Research Proposal

Knowledge, attitude and practice

of dietary intake among pregnant mother in
Antenatal Clinic, MHPP
GROUP 3
NSM Jalilawani Binti Kamaruzaman
NSM Rahayu Binti Ismail
NSM Suhaida Binti Daud
NSM Suhaila Binti Husain
NSM Muliyemalar a/p Subramaniam
CHAPTER 1
1.1 INTRODUCTION
Background
Adequate nutritional intake during pregnancy has been
recognized as an important factor for healthy pregnancy
and desired birth outcomes (Bawadia et al., 2010). It was
found that deficiency of nutrients during gestation may
cause the fetus to receive suboptimal micro and macro
nutrients, causing inadequate intrauterine growth and
development, inherited malformations, preterm
deliveries, and pregnancy complications may occur.
Thus, attention to appropriate dietary behavior
and proper nutrient intake will supply adequate
nourishment to achieve optimum health for both
mother and child (Wen et al., 2010).
Studies show that nutritional knowledge affects
the quality of food intake and also healthy
choices of purchased food (Verbeke, 2008).
Advancement of individual nutrition knowledge (NK)
provides new information which may stimulate
changing of attitude and subsequently result in
enhancement of dietary practices (De Vriendt et al.,
2009). Healthy nutritional behavior and adequate
dietary intake will provide required nutrients for both
mother and her child and result in their optimum
health during pregnancy.
Studies show that nutritional knowledge has
influence on the healthy selection of purchased or
consumed food and quality of food intake.
Improvement of personal nutrition knowledge (NK),
by providing new information possibly influences on
attitude and consequently results in alteration and
enhancement of dietary practices
It was found that women with higher knowledge of
nutrition displayed healthier dietary behavior of
fruit and vegetables intake. It was shown that,
nutrition knowledge was predictive of change in
dietary habits and health advices encouraged
expectant women to advance their food intake.
A number of studies have established that an
improvement in nutrition knowledge is an important tool
to stimulate dietary behavior that will promote healthy
weight in all generations. It has also been shown that
increasing ones knowledge in nutrition improves
attitudes, beliefs, and self-efficacy towards the
consumption of a healthy diet and a possible increase
in physical activity. Therefore, it is important to examine
the relationship between nutrition knowledge and the
consumption of a healthy diet in order to improve the
health status specifically among minority groups.
Though some solutions, such as food assistance programs,
have been proposed and implemented to ensure a healthy
diet among low-income earners many of these solutions
need to be localized in order to target specific populations. It
is evident that solutions that may work for a particular group
of people may not be helpful for others due to factors such
as the level of education, cultural beliefs, financial status,
and different ethnic food consumption. . Thus, to better
tailor nutrition interventions to a specific group, it is
important to understand the differences that exist between
the two largest minority groups.
1.2 PROBLEM STATEMENT
Malnutrition is inadequate intake of nourishing food or
consumption of a particular type of food item that has little
or no nutritional value (Jacinta A.Opara et.al 2011).
Malnutrition is a condition where nutrition is defective in
quantity or quality ( Sweet, D. 2006 cited in Jacinta
A.Opara et.al 2011). Sometimes, a pregnant women does
not know that she needs to eat a greater amount of quality
food. For a healthy pregnancy, steady supplies of micro
nutrients are essential both for mother and the growing
baby.
A mother who is underweight prior to becoming
pregnant also puts her baby at higher risk for
complications, mainly because of the association
between underweight status and malnutrition
(Ehrenberg et.al 2003 cited in Mustafa Kamal& Md
Aynul Islam 2010)). Malnutrition maybe due to
illness, food insecurity or others factor, and both the
malnutrition and the underlying cause need to be
address to maximize positive outcomes for both
mother and baby.
In some cases, underweight status before pregnancy
and failure to gain appropriate weight during pregnancy
may be a sign of either a preexisting eating disorder or
one that has developed during pregnancy. Regardless
of nutritional status, a BMI of less than 18.5 has been
associated with a higher risk of preterm delivery
(Hauger et.al,2008). In addition, one study found that
women with eating disorders were significantly more
likely than those without to be at risk for fetal growth
restriction, preterm labor, anemia and labor induction
(Bansil et.al,2008).
In Penang, statistic from Pejabat Kesihatan Daerah Barat
Daya, showed that the anemic cases among pregnant
women has increased in the year 2013; 18 mothers were
diagnosed in January and the number relatively
increased to 29 in October as reported by the said
department. Thus, it is interesting to examine the
knowledge, attitude and practice related to nutrition of
pregnant women
1.3 Significant of the research
Mother
Knowledge and practice of dietary intake can be improve so that to
be able to perform a healthier dietary intakes and positive
pregnancy outcomes.
Midwife
Help midwives make an early detection on mothers problem. Thus,
midwives can give education to the mother according to their
needs.
Institution
The research finding will help to establish better guidelines and
policy to patient needs. Thus, quality of care is improve, morbidity
and mortality rate will be reduced.
Research Objectives
General Objectives
1.4.1 To explore mothers knowledge, attitude and
practice regarding dietary intake during pregnancy
1.4 Research Objectives
1.4.1 To describe sociodemographic characteristic of
pregnant women.
1.4.2 To identify level of nutritional knowledge and
attitude of dietary intake among pregnant
women.
1.4.3 To determine the relationship between
sociodemographic data and nutrition in knowledge,
attitude and practice of dietary intake among
pregnant women.
1.5 Research questions
1.5.1 What is sociodemographic characteristic of
pregnant women
1.5.2 What level of nutritional knowledge, attitude
and belief of dietary intake among pregnant women.
1.5.3 What is relationship between nutrition
knowledge of pregnant women with their attitude
and belief.
Variable
Independent variable
Age
Race
Education level
Household income
Dependent variable
Knowledge
Attitude
Practice
1.5 Definition of terms
1) Knowledge
Facts, information, understanding and skills acquired by
a person through experience or education.
( The American Heritage Medical dictionary fourth edition
2009 cited in www.thefreedictionary.com 2009 )
2) Attitude
The way a person views something or tends to behave
towards it, often in an evaluation way.
(Collins English dictionary 2003 cited in
www.thefreedictionary.com 2003 )
3) Practise
To do or cause to do repeatedly in order to gain skill.
(Collins English dictionary 2003 cited in
www.thefreedictionary.com 2003)
1.7 Limitations of the Study
There is some limitations to complete this study such as time constraints
is the biggest problem. Due to constriction of time, the number of sample
for this study might not be enough, so it will difficult to find significant
relationships from the data.
Due to time constriction, we had limited scope the study regarding
antenatal dietary only knowledge and practice. In future, researchers
suggest to explore more scope of antenatal dietary among pregnant
women.
Limitation of financial aid to conduct this study as it is a self sponsored
research. This study will be only conducted in Antenatal Clinic MHPP as
it is a near to Nursing College Penang due to cost of transportation. If the
study can be expand to other hospital, sample will be larger and produce
more significant result.
LITERATURE REVIEW
CHAPTER 2
2.1 Introduction
In this chapter, the researcher will discussed
more detail about theory and model which is relate
with this research. Besides that, the researcher also
refer to previous research whether in this country or
outside this country. Researcher also provided
summary from previous research.
2.3 Review of previous research
Knowledge of antenatal nutrition
Most physicians and their patients understand that
proper nutrition during pregnancy is important, but
many are not aware of specific recommendations and
how to achieve these behaviors. In many cases,
healthcare providers simply tell women to eat a
healthy diet and gain appropriate weight during
pregnancy. However, to achieve this, healthcare
providers need to give women the tools and direction
to do so properly (Vause, Martz, Richard, &
Gralich,2006 cited in Jones, J. et.al 2010).
2.2 THEORITICAL GROUNDWORK
According to Conkin Dale ,2005 the theoretical
framework can be a conceptual model that is
used as a guide for the study.
Were focused on antenatal dietary and we
selected based on food pyramid 2010. The food
pyramid guidelines are summarized below:
4 to 8 servings of rice, noodles, breads, tubers, cereals
and cereal products will provide energy/calories to
mothers.
3 servings of vegetables and 2 servings of fruits (at
least one rich in vitamin C and one in vitamin A) to
provide fibre, vitamins and minerals to promote foetal
development.
2 servings of milk or dairy products (cheese, yogurt) to
provide calcium in building healthy foetal teeth, bones,
heart, nerves and muscle.
1 serving offish, 1 serving meat/ poultry and 1 serving
legumes.
6-8 glasses of water mainly plain water, and no more
than a cup of soft drink or coffee or tea per day to limit
caffeine intake.
Knowledge of antenatal
nutrition
2.3 REVIEW OF PREVIOUS
RESEARCH
Pregnant women have also expressed concern
regarding their doctors level of nutritional knowledge
and felt doctors did not have adequate time to discuss
nutrition concerns. Many indicated materials they
received at the doctors offices were not detailed
enough to meet their needs. According to Begley, A.
2002 cited in Jones, J. et.al 2010, suggests there is a
lack of consistent education on nutrition for pregnant
women and there is a need to design and implement
new more effective nutrition programs.
Attitude of antenatal nutrition
There are a number of reasons why pregnancy might
be a suitable time for encouraging dietary change.
First, women might change what they eat during
pregnancy because of physical symptoms and would
welcome any advice which will alleviate these; second,
they are responsive to health advice at this time and
third, they may actively seek health information. The
antenatal care system provides an excellent
opportunity to reach large numbers of healthy women
and, thus, influence the health of the next generation.
Research suggests that many factors including dietary
knowledge, discomfort, and doctor interaction influence
dietary behavior during pregnancy. Low and high levels
of calorie consumption may be affected by discomfort
(Dundas and Yarbro, 2000 cited in John, J.et.al 2010).
Pregnant women have reported eating small amounts of
food more frequently to counteract the feeling of fullness
during their third trimester, and because many believed
that their baby would be healthier if they ate more
frequently.
Furthermore, physical sensations associated with
food deprivation changed during pregnancy making
them feel hunger more often in some cases and less
in others (Fairburn & Welch, 1989 cited in John, J
et.al 2010)
Research supports the idea that knowledge
influences behavior. Increased nutritional knowledge
has been shown to contribute to increase changes in
healthy eating habits as well as healthier lifestyles
(Fahlman, Dake, McCaughtry, & Martin, 2008).
Petrini, Hamner, Flores, and Mulinare 2006 cited in
Jones, J et.al 2010 was reported that women who
were least likely to consume adequate amounts of
folic acid were those who had the least knowledge
about folic acid and its benefits for pregnancy, and
Shanker 2004 cited in Jones, J et.al 2010, found that
the second strongest indicator of females food
choices was nutritional knowledge.
RESEARCH
METHODOLOGY
CHAPTER 3
This chapter will discuss about setting of the
study, the design of the study, research
instrument that will be used by researchers,
ethical consideration, reliability and validity of
the study and how the collection io data will be
performand analyze.
3.1 Study setting
The study is conducted in Maternity Hospital Pulau
Pinang (MHPP). Study will be done at A ward and B
ward MHPP which is located in the state of Penang
Island and is the public hospital in north Malaysia and
it is the major referral centre.
3.2 Study design
According to Polit & Beck (2007), research design is
the overall plan for addressing a research question,
including strategies for enhancing the studys integrity.
To further the research, our study is designed as a
quantitative, non experimental, descriptive design
research proposal.
3.3 Population and sample
Probability sampling was used in this research study.
The target population comprised all the pregnant
women on the Antenatal Clinic MHPP. A total of 30
pregnant women in Antenatal Clinic MHPP will be
respondent. Questionnaire were sent to 30 pregnant
women in this clinic.
3.4 Research instrument
A structured questionnaire was developed by the
researcher. Respondents were assured of their
anonymity and freedom to decide whether to
participate in this study or not. Clear instructions were
given to the respondents regarding completion of
specific items throughout the questionnaire. The
questionnaire was divided into different section in
order to facilitate the processing of the data.
The questionnaire consisted of two section
containing mostly closed-ended questions.
Section A : Sociodemographic data questions
consisting of age, race, education level,
occupation and financial status. The aim of
including this information was to identify whether
there was relationship between the
sociodemographic data of pregnant women and
their intentions about dietary among pregnant
women.
Section B : Level of nutritional knowledge,
attitude and practise of dietary intake among
pregnant women question. There are 10
questions in these section.
Research tools
Research tools is refers to schedules or inventories
on which data from a research project can be
entered and stored for later analysis such of this
tools are paper and electronic tools (Watson
et,al.2008).
Our research tool that will be used in this research
project are papers, pen and the collected data will be
entered into our computer before the data will be
analysed.
3.5 Ethical consideration
The study was conducted after approval
permission from Maternity Hospital Pulau Pinang
(MHPP). Letter requesting permission to conduct
the study had been sent to them before starting
this study. The study was only started after the
researcher received written consent from them.
Therefore all researches that will be involved in
this research have been registered with National
Medical Research Registry ( NMRR ). The
researcher had asked for written consent from
respondents at Antenatal Clinic MHPP.
To answering the questionnaire, written consent
from respondents was taken as a verification that
they had agreed to participate in the study. The
study procedure, including risk and benefit will be
explained. Respondents were also informed that
their involvement in this study was voluntary and
they were allowed to refused to take part at
anytime. All of the information gathered were
strictly confidential and were only used for this
study.
3.7 Reliability and Validity
Validity is quality criteria that indicates the degree
of accuracy of study conclusions (Polit & Beck,
2004). Validity is the ability of an instrument to
measure what it is supposed to measure.
3.8 Collection of data
Data was collected using self-administered
questionnaires as to prevent any missing of the
data collection. There will be no time limit given
to them in completing the questionnaire. The
questionnaires were collected right after they
finished answering them.
3.9 ARRANGEMENT OF DATA
Organizing data into the table and graphs can
help make a data set more meaningful. However
this not provides as much information as
numerical measures. Hence a descriptive statistic
may useful to measure numerical data. The
collection data will be arranged into coding
system using numerical code
3.10 Data analysis
In our research, data entry and analysis were
completed using Statistical Package For Social
Science ( SPSS ) version 16.0.
4.0 Data Analysis
PART A: Demographic data finding.
Samples demographic data were analysed
using descriptive statistics to obtain the mode,
range and standard deviation
4.1 Introduction
During the study period a total of 30 samples
were collected to ascertain understanding,
knowledge, attitude and dietary intake among
women during pregnancy. From this sample we
analysis that dietary intake among pregnant
women need to be improve and able to perform
a healthier dietary intakes and positive
pregnancy outcomes.
Table 4.2.1 Distribution respondent
age
Age Group
Frequency Percent
Valid
Percent
Cumulative
Percent
Valid
15-21
5 16.7 16.7 16.7
22-27
2 6.7 6.7 23.3
28-33
15 50.0 50.0 73.3
34-39
8 26.7 26.7 100.0
Total
30 100.0 100.0
Table 4.2.2 Distribution
respondent race
Race
Frequency Percent
Valid
Percent
Cumulative
Percent
Valid
Malay
17 56.7 56.7 56.7
Chinese
4 13.3 13.3 70.0
Indian
9 30.0 30.0 100.0
Total
30 100.0 100.0
Table 4.2.3 Distribution respondent
education
Education
Frequency Percent
Valid
Percent
Cumulative
Percent
Valid
Primary
3 10.0 10.0 10.0
PMR
3 10.0 10.0 20.0
SPM/
STPM
19 63.3 63.3 83.3
Diploma
4 13.3 13.3 96.7
Degree
1 3.3 3.3 100.0
Total
30 100.0 100.0
4.2.4 Respondent Household
Income
Income
Frequency Percent
Valid
Percent
Cumulative
Percent
Valid
Below
RM1000
6 20.0 20.0 20.0
RM 1001-
RM2000
15 50.0 50.0 70.0
RM 2001-
RM 3000
5 16.7 16.7 86.7
Above
RM3001
4 13.3 13.3 100.0
Total
30 100.0 100.0
Table 4.2.5 Distribution
respondent parity
Parity Of category
Frequency Percent
Valid
Percent
Cumulative
Percent
Valid Primidgravida
7 23.3 23.3 23.3
Multiparous
15 50.0 50.0 73.3
Grand
multiparous
8 26.7 26.7 100.0
Total
30 100.0 100.0
Table 4.2.6 Distribution respondent
attending seminar or talk in dietary
intake
Attended any seminar or talk related to dietary intake
Frequency Percent
Valid
Percent
Cumulative
Percent
Valid
Yes 17
56.7 56.7 56.7
No
13 43.3 43.3 100.0
Total
30 100.0 100.0
4.2.7 Respondent preference source of
information about dietary intake
Printed material
Frequency Percent
Valid
Percent
Cumulative
Percent
Valid 1 5 16.7 16.7 16.7
2 14 46.7 46.7 63.3
3 11 36.7 36.7 100.0
Total 30 100.0 100.0
4.2.7 Respondent preference source of
information about dietary intake
Electronics
Frequency Percent
Valid
Percent
Cumulative
Percent
Valid
1
10 33.3 33.3 33.3
2
10 33.3 33.3 66.7
3
10 33.3 33.3 100.0
Total
30 100.0 100.0
4.2.7 Respondent preference source of
information about dietary intake
Clinic, hospital
Frequency Percent
Valid
Percent
Cumulative
Percent
Valid
1 15 50.0 50.0 50.0
2 6 20.0 20.0 70.0
3 9 30.0 30.0 100.0
Total 30 100.0 100.0
DISCUSSION
Our review is from aspects of age , race ,parity,
level of education and house hold income of our
samples . We also examine the women who exposed
to source of information in pregnancy like health
education by health worker, printed material or
electronics .
The most sample that has been taken is age
range 28-33 years old.
Malay is the highest race that has been taken.
Multiparous is the highest sample that has been
taken in MHPP.
In A and B ward education in SPM / STPM is the
highest in the sample.
Most of samples that has been taken is income
range RM1001-RM2000.
The most of samples preferred to get information
from health promoter via health education while
antenatal visit.There about 15 samples (50%).
Section B
Knowledge, attitude and practice on food
intake during pregnancy.
The survey findings related to section B to
measure the level of knowledge, attitude and
practice on food intake during pregnancy who
analyzed using descriptive statistics for the
frequency and percentage of respondents.
Section B
RECOMMENDATION
Training of Professionals
midwives should offer every woman information
and advice on importance of healthy dietary
Provide information on the benefits of a healthy
diet and practical advice on how to eat healthily
throughout pregnancy.
CONCLUSION
There is relationship between sociodemographic
data and knowledge , attitude and practice in
dietary intake among pregnant women.
These findings could help pregnant women to pay
more attention to their food intake patterns. As we
know health worker play importance roles in
giving health education.
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