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UBC Theses and Dissertations

The relationship between learning, health beliefs, weight gain, alcohol consumption, and tobacco use of pregnant women Strychar, Irene


Understanding how women learn during pregnancy is the foundation for planning prenatal education programs. To date, adult educators have not investigated, in any depth, the learning process during pregnancy. The purpose of this study was to examine learning during pregnancy and relate this learning to learning outcomes. The principal research questions were: "What are the learning patterns of pregnant women?" and "What is the relationship between learning and health behavior of pregnant women?" It is unknown whether learning during pregnancy is directly associated with behavior or mediated through health beliefs. The objectives of this research were to identify pregnant women's health behaviors, learning patterns, and health beliefs. The three health behaviors examined in this study were eating, drinking, and smoking. These behaviors were operationalized in terms of their outcomes: weight gain, alcohol consumption, and tobacco use. These factors are amenable to an education intervention and are behavioral risk factors associated with low birth weight. The process of investigating learning patterns consisted of identifying: what was learned during the pregnancy, which resources were utilized, what advice was given, what amount of time was spent in learning, who initiated the learning episodes, and what learning transaction types emerged. Determining learning transaction types was based upon an adaptation of Tough's (1979) concept of planners and Knowles's concept of self-directed learners. The process of investigating health beliefs consisted of identifying pregnant women's concerns, perceived risk, perceived use of the information, and perceived barriers, defined according to an adaptation of the Health Belief Model. The principal hypotheses of the study were: (1) self-initiated learning will be positively correlated with knowledge scores, (2) self-initiated learning will be positively correlated with ideal health behaviors, and (3) health beliefs will be positively correlated with ideal health behaviors: ideal weight gain during pregnancy, reduced alcohol consumption, and reduced cigarette smoking. The research, an ex post facto design, involved a one hour structured interview with women within the week following delivery of their infants in hospital. A proportional sample of 120 primigravidas was selected from seven hospitals with average number of monthly births greater than 100. Reporting of results was based upon 120 interviews conducted as part of the main sample and eight interviews conducted during the pilot study. Pilot responses were included because these responses were similar to responses provided by the main sample, with the exception of health belief data. One case was excluded from the sample, making for N = 127. Data analyses were based upon the entire sample N = 127, with the exception of health belief measures. Since alcohol and smoking health belief questions were administered to drinkers and smokers and since health belief measures related to weight gain, alcohol, and smoking were missing data, health belief analyses were based upon N=123 for weight gain, N = 88 for alcohol, and N = 43 for smoking. Women had spent an average of forty-one hours learning about weight gain, alcohol consumption, and tobacco use during pregnancy. The principal resources used were: reading materials, physicians, family members, and prenatal classes. The majority of pregnant women had engaged in other-initiated learning episodes in the one to one setting, that is with a health professional, family member, or friend. Self-initiated learning about weight gain was associated with higher knowledge scores and ideal prenatal weight gain (p≤0.05); and, weight gain health beliefs were negatively correlated with ideal prenatal weight gain (p≤0.05). Finding a negative correlation, in contrast to the predicted positive correlation, may have been due to the fact that in a retrospective study the behavior precipitated reporting of health beliefs. Other-initiated learning about alcohol was associated with higher knowledge scores and reduced alcohol intake (p≤0.05); however, alcohol health beliefs were not associated with reduced alcohol intake. For smoking, neither self-initiated nor other-initiated learning was associated with knowledge scores or reduced cigarette smoking; however, a low degree of perceived risk was predictive of reduced cigarette smoking (p≤0.05). Knowledge about tobacco use was positively correlated with health beliefs, suggesting that learning may be indirectly related to smoking behaviors. This study contributes to the knowledge about learning during pregnancy by providing a descriptive profile of learning patterns during pregnancy, and by examining the relationship between learning, health beliefs, and behavior. Fostering a learning environment which stimulates self-initiated learning may assist women reach ideal weight gain during pregnancy. For alcohol, encouraging health professionals, family members, and friends to initiate learning about the hazards of consuming alcohol during pregnancy seems warranted. Self-initiated learning may not be superior to other-initiated learning but may be topic specific, due to the nature of the health behaviors examined. Identification of women's smoking health beliefs seems warranted during prenatal education. Further research is required to better understand the role of learning with respect to changing smoking behaviors during pregnancy.

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