Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Malaysia.
Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia.
Malar J. 2019 Feb 20;18(1):41. doi: 10.1186/s12936-019-2676-3.
The levels of insecticide-treated net use among pregnant women and uptake of intermittent preventive treatment in pregnancy, have been sub-optimal in Nigeria. Previous studies have reported positive correlations between knowledge, attitude and practice of malaria preventive measures. It has also been reported that information and motivation, act through a mediator (behavioural skills), to cause a health behaviour change. The aim of this study was as such to develop, implement, and assess the effects of a health educational intervention based on the information-motivation-behavioural skills (IMB) model on the levels of knowledge, motivation, and behavioural skills for ITN use and IPTp uptake among pregnant women in a hospital in north-eastern Nigeria.
This was a randomized controlled parallel-group trial in which 372 antenatal care attendees were randomly assigned to either an intervention or control group after collecting baseline data using a structured questionnaire. The intervention group received a 4-h health education on malaria, guided by a module developed based on the IMB theory, while the control group received health education on breastfeeding for a similar duration and by the same facilitator. Follow-up data were subsequently collected at 2 months and at 4 months post-intervention using the same questionnaire. The generalized linear mixed models analysis was used to determine the between-group and within-group effects of the intervention. The intention-to-treat analysis was used after missing data had been replaced. This was followed by a sensitivity analysis, where the analyses were repeated without replacing the missing values.
The intervention was significant in achieving a 12.75% (p < 0.001), 8.55% (p < 0.001), and 6.350% (p < 0.001) higher total knowledge, motivation, and behavioural skills scores respectively, for the intervention group over the control group. The sensitivity analysis revealed no great differences in the effect sizes, even when missing data were not replaced.
The intervention module was effective in improving knowledge, motivation and behavioural skills. It is as such recommended to be adopted and incorporated into the routine antenatal health education schedules. It is also recommended that booster doses of the module be given say 2 months after the first dose to sustain levels of motivation and behavioural skills. Trial registration Pan African Clinical Trial Registry, PACTR201610001823405. Registered 26 October 2016, http://www.pactr.org.
在尼日利亚，孕妇使用经杀虫剂处理的蚊帐和接受间歇性预防治疗的比例一直不理想。先前的研究报告称，疟疾预防措施的知识、态度和实践之间存在正相关关系。据报道，信息和动机通过中介（行为技能）起作用，从而导致健康行为的改变。因此，本研究旨在基于信息-动机-行为技能（IMB）模型，为尼日利亚东北部一家医院的孕妇开发、实施和评估基于健康的教育干预措施，以提高孕妇对使用驱虫蚊帐和接受孕期预防性治疗（IPT）的知识、动机和行为技能水平。
这是一项随机对照平行组试验，372 名产前护理就诊者在使用结构化问卷收集基线数据后，被随机分配到干预组或对照组。干预组接受了 4 小时的疟疾健康教育，由基于 IMB 理论开发的模块指导，而对照组接受了类似时长和同一促进者的母乳喂养健康教育。随后在干预后 2 个月和 4 个月使用相同的问卷收集随访数据。使用广义线性混合模型分析来确定干预组的组间和组内效果。在替换缺失数据后，使用意向治疗分析。随后进行敏感性分析，即在不替换缺失值的情况下重复分析。
干预组在总知识、动机和行为技能得分方面，分别比对照组高出 12.75%（p<0.001）、8.55%（p<0.001）和 6.350%（p<0.001），差异具有统计学意义。敏感性分析显示，即使不替换缺失数据，效果大小也没有太大差异。
干预模块在提高知识、动机和行为技能方面是有效的。因此，建议将其采用并纳入常规产前健康教育计划中。也建议在第一剂后 2 个月给予该模块的强化剂量，以维持动机和行为技能的水平。
泛非临床试验注册处，PACTR201610001823405。注册于 2016 年 10 月 26 日，网址为：http://www.pactr.org。
