高效群组孕期保健结合信息-知识-信念-行为健康教育对初产妇社会因素剖宫产率及产后母婴健康状况的影响

Effects of high-efficiency centering pregnancy care combined with information-knowledge-attitude-practice health education on cesarean delivery on maternal request rate,maternal and neonatal health status and breastfeeding in primiparas

目的探讨高效群组孕期保健结合信息-知识-信念-行为(IKAP)健康教育对初产妇社会因素剖宫产(CDMR)率及产后母婴健康状况的影响,为降低初产妇CDMR率和提高产后母婴健康提供借鉴意义。方法采用前瞻性、单中心、对照研究设计方案。以便利抽样法选取2020年1月至2021年12月于合肥市滨湖医院进行产检并分娩的初产妇82例为研究对象,将2020年1—12月的41例初产妇作为常规组,给予孕期常规保健护理,将2021年1—12月的41例初产妇作为联合组,在常规孕期保健基础上给予高效群组孕期保健结合IKAP健康教育,比较2组初产妇剖宫产分娩认知情况、分娩方式、产妇产后并发症发生率、胎儿及新生儿并发症发生率等指标情况。结果常规组年龄(26.71±2.18)岁,联合组年龄(27.16±1.79)岁。联合组初产妇的剖宫产分娩认知情况正确认知、部分认知正确、不正确认知百分率分别为73.17%(30/41)、21.95%(9/41)、4.88%(2/41),常规组分别为53.66%(22/41)、26.83%(11/41)、19.51%(8/41),2组比较差异有统计学意义(Z=4.22,P<0.05)。联合组剖宫产率、CDMR比例为24.39%(10/41)、1/10,低于常规组的46.34%(19/41)、10/19,2组比较差异均有统计学意义(χ^(2)=4.32,P<0.05;Fisher精确概率法P=0.049)。联合组产妇产后并发症总发生率和胎儿、新生儿并发症总发生率分别为4.88%(2/41)、7.32%(3/41),低于常规组的12.20%(5/41)、12.20%(5/41),2组比较差异均无统计学意义(Fisher精确概率法P=0.432,0.712)。联合组功能性、沟通性、批判性健康素养评分分别为(85.73±4.09)、(51.93±4.72)、(58.63±4.32)分,均高于常规组的(80.17±5.26)、(46.37±5.11)、(52.71±5.07)分,2组比较差异均有统计学意义(t=5.34、5.12、5.69,均P<0.01)。联合组产后3个月纯母乳喂养率、奶粉喂养率、混和喂养率分别为58.54%(24/41)、7.32%(3/41)、34.15%(14/41),与常规组的26.83%(11/41)、29.27%(12/41)、43.90%(18/41)比较,差异有统计学意义(χ^(2)=10.73,P<0.05)。结论高效群组孕期保健结合IKAP健康教育可通过提高初产妇剖宫产正确认知来降低初产妇CDMR率,降低产妇并发症及胎儿、新生儿并发症发生率,提升产妇产后健康素养,提高婴儿母乳喂养率,值得临床推广应用。

Objective To explore the effects of high-efficiency centering pregnancy care(CPC)combined with information-knowledge-attitude-practice(IKAP)health education on cesarean delivery on maternal request(CDMR)rate,maternal and neonatal health status so as to provide referential significance for reducing CDMR rate and improving postpartum maternal and neonatal health status and breastfeeding rate.Methods In the prospective,single-center and controlled study,a total of 82 primiparas undergoing antenatal examination and delivery in South Binhu Hospital of Hefei First People′s Hospital were enrolled as the research objects between January 2020 and December 2021 by convenience sampling method,including 41 cases given routine health care in routine group between January and December 2020 and 41 cases given high-efficiency CPC combined with IKAP health education on basis of routine group in combination group between January and December 2021.The cognition of cesarean section,delivery modes,incidence of postpartum complications,neonatal complications and breastfeeding between the two groups were compared.Results The age of the routine group was(26.71±2.18)years old,and the age of the combination group was(27.16±1.79)years old.The proportions of correct cognition,partially correct cognition and incorrect cognition to cesarean section in combination group were 73.17%(30/41),21.95%(9/41),4.88%(2/41),and 53.66%(22/41),26.83%(11/41),19.51%(8/41)in routine group,and the difference between the two groups was statistically significant(Z=4.22,P<0.05).The incidence of cesarean section and CDMR in combination group was 24.39%(10/41)and 1/10,lower than that in routine group[46.34%(19/41),10/19],and the difference between the two groups was statistically significant(χ^(2)=4.32,P<0.05;Fisher′s exact test,P=0.049).The total incidence rates of postpartum complications of primiparas and neonatal complications in the combination group were 4.88%(2/41)and 7.32%(3/41),lower than 12.20%(5/41)and 12.20%(5/41)in the routine group,and the differences between the two groups were not statistically significant(Fisher′s exact test,P=0.432,0.712).The scores of functional health literacy,communicative health literacy and critical health literacy in combination group were(85.73±4.09),(51.93±4.72)and(58.63±4.32)points,higher than those in routine group[(80.17±5.26),(46.37±5.11),(52.71±5.07)points],and the difference between the two groups was statistically significant(t=5.34,5.12,5.69,all P<0.01).At 3 months after delivery,exclusive breastfeeding rate,milk powder feeding rate and mixed feeding rate in combination group were 58.54%(24/41),7.32%(3/41),34.15(14/41),higher than 26.83%(11/41),29.27(12/41),43.90%(18/41)in routine group,and the difference between the two groups was statistically significant(χ^(2)=10.73,P<0.05).Conclusions High-efficiency CPC combined with IKAP health education can reduce incidence of CDMR,decrease maternal and neonatal complications,enhance maternal postpartum health literacy and improve breastfeeding rate in primiparas by improving correct cognition to cesarean section.It is worthy of clinical application.