. 2015; 52(1):175-87. [DOI:10.1016/j.ijnurstu.2014.05.006] [PMID]
36. Millar B, Maggs C, Warner V, Whale Z. Creating consensus about nursing outcomes. I. An exploration of focus group methodology. Journal of Clinical Nursing. 1996; 5(3):193-7. [DOI:10.1111/j.1365-2702.1996.tb00249.x] [PMID]
37. Brown MM, Mack KM, Guzzetta CE, Tefera E. The feasibility of using teach-back to reinforce discharge instructions and its influence on the number of 30-day readmissions of heart failure patients. Heart & Lung: The Journal of Acute and Critical Care. 2014; 43(4):379. [DOI:10.1016/j.hrtlng.2014.06.004]
38. Mohammadi Zeidi I, Pakpour Hajiagha A, Mohammadi Zeidi B. [Reliability and validity of Persian version of the health-promoting lifestyle profile (Persian)]. Journal of Mazandaran University of Medical Sciences. 2012; 21(1):102-13. http://jmums.mazums.ac.ir/article-1-955-en.html