The authors have declared that no competing interests exist.
Parent’s level of knowledge, state of their attitude, and their self-efficacy are the most incriminated reasons for the faulty application of the first aid measures, particularly in children's home injuries.
To assess the effect of a health education intervention on improving knowledge, attitude and self- efficacy of mothers having preschool children about home injuries and the basic first aid measures.
A pre-posttest evaluation of the effect of a health education intervention on changing knowledge, attitude, and self-efficacy about home injuries and the basic first aid measures of 244 rural Egyptian mothers having preschool children.
About 35% of the male children had home injuries 8 weeks earlier to the study. Mean score of total knowledge increased from 10.21±3.1 in pretest to 18.90 ± 2.6 in posttest, total attitude from 6.19±1.8 to 10.26±2.3 and self-efficacy from 20.75±6.1 to 34.43 ± 10.1 with (p < 0.001) for all changes. Age, education level and previous home injuries were the significant predicting factors for total knowledge, attitude and self- efficacy of the mothers.
Health education improves knowledge, attitude, and self-efficacy of the mothers which were obvious regarding home injuries than first aid measures. There is a need for including knowledge about home injuries in the educational curriculum of high schools and universities and to perform training courses to mothers about first aid measures.
Accidents represent a global community health problem with its consequences of morbidities and mortalities [
In Egypt, home injuries have turned into a general public health issue and the main cause disabilities in preschool age [
Home injuries reflect the character and lifestyle of people, where a new pattern of injury emerges with every new technical or cultural change [
The most challenging duty for mothers is to provide a safe environment for their children to minimize or prevent injury [
First aid is providing an immediate care for an illness or injury, by a trained but not- specialized person, until getting the specific medical treatment [
Pre-posttest health education intervention was conducted over 5 months (from June to the end of October) 2016, in "El Ghar village- Zagazig district-Sharkia governorate", which was randomly selected by a simple random sampling technique out of 74 rural villages in Zagazig district. El Ghar village is a small village, with population size about 10152, including 5944 male and 4208 female [
The subjects recruited for this study were only; mothers having at least one preschool child within the age from 1 till 5 years old, literate and willing to participate in this study. Those who didn't have any preschool child, or have any mental disorder, or refused to participate were excluded from this study sample.
The sample size was computed using Epi info 7 program depending on; 95% confidence limit, power of 80%, effect size represented in the mean difference of self-efficacy from pre to post test 2.3 as reported from a similar previous study [
Cluster random sample was used for choosing the mothers, "El Ghar village" has been divided into 5 squares depending on boundaries determined during polio campaigns, from which 3 squares were chosen randomly, then systematically every 5th house within the streets was visited, and all mothers who met the inclusion criteria were invited to join this research.
A Structured anonymous self-administrated pre-posttest questionnaire was developed to assess knowledge, attitude, and self-efficacy of the mothers toward the common home injuries among preschool children (poisoning by drugs and chemicals, burns, wound/ facture and chocking), it was divided into different parts:
General characteristics of the participants: including; mother’s age, education, occupation, family size, the number of children and their genders, the occurrence and the type of home injury if any, 8 weeks earlier to the study.
Knowledge of the mothers: about the predisposing factors, ways of prevention of the selected types of injuries and the immediate measures that should be taken, were tested by 25 questions; 4 questions were related the general knowledge about home injuries, 5 questions were related to drug & chemical poisoning, 5 question for burns, 6 for wound/ fracture and 5 for choking. Each question has to be answered either by Yes, No or I don't know. The answer with Yes was scored as "1", while both answers with No or I don't know were scored as "0", resulting in a range of knowledge ranging from 0–25. At the end of the knowledge section, they were asked to assign the source of their knowledge.
Mother’s attitude: in case of exposure to home injuries, this section includes 11 question, the response was measured with a modified 3 point Likert scale (0: disagree, 1: neutral and 2: agree), every mother has the chance to gain a score ranging from 0 to 22.
The above parts of the questionnaire designed by the researchers based on questionnaires used in previous studies [
Mother's self-efficacy: mothers were tested by 11 questions about self-caring for their children, these questions were designed based on the validated Sherer’s General Self-efficiency Standard Scale (SGSES) [
A pilot study was conducted to evaluate the questionnaire before starting the practical phase of the study. It was carried out on 24 mothers who were excluded from the final sample and statistical analysis. Necessary modifications in the questionnaire were conducted accordingly to make it simpler, shorter and clearer.
The practical phase of our study includes:
Knowledge, attitude and self- efficacy of mothers about home injuries and immediate first aid measures for injured children.
“All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.” Official approval by ZU-IRB was obtained with a number 4336/4-2-2016, and a written informed consent from mothers was taken after full explanation of the study, it included personal data about the participants and details of the study (title, objectives, expected benefits and risks and confidentiality of data).
The data were recorded, represented and analyzed using SPSS (Statistical Package for the Social Sciences) version 19.0 [
Variables | No (244) | %(100.0) |
---|---|---|
mean± S.D | 29.8 ± 5.4 | |
Range | 19–38 | |
Primary education | 41 | 16.8 |
Preparatory education | 92 | 37.7 |
Secondary education | 62 | 25.4 |
University and above | 49 | 20.1 |
Housewives | 198 | 81. 1 |
Working | 46 | 18.9 |
≤ 4 members | 90 | 36.9 |
Five members | 68 | 27.9 |
Six members | 42 | 17.2 |
≥ 7 members | 44 | 18.0 |
Mass media | 79 | 32.4 |
Relatives | 67 | 27.5 |
Physicians | 50 | 20.5 |
Campaigns | 45 | 18.4 |
Others | 3 | 1.2 |
The participated mothers were having 672 children aged (1–5 years), where 34.8% of them exposed to home injuries in the last 8 weeks before the study, 56.4% of the injured children were males 60.3%, in the age from 1–3 years old. The most reported type of home injury was wounds 41.0%, while the least one was choking 8.6%.
Items | No. of preschool children of participated mothers (672) | %(100.0) |
---|---|---|
Not Occurred | 438 | 65.2 |
Occurred | 234 | 34.8 |
1–3 years | 132 | 56.4 |
3–5 years | 102 | 43.6 |
Male | 141 | 60.3 |
Female | 93 | 39.7 |
Wounds | 96 | 41.0 |
Fall/fracture | 53 | 22.6 |
Poisoning | 40 | 17.1 |
Burn | 25 | 10.7 |
Choking | 20 | 8.6 |
Regarding mother's knowledge, attitude and self-efficacy about prevention of home- injuries and basic first aid measures,
Items | Pre-intervention |
Post-intervention |
Score of change | |
---|---|---|---|---|
General knowledge about home injuries | 2.02 ± 0.4 | 3.94 ± 0.7 | 1.92 ± 0.9 | 0.000 |
poisoning by drugs and chemicals | 2.13 ± 0.6 | 3.88 ± 0.7 | 1.74 ± 0.8 | 0.000 |
wound/ fracture | 2.32 ± 0.5 | 4.27 ± 0.8 | 1.95 ± 0.7 | 0.000 |
burn | 2.09 ± 0.4 | 3.32 ± 0.8 | 1.22 ± 0.3 | 0.000 |
choking | 1.63 ± 0.4 | 3.48 ± 0.9 | 1.85 ± 0.5 | 0.000 |
Attitude toward prevention of home injuries | 4.05 ± 1.1 | 8.05 ± 1.5 | 3.99 ± 1.1 | 0.000 |
Attitude toward immediate first aid measures | 2.13 ± 0.5 | 2.21 ± 0.5 | 0.08 ± 0.3 | 0.078 |
*p < o.ooo1 is significant
a Paired t-test was computed.
Age, educational level and previous occurrence of home injuries were the significant predicting factors for post-intervention total knowledge, attitude, and self- efficacy regarding domestic accidents
Variable | B | SE | t | 95.0% CI interval for B | ||
---|---|---|---|---|---|---|
Lower bound | Upper |
|||||
Age | 0.200 | 0.056 | 3.575 | 0.00 | 0.090 | 0.309 |
Education | 0.769 | 0.177 | 4.357 | 0.00 | 0.421 | 1.117 |
Occurrence of home injuries | 2.433 | 0.967 | 2.515 | 0.013 | 0.527 | 4.338 |
*p < o.o5 is significant
Parents especially mothers have an important role in an important role in providing a safe home environment for their children in order to minimize or prevent home injuries. Our study was conducted among 244 rural mothers having preschool children to assess the effect of health education intervention on their knowledge, attitude, and self- efficacy about home injuries and the basic first aid measures.
Our study revealed that (34.8%) from the preschool children showed home injuries 8 weeks earlier to the study; this is quite similar to what was found in two different studies were conducted in Egypt (39.8% & 38.8%) [
Among the injured children, the age from 1–3 years was the most affected (56.4%), which is consistent with other similar studies in Egypt and Turkey [
Most of our children were exposed to: wounds fall/fracture, drug or chemical poisoning, burn and chocking. This could be contributed to the small size of houses in rural areas where the safety measures are too difficult to be applied; also there is no separate place for children to play in. These types of injuries were to a greater extent the same as reported by other studies conducted in Egypt [
The significant improvements in the general knowledge of the mother about home injuries and its subtypes were consistent with the impact of other intervention studies, where the health education leads to a positive improvement of mother's knowledge about home injuries [
Although the highest mean score of the change in the knowledge was for wound/fracture, the score of knowledge about basic first aid was low, which is in line with the results of a study that was conducted in India [
There was a minimal role of physicians and health campaigns as sources of mothers' knowledge compared to mass media and relatives. This could be attributed to the fact that culture in rural areas maximizes the role of relatives' experience, over the role of the healthcare members. This is the same as the results of a study conducted in India; where media, parents and family members were the main source of knowledge [
The attitude of the mothers regarding prevention of home injuries was significantly higher in posttest, in our opinion this has been achieved mainly by changing the faulty beliefe of mothers that accidents occurred by chance. However, the improvement in posttest toward first aid measures was non- significant, this brings us to the same conclusion that first aid needs more time to be well established.
Mother's self- efficacy, which is the mother's belief that they can successfully carry out the desired behavior [
From our point of view, this is one of the important achievements of our study as improving self-efficacy will help the mothers to overcome any surprising and difficult situation in caring of their children, which in turn will help in injuries prevention and providing immediate first aid measures.
Our health education message was supported using multimedia aids "pamphlet and video films", which result in higher percentage of change of total knowledge from pre to posttest by (34.8%), followed by self-efficacy (31.1%) then total attitude (18.5%), this is supported by study in Canada which found that using film videos in the education of the mothers about home injuries had positive effect on mother's knowledge, attitude, and involvement [
Age of the mothers was the main factor that significantly predicts their total knowledge score, may be related to increasing experience and awareness with age. This result is consistent with the study performed in India, which stated that mothers with age group from 30–40 years old were having a higher knowledge than others [
The total attitude score was significantly affected by education of the mothers, which is in the same line with the results of the study conducted in Egypt, demonstrated that the highly educated mothers have better attitude and practice [
The previous occurrence of home injuries was significantly affecting self-efficacy of the mothers, this could be due to the emotional, financial and social consequences that follow the occurrence of injuries, which may drive and empower the mothers to be more confident in taking protective actions for their children. This is consistent with the results of a study performed in India, where the previous occurrence of accidents affects the outcomes of health education intervention [
There is no specific scale to measure the self-efficacy of mothers in case of injuries, so we were forced to use the general one, which was not suitable for some items our research. Also, the self-reported data may lead to some sort of inaccuracy, as well as lack of enough time to assess the impact of this intervention on the incidence of home injuries.
Application of health education intervention among mothers having preschool children improves their knowledge, self-efficacy, and attitude about home injuries; however, the improvement in first aid measures applied after injuries is much lower than that for accidents prevention. Age of the mothers, education level and previous occurrence of home injuries were the significant predicting factors for knowledge, attitude, and self-efficacy of the mothers respectively. Therefore our recommendations are:
Several follow-up studies to determine the impact of a health education intervention on decreasing rate of home injuries.
The need for including knowledge about prevention of home injuries in the educational curriculum of high schools and University.
Training courses about first aid measures for the mothers to develop community-based awareness and sound practice.
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We would like to express our thanks to the mothers who joined us in our study.