dxEffectiveness of Self

Instructional Module (SIM)

on Knowledge Regarding
Selected Aspects of Safe
Motherhood among
Primigravida Women in
Selected Hospitals,
Puducherry
 

Dr. V. Indra
University of Hail, Kingdom of Saudi Arabia

*Corresponding Author’s Email:

ABSTRACT:
Pregnancy is a special event. The labor and birth process is an exciting, anxiety
provoking situation for the woman and her family. Hence, a study was conducted
to assess the effect of self instructional module on knowledge regarding selected
aspects of safe motherhood among primigravida women in selected hospitals,
Puducherry with the objective to assess the existing level of knowledge, assess the
effect of SIM on safe motherhood among primigravida women and associate the
pre test level of knowledge with selected demographic variables. A quantitative
evaluatory approach and pre-experimental one group pre test- post test was used.
Purposive sampling technique was done to select 50 primigravida women. To
collect the data structured questionnaire was administered followed by
administration of SIM. On the 7th day the effectiveness of the SIM assessed by
conducting post test. The statistical analysis of the data shows that the self
instructional module was effective in improving knowledge as the ‘t’ value is
20.12 which is significant at p<0.01. After computation it depicts that the mean
post test score is significantly higher than the mean pre-test score. So in the
inference it reveals that the research hypothesis is accepted and null hypothesis is
rejected. It signifies the association between the level of pre test knowledge with
selected demographic variables like education and occupation.

Objectives:

·        To assess the existing level of knowledge regarding selected aspects of safe
motherhood among primigravida women.

·        To evaluate the effect of SIM regarding safe motherhood in terms of gain in
post test knowledge scores of primigravida when compare to their pre test
scores.

·        To associate the level of knowledge with selected demographic variables

among primigravida women regarding selected aspects of safe motherhood.

Design: The research design adopted for this study is pre experimental design, of
which one group pre-test- post-test design.

Settings: The study was conducted at various hospitals in Puducherry.

Samples: In this study, the samples are the primigravida women who were
admitted to the antenatal wards of selected hospitals, Puducherry and also those
who satisfy the inclusion criteria are included as samples in the study. The sample
size was 50. The sampling technique used is Non-probability purposive sampling.

Result: The researcher found that there was a significant improvement in

knowledge of primigravida women after the administration of self instructional
module on safe motherhood and there was significant association between levels of
pre-test knowledge of primigravida women with selected demographic as
educational status of the samples.
Conclusion: The present study shows that the most of the primigravida women
had moderate knowledge. The difference between pre test and post test score
revealed that self instructional module is very effective in improving knowledge of
primigravida women. The pre test knowledge of safe motherhood is significantly
associated with variables like education and occupational status of primigravida
women, but there is no significant association between the pre test knowledge and
age, family type, number of elder females in the family and age at marriage.

KEYWORDS: Safe motherhood; Self-instructional module.

 

INTRODUCTION:
In every country and community worldwide, pregnancy and childbirth are
momentous events in the lives of women and families, and represent a time of
intense vulnerability. Mothers and children constitute a major part of the total
population. In India, women of the child bearing age (15-44 years) constitute 19%
and children less than 15 years of age about 40% of the total population. Together
they constitute nearly 59% of the total population[1].

Women are half of the nation and half of the power; their concerns must be
addressed on priority basis. Women’s autonomy, dignity, feelings, choices, and
preferences must be respected, including their choice of companionship wherever
possible. Childbirth can be a very frightening experience for many women, but it
should be a joyous occasion—and every woman should feel valued, respected, and
appreciated by all those who aid in her journey of bringing new life into the
world[2].

Saving mother’s life is a global aim as the health of mothers has long been
considered as cornerstone of public health and attention. Safe motherhood
encompasses a series of initiatives, practices, protocols and service delivery
guidelines designed to ensure that women receive high-quality gynaecological,
family planning, prenatal, delivery and postpartum care in order to achieve optimal
health for the mother, fetus and infant during pregnancy, childbirth and
postpartum. The ways to achieve safe motherhood include skilled attendance at all
births, access to quality emergency obstetrical care, access to quality reproductive
health care including family planning and safe post-abortion care[3].

The ''safe motherhood'' programme was launched in 1989. WHO reported that 5,
00,000 women continue to die globally each year due to pregnancy related issues.
Nearly 99% of these deaths occur in developing countries. Maternal mortality is
not only indicator of women's health, but also gives indication of access, integrity,
effectiveness and health sector organizations. South-East Asia accounts for 40% of
global deaths, which is highest in the world.

The high percentage of deaths of women and children with the modern advances in
technology are unacceptable. The region accounts for half of the world's poor
women who have daily income less than 50 rupees and are likely to die 300 times
more than women in advanced countries [4].

The concept of “safe motherhood” is usually restricted to physical safety, but

childbearing is also an important rite of passage, with deep personal and cultural
significance for a woman and her family. Safe motherhood means ensuring that all
women receive the care they need to be safe and healthy throughout pregnancy,
child birth and postnatal period. Safe motherhood includes antenatal care,
intranatal care, postnatal care and neonatal care. Issues of gender equity and
gender-based violence are also at the core of maternity care, so the notion of safe
motherhood must be expanded beyond the prevention of morbidity or mortality to
encompass respect for women’s basic human rights.

Unsafe motherhood consists in maternal mortality or morbidity due to preventable

pregnancy and childbirth-related causes. Maternal mortality is a major cause of
death and disability among women of reproductive age.

500,000 women die every year from complications related to child bearing. Many
more women are injured, some severely from childbirth complications. Maternal
mortality and morbidity adversely affect the health and welfare of children,
families and communities. Safe motherhood decreases maternal and infant
mortality and morbidity. Although, most maternal and infant deaths can be
prevented through safe motherhood practices, millions of women worldwide are
affected by maternal mortality and morbidity from preventable causes.

With respect to gynaecological morbidity, slightly above 40% of the women were
reported to experience any gynaecological morbidity on clinical examination. The
incidence of abortion is higher among adolescent and young women in the ages 15-
19 and 20-24. The most reported pregnancy related problems were excessive
fatigue and swelling in leg, body or face. In the case of post-delivery complication,
massive vaginal bleeding and very high fever were the most reported problems[5]

Reproductive morbidity refers to the morbidity or dysfunction of the reproductive

tract, or any morbidity, which is a consequence of reproductive behaviour
including pregnancy, abortion, childbirth or sexual behaviour. Reproductive
morbidity includes obstetric morbidity and it refers to ill health in relation to
pregnancy and childbirth. Obstetric morbidity is one of the major causes for
maternal death. Obstetric morbidity is defined as “morbidity in a woman who has
been pregnant (regardless of site or duration of the pregnancy) resulting from any
cause related to or aggravate by the pregnancy or its management but not from
accidental or incidental causes”

There are social and medical causes associated with pregnancy complications such
as delay in decisions to seek care, delay in accessing and receiving care. Other
social causes such as inequality in providing proper nutrition, education and
medical treatment may affect women’s health. Malnutrition, infection, early and
repeated child bearing and high fertility also play an important role in poor
maternal health condition in India. Lack of access to health care along with the
poor quality of the delivery system and its responsiveness to women need make
them more vulnerable to maternal morbidity. Maternal morbidity and reproductive
morbidity in general, is an outcome of not just biological factors but of women’s
poverty, powerlessness and lack of control over the resources as well[6]

 
Around one fifth of the births worldwide and one fourth of maternal deaths are
occurring in India. Maternal mortality as well as life risk of maternal death in
central India is well above the national average. The risk of death associated with
the complications of pregnancy, and delivery is relatively high in central India.
This shows that this part of the country shares the maximum burden of
reproduction related morbidity and mortality of women. This problem strongly
arises not only from economic but also social, cultural factors and also inadequate
and under utilization of health services. Thus, there is a relation between maternal
mortality and obstetric morbidity.

Safe motherhood Initiative is global efforts that aim to reduce deaths and illnesses
among women and infants, especially in developing countries. It was launched in
1987 to improve maternal health and cut the number of maternal deaths in half by
the year 2000. To improve well being of mothers through a comprehensive
approach of providing preventive, promotive, curative and rehabilitative health
care.

The White Ribbon Alliance for Safe Motherhood is a global coalition of

individuals and organizations formed to promote increased public awareness of the
need to make pregnancy and childbirth safe for all women and newborns in the
developing, as well as, developed countries. It was launched in 1999. This white
ribbon is dedicated to the memory of all women who have died in pregnancy and
childbirth. Worldwide, every three minute, a woman dies of pregnancy-related
complications - about 800 women every day. Most of these deaths can be
prevented. The White Ribbon Alliance for Safe Motherhood unites individuals,
organizations and communities who are working to increase public awareness
about this needless loss of life and to promote safe motherhood[7].

Each year there are at least 3.2 million stillborn babies, 4 million neonatal deaths
and more than half a million maternal deaths. The majority of these deaths are
avoidable. HIV/AIDS and malaria in pregnancy are having an impact on maternal
mortality and could reverse the progress that has been made. The time spent in
labour and giving birth, the critical moments when a joyful event can suddenly turn
into an unforeseen crisis, needs more attention, as does the often-neglected post-
partum period. These periods account not only for the high burden of post-partum
maternal deaths, but also for the associated large number of stillbirths and early
newborn deaths. A total of 98% of stillbirths and newborn deaths occur in low- and
middle-income countries: obstetric complications, particularly in labour, are
responsible for perhaps 58% of them. The care that can reduce maternal deaths and
improve women’s health is also crucial for newborns’ survival and health[8].

In the International statistical classification of diseases and related health

problems, 10th revision (ICD-10), WHO defines maternal death as: The death of a
woman while pregnant or within 42 days of termination of pregnancy, irrespective
of the duration and site of the pregnancy, from any cause related to or aggravated
by the pregnancy or its management but not from accidental or incidental
causes[9].

Maternal deaths can occur throughout pregnancy, labour and postpartum period.
Such deaths often occur suddenly and unpredictably. Between 11-17% of maternal
deaths happen during childbirth itself and between 50-71% in postpartum period.
Mortality risks strongly associated with the ''three delays'' in receiving skilled care
at the time of an obstetric emergency- delay in the decision to seek care, in
reaching health facility and receiving quality care on arrival. A recent multi-
country study has shown that these delays are often attributed to financial barriers,
transportation challenges and distance to appropriate facilities.

Globally, the major causes of maternal deaths are severe bleeding (25%),
infections (15%), unsafe abortions (13%), eclampsia (12%), obstructed labour
(8%), and other direct causes (8%). In India major causes of maternal mortality are
anaemia (19.4%), haemorrhage (11.8%), toxaemia (15%), abortion (11.8%),
puerperial sepsis (8.1%), and others (21.8%).

In India, the major causes of maternal deaths are haemorrhage (38%), sepsis
(11%), hypertensive disorders (5%), obstructed labour (5%), abortion (8%) and
other conditions (34%). India is among those countries which have a very high
maternal mortality ratio. According to the estimates the MMR has reduced from
254 per 100,000 live births in 2004-06 to 212 per 100,000 in 2007-09, a reduction
of 42 points over a year of three years period. In the four southern states, Kerala
and Tamil Nadu have already achieved the goal of a MMR 100 per 100,000 live
births, but within the group, Karnataka lags behind with MMR 178, and at the
current rate of decline, would reach to about 130 per 100,000 live births in the year
2012. During the year 2010, about 56,000 women died of pregnancy related
causes. It is mainly due to large number of deliveries conducted at home by
untrained person. In addition, lack of adequate referral facilities to provide
emergency obstetric care for complicated cases also contribute to high morbidity
and mortality[10].

Every day, almost 800 women die in pregnancy or childbirth. Every two minutes,
the loss of a mother shatters a family and threatens the wellbeing of surviving
children. Evidence shows that infants whose mothers die are more likely to die
before reaching their second birthday than infants whose mothers survive. And for
every woman who dies, 20 or more experience serious complications. Of the
hundreds of thousands of women who die during pregnancy or childbirth each
year, 90 per cent live in Africa and Asia. The majority of women are dying from
severe bleeding, infections, eclampsia, obstructed labour and the consequences of
unsafe abortions--all causes for which we have highly effective interventions[11].

National Safe Motherhood Day is observed on 11 April every year. The theme for
this year is “Every Woman Counts”. It aims at enforcing the strong voice that all
women should have access to care and no maternal death is acceptable. Surviving
childbirth is a basic right of every woman and each individual directly or indirectly
associated with the issue has a social responsibility to ensure that every woman
counts. The Millennium Development Goal (MDG) 5 has set a target for reducing
maternal mortality to 109 per one lakh live births. Achieving MDG 5 is not only an
important goal in itself, it is also central to the achievement of the other MDGs:
reducing poverty, reducing child mortality, stopping new HIV infections,
providing education and promoting gender equality. This brief argues that maternal
deaths can be prevented by increasing the institutional delivery, reducing anaemia
among women and adolescents by IFA supplementation and by providing better
postnatal care for mothers. It also argues that other indirect causes of maternal
deaths like child marriage must be stopped and education of girls’ encouraged[12].

 
Mother plays an important role within the family. Hence maternal deaths have very
serious consequences within the family. The death of mother increases the risk to
the survival of her young children. The road to maternal and infant death is a long
one, but it is possible to escape the tragedy of its end at various points along the
route. The challenge is to ensure that every woman has the chance of safe
motherhood.

NEED FOR THE STUDY:

Addressing maternal health means ensuring that all women receive the care need
for safe pregnancy and childbirth. Safe Motherhood includes antenatal care,
delivery care and postnatal care, including care of baby and breastfeeding support.
It encompasses social and cultural factors. Improving maternal health is one of the
fifth millennium development goal and great efforts have been put forth to achieve
this. Newborns have the highest risk of death among all children. Each day, about
8,000 babies die within the first 28 days of life. Most of them die at home.
Prematurity/low birth weight, infection, asphyxia/birth traumas causes 77 percent
of neonatal death. Every two minutes, the loss of a mother shatters a family and
threatens the well-being of surviving children. Women in many areas still lack the
power to make choices about their health and lives, with negative consequences for
maternal health. They still have lots of traditional beliefs about the food and
regarding medical seeking.

A survey was conducted to assess the obstetric morbidity among currently married
women in selected states in India. This study uses the data from NFHS-3.
According to NFHS-3, at the national level, 6% women were suffering from
difficulty with vision, 9% had night blindness, 10% reported convulsion, 25%
suffer from swelling in legs, body or face, 48% had excessive fatigue and four
percent had vaginal bleeding during pregnancy. With regard to postpartum
complications around 12% women had massive vaginal bleeding and 14% suffered
from very high fever.

The above survey results also reveal that in Karnataka one third of the women
reported symptoms of reproductive morbidity. Lack of education and economic
status were emerged as significant factors affecting the women’s health. In Tamil
Nadu, the gynaecological morbidity is high among rural women, majority of
women are suffering from one or more gynaecological morbidity. So there is an
urgent need for suitable health education and awareness about reproductive
diseases between both genders. Considering the obstetric morbidity in Kerala and
Andhra Pradesh, it reveals that the prevalence is high in both states and there is
need to stress on the treatment seeking behaviour especially in Andhra Pradesh.

NFHS-2 data shows that, the states Madhya Pradesh and Bihar show the highest
percentage of obstetric morbidity in the country. A large proportion of women
were experiencing almost of all types of complications in these states. The extent
of obstetric complications increases with women’s age and birth order and
decreases with increase in standard of living and education[13].

With regard to the mortality, maternal deaths are found to be shockingly high in
India. Over one lakh women in India die every year from various preventable
causes related to pregnancy and childbirth, mainly due to prevailing social
situation. While the neighbouring state of Sri Lanka has brought down its MMR
from 813(1948) to 58(2005), India had failed to do so. India's MMR is deplorably
high at 254 per 100,000 live births (SRS,2009 estimates) which is higher than Sri
Lanka and China. The current MMR of India is 212 per 100,000 live births,
whereas the country's Millennium Development Goal(MDG) target in this respect
is 109 per 100,000 live births by 2015.

Globally, an estimated 287,000 maternal deaths occurred in 2010, a decline of 47%

from levels 1990. Sub-Saharan Africa(56%) and Southern Asia(29%) accounted
for 85%(245,000 maternal deaths) of the global burden in 2010. At the country
level, two countries account for a third of global maternal deaths; India at 19%
(56,000) and Nigeria at 14% (40,000). The global MMR in 2010 was 210 maternal
deaths per 100,000 live births. The MMR in developing regions (240) was 15 times
higher than in developed regions. Sub- Saharan Africa had the highest MMR at
500 maternal deaths per 100,000 live births, while Eastern Asia had the lowest
among developing regions at 37 maternal deaths per 100,000 live births. The
MMR in southern states fell 17% from 127 to 105, closer to the MDGs. Assam and
Uttar Pradesh/ Uttarakhand were the worst performing states, with MMR of 328
and 292, respectively. Kerala and Tamil Nadu have surpassed the MDG with an
MMR of 66 and 90 respectively.

Millennium Development Goal-5 calls for an improvement in maternal health and

a reduction in maternal mortality by 75% by 2015 from 1990 levels. The
identification of maternal health as one of the eight MDGs firmly situates it as
central to poverty reduction and overall development efforts. Its inclusion has
resulted in increased international attention to maternal mortality, and provided a
mechanism for monitoring progress on maternal health and improving access to
skilled attendants at deliveries (the key indicator for measuring progress for Goal
5). With the MDGs now widely accepted as the framework for assessing progress
on overall health and development at the national and international levels, safe
motherhood can figure more prominently in country programs and in development
agencies’ priorities.

Ensuring that mothers have access to skilled attendant during labour can
dramatically reduce the risk of death for the mother and newborn child. In almost
all countries where health professionals attend more than 80% of deliveries,
maternal mortality ratios are below 200 per 100,000 deliveries. Each day 800
women die worldwide from causes related to pregnancy and childbirth, while
millions more suffer from post partum injuries. A woman is most vulnerable at the
post-partum period. About 50-70% maternal death occur in the postpartum period
of which 45% deaths occur in the first 24 hours after delivery and more than two-
thirds during the first week. Between 11-17% of maternal deaths occur during
child birth itself.

In India, 52% of deliveries are unsafe. Most deliveries in India occur at

home(60%) in rural and even in urban slum areas and urban areas. These deliveries
are attended by trained/ untrained birth attendants. Every year 30 million get
pregnant and 27 million babies are born. Pregnancies which are ill-timed, too
closely spaced, pregnancies to severely anaemic mothers and teenage pregnancies
and pregnancies over the age of 35 are unsafe pregnancies. Women status in India
is low, their literacy is low, mortality level is high and social disparities and gender
biases are too many put them at risk. Information to women is low as access to
modern media-newspaper, television and schooling is low which put them to
disadvantageous position to strive for self help and self-care and utilization of
services for themselves and their children. The postnatal care in rural areas and
urban slums is negligible by health personnel; it is left to traditional birth
attendants. Over 60% maternal deaths occur after birth and more than half of these
take place within one day of delivery and it is sufficient hint to make sure that
Puerperium is safe and postnatal care is sound[14].

There are other costs of maternal mortality as well. The mother’s family loses her
contribution to household management and the care she provides for children and
other family members. The economy loses her productive contributions to the
workforce. Women in developing countries lose more disability-adjusted life years
(28 million) to maternal causes than to any other. The cost in human, social and
economic terms is enormous. Pregnancy is not a disease but a means by which the
human race is propagated. The hazards of childbirth cannot be avoided by simply
preventing pregnancy. Society depends on future generations, and women should
not be required to give their lives or health in undertaking this social and
physiological duty. Safe motherhood is not only a health issue—it is also a moral
issue[15].

Illiteracy is the greatest barrier for any advances in the health condition. The
investigator during the clinical posting had identified that most of the women were
suffering from problems like excessive fatigue, swelling in leg and face, massive
vaginal bleeding during their motherhood period. So the investigator felt the need
for assessing the knowledge and find out the effectiveness of providing self
instructional module. Mother's education level, even within the same socio-
economic class is a key determinant of their children's health. To improve
pregnancy outcomes, education, motivation and mobilization of pregnant women,
including their families and communities on knowledge regarding safe motherhood
should be provided [16] [17] [18].

The above depicted literature throws light to the increased prevalence of

complications related to pregnancy, childbirth and postpartum among mothers. So
the investigator felt the need to evaluate the effectiveness of SIM on knowledge of
primigravida women regarding selected aspects of safe motherhood.
 

REVIEW OF LITERATURE:
The literature review of the study has been organized and presented under the
following headings:

·      Literature related to knowledge on safe motherhood

·      Literature related to knowledge on intranatal care

·      Literature related to knowledge on postnatal care

·      Literature related to knowledge on new born care

Literature related to knowledge on safe motherhood:

A descriptive study was conducted to assess the health worker’s knowledge of safe
motherhood services at selected primary health centres in Hassan District,
Karnataka. A structured questionnaire was prepared and administered to 100
female health workers based on purposive random sampling. The mean knowledge
percentage score was 67% and mean practice percentage score was 69%. The
calculated Pearson's Correlation Co-efficient r = 0.62 was greater than table value
(r=0.388,p<0.05) showing significant positive correlation between the mean
knowledge and practice score[19].

An experimental study was conducted to assess the effectiveness of STP on

knowledge of primigravida regarding selected aspects of safe motherhood in
selected hospitals, Kolar, Karnataka. A sample size 100 was selected through a
process of Simple random sampling out of which 50 were assigned to experimental
group and 50 were in control group. Data were collected through structured
questionnaire. Descriptive and inferential statistics were used for data analysis. The
majority (88% of experimental group and 78% of control group) had moderately
adequate knowledge. The mean value of knowledge scores of experimental group
in pre test was 22.98 with SD 3.21. The mean value of knowledge scores of control
group in pre test score was 23.06, SD was 3.63, where as in post test mean and SD
was 24.1±3.32. There was no significance in the pre test of the both group
(t=0.115,p>0.05 and z=0.116, p>0.05). There were also significant difference
between post test of experimental and control group (t=3.36,p<0.05 and z=10.30,
p<0.001)[20].

A pre-experimental (evaluatory approach) study was conducted to assess the

effectiveness of structured teaching programme on safe motherhood among
adolescent girls in selected higher secondary schools at Thrissur district. One
group pre test - post test design and cluster sampling technique was used. Sample
consists of 120 adolescent girls who are studying in plus two classes. Data were
collected by using structured questionnaire. The data obtained are tabulated and
analyzed using descriptive and inferential statistics. The statistical analysis of the
data shows that 65% of the adolescent girls had moderate knowledge and STP was
effective in improving the knowledge as the ‘t’ value is 37.229 which was highly
significant than the table value at p< 0.01. The findings revealed that there was a
significant improvement in knowledge of adolescent girls in post test after
structured teaching programme[21].

A community-based cross-sectional study was conducted in rural Midwestern

development region Nepal, to identify knowledge and practices of maternal health
care among mothers. There were 81 clusters and 7-8 participants were selected
randomly. Data were collected by interview using structured questionnaire and
focus group discussion, analyzed by SPSS. CD recorded qualitative data were
transcribed and narrated. The study concluded that there were gaps in the
knowledge and practices for health care during pregnancy, childbirth and in the
postpartum period. A high rate of home deliveries with the low postnatal service
utilization was prevalent[22].

A study was conducted to assess the knowledge and attitude of expectant fathers
on safe motherhood. In this study, descriptive research design was adopted to
collect data. A structured interview schedule was prepared and administered to 50
expectant fathers who accompanied Primi antenatal mothers at antenatal OPD Sri
Ramachandra hospital, Chennai. Data collected through structured interview
schedule. 30 structured knowledge questionnaire and Likert 3-point scale used as a
tool. Descriptive and inferential data analysis was used. The mean knowledge
score was 13.25 and standard deviation of knowledge was 9.89. The attitude mean
score 15.75 and SD 6.09 and the Karl Pearson's correlation co-efficient r value was
0.52[23].

An evaluative study on effectiveness of maternal and child health care

participatory training program among staff nurses, Auxiliary nurse midwives and
Lady health visitors at selected health centre’s of Udupi district in India. The
sample size 50 was considered for the study. Major findings of the study were
there was a significant improvement (p<0.05) in the performance skill related to
antenatal, postnatal and newborn. The study concluded that the training was
effective in improving the overall performance of the workers[24].

A cross-sectional descriptive study was conducted to assess the knowledge,

attitude and practice of maternal health care amongst the married women in rural
area of Bangladesh. The study was conducted in 300 rural married women having
at least one living child. Data were collected by face to face interviews using a
semi-structured questionnaire to assess the knowledge, attitude and practice on
maternal health care. Among the participants 57%, 70.7% and 62.3% had average
knowledge on antenatal care(ANC), intranatal care(INC) and postnatal care(PNC)
respectively. The practice was good on ANC among 55.3% respondents where
poor practice was found 69.3% on INC and 72.3% on PNC. The study concluded
that practice on maternal health care also related to socio-economic condition of
the rural women. Women in rural settings are vulnerable due to poor maternal
health care and exposed to risk of pregnancy and child birth. Appropriate health
education activities, encouraging institutional delivery and development of
socioeconomic status are key factors to improve our maternal health[25].

Literature related to Intranatal care:

A case study method was adopted to evaluate the effectiveness of performing
breathing technique in labour by assessing the behavioural responses and progress
of labour during I and II stage of labour. The study was carried out on 20 antenatal
women referred to Seethalakshmi Maternity centre, Coimbatore during their
antenatal period and labour. Out of 20 mothers, 10 mothers were Primigravidae
and 10 were multigravid mothers. They were selected by using sample free
technique. Data was collected through interview, observation and antenatal
palpation. The intensity of pain was determined by the behavioural reactions which
were recorded using an observational checklist. In this study descriptive analysis
was adopted. Out of 10 primigravid mothers,8 mothers were performing the
breathing techniques during labour and were showing positive behavioural
responses during I and II stage of labour. All the multigravid mothers also tolerated
pain well[26].

A quasi-experimental study was conducted to assess the effectiveness of slow

paced breathing on pain perception during first stage of labour among Primipara
mothers at Kovai medical centre, Coimbatore. 40 mothers were selected 20 in
experimental group and 20 in control group. The tools used for this study are pain
intensity scale, facial pain scale and observational checklist for slow paced
breathing exercises. Mother who practiced slow paced breathing reported
significant reduction in pain[27].

A study was conducted to assess the effectiveness of music therapy in reducing

pain perception among primigravida mothers in southern railway hospital,
Chennai. Non-equivalent control group pre test and post test design was adopted.
Based on non-probability purposive sampling technique, 30 mothers were allotted
for experimental and 30 mothers were allotted for control group. Music therapy
was given to assess the level of labour pain perception. The pre and post
assessment of pain was obtained using a modified combined numerical categorical
pain intensity scale. The findings of the study showed that comparison of pre and
post assessment 't' value in session I and the 't' value was 21.53 and in section II the
't' value was 21.05 which were significant at p<0.001 level. It reveals that the
Primigravidae mother pain perception level was reduced after music therapy[28].

A study was conducted to assess the knowledge of antenatal mothers regarding

preparation for safe delivery. 51 antenatal mothers in third trimester attending the
outpatient department in Salem polyclinic, Tamil Nadu were selected by purposive
sampling. Data collected by using closed-ended questionnaire. Area wise mean,
SD and mean percentage of knowledge scores shows that highest mean score
(2.41± 0.6) which is 80.33% was for the area ''personal hygiene'' whereas lowest
mean score (1.29±1.39) which is 64.7% was for the area ''choice of birth setting''.
The overall knowledge of antenatal mothers had good knowledge (72.5%)
regarding preparation for safe delivery. No significant association (P<0.05) was
found between knowledge scores of the antenatal mothers and their demographic
variables[29].

A study was carried out to assess the effectiveness of breast crawl as a diversional
therapy for reduction of pain in primipara women, during episiotomy suturing in
selected maternity hospitals in Mumbai. The research design selected for the study
was quasi-experimental non-equivalent control group design. The subjects selected
in this study included 50 primipara women undergoing episiotomy suturing, 25 in
experimental and 25 in control group, by purposive sampling technique. Data was
collected using demographic data, numerical pain scale, behavioural pain scale and
opinionnaire. The mean score obtained in the experimental group before
episiotomy suturing (6.2) and during suturing with breast crawl intervention (2.72)
with mean difference of 3.48 whereas, in the control group this difference was only
0.44 which was nonsignificant. The comparison between the experimental as well
as the control group too showed significance with mean pain score difference of
4.08. Thus, the findings of the study proved that the breast crawl was effective as
diversional therapy for reduction of pain in primipara women, during episiotomy
suturing[30].

A study was conducted to evaluate the effect of self-instructional module on in

enhancing the knowledge of 3rd year GNM students regarding the effect of
massage therapy in reducing labor pain. One group pre and post test design was
used. A sample size of 50 GNM students was selected through nonprobability
convenient sampling. The tool used for gathering relevant data was a structured
questionnaire. Data analysis of level of knowledge revealed that during pre test, no
student had highly adequate knowledge of effect of massage therapy on labor pain.
While assessing the effectiveness of SIM, the pre test and post test data analysis by
using Wilcoxon signed rank test revealed the mean post test score (27.88±1.27)
was higher than the mean pre test score (13.14±2.93). Since the calculated z-value
was 6.16 and p-value was 0.00, thus proving that p<0.05. Thus, it is concluded that
SIM on effect of massage therapy in reducing labor pain was found effective as a
teaching strategy[31].

 
A pre-experimental study was conducted to assess the effectiveness of antenatal
educational package (AEP) through booklet on knowledge regarding antenatal,
intranatal, and postnatal care and labor outcome among primi antenatal mothers at
selected hospitals of Indore was done. The study approach was pre-experimental
with one group pre test post test research design. Purposive sampling technique
was done to select 60 primi antenatal mothers in their third trimester attending
antenatal clinic and admitted in selected hospitals of Indore. Data was collected
with interview schedule to assess the knowledge and labor outcome assessment.
Findings of the study revealed that the mean post test knowledge score 22.40 was
higher than mean pre test knowledge score 15.01. The computed ’t’
value(t59=9.902) was higher at the level of p≤0.001. The results also revealed that
antenatal educational package regarding antenatal, intranatal and postnatal care
among antenatal mothers was effective and brought about the excellent changes in
their level of knowledge[32].

An experimental study was conducted among 60 Primigravidae in second stage of

labour selected by systematic random sampling techniques, who were admitted in
labour ward of Andhra mahila sabha, Chennai. This study was aimed to find the
effectiveness of semi sitting position during second stage of labour on maternal
neonatal outcomes among Primigravidae. The control group was placed in usual
dorsal recumbent position and the experimental group was placed in semi sitting
position at 450angles with back rest. Maternal and neonatal parameters such as
frequency and duration of uterine contractions, duration of second and third stage
of labour, APGAR score and discomfort level was assessed for both the groups.
The results shows that mean of frequency and duration of uterine contractions in
control group(M=2.69,67.13) was lower than the experimental
group(M=4.23,67.13). The difference was found statistically significant at p<0.05
level, can be attributed to the effect of semi sitting position. The results revealed
that the samples in experimental group experienced better uterine contractions,
shorter duration of second and third stage of labour, good APGAR score and less
discomfort than the control group [33].

Literature related to postnatal care:

A study was conducted on assessment of knowledge of postnatal women regarding

postnatal complications. 100 postnatal women within the period of six weeks were
selected by convenient sampling technique at MMIMSandR Hospital, Mullaana,
Ambala. Data was collected using structured interview schedule. Findings of the
study revealed that out of 100 postnatal women, 78 postnatal women had
experienced one or more than one postnatal complications, whereas 22 postnatal
women had no postnatal complications. Most reported postnatal complication was
backache whereas least reported postnatal complication was dyspareunia. Thus the
findings of the study shows that 39% of postnatal women had good knowledge
followed by 32% had average knowledge, 19% had very good knowledge and 10%
had below average knowledge regarding postnatal complications. Although overall
knowledge of postnatal women was good but postnatal women suffered more with
postnatal complications[34].

A study to develop and evaluate the effectiveness of an information booklet on self

Perineal care management and prevention of complications after episiotomy
suturing in terms of gain in knowledge and practice of postnatal mothers in
selected hospitals of Delhi. The research design used in the study was true
experimental pre-test, post test control group design in the setting of L.N.J.P
Hospital and Safdarjung in Delhi. The sample was 30 postnatal mothers in both
groups (experimental and control group). Simple random sampling was adopted.
Structured knowledge questionnaire and observational checklist used as a tool. The
study revealed that, in experimental group, 23.33% postnatal mothers had advance
knowledge while 76.66% had no advance knowledge related to self perineal care
and prevention of complications after episiotomy suturing. In control group 40%
had advance knowledge and 60% had no knowledge related to postnatal mothers
had low level of knowledge and practice related to self Perineal care management
and prevention of complications after episiotomy suturing as evident from pre-test
knowledge and practice scores. The findings of the present study indicated that the
postnatal mothers who were exposed to informational booklet had more knowledge
and practice skill than postnatal mothers who were not exposed to informational
booklet[35].

A study was conducted on assessment of knowledge of postnatal mothers

regarding breast engorgement. A non-experimental, exploratory study was
conducted in selected hospitals of Ludhiana. The study accessible population was
postnatal mothers admitted in the selected hospitals of Ludhiana. 100 postnatal
mothers were selected by purposive sampling technique. Data was collected from
postnatal mothers by questionnaire. Data was analyzed by descriptive and
inferential statistics and presented through tables and figures. Findings revealed
that majority of postnatal mothers (52%) had average knowledge regarding breast
engorgement. Mean percentage of knowledge score was highest in symptoms
(64.16%) and lowest in area of factors leading to breast engorgement (42.62%).
Education variable was found to be associated with knowledge of postnatal
mothers none of the other variables were found significantly related with the
knowledge of postnatal mothers [36].

A study was conducted to assess the effectiveness of SIM on knowledge of

postnatal care among primigravida women in selected hospital, Thrissur. In this
study, 50 Primigravidae women who were selected using non probability purposive
sampling. Quantitative evaluative approach was used and the study design was pre
experimental one group pre test post test design. To collect the data structured
knowledge questionnaire was administered followed by administration of SIM.
The statistical analysis of the data shows that the self instructional module was
effective in improving knowledge as the ‘t’ value is 20.909 which is greater than
the table value at p<0.05. The mean post test score is significantly higher than the
mean pre-test score, so the hypothesis is accepted [37].

A study was carried out to assess the efficacy of cabbage leaves application on the
breast engorgement among postnatal mothers. A quasi experimental design was
used with convenience sampling technique. The sample for the study consisted of
60 postnatal mothers (30 in each experimental and control group). Subjects in the
experimental group were given intervention with application of cabbage leaves
while the subjects in the control group were given routine care. Assessment for the
severity of breast engorgement in terms of breast consistency and breast tenderness
was done before intervention and at the end of each day. Data was collected by
using interview schedule to assess the socio-demographic data and observational
checklist for assessing breast consistency and breast tenderness. Analysis was done
using both descriptive and inferential statistics. Mean score of breast consistency in
experimental group had a decrease of 1.90 while mean score in control group had
decrease of only 0.80 (p<.001). Similarly in breast tenderness 86.20% subjects in
experimental group had no tenderness at day 3 compared to 58.62% subjects in
control group. Thus the study concluded that application of cabbage leaves were
effective in reducing breast engorgement [38].
 

A quasi experimental study was conducted to assess the effectiveness of perineal

care with and without infrared light application on episiotomy wound healing
among postnatal mothers at selected hospitals, Hyderabad. Total 60 postnatal
mothers, 30 in experimental group and 30 in control group were selected by
purposive sampling technique. Pre-post test observation of episiotomy wound was
measured by REEDA scale. There was a significant reduction in the level of
wound healing after the Perineal care with infrared light, t=5.46 (p<0.01) among
postnatal mothers in experimental group [39].

A study was conducted to assess the effectiveness of planned nursing intervention

on postnatal exercises in terms of attitude, practice and inter recti distance among
postnatal mothers. Using quantitative-evaluative approach and non-probability
convenient sampling data was collected from 50 postnatal mothers of Salem
polyclinic. The tools used are Likert’s scale, observation check list and a Performa
to assess the inter recti distance. The results showed the mean post-test on attitude,
practice and inter recti distance of experimental group was higher than the mean
post-test score of control group. In the post-test the unpaired’t’ value between
experimental and control group for attitude, practice and inter recti distance was
significant. Planned intervention is effective in developing a positive attitude
towards postnatal exercises, improving regular practice of postnatal exercises, and
reducing inter recti distances [40].

A quasi-experimental study was carried out among postnatal mothers at SUM

hospital, Bhubaneswar to assess the level of pain and wound healing in postnatal
mothers after receiving infrared therapy. By convenient sampling technique 40
postnatal mothers were selected. The control group received placebo therapy and
the experimental group received infrared on 1stand 3rd day. The level of pain and
discomfort was assessed by using pain and comfort scale. The level of wound
healing was assessed by using REEDA SCALE. The study result shows that
infrared therapy is effective in reducing episiotomy pain and promotes early wound
healing and reduces the chance of infection in postnatal mother [41].

 
A hospital based randomized controlled trial was conducted to evaluate the
effectiveness of Kegel's exercise on postpartum perineal laxity. The study
conducted at a 1000 bedded tertiary care teaching hospital in India, enrolled 290
postnatal mothers between 20 and 40 years who had vaginal delivery with ≤ 2 on
modified Oxford grading scale as measured by per vaginal digital examination.
The experimental group received instructions to perform Kegel's exercises along
with routine postnatal care while the control group received advice on routine
postnatal care. Two follow-up assessments were done at 6 and 10 weeks.
Comparison of scores between the groups by unpaired t-test yielded p-value of
<0.001 suggesting high significant difference in favour of the experimental group.
However, no additional benefit was observed after Kegel's exercise in the mothers
who had episiotomy during vaginal delivery [42].

A quasi experimental study was conducted to assess the effectiveness of structured

teaching programme on knowledge of postnatal care among postnatal mothers
admitted to the maternity units of selected hospitals in Punjab. The sample size
was 40 where 20 in the experimental group and 20 in the control group. The data
was collected using structured questionnaire before and after the teaching
programme. The findings shows that postnatal mothers were having below average
knowledge regarding postnatal care in experimental (70%)and control group (65%)
followed by average knowledge in both groups (80%). After a STP, postnatal
mothers of experimental group scored in excellent (55%) level followed by good
knowledge level (45%) [43].

A pre-experimental study was conducted to evaluate the effectiveness of planned

teaching programme on puerperal infection for postnatal mothers in a selected
hospital at Mangalore. The sample comprised of 30 postnatal mothers selected
through purposive sampling technique. Through structured interview schedule the
data was collected. The results reveal an increase of 30.38% in the total mean
percentage of knowledge scores of the postnatal mothers. The study was concluded
that there was true gain in the knowledge and teaching programme was effective as
a method to improve knowledge [44].

Literature related to newborn care

A study was conducted to evaluate the effectiveness of planned teaching program
on knowledge of mothers on prevention of hypothermia among newborns. One
group pre-test, post-test design (pre-experimental) was used. 30 postnatal mothers
were selected by non-probability sampling and pre-test questionnaire was
administered through structured interview schedule. 7 days after PTP post-test was
conducted on same group. Results were analysed by 't' test. The results revealed
that the overall knowledge improvement was found after PTP and the paired 't'
15.6 at p<0.05 level significance proved that the selected hypothesis H1 was
accepted and there was statistically significant association between knowledge of
mothers and age and religion (p<0.05). Thus it was inferred that PTP was the best
teaching strategy as it enhance the knowledge on prevention of hypothermia [45].

A study was conducted to assess the effectiveness of structured teaching on

knowledge of primigravida antenatal mother regarding neonatal care practices.
Quasi experimental pre-test post-test design was used. 20 Primigravidae antenatal
mothers were selected using purposive sampling. Knowledge questionnaire was
administered through structured interview schedule. The data were planned to be
analysed in terms of co-efficient of variation, and paired 't' test and interpreted in
the form of tables, frequency, Percentage, figures, bar diagrams and pie charts. The
paired t value (10.69) being greater than T table value of 19 at 5% (2.093), the
study is proved to be statistically significant [46].

An Exploratory study on factors of hypothermia in neonates with special reference

to nursing practice at capital Govt.hospital, Bhubaneswar. A descriptive approach
and non-experimental design was used to describe the phenomena under study. 30
cases were selected by using purposive sampling method. The result reveals that
among the hypothermic babies 50% were cold stress, 40% moderate hypothermia,
and 10% were severe hypothermia. The predisposing factors were found as
defective transport (24%), improper delivery room care (22%), LBW (22% and
prematurity (20), other illness 912%). The associated morbidity was prematurity,
septicaemia, birth asphyxia and pneumonia and no morbid condition was found in
18% cases. In the area of nursing action observed in management of hypothermia
was maintenance of airway (84%), maintaining normal body temperature (86%),
prevention of respiratory distress (66.66%) and (88%) providing general care,
prevention of infection (78%), 14% restriction of visitors were possible. Hence, the
study suggests that more emphasis should be given on nursing action for
prevention of secondary infection, precaution of safety and health teaching to
minimize the morbidity and mortality caused to hypothermia in neonates [47].

A study to assess the knowledge of primigravida mothers on newborn care and

evaluate the practices during postnatal period in hospitals of Mangalore. A
descriptive survey was conducted among 75 normally delivered primi mothers by
using non-probability purposive sampling technique. The tool used for the study
consisted of structured knowledge questionnaire with 50 items to assess the
knowledge where the observational checklist with 24 items to assess the practices
of mothers regarding newborn care. Interview technique was used to collect the
data. Assessment of the level of knowledge of mothers reveals that 47% of the
samples had good knowledge and 53% of the samples had excellent knowledge
regarding newborn care. Observation of the practice of mothers reveals that 13% of
the subjects had average practice scores, 87% of mothers had good practice scores
regarding newborn care. Relationship between knowledge and practice of mothers
regarding newborn care was ascertained using Spearman correlation co efficient (r
= 0.8550) which is significant at 0.05 level [48].

A study to evaluate the effectiveness of planned teaching programme on

prevention of hypothermia for the mothers of neonates in selected hospitals at
Tumkur. The study approach was pre-experimental one group pre test and post test
design. Purposive sampling technique was done to select 60 mothers of neonates.
Data was collected through interview schedule. The findings shows that majority
of the respondents(100%) had good knowledge in the post test, whereas in the pre
test 55% had average knowledge, 23.33% had good knowledge and 21.66% of the
mothers had poor knowledge. The mean post test knowledge score 20.95% was
apparently higher than their mean pre test knowledge score 9 suggesting that the
PTP was apparently effective in increasing the knowledge of mothers on
prevention of hypothermia [49].

A descriptive study was done regarding knowledge and practice of postnatal

mother in newborn care among 100 purposively selected postnatal mothers
admitted in a teaching hospital, Nepal. Newborn practice was observed among 20
mothers and comparison was done between knowledge and practice. Semi-
structured interview questionnaire and observation checklist was used to collect the
data. The descriptive statistics used. Respondent's mean knowledge was on
keeping newborn warm 44.2, on newborn care 47.2, on immunization 67.33, on
danger signs 35.63. All (100%) respondents had have knowledge and practice to
feed colostrums and exclusive breast feeding, 70% knew about early initiation of
breastfeeding. Although 60% had knowledge to wash hands before breastfeeding,
and after diaper care, only 10% followed it in practice. Mean practice of successful
breastfeeding was 37.5, 60% applied nothing kept cord dry [50].

A descriptive cross-sectional study was conducted regarding breastfeeding

practices and newborn care in rural areas. The study was conducted in PHC in
Kengeri, rural Bangalore, Karnataka. Mothers with children who were 9 months
old who came to the PHC for Measles vaccination were included in the study and
data was collected using pre-tested questionnaire on breastfeeding and newborn
practices. The study shows 97% of the mothers initiated breastfeeding, 19% used
pre lacteal feeds, 90% had hospital deliveries and 10% had home deliveries, and
50% used a house knife to cut the umbilical cord among home deliveries.[51].

A pre-experimental study was carried out to assess the effectiveness of innovative

teaching programme on newborn care to antenatal mothers in antenatal OPD, Raja
Muthiah Medical College and Hospital, Chidambaram. A sample of 30 antenatal
mothers was selected by convenient sampling technique. Open and closed ended
questions used to assess the knowledge of antenatal mothers regarding newborn
care. The t test value revealed that there was a significant difference in the mean
knowledge score of the antenatal mothers between pre test and post test at 0.001
levels [52].

A survey was carried out in the postnatal wards of Vydehi hospital, Bangalore to
assess the awareness of danger signs of newborn illnesses among mothers.
Through purposive sampling technique 100 postnatal mothers adopted for the
study. Structured questionnaire used to assess the awareness of dander signs of
newborn illnesses. Descriptive and inferential statistics used for data analysis. It
showed that majority of the mothers (64%) had an average level of awareness and
10% of them had poor level of awareness on danger signs of newborn illnesses
[53].
 

A study was conducted to assess the knowledge and practice regarding newborn
care among the staff nurses working at selected hospitals, Bhubaneswar. The study
revealed that the staff nurses had highest percentage of knowledge (88%) on item
of infection control, lowest percentage of knowledge on item neonatal resuscitation
(44%). The staff nurses had highest percentage of practice score in immunization
(96%) and lowest percentage of practice score (69%) on item of neonatal
resuscitation [54].

OBJECTIVES:
·      To assess the existing level of knowledge regarding selected aspects of safe
motherhood among primigravida women.

·      To evaluate the effect of SIM regarding safe motherhood in terms of gain in
post test knowledge scores of primigravida when compare to their pre test
scores.

·      To associate the level of knowledge with selected demographic variables

among primigravida women regarding selected aspects of safe motherhood.

CONCEPTUAL FRAMEWORK:
H1: There will be a significant increase in the level of knowledge on safe
motherhood after administration of self instructional module among
primigravida women.

H2: There will be a significant association between the pre-test knowledge score
and selected demographic variables.

The conceptual model selected for this study is based on Daniel.L.Stufflebeam's

context, input, process and product evaluation model (CIPP). The CIPP framework
was developed as a means of linking evaluation with programme decision-making.
It aims to provide an analytic and rational basis for programme decision-making,
based on a cycle of planning, structuring, implementing and reviewing and revising
decisions, each examined through a different aspect of evaluation-context, input,
process and product evaluation. The CIPP approach aims to involve the decision-
makers in the evaluation planning process as a way of increasing the likelihood of
the evaluation findings having relevance and being used. Stufflebeam thought that
evaluation should be a process of delineating, obtaining and providing useful
information to decisionmakers, with the overall goal of programme or project
improvement. 17

Context evaluation:

In this study, the context evaluation refers to

Goal:

·      Assess the level of knowledge of primigravida women regarding selected

aspects of safe motherhood

·      Prepareand administer the SIM

·      Evaluate the effectiveness of SIM

·      Associate pre test knowledge with demographic variables

Input evaluations:

In this study input evaluation refers to

Plan:

·      Structured knowledge questionnaire

·      Self instructional module based on intranatal care, postnatal care, newborn care.

·      Validating the tool by experts

·      Pilot study

Process evaluation:

In this study the process evaluation refers to:

Action:

·      Conducted pre test to assess the knowledge of primigravida regarding selected
aspects of safe motherhood

·      Administered SIM

·      Conducted post test after 7 days

·      Analysis of Data

Product evaluation:

In the present study, product evaluation refers to

Outcome:

a)   Gain in knowledge of primigravida women regarding selected aspects of safe

motherhood.

b)  No gain in knowledge

The product evaluation includes identification of feedback, need for modification

or termination etc. In this study, feedback is not included.

 
  
Fig. 1 Conceptual framework of modified Daniel L stufflebeams CIPP evaluation model

SAMPLE:

In this study the samples used are the 50 primigravida women at selected hospitals,
Puducherry. The sampling technique used is Non-probability purposive sampling.

Inclusive criteria for sampling:

·      Primigravidae

·      Primigravidae who fulfils 36 weeks of gestational age

·      Mothers who can understand Malayalam and English

·      Mothers who were willing to participate in the study

Exclusive criteria for sampling:

·      Primigravida who were having high risk pregnancy (eclampsia, preeclampsia,
mothers who had previous abortion and mothers suffering with mental illness.

·      Primigravida who were in the second stage of labour

RESEARCH DESIGN:

The research design adopted for this study is pre experimental design, of which
one group pre-test- post test design.

Group              Pre-test           Treatment            Post test

Primigravida        O1                   X                      O2

 

O1= Pre-test to assess the knowledge of primigravida on safe motherhood.

X= Administration of Self instructional module on safe motherhood to a group of

primigravida women.

O2= Post test to assess knowledge of primigravida on safe motherhood.

Variables:

Variables are concepts at different level of abstraction that are concisely defined to
promote their measurement or manipulation within study. A variable is a
measurable or potentially measurable component of an object or event that may
fluctuate in quantity and quality or that may be different in quantity and quality
from one individual object or event to another individual object or event of same
general class’.

Two variables were identified which includes dependent and independent variable.

Independent variable:

The variables that are used to describe or measure the factors that are assumed to
cause or at least to influence the problem are called independent variable. It is the
phenomenon in the hypothesis that, in the experimental study to test, the
hypothesis, is manipulated by the investigator. It is the variable that is manipulated
by the researcher, in order to study the effect upon the dependent variable’.16

The independent variable in this study is self instructional module on safe

motherhood.

Dependent variable:
The variable that is used to describe or measure the problem under study is called
dependent variable.17

The dependent variable in this study is knowledge scores regarding safe

motherhood.

 
Fig. 2 Schematic representation of the study

TOOL DESCRIPTION:

In this study structured knowledge questionnaire was developed by the researcher

to find out the level of knowledge of primigravida women on safe motherhood.
The researcher adopted the following steps prior to development of the tool which
includes extensive review of research studies conducted in relation to postnatal
care and its components, review of non research literature on postnatal care and
also in discussion with the experts.

A blue print for the knowledge questionnaire was developed with 30 items
pertaining to three domains of learning and covered the selected components of
postnatal care. The data collection instrument consists of following sections:

Section A: Demographic profile:

A semi structured questionnaire was prepared by the researcher to assess the

demographic variables. It comprised of 7 items such as age, religion, type of
family, education, occupation, number of elder females in the family, information
regarding safe motherhood, sources of information to assess the background data
which included personal profile of the primigravida women.

Section B: Structured knowledge questionnaire:

Question includes:

Part I. Intranatal care

Part II. Postnatal care

Part III. Newborn care

All the questions were multiple choice questions. Four options were given for the
questions and out of which only one is the correct answer.
 

Scoring techniques:

For the Section A the scoring key was prepared by coding the demographic
variables to assess the background of the samples and assessment of association by
statistical analysis.

For the section B, there were multiple choice questions and for that only one
correct answers. There was 30 questions and each correct answer carries one score
and incorrect / unanswered questions carry score 0. The maximum score of
knowledge score was 30 and minimum score was zero. The obtained score was
graded as follows:

Inadequate        Score between 0-14                  <50%

Moderately       Score between 15-22                50-75%

Adequate          Score between 23-30                >75%

Preparation of self instructional module:

The self instructional module developed was based on the topic of the study. The
SIM consists of the components of safe motherhood like intranatal care, postnatal
care and newborn care.

Data Collection Process:

Data collection process is the gathering of information to address a research

problem.  After a brief introduction about the research study and its objectives, an
informed consent was taken from the samples. Confidentiality was assured to all
the samples to get their cooperation and data was collected directly by the
researcher. Demographic data and knowledge on selected aspects of safe
motherhood using structured questionnaire was administered to the primigravida
women during their visit. Samples were given 20- 30 minutes to fill the
questionnaire. After pre test investigator distributed the self instructional module
on safe motherhood which includes the selected aspects of safe motherhood. On
the seventh day when the same samples returned for antenatal check up, the
investigator administered the post test to assess the effectiveness of self
instructional module using the same structured knowledge questionnaire. The
samples were very co-operative during the course of the study and there were no
drop outs. The researcher expressed her sincere gratitude to the samples for their
cooperation.     

Pre-test:

Pre-test was conducted in the wards of Hospital with help of structured knowledge
questionnaire to assess the knowledge of primigravida women on safe motherhood.

Administration of self instructional module:

The self instructional module was administered immediately following the

collection of structured questionnaire.

Post-test:
Post-test was conducted on the 5 days after the administration of self instructional
module with the same knowledge questionnaire. It was to assess the effectiveness
of self instructional module in terms of gain in knowledge on safe motherhood in
comparison with the pre-test score.

Plan for data analysis:

Analysis is the systematic organization and synthesis of research data and the
testing of research hypothesis using that data.

It was decided to analyze the data by both descriptive and inferential statistics on
the basis of objectives and hypotheses of the study with help of SPSS package. The
plan for data analysis is as follows:

1.    The sample characteristics were analyzed using frequency and percentage.

2.    The knowledge level among samples on safe motherhood was analyzed using
percentage, mean and standard deviation.

3.    The effectiveness of self instructional module on safe motherhood was

measured by paired‘t’ test.

4.    The association between selected demographic variables and knowledge level
of samples was analyzed by chi-square test.

5.    The data would be represented in the form of tables, bar diagrams and pie
diagrams.

ANALYSIS AND INTERPRETATION:

The collected information was organized and the results are presented in 4 sections

PART I: Description of socio-demographic characteristics in relation to

primigravida women
PART II: Assessment of knowledge of primigravida women on safe motherhood
before and after administration of self instructional module

PART III: Effectiveness of self instructional module on safe motherhood

Part IV: Association between pretest level of knowledge of primigravida women

with selected demographic variables
 

PART I: Description of socio-demographic characteristics in relation to

primigravida women
 

Table 1 Frequency and percentage distribution of demographic variables of primigravida women

Variables Frequency Percent

Age    

18-21 13 26.0

22-25 22 44.0

26-29 14 28.0

>30 1 2.0
Religion    

Hindu 29 58.0

Muslim 13 26.0

Christian 8 16.0
Family Type    

Nuclear 37 74.0

Joint 13 26.0
Education    

SSLC 11 22.0

High School 14 28.0

Graduate 17 34.0
Post-Graduate 8 16.0
Occupation    

House wife 29 58.0

Agriculture 0 0.0

Govt. Employee 7 14.0

Private Employee 14 28.0

Family Income per    
month (Rs.)
7 14.0
Less than 5000
20 40.0
5000-10000
14 28.0
10000-15000
9 18.0
More than 15000
No. of Elder Females    

1 27 54.0

2 17 34.0

3 3 6.0

More than 3 3 6.0

Previous Information    

Yes 47 94.0

No 3 6.0
Source of awareness    

Mass Media 13 26.0

Health Professionals 6 12.0

Elders and Relatives 27 54.0

Others, specify 1 2.0

Age of menarche (in    
years)
0 0.0
 Less than 10 11 22.0

10-12 37 74.0

12-15 2 4.0

More than 15
Age at marriage (in    
years)
19 38.0
18-21
22 44.0
22-25
9 18.0
26-29
0 0.0
>=30

PART II: Assessment of knowledge of primigravida women on safe motherhood before and after
administration of self instructional module

Table 2 Distribution of pretest knowledge scores of the primigravida women on safe motherhood

Table 3 Assessment of knowledge of each dimension

Table 4 Distribution of post test knowledge scores of the primigravida mothers on safe motherhood

Table 5 Comparison of pre test and post test knowledge scores of the primigravida mothers on safe
motherhood

Table 6 Mean and standard deviation of pretest and post test knowledge scores of the samples

PART III: Effectiveness of self instructional module on safe motherhood

Table 7 Area-wise Mean, SD and percentage score of pre test and post test knowledge scores of
primigravida women

Table 8 Comparison of pre test post test knowledge scores of primigravida women on intranatal
care after administration of SIM using Paired t-test

Table 9 Comparison of pre test- post test knowledge scores of primigravida women on postnatal
care after administration of SIM

Table 10 Comparison of pre test and post test knowledge scores of primigravida women on
newborn care after administration of SIM 

Table 11 Mean, Mean difference, SD and 't' value of pre test and post test knowledge scores of
primigravida women
Part IV: Association between pretest level of knowledge of primigravida women with selected
demographic variables

Table 12 Association between level of pre-test knowledge and age

Table 13 Association between level of pre-test knowledge and type of family

Table 14 Association between level of pre-test knowledge and education

Table 15 Association between level of pre-test knowledge and occupational status

Table 16 Association between level of pre-test knowledge and number of females in the family

Table 17 Association between level of pre-test knowledge and age at marriage

CONCLUSION:
The present study shows that the most of the primigravida women had moderate
knowledge. The difference between pre test and post test score revealed that self
instructional module is very effective in improving knowledge of primigravida
women. The pre test knowledge of safe motherhood is significantly associated with
variables like education and occupational status of primigravida women, but there
is no significant association between the pre test knowledge and age, family type,
number of elder females in the family and age at marriage.

REFERENCES:
1.       Rao SK, Johnson P. Community Health Nursing. Revised 5th ed. Chennai: Ecumenical Book
Services. 2012.

2.       Melmer W, Tamara. A guide for advocating for respectful maternity care. Washington, USA:
Futures group, Health policy project;2013 [2013 sept 30].

3.       Safe motherhood home. Acknowledging your sources[academic integrity page] . No date.

4.       J.S Mathur. A Comprehensive Textbook of Preventive and Social Medicine. 1sted. New Delhi: CBS
Publishers and Distributors Pvt Ltd. 2011.

5.       Ramanathan M. Reproductive and child health issues in Kerala. No date.

6.       Sontakke P, Reshmi SR, Sebastian D. Obstetric morbidity among currently married women in
selected states of India.[2009 Dec]
7.       White ribbon alliance for safe motherhood, India. Acknowledging your sources [academic integrity
page]. No date[cited 2013 April].

8.       WHO[home page on internet]. The safe motherhood initiative and beyond. No date.

9.       Piyush Gupta. Text Book of Preventive and Social Medicine. 3rded. New Delhi: CBS Publishers
and Distributors Pvt. Ltd. 2010.

10.     K. Park. Park's Text book of Preventive Social Medicine. 22nded. India: M/s Banarsidas Bhanot
Publishers; 2013.

11.     Stepping up efforts to save mother's lives. Acknowledging your sources [academic integrity
page].No date.

12.     BBC News. Beyond Headlines: An attempt to report a course aright. Thursday 13,2014;

13.     Jain R, Parasuraman S. Maternal Morbidity and utilization of Antenatal care Services: A study of
Madhya Pradesh and Bihar. Population, Health and development in India. Mumbai: Rawat
publication;

14.     Sunderlal, Adarsh, Pankaj. Text Book of Community Medicine Preventive and Social Medicine.
3rded. New Delhi: CBS publishers and distributors;2011.

15.     B S Garg, Chhabra S. Safe motherhood: Social, economic and medical determinants of maternal
mortality. Women and health Learning Package. 2nded. India: 2006.

16.     Polit BF, Beck CT. Nursing Research: Generating and assessing evidence for nursing practice.
8thed. Philadelphia: Wolters Kluwer Lippincott Williams and Wilkins;2008.

17.     The CIPP approach to evaluation. Acknowledging your sources[academic integrity page] No date.

18.     Elakkuvanna Bhaskara Raj. Nursing Research and Biostatistics. Bangalore: EMMESS Medical
Publishers;2010.

19.     P Nandaprakash. Health workers' knowledge of safe motherhood services. Nightingale Nursing
Times. 2012 Sept;8(6):57-60.

20.     Tamrakar A. A study to evaluate the effectiveness of planned teaching programme on knowledge of
primigraviade regarding selected aspects of safe motherhood in selected hospitals, Kolar,
Karnataka(Dissertation). Rajiv Gandhi University of Health Sciences. Banglore;2007.

21.     A P Lijitha. A study to assess the effectiveness of structured teaching programme on safe
motherhood among adolescent girls in selected higher secondary schools at Thrissur
district(Dissertation). Kerala University of Health Sciences. Thrissur;2013.

22.     Gyawali K, Jnawali B, Jnawali K, Paneru D P. Knowledge and practices on maternal health care
among mothers: A cross sectional study from rural areas of mid-western development region Nepal
[Internet]. 2013; 40(1):[about 4 p].
23.     Rajewari S, Poongodi R. Assessing knowledge and attitude of expectant fathers on safe
motherhood. Nightingale Nursing Times. 2012 Dec; 8(9):43-5.

24.     Rao AC, Shetty P. Evaluate study on effectiveness of maternal and child health care participatory
training program among staff nurses, auxiliary nurse midwives and lady health visitors. J South Asian
Feder Obst Gynae.2012;4(2):120-22.

25.     Shirin S. Knowlegde, attitude and practice of maternal health care amongst the married women in a
rural area of Bangladesh. Ibrahim Med.Coll.J. 2011;5(1):13-6.

26.     John E, Appavu S, Rajalakshmi K. Breathing exercises and labour outcomes in primi and
multigravid women. Nightingale Nursing Times.2011: Dec;7(5):15-6.

27.     A Kalaimathy. Assessing pain perception of primipara mothers during labour. Nightingale Nursing
Times.2011 July;7(4):28-30.

28.     G Rajakumari. Effectiveness of music therapy in reducing pain perception among primigraviade
mothers. Nightingale Nursing Times.2012 Jan;7(10):37-9.

29.     Devi KM. Knowledge of antenatal mothers preparing for safe delivery. Nightingale Nursing
Times.2011 June;7(3):37-9.

30.     Gurav D, Lobo J. Effectiveness of breast crawl as a diversional therapy for reduction of pain in
primipara women, during episiotomy suturing. Indian Journal of Nursing studies.2013 Jan-
June;4(1):`18-25.

31.     Kaur P S, Raddi A S. To assess the effectiveness of self-instructional module on knowledge effect
of massage therapy in reducing labor pain. J South Asian Feder Obst Gynae.2011 Jan-April;3(1):49-
52.

32.     Kujur V, Toppo S, Hariharan V. Do the mothers have knowledge regarding antenatal care,
intranatal care and postnatal care? Indian Journal of Nursing Studies.2013 Jan-Jun; 4(1):32-7.

33.     R Kannaki, Venkatesan L, N Jamuna. Effectiveness of semi sitting position during second stage of
labour on maternal neonatal outcomes among Primigravidae. The official journal of trained nurses'
association of India, Kerala branch.2009 April-June;4(2):20-5.

34.     Kaur A, Sheoran P, Devi KR. A study to assess knowledge of postnatal women regarding postnatal
complications at MMIMS andR hospital, Mullana, Ambala, Haryana. International Journal of
Nursing Education.2013 July-Dec;5(2):1-6.

35.     Seema. Self care management and preventing complications after episiotomy suturing. Nightingale
Nursing Times.2014 Feb;9(1):45-7.

36.     Sharma P. A study to assess knowledge of postnatal mothers regarding breast engorgement.
International Journal of Nursing Education.2013 July-Dec;5(2):130-32.

37.     Gagandeep, Sagar N, Mamta, Kaur J. Efficacy of cabbage leaves in relief of breast engorgement
among postnatal mothers. International Journal of Nursing Education.2013 July-Dec;5(2):76-9.
38.     George G. A study to assess the effectiveness of self instructional module on knowledge of
postnatal care among Primigravidae women selected hospital, Thrissur. (Dissertation). Kerala
University of Health Sciences. Thrissur;2013.

39.     Ceciliamma T. Perineal care with and without infrared light application on episiotomy wound
healing among postnatal mothers. The Nurse.2012 Feb;4(1):12-3.

40.     Philip A, Maragatham S, Thilagavathy K. Effectiveness of planned nursing intervention on

postnatal exercises in terms of attitude practice and inter recti distance among postnatal mothers. The
Nurse.2011 Nov-Dec;3(6):5-6.

41.     Sahoo S. Effect of infrared therapy on episiotomy pain and wound healing among postnatal
mothers. International Journal of Nursing Education.2013 July-Dec;5(2):139-42.

42.     42. Sheeba T, Raddi A S, Ballad MB. A hospital based randomized controlled trail to evaluate the
effectiveness of kegel's exercise on postpartum perineal laxity. J South Asian Feder Obst Gynae.2011
Sept-Dec;3(3):157-59.

43.     Viba. Caring for postnatal mothers and newborns. Nightingale Nursing Times.2012 Aug;8(5):61-4.

44.     Sonar SA. Puerperal infection among postnatal mothers. Nightingale Nursing Times.2011
Oct;7(7):29-32.

45.     Bhandari MU, Kharde NS, Raddi AS. A study to evaluate the effectiveness of planned teaching
program on knowledge of mothers on prevention of hypothermia among newborns in selected
hospitals of Belgaum, Karnataka. J South Asian Feder Obst Gynae.2010 Jan-April;2(1):89-92.

46.     Joson MA etal. Effectiveness of structured teaching on knowledge of primigravidae antenatal

mothers regarding neonatal care practices. The official journal of trained nurses' association of India,
Kerala branch.2010 April-June;5(2):36-9.

47.     Swain D. A n exploratory study on factors of hypothermia in neonates with special reference to
nursing practice at capital Govt. Hospital, Bhubaneswar, Odisha. International Journal of Nursing
Education.2013 July-Dec;5(2):57-60.

48.     GS Shilpa, Shetty PA. Care of newborn by primi mothers. Nightingale Nursing Times.2011
Jan;6(10):30-2.

49.     Ashi SR. Prevention of hypothermia in neonates. Nightingale Nursing Times.2011 March;6(12):39-
42.

50.     Shrestha T, Bhattarai GS, Silwal K. Knowledge and practice of postnatal mother in newborn care.
Journal of Nepal medical association[Internet].2013;52(190):

51.     K Madhu, Chowdary S, Masthi R. Breast feeding practices and newborn care in rural areas: A
descriptive cross-sectional study. Indian Journal of Community Medicine.2009 July;34(3):243-6.

52.     Vidhya K. Teaching newborn care to antenatal mothers. Nightingale Nursing Times.2012
Jan;7(10):12-5.
53.     Valliammal S. Awareness of newborn illnesses among mothers. Nightingale Nursing Times. 2012
March;7(12):22-5.

54.   Das S. Nurses' knowledge of newborn care. Nightingale Nursing Times.2014 April;10(1):57-60 .

 
 

Received on 10.02.2016           Modified on 22.02.2016

Accepted on 06.04.2016           © A&V Publication all right reserved

Int. J. Adv. Nur. Management. 2016; 4(3): 253-270.

DOI: 10.5958/2454-2660.2016.00048.X