Changes in Knowledge and Attitudes Toward Pregnancy Complication Prevention Following a Health Promotion Intervention: A One-Group Pretest–Posttest Study
DOI:
https://doi.org/10.53713/htechj.v4i5.743Keywords:
antenatal care, health promotion, knowledge, maternal health, pregnancy complicationsAbstract
Pregnancy complications remain an important contributor to maternal morbidity and mortality, highlighting the need for preventive strategies that strengthen pregnant women's knowledge and attitudes toward early recognition and appropriate management of pregnancy-related risks. This study aimed to evaluate changes in pregnant women's knowledge and attitudes regarding the prevention of pregnancy complications following a health promotion intervention. A quantitative pre-experimental study with a one-group pretest-posttest design was conducted among 15 pregnant women attending antenatal care at an Independent Midwife Practice in April 2026. Participants were recruited using total sampling. The intervention consisted of structured health promotion delivered through counseling, presentations, and educational leaflets. Knowledge and attitudes were assessed using a structured questionnaire that had undergone validity and reliability testing. Pretest and posttest outcomes were analyzed using paired statistical procedures based on the data distribution. The mean knowledge score increased from 56.2 before the intervention to 82.5 after the intervention, with a mean difference of 26.3 points. The mean attitude score increased from 60.1 to 85.7, representing a mean difference of 25.6 points. Both changes were statistically significant (p < 0.001). These findings indicate that structured health promotion was associated with substantial improvements in pregnant women's knowledge and attitudes regarding the prevention of pregnancy complications. Integrating systematic and accessible health education into routine antenatal care may strengthen maternal preparedness and support preventive practices. However, larger controlled studies are required to confirm the effectiveness and generalizability of the intervention.
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Abdisa, D. K., Jaleta, D. D., Tsegaye, D., Jarso, M. H., Jaleta, G. D., Tolesa, G. F., & Kitila, K. M. (2023). Effect of community-based nutritional education on knowledge, attitude and compliance to IFA supplementation among pregnant women in rural areas of southwest Ethiopia: A quasi-experimental study. BMC Public Health, 23, 1923. https://doi.org/10.1186/s12889-023-16798-y
Akaishi, T., Tarasawa, K., Hamada, H., Iwama, N., Tomita, H., Akaishi, M., Fushimi, K., Fujimori, K., Yaegashi, N., & Saito, M. (2024). Prenatal hypertension as the risk of eclampsia, HELLP syndrome, and critical obstetric hemorrhage. Hypertension Research, 47, 455–466. https://doi.org/10.1038/s41440-023-01511-8
Al-Matarneh, B. M., Al-Khawaldeh, O. A., & Alsaraireh, A. M. (2023). Knowledge, attitudes and practices regarding obstetric danger signs among Jordanian pregnant women attending antenatal clinic in Jordan. Central European Journal of Nursing and Midwifery, 14(2), 860–868. https://doi.org/10.15452/cejnm.2022.13.0021
Anggondowati, T., Deviany, P. E., Latief, K., Adi, A. C., Nandiaty, F., Achadi, A., Kalter, H. D., Weaver, E. H., Rianty, T., Ruby, M., Wahyuni, S., Riyanti, A., Lisnawati, N., Kusariana, N., Achadi, E. L., & Setel, P. W. (2022). Care-seeking and health insurance among pregnancy-related deaths: A population-based study in Jember District, East Java Province, Indonesia. PLOS ONE, 17(3), e0257278. https://doi.org/10.1371/journal.pone.0257278
Arifah, I., Pambarep, T. S. A., Khoiriyah, L., Kusumaningrum, T. A. I., Werdani, K. E., & Ngadiyono, N. P. (2023). Effectiveness of daily educational message on pregnancy anemia prevention behavior and knowledge: A pilot randomized controlled trial. Journal of Education and Health Promotion, 12, 296. https://doi.org/10.4103/jehp.jehp_108_23
Ariyani, N. W., Wirawan, I. M. A., Pinatih, G. N. I., & Kusuma, A. A. N. J. (2022). The effect of an application-based educational intervention with a social cognitive theory model on pregnant women in Denpasar, Bali, Indonesia: A randomized controlled trial. Osong Public Health and Research Perspectives, 13(2), 153–161. https://doi.org/10.24171/j.phrp.2021.0209
Bayrami, R., Masudi, S., Didarloo, A., & Nournezhad, H. (2024). Determining the predictors of preventive behaviors adopted by pregnant women against COVID-19 based on the Health Belief Model constructs: A cross-sectional study. BMC Women's Health, 24, 528. https://doi.org/10.1186/s12905-024-03305-7
Bierer, S. B., Dallaghan, G. B., Borges, N. J., Brondfield, S., Fung, C. C., Huggett, K. N., Teal, C. R., Thammasitboon, S., & Colbert, C. Y. (2025). Moving beyond simplistic research design in health professions education: What a one-group pretest-posttest design will not prove. MedEdPORTAL, 21, 11527. https://doi.org/10.15766/mep_2374-8265.11527
Candidori, S., Osouli, K., Graziosi, S., Zanini, A. A., Costantino, M. L., & De Gaetano, F. (2024). A novel low-cost uterine balloon tamponade kit to tackle maternal mortality in low-resource settings. Scientific Reports, 14, 10004. https://doi.org/10.1038/s41598-024-60064-z
Cao, Y., Chen, R. C., & Katz, A. J. (2024). Why is a small sample size not enough? The Oncologist, 29(9), 761–763. https://doi.org/10.1093/oncolo/oyae162
Cresswell, J. A., Alexander, M., Chong, M. Y. C., Link, H. M., Pejchinovska, M., Gazeley, U., Ahmed, S. M. A., Chou, D., Moller, A.-B., Simpson, D., Alkema, L., Villanueva, G., Sguassero, Y., Tunçalp, Ö., Long, Q., Xiao, S., & Say, L. (2025). Global and regional causes of maternal deaths 2009–20: A WHO systematic analysis. The Lancet Global Health, 13(4), e626–e634. https://doi.org/10.1016/S2214-109X(24)00560-6
Damayanti, N. A., Wulandari, R. D., & Ridlo, I. A. (2023). Maternal health care utilization behavior, local wisdom, and associated factors among women in urban and rural areas, Indonesia. International Journal of Women's Health, 15, 665–677. https://doi.org/10.2147/IJWH.S379749
Essam, N., Khafagy, M. A., & Alemam, D. S. (2022). Health literacy of pregnant women attending antenatal care clinics in Mansoura district, Egypt. Journal of the Egyptian Public Health Association, 97, Article 24. https://doi.org/10.1186/s42506-022-00119-z
Gesese, S. S., Mersha, E. A., & Balcha, W. F. (2023). Knowledge of danger signs of pregnancy and health-seeking action among pregnant women: A health facility-based cross-sectional study. Annals of Medicine & Surgery, 85(5), 1722–1730. https://doi.org/10.1097/MS9.0000000000000610
Getachew, D., Getachew, T., Debella, A., Eyeberu, A., Atnafe, G., & Assefa, N. (2022). Magnitude and determinants of knowledge towards pregnancy danger signs among pregnant women attending antenatal care at Chiro town health institutions, Ethiopia. SAGE Open Medicine, 10, 20503121221075125. https://doi.org/10.1177/20503121221075125
Gurara, M. K., Draulans, V., Jacquemyn, Y., & Van Geertruyden, J.-P. (2023). Evaluation of a community-based intervention package to improve knowledge of obstetric danger signs, birth preparedness, and institutional delivery care utilization in Arba Minch Zuria District, Ethiopia: A cluster-randomized trial. Reproductive Health, 20, 169. https://doi.org/10.1186/s12978-023-01713-w
Halake, D. G., Maranga, E. I., Nzioki, J. M., & Gachohi, J. (2024). Enhancing pastoralist women’s knowledge of danger signs through home-based life-saving skills intervention in Northern Kenya: A quasi-experimental study. Clinical Epidemiology and Global Health, 26, 101539. https://doi.org/10.1016/j.cegh.2024.101539
Hatamzadeh, N., Shakerinejad, G., Navak, T., Haghi, M., Haghighizadeh, M. H., & Baumann, S. L. (2024). The efficiency of the Health Belief Model in predicting the preventive behaviors of pregnant women during the COVID-19 pandemic in Iran. Nursing Science Quarterly, 37(1), 76–80. https://doi.org/10.1177/08943184231207384
Jeihooni, A. K., Razmjouie, F., Jormand, H., Sedghi Jahromi, F., Afzali Harsini, P., Kamyab, A., & Ghaleh Golab, F. (2024). Effectiveness of educational intervention in improving physical activity and nutritional performance among pregnant women: A pre-post quasi-experimental study using health belief model. Frontiers in Global Women's Health, 5, 1471957. https://doi.org/10.3389/fgwh.2024.1471957
Kumar, A., Raj, D., Gupta, A., & Kumar, A. (2022). Assessment of knowledge of obstetric danger signs and its associated factors among pregnant women attending antenatal clinic of rural health training centre of a medical college: A cross-sectional study from Rajasthan. Journal of Family Medicine and Primary Care, 11(10), 6487–6492. https://doi.org/10.4103/jfmpc.jfmpc_774_22
Lee, S., Kasibante, S., Eminai, A., Wani, S., Opii, D. J., Levine, L. D., & Kanyike, A. M. (2025). Effectiveness of a community health worker-led education intervention on knowledge, attitude, and antenatal care attendance among pregnant women in Eastern Uganda. Journal of Health, Population and Nutrition, 44, 232. https://doi.org/10.1186/s41043-025-00876-5
Lim, K. M. X., Lewis, C., Wong, H. C., Chong, G. S. L., Gosavi, A., & Choolani, M. A. (2023). Does an educational video for aneuploidy screening improve informed choice among pregnant women? A randomised controlled trial. Prenatal Diagnosis, 43(1), 42–50. https://doi.org/10.1002/pd.6279
Meldgaard, M., Gamborg, M., & Terkildsen Maindal, H. (2022). Health literacy levels among women in the prenatal period: A systematic review. Sexual & Reproductive Healthcare, 34, 100796. https://doi.org/10.1016/j.srhc.2022.100796
Merriel, A., Toolan, M., Lynch, M., Clayton, G., Demetri, A., Willis, L., Mampitiya, N., Clarke, A., Birchenall, K., de Souza, C., Harvey, E., Russell-Webster, T., Larkai, E., Grzeda, M., Rawling, K., Barnfield, S., Smith, M., Plachcinski, R., Burden, C., . . . Davies, A. (2024). Codesign and refinement of an optimised antenatal education session to better inform women and prepare them for labour and birth. BMJ Open Quality, 13(2), e002731. https://doi.org/10.1136/bmjoq-2023-002731
Mulyani, E. Y., Jus’at, I., & Sumaedi, S. (2023). The effect of augmented-reality media-based health education on healthy lifestyle knowledge, attitude, and healthy lifestyle behaviors among pregnant women during COVID-19 pandemic in Jakarta, Indonesia. Digital Health, 9, 20552076231167255. https://doi.org/10.1177/20552076231167255
Mwilike, B. E., Welsh, J., Nyamuryekung’e, K. K., Nyaruchary, A. J., Pembe, A. B., & Gross, M. M. (2024). Midwife-led mobile antenatal clinic: An innovative approach to improve utilization of services in Pwani, Tanzania. International Journal of Environmental Research and Public Health, 21(11), 1446. https://doi.org/10.3390/ijerph21111446
Neely, E., & Reed, A. (2023). Towards a mother-centred maternal health promotion. Health Promotion International, 38(2), daad014. https://doi.org/10.1093/heapro/daad014
Ningrum, E. W., Lusmilasari, L., Huriyati, E., Marthias, T., & Hasanbasri, M. (2024). Improving maternal health literacy among low-income pregnant women: A systematic review. Narra J, 4(2), e886. https://doi.org/10.52225/narra.v4i2.886
Okafor, I. P., Balogun, M. R., Sekoni, A. O., Dolapo, D. C., Hawkins, C. A., & Afolabi, B. B. (2024). Effectiveness of multimethod, community-based educational interventions on the knowledge and attitude to birth preparedness and complications readiness among women in southwest Nigeria. BMJ Public Health, 2(1), e000203. https://doi.org/10.1136/bmjph-2023-000203
Pan, S. C., & Carpenter, S. K. (2023). Prequestioning and pretesting effects: A review of empirical research, theoretical perspectives, and implications for educational practice. Educational Psychology Review, 35, 97. https://doi.org/10.1007/s10648-023-09814-5
Putri, A. P., & Lu, Y.-Y. (2024). Maternal health literacy in pregnant women: A concept analysis. Maternal and Child Health Journal, 28(8), 1272–1282. https://doi.org/10.1007/s10995-024-03945-z
Radu, M. C., Armean, M. S., Pop-Tudose, M., Medar, C., & Manolescu, L. S. C. (2024). Exploring factors influencing pregnant women’s perceptions and attitudes towards midwifery care in Romania: Implications for maternal health education strategies. Nursing Reports, 14(3), 1807–1818. https://doi.org/10.3390/nursrep14030134
Şenol, D. K., Özkan, S. A., & Ağralı, C. (2024). The effect of the training provided to primiparous pregnant women based on the model on pregnancy risk perception and health literacy. Women & Health, 64(3), 283–293. https://doi.org/10.1080/03630242.2024.2322130
Shannon, K., Burridge, J., Franklin, B., Bhushan, S., Hilsenbeck, S., Petrova, E. V., N’Dow, J., Iwuh, I., Anandasabapathy, S., & Wilkinson, J. P. (2024). Gambian mothers lack obstetric danger sign knowledge, but educational intervention shows promise. Annals of Global Health, 90(1), 31. https://doi.org/10.5334/aogh.3930
Shorey, S., Loh, D. N. L., Chan, V., Chua, C., & Choolani, M. A. (2022). Parents’ perceptions of antenatal educational programs: A meta-synthesis. Midwifery, 113, 103432. https://doi.org/10.1016/j.midw.2022.103432
Somji, A., Ramsey, K., Dryer, S., Makokha, F., Ambasa, C., Aryeh, B., Booth, K., Xueref, S., Moore, S., Mwenesi, R., & Rashid, S. (2022). “Taking care of your pregnancy”: A mixed-methods study of group antenatal care in Kakamega County, Kenya. BMC Health Services Research, 22, 969. https://doi.org/10.1186/s12913-022-08200-1
Syairaji, M., Nurdiati, D. S., Wiratama, B. S., Prüst, Z. D., Bloemenkamp, K. W. M., & Verschueren, K. J. C. (2024). Trends and causes of maternal mortality in Indonesia: A systematic review. BMC Pregnancy and Childbirth, 24, 515. https://doi.org/10.1186/s12884-024-06687-6
Tsiamparlis-Wildeboer, A. H. C., Feijen-De Jong, E. I., van Lohuizen, M. T., Tichelman, E., de Jonge, A., & Scheele, F. (2023). Self-management support by health care providers in prenatal Shared Medical Appointments (CenteringPregnancy©) and prenatal individual appointments. Patient Education and Counseling, 107, 107579. https://doi.org/10.1016/j.pec.2022.107579
Uwiringiyimana, E., Manirambona, E., Byiringiro, S., Nsanzimana, A., Uhawenayo, N., Ufitinema, P., Bayizere, J., Moreland, P. J., Meharry, P., & Ntasumbumuyange, D. (2022). Pregnant women’s knowledge of obstetrical danger signs: A cross-sectional survey in Kigali, Rwanda. PLOS Global Public Health, 2(11), e0001084. https://doi.org/10.1371/journal.pgph.0001084
Velasco-Velásquez, S., Orozco, A. S., Ramirez, M., Pachón, L., Hurtado-Gomez, M. J., Valois, G., Celis-Giraldo, D., Cordero-López, S. S., McLeod, R., & Gómez-Marín, J. E. (2024). Impact of education on knowledge, attitudes, and practices for gestational toxoplasmosis. Journal of Infection and Public Health, 17(9), 102516. https://doi.org/10.1016/j.jiph.2024.102516
Yang, C.-L., Xu, Z.-Y., & Chang, C.-Y. (2025). The impact of robot-assisted digital education on prenatal women’s health literacy: A randomized controlled trial. Journal of Nursing Management, 2025, 8865606. https://doi.org/10.1155/jonm/8865606
Yimer, A., Endris, S., Wossen, A., & Abate, M. (2024). Pregnant women’s knowledge, attitude, and practice toward physical exercise during pregnancy and its associated factors at Dessie town health institutions, Ethiopia. AJOG Global Reports, 4(4), 100391. https://doi.org/10.1016/j.xagr.2024.100391
Yom, S. S., Deville, C., Boerma, M., Carlson, D., Jabbour, S. K., & Braverman, L. (2022). Evaluating the generalizability and reproducibility of scientific research. International Journal of Radiation Oncology, Biology, Physics, 113(1), 1–4. https://doi.org/10.1016/j.ijrobp.2022.02.002












