INTRODUCTION:

Pregnancy and motherhood are natural processes in the lives of women of reproductive age. However, for various reasons, many women end up dying as a result of these processes.¹ Almost 15% of all the pregnant women can develop potentially life-threatening complications which might require skilled care with some requiring major intervention for survival.²

According to WHO 2017, Overall maternal mortality rate in the US was 19/100,000 deliveries, incidence is 3 to 4 times higher in nonwhite women. Almost 50% of pregnancy-associated deaths in the US occur in non-Hispanic black women. The most common causes of maternal death worldwide is haemorrhage (27.1%).³

The over all prevalence of PPH worldwide is estimated to be 6 to 11%. Post partum hemorrhage accounts for nearly one quarter of all maternal deaths.⁴

WHO, defined Postpartum Hemorrhage (PPH) as a blood loss of 500ml or more within 24 hours after birth, while severe PPH is defined as a blood loss of 1000ml or more within the same time frame. PPH is a leading cause of maternal mortality and morbidity worldwide and accounts for nearly one-quarter of all maternal pregnancy-related deaths.⁵

BACKGROUND OF THE STUDY:

According to latest report of WHO every 5 minutes, one woman dies during pregnancy and child birth. Out of which 5,29,000 maternal deaths occurring worldwide every year, and 1,36,000(25.7%) occurs in India. PPH being the most commonly reported complication.⁶

According to The Times 2019 the latest maternal mortality data for 2015-17, Madhya Pradesh has a MMR of 188 per lakh live births the third highest in country. In 2014-16, the MMR for Madhya Pradesh, combined with Chhattisgarh, was 173.⁷

Health App is an effort to improve data collection and the overall standards of child and maternal health services programme in India. The ministry of health and family welfare with support from UNICEF has introduced and android based tablet application for health Professionals.⁸

NEED OF THE STUDY:

Rajoriya Mohini et. al.(2018)⁹ mentioned in their study that Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide with a prevalence rate of approximately 6% and 50% is due to atonic PPH.In India 45,000 maternal deaths take place annually and 20- 60% are due to postpartum hemorrhage.

Toppo Manju 2019¹⁰mentioned in her study that as per recent SRS data, 2014–2016 Maternal mortality rate (MMR) was observed in Madhya Pradesh (MP) as 173 and that majority (64.7%) of maternal deaths occurred between age 18 and 25 years and the post partum hemorrhage was the most common cause. She also recommended that Service providers at the periphery should timely refer the high-risk patients, and transport facilities should be made available for them on time.

As per The Times of India (2019)⁷ Indore reported with least maternal mortality Ratio (MMR), at 162, Indore division remains a bright spot in Madhya Pradesh.

Akbar Saba and et.al (2020)¹¹in their study reported that Advancements in digital technologies have provided consumers with access to a wide range of resources to manage their health.

As each Community health officers have been provided smart devices (Tab.) from the government of Madhya Pradesh for data entry so Researcher felt that health app will be useful for Community health Officers those who are working in Health and Wellness centres of Indore, if they use this health app on symptomatic management of selected high risk obstetrical condition (PPH). As many death occurs due to complication of PPH like delay referral, lack of basic management by health workers. So, if this health app is installed in their tab it will be easy for them to give basic management for PPH cases and timely refer the cases at appropriate centre.

STATEMENT OF PROBLEM:

An Evaluative Study to Assess The Utility Of Health App On Symptomatic Management Of Selected High Risk Obstetrical Condition Among Health Professionals Working At Selected Rural Health Centres Of Indore District.

OBJECTIVES:

1. To assess the pre-interventional knowledge score on symptomatic management of selected high risk obstetrical condition among health professionals.

2. To assess the mid interventional knowledge score on symptomatic management of selected high risk obstetrical condition among health professionals.

3. To assess the post interventional knowledge score on symptomatic management of selected high risk obstetrical condition among health professionals.

4. To compare between the Pre, Mid and post interventional knowledge score on symptomatic management of selected high risk obstetrical condition among health professionals.

5. To associate pre interventional level knowledge score on symptomatic management of selected high risk obstetrical condition among health professionals with their selected demographic variables.

6. To find out the opinion of health professionals regarding utility of health App on selected high risk obstetrical condition.

HYPOTHESES:

H₀₁: There will be no significant difference between mean pre and mean mid intervention knowledge score of health professionals regarding utility of health app on symptomatic management of selected high risk obstetrical condition at significance level 0.05.

Ho₂: There will be no significant difference between mean pre and mean post interventional knowledge score of health professionals regarding utility of health app on symptomatic management of selected high risk obstetrical condition at significance level 0.05.

H0_3:There will be no significant difference between mean mid and mean post interventional knowledge score of health professionals regarding utility of health app on symptomatic management of selected high risk obstetrical condition at significance level 0.05.

H₀₄: There will be no significant association between pre interventional knowledge score of health Professionals regarding utility of health App on symptomatic management of selected high risk obstetrical condition with their selected demographic variable at significance level 0.05.

CONCEPTUAL FRAMEWORK:

As the study was intended to assess the utility of health app on symptomatic management of selected high risk obstetrical condition (PPH). The conceptual framework of the study is based on Imogene M. King’s “Goal attainment Model”.

METHODOLOGY:

Research Approach: Quantitative Evaluative design

Research Design: Time series

Population: Health Professionals (CHO)

Sampling Technique: Non- Probability purposive sampling

Sample size: 10

Setting: Health and Wellness centres

Tool I- Part (A) Development of Mobile app on management of selected high risk obstetrical condition

Part (B) Rating scale to assess the quality of Health App on symptomatic management of selected high risk obstetrical condition.

Tool II - Part (A) Demographic variables,

Part (B) Structured questionnaire on knowledge of selected high risk obstetrical condition PPH

Tool III - Evaluation checklist to assess the Utility of health app on management of selected high risk obstetrical condition.

RELIABILITY OF THE TOOL:

The Reliability of the tool was assessed using Karl Pearson Correlation- Coefficient formula. The ‘r’ value obtained was 0.910 means tool were highly reliable. The internal consistency of Opinion Statements for Utility of Health App was checked using Cronbach’s alpha. The Cronbach’s alpha value obtained was 0.735, which shows a good internal consistency among the opinion statements.

PILOT STUDY:

The predominant objectives of the pilot study were to help the investigator to become familiar with the use of tool and to find out any difficulties to conduct the main study. The Researcher obtained written permission from the concerning authority and research ethical committee prior to data collection. A total of 10 samples were taken by the purposive sampling. The pilot study was conducted in the year 2021. Non - probability purposive sampling Technique was adopted to collect data. After receiving content validity of app and tools from various experts pilot study was conducted. On the first day pre- test knowledge score was assessed. Then after completion of Pretest Health app on symptomatic management (PPH) was installed in health Professionals Tab. After 15 Days mid test was assessed using same tool. Then finally post test was assessed with same tool on day 30^th. At last utility of app was assessed using section- C.

FINDINGS OF THE STUDY:

Tool- I, Part (B) Rating scale to assess the quality of Health App on symptomatic management of high risk obstetrical condition.

Table No.1: Grading score on Quality of Health App in terms of frequency and percentage

Grade	Frequency	Percentage
Poor Quality (0-7)	0	0 %
Average Quality (8-14)	0	0 %
Good Quality (15-21)	2	20 %
Excellent Quality (22-30)	8	80 %
Total	10	100 %

The above table shows that 2 (20%) IT experts graded Quality of Health App as ‘Good’ and 8 (80%) experts graded Quality of Health App as ‘Excellent”, while none of the expert categorized them as poor or average.

Tool- II, Part (A) (Section- 1) Socio- demographic data of Respondents:

A total of 10 respondents participated in the study. Regarding age of the samples 4(40%) health professionals were in the age group 23-26 years, 4(40%) health professionals were in the age group 27-30 years, 2 (20%) health professionals were in the age group 31-34 years and 0(0%) health professionals were in the age group more than 35 years. In gender there were 2 (20%) males and 8(80%) females in the present study. Regarding marital status 9(90%) health professionals were married and 1(10%) health professionals were unmarried. In religion of samples all 10(100%) health professionals were Hindus. Regarding distribution of samples according to professional qualification 1(10%) health professionals had done their GNM, 6(60%) health professionals had done their B.Sc. (Nursing), 1(10%) health professionals had done their Post-Basic B.Sc. (Nursing), 1(10%) health professional had done their BAMS and 1(10%) health professional had done their M.Sc. (Nursing). Regarding experience of samples 2 (20%) health professionals had experience of less than 0-6 months, 4(40%) health professionals had experience of 7- 12 months, 2(20%) health professionals had 13-18 months of experience and 2(20%) health professionals had experience of 19- 24 months and above. Majority of the health professionals had 2-3 years of experience. For the question, “Any previous experience of using Health App, if yes, specify the source”, 5(50%) health professionals had used Health App on their Tablet, 2 (20%) health professionals had used it on their Smart Phone and 3 (30%) health professionals had used it on their laptops. Tablet was the most common device used for using Health App.

Regarding experience of samples 1(10%) health professionals had an experience 0-6 months using Health App, 4(40%) health professionals had an experience of 7-12 months, 3(30%) health professionals had an experience of 13-19 months and 2(20%) health professionals had experience of 20-25 months.

Tool-II, Part-B, (Section–II) Assessment of Knowledge on symptomatic management of High Risk obstetrical conditions.

Table No. 2: Pre-, mid- and posttest knowledge scores

Pretest/Midtest/Posttest	No.	Mean ± SD
Pretest	10	9.10 ± 3.35
Midtest	10	12.60 ± 0.84
Posttest	10	17.90 ± 1.79

The above table shows the pre-, mid- and posttest knowledge scores.

The mean pretest knowledge score was 9.10±3.35, mean mid-test knowledge score was 12.60±0.84 and mean posttest knowledge score was 17.90±1.79.

Section- III Comparision of Pre Test, MID Test and Post Test

Table No. 3: Comparison of pre-, mid- and posttest knowledge score

Pretest/Midtest/ Posttest	No.	Mean ± SD	‘t’ value	P value
Pretest	10	9.10 ± 3.35	-3.346, df=9	0.009*
Midtest	10	12.60 ± 0.84	-3.346, df=9	0.009*
Pretest	10	9.10 ± 3.35	-7.117, df=9	0.001*
Posttest	10	17.90 ± 1.79	-7.117, df=9	0.001*
Midtest	10	12.60 ± 0.84	-8.368, df=9	0.001*
Posttest	10	17.90 ± 1.79	-8.368, df=9	0.001*

Paired ‘t’ test applied. P value = 0.001, Significant

In comparison the mean pretest knowledge score was 9.10±3.35, mean midtest knowledge score was 12.60± 0.84 and mean posttest knowledge score was 17.90± 1.79.

If we compare Pretest, Midtest and post test the mean midtest knowledge score was significantly higher than the mean pretest knowledge score (P=0.009), the mean posttest was significantly higher than the mean midtest knowledge score (P=0.001) and the mean posttest was significantly higher than the mean pretest knowledge score (P=0.001).

There was a significant improvement in the knowledge after intervention.

Section IV: Analysis of Association of Pretest Knowledge Grade with Demographic Variables Among Health Professionals in Terms of Chi-Square

In association no significant association found with any demographic variables under the categorization of age of health Professionals, Gender, Religion, Marital status, educational qualification of health Professionals, working Experience, Any previous experience of using health app/Tab, Year of experience using App.

Tool-III Analysis of the Utility of Health APP on Symptomatic Management of Selected High-Risk Obstetrical Condition

Grading score on utility of Health App on selected high obstetrical condition in terms of frequency and percentage

Grade	Frequency	Percentage
Poor Utility (0-5)	0	0%
Average Utility (6-10)	0	0%
Good Utility (11-15)	0	0%
Excellent Utility (16-20)	10	100%
Total	10	100%

The above table shows that all the health professionals i.e. 10 (100%) showed that the utility of Health App was ‘excellent’ and none of the health professionals categorized them as poor, average or good.

CONCLUSION:

The aim of the study is to assess the utility of Health app on symptomatic management of selected high risk obstetrical condition (PPH). Many death occurs due to delay referal and timely management.Therefore it could be concluded that Health App on selected high risk obstetrical condition(PPH) can help in managing the cases at Health and wellness centres and remote areas.

REFERENCES:

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3. MD, saint Louis University school of Medicine(2020). “ Overview of High - Risk Preganacy”. Sep 2020. Content last modified on sep 2020.

4. World Health Organization( 2017). Managing Complications in Pregnancy and Childbirth: A Guide for Midwives and Doctors. World Health Organization, United Nations. 2nd ed. Retrieved from: https://apps.who.int/iris/handle/10665/255760.

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7. Retrieved from http://Times of India. India Times (2019). 23 December. http://Times of India.INDIATIMES.COM.

8. Maternal health division(2019). “Ministry of health and Family welfare. Govt. of India. https.://www.nhm.gov.in> programmes guidelines.

9. Rajoria Mohini and Singh Hemendra (2018).”PPH- Study of Causes and its Management”. Scholars Journal of Applied Medical Sciences (SJAMS).Sch. J. App. Med. Sci., Sept. 6(9): 3519-3521.

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Received on 22.04.2022 Modified on 19.05.2022

Int. J. Nur. Edu. and Research. 2022; 10(3):239-243.

DOI: 10.52711/2454-2660.2022.00056