The effect of Orem’s theory of interventional education on self-care, worry and health practices of pregnant women aged 35 years or above, referring to health service centers in Gonabad county, 2024

The effect of Orem’s theory of interventional education on self-care, worry and health practices of pregnant women aged 35 years or above, referring to health service centers in Gonabad county, 2024 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The effect of Orem’s theory of interventional education on self-care, worry and health practices of pregnant women aged 35 years or above, referring to health service centers in Gonabad county, 2024 Zahra Hasannia Kheibari, Fatemeh Mohammadzadeh, Narjes Bahri, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4925136/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Self-care during pregnancy requires special attention, particularly among women aged 35 and above. This study aimed to determine the impact of an educational intervention based on the Orem theory on self-care, worry, and health practices among pregnant women aged 35 and older referred to comprehensive health service centers in Gonabad County. Methods: This randomized controlled trial was conducted in 2023 among 53 pregnant women aged 35 and above referred to comprehensive health service centers in Gonabad County. Participants were randomly assigned to the intervention or control group. Data was collected using questionnaires on demographic and obstetric characteristics, the Cambridge worry Scale, Hart's prenatal care actions, and Health Practices in Pregnancy Questionnaire-II. The intervention group received a theory-based educational intervention in three sessions, while the control group received no intervention. Research staff completed questionnaires before, immediately, and one month after the intervention. Data analysis was performed using generalized estimating equations (GEE) with a significance level 0.05. Results: Based on the GEE model, there were no statistically significant differences in mean scores for self-care, health practices, and worry between the two groups prior to the intervention (p > 0.05). Post-intervention, both groups exhibited an increase in mean scores for self-care and health practices, but the intervention group demonstrated a steeper increase, which was statistically significant. In contrast, the intervention group experienced a more pronounced decrease in mean worry scores than the control group (p < 0.05). Conclusion: The findings suggest that a self-care educational program based on the Orem's theory can be effective in enhancing self-care and health practices and reducing worry among pregnant women. Therefore, it is recommended that this educational program be implemented for pregnant women aged 35 and above. Trial registration and ethics code : IRCT registration number: IRCT20231107059980N1 and ethics code: IR.GMU.REC.1402. Registration date: 30/11/2023 health practice Orem’s theory self-care worry Figures Figure 1 Background Pregnancy is a critical period in a woman's life, accompanied by significant physical and psychological changes, and is associated with certain risks that can threaten both the mother and fetus. Advanced maternal age, particularly over 35 years, is linked to an increased risk of complications such as diabetes, hypertension, placenta previa, preeclampsia, and stillbirth. These complications can heighten maternal worry, which, in turn, can adversely affect pregnancy outcomes (1,2). worry is described as uneasiness, characterized by negative thoughts and feelings (3). Some studies have shown a U-shaped pattern in worry levels during pregnancy, with higher levels in the first and third trimesters compared to the second. This is likely due to the adaptation to pregnancy during the second trimester, as women experience relief from symptoms such as nausea, vomiting, and the risk of miscarriage. Conversely, concerns about childbirth may contribute to higher worry levels in the third trimester(4). Mild worry is commonly experienced during pregnancy, however, in some cases, it can escalate to a severe, uncontrollable level, leading to pathological worry and posing a threat to the pregnancy. Moreover, excessive worry can result in a negative pregnancy experience, reducing or delaying the desire for future pregnancies, which may conflict with current national policies (3). A study found that the prevalence of low worry during pregnancy was 86.4%, while high worry was reported in 13.6% of cases (5). Given that pregnant women's primary concern is ensuring a healthy pregnancy and delivery, mothers often take steps to achieve this goal. These actions and decisions are called health practices, and they can have lasting impacts on both the mother and the infant (6). Studies have shown that women's knowledge of prenatal care and health behaviors is generally moderate, indicating insufficient understanding (7). A recent trend in healthcare is self-care, which refers to self-directed actions to improve one's health (8). A study found that pregnant women in high-risk age groups (under 18 or over 35 years) engaged in less self-care compared to those in the low-risk age group (18-35 years) (9). One of the most comprehensive theories of self-care is Orem's Self-Care Theory, which integrates the theories of self-care, self-care deficit, and nursing systems (10). This theory posits that humans are thinking beings capable of interacting with their environment and engaging in adaptive behaviors, possessing both the ability and the right to self-care. When this ability is compromised, nurses act as facilitators and agents of change to restore the individual's lost capacity. Based on the patient's needs and the nurse's involvement in care, three types of nursing systems have been designed: the wholly compensatory system, the partially compensatory system, and the supportive-educative system (11). Given that improving conditions can be achieved through increased knowledge and awareness facilitated by education, this study aimed to determine the effect of education based on Orem's Self-Care Theory on self-care, worry and health practices among pregnant women aged 35 and over in Gonabad County. Materials and methods Study Design, Participants, and Sampling This randomized controlled trial was conducted on 53 pregnant women aged 35 and over who visited comprehensive health service centers in Gonabad County in 2023. The sample size was determined using the formula for comparing means in two independent groups, considering an alpha level of 0.05, a power of 0.9, and an \(\:{\mu\:}_{1}=58.85.{\mu\:}_{2}=55.25.\:\sigma\:=4.48\:\) effect size of 0.8 ( 12 ) based on a similar study ( 3 ). To account for a potential 10% dropout rate, the sample size was increased to 30 individuals per group. the study population consisted of all pregnant women aged 35 and over who visited comprehensive health service centers in Gonabad County. This study employed a stratified random sampling method. The health service centers were stratified into two categories: urban and rural. At this stage, the health center was the sampling unit. Therefore, four centers were randomly selected from urban areas and three from rural areas. Randomization was conducted at the center level to prevent interaction between participants in the two groups. Simple random sampling was employed within each center after randomly assigning centers to either the intervention or control group. To do this, a list of eligible women was created for each center, and a specific number of individuals were randomly selected using a lottery method based on the calculated sample size and the total population of the center. Participants were then included in the study if they met the inclusion criteria. Inclusion criteria were: gestational age between 14 and 29 weeks, absence of any underlying diseases including chronic hypertension, chronic diabetes, coagulation disorders, HIV/AIDS, rheumatoid arthritis, asthma, iron deficiency anemia, sickle cell anemia, thyroid disease, heart disease, gastrointestinal disease, chronic kidney disease, prolactinoma, kidney transplant, thalassemia, thromboembolism, TORCH infections (toxoplasmosis, other infections, rubella, cytomegalovirus, and herpes simplex), rubella, tuberculosis, history of or current breast cancer, epilepsy, lupus, multiple sclerosis, migraine, skeletal abnormalities, genital abnormalities, hepatitis, psychiatric disorders (suicide and depression), singleton pregnancy, at least primary education, and complete health based on medical records. Exclusion criteria included:missing more than one class session, experiencing a stressful event in the past six months, participating in similar training programs, and experiencing pregnancy complications such as miscarriage. Instruments • demographic and obstetric characteristics questionnaire Data were collected using a demographic and obstetric characteristics questionnaire, the Cambridge Worry Scale, Hart prenatal care actions Scale, and the Health Practices in pregnancy Questionnaire. The demographic and obstetric characteristics questionnaire included information about personal characteristics (age, spouse's age, age at marriage, woman's education level, woman's occupation, spouse's education level, spouse's occupation) and obstetric history (number of pregnancies, gestational age in weeks, number of miscarriages, number of live births, number of living children, number of deceased children, number of stillbirths). • Cambridge Worry Scale The Cambridge Worry Scale was developed in 2003 by Green and colleagues in Cambridge to measure the level of worry in pregnant women. This questionnaire consists of 16 items, and the scoring is based on a 6-point Likert scale ranging from 0 to 5. The minimum score is 0, and the maximum score is 80. Higher scores indicate higher levels of worry ( 13 ). The content validity of the Persian version of this questionnaire was confirmed by Safari Komeil and colleagues in 2018 using the content validity index (CVI) and content validity ratio (CVR) methods. The overall CVI for the instrument was 0.81, and the overall CVR was 0.96 ( 14 ). The reliability of the questionnaire was assessed in terms of test-retest reliability and internal consistency (Cronbach's alpha coefficient). The intraclass correlation coefficient (95% confidence interval) and Cronbach's alpha were 0.84 and 0.73, respectively ( 14 ). • Health Practices in Pregnancy Questionnaire-II (HPQ-II) The Health Practices in Pregnancy Questionnaire-II is designed to measure the health practices of pregnant women. It consists of six subscales: balancing activity and rest, caring for illnesses and injuries, taking care of nutrition and diet, avoiding harmful drugs and narcotics, following up on healthcare, and gaining knowledge about pregnancy and childbirth. The questionnaire contains 34 items with a 5-point Likert scale ranging from 1 to 5. The minimum score is 34, and the maximum score is 170. Higher total scores indicate healthier behaviors ( 2 ). The content validity and internal consistency of this questionnaire were confirmed by Lindgren with a Cronbach's alpha of 0.81 ( 2 ). The validity and reliability of the Persian version of this questionnaire were confirmed by Maddahi in 2017 ( 15 ). In Parsa's 2018 study, Cronbach's alpha was 0.79 ( 2 ). • Hart's Prenatal Care Actions Scale The Hart's Prenatal Care Actions Scale is derived from the self-care items of the Orem and antenatal care guidelines and was developed by Hart in 1995. It consists of 41 items based on a 5-point Likert scale, with scores ranging from 1 to 5. Reverse scoring is applied to items 1, 2, 9, 12, 23, 29, and 34. Higher total scores indicate higher levels of self-care ( 16 ). Chainy Seahan confirmed the validity of the questionnaire. The validity of the questionnaire has been confirmed by Chainy Seahan. The validity of the Persian version of this questionnaire was determined by Abedian and colleagues in 2016. After being translated into Persian, the questionnaire was given to 10 faculty members at the School of Nursing and Midwifery, Mashhad University of Medical Sciences, and was used after making necessary revisions. The reliability of this questionnaire was confirmed by Chainy Saha with a Cronbach's alpha of 80%. The questionnaire was also confirmed with a Cronbach's alpha of 76.2% in Abedian's study ( 16 ). Intervention • Intervention Group In the intervention group, an educational program based on Orem's Theory was implemented by the principal investigator. After assessing the self-care needs of the participants using the Hart questionnaire in the first session, an educational program was developed for each individual based on Orem's Theory, categorized into universal, developmental, and health deviation needs. This educational program was conducted in three 30-minute individual sessions once a week (a total of three sessions). Participants completed the Cambridge Worry Scale, Hart's Prenatal Care Actions Scale, and Health Practices in Pregnancy Questionnaire-II (HPQ-II) at the beginning of the study, immediately, and one month after the intervention. • Control Group No intervention was provided to the control group. They completed the worry, Hart's prenatal care actions, and health-practices questionnaires at the beginning of the study, immediately, and one month after the intervention. To adhere to research ethics, an educational booklet containing educational tips was provided to the control group at the end of the study. The workflow is illustrated in Fig. 1 . Data Analysis Data was analyzed using SPSS version 16 and statistical tests, including independent t-test, Mann-Whitney U test, Chi-square test, and generalized estimating equations (GEE). The level of significance was set at 0.05. Results Demographic and obstetric characteristics, including age, spouse's age, education level, spouse's education level, occupation, spouse's occupation, number of pregnancies, current gestational age, number of miscarriages, number of live births, and type of pregnancy (desired or undesired) are presented in Table 1 . The mean scores of self-care, worry, and health- practices before, immediately after, and one month after the intervention in both the control and intervention groups are reported in Table 2. Table 1 Demographic and obstetric characteristics, including age, spouse's age, education level, spouse's education level, occupation, spouse's occupation, number of pregnancies, current gestational age, number of miscarriages, number of live births, and type of pregnancy (desired or undesired) Before intervention Immediately after the intervention One month after the intervention Regression coefficient standard error Parent statistics Significant level mean scores of health practices Intervention group (6/36) 116/92 (6/65) 140/59 (3/37) 142/85 group 2/098 1/935 1/175 0/278 Time 0/346 0/129 7/115 0/008 Control group (7/15) 118/53 (6/42) 118/88 (6/51) 119/23 Group*time 12/617 0/425 877/533 < 0/001 mean scores of worry Intervention group (12/05) 38/25 (10/35) 27/29 (8/11) 22/85 group -0/494 3/128 0/025 0/875 Time 0/058 0/285 0/041 0/840 Control group (10/86) 38/42 (10/45) 38/57 (9/88) 38/53 Group*time -7/761 0/571 184/423 < 0/001 mean scores of self-care Intervention group (7/42) 139/22 (9/47) 170/48 (5/95) 179/44 group 0/522 2/442 0/046 0/831 Time 0/904 0/232 15/126 < 0/001 Control group (10/47) 142/76 (9/28) 144/03 (9/35) 144/57 Group*time 19/207 0/617 969/025 < 0/001 Table 2. mean scores of self-care, worry, and health- practices before, immediately after, and one month after the intervention in both the control and intervention groups Before intervention Immediately after the intervention One month after the intervention Regression coefficient standard error Parent statistics Significant level mean scores of health practices Intervention group (6/36) 116/92 (6/65) 140/59 (3/37) 142/85 group 2/098 1/935 1/175 0/278 Time 0/346 0/129 7/115 0/008 Control group (7/15) 118/53 (6/42) 118/88 (6/51) 119/23 Group*time 12/617 0/425 877/533 <0/001 mean scores of worry Intervention group (12/05) 38/25 (10/35) 27/29 (8/11) 22/85 group -0/494 3/128 0/025 0/875 Time 0/058 0/285 0/041 0/840 Control group (10/86) 38/42 (10/45) 38/57 (9/88) 38/53 Group*time -7/761 0/571 184/423 <0/001 mean scores of self-care Intervention group (7/42) 139/22 (9/47) 170/48 (5/95) 179/44 group 0/522 2/442 0/046 0/831 Time 0/904 0/232 15/126 <0/001 Control group (10/47) 142/76 (9/28) 144/03 (9/35) 144/57 Group*time 19/207 0/617 969/025 <0/001 Results of the Generalized Estimating Equations (GEE) model showed a significant interaction effect between group and time. The positive coefficient indicated that for each unit increase in time, the worry score in the intervention group was significantly lower by 7.61 compared to the control group (p < 0.001). Similarly, there was a significant interaction effect between group and time for health practice. The positive coefficient indicated that for each unit increase in time, the health practice score during pregnancy in the intervention group was significantly higher by 12.617 units compared to the control group (p < 0.001). Moreover, there was also a significant interaction effect between group and time for self-care. The positive coefficient indicated that for each unit increase in time, the prenatal care actions score in the intervention group was significantly higher by 19.207 units compared to the control group (p < 0.001). Discussion This study aimed to determine the effect of educational intervention based on Orem's theory on self-care, worry, and health practice among pregnant women aged 35 years or older attending comprehensive health service centers in Gonabad County. The results showed a significant difference in self-care, health practice, and worry scores between the intervention and control groups immediately and one month after the intervention. Therefore, it can be concluded that educational intervention based on Orem's theory can improve self-care and health practice and reduce worry. These results are consistent with a previous study conducted in Mashhad in 2015–2016 aimed at determining the application of Orem's theory in promoting self-care behaviors among pregnant women at risk of preterm birth. Findings indicated that an educational intervention aligned with Orem's self-care theory led to a significant improvement in self-care practices among women at risk of preterm birth. Specifically, the intervention group exhibited significantly higher post-intervention self-care scores compared to the control group ( 16 ).The self-care scores among women at risk of preterm birth were higher in the previous study compared to the current study. This discrepancy could be attributed to differences in access to healthcare services between the two settings. However, the increase in self-care scores after the intervention in the intervention group of the current study indicates the positive impact of using Orem's Self-Care Theory on the self-care of pregnant women. This study aligns with the previous study regarding using Orem's Self-Care Theory in pregnant women and assessing self-care. In a randomized controlled trial, a study was conducted on 64 pregnant women with insulin-treated gestational diabetes to determine the impact of couples' supportive counseling on self-care behaviors. After being randomly assigned to either a control or intervention group, the intervention group received couples' supportive counseling sessions. Data analysis revealed a significant difference in mean self-care scores between pre-and post-intervention in the intervention group, indicating that couples' supportive counseling can improve self-care behaviors, consistent with the findings of the current study ( 17 ). In this study, the educational intervention was conducted with the pregnant woman and her partner, whereas in the current study, the intervention was solely provided to the pregnant woman. This methodological difference makes it incompatible with the current study; however, both studies align in terms of examining self-care in pregnant women. One reason for the increase in self-care scores is the lack of information regarding pregnancy, its complications, and related actions. Education has led to increased awareness and improved self-care. Moreover, managing pregnancy complications requires the pregnant woman's active participation in prenatal care, which necessitates a higher level of awareness. Self-care education is an effective tool for increasing this level of awareness. Furthermore, inadequate knowledge regarding prenatal care can lead to various complications and ultimately result in adverse pregnancy outcomes. Education can foster the pregnant woman's active and informed participation in self-care. Therefore, the findings of this study demonstrate the positive impact of Orem's Self-Care Theory on self-care among pregnant women aged 35 and over. A study aimed to determine the impact of electronic education on prenatal screening tests on the anxiety and worry of pregnant women. The Cambridge Worry Scale was used to assess the women's worry both before and two weeks after the intervention. The results indicated that electronic education significantly reduced worry among pregnant women. One reason for the higher worry scores in the previous study compared to the current study might be the gestational age inclusion criteria (7–9 weeks in the previous study and 14–29 weeks in the current study). According to some studies, worry is higher in the first trimester due to the risk of miscarriage compared to the second trimester. Moreover, the decrease in worry scores was more pronounced in the current study, which can be attributed to the comprehensive educational intervention. While the previous study only provided a 7-minute animation on screening tests, the current study included three sessions with a broader focus on various topics such as nutrition, maternal and fetal health, relationships, and mental health during pregnancy. This study aligns with the current study in terms of assessing worry ( 18 ). Furthermore, a similar study comparing the effects of group and individual education on anxiety and worry among pregnant women regarding prenatal screening tests found that educational interventions reduced worry levels, aligning with the findings of the current study. This study involved three groups of pregnant women (individual education, group education, and control). The results showed an increase in mean anxiety scores in both the control and group education groups, while no increase was observed in the individual education group ( 13 ). One possible explanation for this lack of increase is the individual education method, which was also used in the current study. Although group education has its advantages, it also has limitations. For example, some individuals may disrupt group dynamics, and participants may feel pressured to self-disclose. In contrast, individual education gives individuals more opportunities to express their thoughts and opinions. Therefore, the use of individual education to reduce woy in this study is consistent with the current study. A randomized controlled trial was performed among pregnant women and their partners in Urmia to investigate the impact of couples' counseling based on spousal support on anxiety and worry during pregnancy.The results demonstrated a significant difference in mean woryy scores between the intervention and control groups following the counseling intervention, indicating that the intervention effectively reduced worry in pregnant women. This finding aligns with the current study ( 19 ). However, in terms of methodology and the specific content of couples' counseling, this study differs from the present one. A study aimed to determine the impact of cognitive-behavioral counseling on anxiety and worry levels among pregnant women with a moderate risk of Down syndrome in the first-trimester screening. The intervention group received cognitive-behavioral counseling. The results indicated that this intervention reduced anxiety and worry, which is consistent with the current study. In this study, the level of worry among pregnant women was higher compared to the current study. This can be attributed to the characteristics of the study population; participants were pregnant women with a moderate risk of Down syndrome, a condition that could increase their worry levels ( 20 ). A study aimed to determine the impact of individual counseling intervention on pregnancy-related health practices. The results showed no significant difference in the mean score of health practices between the intervention and control groups before the educational intervention. However, a significant difference was observed after the intervention, indicating that providing individual counseling to pregnant women is an effective way to enhance their health practices. This study aligns with the current study in terms of individual counseling and the assessment of health practices. The educational intervention was conducted in Turkey in three sessions, with self-care scores measured before the intervention and during the second and third trimesters. These findings are consistent with the results of the current study ( 21 ). The similarity in findings can be attributed to cultural factors and the effectiveness of individual counseling. The current study utilized Orem's Self-Care Theory, which differs from the theory used in the study being compared. A study aimed to investigate the impact of self-care counseling on the health practice of adolescent pregnant women, as well as their attitudes toward motherhood, pregnancy, and pregnancy symptoms. After the counseling intervention and data analysis, the results indicated that the intervention improved health practice among adolescent pregnant women, consistent with the current study. This study focused on adolescent pregnant women and involved a six-session group counseling intervention. The health practice scores in this study were lower compared to the current study, which could be attributed to the age of the participants. In this regard, this study is not directly comparable to the current study ( 22 ). Furthermore, a study aimed to determine the impact of self-care counseling on the health practice of pregnant women aged 35 and over who visited comprehensive health centers in Hamadan. The study involved a group counseling intervention for pregnant women aged 35 and older. Data analysis confirmed the positive impact of self-care counseling on the health practice of high-risk pregnant women. This study aligns with the current study in terms of assessing the health practices of pregnant women aged 35 and over. The intervention in this study consisted of four group counseling sessions, and health practice scores were measured before and one month after the intervention. The higher health practice scores in the current study can likely be attributed to the use of Orem's Self-Care Theory and individual sessions ( 2 ). In a 2015 Turkish study, 111 primiparous women who had a natural vaginal delivery were enrolled and randomly assigned to either a control or intervention group. Data was collected using a self-developed personal information form, a data collection form based on Orem's Self-Care Deficit Theory, and the Postpartum Self-Evaluation Questionnaire (to assess women's adaptation to motherhood in the postpartum period). A nursing intervention was then implemented based on identified diagnoses over six sessions. At the end of the sixth week postpartum, questionnaires were completed again by both groups. The results indicated that the care provided based on Orem's Self-Care Theory in the postpartum period improved or prevented postpartum problems and increased postpartum adaptation ( 23 ), demonstrating the positive impact of Orem's model on postpartum adaptation. This aligns with the use of Orem's model in the current study. A study conducted in China in 2020 aimed to investigate the impact of Orem-based nursing intervention on pain levels, self-care, psychological status, and quality of life in patients with bone cancer. Data was collected using the Visual Analogue Scale for pain, the Hamilton Anxiety and Depression Rating Scale, and the Quality of Life Scale, as well as a self-care competency questionnaire. Results showed that the intervention group had significantly higher quality of life and self-care scores compared to the control group and lower pain levels and negative emotions such as anxiety and depression. These findings support the results of the current study ( 24 ). One strength of this study is its focus on pregnant women aged 35 and over, which is significant considering current population policies and the importance of self-care in this population. Additionally, the study included both urban and rural populations. Limitations of the study include the reliance on self-reported questionnaire data, as well as the inability to control for genetic differences among participants and individual and psychological differences. Coclusion This study concludes that an Orem-based self-care education program can significantly improve self-care levels and health practice and reduce worry in pregnant women. Consequently, it is recommended that this educational approach be implemented for pregnant women aged 35 and over. Declarations Ethics approval and consent to participate This article is based on a master's thesis in midwifery with the ethics code IR.GMU.REC.1402.100 and clinical trial registration number IRCT20231107059980N1. Ethical considerations for this research included obtaining written approval from the ethics committee and presenting it to the relevant authorities, obtaining permission to collect samples, explaining the study's objectives, methods, and confidentiality of information to participants, obtaining written informed consent, maintaining confidentiality of information, and providing a contact number to the control group to monitor the psychological impact of the presence of the educator. No physical harm was caused to participants. Consent for publication Not applicable Availability of data and material The dataset in this study is available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This study was funded by the Research Deputy of Gonabad University of Medical Sciences. Author Contributions Study design: FA, NBB, FM, ZHKh; Data collection: ZHKh; Data analysis: FM; Original draft preparation: ZHKh; All authors read and approved the final manuscript. Acknowledgments The authors thank the Vice Chancellor for Research at Gonabad University of Medical Sciences for their support and the professors who contributed to this research. We are also grateful to the staff and officials of Gonabad health centers and, most importantly, the pregnant women and their families for their participation. References Momeni javid F, simbar M, Dolatian M, Alavi Majd H. Comparison of pregnancy self-care, perceived social support and perceived stress of women with gestational diabetes and healthy pregnant women. Iran J Endocrinol Metab. 2019;(January 2015):156–64. Aghababaei S, Omidifard F, Roshanaei G, Parsa P. The effect of self-care counseling on health practices of 35-year-old or more aged pregnant women referring to Hamadan health care centers , in 2018. 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Available from: http://www.ncbi.nlm.nih.gov/pubmed/36915789%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC10006768 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4925136","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":343981359,"identity":"95e49b84-6400-442c-a16a-efea757fe5ac","order_by":0,"name":"Zahra Hasannia Kheibari","email":"","orcid":"","institution":"Gonabad University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zahra","middleName":"Hasannia","lastName":"Kheibari","suffix":""},{"id":343981360,"identity":"d72e868f-ebc5-4e04-994d-4cd08ad57be3","order_by":1,"name":"Fatemeh Mohammadzadeh","email":"","orcid":"","institution":"Gonabad University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Fatemeh","middleName":"","lastName":"Mohammadzadeh","suffix":""},{"id":343981361,"identity":"7aaf382c-2a72-4643-841a-cd275f13e7d4","order_by":2,"name":"Narjes Bahri","email":"","orcid":"","institution":"Gonabad University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Narjes","middleName":"","lastName":"Bahri","suffix":""},{"id":343981362,"identity":"e1e90a72-fc45-4855-a18c-cf31a4683485","order_by":3,"name":"Fariba Askari","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9klEQVRIiWNgGAWjYBAC9gYGhsMghgQQH0gwsIGw8AGeA8haHlSkEaeFGaaF8cGZw0RoYT/78HBBjZ29ZPvZhwcS284n9s9uPviAocYmGqcWnnSDwzOOJSfOBjKAWm4nzrhzLNmA4VhabgMOLfYMaQyHediYE+SADLCWhhs5ZhKMDYdxauHhfwbU8q/eXg7IAGo5lzifoBYJoC28bYcZZwMZBxLOHEjcQFgL0JaZfccTZ84A2pJQkWy88UZaskECHr/w8Kcxfy74Vm0vcT6N+eMPAzvZeTeSDz74UGODUwsGcASrTCBWOQjYk6J4FIyCUTAKRgYAAA6MYYKi63gWAAAAAElFTkSuQmCC","orcid":"","institution":"Gonabad University of Medical Sciences","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Fariba","middleName":"","lastName":"Askari","suffix":""}],"badges":[],"createdAt":"2024-08-16 12:55:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4925136/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4925136/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":66656370,"identity":"c9d3b745-e601-4ede-9012-f90a1d1f9b09","added_by":"auto","created_at":"2024-10-15 08:20:28","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":66708,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCONSORT diagram of the study on the effect of educational intervention on self-care, worry, and health practices in pregnant women aged 35 years and over.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4925136/v1/b212338f7e5767a8d734f262.png"},{"id":87102696,"identity":"b741aedd-a5d2-4a18-957e-6ac79ab1af5b","added_by":"auto","created_at":"2025-07-19 13:31:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1098949,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4925136/v1/a6d09f49-7161-438a-984c-dfdfac68d80c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The effect of Orem’s theory of interventional education on self-care, worry and health practices of pregnant women aged 35 years or above, referring to health service centers in Gonabad county, 2024","fulltext":[{"header":"Background","content":"\u003cp\u003ePregnancy is a critical period in a woman\u0026apos;s life, accompanied by significant physical and psychological changes, and is associated with certain risks that can threaten both the mother and fetus. Advanced maternal age, particularly over 35 years, is linked to an increased risk of complications such as diabetes, hypertension, placenta previa, preeclampsia, and stillbirth. These complications can heighten maternal worry, which, in turn, can adversely affect pregnancy outcomes (1,2).\u003c/p\u003e\n\u003cp\u003eworry is described as uneasiness, characterized by negative thoughts and feelings (3). Some studies have shown a U-shaped pattern in worry levels during pregnancy, with higher levels in the first and third trimesters compared to the second. This is likely due to the adaptation to pregnancy during the second trimester, as women experience relief from symptoms such as nausea, vomiting, and the risk of miscarriage. Conversely, concerns about childbirth may contribute to higher worry levels in the third trimester(4). Mild worry is commonly experienced during pregnancy, however, in some cases, it can escalate to a severe, uncontrollable level, leading to pathological worry and posing a threat to the pregnancy. Moreover, excessive worry can result in a negative pregnancy experience, reducing or delaying the desire for future pregnancies, which may conflict with current national policies (3). A study found that the prevalence of low worry during pregnancy was 86.4%, while high worry was reported in 13.6% of cases (5).\u003c/p\u003e\n\u003cp\u003eGiven that pregnant women\u0026apos;s primary concern is ensuring a healthy pregnancy and delivery, mothers often take steps to achieve this goal. These actions and decisions are called health practices, and they can have lasting impacts on both the mother and the infant (6). Studies have shown that women\u0026apos;s knowledge of prenatal care and health behaviors is generally moderate, indicating insufficient understanding (7).\u003c/p\u003e\n\u003cp\u003eA recent trend in healthcare is self-care, which refers to self-directed actions to improve one\u0026apos;s health (8). A study found that pregnant women in high-risk age groups (under 18 or over 35 years) engaged in less self-care compared to those in the low-risk age group (18-35 years) (9).\u003c/p\u003e\n\u003cp\u003eOne of the most comprehensive theories of self-care is Orem\u0026apos;s Self-Care Theory, which integrates the theories of self-care, self-care deficit, and nursing systems (10). This theory posits that humans are thinking beings capable of interacting with their environment and engaging in adaptive behaviors, possessing both the ability and the right to self-care. When this ability is compromised, nurses act as facilitators and agents of change to restore the individual\u0026apos;s lost capacity. Based on the patient\u0026apos;s needs and the nurse\u0026apos;s involvement in care, three types of nursing systems have been designed: the wholly compensatory system, the partially compensatory system, and the supportive-educative system (11).\u003c/p\u003e\n\u003cp\u003eGiven that improving conditions can be achieved through increased knowledge and awareness facilitated by education, this study aimed to determine the effect of education based on Orem\u0026apos;s Self-Care Theory on self-care, worry and health practices among pregnant women aged 35 and over in Gonabad County.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design, Participants, and Sampling\u003c/h2\u003e \u003cp\u003eThis randomized controlled trial was conducted on 53 pregnant women aged 35 and over who visited comprehensive health service centers in Gonabad County in 2023. The sample size was determined using the formula for comparing means in two independent groups, considering an alpha level of 0.05, a power of 0.9, and an \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\mu\\:}_{1}=58.85.{\\mu\\:}_{2}=55.25.\\:\\sigma\\:=4.48\\:\\)\u003c/span\u003e\u003c/span\u003eeffect size of 0.8 (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) based on a similar study (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). To account for a potential 10% dropout rate, the sample size was increased to 30 individuals per group. the study population consisted of all pregnant women aged 35 and over who visited comprehensive health service centers in Gonabad County. This study employed a stratified random sampling method. The health service centers were stratified into two categories: urban and rural. At this stage, the health center was the sampling unit. Therefore, four centers were randomly selected from urban areas and three from rural areas. Randomization was conducted at the center level to prevent interaction between participants in the two groups. Simple random sampling was employed within each center after randomly assigning centers to either the intervention or control group. To do this, a list of eligible women was created for each center, and a specific number of individuals were randomly selected using a lottery method based on the calculated sample size and the total population of the center. Participants were then included in the study if they met the inclusion criteria.\u003c/p\u003e \u003cp\u003eInclusion criteria were: gestational age between 14 and 29 weeks, absence of any underlying diseases including chronic hypertension, chronic diabetes, coagulation disorders, HIV/AIDS, rheumatoid arthritis, asthma, iron deficiency anemia, sickle cell anemia, thyroid disease, heart disease, gastrointestinal disease, chronic kidney disease, prolactinoma, kidney transplant, thalassemia, thromboembolism, TORCH infections (toxoplasmosis, other infections, rubella, cytomegalovirus, and herpes simplex), rubella, tuberculosis, history of or current breast cancer, epilepsy, lupus, multiple sclerosis, migraine, skeletal abnormalities, genital abnormalities, hepatitis, psychiatric disorders (suicide and depression), singleton pregnancy, at least primary education, and complete health based on medical records. Exclusion criteria included:missing more than one class session, experiencing a stressful event in the past six months, participating in similar training programs, and experiencing pregnancy complications such as miscarriage.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eInstruments\u003c/h2\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003e\u0026bull; demographic and obstetric characteristics questionnaire\u003c/h2\u003e \u003cp\u003eData were collected using a demographic and obstetric characteristics questionnaire, the Cambridge Worry Scale, Hart prenatal care actions Scale, and the Health Practices in pregnancy Questionnaire. The demographic and obstetric characteristics questionnaire included information about personal characteristics (age, spouse's age, age at marriage, woman's education level, woman's occupation, spouse's education level, spouse's occupation) and obstetric history (number of pregnancies, gestational age in weeks, number of miscarriages, number of live births, number of living children, number of deceased children, number of stillbirths).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e\u0026bull; Cambridge Worry Scale\u003c/h2\u003e \u003cp\u003eThe Cambridge Worry Scale was developed in 2003 by Green and colleagues in Cambridge to measure the level of worry in pregnant women. This questionnaire consists of 16 items, and the scoring is based on a 6-point Likert scale ranging from 0 to 5. The minimum score is 0, and the maximum score is 80. Higher scores indicate higher levels of worry (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The content validity of the Persian version of this questionnaire was confirmed by Safari Komeil and colleagues in 2018 using the content validity index (CVI) and content validity ratio (CVR) methods. The overall CVI for the instrument was 0.81, and the overall CVR was 0.96 (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The reliability of the questionnaire was assessed in terms of test-retest reliability and internal consistency (Cronbach's alpha coefficient). The intraclass correlation coefficient (95% confidence interval) and Cronbach's alpha were 0.84 and 0.73, respectively (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e\u0026bull; Health Practices in Pregnancy Questionnaire-II (HPQ-II)\u003c/h2\u003e \u003cp\u003eThe Health Practices in Pregnancy Questionnaire-II is designed to measure the health practices of pregnant women. It consists of six subscales: balancing activity and rest, caring for illnesses and injuries, taking care of nutrition and diet, avoiding harmful drugs and narcotics, following up on healthcare, and gaining knowledge about pregnancy and childbirth. The questionnaire contains 34 items with a 5-point Likert scale ranging from 1 to 5. The minimum score is 34, and the maximum score is 170. Higher total scores indicate healthier behaviors (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The content validity and internal consistency of this questionnaire were confirmed by Lindgren with a Cronbach's alpha of 0.81 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The validity and reliability of the Persian version of this questionnaire were confirmed by Maddahi in 2017 (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In Parsa's 2018 study, Cronbach's alpha was 0.79 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e\u0026bull; Hart's Prenatal Care Actions Scale\u003c/h2\u003e \u003cp\u003e The Hart's Prenatal Care Actions Scale is derived from the self-care items of the Orem and antenatal care guidelines and was developed by Hart in 1995. It consists of 41 items based on a 5-point Likert scale, with scores ranging from 1 to 5. Reverse scoring is applied to items 1, 2, 9, 12, 23, 29, and 34. Higher total scores indicate higher levels of self-care (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Chainy Seahan confirmed the validity of the questionnaire. The validity of the questionnaire has been confirmed by Chainy Seahan. The validity of the Persian version of this questionnaire was determined by Abedian and colleagues in 2016. After being translated into Persian, the questionnaire was given to 10 faculty members at the School of Nursing and Midwifery, Mashhad University of Medical Sciences, and was used after making necessary revisions. The reliability of this questionnaire was confirmed by Chainy Saha with a Cronbach's alpha of 80%. The questionnaire was also confirmed with a Cronbach's alpha of 76.2% in Abedian's study (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eIntervention\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section4\"\u003e \u003ch2\u003e\u0026bull; Intervention Group\u003c/h2\u003e \u003cp\u003eIn the intervention group, an educational program based on Orem's Theory was implemented by the principal investigator. After assessing the self-care needs of the participants using the Hart questionnaire in the first session, an educational program was developed for each individual based on Orem's Theory, categorized into universal, developmental, and health deviation needs. This educational program was conducted in three 30-minute individual sessions once a week (a total of three sessions). Participants completed the Cambridge Worry Scale, Hart's Prenatal Care Actions Scale, and Health Practices in Pregnancy Questionnaire-II (HPQ-II) at the beginning of the study, immediately, and one month after the intervention.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e\u0026bull; Control Group\u003c/h2\u003e \u003cp\u003eNo intervention was provided to the control group. They completed the worry, Hart's prenatal care actions, and health-practices questionnaires at the beginning of the study, immediately, and one month after the intervention. To adhere to research ethics, an educational booklet containing educational tips was provided to the control group at the end of the study.\u003c/p\u003e \u003cp\u003eThe workflow is illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eData was analyzed using SPSS version 16 and statistical tests, including independent t-test, Mann-Whitney U test, Chi-square test, and generalized estimating equations (GEE). The level of significance was set at 0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eDemographic and obstetric characteristics, including age, spouse's age, education level, spouse's education level, occupation, spouse's occupation, number of pregnancies, current gestational age, number of miscarriages, number of live births, and type of pregnancy (desired or undesired) are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The mean scores of self-care, worry, and health- practices before, immediately after, and one month after the intervention in both the control and intervention groups are reported in Table\u0026nbsp;2.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and obstetric characteristics, including age, spouse's age, education level, spouse's education level, occupation, spouse's occupation, number of pregnancies, current gestational age, number of miscarriages, number of live births, and type of pregnancy (desired or undesired)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBefore intervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eImmediately after the intervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOne month after the intervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRegression coefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003estandard error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eParent statistics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSignificant level\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003emean scores of health practices\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eIntervention group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(6/36)\u003c/p\u003e \u003cp\u003e116/92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(6/65)\u003c/p\u003e \u003cp\u003e140/59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(3/37)\u003c/p\u003e \u003cp\u003e142/85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003egroup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2/098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1/935\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1/175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0/278\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0/346\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0/129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7/115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0/008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eControl group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(7/15)\u003c/p\u003e \u003cp\u003e118/53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(6/42)\u003c/p\u003e \u003cp\u003e118/88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(6/51)\u003c/p\u003e \u003cp\u003e119/23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGroup*time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12/617\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0/425\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e877/533\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0/001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003emean scores of worry\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eIntervention group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(12/05)\u003c/p\u003e \u003cp\u003e38/25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(10/35)\u003c/p\u003e \u003cp\u003e27/29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(8/11)\u003c/p\u003e \u003cp\u003e22/85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003egroup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0/494\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3/128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0/025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0/875\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0/058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0/285\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0/041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0/840\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eControl group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(10/86)\u003c/p\u003e \u003cp\u003e38/42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(10/45)\u003c/p\u003e \u003cp\u003e38/57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(9/88)\u003c/p\u003e \u003cp\u003e38/53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGroup*time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-7/761\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0/571\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e184/423\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0/001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003emean scores of self-care\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eIntervention group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(7/42)\u003c/p\u003e \u003cp\u003e139/22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(9/47)\u003c/p\u003e \u003cp\u003e170/48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(5/95)\u003c/p\u003e \u003cp\u003e179/44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003egroup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0/522\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2/442\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0/046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0/831\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0/904\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0/232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e15/126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0/001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eControl group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(10/47)\u003c/p\u003e \u003cp\u003e142/76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(9/28)\u003c/p\u003e \u003cp\u003e144/03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(9/35)\u003c/p\u003e \u003cp\u003e144/57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGroup*time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e19/207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0/617\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e969/025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0/001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable 2. mean scores of self-care, worry, and health- practices before, immediately after, and one month after the intervention in both the control and intervention groups\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.126582278481013%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.917721518987342%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.759493670886076%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBefore intervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.917721518987342%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eImmediately after the intervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.759493670886076%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOne month after the intervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.60126582278481%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.810126582278482%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegression coefficient\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.386075949367088%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003estandard error\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.227848101265822%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eParent statistics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.49367088607595%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSignificant level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.126582278481013%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003emean scores of health practices\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.917721518987342%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.759493670886076%\" valign=\"top\"\u003e\n \u003cp\u003e(6/36)\u003c/p\u003e\n \u003cp\u003e116/92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.917721518987342%\" valign=\"top\"\u003e\n \u003cp\u003e(6/65)\u003c/p\u003e\n \u003cp\u003e140/59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.759493670886076%\" valign=\"top\"\u003e\n \u003cp\u003e(3/37)\u003c/p\u003e\n \u003cp\u003e142/85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.60126582278481%\" valign=\"top\"\u003e\n \u003cp\u003egroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.810126582278482%\" valign=\"top\"\u003e\n \u003cp\u003e2/098\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.386075949367088%\" valign=\"top\"\u003e\n \u003cp\u003e1/935\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.227848101265822%\" valign=\"top\"\u003e\n \u003cp\u003e1/175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.49367088607595%\" valign=\"top\"\u003e\n \u003cp\u003e0/278\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.147887323943662%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.971830985915492%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.147887323943662%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.971830985915492%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.795774647887324%\" valign=\"top\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e0/346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.330985915492958%\" valign=\"top\"\u003e\n \u003cp\u003e0/129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.154929577464788%\" valign=\"top\"\u003e\n \u003cp\u003e7/115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.56338028169014%\" valign=\"top\"\u003e\n \u003cp\u003e0/008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.147887323943662%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.971830985915492%\" valign=\"top\"\u003e\n \u003cp\u003e(7/15)\u003c/p\u003e\n \u003cp\u003e118/53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.147887323943662%\" valign=\"top\"\u003e\n \u003cp\u003e(6/42)\u003c/p\u003e\n \u003cp\u003e118/88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.971830985915492%\" valign=\"top\"\u003e\n \u003cp\u003e(6/51)\u003c/p\u003e\n \u003cp\u003e119/23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.795774647887324%\" valign=\"top\"\u003e\n \u003cp\u003eGroup*time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e12/617\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.330985915492958%\" valign=\"top\"\u003e\n \u003cp\u003e0/425\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.154929577464788%\" valign=\"top\"\u003e\n \u003cp\u003e877/533\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.56338028169014%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0/001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.126582278481013%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003emean scores of worry\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.917721518987342%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.759493670886076%\" valign=\"top\"\u003e\n \u003cp\u003e(12/05)\u003c/p\u003e\n \u003cp\u003e38/25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.917721518987342%\" valign=\"top\"\u003e\n \u003cp\u003e(10/35)\u003c/p\u003e\n \u003cp\u003e27/29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.759493670886076%\" valign=\"top\"\u003e\n \u003cp\u003e(8/11)\u003c/p\u003e\n \u003cp\u003e22/85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.60126582278481%\" valign=\"top\"\u003e\n \u003cp\u003egroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.810126582278482%\" valign=\"top\"\u003e\n \u003cp\u003e-0/494\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.386075949367088%\" valign=\"top\"\u003e\n \u003cp\u003e3/128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.227848101265822%\" valign=\"top\"\u003e\n \u003cp\u003e0/025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.49367088607595%\" valign=\"top\"\u003e\n \u003cp\u003e0/875\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.147887323943662%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.971830985915492%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.147887323943662%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.971830985915492%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.795774647887324%\" valign=\"top\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e0/058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.330985915492958%\" valign=\"top\"\u003e\n \u003cp\u003e0/285\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.154929577464788%\" valign=\"top\"\u003e\n \u003cp\u003e0/041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.56338028169014%\" valign=\"top\"\u003e\n \u003cp\u003e0/840\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.147887323943662%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.971830985915492%\" valign=\"top\"\u003e\n \u003cp\u003e(10/86)\u003c/p\u003e\n \u003cp\u003e38/42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.147887323943662%\" valign=\"top\"\u003e\n \u003cp\u003e(10/45)\u003c/p\u003e\n \u003cp\u003e38/57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.971830985915492%\" valign=\"top\"\u003e\n \u003cp\u003e(9/88)\u003c/p\u003e\n \u003cp\u003e38/53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.795774647887324%\" valign=\"top\"\u003e\n \u003cp\u003eGroup*time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e-7/761\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.330985915492958%\" valign=\"top\"\u003e\n \u003cp\u003e0/571\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.154929577464788%\" valign=\"top\"\u003e\n \u003cp\u003e184/423\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.56338028169014%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0/001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.126582278481013%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003emean scores of self-care\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.917721518987342%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.759493670886076%\" valign=\"top\"\u003e\n \u003cp\u003e(7/42)\u003c/p\u003e\n \u003cp\u003e139/22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.917721518987342%\" valign=\"top\"\u003e\n \u003cp\u003e(9/47)\u003c/p\u003e\n \u003cp\u003e170/48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.759493670886076%\" valign=\"top\"\u003e\n \u003cp\u003e(5/95)\u003c/p\u003e\n \u003cp\u003e179/44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.60126582278481%\" valign=\"top\"\u003e\n \u003cp\u003egroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.810126582278482%\" valign=\"top\"\u003e\n \u003cp\u003e0/522\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.386075949367088%\" valign=\"top\"\u003e\n \u003cp\u003e2/442\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.227848101265822%\" valign=\"top\"\u003e\n \u003cp\u003e0/046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.49367088607595%\" valign=\"top\"\u003e\n \u003cp\u003e0/831\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.147887323943662%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.971830985915492%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.147887323943662%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.971830985915492%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.795774647887324%\" valign=\"top\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e0/904\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.330985915492958%\" valign=\"top\"\u003e\n \u003cp\u003e0/232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.154929577464788%\" valign=\"top\"\u003e\n \u003cp\u003e15/126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.56338028169014%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0/001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.147887323943662%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.971830985915492%\" valign=\"top\"\u003e\n \u003cp\u003e(10/47)\u003c/p\u003e\n \u003cp\u003e142/76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.147887323943662%\" valign=\"top\"\u003e\n \u003cp\u003e(9/28)\u003c/p\u003e\n \u003cp\u003e144/03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.971830985915492%\" valign=\"top\"\u003e\n \u003cp\u003e(9/35)\u003c/p\u003e\n \u003cp\u003e144/57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.795774647887324%\" valign=\"top\"\u003e\n \u003cp\u003eGroup*time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e19/207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.330985915492958%\" valign=\"top\"\u003e\n \u003cp\u003e0/617\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.154929577464788%\" valign=\"top\"\u003e\n \u003cp\u003e969/025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.56338028169014%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0/001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\u003cp\u003eResults of the Generalized Estimating Equations (GEE) model showed a significant interaction effect between group and time. The positive coefficient indicated that for each unit increase in time, the worry score in the intervention group was significantly lower by 7.61 compared to the control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similarly, there was a significant interaction effect between group and time for health practice. The positive coefficient indicated that for each unit increase in time, the health practice score during pregnancy in the intervention group was significantly higher by 12.617 units compared to the control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Moreover, there was also a significant interaction effect between group and time for self-care. The positive coefficient indicated that for each unit increase in time, the prenatal care actions score in the intervention group was significantly higher by 19.207 units compared to the control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to determine the effect of educational intervention based on Orem's theory on self-care, worry, and health practice among pregnant women aged 35 years or older attending comprehensive health service centers in Gonabad County. The results showed a significant difference in self-care, health practice, and worry scores between the intervention and control groups immediately and one month after the intervention. Therefore, it can be concluded that educational intervention based on Orem's theory can improve self-care and health practice and reduce worry. These results are consistent with a previous study conducted in Mashhad in 2015\u0026ndash;2016 aimed at determining the application of Orem's theory in promoting self-care behaviors among pregnant women at risk of preterm birth. Findings indicated that an educational intervention aligned with Orem's self-care theory led to a significant improvement in self-care practices among women at risk of preterm birth. Specifically, the intervention group exhibited significantly higher post-intervention self-care scores compared to the control group (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).The self-care scores among women at risk of preterm birth were higher in the previous study compared to the current study. This discrepancy could be attributed to differences in access to healthcare services between the two settings. However, the increase in self-care scores after the intervention in the intervention group of the current study indicates the positive impact of using Orem's Self-Care Theory on the self-care of pregnant women. This study aligns with the previous study regarding using Orem's Self-Care Theory in pregnant women and assessing self-care.\u003c/p\u003e \u003cp\u003eIn a randomized controlled trial, a study was conducted on 64 pregnant women with insulin-treated gestational diabetes to determine the impact of couples' supportive counseling on self-care behaviors. After being randomly assigned to either a control or intervention group, the intervention group received couples' supportive counseling sessions. Data analysis revealed a significant difference in mean self-care scores between pre-and post-intervention in the intervention group, indicating that couples' supportive counseling can improve self-care behaviors, consistent with the findings of the current study (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). In this study, the educational intervention was conducted with the pregnant woman and her partner, whereas in the current study, the intervention was solely provided to the pregnant woman. This methodological difference makes it incompatible with the current study; however, both studies align in terms of examining self-care in pregnant women.\u003c/p\u003e \u003cp\u003eOne reason for the increase in self-care scores is the lack of information regarding pregnancy, its complications, and related actions. Education has led to increased awareness and improved self-care. Moreover, managing pregnancy complications requires the pregnant woman's active participation in prenatal care, which necessitates a higher level of awareness. Self-care education is an effective tool for increasing this level of awareness. Furthermore, inadequate knowledge regarding prenatal care can lead to various complications and ultimately result in adverse pregnancy outcomes. Education can foster the pregnant woman's active and informed participation in self-care. Therefore, the findings of this study demonstrate the positive impact of Orem's Self-Care Theory on self-care among pregnant women aged 35 and over.\u003c/p\u003e \u003cp\u003eA study aimed to determine the impact of electronic education on prenatal screening tests on the anxiety and worry of pregnant women. The Cambridge Worry Scale was used to assess the women's worry both before and two weeks after the intervention. The results indicated that electronic education significantly reduced worry among pregnant women. One reason for the higher worry scores in the previous study compared to the current study might be the gestational age inclusion criteria (7\u0026ndash;9 weeks in the previous study and 14\u0026ndash;29 weeks in the current study). According to some studies, worry is higher in the first trimester due to the risk of miscarriage compared to the second trimester. Moreover, the decrease in worry scores was more pronounced in the current study, which can be attributed to the comprehensive educational intervention. While the previous study only provided a 7-minute animation on screening tests, the current study included three sessions with a broader focus on various topics such as nutrition, maternal and fetal health, relationships, and mental health during pregnancy. This study aligns with the current study in terms of assessing worry (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFurthermore, a similar study comparing the effects of group and individual education on anxiety and worry among pregnant women regarding prenatal screening tests found that educational interventions reduced worry levels, aligning with the findings of the current study. This study involved three groups of pregnant women (individual education, group education, and control). The results showed an increase in mean anxiety scores in both the control and group education groups, while no increase was observed in the individual education group (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). One possible explanation for this lack of increase is the individual education method, which was also used in the current study. Although group education has its advantages, it also has limitations. For example, some individuals may disrupt group dynamics, and participants may feel pressured to self-disclose. In contrast, individual education gives individuals more opportunities to express their thoughts and opinions. Therefore, the use of individual education to reduce woy in this study is consistent with the current study.\u003c/p\u003e \u003cp\u003eA randomized controlled trial was performed among pregnant women and their partners in Urmia to investigate the impact of couples' counseling based on spousal support on anxiety and worry during pregnancy.The results demonstrated a significant difference in mean woryy scores between the intervention and control groups following the counseling intervention, indicating that the intervention effectively reduced worry in pregnant women. This finding aligns with the current study (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). However, in terms of methodology and the specific content of couples' counseling, this study differs from the present one.\u003c/p\u003e \u003cp\u003eA study aimed to determine the impact of cognitive-behavioral counseling on anxiety and worry levels among pregnant women with a moderate risk of Down syndrome in the first-trimester screening. The intervention group received cognitive-behavioral counseling. The results indicated that this intervention reduced anxiety and worry, which is consistent with the current study. In this study, the level of worry among pregnant women was higher compared to the current study. This can be attributed to the characteristics of the study population; participants were pregnant women with a moderate risk of Down syndrome, a condition that could increase their worry levels (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA study aimed to determine the impact of individual counseling intervention on pregnancy-related health practices. The results showed no significant difference in the mean score of health practices between the intervention and control groups before the educational intervention. However, a significant difference was observed after the intervention, indicating that providing individual counseling to pregnant women is an effective way to enhance their health practices. This study aligns with the current study in terms of individual counseling and the assessment of health practices. The educational intervention was conducted in Turkey in three sessions, with self-care scores measured before the intervention and during the second and third trimesters. These findings are consistent with the results of the current study (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). The similarity in findings can be attributed to cultural factors and the effectiveness of individual counseling. The current study utilized Orem's Self-Care Theory, which differs from the theory used in the study being compared.\u003c/p\u003e \u003cp\u003eA study aimed to investigate the impact of self-care counseling on the health practice of adolescent pregnant women, as well as their attitudes toward motherhood, pregnancy, and pregnancy symptoms. After the counseling intervention and data analysis, the results indicated that the intervention improved health practice among adolescent pregnant women, consistent with the current study. This study focused on adolescent pregnant women and involved a six-session group counseling intervention. The health practice scores in this study were lower compared to the current study, which could be attributed to the age of the participants. In this regard, this study is not directly comparable to the current study (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFurthermore, a study aimed to determine the impact of self-care counseling on the health practice of pregnant women aged 35 and over who visited comprehensive health centers in Hamadan. The study involved a group counseling intervention for pregnant women aged 35 and older. Data analysis confirmed the positive impact of self-care counseling on the health practice of high-risk pregnant women. This study aligns with the current study in terms of assessing the health practices of pregnant women aged 35 and over. The intervention in this study consisted of four group counseling sessions, and health practice scores were measured before and one month after the intervention. The higher health practice scores in the current study can likely be attributed to the use of Orem's Self-Care Theory and individual sessions (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn a 2015 Turkish study, 111 primiparous women who had a natural vaginal delivery were enrolled and randomly assigned to either a control or intervention group. Data was collected using a self-developed personal information form, a data collection form based on Orem's Self-Care Deficit Theory, and the Postpartum Self-Evaluation Questionnaire (to assess women's adaptation to motherhood in the postpartum period). A nursing intervention was then implemented based on identified diagnoses over six sessions. At the end of the sixth week postpartum, questionnaires were completed again by both groups. The results indicated that the care provided based on Orem's Self-Care Theory in the postpartum period improved or prevented postpartum problems and increased postpartum adaptation (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), demonstrating the positive impact of Orem's model on postpartum adaptation. This aligns with the use of Orem's model in the current study.\u003c/p\u003e \u003cp\u003e A study conducted in China in 2020 aimed to investigate the impact of Orem-based nursing intervention on pain levels, self-care, psychological status, and quality of life in patients with bone cancer. Data was collected using the Visual Analogue Scale for pain, the Hamilton Anxiety and Depression Rating Scale, and the Quality of Life Scale, as well as a self-care competency questionnaire. Results showed that the intervention group had significantly higher quality of life and self-care scores compared to the control group and lower pain levels and negative emotions such as anxiety and depression. These findings support the results of the current study (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOne strength of this study is its focus on pregnant women aged 35 and over, which is significant considering current population policies and the importance of self-care in this population. Additionally, the study included both urban and rural populations. Limitations of the study include the reliance on self-reported questionnaire data, as well as the inability to control for genetic differences among participants and individual and psychological differences.\u003c/p\u003e"},{"header":"Coclusion","content":"\u003cp\u003eThis study concludes that an Orem-based self-care education program can significantly improve self-care levels and health practice and reduce worry in pregnant women. Consequently, it is recommended that this educational approach be implemented for pregnant women aged 35 and over.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThis article is based on a master\u0026apos;s thesis in midwifery with the ethics code IR.GMU.REC.1402.100 and clinical trial registration number\u0026nbsp;IRCT20231107059980N1. Ethical considerations for this research included obtaining written approval from the ethics committee and presenting it to the relevant authorities, obtaining permission to collect samples, explaining the study\u0026apos;s objectives, methods, and confidentiality of information to participants, obtaining written informed consent, maintaining confidentiality of information, and providing a contact number to the control group to monitor the psychological impact of the presence of the educator. No physical harm was caused to participants.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe dataset in this study is available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThis study was funded by the Research Deputy of Gonabad University of Medical Sciences.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eStudy design: FA, NBB, FM, ZHKh; Data collection: ZHKh; Data analysis: FM; Original draft preparation: ZHKh; All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe authors thank the Vice Chancellor for Research at Gonabad University of Medical Sciences for their support and the professors who contributed to this research. We are also grateful to the staff and officials of Gonabad health centers and, most importantly, the pregnant women and their families for their participation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMomeni javid F, simbar M, Dolatian M, Alavi Majd H. Comparison of pregnancy self-care, perceived social support and perceived stress of women with gestational diabetes and healthy pregnant women. Iran J Endocrinol Metab. 2019;(January 2015):156\u0026ndash;64. \u003c/li\u003e\n\u003cli\u003eAghababaei S, Omidifard F, Roshanaei G, Parsa P. The effect of self-care counseling on health practices of 35-year-old or more aged pregnant women referring to Hamadan health care centers , in 2018. Avicenna J Nurs Midwifery Care. 2020;28(1):67\u0026ndash;74. \u003c/li\u003e\n\u003cli\u003eKarrabi R, Farjamfar M, Mortazavi FS, Nazari AM, Goli Sh. The effect of solution-focused group counseling on pregnant women\u0026rsquo;s worries: A randomized clinical trial. J Hayat. 2019;25(1):81\u0026ndash;94. \u003c/li\u003e\n\u003cli\u003eFathi A, Golakeh kheibari S. The relationship between prenatal concerns, depression, quality of life and general health of pregnant women. Nurs Midwifery J. 2018;15(12):939\u0026ndash;49. \u003c/li\u003e\n\u003cli\u003eBarjasteh S, Moghaddam Tabrizi F. Antenatal anxiety and pregnancy worries in association with marital and social support. Nurs Midwifery J. 2016;14(6):504\u0026ndash;15. \u003c/li\u003e\n\u003cli\u003eFathnezhad Kazemi A, Hajian S, Ebrahimi-Mameghani, Khabazkhob M. A review of various aspects of health promotion behavior during pregnancy: review article. Tehran Univ Med J. 2019;76(10):647\u0026ndash;53. \u003c/li\u003e\n\u003cli\u003eJaras M, Mansoorian MR, Delshad Noghabi A, Nezami H. Comparison of effectiveness self-care returns two methods of focus group discussions and teach-back on lifestyle of pregnant women. Q Horiz Med Sci. 2020;26(1):94\u0026ndash;107. \u003c/li\u003e\n\u003cli\u003eAghakhani N, alizadeh S, Hemmati Maslakpak M, Alinejad V, Khademvatan K. Study of the effect of self-care program model based on Orem\u0026rsquo;s pattern on the quality of life in patients with heart failure. Nurs Midwifery J. 2018;16(1):65\u0026ndash;72. \u003c/li\u003e\n\u003cli\u003eNaghizadeh S. Comparison of pregnancy self-care, perceived social support and perceived stress in low-risk and high-risk groups. J Heal Care. 2019;21(1):16\u0026ndash;25. \u003c/li\u003e\n\u003cli\u003eRajai N, Mahmoudi H, Parandeh A. An integrated review of the application of Orem\u0026rsquo;s self-care theory in care of diabetic patients. J Diabetes Nurs. 2022;10(2):1829\u0026ndash;43. \u003c/li\u003e\n\u003cli\u003eValizadeh S, Soheili A, Moghbeli G, Aliafsari E. Applicablity of Orem\u0026rsquo;s self-care model in iran: an integrated review. Nurs Midwifery J. 2017;15(4):313\u0026ndash;28. \u003c/li\u003e\n\u003cli\u003eKohen J. statistical power analysis for the behavioral sciences. In 2013. \u003c/li\u003e\n\u003cli\u003eKordi M, Riazi S, Lotfalizadeh M, Shakeri MT, jafari sani H. Comparison of the effect of group and individual training on the worry and anxiety of pregnant women regarding screening tests for fetal chromosomal disorders. Iran J Obstet Gynecol Infertil. 2015;18(157):1\u0026ndash;10. \u003c/li\u003e\n\u003cli\u003eMalakouti J, Mirghafourvand M, Salehi Pour Mehr H, Shamsaei F, Safari Komeil M. Maternal worries and their relationship with coping strategies in pregnant women referring to health centers in Hamadan. Hayat, J Sch Nurs Midwifery, Tehran Univ Med Sci. 2018;24(1):35\u0026ndash;47. \u003c/li\u003e\n\u003cli\u003eMaddahi MS, Dolatian M, Khoramabadi M, Talebi A. Correlation of maternal-fetal attachment and health practices during pregnancy with neonatal outcomes. Electron Physician. 2016;8(7):2639\u0026ndash;44. \u003c/li\u003e\n\u003cli\u003eRezaian SM, Abedian Z, latifnezhad roodsari R, Mazloom SR, Dadgar S. Relationship of stress, anxiety and depression with self-care behaviors during pregnancy in women at risk of preterm labor. Iran J Women, Obstet Infertil. 2017;20(3):68\u0026ndash;76. \u003c/li\u003e\n\u003cli\u003eRostampour S, Erfanian Arghavanian F, Kordi M, Shakeri MT, Akhlaghi F, Asghari Nekah SM. The effect of couples\u0026rsquo; supportive counseling on self-care behavior in women with insulin-treated gestational diabetes: A randomized clinical trial. Hayat, J Sch Nurs Midwifery. 2020;26(1):58\u0026ndash;71. \u003c/li\u003e\n\u003cli\u003eMajlesi E, Navidian A, Navaee M, Montazer-Zohouri M. The effects of e-Learning about fetal screening tests on the level of anxiety and worry in pregnant women. J Isfahan Med Sch. 2021;39(626):363\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eBarjasteh S, Alizadeh S, Moghaddamtabrizi F. The effect of couple counselling based on marital support on anxiety and worry during pregnancy. Nurs Midwifery J. 2018;15(11):851\u0026ndash;62. \u003c/li\u003e\n\u003cli\u003eKharaghani R, Vaezi F, Dadashi M, Rastegari L, Maleki A. The effect of cognitive behavioral counseling on anxiety and worry level of women with intermediate risk during first trimester screening for down syndrome: a randomized controlled trial: a randomized controlled trial. BMC Pregnancy Childbirth. 2023;23(1):1\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eSezer G, Sen S. The effect of individual counseling intervention on health practices in pregnancy: a randomized controlled trial. Health Educ Res [Internet]. 2020 Oct 1;35(5):450\u0026ndash;9. Available from: https://academic.oup.com/her/article/35/5/450/5935524\u003c/li\u003e\n\u003cli\u003eRezaie R, Mohammad-Alizadeh-Charandabi S, Nemati F, Mirghafourvand M. The effect of self-care counseling on health practices of adolescent pregnant women: a randomized controlled trial. BMC Pregnancy Childbirth [Internet]. 2021;21(1):1\u0026ndash;11. Available from: https://doi.org/10.1186/s12884-021-04203-8\u003c/li\u003e\n\u003cli\u003eApay S, Kanbur A, Evsen N. The effect of the care given using Orem\u0026rsquo;s self-care model on the postpartum self-evaluation. Int J Caring Sci [Internet]. 2015;8(2):393\u0026ndash;403. Available from: www.internationaljournalofcaringsciences.org\u003c/li\u003e\n\u003cli\u003eLi X, Zhang K, Xu D, Xu Y. The effect of Orem\u0026rsquo;s nursing theory on the pain levels, self-care abilities, psychological statuses, and quality of life of bone cancer patients. Am J Transl Res [Internet]. 2023;15(2):1438\u0026ndash;45. Available from: http://www.ncbi.nlm.nih.gov/pubmed/36915789%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC10006768\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"health practice, Orem’s theory, self-care, worry","lastPublishedDoi":"10.21203/rs.3.rs-4925136/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4925136/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003eSelf-care during pregnancy requires special attention, particularly among women aged 35 and above. This study aimed to determine the impact of an educational intervention based on the Orem theory on self-care, worry, and health practices among pregnant women aged 35 and older referred to comprehensive health service centers in Gonabad County.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This randomized controlled trial was conducted in 2023 among 53 pregnant women aged 35 and above referred to comprehensive health service centers in Gonabad County. Participants were randomly assigned to the intervention or control group. Data was collected using questionnaires on demographic and obstetric characteristics, the Cambridge worry Scale, Hart's prenatal care actions, and Health Practices in Pregnancy Questionnaire-II. The intervention group received a theory-based educational intervention in three sessions, while the control group received no intervention. Research staff completed questionnaires before, immediately, and one month after the intervention. Data analysis was performed using generalized estimating equations (GEE) with a significance level 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Based on the GEE model, there were no statistically significant differences in mean scores for self-care, health practices, and worry between the two groups prior to the intervention (p \u0026gt; 0.05). Post-intervention, both groups exhibited an increase in mean scores for self-care and health practices, but the intervention group demonstrated a steeper increase, which was statistically significant. In contrast, the intervention group experienced a more pronounced decrease in mean worry scores than the control group (p \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The findings suggest that a self-care educational program based on the Orem's theory can be effective in enhancing self-care and health practices and reducing worry among pregnant women. Therefore, it is recommended that this educational program be implemented for pregnant women aged 35 and above.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration and ethics code\u003c/strong\u003e: IRCT registration number: \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eIRCT20231107059980N1 and ethics code: IR.GMU.REC.1402.\u003c/p\u003e\n\u003cp\u003eRegistration date: 30/11/2023\u003c/p\u003e","manuscriptTitle":"The effect of Orem’s theory of interventional education on self-care, worry and health practices of pregnant women aged 35 years or above, referring to health service centers in Gonabad county, 2024","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-15 08:20:23","doi":"10.21203/rs.3.rs-4925136/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6b30548f-6cab-45e8-9248-3ff4b00c4696","owner":[],"postedDate":"October 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-19T13:23:23+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-15 08:20:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4925136","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4925136","identity":"rs-4925136","version":["v1"]},"buildId":"-HB7Z8yhvgn0wM9Nzuekk","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}