Understanding how women learn during pregnancy is the foundation for planning prenatal education programs. To date, adult educators have not investigated, in any depth, the learning process during pregnancy. The purpose of this study was to examine learning during pregnancy and relate this learning to learning outcomes. The principal research questions were: "What are the learning patterns of pregnant women?" and "What is the relationship between learning and health behavior of pregnant women?" It is unknown whether learning during pregnancy is directly associated with behavior or mediated through health beliefs. The objectives of this research were to identify pregnant women's health behaviors, learning patterns, and health beliefs. The three health behaviors examined in this study were eating, drinking, and smoking. These behaviors were operationalized in terms of their outcomes: weight gain, alcohol consumption, and tobacco use. These factors are amenable to an education intervention and are behavioral risk factors associated with low birth weight. The process of investigating learning patterns consisted of identifying: what was learned during the pregnancy, which resources were utilized, what advice was given, what amount of time was spent in learning, who initiated the learning episodes, and what learning transaction types emerged. Determining learning transaction types was based upon an adaptation of Tough's (1979) concept of planners and Knowles's concept of self-directed learners. The process of investigating health beliefs consisted of identifying pregnant women's concerns, perceived risk, perceived use of the information, and perceived barriers, defined according to an adaptation of the Health Belief Model. The principal hypotheses of the study were: (1) self-initiated learning will be positively correlated with knowledge scores, (2) self-initiated learning will be positively correlated with ideal health behaviors, and (3) health beliefs will be positively correlated with ideal health behaviors: ideal weight gain during pregnancy, reduced alcohol consumption, and reduced cigarette smoking. The research, an ex post facto design, involved a one hour structured interview with women within the week following delivery of their infants in hospital. A proportional sample of 120 primigravidas was selected from seven hospitals with average number of monthly births greater than 100. Reporting of results was based upon 120 interviews conducted as part of the main sample and eight interviews conducted during the pilot study. Pilot responses were included because these responses were similar to responses provided by the main sample, with the exception of health belief data. One case was excluded from the sample, making for N = 127. Data analyses were based upon the entire sample N = 127, with the exception of health belief measures. Since alcohol and smoking health belief questions were administered to drinkers and smokers and since health belief measures related to weight gain, alcohol, and smoking were missing data, health belief analyses were based upon N=123 for weight gain, N = 88 for alcohol, and N = 43 for smoking. Women had spent an average of forty-one hours learning about weight gain, alcohol consumption, and tobacco use during pregnancy. The principal resources used were: reading materials, physicians, family members, and prenatal classes. The majority of pregnant women had engaged in other-initiated learning episodes in the one to one setting, that is with a health professional, family member, or friend. Self-initiated learning about weight gain was associated with higher knowledge scores and ideal prenatal weight gain (p≤0.05); and, weight gain health beliefs were negatively correlated with ideal prenatal weight gain (p≤0.05). Finding a negative correlation, in contrast to the predicted positive correlation, may have been due to the fact that in a retrospective study the behavior precipitated reporting of health beliefs. Other-initiated learning about alcohol was associated with higher knowledge scores and reduced alcohol intake (p≤0.05); however, alcohol health beliefs were not associated with reduced alcohol intake. For smoking, neither self-initiated nor other-initiated learning was associated with knowledge scores or reduced cigarette smoking; however, a low degree of perceived risk was predictive of reduced cigarette smoking (p≤0.05). Knowledge about tobacco use was positively correlated with health beliefs, suggesting that learning may be indirectly related to smoking behaviors. This study contributes to the knowledge about learning during pregnancy by providing a descriptive profile of learning patterns during pregnancy, and by examining the relationship between learning, health beliefs, and behavior. Fostering a learning environment which stimulates self-initiated learning may assist women reach ideal weight gain during pregnancy. For alcohol, encouraging health professionals, family members, and friends to initiate learning about the hazards of consuming alcohol during pregnancy seems warranted. Self-initiated learning may not be superior to other-initiated learning but may be topic specific, due to the nature of the health behaviors examined. Identification of women's smoking health beliefs seems warranted during prenatal education. Further research is required to better understand the role of learning with respect to changing smoking behaviors during pregnancy. / Education, Faculty of / Educational Studies (EDST), Department of / Graduate

Intrauterine infection with the oral commensal anaerobe Fusobacterium nucleatum has been associated with adverse pregnancy outcomes. We have previously established a mouse model to study the mechanism of hematogenous F. nucleatum leading to fetal and neonatal death. Here, we report that Toll-like Receptor 4 (TLR4) from the maternal rather than paternal, and endothelial rather than hematopoietic cells mediate placental inflammation, especially the production of the proinflammatory cytokine interleukin-1 beta. Downstream of TLR4, a spatiotemporal pattern of the transcription factor NF-kB activation was observed spreading from the decidual endothelium to the surrounding spongiotrophoblasts within the first six hours of infection. Maternal TRIF, an adaptor protein downstream of TLR4 pathway, but not NLRP3, a cytosolic signaling receptor that constitutes inflammasome complex, mediated the fetal and neonatal death. In an effort to find a prophylactic preventive method against the detrimental birth outcome induced by F. nucleatum placental infection, omega-3 fatty acids were tested for their anti-inflammatory properties. Omega-3 oil supplementation in pregnant mice inhibited the transcription and release of inflammatory cytokines, prevented fetal and neonatal death, and also suppressed the proliferation of F. nucleatum in the placenta. Moreover, omega-3 supplementation was shown to enhance neutrophil recruitment to the site of infection. However, omega-3 supplementation did not protect the pregnancy from Listeria monocytogenes infection in vivo, despite the in vitro results where inflammation induced by both Gram-negative and Gram-positive bacteria were suppressed by omega-3 fatty acids. This study presents the first direct evidence of maternal, rather than fetal, signal leading to adverse pregnancy outcome, and suggests an exciting therapeutic potential of dietary omega-3 fatty acids.

This dissertation investigates the pressing issue of education in cardiac arrest during pregnancy, an emergency of life-threatening significance that necessitates a coordinated response from maternal and neonatal healthcare teams. The study encompasses three primary chapters, each addressing a crucial facet of this intricate scenario. In the chapter titled "Cardiac Arrest in Pregnancy: A Scoping Review on Knowledge and Confidence in a Maternal & Neonatal Response," an extensive examination of existing literature illuminated substantial knowledge gaps in the resuscitation of pregnant individuals, a concern that has persisted for over a decade. These gaps encompass critical domains, including a dearth of high-quality research with a heavy reliance on limited experimental designs, small sample sizes that curtail the generalizability of findings, a lack of comprehensive comparisons among various teaching strategies for enhancing knowledge and confidence, an emphasis on short-term outcomes without adequate longitudinal assessments of knowledge retention and clinical impact, a need for tailored education programs catering to diverse healthcare professionals, and a scarcity of research on collaborative learning experiences, particularly concerning neonatology teams. These identified gaps offer valuable opportunities for future research aimed at fortifying the evidence base, refining educational approaches, and ultimately enhancing the management of cardiac arrest during pregnancy and neonatal resuscitation. This manuscript underscores the pressing need to expand educational initiatives beyond obstetrical units and to foster interdisciplinary collaboration among healthcare teams. The chapter titled, "Escaping PowerPoint: Enhancing Knowledge, Satisfaction, and Self-Confidence in Cardiac Arrest in Pregnancy," introduces an innovative teaching strategy known as the Virtual Escape Room (VER). The randomized controlled study compares the effectiveness of this virtual gamified approach with a traditional online PowerPoint method in improving knowledge acquisition, learner satisfaction, and self-confidence. The findings demonstrate the statistically significant superiority of the VER in enhancing these critical outcomes, highlighting the potential of immersive learning experiences in healthcare education. Notably, the data reveal a substantial increase in mean scores from the knowledge pre-test (M = 59.58, SD = 16.30) to the knowledge post-test (M = 68.24, SD = 17.42), t(64) = 5.635, p < .001 . The assessment tools employed included a knowledge quiz and The National League for Nursing (NLN) Student Satisfaction and Self-Confidence instruments. The chapter titled "Puzzling Out the Correlates of Learner Engagement and Exploring Motivational States within a Virtual Escape Room," delves into the intricate aspects of learner engagement within the gamified learning environment of the VER. It uncovers the relationships between engagement, learner satisfaction, and specific engagement components such as enjoyment, creative thinking, and dominance. This manuscript underscores the multifaceted nature of engagement and highlights the imperative need for further research to achieve a more profound comprehension of its role in shaping learning outcomes. The study employed the Gameful Experience Scale (GAMEX) and the Telic/Paratelic State Measure (TPSI) instrument. Notably, statistically significant positive correlations were observed, including r = 0.346 (p = 0.005) between the Enjoyment Score and knowledge post-test, r = 0.305 (p = 0.013) between the Creative Thinking Score and knowledge post-test, and r = 0.255 (p = 0.04) between the Dominance Score and knowledge post-test. Additionally, a significant interaction effect emerged between the T/PSI score (pre vs. post) and the educational intervention (VER vs. control group). T/PSI score increased from 35.83 (SD = 8.67) before the intervention to 38.86 (SD = 9.91) after the intervention, indicating a substantial change. In contrast, there was no statistically significant difference in T/PSI scores before and after the traditional PowerPoint intervention for the control group, where the mean scores changed from 35.89 (SD = 7.02) to 35.57 (SD = 7.94). These findings strongly suggest that the VER condition contributes to a paratelic state among participants when compared to the control condition. This dissertation underscores the paramount importance of effective education in managing cardiac arrest during pregnancy, given the persistent knowledge gaps among resuscitation teams. The introduction of the VER as an innovative educational strategy represents a significant advancement in addressing these deficits. Furthermore, the exploration of engagement and motivational states within the gamified learning environment offers valuable insights into the complexities of learner engagement, paving the way for more effective educational strategies in healthcare settings. Ultimately, these findings have the potential to empower healthcare teams, potentially reducing maternal mortality rates and improving neonatal outcomes in the face of this critical emergency.

Studies have shown that pregnant women do understand and value information of their unborn child. However, those providing health promotion services often focus on medical procedures and health education messages, ignoring the cultural, socio-economic and psychological dimensions that impact on women's health. This research aimed to look at a specific component of health promotion, i.e. health promotion messages shared with pregnant women attending Stellenbosch and Klapmuts Community Health Centre Antenatal Health Promotion Programme and their perceptions of how they apply messages in their daily lives.

Thesis (M.CUR.) -- University of Limpopo, 2014 / Indigenous practices (IPs) are experiences generated by people who are living in a specific region context and a specific cultured group. IPs are shaped by cultural traits that are passed from one generation to the next. The practices are rooted and embedded in such a society and, therefore, the practices become part of the people’s lifestyle. It is difficult to try and change these practices, since people have adhered to them throughout their entire lives. The believe system plays a major role in health care seeking behaviour of individuals because they are informed by the IPs that are observed in their environment (Shaik & Hatcher, 2005). IPs are stored in people’s memories and are expressed in songs, dances, beliefs, rituals, cultural values, myths, and healing of diseases by using herbs. During pregnancy, IPs are still applied worldwide. Ayaz and Efe (2008) indicate that it occurs mostly in Turkey and Africa where women’s reassurance is depending on the local context and meaning of pregnancy. THE PURPOSE OF THE STUDY To determine indigenous practices of pregnant women at the Dilokong Hospital in the Greater Tubatse Municipality of the Limpopo Province.This was achieved by the exploring and describing the indigenous practices of pregnant women in the antenatal (ANC) clinic of the maternity ward at the Dilokong Hospital.. DESIGN AND METHOD A qualitative, descriptive, explorative and contextual research design was used for the participants to describe the indigenous practices by pregnant women. Data was collected by means of unstructured one-on-one interviews in maternity unit of the ANC clinic at the Dilokong Hospital of the Greater Tubatse Municipality. Ethical considerations as described by Denosa (2000) were adhered to in order to ensure the v quality of the study. The criteria for trustworthiness were observed as stipulated in Babbie and Mouton (2009).Fifteen pregnant women were interviewed. FINDINGS AND RECOMMENDATIONS Four themes with sub-themes emerged from the data analysis by using Tech’ṡ open coding approach (Creswell 2006, Botma, Greef, Mulaudzi & Wright, 2010). Four themes were emerged namely; indigenous practices based on ancestral knowledge; indigenous practices based on spiritual diviners versus church principles; restricted practices versus instructions followed during pregnancy and labour and indigenous practices during labour and delivery. It is recommended that a national IP strategy needs to be developed to provide a framework and platform to support and promote grass roots IPs into mainstream development in the health care system in relation to midwifery practice. CONCLUSION The study findings indicated that IPs were regarded as an honourable health intervention by THPs, families, and pregnant women. They showed trust in methods used to preserve pregnancy, labour, and delivery, although, the indigenous practices by pregnant women still continue. Indigenous practices such as cords around their waists, are still observed during physical examinations. However, there is a reduction of prescribed potions mixed with cool drinks for use to accelerate labour and to prevent negative consequences because the potential toxicity has been explained during the provision of health education. These findings call for health care professionals to emphasise training and workshops for the THPs church diviners that are the fundamental principle of effective implementation of IPs to enhance improvement in the prevention of complications during pregnancy, labour and delivery. KEYWORDS Pregnant women Indigenous practice Indigenous knowledge Antenatal care

Overweight and obesity are a growing national concern, particularly among women and selected minority populations (Ayala, Elder, Campbell, Slymen, Roy, Engelberg, et al., 2004; NHANES, 2003). Pregnant women bear a disproportionate risk of becoming overweight or obese (Greene, Smickikias-Wright, Scholl, & Karp, 1988; Gunderson et al., 2000; Rossner, 1999). Although exercise is a key factor in preventing overweight and obesity, women often decrease their exercise levels during pregnancy (McTigue, Garrett, & Popkin, 2002; Viau, Padula, & Eddy, 2002; Zhang & Savitz, 1996). Reported percentages of regular exercise during pregnancy have been documented as low as 5% in a predominately White population (Steele, 2002). Although there is ample evidence demonstrating that Hispanic women exercise less than White women during every other stage of life, little is known about how pregnant Hispanic and White women compare in exercise behaviors (Crespo, Smit, Andersen, Carter-Pokras, & Ainsworth, 2000). The purpose of this research was to study low-income White and Hispanic pregnant women to (1) determine the nature and the extent of exercise behaviors both before pregnancy and during pregnancy (2) identify factors that influence exercise behaviors (3) determine if there are differences in factors that influence exercise between ethnicities. Data were collected via a questionnaire developed by the author. A sample of 301 White and Hispanic pregnant women were recruited through the Women, Infants, and Children [WIC] agencies in four selected counties in Oregon. Although ACOG guidelines provide clear information on the benefits of exercise, over 90% of the women surveyed did not exercise at ACOG guidelines. A majority of the women, 57.8%, actually decreased exercise during pregnancy. Although ethnic differences did not exist in the prevalence of exercise during pregnancy, differences between ethnicities were found in the variety of exercise activities performed and behavioral factors that predicted exercise behavior. Analysis of these differences and the factors contributing to the overall low levels of exercise may provide critical information for future intervention program planning. Well targeted programs will ultimately decrease the excessive weight gain and subsequent increased risk for overweight or obesity that pregnant women face. / Graduation date: 2006

published_or_final_version / Buddhist Studies / Doctoral / Doctor of Philosophy

The health of pregnant women is a major concern to health care providers. This grounded theory study of 40 women examined the health of pregnant women and the special threat that poverty and violence posed to their capacity for health. Pregnant women experienced their health as an integrated part of their daily lives; that is, they reported that their health was affected by 'everybody and everything." Women's main concern during pregnancy was to have a healthy newborn and, to this end, they engaged in the process of creating a healthy pregnancy by engaging in health-enhancing behaviours. In this process, the woman focused primarily on ensuring the birth of a healthy baby. Three conditions were essential to a woman's capacity to create a healthy pregnancy: (1) the acceptance of the pregnancy, (2) adequate financial resources, and (3) supportive relationships (especially having a supportive partner). Pregnancies invariably carried with them some uncertainty, and this caused the 40 women in this study to experience a state of vulnerability which, in turn, triggered attempts to create healthy pregnancies. This led to a cycle of improving health: the more energy women had to carry out health-enhancing behaviours the better they felt physically and mentally; the more able they were to conduct their daily activities; and, consequently, the better their health. However, living within a context of poverty and/or violence increased pregnant women's vulnerability and decreased their capacity for creating a healthy pregnancy, leading to extreme stress and the experience of threat. Male violence threatened the women's ability to be connected to those who were important sources of emotional, financial, task-oriented, and knowledge-oriented support, and, thus jeopardized their ability to meet their fundamental needs. Furthermore, the lack of sufficient financial resources limited women's abilities to leave their abusive partners. In order to survive, women in these circumstances sometimes reverted to previous, often harmful, ways of coping in an attempt to reduce their high levels of stress. These coping strategies usually took the form of behaviours that required little energy, such as smoking, not eating properly, and consuming alcohol. Having financial support and a safe place to go were crucial with regard to enabling women to decide to leave abusive partners. Regaining control of their lives in this way allowed women to refocus their energy on health-enhancing behaviours. The women in this study showed incredible strength as they met the challenges imposed by poverty and abuse. They did not remain victims but took hold of their lives with courage and conviction. In order to promote the adoption of health-enhancing behaviours by childbearing women, health care providers must recognize poverty and violence as factors that significantly threaten women's capacity for health. Further to this, special efforts must be made to render culturally sensitive care to First Nations women (i.e., recognizing their cultural identity and heritage, their connection to nature, and the importance of the elders of their community). To this end, we must recognize the connections between racism, colonization, poverty, and violence. For until we have eradicated poverty, and the cycle of violence and degradation that is its legacy, we will not have succeeded in doing all we can to ensure the health and well being of our citizens.

Studies have shown that pregnant women do understand and value information of their unborn child. However, those providing health promotion services often focus on medical procedures and health education messages, ignoring the cultural, socio-economic and psychological dimensions that impact on women's health. This research aimed to look at a specific component of health promotion, i.e. health promotion messages shared with pregnant women attending Stellenbosch and Klapmuts Community Health Centre Antenatal Health Promotion Programme and their perceptions of how they apply messages in their daily lives.

The health of pregnant women is a major concern to health care providers. This grounded theory study of 40 women examined the health of pregnant women and the special threat that poverty and violence posed to their capacity for health. Pregnant women experienced their health as an integrated part of their daily lives; that is, they reported that their health was affected by 'everybody and everything." Women's main concern during pregnancy was to have a healthy newborn and, to this end, they engaged in the process of creating a healthy pregnancy by engaging in health-enhancing behaviours. In this process, the woman focused primarily on ensuring the birth of a healthy baby. Three conditions were essential to a woman's capacity to create a healthy pregnancy: (1) the acceptance of the pregnancy, (2) adequate financial resources, and (3) supportive relationships (especially having a supportive partner). Pregnancies invariably carried with them some uncertainty, and this caused the 40 women in this study to experience a state of vulnerability which, in turn, triggered attempts to create healthy pregnancies. This led to a cycle of improving health: the more energy women had to carry out health-enhancing behaviours the better they felt physically and mentally; the more able they were to conduct their daily activities; and, consequently, the better their health. However, living within a context of poverty and/or violence increased pregnant women's vulnerability and decreased their capacity for creating a healthy pregnancy, leading to extreme stress and the experience of threat. Male violence threatened the women's ability to be connected to those who were important sources of emotional, financial, task-oriented, and knowledge-oriented support, and, thus jeopardized their ability to meet their fundamental needs. Furthermore, the lack of sufficient financial resources limited women's abilities to leave their abusive partners. In order to survive, women in these circumstances sometimes reverted to previous, often harmful, ways of coping in an attempt to reduce their high levels of stress. These coping strategies usually took the form of behaviours that required little energy, such as smoking, not eating properly, and consuming alcohol. Having financial support and a safe place to go were crucial with regard to enabling women to decide to leave abusive partners. Regaining control of their lives in this way allowed women to refocus their energy on health-enhancing behaviours. The women in this study showed incredible strength as they met the challenges imposed by poverty and abuse. They did not remain victims but took hold of their lives with courage and conviction. In order to promote the adoption of health-enhancing behaviours by childbearing women, health care providers must recognize poverty and violence as factors that significantly threaten women's capacity for health. Further to this, special efforts must be made to render culturally sensitive care to First Nations women (i.e., recognizing their cultural identity and heritage, their connection to nature, and the importance of the elders of their community). To this end, we must recognize the connections between racism, colonization, poverty, and violence. For until we have eradicated poverty, and the cycle of violence and degradation that is its legacy, we will not have succeeded in doing all we can to ensure the health and well being of our citizens. / Applied Science, Faculty of / Nursing, School of / Graduate