Health Practices in Adolescent Pregnant Women : A Sequential Explanatory Mixed Method Study

Abstract

Abstract Introduction: Adolescence is a distinct and unique stage in a woman's life and, according to the World Health Organization (WHO), is between the ages of 10 and 19. Due to the high risk of pregnancy in adolescents and the positive effect of health practices on health promotion and reduction of adverse maternal and neonatal outcomes of maternal and neonatal, it is necessary to improve these functions during pregnancy, especially in adolescents, and this is in the shadow of recognizing the status of these practices; Therefore, the research team decided to identify the status of health practices in adolescent pregnant women, its relationship with some maternal, fetal and neonatal outcomes, its predictors and explain their understanding of these practices and strategies to improve health practices in adolescent pregnant women. Methods: This is a mixed method study with sequential explanatory approach. The design of study in quantitative phase was prospective descriptive-analytical and in this phase, the status of health practices as well as its predictors among adolescent pregnant women, the relationship between these practices and some maternal, neonatal and fetal outcomes as well as the relationship between health practices and maternal-fetal attachment were determined. 316 adolescent pregnant women in health centers of Tehran (the capital of Iran) were recruited into this phase of study using census method. Pearson correlation, independent t-test, one-way analysis of variance and general linear model were used to determine the correlation between socio-demographic and pregnancy characteristics with the status of health practices. Then, in the qualitative phase, the perception of adolescent pregnant women on aspects and determinants of health practices from the viewpoint of 15 adolescent pregnant women was explored. Data were collected using in-depth individual interviews and note-taking and purposeful sampling and analyzed using conventional content analysis method. Then, by analyzing the data obtained in the quantitative and qualitative phases of the study, by literature review and by collecting viewpoints of expert panel, strategies for improving of health practices were developed. Results: The results of the quantitative phase showed that the mean score of health practice was 135.29 (SD 9.08) from obtainable range score of 34 to 170. The participants gained the highest mean score in the subscale of avoiding of harmful drugs and opiates and the lowest mean score in the subscale of balance between rest and exercise.There was no statistically significant relationship between health practices with some pregnancy and maternal outcomes such as preeclampsia, type of delivery, anemia and maternal weight gain (p >0.05). The results of the Pearson correlation test showed that health practices had a significant inverse relationship with depression (r=-0.294 and p<0.001) and a significant direct relationship with maternal-fetal attachment (r=0.367 and p<0.001). Results of the general linear model, after adjusting for the socio-demographic characteristics, showed that an increase in the health practice score led to a significant decrease in the depression score during pregnancy [β=-0.105; 95% CI (-0.168 to -0.042); p=0.001] and a significant increase in the maternal-fetal attachment score [β= 0.296; 95% CI (0.192 to 0.4); p<0.001].There was also no statistically significant relationship between health practices during pregnancy and fetal and neonatal outcomes (p>0.05). The general linear model showed that lower level of education, a history of abortion, lack of attendance in pre-pregnancy counseling, and delayed attendance for prenatal care, reduced the health practices score. However, high level of emotional support from the spouse increased the health practice score. The analysis of qualitative data led to the formation of 12 main categories that included balance the pattern of rest/activity, take care to the right food pattern, sensitivity and responsibility to maintain personal health, creating an appropriate model of social interaction, religious and spiritual orientation, having pleasurable and beloved entertainment, feeling physically fit, positive attitude to the impact of nutrition on the health of pregnancy and childbirth, feeling better mental health, stress management, individual and social factors affecting health practices, health practices inhibitors. The results of the third phase led to the presentation of 57 strategies to improve health practices. Strategies:1- Empowerment of all health Caregivers (including doctors, midwives, etc.) to provide appropriate services needed by adolescent pregnant women based on the latest scientific evidence,2- Involve a pregnant woman's spouse in prenatal care, 3- Creating facilities (financial, space, capable coach, etc.) necessary to have proper health practices, such as exercise and proper nutrition, 4- appropriate consultation with the spouses of adolescent pregnant women and other influential family members and 5- proper use of Peer education method in various face-to-face and virtual methods and encouraging successful people to share their experiences with other adolescent women under the supervision of experienced counselors, respectively had the highest scores in terms of priority. Conclusion Considering the relationship between health practices and some maternal outcomes and socio-individual characteristics, it is suggested that the developed strategies be made available to policy makers and planners to design programs to improve the health practices of adolescent pregnant women. It is also recommended that health care providers receive training on strategies to improve health practices.