DOI QR코드

DOI QR Code

Effects of a Pre-Conception Care Program in Women with Inflammatory Bowel Disease: A Mixed-Methods Study Including a Randomized Controlled Trial

  • Lee, Young Jin (College of Nursing, Eulji University) ;
  • Kim, Hae Won (College of Nursing, Seoul National University) ;
  • Kim, Yeon Hee (Department of Clinical Nursing, University of Ulsan) ;
  • Yang, Suk-Kyun (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Ji-Yeon (College of Nursing, Eulji University)
  • Received : 2024.01.25
  • Accepted : 2024.06.25
  • Published : 2024.08.31

Abstract

Purpose: The purpose of this study was to conduct a pre-conception care program for women of childbearing age with inflammatory bowel disease (IBD) in Korea and verify its effects on self-efficacy for IBD management, IBD-related pregnancy knowledge, and IBD-related pregnancy anxiety. It also aimed to explore the changes in participants through the program. Methods: A convergent mixed-methods study design was adopted. In the quantitative phase, 35 women (17 and 18 in the intervention and control group, respectively) participated. The intervention group attended a program that included small-group sessions and individual tele-coaching. To confirm the effects, data were collected before and one and four weeks after the intervention. In the qualitative stage, focus group interviews and tele-coaching were conducted with the intervention group. Results: After the program ended, significant differences were observed over time between the intervention and control groups for self-efficacy for IBD management (Wald χ2 = 4.41, p = .036), IBD-related pregnancy knowledge (Wald χ2 = 13.80, p < .001) and IBD-related pregnancy anxiety (Wald χ2 = 8.61, p = .003). Qualitative data analysis revealed the following themes: (1) improving confidence in IBD management and awareness for planned pregnancy; (2) improving IBD awareness related to pregnancy and childbirth; and (3) relieving anxiety about and actively facing pregnancy. Conclusion: This study is meaningful in that, to the best of our knowledge, it is the first to develop a pre-conception care program for women diagnosed with IBD and confirm its effectiveness. Furthermore, this program is expected to be suitable for patient counseling and education in clinical practice.

Keywords

Acknowledgement

This study was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (Grant No. 2018-R1A2B2-001231). This research was supported by the BK 21 Four Project (Center for World-Leading Human-Care Nurse Leaders for the Future) funded by the Ministry of Education (MOE, Korea) and National Research Foundation of Korea (NRF).

References

  1. Ng WK, Wong SH, Ng SC. Changing epidemiological trends of inflammatory bowel disease in Asia. Intestinal Research. 2016;14(2):111-119.  https://doi.org/10.5217/ir.2016.14.2.111
  2. Park SH, Kim YJ, Rhee KH, Kim YH, Hong SN, Kim KH, et al. A 30-year trend analysis in the epidemiology of inflammatory bowel disease in the Songpa-Kangdong district of Seoul, Korea in 1986-2015. Journal of Crohn's and Colitis. 2019;13(11):1410-1417.  https://doi.org/10.1093/ecco-jcc/jjz081
  3. O'Toole A, Nwanne O, Tomlinson T. Inflammatory bowel disease increases risk of adverse pregnancy outcomes: A meta-analysis. Digestive diseases and sciences. 2015;60(9):2750-2761.  https://doi.org/10.1007/s10620-015-3677-x
  4. Lee HH, Bae JM, Lee BI, Lee KM, Wie JH, Kim JS, et al. Pregnancy outcomes in women with inflammatory bowel disease: A 10-year nationwide population-based cohort study. Alimentary Pharmacology and Therapeutics. 2020;51(9):861-869. https://doi.org/10.1111/apt.15654
  5. Gawron LM, Sanders J, Steele KP, Flynn AD. Reproductive planning and contraception for women with inflammatory bowel diseases. Inflammatory Bowel Diseases. 2016;22(2):459-464.  https://doi.org/10.1097/mib.0000000000000606
  6. Marri SR, Ahn C, Buchman AL. Voluntary childlessness is increased in women with inflammatory bowel disease. Inflammatory Bowel Diseases. 2007;13(5):591-599.  https://doi.org/10.1002/ibd.20082
  7. Purewal S, Chapman S, Czuber-Dochan W, Selinger C, Steed H, Brookes MJ. Systematic review: The consequences of psychosocial effects of inflammatory bowel disease on patients' reproductive health. Alimentary Pharmacology and Therapeutics. 2018;48(11-12):1202-1212.  https://doi.org/10.1111/apt.15019
  8. Toomey D, Waldron B. Family planning and inflammatory bowel disease: The patient and the practitioner. Family Practice. 2013;30(1):64-68.  https://doi.org/10.1093/fampra/cms035
  9. Mahadevan U, Long MD, Kane SV, Roy A, Dubinsky MC, Sands BE, et al. Pregnancy and neonatal outcomes after fetal exposure to biologics and thiopurines among women with inflammatory bowel disease. Gastroenterology. 2021;160(4): 1131-1139. https://doi.org/10.1053/j.gastro.2020.11.038
  10. Akiyama S, Steinberg JM, Kobayashi M, Suzuki H, Tsuchiya K. Pregnancy and medications for inflammatory bowel disease: An updated narrative review. World Journal of Clinical Cases. 2023;11(8):1730-1740.  https://doi.org/10.12998/wjcc.v11.i8.1730
  11. Lee KE, Jung SA, Yoon H, Park SH, Moon CM, Kim ES, et al. Factors associated with pregnancy-related knowledge in women of reproductive age with inflammatory bowel disease. Scandinavian Journal of Gastroenterology. 2017;52(8):833-839. https://doi.org/10.1080/00365521.2017.1310288
  12. Selinger CP, Eaden J, Selby W, Jones DB, Katelaris P, Chapman G, et al. Patients' knowledge of pregnancy-related issues in inflammatory bowel disease and validation of a novel assessment tool ('CCPKnow'). Alimentary Pharmacology Therapeutics. 2012;36(1):57-63.  https://doi.org/10.1111/j.1365-2036.2012.05130.x
  13. Yerushalmy-Feler A, Ron Y, Barnea E, Nachum A, Matalon S, Dali-Levy M, et al. Adolescent transition clinic in inflammatory bowel disease: Quantitative assessment of self-efficacy skills. European Journal of Gastroenterology and Hepatology. 2017;29(7):831-837.  https://doi.org/10.1097/meg.0000000000000864
  14. Bandura A. The explanatory and predictive scope of self-efficacy theory. Journal of Social and Clinical Psychology. 1986;4(3):359-373. https://doi.org/10.1521/jscp.1986.4.3.359
  15. Magharei M, Jaafari S, Mansouri P, Safarpour A, Taghavi SA. Effects of self-management education on self-efficacy and quality of life in patients with ulcerative colitis: A randomized controlled clinical trial. International Journal of Community Based Nursing and Midwifery. 2019;7(1):32-42. https://doi.org/10.30476/ijcbnm.2019.40844
  16. Creswell JW, Plano Clark VL, Gutmann ML, Hanson WE. Advanced mixed methods research designs. In: Tashakkori A, Teddlie C, editors. Handbook of Mixed Methods in Social and Behavioral Research. SAGE Publishing; 2003. p. 209-240.
  17. Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials. Journal of Pharmacology and Pharmacotherapeutics. 2010;1(2):100-107.  https://doi.org/10.4103/0976-500x.72352
  18. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods. 2009;41(4):1149-1160.  https://doi.org/10.3758/brm.41.4.1149
  19. Keefer L, Kiebles JL, Taft TH. The role of self-efficacy in inflammatory bowel disease management: Preliminary validation of a disease-specific measure. Inflammatory Bowel Diseases. 2011;17(2):614-620.  https://doi.org/10.1002/ibd.21314
  20. World Health Organization (WHO). Process of translation and adaptation of instruments [Internet]. WHO; c2018 [cited 2024 Mar 15]. Available from: https://www.coursehero.com/file/30372721/WHO-Process-of-translation-and-adaptation-of-instrumentspdf/.
  21. Huang VWM. Reproductive knowledge specific to inflammatory bowel disease among women with IBD and physicians who treat women with IBD [master's thesis]. Alberta (AB): University of Alberta; 2014. p. 1-402.
  22. Lee YJ, Oh EG. Body image, self esteem, and health related quality of life in patients with Crohn's disease. Korean Journal of Adult Nursing. 2014;26(4):383-392.  https://doi.org/10.7475/kjan.2014.26.4.383
  23. Jeong P, Woo SM. 5R coaching leadership. Asia Coach Center; 2012. p. 1-127.
  24. Lee YJ, Kim YH, Kim HW. Preconception care program for women with inflammatory bowel disease using intervention mapping: A protocol for program development. International Journal of Environmental Research and Public Health. 2020;17(24):9365. https://doi.org/10.3390/ijerph17249365
  25. Ziegler A, Vens M. Generalized estimating equations. Methods of Information in Medicine. 2010;49(5):421-425.  https://doi.org/10.3414/ME10-01-0026
  26. Elo S, Kyngas H. The qualitative content analysis process. Journal of Advanced Nursing. 2008;62(1):107-115.  https://doi.org/10.1111/j.1365-2648.2007.04569.x
  27. Sandelowski M. The problem of rigor in qualitative research. Advances in Nursing Science. 1986;8(3):27-37.  https://doi.org/10.1097/00012272-198604000-00005
  28. Maeda E, Nakamura F, Kobayashi Y, Boivin J, Sugimori H, Murata K, et al. Effects of fertility education on knowledge, desires and anxiety among the reproductive-aged population: Findings from a randomized controlled trial. Human Reproduction. 2016;31(9):2051-2060.  https://doi.org/10.1093/humrep/dew133
  29. Mountifield R, Andrews JM, Bampton P. It IS worth the effort: Patient knowledge of reproductive aspects of inflammatory bowel disease improves dramatically after a single group education session. Journal of Crohn's and Colitis. 2014;8(8):796-801.  https://doi.org/10.1016/j.crohns.2013.12.019
  30. Gandomi N, Sharifzadeh G, Torshizi M, Norozi E. The effect of educational intervention based on self-efficacy theory on pregnancy anxiety and childbirth outcomes among Iranian primiparous women. Journal of Education and Health Promotion. 2022;11(1):14.  https://doi.org/10.4103/jehp.jehp_1548_20
  31. Mukherjee S, Sloper P, Turnbull A. An insight into the experiences of parents with inflammatory bowel disease. Journal of Advanced Nursing. 2002;37(4):355-363.  https://doi.org/10.1046/j.1365-2648.2002.02098.x
  32. Sajadinejad MS, Asgari K, Molavi H, Kalantari M, Adibi P. Psychological issues in inflammatory bowel disease: An overview. Gastroenterology Research and Practice. 2012;2012:106502. https://doi.org/10.1155/2012/106502
  33. Yu A, Friedman S, Ananthakrishnan AN. Incidence and predictors of flares in the postpartum year among women with inflammatory bowel disease. Inflammatory Bowel Diseases. 2020;26(12):1926-1932. https://doi.org/10.1093/ibd/izz313
  34. Malhi G, Tandon P, Perlmutter JW, Nguyen G, Huang V. Risk factors for postpartum disease activity in women with inflammatory bowel disease: A systematic review and meta-analysis. Inflammatory Bowel Disease. 2022;28(7):1090-1099. https://doi.org/10.1093/ibd/izab206
  35. Con D, De Cruz P. Mobile phone apps for inflammatory bowel disease self-management: A systematic assessment of content and tools. JMIR Mhealth Uhealth 2016;4(1):e13.  https://doi.org/10.2196/mhealth.4874