Effect of health education intervention using health belief model on haemoglobin level among anaemic pregnant women in sepang

Health education -The goal of this health educational intervention is for behavioural change (dietary iron intake and compliance towards iron supplementation). -Intervention group : anaemic pregnant women at Dengkil Health clinic in Sepang district, Selangor, Malaysia -Intervention strategies This program will be implemented using three strategies: Pre and post intervention assessment and health education intervention. The pre-test assessment will be measured through standardised questionnaire given to the participating women before 24 weeks of gestation and followed by the health education intervention will be held within 12 weeks (3 month). There is a variety of learning activities during that period that include health talks, small group discussions, poster presentation and pamphlets. Post intervention evaluation will be measured between the 35th to 37th week of gestation in the third trimester. -Baseline assessment Prior to starting the intervention program, baseline or pre-test assessment need to be performed among the anaemic pregnant women at the selected health clinics to identify their baseline haemoglobin level, socio-demographic status, baseline status of their knowledge, perception towards anaemia in pregnancy, dietary iron status and level of compliance towards iron supplementation. A set of self-administrated pre-test questionnaire will be used to capture the baseline data. The questionnaires will be answered by all participants and their answers are made confidential. The questionnaires consist of four sections. All participants must give their consent prior to answering the questionnaires. The outcome of the activity is to determine a baseline level of knowledge, perception and anaemia preventive behaviour and haemoglobin level prior to health education program. The approximate duration required to complete the baseline assessment is within 10 minutes. -Post intervention assessment After the completion of the twelve week intervention period, the impact and outcome evaluation of the intervention program will be carried out using a set of questionnaires. The same set of questionnaire that is used in the pre-intervention assessment, except their socio-demographic status, is distributed to the participants which consists of measurement of knowledge, HBM construct, dietary practices and compliance towards iron supplementation. The post intervention haemoglobin level will be taken from the participants’ antenatal book. The outcome of the activity is to determine a post-intervention level of knowledge, perception and anaemia preventive behaviour after health education program. The evaluations will be attained through comparing the result of pre and post the implementation of health education intervention program among and between both intervention and control groups. Evaluation of the health education process is also done to control, assure or improve the quality of the program -Health education intervention Health education interventions are implemented after a pre-intervention assessment has been conducted. The health education intervention periods will be held within 12 weeks. There is a variety of learning activities during that period. The methods and material of the theory based health intervention programme included health talk, small group discussion, poster presentation and pamphlets. The health talk is given by the researcher on topics such as introduction to anaemia in pregnancy, predisposing factor of anaemia in pregnancy, sign and symptoms of anaemia in pregnancy, complication of anaemia in pregnancy, prevention of anaemia in pregnancy, benefit of taking iron supplementation, knowledge on wrong perception of anaemia and iron supplementation and knowledge on the various sources of food that contain high iron. It is later followed by question and answer session or activity. In this activity, participants are able to ask anything regarding anaemia in pregnancy and all questions will be answered with the simple way and easier for them to understand. The time required to complete health talk session is within 60 minutes. The outcome of the health talk would enable participants to gain knowledge on the facts of anaemia in pregnancy, complication of untreated anaemia and management of anaemia in pregnancy (Iron supplementation and dietary iron intake) and its importance. The second activity of the health education intervention programme is small group discussion. A session on small group discussion will be conducted and facilitated by the researcher between two to four weeks after the health talk. The participants are divided into nine small groups with eight to ten participants in one group. Each group will encounter one session during the intervention period based on timing of the participants. This activity deals with the issues to enhance the compliance towards iron supplementation and to increase the dietary iron intake by identifying their barriers towards anaemia preventive behaviours. The outcome of the discussion would enable participants to understand the severity of anaemia in pregnancy, understand the susceptibility of anaemia in pregnancy, identify and overcome the barrier of not comply with iron supplement and dietary iron intake and identify the benefit of taking iron supplement and dietary iron intake. The participant also will be provided with the checklist on compliance for iron supplementation. The time required to complete group discussion session is within 60 minutes. The materials used in the health education intervention programme are poster and pamphlets. Posters and pamphlets is designed specifically for this study and it based on health belief model. Poster and pamphlets will be designed to make teaching interesting and receptive. Two posters will be used in this activity. A large poster (A1 size) will be placed in the health clinic at all time during the intervention period. It will include information regarding the complication of anaemia and importance of taking iron supplementation and consumption of iron rich food. In addition, the participants will be given a small poster (A4 size) to bring home as their continuous learning material after the small group discussion session. The small poster will provide guidelines of various iron rich food. A checklist on compliance towards iron supplementation will be pasted in the maternal health record. Apart from that, a pamphlet also will be distributed to the participant as a self-learning tool and continuous material that aimed at enriching their information about anaemia after the health talk or small group discussion. It also helps to deliver take home messages to the participants about anaemia in pregnancy. It will cover the information regarding the definition, causes, complications and prevention of anaemia in pregnancy and examples of food rich of iron. These materials are also aiming to maintain adherence towards anaemia preventive behaviour. This study uses a quasi-experimental study design. It will involve pre-post intervention with control study involving two groups of the antenatal mothers (control and intervention) from two health clinics in Sepang area. Through simple random sampling, pregnant women in Salak Health clinic will be recruited as the control and those at Dengkil Health clinic will be recruited as the interventional subject. Both groups will be receiving routine antenatal care and practice which included iron supplementation from their respective clinics. Additionally, the intervention group will be given theory-based health education intervention on anaemia in pregnancy.