Antenatal education : meeting consumer needs a study in health services development

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This research situated antenatal education within a health promotion framework to determine a consumer-based approach to improving antenatal and postnatal education purported to prepare for parenthood. Research, both published and unpublished, criticises current structured educational programs and first time parents are reported to experience high levels of stress and unhappiness. Stage One of this study was a multiple source, multiple methods needs assessment conducted at two large, metropolitan hospitals in Sydney. The aim of the needs assessment was to explore the needs, interests and concerns of first time expectant and new parents, their changing nature during the childbearing year, ascertain learning processes that best suited their needs, and plan effective antenatal education around the results. Repeated in-depth interviews, focus groups, participant observation and surveys were used to collect data from expectant and new parents. Focus groups, surveys and participant observation were used to collect complementary data from educators, midwives and Child and Family Health Nurses who work with expectant and new parents. The third source of data analysed was documentary, that is program outlines and session plans of three comparable hospitals. The needs assessment demonstrated that to effectively prepare women and men for their childbearing experience, a range of strategies, programs and learning activities were required. This resulted in the design of a ‘menu’1 approach to antenatal and postnatal education with an emphasis placed on ‘life as a mum and a dad’, and the ‘world’ of their baby. The results also demonstrated a significant difference existed between the actual learning needs and priorities of expectant and new parents and those perceived to be their needs by the professionals. Expectant and new parents questioned the group facilitation skills of educators and identified methods to improve practice. Three strategies identified by these expectant and new parents as priorities were designed, implemented and an evaluation of each was undertaken in Stage Two of this study. The strategies were: 1. Seven session Having a Baby program for first time parents. 2. Group skills training program for antenatal and postnatal educators. 3. Breastfeeding resource package for antenatal educators. Stage Three of this research was an empirical study. A repeated measures randomised control trial was undertaken to test the effectiveness of the new Having a Baby program. In particular whether women and men who attended this program had improved perceived parenting self-efficacy, knowledge, and decreased worry about the baby eight weeks after birth compared with those who attended the conventional antenatal education program. The new program placed the labour and birth experience as a microcosm of the childbearing experience, and incorporated learning activities designed to enhance the confidence of pregnant women and their partners during their adjustment to parenthood. Perceived parenting self-efficacy2 was the measure by which parenting confidence, and therefore adjustment to parenthood, was measured The randomised control trial demonstrated that the perceived parenting self-efficacy of women and men in the experimental group was higher than those of control group participants at approximately eight weeks after the birth, with the difference being statically significant. The labour and birth outcomes of both groups, and their demographic details, were similar. Evaluation of the group skills training program for antenatal and postnatal educators and the breastfeeding resource package for antenatal educators were undertaken. Data collected from focus groups, interviews and surveys demonstrated the effectiveness of these strategies. The findings of this research question the validity of conventional antenatal classes and confirm the need for training and mentoring of antenatal educators. Effective, high quality antenatal education operating within budget allocation, facilitated by group skills trained educators, can produce superior postnatal outcomes.
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