Comparison of the Effect of Electronic Education and Educational Booklet on Pain and Anxiety During Labor: A Randomized Controlled Trial

Abstract

Abstract: Introduction: Due to the severe effects of pain and anxiety on childbirth outcomes and the effect of promoting the quality of prenatal education on maternal and newborn health and the lack of study on the impact of education on pain and anxiety during labor and to compare two methods of educational booklet and electronic education, this study aimed to compare the effect of electronic education and booklet labor on pain and anxiety during labor (primary outcomes) and self-efficacy, knowledge of the management of labor pain and duration of the active phase and second stage of labor (secondary outcomes). Materials and methods: This randomized controlled clinical trial was conducted on 153 pregnant women referred to healthcare centers of Miandoab in 2015-2016. Using a randomized block design, participants were assigned into three groups classified as 2 intervention groups (Intervention 1: Receiving e-learning and Intervention 2: Receiving booklet) and a control group (receiving routine care). A face-to-face training session was held by the researcher for the intervention groups for 15 minutes in weeks 30-36 and they were was taught how to use the training tool and the software and booklet were given to them. The participants were contacted by the researcher every two weeks to remind them to study the educational booklet and software. Pregnant women were followed up until the delivery time and the pain intensity in the active phase was measured using visual analogue scale (VAS). The questionnaire of knowledge of labor pain management was completed by the participants before and two weeks after the intervention. Anxiety and self-efficacy questionnaire was completed for participants after accepting pregnant women with 4-5cm cervical dilatation. Duration of the active phase and second stage of labor was assessed. ANCOVA, One-way ANOVA and Chi-square tests were used for analyzing the data. Results: There was no statistically significant difference between the three groups in terms of sociol-demographic characteristics, the baseline scores of knowledge and state anxiety (P>0.05). There was no statistically significant difference between groups in terms of the average labor pain intensity (P>0.05). After adjusting for baseline score, the mean score of state anxiety after the intervention in the e-learning group (adjusted mean difference: -24.6; confidence interval 95%: -27.6 to -21.6) and the educational booklet group (-19.1; -22.1 to -15.9) was siginficantly lower compaed with the control group. Also, the state anxiety score was significantly lower in the e-learning group than the educational booklet group (-5.6; -8.7 to 2.5). After adjusting for baseline score, the mean score of trait anxiety was significantly lower in the e-learning group (-14.4; -15.9 to -12.9) and the educational booklet group (-4.6; -16.1 to -13.1) than the control group. After the intervention, the mean score of the childbirth self-efficacy in the educational booklet group (113.4; 100.7 to 126.1) and e-learning group (159.3; 146.5 to172.0) was significantly higher than the control group. Also, the mean score of the childbirth self-efficacy in the e-Learning group had a significant increase compared to the training manual group (45.9; 33.0 to 58.7). Also by adjusting the baseline score, the mean score of knowledge after the intervention compared to the control group in both e-learning group (5.5; 4.6 to 6.3) and booklet group (3.4; 2.5 to 4.2) was significantly higher than the control group. Also, the increase in knowledge score in the e-learning group (2.1; 1.2 to 2.9) was significantly higher than the booklet group. There was no statistically significant difference between groups in terms of the duration of active phase and second stage of labor. Conclusion: The results show that both e-learning and educational booklet methods are effective in reducing maternal state and trait anxiety, Promoting of self-efficacy and increasing of knowledge about labor pain management and the e-learning is more effective than the educational booklet. Therefore, it seems that e-learning can be used to replace traditional methods of teaching considering the prevalence of information technology.