RESEARCH ARTICLES

Application of prenatal care light technology: focus on pregnant women’s perception

Ana Carla Pereira Alves^I; Maria de Fátima Esmeraldo Ramos Figueiredo^II; Natalia Peixoto Luis de Sousa^III; Célida Juliana de Oliveira^IV; Dayanne Rakelly de Oliveira^V; Wilker Malta de Sousa^VI
INurse. Graduate by the Regional University of Cariri. Brejo Santo, Ceará, Brazil. E-mail: enf_anacarlaemalta@hotmail.com
^IINurse. Master degree in Education Scienceo. Professor of the Nursing Course of the Regional University of Cariri. Crato, Ceará, Brazil. Email: faef2129@hotmail.com
^IIINurse. Graduate by the Regional University of Cariri. Crato, Ceará, Brazil. E-mail: naty.peixoto@hotmail.com
^IVNurse. Doctorate in Nursing. Professor of the Nursing Course of the Regional University of Cariri. Crato, Ceará, Brazil. E-mail: celidajuliana@yahoo.com.br
^VObstetric nurse. Master degree in Molecular Bio-prospection. Doctorate student in Biochemistry Toxicology, Federal University of Santa Maria. Professor if the Nursing Course of the Regional University of Cariri. Crato, Ceará, Brazil. E-mail: dayanne_rakelly@yahoo.com.br
^VIDoctor. Graduate by the Potiguar University. Brejo Santo, Ceará, Brazil. E-mail: wilkermalta@hotmail.com

ABSTRACT: This study aimed at identifying perceptions of pregnant women about educational technology on prenatal care. Participatory, descriptive, quantitative, and qualitative research based on the application of an educational game with 17 pregnant women in two Basic Health Units in the city of Brejo Santo, Ceará, Brazil, from October to November, 2011. Data was collected on the basis of both a form and participant observation. Thematic analysis was used for data treatment. Most pregnant women aged 26 to 29 years, were married, and had low education and income. The group proved to be very active during game application. Questions were addressed and experience exchanged. Assessment by the pregnant women indicated that the strategy contributed to the teaching-learning process. The group expressed high acceptance level and willingness to participate again. The game proved to be a suitable educational strategy for pregnant women.

Keywords: Nursing; Health education; Prenatal care; Pregnant women.

INTRODUCTION

The prenatal assistance is effective in the family health strategy (FHS) and consists of attention to women in their state of a gravid integral quality care, which aims to provide a healthy pregnancy for the mother-child. So, to improve the access, the coverage and quality of antenatal monitoring, as well as assistance to childbirth, puerperium and neonatal, the Ministry of health, through the ordinance nr. 569/GM, 6/1/2000, creates the Program of Humanization in Prenatal and Birth (PHPN) that aimed at the recovery of obstetric attention humanized, qualified and integrated with the involvement of articulated form of states, municipalities and health units in these actions¹.

In order to meet this perspective, we can say that the use of new educational strategies could provide a further clarification on the pre-natal, labor and delivery, in which women can develop a new perception of their pregnancy. So when the expectant mother is touched, she can take better care of her health and to collaborate with professionals in order to improve the quality of assistance provided.

The use of educational games during prenatal care, though innovative, is not yet being very explored in the literature. So women's opinions on the use of the instrument of education in health aims to identify its viability as a tool facilitating the teaching-learning process and whether it can enable recognition of women, their role in childbirth, through the construction of their empowerment in the gravid-puerperal cycle. Thus, it was defined as objective to identify the perceptions of pregnant women about the use of educational technology to be used in prenatal care.

LITERATURE REVIEW

The prenatal care assumes the responsibility to meet the numerous requirements that may arise during the gestational process, through health education. Soon, the insecurities, fears and anxieties can be minimized in a simple and understandable way by health professionals. Some authors highlight that educational action strategies allow the woman to know her body and to develop safety and tranquility in gestate and give birth and participatory approaches that encourage interaction among pregnant women, especially when using health technologies².

As the production of health care requires access to these technologies, whether they are tough, soft and hard and/or soft, these new do and materialize in practice work technologies, understood as the set of knowledge and act applied to the production of something. Thus, it can be pointed out that light technologies (host, accountability and linking) are reflected as an indispensable working tool in health for health education activities³.

It is recognized the importance of pregnant women to be fully informed about every nuance of the gravid-puerperal cycle and the Ministry of health emphasizes the importance of this preparation, which should be started early during the prenatal period. However in practice, most of the time, these information is not made available in an appropriate manner, or they be so unplanned, without knowing of real needs of pregnant women. Thus, it requires a big effort, but fully viable, in order to sensitize and motivate health workers of basic network and provide them with tools to work with pregnant women⁴.

In this sense, the importance of this information and its outstanding contribution are highlighted in the literature and the guidance provided by the nurse can appease a lot of these fears, reduce anxiety and facilitate the processes of pregnancy and birth in every opportunity to contact with pregnant women in prenatal consultations, so that she can be assumed as the protagonist in these important moments, participating actively in the teaching-learning process and not just act as a listener that receives information⁵.

METHODOLOGY

This study has a quantitative and qualitative and descriptive design⁶, characterized as being a research participant, since educational technology was developed for thematic work regarding labor, childbirth and the immediately puerperium with groups of pregnant women.

The survey was developed in two Basic Health Units (BHU), located in the municipality of Brejo Santo CE. The criterion of choice of units occurred as a result of the identification of the following characteristics: high demand of pregnant women; existence of group of active pregnant women; predominance of low socioeconomic conditions; ease of access to them and the distinct location (urban vs. rural).

The target population of the study, i.e., the pregnant women who participated in the educational game was all pregnant women who were present in the days of carrying out the activities, totaling 28 women. However, after the application of the criteria for inclusion: be registered at FHS, to join the group of pregnant women and have age over 19 years old, the group was defined in 17 pregnant women, which was the number of pregnant women who responded to the form and conducted the evaluation of the technology used.

The application of educational technology occurred in the period from October to November 2011 in three different moments, in both BHU's in days for the monthly meeting with pregnant women, which already happens routinely in the units.

To work the theme proposal differently, an educational strategy was developed entitled Maternal knowledge Roulette, which addressed four central themes: labor, childbirth, puerperium and breast care. The themes were specified by colors and engravings corresponding to each one and were also used four envelopes, each one containing questions that corresponded to themes of the roulette. There were also moments of relaxation, in which members of the teams players were asked to perform a task in the form of a gift.

Another feature developed was a big dice, which featured on each side an engraving that indicated a care for the baby, addressing the bath, watch the umbilical stump, what to do with the cramps, the correct position for the baby to breastfeed, position to burp and position to sleep.

The development of educational activities has the participation of the researcher and three assistants that facilitated the development of technology. The game took place in three steps:

• Survey of the characteristics of pregnant women: a form was used as an instrument of socio-demographic variables of pregnant women (age, profession, education, marital status and income) and obstetric (number of pregnancies, births and abortions, types of birth, number of children, calculation of gestational weeks, probable date of childbirth and pregnancy planning), totaling 12 questions posed to pregnant women who attended the game.
• Use of educational activity: The pregnant women were divided into groups and through lot, the game was started. The team chosen spins the roulette that determined a thematic and answered one of the questions of the envelope specific to such a subject. To answer correctly, the team earned 10 points and if they answer wrong, would pay a gift, with the use of the dice, which stipulated to a type of care that should be carried out at the baby, through one of the prints of the faces of the dice. In this sense, objects were available (baby, baby cot, bath, among others) that could facilitate the actions of care. After each response, regardless of being correct or wrong, the facilitators commented, stimulating access to new information and interaction between the groups.
• Evaluation of the activity: It has been requested for the participants who express verbally their opinion on the use of educational technology as a strategy of health education for prenatal care, through the following topics: what was good? What's not cool? Give your suggestions. It is worth mentioning that it was used a tape recorder to record these opinions, with the prior written permission of pregnant women.

So, for the organization and interpretation of the lines of pregnant women, during the evaluation of the activity, content analysis was used, in which the thematic speeches, after transcripts were analyzed by comprehensive reading of the selected material, exploitation of this material and interpretive synthesis. Then, categories were constructed related to the subject and the lines were grouped according to their sense cores⁷. Every pregnant woman has been identified as a subject, receiving the letter S and a respective number.

Finally, three categories were built: Educational technology as a facilitator of the teaching-learning process; Need educational game return and Acceptance and satisfaction with the educational strategy.

For carrying out the research, the project was submitted to the Ethics and Research Committee of the Regional University of Cariri and obtained the assent of nº 86/2011. All the participants signed an Free and Clarified Consent Statement and the research has been developed in line with Resolution No. 466/20128.

RESULTS AND DISCUSSION

The data from this study were organized, with the early draft of the socioeconomic profile and population birth. Then we analyzed the use of educational technology and its evaluation.

Characterization of pregnant women

The educational technology was applied to pregnant women who were, for the most part, the following socio-economic profile: age group between 26 and 29 years old (7); married (13); with incomplete elementary school (8); profession restricted to home (9) and agriculture (8), resulting in a lower income (8) or equal to the minimum wage (9).

In this scenario, the Ministry of health of Brazil emphasizes that the age and the marital status directly influence the state of health of the mother and son, since some of the unfavorable factors for pregnancy are ages less than 15 years old and above 35 years, as well as the marital status insecure and/or unstable⁹.

Regarding obstetric variables, there was no prevalence of the group of two pregnancies (7), absence of abortion (12), only one child alive (9), born in Cesarean’s births (9). On these findings, it is worth noting that there is a perception that the cesarean delivery is painless and as safe as vaginal birth. However, the realization of unnecessary cesarean section is potentially harmful, whereas the risks of maternal and perinatal morbidity and mortality are higher in this procedure than in vaginal birth⁴.

The data about the current pregnancy report that there was a greater number of pregnant women who were in the 1^st (6) and 3^rd (6) quarter of gestation. It is worth pointing out that each gestational period has its own characteristics, because while the first is marked by innovation and adaptation to the news of the arrival of a son, the latter is characterized by anxiety nears delivery. Thus, pregnant women live with opposing feelings, i.e. with the joy of knowing the child, but with the fear of giving birth, reproduced by the experiences of personal life, the childbirth stories heard or experienced by a family member or closer friend¹⁰.

As for the planning of pregnancy, most pregnant women reported that the couple programmed for pregnancy (10). However, it is important to emphasize that the participants in the study could have considered such a question as a synonym of wanting to have the child, since many times the child is not planned for a specific time, but after the news, it is desired by the family.

Educative Technology

Despite the educational activity have been developed in two health units, such objective study did not compare the peculiarities found in the application of this technology in different places. However, there was the intent to validate it in the different environments in which these health units are inserted (in this case, rural and urban environment), making it possible to cover a greater number of pregnant women, even presenting social, economic, cultural characteristics and different biological.

It was observed that the educative game emerges as an innovative strategy to be used during the prenatal period for allowing pregnant women an active participation and the possibility of taking as subject during development of the activity, from the perspective of health promotion, educational practices must assume a new character, once the guiding axis is the strengthening of the capacity of choice of subjects. However, for this to occur, the health information need to be worked in a simple and contextualized, by actually instrumenting people to make healthier choices of life¹¹.

Therefore, the game, as educational technology, proved conducive to groups of pregnant women, by allowing greater fixation of the subject through the exchange of information between facilitator/pregnant women dynamically and interactively. In addition, strategies like this contribute to demystify and revise beliefs and myths relating to pregnancy, childbirth and post-partum care, to better understand the changes that occur in pregnancy, their care and the baby´s and women's rights throughout the process¹².

Technology assessment

The evaluation of the activity for pregnant women was carried out to identify the opinions, suggestions and criticisms, as well as provide the clarification of questions and the approach of new issues, since the game was developed and applied for the first time. Reading the lines relating to the evaluation allowed was grouped according to the main subject and subsequently three categories were built relating to main approaches highlighted by women.

Educational technology as a facilitator of the teaching-learning process

Technology development allowed new information regarding gravid-puerperal period were better understood by the group. It also demonstrated viability, to be used with both and primiparous multiparous, since, while for primiparous, much of the information was unpublished, to the other, in some situations, they were fundamental to recall that care over time were forgotten or modified. Such situations are evidenced in the following lines:

For me to learn new things that I didn't know, like first-time mother, a lot of things I didn't know and I learned today. (S3)

The exchange of experiences, remember things we've done, but that over time we forgot, today was remembered. (S2)

It should be noted that women perceive the need and crave receive information during prenatal care, educational actions being the major responsible for making all the necessary clarifications. It is known that pregnancy brings with it changes that influence the daily life of a wife and family/community and which mobilizes anxieties and fantasies often distorted, as well as being pervaded by many myths and superstitions¹³. Thus, it becomes essential to bringing up the clarification of these changes in order to increase the safety and satisfaction of woman.

At the same time, the use of toys for the baby care proved to be quite useful as it allowed for a greater involvement of pregnant women to develop the practical activity, as well as an environment conducive to better know the correct way to take care of the newborn and to remove doubts, as exemplified in the following excerpt:

To me it was everything good, the care for the child, in the bath, put to sleep, feeding straight, put to burp right [...] All this it was good. (S11)

Viewing through the toys, the way should be carried out with care the newborn, was quite accepted by pregnant women, as they could simply identify how they should proceed in specific action and consequently to develop greater tranquility. It was noted that the use of this feature can assist in the improvement of health education in pregnant women.

Another practical experience in the area of health education, held with a group of pregnant women, found that the activity mediated by creative interventions, differentiated features and in a relaxed manner, contributes to a better acquisition of knowledge¹⁴.

Need for return of educative game

As the availability of time for the application of this technology was reduced, because the time proposed for the facilitators was only an hour and a half, as combined with the coordination of the group of pregnant women, the group noted that there was a limitation to access more information, according to the following lines:

The time was too short, because the subject is very interesting, but the time was very short [...] We did not have time to tell people everything that we wanted. (S2)

In this sense, it is clear that we need to use the educational game in more than one time for the same group, with the purpose of meeting the needs of each woman. As learning becomes even more significant as the person realizes that is part of the educational context, it is emphasized the importance of always seek the development of a learning environment, preventive and therapeutic, which serve to support to pregnant women, workers who have recently given birth and their families/dates¹⁵.

Acceptance and satisfaction with the educational strategy

The dynamics adopted to carry out health education to pregnant women provided a scenario of great participation, involvement and fun. The strategy allowed greater spontaneity to expose experiences, take questions and offer new information. Thus, pregnant women reported to have enjoyed much of the activity that showed favorable results.

Finally, the women requested that the group returned for more subjects to be worked out. The following speeches confirm such claims:

For me it was good, it was wonderful, I like it, I love it. (S14)
For you to come back, for you to teach more things. (S2)

The development of the activity provided a different scenario, which sought to break away from the monotony of the lectures, in which, often, only the professional assumes the entire discussion. The dynamic game secured a greater motivation to participate.

The use of educational games as health technology dynamize the teaching-learning process through the discussion that he provides, increases the interest, communication and motivation, facilitates the assimilation of concepts by stimulation of the cognitive process, allows the expression of opinions, clarifies concepts, strengthens and supplements the learning and promotes positive affective learning¹⁶.

From this perspective, it is important to remember the strengthening bond and trust established between facilitators and pregnant women, facilitated by the plain language and contextualized, who favored an excellent repercussion of the educational game. Thus, the educational work can transform the relationship between health professional and user make it more horizontal, to enable individual and collective expression of needs and expectations¹⁷.

CONCLUSION

The process of development and implementation of educational technology represented an experience of great importance, both to the group of pregnant women as for the facilitators of the strategy. Then, the scenario that characterized the educational activity was of interactivity, dynamism, relaxation and exchange of knowledge and experiences that contributed to the success of the teaching-learning process.

The positive evaluation performed by pregnant women represented one of the most important moments, because the group had the opportunity to express feelings, opinions and suggestions regarding experience with the educational game. Thus, it was possible to identify the extent to which the strategy has contributed to the access to new information, as well as the approval by the women in this new strategy, because the group reported an excellent acceptance and desire to participate again, demonstrating the suitability of the game to be worked with pregnant women.

In addition, the scenario provided by the game favored not only that knowledge was transmitted by the facilitators, but that through the exchange dynamics between popular and scientific knowledge, the expectant mother build her own learning.

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