Document Type : Original Article
Authors
1 Department of Midwifery, School of Nursing and Midwifery, Patient Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran
2 Department of Biostatistics and Epidemiology, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran
Abstract
BACKGROUND: Preconception reduces unplanned pregnancies and plays an important role in
reducing maternal and infant mortality. Considering the importance of these care services, this study
was conducted to determine the status of preconception care (PCC) model with Structural Equation
Modeling (SEM).
MATERIALS AND METHODS: This cross-sectional descriptive study was conducted on 394 pregnant
women referring to Gorgan’s health centers. Samples were selected by multi‑stage stratified sampling
method. The instrument used in this research was a researcher-made questionnaire by Bayrami. Data
were analyzed using R software version 4.1.4. Structural equation modeling (SEM) with weighted
least square mean and variance method was used to fit the conceptual model and the significance
level of the tests was considered 0.05.
RESULTS: The results showed that PCC model was deemed appropriate as optimum conditions
indicators of goodness of fit; knowledge with a coefficient of 0.182 leads to self‑efficacy (SE), and
SE affects the accessibility of facilities with a coefficient of 0.465 and the expected outcome with a
coefficient of 0.500. After facility structure with a coefficient of 0.500, SE construct with a coefficient
of 0.215 had the most effect on performing PCC behavior.
CONCLUSIONS: Facilities and SE as a key element of empowerment have an important role in
promoting PCC. Identifying the factors associated with this care appears to help health policymakers
to planning for these caregivers more precise and sensitive.
Keywords
Cornel MC, de Weerd SR, et al. The Dutch national summit on
preconception care: A summary of definitions, evidence and
recommendations. J Community Genet 2015;6:107-15.
2. Wildschut HI, van Vliet‑Lachotzki EH, Boon BM, Lie Fong S,
Landkroon AP, Steegers EA. Preconception care: An essential
part of the care for mother and child. Ned Tijdschr Geneeskd
2006;150:1326-30.
3. Hafez SK, Dorgham LS, Sayed S. Profile of high risk pregnancy
among Saudi women in Taif-KSA. World J Med Sci 2014;11:90-7.
4. Posner SF, Johnson K, Parker C, Atrash H, Biermann J.
The national summit on preconception care: A summary
of concepts and recommendations. Matern Child Health J
2006;10:S197-205.
5. Oza‑Frank R, Gilson E, Keim SA, Lynch CD, Klebanoff MA.
Trends and factors associated with self-reported receipt of
preconception care: PRAMS, 2004-2010. Birth 2014;41:367-73.
6. Pandolfi E, Agricola E, Gonfiantini MV, Gesualdo F, Romano M,
CarloniE, et al. Women participating in a web-based preconception
study have a high prevalence of risk factors for adverse pregnancy
outcomes. BMC Pregnancy Childbirth 2014;14:169.
7. Kar SB, Pascual CA, Chickering KL. Empowerment of
women for health promotion: A meta-analysis. Soc Sci Med
1999;49:1431-60.
8. Shadab P, Nekuei N, Yadegarfar G. The prevalence of
preconception care, its relation with recipients’ individuality,
fertility, and the causes of lack of checkup in women who
gave birth in Isfahan hospitals in 2016. J Educ Health Promot
2017;6:88.
9. Poels M, Koster MP, Boeije HR, Franx A, van Stel HF. Why do
women not use preconception care? A systematic review on
barriers and facilitators. Obstet Gynecol Surv 2016;71:603-12.
10. M’hamdi HI, van Voorst SF, Pinxten W, Hilhorst MT, Steegers EA.
Barriers in the uptake and delivery of preconception care:
Exploring the views of care providers. Matern Child Health J
2017;21:21-8.
11. Frey KA, Files JA. Preconception healthcare: What women know
and believe. Matern Child Health J 2006;10:S73-7.
12. Mazza D, Chapman A, Michie S. Barriers to the implementation
of preconception care guidelines as perceived by general
practitioners: A qualitative study. BMC Health Serv Res
2013;13:36.
13. Robbins CL, Zapata LB, Farr SL, Kroelinger CD, Morrow B,
Ahluwalia I, et al. Core state preconception health
indicators-Pregnancy risk assessment monitoring system and
behavioral risk factor surveillance system, 2009. MMWR Surveill
Summ 2014;63:1-62.
14. Klerman LV, Jack BW, Coonrod DV, Lu MC, Fry-Johnson YW,
Johnson K. The clinical content of preconception care: Care of
psychosocial stressors. Am J Obstet Gynecol 2008;199:S362-6.
15. Hatam N, Khammarnia M, Ghorbanian A. The relationship
between gender inequality and health service coverage in
the member countries of the United Nations. Sadra Med Sci J
2017;2:21-30
16. Glanz K, Rimer BK, Viswanath K. Health Behavior and Health
Education: Theory, Research, and Practice. USA. San Francisco
John Wiley & Sons; 2008.
17. Bandura A. Health promotion from the perspective of social
cognitive theory. Psychol Health 1998;134:623-49.
18. Bandura A, Freeman WH, Lightsey R. Self‑efficacy: The exercise
of control. J Cogn Psychother 1999;13:158-66.
19. Al-Akour NA, Sou’Ub R, Mohammad K, Zayed F. Awareness of
preconception care among women and men: A study from Jordan.
J Obstet Gynaecol 2015;35:246-50.
20. Bashirian S, Jalili M, Karimi-Shahanjarini A, Soltanian A,
Barati M. Effectiveness of educational program based on social
cognitive theory constructs to promote nutritional behaviors
among pregnant women in Tabriz. Iran J Nutr Sci Food Technol
2017;12:1-10.
21. Hosli EJ, Elsinga J, Buitendijk SE, Assendelft WJ,
van der Pal-de Bruin KM. Women’s motives for not participating
in preconception counseling: Qualitative study. Community
Genet 2008;11:166-70.
22. Karami Z, Nekuei N, Kazemi A, Paknahad Z. Psychosocial factors
related to dietary habits in women undergoing preconception
care. Iran J Nurs Midwifery Res 2018;23:311-5.
23. Wang W, Temsah G, Mallick L. The impact of health insurance on
maternal health care utilization: Evidence from Ghana, Indonesia
and Rwanda. Health Policy Plan 2017;32:366-75.
24. Wang SL, Charron-Prochownik D, Sereika SM, Siminerio L,
Kim Y. Comparing three theories in predicting reproductive
health behavioral intention in adolescent women with diabetes.
Pediatr Diabetes 2006;7:108-15.
25. Ding Y, Li XT, Xie F, Yang YL. Survey on the implementation
of preconception care in Shanghai, China. Paediatr Perinat
Epidemiol 2015;29:492‑500.
26. Resnick B, Zimmerman SI, Orwig D, Furstenberg AL,
MagazinerJ. Outcome expectations for exercise scale: Utility and
psychometrics. J Gerontol B Psychol Sci Soc Sci 2000;55:S352-6.
27. Norouzi S, Moghaddam MH, Morowatisharifabad MA,
Norouzi A, Jafari AR, Fallahzadeh H. Examining social‑cognitive
predictors of parenting skills among mothers with preschool and
early elementary school‑aged children. J Educ Health Promot
2015;4:96.
28. Aliakbari F, Alipour FM, Tavassoli E, Sedehi M. The effect of
empowerment program based on the social cognitive theory on
the activity of daily living in patients with chronic obstructive
pulmonary disease. J Educ Health Promot 2020;9:146.
29. Elsinga J, de Jong‑Potjer LC, van der Pal‑de Bruin KM, le Cessie S,
Assendelft WJ, Buitendijk SE. The effect of preconception
counselling on lifestyle and other behaviour before and during
pregnancy. Womens Health Issues 2008;18:S117-25.
30. Bandura A. Health promotion by social cognitive means. Health
Educ Behav 2004;31:143‑64.
31. Bayrami R, Roudsary RL, Javadnoori M, Allahverdipour H,
Esmaily H. Predicting preconception health behavior in Iranian
women based on mixed methods sequential explanatory
approach: Developing a descriptive model. PhD thesis. Mashhad
university of medical sciences. 2016.
32. Sohrabi MR, Albalushi RM. Clients’ satisfaction with primary
health care in Tehran: A cross-sectional study on Iranian Health
Centers. J Res Med Sci 2011;16:756-62.
33. Kaufman W, Chavez AS, Skipper B, Kaufman A. Effect of high
up front charges on access to surgery for poor patients at a public
hospital in New Mexico. Int J Equity Health 2006;5:6.
34. Mastroiacovo P, Nilsen RM, Leoncini E, Gastaldi P, Allegri V,
Boiani A, et al. Prevalence of maternal preconception risk factors: An Italian multicenter survey. Ital J Pediatr 2014;40:91.
35. Jahani Shourab N, Ghaffari Sardasht F, Jafarnejad F, Esmaili H.
Assessment of prenatal care process based on donabedian
model in Mashhad health centers. Iran J Obstet Gynecol Infertil
2013;16:7-17.
36. Simbar M, Ahmadi M, Ahmadi G, Majd HR. Quality assessment
of family planning services in urban health centers of Shahid
Beheshti Medical Science University, 2004. Int J Health Care Qual
Assur Inc Leadersh Health Serv 2006;19:430-42.
37. Farshbaf‑Khalili A, Sattarzade N, Khari E. Attitude of midwives’,
suggested solutions and current problems of preconception care.
J Nurs Midwifery Urmia Univ Med Sci 2016;14:783-90.
38. Mason E, Chandra‑Mouli V, Baltag V, Christiansen C, Lassi ZS,
Bhutta ZA. Preconception care: Advancing from ‘important to do
and can be done’ to ‘is being done and is making a difference’.
Reprod Health 2014;11 Suppl 3:S8.
39. Roudsari RL, Bayrami R, Javadnoori M, Allahverdipour H,
Esmaily H. Patterns and determinants of preconception health
behaviors in Iranian women. Iran Red Crescent Med J 2016;
18 (2):e28565.
40. Mirkhan Ahmed H, Jamil Piro T. Knowledge, practice, and
attitude of married women about preconception care. J Client
Cent Nurs Care 2017;3:37-44.
41. Kordi M, Banaei M, Asgharipour N, Mazloum SR, Akhlaghi F.
Prediction of self-care behaviors of women with gestational
diabetes based on belief of person in own ability (Self‑Efficacy).
Iran J Obstet Gynecol Infertil 2016;19:6-17.
42. Farideh B. The effect of education on nutrition behavioral intention
and self‑efficacy in women. Health Scope 2012;2012:12‑7.
43. Roosta F, Ahmadi A. Self‑efficacy and health promoting behaviors
among women of reproductive ages in Shiraz during 2013. Sci J
Ilam Univ Med Sci 2016;24:90-100.
)