Effect of Video-assisted Teaching Programs on the Knowledge, Practices, and Attitude of Pregnant Women at Risk for Preeclampsia

Background : Providing video-assisted teaching programs to pregnant women at risk for preeclampsia is very important and will lower maternal, fetal, and neonatal morbidity and mortality. The aim of this study was to examine the effect of video-assisted teaching programs on the Knowledge, practices, and attitude of pregnant women at Risk for Preeclampsia. Method : Quasi-experimental research design (pretest/posttest) was adopted. A purposive sample of 120 pregnant women at Risk for Preeclampsia was recruited based on specific criteria. This study was conducted at EL Shohada Hospital at the Department of Obstetrics and Gynecology in the Menoufia government. Four tools were used : 1. A structured Interviewing questionnaire; II. Pregnant women's knowledge regarding preeclampsia; III. Pregnant women’s practice regarding pre-eclampsia preventive behavior; IV. Pregnant women’s attitude questionnaire regarding preeclampsia prevention. Results : In the pre-video-assisted teaching program 51.7%, 89.2%, and 47.5% of pregnant women had poor knowledge, unsatisfactory practices, and a negative attitude respectively. While post-intervention, (60%, 88.3% and 70% of pregnant women had high knowledge, satisfactory practice, and a positive attitude respectively. Pre-and post-intervention differences in women's overall preeclampsia knowledge, practices, and attitudes were highly statistically significant (p < 0.001). Conclusion : Pregnant women who participated in Video-assisted teaching programs experience an expedited acquisition of knowledge, promote caring practices, and encourage a positive attitude toward the prevention of preeclampsia during pregnancy. Recommendation : Applying video-assisted teaching programs during antenatal care for pregnant women at risk of preeclampsia will improve their knowledge, practices, and attitude regarding preeclampsia disease.


Introduction
Pregnancy is natural and the most joyful phenomenon in a woman's life.It leads to transient physiological changes that may have widespread ramifications.Pregnancy-related illnesses that worsen the body's physiology leave an imprint of earlier illnesses and have an effect on the health of affected women for the rest of their lives.
Preeclampsia is the leading cause of maternal morbidity and death globally (Rana et al., 2019).

Preeclampsia means new-onset hypertension.
Preeclampsia can be initially diagnosed based on certain criteria, such as a systolic blood pressure of 140 mm Hg or higher, or diastolic blood pressure of 90 mm Hg or higher on two separate occasions spaced at least four hours apart; alternatively, a shorter interval timing of 160 mm Hg or higher, or a diastolic blood pressure of 110 mm Hg or higher, Additional subtypes of preeclampsia that can be distinguished include mild and severe, all of which must be determined after twenty weeks of gestation (Garovic et al., 2022).
Preeclampsia has no known cause.It is understood that altered placental function is the reason, though.It is thought that during pregnancy, inflammatory compounds from the placenta circulate inside the woman's body and influence the artery walls, raising blood pressure and allowing the protein to leak through the kidney's vessel walls (leading to proteinuria).Early-onset preeclampsia frequently results in severe placental insufficiency and decreased fetal growth.A Video-assisted teaching program used in education can promote an easy and innovative way to attract today's women to their intervention.
Video-assisted teaching is regarded as a crucial component of education since it connects theory to practice (Devi et al., 2019).Sadly few studies explored the effect of video-assisted teaching programs on the knowledge, practices, and attitude of pregnant women at risk for preeclampsia.Thus, this study aimed at examining the effect of videoassisted teaching programs on the knowledge, practices, and attitude of pregnant women at risk for preeclampsia.

Aim of the study
The aim of the current study was to examine the effect of Video-assisted Teaching Programs on the knowledge, practices, and attitude of pregnant women at risk for preeclampsia.

Research Hypothesis
Pregnant Women who receive Video-assisted Teaching Programs may exhibit higher post-test knowledge, practices, and attitude scores than in the pre-test.

Research design
The current study used a quasi-experimental design (one group pre-and post-test) where the result of interest is tested twice, once before and once after exposing a non-random group of individuals to a particular intervention/treatment (Maciejewski., 2020).

Setting
The The algorithm indicates that a total sample size of 120 is needed for the investigation.

Tools of data collection
The data for the study was collected using the following 4 tools: Who is susceptible to preeclampsia?How can preeclampsia be avoided?Which supplements help decrease blood pressure when expecting?Does preeclampsia cause Convulsions?Is preeclampsia serious for the fetus in the uterus?

Scoring system
The right answer received a score of two, the incomplete answer received a score of one, and the incorrect answer received a score of zero.Each question's score was added together to provide a final score that ranged from zero to ten.Three categories were created from the overall knowledge scores: low knowledge (less than 50%, or less than 5); acceptable knowledge (between 50% and less than 75% or from 5 to less than 7.5); and high knowledge (greater than 75%, or equal to or more than 7.5) utilizing the Bloom's cut-off point (Bloom., 1968).Bloom's cut-off point (Bloom,.1968). Tool

Scoring system
Agree received a score of two, disagree received a score of one, and neutral received a score of zero.The scores for five statements were reversed.Each statement was assigned a score, and these scores were added up to calculate an overall attitude score between five and ten.Three levels were assigned based on the overall score: negative (less than or equal to 5) and positive (more than 5), utilizing Bloom's cut-off point (Bloom,.1968).

Validity
A structured interview questionnaire schedule was developed by the researchers, and five academic nursing professionals with expertise in women's health and midwifery nursing evaluated and confirmed its content validity.The accuracy, relevance, and clarity of the tool's contents were verified.That's why the recommended changes were made.

Reliability
The reliability of the recommended instruments was evaluated using the Cronbach's alpha coefficient test.The structured interview questionnaire schedule's Cronbach's alpha of 0.89 showed a high degree of positive correlation between its components.In contrast, the test-retest validity and reliability of the knowledge, practices, and attitude of the prenatal population was 0.95.

Ethical Considerations
Participants who agreed to participate in the study provided written informed consent.Each participant received information about the purpose and designs of the study, as well as assurances that confidentiality, privacy, and anonymity would be upheld and that participation was entirely voluntary and may be withdrawn at any time without compromising the quality of care received.
On 21-6-2023, the Ethical Committee of Menoufia University Research No: 958 met and issued initial approval to conduct the study, and following data collection, final approval was obtained for the study.

Pilot Study
Ten percent of the samples (twelve women) were enrolled in pilot research that was done to evaluate the tools' objectivity, clarity, and viability.
According to the pilot study, the tools took an average of one hour to complete (fifteen minutes for socio-demographic tools and thirty hours for other tools).

Procedure
Between June 2023 and November 2023, a period of five months was used to gather data.The researcher spent four days from 10:00 am to 2:00 pm in the prearranged location.In order to conduct this study, assessment, implementation, and evaluation were done through interviews.and determine gestational age.

Interviewing and assessment:
In addition, at the first session, an assessment was done for each woman both groups at (12 th to 20 th week of gestation) through maternal blood pressure, and lab investigation.In addition, each woman was assessed for their knowledge, practices, and attitude related to the preeclampsia prevention pretest questionnaire; tools were completed by the women attending the outpatient clinic who agreed to engage in the study as baseline information and to develop the content of the health education intervention.
Researchers distributed the tools to the attending pregnant women at risk for preeclampsia.
Baseline interviews for about 20-25 minutes were done in the outpatient clinic with each pregnant woman at risk for preeclampsia.

Implementation
Two video sessions teaching programs regarding preeclampsia were conducted for pregnant women liable to preeclampsia.For four weeks, they received one theoretical and one practical session per two weeks in the lecture room of the outpatient clinics.The sessions lasted 45 to 60 minutes each and were given to twelve groups of eleven to twelve pregnant women.Susceptible to preeclampsia, avoiding preeclampsia, supplements will decrease blood pressure when expecting, complications of preeclampsia such as convulsions, preeclampsia serious for the fetus in the uterus.All previously mentioned were covered in the first session.
The second session focused on the effort to lose as much excess weight as possible, do regular exercise, cut back on coffee intake, eat less salt in the diet, get lots of good sleep, consume enough calcium, folic acid, and vitamin D in the diet, manage kidney health effectively, prevent diabetes occurrence, regular following up with the doctor, take a little dosage of aspirin every day and seek medical attention when experiencing a headache.
Every pregnant woman could measure her blood pressure during follow-up visits and identify mean arterial blood pressure, pregnant women and all medical professionals must avoid preeclampsia in young women who may be at risk for it.Eating a healthy diet rich in fruits and vegetables helps decrease the risk of preeclampsia.
Presentations of edited films and eyecatching images were made.At the conclusion of every meeting, the key elements were examined again.Every group of women received the same instruction twice.At the conclusion of the first session, each pregnant woman who was at risk of developing preeclampsia received an instructional booklet as a guide and was advised of the time of the following session.

The Evaluation phase
Video-assisted teaching programs were evaluated after two weeks of the implementation using the same tools two, three, and four.

Statistical Analysis
All statistical analyses were performed using SPSS for Windows, version 26.0 (SPSS, Chicago, IL).The continuous data had a normal distribution and were shown as mean ± standard deviation (SD).Categorical data were expressed as numbers and percentages.To compare variables related to categorical data, the chi-square test was used.The correlation coefficient test was used to look for correlations between two variables in continuous data.The study's questionnaires' reliability (internal consistency) test was calculated.
Statistical significance was established at p<0.05.

Results of the research
The current study's conclusions are presented in 5 primary sections:  Concerning educational level, more than one-third (38.3%) had higher education.As regards occupation, less than two-thirds (61.7%) of the sample were housewives.

Table (2)
shows that the family history of the sample for PIH revealed that, the majority (85 %) of pregnant women had a history of PIH.This can be explained by the fact that efforts to lower maternal mortality are seriously hampered by video-assisted teaching programs.

Conclusions
It was determined based on the research's conclusions and hypothesis that, the hypothesis was accepted and then summarized Pregnant Women who received video-assisted teaching programs on preeclampsia prevention had higher post-test knowledge, practice, and attitude scores than in the pretest to prove this.

Recommendations
In light of the study's findings, the researchers recommended that:  Applying video-assisted teaching programs to promote and improve their knowledge, practices, and attitudes among pregnant women at risk of preeclampsia.
 Suggest including video-assisted teaching programs among pregnant women at risk of preeclampsia in the nursing curriculum.
 Future research could replicate the current study in a different setting to allow for generalization.
Preeclampsia runs in families, primigravida, preexisting hypertension, advanced maternal age (above 35), multiple gestation (twins, triplets, etc.), thrombophilia, women with a few uncommon autoimmune diseases, diabetes, women whose most recent delivery took place more than ten years ago, use of donor egg, and obesity are risk factors (Magee et al., 2022; Ugurlu et al., 2021; Snead et al., 2020).Preeclampsia usually first manifests itself in near-term pregnancies.Additional noteworthy discoveries that might or might not be a component of the clinical manifestation encompass; proteinuria, indications of end-organ injury, like thrombocytopenia, compromised liver function, epigastric pain, ruling out any other plausible diagnosis, abruptly developing headache that is unresponsive to treatment, pulmonary edema, or renal insufficiency with aberrant laboratory results.(Sinkey et al., 2020; Phipps et al., 2019) Preeclamptic women may eventually experience symptoms like lethargy, swelling of the hands, feet, and face, headache, nausea, and visual problems (usually represented by flickering lights).Some preeclamptic pregnant women also experience reduced fetal movement due to placental insufficiency and Fetal growth restriction, Placental abruption, and Preterm birth (Garovic et al., 2020; Sinkey et al., 2020; Turbeville et al., 2020).Pregnant women may seek care earlier in their pregnancies if they can identify the early symptoms and warning indications of preeclampsia.With the right information and counseling, up to 50% of the serious effects of preeclampsia symptoms in women might be avoided.Preeclampsia adversely affects the quality of life as it relates to health.Additionally, high-risk women's increased risk of preeclampsia can be decreased or avoided by adopting good lifestyle habits (Iqomatulhaq et al., 2019).
study was conducted at the Menofia University Hospital's Obstetrics and Gynaecology Outpatient Clinic in Shebinelkom, Menofia Governorate, Egypt.The clinic is made up of two rooms and is located on the hospital's first floor.The first room is set apart to take a history, make a diagnosis, and do an ultrasound.The second room is intended for clinical examinations related to obstetrics and gynecology.According to local statistics for 2022, the clinic serves about 6830 women yearly (El Shohada Hospital's Department of Obstetrics and Gynaecology, 2022).Sample A purposive sample of one hundred and twenty pregnant women at risk for preeclampsia, attended an outpatient clinic to obtain regular antenatal clinic treatment in accordance with their scheduled appointment.The included sample consisted of primiparous with gestational age from 12 to 20 weeks, who were at risk of preeclampsia and met the following criteria: Having a preeclampsia-related family history (mother or sister), obesity, having twins or more, being under the age of 20 or above the age of 35.While some medical issues are disqualified in the sample such as chronic hypertension, also known as gestational hypertension, thrombophilia and antiphospholipid syndrome are examples of blood clotting diseases.Diabetes or renal illness, for example, Lupus, Periodontal disease, and Congenital Anomalies are examples of autoimmune disorders.Sample Size Based on data from the literature (Abd Elhaleem et al., 2021), the sample size is calculated using the following formula, which has a 5% precision/absolute error and a 5% type 1 error.n= (−/)^.(−)^ where Z1-α/2 at 5% type 1 error (p<0.05) is 1.96, P represents the population's expected proportion based on past studies, while d stands for precision or absolute error.As such, the sample size n= (1.96)^2.(0.90)(1−0.90)(0.0536)^2 =120.3.
The author of the study created this tool following an evaluation of the relevant literature (Abd Elhaleem et al., 2021).It included: Part 1: Personal data which included; age, residence, level of education, occupation & family history for chronic diseases.Part 2: Physical assessment which included height, weight, and body mass index.Part 3: Obstetric History such as gestational age, gravidity, complications during previous pregnancy & type of complications during previous pregnancy.Tool II: Pregnant women's knowledge regarding preeclampsia: It was created by the researcher to determine the degree of pregnant women's knowledge of preeclampsia following a thorough analysis of the relevant literature (Abd Elhaleem et al., 2021).Five inquiries addressed:

Tool
post tool); ten questions, such as "Do you try to lose as much excess weight as possible?Do you regularly exercise?Have you cut back on your coffee intake and eaten less salt in your diet?Are you consuming enough calcium, folic acid, and vitamin D in your diet?Do you try to take enough time to sleep?How well-managed is your kidney health?Do you manage or prevent diabetes?Have you been following up with your doctor?Do you take a little dosage of aspirin every day?Do you seek a physician when you have a headache?Scoring systemIf completed correctly, a score of (one); if not, a score of (zero).The entire score fell between zero and ten.The entire practice score was converted to a percent score, with a score of at least five seventy percent indicating satisfactory practice and a score of less than five seventy percent indicating unsatisfactory practice utilizing BMI assessment was performed by measuring height by measuring tap with cm and weight utilizing an adult scale and calculation of BMI; blood pressure was measured through a sphygmomanometer; lab investigation as albumen in urine was taken from woman's record, ultrasound was done by the obstetrician to rule out the presence of twins and any congenital anomalies.

Section I :
Personal data of the studied sample; Section II: Family History of the studied sample; Section III: The body mass index of the studied sample; Section IV: Obstetric history of the studied sample; SectionVI: Pregnant women's knowledge, practices, and attitude regarding preeclampsia.

Figure ( 1 )
Figure (1) illustrates the distribution of pregnant women for the family history regarding the classification of PIH.Less than half of them (47.06 % & 45.10%) had preeclampsia and eclampsia respectively and the least of them (7.84%) had gestational hypertension.
The current study's findings revealed that the preeclampsia preventive behavior total practices score and attitude of pregnant women pre and one month after the intervention had improved to good practices for the majority of pregnant women.This matches the findings of a study conducted by Abd Elhaleem.etal.,(2021) to demonstrate the significance and efficacy of introducing education through PRECEDE Mode, which is commonly associated with improving practice.This may be because intervention may increase pregnant women's self-determination, resulting in a findings of this study, the majority of pregnant women had a positive attitude following the intervention.According to the pregnant women's'' attitudes toward pregnancyinduced hypertension, the majority of the sample preferred to go to hospitals/clinics whenever they experienced various symptoms such as abdominal pains and headaches.These results confirm that of Kamal et al., (2020), who report that pregnant women's knowledge and practices regarding the prevention of preeclampsia were effectively improved in the intervention group as compared to the control group by the application of the health promotion model and self-determination theory-based intervention.The current study's findings revealed that Pre-and post-intervention differences in women's overall preeclampsia knowledge, practices, and attitudes were highly statistically significant (p < 0.001).These findings were consistent with the findings of Abd Elhaleem et al., (2021), who revealed that all study participants had adequate knowledge, a positive attitude, and good practices towards Preeclampsia.Our findings conflicted with those of Chanda.(2023), who found that pregnant women lacked preventive practices, negative attitudes, and insufficient knowledge.

Ahmed et al., 2021; Shaheen., 2020; Hassan, 2018). Significance of the study
Because the video teaching method understandably presents complicated concepts and concerns through sight, voice, and motion, it improves women's learning.The video teaches in a way that spoken words alone just cannot, and it bridges the educational gap by making it easier for women with low reading proficiency to understand what they are learning.The fact that drawings and procedures rely on pictures rather than words makes it easier to overcome language obstacles.It is a tool that improves the relationships between women in follow-up discussions by giving nurses and women educators a point of reference or a subject of shared interest (Devi et al., 2019).

IV: Pregnant women's attitude questionnaire regarding preeclampsia prevention
: It was developed by the researchers.It had five questions.Do you think it should be required for every pregnant woman to have her

Table ( 1
) shows that the age range was 15-±6.2years.Regarding residence, more than half (64.2%) of the sample were living in rural areas.

Table 1
Personal data of the studied sample (n=120).

Table 2
Family History of the studied sample (n=120).The Family History of the studied sample regarding the Classification of PIH.

Table 3
The body mass index of the studied sample (n=120).

Table 4 .
The obstetric

Table 5
Comparison of the Knowledge, Practices and Attitude levels between Pre -& Post -Intervention (n=120).
This result was congruent with Gingras-Charland et al. (2019).They showed that the