Shigeko Horiuchi

Evaluation of a web-based graduate continuing nursing education program in Japan: A randomized controlled trial

Web-based learning provides educational opportunities for students who are independent and self-directed. While the complexities of educational outcomes of web-based learning have not yet been completely documented, further studies are required using rigorous research design techniques to study the outcomes of web-based learning as compared to traditional face-to-face learning. The purposes of this study were to: (1) assess the learner outcomes of web-based learning as compared to face-to-face learning group, and (2) explore methods that maximize the use of web-based learning for continuing nursing education. A randomized controlled trial of web-based learning in comparison to face-to-face lectures for registered nurses or midwives was conducted. One hundred and one nurses and midwives were eligible to participate and 93 were randomized, 45 for the web-based learning and 48 for the face-to face group. Thirty-seven (82.2%) completed the web-based learning and 33 (68.8%) the face-to-face program. There was no difference in the post-test scores between the web-based learning group (mean=76.2) and the face-to-face learning group (mean=79.4) (t=0.66, df=68, p=0.51). There were three distinct advantages to the web-based group, even though both group demonstrated the same learning outcomes. First the dropout rate was lower in the web-based program. Second the flexibility of web-based learning was reported by several participants. Finally, web-based learning was attractive to an affordable for a wide age range of the nurses.

Factors influencing the use of antenatal care in rural West Sumatra, Indonesia

BackgroundEvery year, nearly half a million women and girls needlessly die as a result of complications during pregnancy, childbirth or the 6 weeks following delivery. Almost all (99%) of these deaths occur in developing countries. The study aim was to describe the factors related to low visits for antenatal care (ANC) services among pregnant women in Indonesia.MethodA total of 145 of 200 married women of reproductive age who were pregnant or had experienced birth responded to the questionnaire about their ANC visits. We developed a questionnaire containing 35 items and four sections. Section one and two included the womens socio demographics, section three about basic knowledge of pregnancy and section four contained two subsections about preferences about midwives and preferences about Traditional Birth Attendant (TBA) and the second subsections were traditional beliefs. Data were collected using a convenience sampling strategy during July and August 2010, from 10 villages in the Tanjung Emas. Multiple regression analysis was used for preference for types of providers.ResultsThree-quarter of respondents (77.9%) received ANC more than four times. The other 22.1% received ANC less than four times. 59.4% received ANC visits during pregnancy, which was statistically significant compared to multiparous (p = 0.001). Women who were encouraged by their family to receive ANC had statistically significant higher traditional belief scores compared to those who encouraged themselves (p = 0.003). Preference for TBAs was most strongly affected by traditional beliefs (p < 0.001). On the contrary, preference for midwives was negatively correlated with traditional beliefs (p < 0.001).ConclusionsParity was the factor influencing womens receiving less than the recommended four ANC visits during pregnancy. Women who were encouraged by their family to get ANC services had higher traditional beliefs score than women who encouraged themselves. Moreover, traditional beliefs followed by lower income families had the greater influence over preferring TBAs, with the opposite trend for preferring midwives. Increased attention needs to be given to the women; it also very important for exploring womens perceptions about health services that they received.

ANALYSES OF MOTHERS' SLEEP LOGS IN POSTPARTUM PERIODS

In order to investigate mothers’ sleep–wake patterns from five to 12 weeks in the postpartum period, we analyzed continuous sleep logs. Data for 341 days from seven mothers were analyzed for each postpartum week. There were significant differences in total sleep time and wake time at night. Wake time at night gradually decreased from the fifth to the twelfth week. These results from continuous sleep logs support the results of our previous polysomnographic findings based on intermittent measurements. A transition from interrupted sleep to non‐interrupted sleep was observed from the ninth to twelfth week of postpartum. The mothers’ sleep–wake patterns are discussed focusing on their relationships to the infants’ sleep–wake patterns and feeding rhythm.

Self-administered questionnaire versus interview as a screening method for intimate partner violence in the prenatal setting in Japan: a randomised controlled trial.

BackgroundIntimate partner violence (IPV) is a serious social issue in Japan. In order to start effective interventions for abused women, the appropriate method of screening for IPV in healthcare settings needs clarifying. The objective of this study was to compare the effectiveness of a face-to-face interview with a self-administered questionnaire. We used the Violence Against Women Screen (VAWS), a Japanese screening instrument for intimate partner violence (IPV), for identifying pregnant women who have experienced abuse.MethodsWe conducted a randomised controlled trial to screen participants at three points in time in a prenatal clinic in Tokyo, Japan. There were 328 consenting women between 14 and 25 weeks of pregnancy who were consecutively selected and randomly assigned to either the interview or self-administered questionnaire group. Both groups completed the same screening instrument three times during their pregnancy. The primary outcome was the total number of women identified by each screening method and the secondary outcome was the effect of the screening as measured by the womens comfort level and their expressed need to consult with the nurse.ResultsFor all three screenings, the identification rate in the interview group was significantly lower than that for the self-administered questionnaire group (relative risk 0.66, 95% CI 0.46 to 0.97), even after controlling for smoking (adjusted odds ratio 0.59, 95% CI 0.35 to 0.98). The two groups did not differ for secondary outcomes.ConclusionsThe self-administered questionnaire identified more IPV than the face-to-face interview when screening pregnant women in a Japanese prenatal clinic.Trial RegistrationUMIN-CTRC000000353

Mothers’ wakefulness at night in the post-partum period is related to their infants’ circadian sleep–wake rhythm

The relationship between a post‐partum mother’s wakefulness at night and her infant’s circadian sleep–wake rhythm was examined. The subjects were seven primipara and their infants. Actigraphic recordings for the mothers and their infants were made over three to five continuous days during Weeks 3, 6, 9 and 12. A 24‐h peak of autocorrelograms of the infants’ movements appeared in two cases at Week 6, in six cases at Week 9, and in seven cases at Week 12. The mothers’ night‐time movements significantly decreased from Week 3 to Week 12. Mothers’ wakefulness during night sleep in the post‐partum period is related to their infants’ obtaining circadian sleep–wake rhythm.

Rural Indonesia women's traditional beliefs about antenatal care.

BackgroundThe Indonesia Maternal Mortality Rate (MMR) of 420/100.00 live births remains among the highest in East Asia while coverage of births assisted by skilled providers is still low. Traditional beliefs have been a key factor associated with the choice between midwives or traditional birth attendants (TBA) and the low number of antenatal care visits in rural West Sumatra.MethodsWe conducted three focus groups with 16 women from rural West Java to describe their perception regarding issues related to traditional beliefs. Focus group discussions provided data for the content analysis.ResultsThe majority of the 16 women interviewed was from Village Dago, West Java and had only an elementary school education. Their ages ranged from 19 to 40 years. Most were multiparous housewives with an income of IDR 918.750 per month, which was lower than the monthly income in West Java (IDR. 1.172.060). Emerging from the focus group discussion were four main themes regarding their pregnancy and traditional beliefs: 1) pregnancy was a normal cycle in women’s life (pregnancy is a natural phenomena, not a sickness; no recognition of danger signs during pregnancy and death of baby or mother during pregnancy was brought about by God’s will); 2) women followed the traditional beliefs (positive motivation to follow the traditional beliefs and fear of not following the traditional beliefs); 3) relying on TBA called paraji rather than midwife (parajis are kind, tolerant and patient and have more experience than midwives; more accessibility than midwives and encouragement of natural birth) and 4) midwives are more secure than paraji; (they use a medical standard of care).ConclusionsWomen’s beliefs grounded in religion and tradition permeated the village culture making it difficult to counter their long held health practices with practices based on recent advances in health care. Use of TBA in this village was still dominant and women believed that following traditional beliefs led to a healthy pregnancy therefore, they also followed all relatives’ suggestions. Understanding the complexities of local culture is the first step to improving women’s awareness of how to preserve their pregnancy and prevent complications.

The relationship between women-centred care and women's birth experiences: A comparison between birth centres, clinics, and hospitals in Japan

OBJECTIVE the goal of women-centred care (WCC) is respect, safety, holism, partnership and the general well-being of women, which could lead to womens empowerment. The first step in providing WCC to all pregnant women is to describe womens perceptions of WCC during pregnancy in different health facilities. The objectives of this study were to ask (a) what are the perceptions and comparison of WCC at Japanese birth centres, clinics, and hospitals and (b) what are the relationships between WCC and three dimensions of womens birth experience: (1) satisfaction with care they received during pregnancy and birth, (2) sense of control during labour and birth, and (3) attachment to their new born babies. DESIGN this was a cross-sectional study using self-completed retrospective questionnaires. SETTING three types of health facility: birth centres (n=7), clinics (n=4), and hospitals (n=2). PARTICIPANTS participants were women who had a singleton birth and were admitted to one of the study settings. Women who were seriously ill were excluded. Data were analysed on 482 women. MEASUREMENTS instrumentation included: a researcher-developed WCC-pregnancy questionnaire, Labour Agentry Scale, Maternal Attachment Questionnaire, and a researcher-developed Care Satisfaction Scale. FINDINGS among the three types of settings, women who delivered at birth centres rated WCC highly and were satisfied with care they received compared to those who gave birth at clinics and hospitals. WCC was positively associated with womens satisfaction with the care they received. KEY CONCLUSIONS women giving birth at birth centres had the most positive perceptions of WCC. This was related to the respectful communication during antenatal checkups and the continuity of care by midwives, which were the core elements of WCC. IMPLICATIONS FOR PRACTICE health-care providers should consider the positive correlation of WCC and womens perception of satisfaction. Every woman should be provided continuity of care with respectful communication, which is a core element of WCC.

Comparisons of sleep patterns between mothers in post-partum from 9 to 12 weeks and non-pregnant women

In order to evaluate two patterns of interrupted and non‐interrupted sleep for the post‐partum mothers from 9 to 12 weeks after delivery, we compared them with sleep patterns of non‐pregnant women. Subjects were 10 primipara and 12 non‐pregnant women. Their polysomnographic recordings were made using a Medilog recorder at home. In interrupted sleep, low sleep efficiency, decreased total sleep time, and a decreased percentage of stage 2 were significantly observed compared with non‐pregnant women. Sleep parameters of non‐interrupted sleep, except for increased percentage of stage 4, did not show any significant differences from non‐pregnant women. Mothers’ sleep fluctuated between interrupted sleep similar to the early post‐partum sleep from 1 to 6 weeks and non‐interrupted sleep with increased stage 4.

Pregnant women's awareness of sensitivity to cold (hiesho) and body temperature observational study: A comparison of Japanese and Brazilian women

BackgroundSensitivity to cold (hiesho) is a serious health problem in Japan, yet it is minimally understood within Western cultures. The purpose of this study was to clarify the divergence between pregnant Japanese woman living in Japan and pregnant Brazilian women living in Brazil in awareness of hiesho and differences between core body and peripheral temperatures.MethodsThe subjects of this study were 230 pregnant Japanese women living in Japan and 200 pregnant Brazilian women living in Brazil. Data was collected in June/July and November 2005 in Japan and from October 2007 to February 2008 in Brazil. The survey methods consisted of measurement of deep body temperatures and questionnaires.Results67.0% of Japanese women and 57.0% of Brazilian women were aware of hiesho, which showed a significant difference between the Japanese and Brazilian women (p = 0.034). The difference between forehead and sole temperatures was 2.0°C among Japanese and 2.8°C among Brazilians in June-July (p = 0.01). But in November the difference between those temperatures was 5.2°C among Japanese and 2.8°C among Brazilians (p < 0.001).ConclusionsThere are differences between Japanese and Brazilians both in awareness of hiesho and in body temperatures.

Intimate partner violence against Japanese and non-Japanese women in Japan: a cross-sectional study in the perinatal setting.

AIM To identify the prevalence of intimate partner violence (IPV) against Japanese women (JW) and non-Japanese women (NJW) in a perinatal setting. Additional purposes were to identify the associated factors of IPV, describe the characteristics of IPV against NJW, and assess the acceptability of the Violence Against Women Screen (VAWS) instrument as a screening tool. METHODS A cross-sectional survey was conducted from September to November 2007 in an urban hospital maternity clinic in Tokyo, Japan. Women who attended the maternity clinic received the VAWS instrument, which was translated into four languages (Japanese with Kanji and Hiragana, English, Chinese, and Tagalog) and was used to identify IPV. RESULTS A total of 400 women participated in the study: 357 were JW and 43 were NJW. The prevalence rate of IPV among the JW was 31.4% and 21.4% among the NJW. There was no statistical significance between the two groups. A multiple logistic regression with adjusted odds ratio identified two associated factors for IPV: being multipara and previous experience of physical violence from a partner. CONCLUSION The prevalence of IPV was not statistically different among JW and NJW. Screening for IPV, early intervention, and support should be expanded in hospitals and maternity clinics in Japan.