Journal of Education and Health Promotion

Abstract BACKGROUND: Gestational diabetes is the most common medical complication and a common
metabolic disorder during pregnancy. Increasing people’s self‑efficacy is one of the best ways to
control this disease. As there is a lag of intervention in this regard, the purpose of this study was to
determine the effect of couple supportive counseling on self‑efficacy in women with insulin‑treated
gestational diabetes.
MATERIALS AND METHODS: In this randomized clinical trial, 64 women with gestational diabetes
who referred to diabetes clinic of Mashhad Ommolbanin Hospital were divided into intervention and
control groups through block randomization during 2019. Their gestational age was in 26–30 weeks.
For the couples in the intervention group, three couple supportive counseling session was held. Each
session lasted 1 h and was held one time per week. The instruments were diabetes self‑efficacy
questionnaire, fasting and 2‑h postprandial checklist and Cassidy social support, which were assessed
before and 4 weeks after intervention in both groups. Data was analyzed by SPSS software version 25
through Mann–Whitney and Wilcoxon test. P values of < 0.05 were reported to be significant.
RESULTS: In the preintervention, the diabetes self‑efficacy score had no significant difference
in the intervention (30/6 ± 38/50) and control groups (09/8 ± 56/51) (P = 515/0). However, in
the postintervention, the diabetes self‑efficacy score was significantly higher in the intervention
group (58/6 ± 41/71) compared to the control group (15/7 ± 31/51) (P < 001/0). Also, before the
intervention, there was no significant difference between the intervention (30/2 ± 72/10) and control
group (87/1 ± 63/11) (P = 137/0) regarding social support. However, after the intervention, there was
a significant difference between the intervention and control groups (879/0 ± 53/13, 03/2 ± 41/11,
P < 0/001 respectively). Also, data analysis showed a significant correlation between self‑efficacy
and social support (r = 0.451, P < 0.001), self‑efficacy and fasting blood sugar (P < 0.001, r = ‑0.577),
and 2 h post prandial (r = ‑0.778, P < 0.001).
CONCLUSION: Couple supportive counseling leads to increased self‑efficacy and social support
in pregnant women with gestational diabetes. Therefore, it is recommended to use this counseling
as an effective method in the management of diabetic pregnant women during their prenatal care
to have a healthier pregnancy.

Abstract INTRODUCTION: Maternal confidence is an extremely important factor in playing the mother’s role
and her identity formation. Loss of self‑confidence occurs in primiparous women due to the lack of
maternal skills. Obtaining the behaviors of maternal role and self‑confidence, the mother provides
better care for her child. Hence, the aim of this study was to examine the effect of maternal role
training program based on Mercer theory on maternal self‑confidence of primiparous women with
unplanned pregnancy.
METHODOLOGY OF THE RESEARCH: This clinical trial was performed on 67 primiparous
women referring to Mashhad health centers. Individuals were randomly divided into intervention
and control groups. A maternal role training program based on Mercer theory was carried out for
intervention group (three sessions of group training in the 34th, 35th, and 36th weeks of pregnancy
and one individual training session before discharge from the hospital and then, weekly follow‑up
over the phone for 4 weeks). The control group received the normal pregnancy care. The research
tools were questionnaires of demographic characteristics, London, DASS 21, Edinburgh Postnatal
Depression Scale, Parenting Sense of Competence, General Impressions on Infant Temperament
Questionnaire, and Six Simple Questions. Maternal self‑confidence was measured before training,
4 weeks after delivery, and 4 months after delivery. Data analysis was carried out using independent
t‑test, Chi‑square test, paired t‑test, Mann–Whitney test, one‑way ANOVA, and Wilcoxon test. P < 0.05
was considered statistically significant.
RESULTS: There was a significant difference between mean maternal self‑confidence
changes (before training and 4 weeks after delivery (P = 0.003) and before training and 4 months
after delivery (P = 0.001) in both groups. After eliminating the effect of interventional variables, the
mean scores of maternal self‑confidence after training in the intervention group had a statistically
significant difference with that in the control group (P = 0.001).
CONCLUSIONS: Maternal role training program based on Mercer theory increases maternal
self‑confidence in primiparous women with unplanned pregnancy. Teaching maternal role is
recommended to all health‑care providers.

Abstract INTRODUCTION: Preeclampsia is the most common medical complication in pregnancy; along
with bleeding and infection, it is one of the three causes of death in pregnant women. Most of these
deaths were due to delays in the diagnosis and improper midwifery management and care. On
the other hand, the quality of midwifery education has a profound effect on the proper provision of
services. Therefore, the present study has been done to compare the effect of simulation‑, blended‑,
and lecture‑based education on simulated midwife performance in the management of preeclampsia
and eclampsia.
MATERIALS AND METHODS: This three‑group clinical trial study was performed on 90 midwives
of selected hospitals in Mashhad in 2016. Midwives were divided into three groups of simulation‑,
blended‑, and lecture‑based education using the random number table. The simulation group was
trained for 6 h at the Center for Clinical Skills, the blended group was trained for 4 h by lecture, and
6 weeks through the educational website, and the lecture group was trained for 6 h through lecture.
An objective structured clinical test was performed before and 2 weeks after the intervention. Data
were analyzed using SPSS Version 16 software and descriptive statistics, paired t‑test, one‑way
ANOVA, and Wilcoxon and Kruskal–Wallis tests. Significance level was considered to be P < 0.05
in all cases.
RESULTS: The mean score of midwives’ performance was not statistically significant before education
in all three groups (P < 0.05). The mean score of midwives’ performance was significantly increased
in all three groups 2 weeks after education (P < 0.001), and the results of intergroup comparison
showed that the mean score of performance in the simulation group was significantly higher than the
blended group and the lecture group (P < 0.001), and it was higher in the blended group compared
to the lecture group (P < 0.001).
CONCLUSION: Education increased the midwives’ simulated performance in preeclampsia and
eclampsia. The performance of the management of preeclampsia and eclampsia in the simulation
educational group is more than that of the blended and lecture groups, so we can use the simulation
education which is a self‑centered method.

Abstract BACKGROUND AND GOAL: Screening of fetal anomalies is assumed as a necessary
measurement in antenatal cares. The screening plans aim at empowerment of individuals to
make the informed choice. This study was conducted in order to compare the effect of group and
face‑to‑face education and decisional conflicts among the pregnant females regarding screening
of fetal abnormalities.
METHODS: This study of the clinical trial was carried out on 240 pregnant women at <10‑week
pregnancy age in health care medical centers in Mashhad city in 2014. The form of
individual‑midwifery information and informed choice questionnaire and decisional conflict scale
were used as tools for data collection. The face‑to‑face and group education course were held
in two weekly sessions for intervention groups during two consecutive weeks, and the usual
care was conducted for the control group. The rate of informed choice and decisional conflict
was measured in pregnant women before education and also at weeks 20–22 of pregnancy in
three groups. The data analysis was executed using SPSS statistical software (version 16), and
statistical tests were implemented including Chi‑square test, Kruskal–Wallis test, Wilcoxon test,
Mann–Whitney U‑test, one‑way analysis of variance test, and Tukey’s range test. The P < 0.05
was considered as a significant.
RESULTS: The results showed that there was statically significant difference between three groups
in terms of frequency of informed choice in screening of fetal abnormalities (P = 0.001) in such
a way that at next step of intervention, 62 participants (77.5%) in face‑to‑face education group,
64 members (80%) in group education class, and 20 persons (25%) in control group had the informed
choice regarding screening tests, but there was no statistically significant difference between two
individual and group education classes. Similarly, during the postintervention phase, there was a
statistically significant difference in mean score of decisional conflict scale among pregnant women
regarding screening tests in three groups (P = 0.001).
DISCUSSION AND CONCLUSION: With respect to effectiveness of group and face‑to‑face
education methods in increasing the informed choice and reduced decisional conflict in pregnant
women regarding screening tests, each of these education methods may be employed according
to the clinical environment conditions and requirement to encourage the women for conducting the
screening tests.

Abstract INTRODUCTION: Fear of childbirth is a common problem in pregnant women, which in many cases
leads to maternal requested cesarean. A midwife, as a responsible person, plays an important role in
providing advice and giving care to mothers during pregnancy, delivery, and the postpartum period.
The present study was conducted with the aim of determining the effect of individual counseling
program by a midwife on fear of childbirth in primiparous women.
MATERIALS AND METHODS: This clinical trial was conducted in 2015–16, on ninety primiparous
women with gestational ages of 28–30 weeks, who presented themselves at health‑care centers
in Mashhad. The individuals were randomly divided into two groups: intervention and control. The
intervention group received the counseling program individually during three sessions, and the routine
care was given to the control group. Data collection tools the Wijma Delivery Expectancy/Experience
Questionnaire. The data were collected at recruitment during 34–36 weeks of pregnancy and were
analyzed using SPSS 16 software and the statistical tests: Chi‑square and t‑test, and P < 0.05 was
considered to be significant.
RESULTS: During weeks 34–36 of pregnancy, the mean scores for fear of childbirth in the intervention
group and control group were 39.733 ± 17.085 and 65.666 ± 15.019, respectively, and there was a
significant difference between the two groups (P < 0.001).
CONCLUSION: The individual counseling program provided by the midwife to the primiparous women
during pregnancy resulted in reduced fear of childbirth.

Abstract INTRODUCTION: Gestational diabetes is the most common metabolic disorder in pregnancy, and
lack of self‑care is the most important reason for mortality in diabetic patients. Since the glycemic
control is associated with physiological and psychological mechanisms, variables such as health
locus of control can play a role in health behaviors of diabetic patients. Therefore, this study was
aimed to predict self‑care behaviors among women with gestational diabetes based on maternal
health locus of control (MHLC) and fetal health locus of control (FHLC).
METHODS: This study is a descriptive, predictive correlational study that it is conducted on
over 400 women with gestational diabetes attending the health centers and clinic of hospitals
affiliated to Mashhad University of Medical Sciences in 2015. Data were collected using individual
questionnaire, self‑care derived from the summary of diabetes self‑care activities, MHLC, and FHLC
scale. The data were analyzed using Spearman’s correlation coefficient test, linear regressions
model, and multiple regression in SPSS software version 16. P < 0.05 was considered statistically
significant.
RESULTS: Results of Spearman’s correlation coefficient test showed a significant direct linear
relationship between self‑care and internal MHLC (P = 0.027) and internal dimensions (P < 0.0001)
and powerful others (P = 0.012) of FHLC. According to linear regressions model, internal
MHLC (P = 0.027), internal dimensions (P < 0.0001), and powerful others (P = 0.012) of FHLC are
considered as predictor variables of self‑care.
CONCLUSION: Midwives should perform interventions to increase internal locus of control and
encourage more responsibility among women with gestational diabetes to achieve better self‑care.

Abstract INTRODUCTION: The maternal role is one of the most basic and important roles played by
women during their lifetime. The process of the maternal role starts during pregnancy and
to continue and develop after postpartum with the growth of suckling. However, unplanned
pregnancy may jeopardize achieving the maternal role and reduce maternal role satisfaction.
Therefore, the researcher conducted the present study to determine the impact of maternal
role training program on attainment of role and role satisfaction in nulliparous women with
unplanned pregnancy.
METHODOLOGY OF THE RESEARCH: In this clinical trial, the researcher divided 67 nulliparous
women with unplanned pregnancies into two groups at random by drawing lots. For the
intervention group, in addition to the usual pregnancy care, the researcher conducted 3 group
training sessions at weeks 34, 35, and 36 of pregnancy and an individual training session in the
1st day after delivery before release; then, during the next 4 weeks, the researcher made follow‑up
phone calls each week. The control group received the usual pregnancy care. The research
tools included London questionnaire to measure unplanned pregnancy, Myself‑As‑Mother
Scale (SD‑Self), My‑Baby Scale (SD‑Baby), Perceived Competence Scale to measure maternal
role attainment, and Parenting Sense of Competence Scale to measure maternal role satisfaction.
The researcher measured the maternal role attainment and maternal role satisfaction before
training and 4 weeks after delivery. The researcher analyzed the data using SPSS software
version 21 and statistical tests such as independent t‑test, Chi‑square, paired sample t‑test,
Mann–Whitney, one‑way analysis of variance, and Wilcoxon. The amount of P was supposed
to be <0.05.
RESULTS: The mean age of research units was 24.10 ± 4.3. Twenty‑one persons (60%) in the
intervention group and ten persons (31.3%) in the control group attained the maternal role (P = 0.019)
and changes to achieve the maternal role in intervention group were significantly more than the control
group (P = 0.002). Changes in the mean scores of maternal role satisfaction in the intervention group
were significantly more than the control group (P = 0.023).
CONCLUSION: Maternal role training for nulliparous women with unplanned pregnancy during
pregnancy and postpartum period can help them in maternal role attainment and maternal role
satisfaction.

Abstract INTRODUCTION: Shoulder dystocia is one of the obstetric emergencies that are accompanied to
serious risks for mother and fetus. It necessitates making the method of training of shoulder dystocia
management more efficient, i.e., better management and giving services with higher quality. Thus,
this study was carried out to compare the impact of training by simulation and oral technique on
the skill of the employed midwives in obstetric clinics at Mashhad city (Iran) in shoulder dystocia
management during 2012.
METHODS: The current research is a double‑group clinical trial that was conducted on 51 members of
the employed midwives in the obstetric clinic at Mashhad city in 2012. The questionnaire of personal
specification and awareness about shoulder dystocia and practical examination (objective‑structured
clinical examination) were employed as tools for data collection. The learners were divided into two
groups by randomized allocation. Training was done by the presentation of lecture in the oral content
group and a short movie was displayed at the end of it. The shoulder dystocia management technique
was simulated in another group and through role‑playing of instructor application of moulage (station)
training was conducted. The period of the training course (4 h) and content of the educational
workshop was identical for both groups. The practical examination was held for the learners
before and immediately after training course. The given data were analyzed by means of statistical
descriptive tests including Mann–Whitney U‑test and Wilcoxon test via SPSS software (version 16).
The significance level was considered as (P < 0.05) in all cases.
RESULTS: The total mean score was significantly increased for the variable of shoulder
dystocia management skill after intervention in both groups (P < 0.0001). Similarly, the results of
Mann–Whitney U‑test statistical tests indicated that total mean score for the variable of shoulder
dystocia management skill after the intervention was significantly greater in simulation group than
in an oral group (P = 0.040).
CONCLUSION: Training in simulated delivery room by means of role‑playing is an efficient method
for training shoulder dystocia management skill, so it is recommended to use this program in the
training of this skill.

Abstract Introduction: Delay in diagnosis of bleeding can be due to underestimation of the actual
amount of blood loss during delivery. Therefore, this research aimed to compare the efficacy
of web‑based, simulation‑based, and conventional training on the accuracy of visual estimation
of postpartum hemorrhage volume. Materials and Methods: This three‑group randomized
clinical trial study was performed on 105 midwifery students in Mashhad School of Nursing and
Midwifery in 2013. The samples were selected by the convenience method and were randomly
divided into three groups of web‑based, simulation‑based, and conventional training. The three
groups participated before and 1 week after the training course in eight station practical tests,
then, the students of the web‑based group were trained on‑line for 1 week, the students of the
simulation‑based group were trained in the Clinical Skills Centre for 4 h, and the students of
the conventional group were trained for 4 h presentation by researchers. The data gathering
tool was a demographic questionnaire designed by the researchers and objective structured
clinical examination. Data were analyzed by software version 11.5. Results: The accuracy of
visual estimation of postpartum hemorrhage volume after training increased significantly in
the three groups at all stations (1, 2, 4, 5, 6 and 7 (P = 0.001), 8 (P = 0.027)) except station
3 (blood loss of 20 cc, P = 0.095), but the mean score of blood loss estimation after training did
not significantly different between the three groups (P = 0.95). Conclusion: Training increased
the accuracy of estimation of postpartum hemorrhage, but no significant difference was found
among the three training groups. We can use web‑based training as a substitute or supplement
of training along with two other more common simulation and conventional methods.

Abstract Background: Multi‑dimensional self‑compassion is one of the important factors predicting
fetal‑maternal attachment which vary among different cultures and countries. So the aim of
this study was to determine the relationship between multi‑dimensional, self‑compassion, and
fetal‑maternal attachment in the prenatal period. Subjects and Methods: This cross‑sectional
study was carried on 394 primigravida women to Mashhad Health Care Centers in with
two stage sampling method (cluster‑convenience) in the year 2014. Demographic/prenatal
characteristics, multi‑dimensional self‑compassion (26Q) with five dimension (including
self‑kindness, self‑judgment, common humanity, isolation items, mindfulness, over‑identified),
and fatal‑maternal attachment (21Q) were completed by the participants. The statistical analysis
was performed with various statistical tests such as Pearson correlation coefficient, t‑test, one‑way
ANOVA, and linear regression using SPSS statistical software (version 14). Results: Based
on the findings, the mean (standard deviation) value for multi‑dimensional self‑compassion
was 59.81 (6.4) and for fatal‑maternal attachment was 81.63 (9.5). There was a positive
correlation between fatal‑maternal attachment and total self‑compassion (P = 0.005, r = 0.30)
and its dimension including self‑kindness (P = 0.003, r = 0.24), self‑judgment (P = 0.001,
r = 0.18), common humanity (P = 0.004, r = 0.28), isolation items (P = 0.006, r = 0.17),
mindfulness (P = 0.002, r = 0.15), over‑identified (P = 0.001, r = 0.15). Conclusions: There
was a correlation between the multi‑dimensional self‑compassion and fetal‑maternal attachment
in pregnant women. Hence, educating people like caregivers by community health midwives
regarding psychological problems in during pregnancy can be effective in early diagnosing
and identifying such disorders.