Construction Of Health Education Program For Postpartum Post-traumatic Stress Disorder Of Women With High-risk Pregnancy Based On Snyder’s Hope Theory

Objectives1 To investigate the status of postpartum post-traumatic stress disorder（PTSD）in high-risk pregnant women.This provides a reference for the construction of health education programs.2 To investigate the real psychological experience of postpartum PTSD in high-risk pregnant women through semi-structured interviews,and supplement the information that could not be obtained by quantitative research.3 To construct a health education program on postpartum PTSD in high-risk pregnant women,a literature review and Delphi expert consultation were used with Snyder’s Hope Theory as the theoretical framework.MethodsThe study was divided into three parts,Part Ⅰ:500 women with high-risk pregnancies who met the inclusion and exclusion criteria in three tertiary care hospitals in Yangzhou City from October 2020 to March 2021 were selected for the questionnaire survey through a convenience sampling method.The research instruments used in this part included the General Information Questionnaire,Post Traumatic Stress Disorder Scale-Civilian Version,Anxiety Self-Rating Scale,Edinburgh Postnatal Depression Scale,the Psychological Resilience Scale and the Appreciative Social Support Scale.The results were analysed using descriptive analysis,chi-square test,Mann-Whitney U test and binary logistic regression analysis to reflect the current status and factors influencing postnatal PTSD in high-risk pregnancies.Part Ⅱ:A descriptive qualitative research method was used based on cross-sectional findings to conduct semi-structured in-depth interviews with 12 high-risk pregnant women with postpartum PTSD who delivered in a tertiary hospital in Yangzhou City from April to July 2021.Traditional content analysis was used for data analysis.Part 3:Through the preliminary status survey,semi-structured interviews and literature review analysis,a preliminary health education programme was formed;subsequently,the Delphi expert consultation method was used to explore the necessity and scientific validity of the programme,collate opinions,improve the programme content and form the final draft of the health education programme.Results1 The results of a cross-sectional study showed that the incidence of postpartum PTSD positive was 14.8%.The post-traumatic stress disorder scale-civilian version of the 500 high-risk pregnant women scored 20.00（17.00,27.00）,Connor-Davidson Resilience Scale was 72.36±15.39,and the Perceived Social Support Scale was 65.10±13.96.Social support（r=-0.60）and resilience（r=-0.43）were negatively correlated with postpartum PTSD.Cesarean section（aOR=2.66,P<0.01）,instrumental delivery（aOR=4.53,P=0.03）,no epidural analgesia（aOR=2.78,P<0.01）and postpartum anxiety（aOR=2.18,P=0.04）were risk factors for postpartum PTSD.Social support（aOR=0.91,P<0.01）and resilience（aOR=0.92,P<0.01）were protective factors for postpartum PTSD.2 The results of the qualitative study showed that a total of 12 women with high-risk pregnancies were interviewed,with questions focusing on four themes and eleven subthemes:cognitive and coping styles（lack of knowledge about the disease,avoidance of talking about the birthing process）,changes in interpersonal relationships（coldness in the couple’s relationship,intensification of conflicts between mother and daughter-in-law,poor mother-infant attachment）,negative emotional distress（postpartum anxiety,worries about the child’s health,helplessness and loss of disease stigma,fear of another pregnancy）and the desire for a variety of health education by health care professionals（content needs,form needs）.fear of another pregnancy)and the desire for a variety of health education by health care professionals（content needs,form needs）.3 The results of the scheme construction showed that a total of 13 literatures（5 in Chinese and 8 in English）were included in the literature review and analysis.The literature quality evaluation results are all medium and high-quality literatures.The researcher combined the results of quantitative and qualitative surveys to determine the content of the health education programme,the form of intervention,the duration of intervention and the intervention personnel,and constructed the first draft of the intervention programme.A total of 15 experts participated in this study.The effective recovery rate was 100%in both rounds.Eight experts made constructive comments.The coefficient of judgment of the two rounds of experts was 0.83,the degree of familiarity was 0.79,and the coefficient of authority for consulting experts was 0.81.The Kendall’s W of the primary,secondary and tertiary indicators after two rounds of consultation were 0.240,0.168,and 0.128,respectively.The results were all statistically significant（P<0.01）.The final health education program included 4 first-level titles,9 second-level titles and 25 third-level titles（intervention content）.Conclusion1 Postpartum PTSD in high-risk pregnant women is at a higher level.We need to pay attention to the screening of postpartum PTSD in high-risk pregnancies,early identification of risk factors,and appropriate intervention;2 The health education intervention plan will help women in high-risk pregnancies to understand and choose correct health behaviors.It also contributes to the safety and health of mother and baby.