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Health Beliefs and Health Practices of Pregnant Women
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research in brief Health Beliefs and Health Practices of Pregnant Women LYNNE PORTER LE WALLEN, RNC, MSN
In the past, pregnancy was treated as an illness. Little time was spent teaching the woman how to care for herself; instead, she was taken care of by her physician.’ Now, pregnancy is increasingly becoming thought of as a well event but one that involves life change and s t r e s ~ For . ~ ~the ~ pregnant woman to deal with this change and stress, and to make her pregnancy a positive, well event, she must take responsibility for her health and think that she has control over what happens to her. Nurses have a major role in teaching self-health care and can assist the pregnant client in taking responsibility for her own health and contributing to the well-being of her unborn child. The purpose of this study was to determine if a relationship existed between the health practices of pregnant women and their health loci of control. In this descriptive research design, two data collection instruments were used. The first was the Multidimensional Health Locus of Control Scale (MHLC), an 18-item Likert-type q~estionnaire.~ The scale divides responses into three subscales: six items testing internal health locus of control (IHLC), six items testing powerful others health Accepted: November 1988
May/June 1989 JOCNN
locus of control (PHLC), and six items testing chance health locus of control (CHLC). Alpha reliabilities for each subscale range from 0.67 to 0.77. The second data collection instrument was the Personal Health Inventory (PHI), a tool modified by the researcher from a test produced by the National Health Information Clearinghouse. This is a 24-item Likerttype questionnaire, with items addressing alcohol and tobacco use, exercise, nutrition, safety, and stress management. N o reliability or validity information is available for this modified test. Modifications of the original instrument consisted of wording 50% of the questions positively and 50% negatively and breaking down double-barreled questions into separate questions. A personal data sheet for demographic purposes was used. This research used a convenience sample consisting of 51 pregnant women who experienced no complications during their pregnancies while attending childbirth education classes at a community hospital in the southeastern United States. Return of the completed questionnaires from participants was considered implied consent to participate in the study. Of the 51 subjects, 19 scored
highest on the IHLC scale, which measured their beliefs that their own actions control their health; 17 scored highest on the PHLC scale, which measured their beliefs that their health is controlled by powerful others, such as their families, doctors, or God; and 15 scored highest on the CHLC scale, which measured their beliefs that their health is controlled by chance or fate. A high score on the Personal Health Inventory indicated that subjects reported practicing a high number of health-promoting behaviors. A statistically significant (p = .027) correlation of 0.26 was found between subjects’ high scores on both the IHLC and the PHI: A statistically significant (p = .007) negative correlation was found between subjects’ high scores on the CHLC and the PHI. A small positive correlation of 0.09 was found between subjects’ high scores on the PHLC and the PHI, but the correlation was not statistically significant ( p = 0.25). This study has several limitations. A sample of convenience was used rather than a random sample, so results cannot be generalized to other populations. The descriptive design prevents the establishment of a cause-and-effect relationship and can only lay t h e groundwork for future re245
search. Also, the sample size is a limitation, and future research may obtain more significant results using larger samples. Additional research is needed in this area of nursing. This researcher would recommend replications of this study using larger and more heterogeneous samples to increase the generalization of the findings; studies to investigate the relationships of teaching strategies aimed at altering the individual’s health locus of control and actual documented change in the health locus of control; and studies of individuals known to hold a certain health locus of control and any changes in their health-promoting activities after exposure to health-teaching aimed specifically at a certain
health locus of control set of beliefs. Results of this study show that the health locus of control had an effect on the practice of healthpromoting activities in those pregnant women studied. Health promotion is an integral part of good prenatal care, which has been widely shown to contribute t o good pregnancy outcomes. Nurses working with pregnant women have a responsibility to take this factor into account when providing health teaching t o their clients.
Tegtmeier, D., and S. Elsea. 1984. Wellness throughout the maternity cycle. Nurs Clin North Am. 1 9 ~19-27. 2 McKay, S., and C.R. Phillips. 1984. Family-Centered Maternity Care. Rockville, MD: Aspen Systems Corp. Wallston, K.A., B.S. Wallston, R. DeVellis. 1978. Development of the multidimensional health locus of control scales. Health Education Monographs. 6:160-71.
Address for correspondence: Lynne P. Lewallen, 135 Dubois Street, Indian Orchard, MA 01151.
REFERENCES 1. Boston Women’s Health Book Collective 1979. Our Bodies, Ourseloes. (2d ed.). New York: Simon & Schuster.
Lynne Porter Lewallen is on the maternalchild nursing faculty at Elms College in Chicopee, Massachusetts. Ms. Lewallen is a member of the American Nurses’ Association and Sigma Theta Tau.
Do you have a question about NAACOG but do not know who to call? Listed below are direct dial numbers for NAACOG staff. When you have a question, just pick up the phone and dial 1-202 and the number of the appropriate staff person. processing secretary, new member Administration information . . . . . . . . . . . . . . . . . . . 863-2449 Sallye B. Shaw, executive director . 863-2443 Lisa Katz, department secretary, Suzanne Klein Davidson, administrative address changes, applications . . . 863-2452 assistant . . . . . . . . . . . . . . . . . . . . . 863-2442 Michelle Copelin, publications Education and Research fulfillment clerk, publications orders, Fran Weed, director . . . . . . . . . . . . . 863-2438 and general inquiries . . . . . . . . . . 863-2464 Jill Bobbin, special assistant, continuing education course Communications inquiries . . . . . . . . . . . . . . . . . . . . . 863-2467 Judith Serevino, director, editor, Melanie Gross, special assistant, Journal of Obstetric, Gynecologic, national meetings planning . . . . . 863-2446 and Neonatal Nursing . . . . . . . . . . . 863-2414 Graziella Andriani, special assistant, Nancy Rhodes, editor, NAACOG continuing education credit 863-2445 Newsletter . . . . . . . . . . . . . . . . . . . . approval . . . . . . . . . . . . . . . . . . . . . 863-2436 Dan Noyes, public relations Denise Savage, secretary, general coordinator . . . . . . . . . . . . . . . . . . . 863-2444 education and research inquiries 863-2434 Tina Lynch, department secretary . 863-2441 Satta Nallo, secretary registration information . . . . . . . . . . . . . . . . . . . 863-2447 Membership Practice and Legislation Pamela Williams, director, membership problems . . . . . . . . . 863-2451 Nancy Sharp, director . . . . . . . . . . . . 863-2439 Bridget Phelps, special assistant, Lois Eck, special assistant, practice information . . . . . . . . . . . 863-2440 district/section activities . . . . . . . 863-2450 Susan Biggs, special assistant, Shareese Wimbley, renewal processing legislative information . . . . . . . . . 863-2468 secretary, renewal information . . 863-2454 Sandi Kelly, department secretary . 863-2435 Jennifer Weaver, new member
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May/June 1989 JOGNN
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research in brief Health Beliefs and Health Practices of Pregnant Women LYNNE PORTER LE WALLEN, RNC, MSN
In the past, pregnancy was treated as an illness. Little time was spent teaching the woman how to care for herself; instead, she was taken care of by her physician.’ Now, pregnancy is increasingly becoming thought of as a well event but one that involves life change and s t r e s ~ For . ~ ~the ~ pregnant woman to deal with this change and stress, and to make her pregnancy a positive, well event, she must take responsibility for her health and think that she has control over what happens to her. Nurses have a major role in teaching self-health care and can assist the pregnant client in taking responsibility for her own health and contributing to the well-being of her unborn child. The purpose of this study was to determine if a relationship existed between the health practices of pregnant women and their health loci of control. In this descriptive research design, two data collection instruments were used. The first was the Multidimensional Health Locus of Control Scale (MHLC), an 18-item Likert-type q~estionnaire.~ The scale divides responses into three subscales: six items testing internal health locus of control (IHLC), six items testing powerful others health Accepted: November 1988
May/June 1989 JOCNN
locus of control (PHLC), and six items testing chance health locus of control (CHLC). Alpha reliabilities for each subscale range from 0.67 to 0.77. The second data collection instrument was the Personal Health Inventory (PHI), a tool modified by the researcher from a test produced by the National Health Information Clearinghouse. This is a 24-item Likerttype questionnaire, with items addressing alcohol and tobacco use, exercise, nutrition, safety, and stress management. N o reliability or validity information is available for this modified test. Modifications of the original instrument consisted of wording 50% of the questions positively and 50% negatively and breaking down double-barreled questions into separate questions. A personal data sheet for demographic purposes was used. This research used a convenience sample consisting of 51 pregnant women who experienced no complications during their pregnancies while attending childbirth education classes at a community hospital in the southeastern United States. Return of the completed questionnaires from participants was considered implied consent to participate in the study. Of the 51 subjects, 19 scored
highest on the IHLC scale, which measured their beliefs that their own actions control their health; 17 scored highest on the PHLC scale, which measured their beliefs that their health is controlled by powerful others, such as their families, doctors, or God; and 15 scored highest on the CHLC scale, which measured their beliefs that their health is controlled by chance or fate. A high score on the Personal Health Inventory indicated that subjects reported practicing a high number of health-promoting behaviors. A statistically significant (p = .027) correlation of 0.26 was found between subjects’ high scores on both the IHLC and the PHI: A statistically significant (p = .007) negative correlation was found between subjects’ high scores on the CHLC and the PHI. A small positive correlation of 0.09 was found between subjects’ high scores on the PHLC and the PHI, but the correlation was not statistically significant ( p = 0.25). This study has several limitations. A sample of convenience was used rather than a random sample, so results cannot be generalized to other populations. The descriptive design prevents the establishment of a cause-and-effect relationship and can only lay t h e groundwork for future re245
search. Also, the sample size is a limitation, and future research may obtain more significant results using larger samples. Additional research is needed in this area of nursing. This researcher would recommend replications of this study using larger and more heterogeneous samples to increase the generalization of the findings; studies to investigate the relationships of teaching strategies aimed at altering the individual’s health locus of control and actual documented change in the health locus of control; and studies of individuals known to hold a certain health locus of control and any changes in their health-promoting activities after exposure to health-teaching aimed specifically at a certain
health locus of control set of beliefs. Results of this study show that the health locus of control had an effect on the practice of healthpromoting activities in those pregnant women studied. Health promotion is an integral part of good prenatal care, which has been widely shown to contribute t o good pregnancy outcomes. Nurses working with pregnant women have a responsibility to take this factor into account when providing health teaching t o their clients.
Tegtmeier, D., and S. Elsea. 1984. Wellness throughout the maternity cycle. Nurs Clin North Am. 1 9 ~19-27. 2 McKay, S., and C.R. Phillips. 1984. Family-Centered Maternity Care. Rockville, MD: Aspen Systems Corp. Wallston, K.A., B.S. Wallston, R. DeVellis. 1978. Development of the multidimensional health locus of control scales. Health Education Monographs. 6:160-71.
Address for correspondence: Lynne P. Lewallen, 135 Dubois Street, Indian Orchard, MA 01151.
REFERENCES 1. Boston Women’s Health Book Collective 1979. Our Bodies, Ourseloes. (2d ed.). New York: Simon & Schuster.
Lynne Porter Lewallen is on the maternalchild nursing faculty at Elms College in Chicopee, Massachusetts. Ms. Lewallen is a member of the American Nurses’ Association and Sigma Theta Tau.
Do you have a question about NAACOG but do not know who to call? Listed below are direct dial numbers for NAACOG staff. When you have a question, just pick up the phone and dial 1-202 and the number of the appropriate staff person. processing secretary, new member Administration information . . . . . . . . . . . . . . . . . . . 863-2449 Sallye B. Shaw, executive director . 863-2443 Lisa Katz, department secretary, Suzanne Klein Davidson, administrative address changes, applications . . . 863-2452 assistant . . . . . . . . . . . . . . . . . . . . . 863-2442 Michelle Copelin, publications Education and Research fulfillment clerk, publications orders, Fran Weed, director . . . . . . . . . . . . . 863-2438 and general inquiries . . . . . . . . . . 863-2464 Jill Bobbin, special assistant, continuing education course Communications inquiries . . . . . . . . . . . . . . . . . . . . . 863-2467 Judith Serevino, director, editor, Melanie Gross, special assistant, Journal of Obstetric, Gynecologic, national meetings planning . . . . . 863-2446 and Neonatal Nursing . . . . . . . . . . . 863-2414 Graziella Andriani, special assistant, Nancy Rhodes, editor, NAACOG continuing education credit 863-2445 Newsletter . . . . . . . . . . . . . . . . . . . . approval . . . . . . . . . . . . . . . . . . . . . 863-2436 Dan Noyes, public relations Denise Savage, secretary, general coordinator . . . . . . . . . . . . . . . . . . . 863-2444 education and research inquiries 863-2434 Tina Lynch, department secretary . 863-2441 Satta Nallo, secretary registration information . . . . . . . . . . . . . . . . . . . 863-2447 Membership Practice and Legislation Pamela Williams, director, membership problems . . . . . . . . . 863-2451 Nancy Sharp, director . . . . . . . . . . . . 863-2439 Bridget Phelps, special assistant, Lois Eck, special assistant, practice information . . . . . . . . . . . 863-2440 district/section activities . . . . . . . 863-2450 Susan Biggs, special assistant, Shareese Wimbley, renewal processing legislative information . . . . . . . . . 863-2468 secretary, renewal information . . 863-2454 Sandi Kelly, department secretary . 863-2435 Jennifer Weaver, new member
246
May/June 1989 JOGNN