Healthc Inform Res.  2014 Oct;20(4):266-271. 10.4258/hir.2014.20.4.266.

Impact of Computer-Based Pregnancy-Induced Hypertension and Diabetes Decision Aids on Empowering Pregnant Women

• Aslani A
• Tara F
• Ghalighi L
• Pournik O
• Ensing S
• Abu-Hanna
• Eslami S

• KMID: 2166801
• DOI: http://doi.org/10.4258/hir.2014.20.4.266

Abstract

OBJECTIVES
We designed a computer-based decision aid (CDA) for use by pregnant women at home to investigate and participate in solving their pregnancy problems related to pregnancy-induced hypertension (PIH) and gestational diabetes (GD). The system cannot and is not intended to replace visits to physicians; rather it can help women focus on the most important symptoms and provides guidance on when to see a doctor.
METHODS
The study is a randomized controlled trial, which is performed among Iranian pregnant women. For subjects, 420 healthy pregnant women have been recruited from two private and two public prenatal centers. The intervention group will receive the CDA for use at home, and the control group will receive care as usual. The CDA relies on knowledge extracted from the national guidelines on PIH and GD.
RESULTS
The two primary outcomes for the study are self-efficacy and knowledge. Self-efficacy will be measured by the Stanford self-efficacy scale and knowledge will be evaluated by 15 binary (true/false) questions provided by the researchers. Secondary outcomes include type and frequency of doctor and/or medical center visits; blood pressure and blood sugar changes based on the national guidelines and according to pregnancy records, and anxiety will be assessed by the state component of the short Spielberger anxiety scale.
CONCLUSIONS
This paper describes the design of a CDA and a protocol for a randomized controlled trial to study the effects of the CDA on self-efficacy and knowledge of pregnant women pertaining to PIH and GD. Differences in the primary outcomes will be analyzed using 'intention-to-treat' principles.

Keyword

Decision Support Technique; Decision Aid; Pregnancy-Induced Hypertension; Gestational Diabetes; Prenatal Education

MeSH Terms

Anxiety
Blood Glucose
Blood Pressure
Decision Support Techniques*
Diabetes, Gestational
Female
Humans
Hypertension, Pregnancy-Induced*
Pregnancy
Pregnant Women*
Prenatal Education
Blood Glucose

Figure

• 

  Figure 1 The process of recommendations' suggestion in the computerized decision aid for PIH and GD (CDA-PIHGD). PIH: pregnancy-induced hypertension, GD: gestational diabetes, BMI: body mass index.

Reference

1. Iran at a glance [Internet]. Tehran: United Nations Population Fund (UNFPA);c2012. cited at 2014 Sep 15. Available from: http://iran.unfpa.org/Country%20Profile.asp.

2. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Williams Obstetrics. 24th ed. New York (NY): McGraw-Hill Education;2014.

3. Hicks R. Managing gestational diabetes in pregnancy [Internet]. London: WebMD;c2014. cited at 2014 Sep 15. Available from: http://www.webmd.boots.com/diabetes/guide/managing-gestational-diabetes-pregnancy.

4. Unicef. Statistics: Iran, Islamic Republic of [Internet]. New York (NY): Unicef;c2013. cited at 2014 Sep 15. Available from: http://www.unicef.org/infobycountry/iran_statistics.html.

5. Beigi M, Javanmardi Z, Shahidi S. Interventions to decrease the mortality rate among pregnant women. Iran J Nurs Midwifery Res. 2009; 14(3):151–154.

6. Watkins L, Weeks AD. Providing information to pregnant women: how, what and where. BJOG. 2009; 116(7):877–879.

7. Angelmar R, Berman PC. Patient empowerment and efficient health outcomes. Financing sustainable healthcare in Europe: new approaches for new outcomes. Luxembourg: Ministry of Health;2007. p. 139–160.

8. Vlemmix F, Warendorf JK, Rosman AN, Kok M, Mol BW, Morris JM, et al. Decision aids to improve informed decision-making in pregnancy care: a systematic review. BJOG. 2013; 120(3):257–266.

9. Kar SB, Pascual CA, Chickering KL. Empowerment of women for health promotion: a meta-analysis. Soc Sci Med. 1999; 49(11):1431–1460.

10. Samoocha D, Bruinvels DJ, Elbers NA, Anema JR, van der Beek AJ. Effectiveness of web-based interventions on patient empowerment: a systematic review and meta-analysis. J Med Internet Res. 2010; 12(2):e23.

11. Vasegh Rahimparvar SF, Hamzehkhani M, Geranmayeh M, Rahimi R. Effect of educational software on self-efficacy of pregnant women to cope with labor: a randomized controlled trial. Arch Gynecol Obstet. 2012; 286(1):63–70.

12. Eysenbach G. Consumer health informatics. BMJ. 2000; 320(7251):1713–1716.

13. Horey D, Kealy M, Davey MA, Small R, Crowther CA. Interventions for supporting pregnant women's decision-making about mode of birth after a caesarean. Cochrane Database Syst Rev. 2013; 7:CD010041.

14. Bastani F, Zarabi R. Correlations of self-efficacy among women with gestational diabetes. HAYAT. 2011; 16(3-4):56–65.

15. Shojaezadeh D, Tol A, Sharifirad GR, Mohajeri Tehrani MR. Evaluation of educational program based on empowerment model on promoting self-efficacy and its relation with diabetes control among type 2 diabetes. Iran J Diabetes Metab. 2012; 11(5):474–482.

16. Nagle C, Lewis S, Meiser B, Metcalfe S, Carlin JB, Bell R, et al. Evaluation of a decision aid for prenatal testing of fetal abnormalities: a cluster randomised trial [ISRCTN22532458]. BMC Public Health. 2006; 6:96.

17. Stanford Patient Education Research Center [Internet]. Stanford (CA): Stanford School of Medicine;c2014. cited at 2014 Sep 15. Available from: http://patienteducation.stanford.edu/research/diabscales.htm.

18. Marteau TM, Bekker H. The development of a six-item short-form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI). Br J Clin Psychol. 1992; 31(Pt 3):301–306.

19. Moen A, Mæland Knudsen LM. Nursing informatics: decades of contribution to health informatics. Healthc Inform Res. 2013; 19(2):86–92.

20. Luna D, Almerares A, Mayan JC 3rd, González Bernaldo de Quirós F, Otero C. Health informatics in developing countries: going beyond pilot practices to sustainable implementations: a review of the current challenges. Healthc Inform Res. 2014; 20(1):3–10.