Effects of the Perceived Self-Efficacy Enhancement Program via Electronic Media on Health Promoting Behaviors Among Primiparous Adolescent Mothers

Abstract

Introduction Primiparous adolescent mothers undergo significant physical, psychological, and emotional changes that may impact their postpartum health. Engaging in health-promoting behaviors is therefore essential for their well-being. The adoption of appropriate health-promoting behaviors is influenced by various factors. Perceived self-efficacy is a significant factor that strongly correlates with health-promoting behaviors. In the context of adolescent mothers, perceived self-efficacy refers to their ability to perceive and evaluate their own capabilities, which in turn facilitates the planning and successful implementation of health-promoting behaviors. When adolescent mothers possess a high level of perceived self-efficacy, they are more likely to engage in proper health-promoting behaviors, ultimately contributing to improved health. 

Objective: This study aims to compare health-promoting behaviors in primiparous adolescent mothers between a control group receiving routine nursing care and an experimental group receiving the perceived self-efficacy enhancement program via electronic media and routine nursing care.

Design This study employed a quasi-experimental with a two-group posttest-only design. The researchers developed a perceived self-efficacy enhancement program based on Pender’s Health Promotion Model, Bandura’s concept of self-efficacy, and literature reviews. The program aims to promote postpartum adolescent mothers’ perception and confidence in their ability to manage and engage in health-promoting behaviors during the postpartum period. The program was delivered through four sources of learning combined with electronic media and consisted of three phases over a six-week postpartum period: Phase 1: within the first 24 hours after childbirth; Phase 2: 48 hours postpartum; and Phase 3: 1-6 weeks postpartum.

Methodology The sample consisted of 32 primiparous adolescent mothers who received care at the obstetrics and gynecological ward in a hospital of a northern province between November 2022 and October 2023. Participants were purposively selected based on the following inclusion criteria: 1) aged 10–19 years; 2) singleton pregnancy with vaginal delivery; 3) no complications during pregnancy, delivery, or postpartum period, such as heart disease, diabetes, hypertension, postpartum hemorrhage, or postpartum infection; 4) infants without birth or postnatal complications, such as birth trauma; 5) ability to communicate in Thai and possession of a smartphone with the LINE application installed; and 6) scores of perceived self-efficacy for health-promoting behaviors ranging from low to moderate (34.00-124.66). Sample size was calculated using G*Power program, with a significance level of .05, statistical power of .95, and an effect size of 0.64 based on previous research, resulting in a total of 32 participants. They were purposively assigned into either a control group or an experimental group, with 16 participants in each group. The experimental group participated in a perceived self-efficacy enhancement program via electronic media combined with routine nursing care, while the control group received only routine nursing care. Research instruments included: 1) a perceived self-efficacy enhancement program via electronic media, consisting of three phases over a six-week postpartum period, incorporating four sources of self-efficacy: mastery experiences; vicarious experiences, verbal persuasion, and physiological and emotional states; 2) a follow-up record form via telephone and the LINE application; and 3) a perceived self-efficacy questionnaire for health-promoting behaviors. Data collection tools included: 1) a personal information questionnaire and 2) a health-promoting behavior questionnaire assessing six dimensions of postpartum health behavior among adolescent mothers: 1) health responsibility, 2) nutrition, 3) physical activity, 4) stress management, 5) interpersonal relationships, and 6) spiritual growth. Data were analyzed using descriptive statistics, Chi-square test, Fisher’s exact test, and Mann–Whitney U test.

Results The median age of participants in the experimental and control groups was 17 and 17.5 years, respectively (IQR = 3.0 and 2.0). The majority were students (56.25% in the experimental group and 50% in the control group) and had completed lower secondary education (56.25% and 68.75%, respectively). Most participants were single (93.75% and 68.75%) and lived in extended families (93.75% and 75.00%). A majority reported having sufficient income (81.25% and 75.00%). The husbands of participants were predominantly aged 20 years or older (68.75% and 62.5%). In terms of occupation, 43.75% of husbands in the experimental group were private-sector employees, while 37.5% of husbands in the control group were laborers. After the program, the experimental group had a statistically significant higher mean score in overall health-promoting behaviors compared to the control group (p < .001). Significant differences were also observed between the two groups in five specific dimensions of health-promoting behaviors: health responsibility, nutrition, interpersonal relationships, spiritual growth, and stress management (p < .05). However, no significant difference was found in the physical activity dimension (p = .060).

Recommendation Midwives can apply the perceived self-efficacy enhancement program via electronic media to promote appropriate health-promoting behaviors among primiparous adolescent mothers. In the field of education, nursing institutions may utilize the findings of this study as approaches for curriculum development plans, aiming to raise nursing students’ awareness of the importance of enhancing perceived self-efficacy in primiparous adolescent mothers. Furthermore, future research should include a follow-up study and focus on the development and evaluation of perceived self-efficacy enhancement programs to promote health behaviors for other groups of postpartum adolescent mothers, such as those who underwent cesarean delivery or experienced preterm birth.