Document Type : Erratum
Authors
1 Department of Midwifery, Faculty of Nursing and Midwifery, Dezful University of Medical Sciences, Dezful, Iran
2 Department of Reproductive Health and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Department of Statistics, Dezful University of Medical Sciences, Dezful, Iran
Abstract
Keywords
Quality of life is defined as individuals' perceptions of his/her position in life, the context of culture, and value systems that they live, and also in
relation to their goals, expectations, standards and
concerns (
Quality of life has been increasingly recognized
as an important outcome measure in both treatment studies and service evaluations (
Assessing quality of life in this period will allow a woman to make a self-evaluation of her own
postnatal situation, and will also assist health care
providers for further promotion of women and infants’ health. Akyn et al. (
This single-blind randomized control trial was performed between June 2010 and December 2011. The 160 pregnant women were randomly assigned into two groups using a random sampling method. Interventional group included 80 participants (received prenatal education classes), while control group included 80 participants (not received prenatal education classes). Participants are referred to Health and Treatment Center of number one, Dezful, Iran. All participants (intervention group and control group) were enrolled in the routine prenatal care classes. First-time pregnant women with a singleton fetus were invited to participate in the study if they met the following criteria: i. aged 18 to 35, ii. between 24 and 28 weeks’ gestation, iii. without history of medical, psychological, and infertility diseases, iv. with at least eight prenatal visits during pregnancy, whilst two visits occurred before the 20th week of pregnancy, v. reading and writing in Farsi (Persian), and vi. giving written informed consent. Women were excluded if they met the following exclusion criteria: i. neonate with congenital anomalies, ii. neonatal death, iii. complicated pregnancy, iv. drug consumption, v. birth weight <2500 gram, vi. postpartum depression, vii. family difficult during six month after child birth, and viii. failure to attend 2 sessions of prenatal education classes. The antenatal education classes were eight daytime sessions for 90 minutes in a period of 3 months (2-4 sessions per month at 9-10:30 am.), located at the Health and Treatment Center of number one, Dezful, Iran. Classes included 8-10 mothers.
The antenatal education class, presented by an experienced midwife, consisted of the following programs: anatomical, physiological, and psychological changes during pregnancy; a proper diet during pregnancy; stages of natural labor; care of the mother and newborn following delivery; breastfeeding; and family planning. Training was carried out theoretically using educational and audiovisual devices, such as television and computer. Proper position during labor and delivery, the correct way of breathing during pregnancy, relaxation, and neuromuscular exercises were introduced, and also, were practically performed. A counseling session was also held to answer all questions of participated mothers. The Ethics Committee of Dezful University of Medical Sciences approved the study protocol.
llection consisted of a demographic questionnaire, as well as the Iranian interview-administered version of the World Health
Organization’s Quality of Life Questionnaire
(WHOQOL-BREF). The WHOQOL-BREF is a
26-item instrument including the following four
domains: physical health (7 items), psychological health (6 items), social relationships (3 items),
and environmental health (8 items), as well as two
overall quality of life and general health items. All scores are transformed to reflect 4 to 20 for
each domain with higher scores corresponding
to a better quality of life. There is no overall
score for the WHOQOL-BREF (
One hundred sixty women with mean age of 24.2 ± 4.05 years (mean ± SD) participated in the study. Their demographic and fertility characteristics were compared and summarized in table 1. As shown in table 1, no significant differences between the groups were found regarding the possible confounding variables.
The comparison of individual and fertility characteristics of mothers in the interventional and the control groups in the Dezful Health Center
Group characteristics | Interventional group n=80 | Control group n=80 | P valuea |
---|---|---|---|
Age (Y): mean ± SD | 24.6 ± 3.9 | 23.8 ± 4.2 | NS |
BMI (kg/m2): mean ± SD | 26.8 ± 4.3 | 26.1 ± 3.6 | NS |
Housewife | 74 (92.5) | 77 (96.2) | |
Employed | 6 (7.5) | 3 (3.8) | NS |
< 12years | 58 (72.5) | 52 (65) | |
> 12years | 22 (27.5) | 28 (35) | NS |
< 12years | 43 (53.8) | 41(51.2) | |
> 12years | 37 (46.2) | 39 (48.8) | NS |
Good | 14 (17.5) | 17 (21.2) | |
Intermediate | 66 (82.5) | 63 (78.8) | NS |
Vaginal delivery | 52 (65) | 48 (60) | |
Cesarean section | 28 (35) | 32 (40) | NS |
Female | 37 (46.2) | 38 (47.5) | |
Male | 43 (53.8) | 42 (52.5) | NS |
a; t test and Chi- Square test were used and NS; Non significant.
Mothers (at 6-8 weeks postpartum in the interventional group) rated their overall quality of life as follows: i. very good (17%), ii. good (58%), iii. neither good nor bad (20%), iv. bad (4%), and v. very bad (1%). Participants rated level of satisfaction of their health as follows: i. very satisfied (16%), ii. satisfied (52%), iii. neither satisfied nor dissatisfied (24%), iv. dissatisfied (6%), and v. very dissatisfied (2%). But, control group showed a decrease in percentages of quality of life and health levels compared to the interventional group. Table 2 presents the mean and standard deviation for domains of mother’s quality of life in the interventional and the control groups (at 6-8 weeks postpartum). As shown in table 2, the interventional group demonstrates higher scores for different domains of quality of life (p<0.05) compared to those of the control group.
The differences were statistically significant for domains of physical health, psychological health, social relationships and environmental health between two groups (p<0.05). The domain of physical health showed the highest score, while the domain of environment health showed the lowest score among the domains of WHOQOL-BREF (at 6-8 weeks postpartum). The results revealed significant differences among the mean scores for domains of the physical health, psychological health, and environmental health between two groups (at 1 year postpartum). In this study, the interventional group (at 1 year postpartum) was more likely to demonstrate higher scores for different domains of quality of life, including physical health, psychological health, and environmental health domains in comparison to the control group (p<0.05). In the current study, the interventional group had higher scores on social relationships, but the difference was not statistically significant. Table 3 depicts the four mean scores belonging to the domains of the quality of life (at 1 year postpartum). In addition, the interventional group showed a significant increase in the mean scores of three domains belonging to physical health, psychological health, and environmental health, from 6-8 weeks postpartum to 1 year postpartum (p<0.05). But, the control group revealed a significant increase in the mean scores of two domains belonging to physical health and environmental health, from 6-8 weeks postpartum to 1 year postpartum (p<0.05).
The comparison of mean and standard deviation (SD) per domains of mother’s quality of life in the interventional and the control groups at 6-8 weeks postpartum
Group characteristics | Interventional group n=80 | Control group n=80 | P valueb |
---|---|---|---|
15.1 ± 1.8 | 12.9 ± 2.3 | 0.000 | |
13.9 ± 2.3 | 13.2 ± 1.6 | 0.017 | |
14.3 ± 4.3 | 13.8 ± 3.6 | 0.01 | |
13.1 ± 4.3 | 12.2 ± 3.6 | 0.000 | |
a; The higher score represents a better condition (scores range from 4 to 20) and b; t test was used.
Mean (± SD) of mother’s quality of life in the interventional and the control groups at 1 year postpartum
Group characteristics | Interventional group n=80 | Control group n=80 | P valueb |
---|---|---|---|
15.7 ± 1.7 | 14.4 ± 2.8 | 0.000 | |
14.8 ± 2.6 | 13.5 ± 1.6 | 0.002 | |
14.5 ± 3.1 | 14.2 ± 3.1 | 0.17 | |
13.9 ± 2.4 | 13.1 ± 2.9 | 0.01 | |
a; The higher score represents a better condition (scores range from 4 to 20) and b; t test was used.
To the best of our knowledge, this is the first large randomized controlled interventional trial of antenatal group education that includes long-term follow up of the mother’s quality of life between 6-8 weeks postpartum and 1 year postpartum.
The majority of participants in the interventional
group reported that their overall quality of life and
health were good and satisfactory, respectively, according to the WHOQOL-BREF questionnaire. In
the study by Zubaran et al. (
In the interventional group, the high mean scores
for domains of the quality of life at 6-8 weeks
postpartum indicated higher level of physical, psychological, social relationships and environmental
health compared to the control group. Results from
the study by Zubaran et al. (
In our study, the interventional group (at 1
year postpartum) demonstrated higher scores for
domains of quality of life (QOL), like physical
health, psychological health, and environmental
health compared with the control group. Quality of
life of mothers receiving support from their families and spouses was much more positive score
compared to whom did not receive this support.
In many studies, a relationship between emotional
support and the health level of the mother has been
detected (
The significant increase in domains at 1 year postpartum compared with 6-8 weeks postpartum may
indicate additional demands by pregnant women
to receive this prenatal education. In a study by
Hill and Aldag they assessed the quality of life on
184 mothers, and revealed a significant increase in
terms of their health and mental functioning during the study. From weeks 1-3, the mean scores for
domains of the health and functioning have shown
significant increase for mothers of intervention
group. Mothers can be informed that their satisfaction with their health and mental functioning, as
well as overall QOL will likely improve with time.
The overall mean QOL scores for mothers was
higher at the week 3 compared to the first week
postpartum. This finding suggests that this sample
of mothers was more satisfied with their lives in
general as time passed (
Our findings suggest that the mother’s knowledge could potentially reduce their levels of anxiety and stress in pregnant women, which in turn, may improve maternal health and quality of life during first year postpartum. Further research on the effect of prenatal education on mother’s quality of life during breastfeeding or up to 5 years after childbirth is required in order to enhance our existing knowledge.