Effects of an mHealth intervention on maternal and infant outcomes from pregnancy to early postpartum for women with overweight or obesity: A randomized controlled trial.

BACKGROUND: Women with overweight (OW) and those with obesity (OB) tend to gain excessive weight during pregnancy, often resulting in adverse outcomes. The long-term effects of mobile health (mHealth) interventions on maternal and infant outcomes remain unclear. AIMS: To examine the effects of an mHealth intervention on OW and OB from the course of their pregnancy to six months postpartum. METHODS: A randomized controlled trial was conducted in northern Taiwan. Ninety-two pregnant women with a body mass index (BMI)of ≥25 kg/m2 were recruited from prenatal clinics at <17 weeks of gestation. Prepregnancy weight was baseline maternal weight, with data collected subsequently at the last assessment before childbirth and six months postpartum. The intervention group (IG) received the mHealth intervention, while the control group (CG) received standard antenatal care. The trial was registered on ClinicalTrials.gov (identifier: NCT04553731) with the initial registration date of September 16, 2020. FINDINGS: The IG tended to have a lower mean body weight than the CG at the last assessment before childbirth (82.23 kg vs 84.35 kg) and at six months postpartum (72.55 Kg vs 72.58 Kg). IG's newborn birth weight was significantly lower than CG's (3074.8 vs. 3313.6 g; p = 0.009). Regression analysis revealed that OB in IG had a significant reduction in weight before childbirth (ß = -7.51, p = 0.005) compared to OB in CG. Compared to OW in CG, both OW in IG (ß = -243.59, p = 0.027) and OB in IG (ß = -324.59, p = 0.049) were associated with decreased newborn birth weight. CONCLUSIONS: mHealth helped women with obesity to successfully manage their GWG and body weight before childbirth and newborns' birth weight, despite this effect not persisting to reduce weight retention at six months postpartum.

Evidence-based trends and association between symptom disturbance and physical activity among pregnant women: A longitudinal study.

BACKGROUND: Women usually decrease their physical activity (PA) after becoming pregnant. The change in PA may influence their symptom distress (SD). The changes and correlations between SD and PA throughout pregnancy remain unclear. AIMS: The aims of this study were to describe PA and SD trajectories across all three trimesters and examine their correlations during pregnancy. METHODS: A repeated-measure longitudinal study with convenience sampling at a hospital in Northern Taiwan was performed. Participants were recruited at 8-16 weeks of gestation, and two follow-up visits were performed at 24-28 weeks of gestation (second trimester) and after 36 weeks of gestation (third trimester). A total of 225 participants completed the study. The participants completed the Pregnancy Physical Activity Questionnaire (PPAQ) and Pregnancy-related Symptom Disturbance Scale (PSD), and sociodemographic and prenatal variables were recorded. RESULTS: Throughout pregnancy, SD decreased then increased, showing an overall upward trend, whereas PA showed the opposite pattern, increasing then decreasing, with an overall downward trend. Sedentary activity was positively correlated with both physical and psychological SD during the second and third trimesters. Exceeding the Institute of Medicine's recommendations for gestational weight gain, having childcare support, sport/exercise-type, and light-intensity PA were negatively associated with the physical and psychological SD, while a history of miscarriage and sedentary-intensity PA were positively associated with the physical and psychological SD. LINKING EVIDENCE TO ACTION: While several factors, including light-intensity PA, were found negatively associated with the physical and psychological SD, sedentary-intensity PA were positively associated with the physical and psychological SD, our findings shed light on future intervention strategies to relieve SD and decrease sedentary behavior among pregnant women.

Effectiveness of a nurse-led mHealth app to prevent excessive gestational weight gain among overweight and obese women: A randomized controlled trial.

OBJECTIVE: To explore the effectiveness of a nurse-led mobile health (mHealth) intervention to prevent excessive gestational weight gain (GWG) in overweight and obese women. METHODS: A randomized controlled trial with an experimental study design. Ninety-two pregnant women with body mass index (BMI) ≥25 kg/m2 at less than 17 weeks gestation were recruited from two prenatal clinics in northern Taiwan from January to June 2020. The experimental group used the MyHealthyWeight (MHW) app and a wearable activity tracker (WAT), and the controls received standard antenatal treatments with no mHealth-based elements. Two hospital follow-up visits were scheduled at 24-26 weeks in the second trimester and 34-36 weeks in the third trimester. A generalized estimating equation (GEE) was used to examine the trajectories and the effectiveness of mHealth on GWG. RESULTS: No difference in GWG was found between the intervention and control groups at baseline (p > 0.05). The GWG trajectory in the entire cohort of women with obesity exhibited a quadratic pattern (ß = 1.8, 95% confidence interval [CI] = 1.27-2.32), and intervention participants' weekly GWG was gained significantly lower than their controls in the second trimester (p < 0.05). Throughout the pregnancy, the mHealth intervention group had a significantly lower proportion of individuals who exceeded their GWG in both total (21.6% vs. 32.6%) and weekly weight gain (first trimester = 58.7% vs. 65.2%; second trimester = 45% vs. 67.4%; third trimester = 48.6% vs. 55.1%). In particular, among obese women in the third trimester, those in the intervention group gained less gestational weight than their controls. The adjusted body weight difference was 5.44 kg (p = 0.023), signifying the total GWG difference (3.30 vs. 8.74 kg) between the means of the two groups. The GEE model indicated that obese women who were aged 35 years, had prepregnancy exercise habits, perceived self-efficacy of diet, and more physical activity tended to have low GWG (p < 0.05). CONCLUSIONS: The nurse-led mHealth-based intervention shows promising results in significantly preventing excessive GWG among high-BMI women. More effectiveness was found among the obese subgroup. CLINICAL RELEVANCE: The mHealth-based intervention would be successfully implemented by nurses to help high-BMI women maintain their optimal body weight and promote healthy behavioral changes, particularly in diet and physical activity during pregnancy.

"Help me fight my constant battle": A focus group study of overweight and obese women's mHealth app experiences to manage gestational weight gain.

OBJECTIVES: To understand and describe overweight and obese pregnant women's mHealth app experiences in managing gestational weight gain (GWG) for optimal weight goals. DESIGN: A focus group study. SETTING: We identified and invited pregnant women from a prenatal outpatient clinic in a metropolitan city in Northern Taiwan. PARTICIPANTS: The participants were women whose pre-pregnancy BMI≥25 Kg/m2 at antenatal booking, and have experience using smartphone apps for pregnancy e-information. A total of 13 overweight and obese women were agreed to participate, their gestation weeks from 11 to 38 weeks. METHODS: Three focus group of six sessions were conducted from July to October of 2019. Thematic analysis was employed to inductively analyze the qualitative data. FINDINGS: Overweight and obese pregnant women...s major concern was to safely deliver a healthy baby. Main themes identified included: planning to know more and wanting to do right, feeling like a failure and having low self-expectations, struggling with life and desiring peace of mind, yearning to be supported and hoping to be seen, adjusting for the future and embracing new technology to engage in GWG management. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The core theme was presented as high BMI pregnant women...s shared need to be well-equipped to fight their constant weight battle, reflecting these women...s mixed feelings and barriers toward GWG control and body image during pregnancy. Experiences with a GWG addressing mHealth APP seemed to be positive and further facilitated healthy eating and physical activities, participants... self-efficacy may be increased along with satisfactory APP adherence to prevent excessive GWG for women with obesity.

Perceptions of Behavioral Awareness, Intention, and Readiness for Advance Care Planning: A Mixed-Method Study among Older Indigenous Patients with Late-Stage Cancers in Remote Areas of Eastern Taiwan.

The first Patient Right to Autonomy Act enacted in Asia in 2019 has enabled every Taiwanese citizen to plan for his/her end-of-life (EOL) in case of incompetency. Advance care planning (ACP) has been highly promoted for individuals with terminal, life-threatening illnesses, particularly in the mainstream society, and efforts have been made by the Taiwanese government to train health care providers in order to optimize patients' quality of dying. However, such advanced decisions and discussions regarding life-sustaining treatment and EOL care remain scarce among older ethnically minority patients. A multiple-case study employing a mixed-method (n = 9) was undertaken to explore indigenous patients' ACP perceptions. Both quantitative and qualitative information was obtained from indigenous patients, a minority group whose socio-economic and educational status are different from the general Taiwanese population. An initiative was made to describe ACP behavioral awareness, intention, and readiness of older terminal patients from four tribes with seven late-stage cancers in remote, mountainous areas of eastern Taiwan. Our findings showed that according to the Transtheoretical Model, terminal indigenous patients' ACP readiness was at a precontemplation stage. Their lack of fundamental ACP awareness, insufficient healthcare resources, life-sustaining value in a Christian faith context, and the prevalent health disparity in the remote communities have negatively affected indigenous patients' intention to participate in ACP. We provide suggestions to further promote ACP in this group and suggest that health information should be tailored at various readiness stages in order to overcome barriers and decrease ACP literacy discrepancies. This study calls attention to an understudied area of ACP behaviors, an overlooked need in EOL care for older cancer patients of unique cultural backgrounds, and the imperativeness to ensure cultural minority group's EOL care is consistent with patients' preferences.

Identifying Patterns of Symptom Distress in Pregnant Women: A Pilot Study.

During pregnancy, a woman's enlarged uterus and the developing fetus lead to symptom distress; in turn, physical and psychological aspects of symptom distress are often associated with adverse prenatal and birth outcomes. This study aimed to identify the trends in the trajectory of these symptoms. This longitudinal study recruited 95 pregnant women, with a mean age of 32 years, from the prenatal wards of two teaching hospitals in northern Taiwan. Symptom distress was measured by a 22-item scale related to pregnancy-induced symptoms. The follow-up measurements began during the first trimester and were taken every two to four weeks until childbirth. More than half of the pregnant women experienced symptom distress manifested in a pattern depicted to be "Decreased then Increased" (56.8%). Other noticeable patterns were "Continuously Increased" (28.4%), "Increased then Decreased" (10.5%) and "Continuously Decreased" (4.2%), respectively. It is worth noting that most pregnant women recorded a transit and increase in their symptom distress, revealed by their total scores, at the second trimester (mean 22.02 weeks) of pregnancy. The participants' major pregnancy-related distress symptoms were physical and included fatigue, frequent urination, lower back pain, and difficulty sleeping. The mean scores for individual symptoms ranged from 2.32 to 3.61 and were below the "moderately distressful" level. This study provides evidence that could be used to predict women's pregnancy-related symptom distress and help healthcare providers implement timely interventions to improve prenatal care.

"Moving for My Baby!" Motivators and Perceived Barriers to Facilitate Readiness for Physical Activity during Pregnancy among Obese and Overweight Women of Urban Areas in Northern Taiwan.

Low levels of physical activity (PA) are of a health concern among high body mass index (BMI) women living a sedentary lifestyle and being overweight or obese during pregnancy is associated with increased risks of maternal and fetal health complications. Obstetricians often provide advice regarding recommended PA levels, yet this has not been easily achieved in this group to prevent adverse birth-related outcomes. The purpose of this study is to explore motivators/enablers and perceived barriers through in-depth qualitative inquiry, guided by a behavioral change model, for understanding of pregnant women's decisions to engage, or refrain from PA practice. Thirteen overweight and obese pregnant women aged 28 to 45 years with an inactive, sedentary lifestyle in urban areas of northern Taiwan were recruited to participate in six focus group sessions for their intent and readiness for PA engagement in pregnancy. A thematic content analysis was performed with a constant comparison method to categorize interview data and generate themes. The findings illustrate the extent to which obese and overweight pregnant women's readiness for PA is affected by multiple factors, including personal beliefs, perceived societal norms, peer support, and the competing priorities in the environment. PA interventions are to be effective by focusing on overcoming barriers, increasing motivations, and enhancing self-management. Strategies shared by participants shed lights for program developers to design preferable behavioral interventions for this group of women who are low self-esteem with low self-efficacy to increase PA and meet recommended levels. There is considerable potential for health care providers to provide accessible information, facilitate PA, and promote an active lifestyle during and after pregnancy.

The Evidence Base in Exercise Knowledge of Pregnant Women: A Latent Class Analysis.

BACKGROUND: Exercise has many benefits for women with uncomplicated pregnancies. However, poor exercise knowledge may contribute to problems or barriers that reduce a woman's level of exercise after becoming pregnant. AIM: This study was performed to identify pregnancy exercise knowledge among pregnant women using latent class analysis and to examine the relationship between pregnancy exercise knowledge patterns and sociodemographic characteristics. DESIGN: A descriptive, cross-sectional approach was used in this study. METHODS: Participants were recruited from the prenatal outpatient departments of two hospitals and a certified prenatal center in Taipei, Taiwan. A total of 618 participants completed a pregnancy exercise knowledge test. The data were analyzed using WINMIRA and SPSS 20.0 software. RESULTS: Two latent classes were identified based on exercise knowledge among pregnant women. The Accurate Knowledge group (n = 543, 87.9%), which had a higher latent trait for exercise knowledge (M = 1.31, SD = 0.94), was larger than the Limited Knowledge group (n = 75, 12.1%), which had a lower latent trait (M = -0.22, SD = 1.14). The principles of exercise for pregnant women, particularly the appropriate intensity and duration, may be difficult items for women in the Limited Knowledge group to understand. Women with Limited Knowledge had significantly lower education levels and greater rates of unemployment, multiparity, and miscarriage than women in the Accurate Knowledge group. LINKING EVIDENCE TO ACTION: A two-class system for interpreting exercise knowledge among pregnant women is statistically supported. We believe that this study has evidence-based potential to help healthcare providers improve pregnant women's exercise knowledge as part of routine prenatal care to promote exercise.

Effectiveness of individual face-to-face exercise counselling in changing exercise behaviours to relieve symptom distress in pregnant women.

AIM: The present study aimed to evaluate the effectiveness of individualized exercise counselling in changing exercise behaviour and relieving pregnancy-related distress symptoms in pregnant women. METHODS: A quasi-experimental design and convenience sampling technique were used. Participants were recruited from the prenatal outpatient departments of medical centre hospitals in Taipei, Taiwan. The experimental group (n = 52) received face-to-face exercise counselling followed by 8 weeks of exercise sessions in their homes. The control group (n = 49) received no exercise counselling. Pregnancy-related distress symptoms were assessed before and after 8 weeks in both groups. RESULTS: The after-counselling scores of total (t = 2.46, P < 0.05) and physical (t = 3.18, P < 0.01) distress symptoms were significantly lower than the before-counselling scores in the experimental group. The total, physical and psychological distress scores significantly differed between groups and before and after counselling. The adjusted R2 values for total, physical and psychological distress symptoms ranged from 0.59 to 0.70. Participants' exercise habits increased from prepregnancy (19.2%) to after counselling (71.2%). CONCLUSION: Exercise counselling may effectively increase exercise habits and reduce pregnancy-related distress symptoms among pregnant women. Women with higher pretest symptom distress scores also had higher posttest symptom distress scores. Based on our outcomes, health care providers should routinely provide exercise counselling to pregnant women.

Total gestational weight change and rate of change in pregnant Taiwanese women.

OBJECTIVE: The purpose of this study was to estimate and compare total gestational weight gain (GWG) and the trimester-specific mean rate of GWG based on pre-pregnancy body mass index (BMI) as recommended by the Institute of Medicine (IOM). MATERIALS AND METHODS: The medical records of 470 participants who had received antenatal care at medical teaching hospitals in northern Taiwan and who delivered after 37 weeks of pregnancy were analyzed. RESULTS: The mean total GWG was 13.84 (SD = 4.33) kg, and nearly 60% of women had not complied with the current IOM recommendations for total GWG. The best-fit model for the mean GWG rate revealed that all groups had a GWG rate of zero in the 1st trimester and had an equivalent mean GWG rate in the 3rd trimester. Women tended to have excessive weekly GWG in the 2nd and 3rd trimesters, and women with a higher pre-pregnancy BMI were more likely to have excessive weekly GWG in the 2nd and 3rd trimesters. Moreover, the plurality of normal-weight (30.4%), overweight (75.8%) and obese (62.5%) women experienced excessive weekly weight gain during the 2nd and 3rd trimesters. Few women met the recommended 2009 IOM weekly weight-gain guidelines in the 2nd trimester, but more met them in the 3rd trimester. CONCLUSION: These findings indicate that most pregnant Taiwanese women currently exceed the total and weekly GWG recommendations of the IOM. More specifically, weekly GWG in excess of the IOM recommendations is common among normal-weight, overweight and obese women.

Constructing and applying an exercise counseling model for pregnant women: A preliminary study.

Pregnant women tend to exercise less than women who have not yet been pregnant. In the present study, which involves two studies, we aimed to construct an effective, individualized exercise counseling model for pregnant women. In study 1, a three-round session that involved 10 multidisciplinary health care experts reached a consensus via the Delphi method. In the preliminary study, two healthy pregnant women were recruited from the prenatal outpatient departments of hospitals in Taipei, Taiwan. Both of them were 32 years old and primipara. The results of study 1, the established five stages of the individualized exercise counseling model for pregnant women were as follows: assessment, defining barriers that interfere with achieving the target, planning, implementation and monitoring, and evaluation. In the preliminary study, we applied this counseling model of study 1 to 2 healthy pregnant women. The 5-stage counseling model can encourage pregnant women to begin to exercise or to continue exercising. We believe that this exercise counseling model can potentially be used by nurses. It can help them to encourage pregnant women to regularly exercise, and to promote exercise as part of a healthy lifestyle.

Development and Validation of a Fertility Intention Scale in Breast Cancer Survivors.

BACKGROUND: Evidence indicates that breast cancer survivors with reproductive concerns have a poorer quality of life than survivors without fertility concerns. There is a lack of reliable and valid assessments of fertility intention among breast cancer survivors. PURPOSE: The aim of this study was to develop and validate the Fertility Intention Scale (FIS) that is sensitive to the fertility intention of women with breast cancer. METHODS: A literature review and a qualitative study were conducted to generate the items in the scale. Content validity was evaluated by 15 experts, and face validity was assessed by 10 patients with cancer. Factor analysis was used to assess construct validity, and criterion validity was evaluated using two percentile items of fertility willingness. We developed and examined the validity and reliability of the FIS using a sample of 178 patients with breast cancer who had completed chemotherapy. RESULTS: The Cronbach's alpha calculated for the FIS (15 items) was .88. The factor analysis performed for the construct validity of the scale identified four factors that accounted for approximately 68.72% of the total variance. These four factors were pregnancy risk, disease control, social support, and happiness. There was a significant correlation between the total FIS and the level of desiring fertility preservation or pregnancy. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The FIS has acceptable reliability, content validity, and construct validity. This scale is appropriate for use in research and clinical practice settings to evaluate the risk-benefit perceptions of pregnancy in patients with breast cancer.

The Physical Activity Patterns of Pregnant Taiwanese Women.

BACKGROUND: Physical activity reduces the risk of maternal disorders during pregnancy. However, many pregnant women reduce their levels of physical activity while pregnant. PURPOSE: The purpose of this study was to examine and compare the physical activity (total amount, intensity, type) of Taiwanese women during each trimester. METHODS: This cross-sectional survey used purposive sampling to enroll 581 Taiwanese women as participants. The physical activity of participants was measured using the Mandarin version of the Pregnancy Physical Activity Questionnaire. RESULTS: The levels of household/caregiving activity and occupational activity differed significantly across trimesters. Household/caregiving (43.2%-54.5%) and occupational activity (42.0%-54.0%) accounted for the largest percentages of total energy expenditure for all three trimesters. In terms of total and household/caregiving activities, multiparous women had significantly higher mean energy expenditures than their primiparous peers. Moreover, income had a pervasive influence on all types and amounts of physical activity and energy expenditures, respectively, with the exception of sports/exercise. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Further careful assessment of the types and intensities of physical activity that are suitable for pregnant women in different parity and income categories in Taiwan is necessary. Furthermore, healthcare providers should encourage pregnant women to use strategies that promote their more regular participation in enjoyable physical activities. One of these potential strategies is to do activities together with children, family members, or friends.

Using the Theory of Planned Behavior to predict pregnant women's intention to engage in regular exercise.

OBJECTIVE: the objectives of this study were to use the Theory of Planned Behavior (TPB) in order to determine to what degree pregnant women intended to exercise regularly during pregnancy, and then to evaluate the TPB model fit. DESIGN: this study was based on a cross-sectional survey with a tool which was developed specifically for this study. SETTING: we identified and invited pregnant women from two medical center hospitals and one certified prenatal center in northern Taiwan to participate. PARTICIPANTS: using purposive sampling, we selected participants who were in at least the 12th week of gestation and did not have a high-risk pregnancy. 621 completed the instrument, their mean age was 31.76 (SD=3.87). METHODS: a self-administered instrument was used to determine the firmness of participants' intention to engage in regular exercise during pregnancy. The data were analyzed using SPSS 19.0 software and LISREL 8.72 software. FINDINGS: of the pregnant women in our study, 64.2% were found to be likely to exercise regularly up until delivery. The TPB was used to arrive at specific findings with regard to "intention to exercise regularly during pregnancy." Our participants demonstrated a positive intention to exercise regularly, a positive attitude (ATT), positive subjective norms (SN) and positive perceived behavioral controls (PBC) during pregnancy. The most influential factor in determining the participants' positive intention to exercise was found to be PBC (ß=0.68, p<0.01), followed by the SN (ß=0.12, p<0.01). The participants' ATT did not significantly influence their intention. Overall, the final model explained 59% of the variation in "intention to exercise regularly." KEY CONCLUSION AND IMPLICATION FOR PRACTICE: the most important factor in determining the participants' intention to exercise regularly was PBC, followed by the SN. Medical staff members should be able to help pregnant women overcome obstacles to regular exercise, for example, by assisting in providing appropriate resources.

The exercise patterns of pregnant women in Taiwan.

BACKGROUND: Unless advised otherwise by their doctor, pregnant women should get approximately 30 minutes of moderate exercise on most days. However, most pregnant women do not exercise regularly and do not meet the American College of Obstetricians Gynecology's standard for the minimum amount of exercise needed to stay healthy during pregnancy. PURPOSE: We investigate the factors related to regular exercise among pregnant women and describe the type, duration, and change in regular exercise from prepregnancy to pregnancy in Taiwan. METHODS: Pregnant women (N = 692) completed a questionnaire on exercise habits and were then grouped into regular exercise (105, 15.2%) and nonregular exercise (587, 84.8%) groups. Demographic and exercise-related variables were then investigated for their association with exercise during pregnancy. RESULTS: Work status, prepregnancy exercise, and trimester were significant predictors of regular exercise during pregnancy. The most commonly reported exercise types were walking, climbing stairs, and yoga. Nearly four fifths (n = 526, 76.0%) of participants did not exercise regularly before pregnancy, whereas 42.9% of participants continued exercising regularly after becoming pregnant. Among those who were inactive before pregnancy, 10.1% began exercising after becoming pregnant. In contrast, 57.1% of participants who had been more active before pregnancy stopped exercising regularly after becoming pregnant. Overall, it was found that participants decreased their amount (minutes × times/week) of exercise compared with their prepregnancy amount. CONCLUSIONS: Results suggest that walking and climbing stairs, each beneficial to the health of pregnant women, are the most common types of regular exercise engaged in by pregnant women in Taiwan. Regular exercise benefits the health of pregnant women. The findings of this study may be useful to doctors and nurses responsible to counsel pregnant women to exercise regularly and to have a reasonably active lifestyle during pregnancy.

The interrelationships among parenting stress and quality of life of the caregiver and preschool child with very low birth weight.

This study examined the interrelationships of quality of life (QOL) of primary caregivers and their preschool children with very low birth weight (VLBW) and parenting stress. Primary caregivers of 118 VLBW and 170 non-VLBW children completed questionnaires. Structural equation modeling suggested that the QOL of the primary caregivers was directly related to parenting stress, and that parenting stress was directly related to the children's QOL. The aforementioned relationship did not differ between VLBW and non-VLBW groups. Targeting the QOL and parenting skills of the primary caregiver could also improve the QOL of the preschooler.

Changing quality of life in hysterectomized women.

BACKGROUND/PURPOSE: Most women undergo a hysterectomy to relieve symptoms and improve their quality of life rather than to solve a life-threatening problem. We used hierarchical linear modeling to evaluate the changes, in a 6-8-week period, in the quality of life of women who had undergone hysterectomy. METHODS: This was a prospective follow-up study of 64 women who had undergone hysterectomy and 68 controls of similar age and marital status. A quasi-experimental design was used. The World Health Organization Questionnaire on Quality of Life: BREF-Taiwan Version was used to assess quality of life before surgery, at discharge, and 2 and then 6-8 weeks after surgery. The control group was measured three times: after their initial hospital visit, and 2 and then 6-8 weeks later. RESULTS: Women with hysterectomy (H-group) had significantly lower scores for the physical health dimension of quality of life at all time-points as compared with the control group, yet postoperatively, they showed a more dramatic increase in this dimension. As for the group mean trajectories, the vaginal hysterectomy (VH) subgroup had a relatively low quality of life immediately after surgery, which then gradually improved, especially in the dimension of physical health. As for the social relationships dimension, the abdominal hysterectomy (AH) subgroup showed an upward curve similar to the pattern of their physical health dimension. The psychological and environmental dimensions did not show a clear trajectory for either group. As for individual trajectories, the social relationships and environmental dimensions showed different patterns for women with hysterectomy. CONCLUSION: Hysterectomy can improve physical health. In the VH subgroup, physical health was improved significantly, especially from 6-8 weeks postoperatively. In the AH subgroup, physical health and social relationships were improved significantly postoperatively. Social relationships and environmental dimensions tended to show different patterns for women with hysterectomy. These findings may be useful to doctors and nurses, especially in counseling women who have had, or plan to have, a hysterectomy.

[Applying the hierarchical linear model in longitudinal studies: an example of symptom distress in women who had undergone a hysterectomy].

The purpose of this study was to introduce the Hierarchical Linear Model (HLM) and apply it to the topic of symptom distress in women who had undergone a hysterectomy. HLM was developed to analyze multilevel data and included a longitudinal study, which focused in particular on unbalanced design. A quasi-experimental design was conducted. Data on symptom distress in women who had undergone a hysterectomy (experimental group) and those who had not (control group) were collected over a six-week period and analyzed using HLM. Findings indicated that the experimental group had a quadratic trajectory in physical distress changes and a negative linear trend in psychological distress, both of which differed significantly from the control group. Additionally, physical and psychological distress influenced one another in three measurement variables, and physical distress in the experimental group actually improved over the six week period. Using HLM was able to estimate the different trajectories for each subject in the experimental group. This study shows that HLM can be applied effectively in longitudinal studies.

Effectiveness of a prenatal education programme on breastfeeding outcomes in Taiwan.

AIMS: The objectives of this study were to design a structured prenatal education programme on breastfeeding and to evaluate the effectiveness of the programme. Indicators of effectiveness were selected based on Kirkpatrick's Training Evaluation Model, including satisfaction with the programme, breastfeeding knowledge, breastfeeding attitude, breastfeeding satisfaction, breastfeeding problems and rate of exclusive breastfeeding. METHODS: This study applied a quasi-experimental design. The experimental group included 46 women who received a 90-minute group educational programme on breastfeeding during their 20th-36th week of pregnancy. Each experimental subject was matched by a control subject according to age, educational level, work status and pregnancy gestational age. Control subjects did not receive any intervention. Data were collected through self-administered questionnaires at preintervention, postintervention, three days postpartum and one month postpartum. RESULTS: Satisfaction with the programme was high. The experimental group had higher scores in breastfeeding knowledge and breastfeeding attitude at three days postpartum. The experimental group showed higher breastfeeding satisfaction at three days and one month postpartum. There were no significant differences in experiencing breastfeeding problems. The rate of exclusive breastfeeding was higher for the experimental group at three days and one month postpartum, but the differences were not statistically significant. CONCLUSION: This study demonstrated the effectiveness of a prenatal education programme on maternal knowledge, attitude and satisfaction toward breastfeeding. RELEVANCE TO CLINICAL PRACTICE: Other hospitals could apply this model to plan and evaluate their prenatal education programme on breastfeeding.

Health-related quality of life among 3--4-year-old children born with very low birthweight.

AIM: This paper reports a study comparing health-related quality of life at 3-4 years of age among children born with very low birthweight (