The Impact of Preconception Counseling Through ayukSEHAT Application for Conceiving A Healthy Baby

1. INTRODUCTION

Over the past few decades, maternal and child health has been a global priority and an essential public health service [ 1]. Globally, In 2020, approximately 800 women per day will perish from pregnancy and childbirth-related preventable causes, or one woman every two minutes [ 2]. An estimated 295,000 maternal deaths occurred annually in 2017, and 18 newborns per 1,000 live births died in 2018 [ 3]. Around 86% of the maternal deaths reported worldwide occur in Sub-Saharan Africa and Southern Asia [ 4]. Maternal mortality continues to be an unacceptable problem in Indonesia. Indonesia's maternal mortality ratios (MMR) have consistently ranged between 200 and 350 maternal deaths per 100,000 live births over the past decade, based on a variety of methods of estimation [ 5]. The neonatal mortality rate (NMR) decreased slowly from 32 deaths per 1000 live births in 1991 to 15 deaths per 1000 live births in 2017. Compared to ASEAN countries, this NMR is higher than the Philippines (13,8), Malaysia (4,4), Thailand (5,3) and Singapore (1,1) [ 6]. West Sumatra Province is one of the provinces in Indonesia where the MMR and NMR are still high; namely, 193 mothers and 891 babies are reported to have died in 2021. This has not yet reached the SDGs target of reducing the maternal mortality ratio to less than 70 per 100,000 live births and reducing the NMR to at least 12 per 1000 KH (Live Births)

The goal of every family is to have healthy mothers and babies. Maternal health during pregnancy, childbirth, and postpartum is influenced by women's health during preconception or before pregnancy [ 7, 8]. Preconception care is essential for a healthy pregnancy, improving infants' health and avoiding fatal situations [ 9, 10, 11]. Preconception care policies in Indonesia have been issued but not implemented properly, so the number of preconception services is still lacking. Based on the Padang City health office report, 74.67% of the prospective bride and groom did not perform preconception services. Improper preconception care has an impact on unhealthy lifestyles, and disease is not detected early, so the pregnancy is unhealthy, and the baby born is unhealthy. Research suggests that, in addition to regular checkups, other pregnancy care methods, including yoga, physical activity, lifestyle, mindfulness, and psychotherapeutic experiments, are effective ways to improve maternal well-being during pregnancy, as are regular checkups, therapists, and social workers [ 12]. Preconception care is “a set of experiments aimed at identifying and modifying, through prevention and management, biomedical behavior, and social risks to a woman's health or pregnancy outcome; we focus on risk factors used early to have the greatest impact [ 13, 14]. Preconception care provides an opportunity for women and their partners to intervene early and address health risks that benefit all women and men, regardless of their intentions or desire to conceive. Extension applications can overcome the risk of HIV transmission to the mother and fetus, the risk of anemia in pregnant women, hereditary diseases, low birth weight, and reduce the risk of stunting. Preconception care can help improve sperm and partner health, which is also associated with pregnancy and birth outcomes [ 10].

However, working couples of bride and groom may be unable to attend these traditional health services in the daytime because of time and location restrictions [ 15]. E-Health is becoming increasingly popular as a tool to improve preconception care for women and men getting married. The smartphone app for e-Health can provide women with easy access to evidence-based, comprehensive preconception health information available 24 hours a day which broadens the range of services, and it could contribute to the optimal health of women before and during pregnancy [ 16]. Mobile phone applications can be used to address these risks of anemia in pregnancy, early detection of disease, and risk of stunting because of low birth weight by providing information, supporting healthier lifestyles, and supporting informed decision-making. In the perinatal period, experiments based on mobile applications were found to be feasible and promising for improving parents' well-being [ 17].

Several application models already exist designed to improve the welfare of mothers and children, but they focus more on knowledge about pregnancy, while preconception preparation has not yet been developed. The study of the preconception counseling model development program through this android application really needs to be reviewed and researched to measure the level of public awareness to carry out early screening before pregnancy. The development of this android-based preconception model is implemented to make it easier for the bride and groom to access and get information easily without having to visit a health facility. The counseling content includes determining nutritional status, nutrition of prospective fathers and mothers, diseases that affect pregnancy, healthy lifestyles, bad habits, preconceptional problems, information on healthy births and recommendations for brides and grooms to prepare for healthy births. To understand and seek the best way the bride and groom can think of so that the best and most accurate results are obtained as an effort to plan for a healthy baby. The study aims to see the impact of preconception counseling using the Android application on the level of knowledge, attitudes, and perceptions of the prospective bride and groom regarding the preparation for giving birth to a healthy baby.

2. MATERIALS AND METHODS

A quasi-experiment approach was used in this study. The data was collected through a pre-and post-test. This research was conducted in the Kuranji and Padang Timur Public Health Centers, Padang, Indonesia, from November 2021 to March 2022. This research was approved by the public health study program at the doctoral faculty of Andalas University. The respondents of the study were 138 brides and grooms in this area. The experimental group consisted of 69 pairs who received preconception counseling through an android application, and the 69 pairs control group practiced conventional counseling methods. The sampling technique was purposive sampling. Samples are taken randomly. The inclusion criteria in this study were the bride and groom couple who had completed the research approval, and everyone had an Android phone. The application is uploaded by the bride and groom's cell phones. The research instrument uses an android application called ayukSEHAT, which researchers have designed. It can be accessed by clicking the following link ayukSEHAT. This preconception counseling application contains material on nutritional status, nutrition and illnesses suffered, and family history of the disease. Both groups were given a pre-test, and then the experimental group was given preconception counseling with ayukSEHAT for 4 weeks, while conventional methods gave the control group counseling. After that, both groups were given a post-test to see whether there were differences in the level of knowledge, attitudes, and perceptions. For data analysis, the Wilcoxon test was used.

3. RESULTS

Respondent's characteristics included socio-demographics, as represented in Table 1. A total of 138 respondents participated in this study. Most of the respondents were of reproductive age (25-36 years). Nearly half of the respondents have low education levels, 42% in the experimental group and 40% in the control group. There were unemployed respondents, about 30% in the experimental group and 33% in the control group. Most of them have low income, 58% in the experimental group and 61% in the control group.

After being given preconception counseling on the ayukSEHAT application to the bride, the results are as follows:

The Wilcoxon test result shows that there was a significant difference before and after the preconception counseling of ayukSEHAT was given in level of knowledge (p<0.001), attitude (p<0.001) and perception (p=0.03). There was no significant difference in the control group, just a slight increase. Preconception counseling with ayukSEHAT application to grooms also showed significant differences.

Table 3 shows improvement in the average knowledge level, attitude, and perception in the experiment group. Statistical tests show that there is an effect of preconceptions on counseling using the ayukSEHAT application (p<0.000). The control group remained unchanged at the final grade point average.

4. DISCUSSION

The ayukSEHAT application is a form of preconception health education media which contains information related to the physical health of the bride and groom, including nutritional status, medical history, history of hereditary diseases, bad habits, basic vaccinations, and information on babies born healthy. In this application, there are also recommendations for the couple to behave regarding health. Moreover, there are also questions related to preconception health that can be measured to see the level of knowledge in this application. Preconception counseling through the ayukSEHAT application in this study increased the understanding related to respondents' knowledge level, attitude, and perception. There is a significant difference between the experiment groups before and after counseling. These results indicated that the ayukSEHAT application is an effective method in improving preconceptions about the health of brides and grooms in Padang, Indonesia.

This study is in line with Hussein's research (2016). The brides with good knowledge have a higher level of education, and the more they need health counseling, especially in preparing for pregnancy as future wives. Meanwhile, the brides with less knowledge have a low level of education and feel less in need of health education which affects their preparation for pregnancy as future wives [ 18]. Khan's research in 2019 also suggests that knowledge of reproductive health affects marriage readiness [ 19], and the finding by Priani et al. showed that preconception education for unmarried women to increase their knowledge about health in West Java, Indonesia [ 20].

Based on Table 2, it was found that the p-value of knowledge in the experiment group was 0.000 and the control group was 0.288, indicating that the knowledge variable experiment group had a relationship with the development of the preconception counseling model, while the knowledge variable control group had no relationship with the preconception counseling model. Meanwhile, for the attitude variable, it is known that the p-value of the experiment group is 0.000, and the control group is 0.102. It can be concluded that the experiment group is related to the development of the preconception counseling model, while the knowledge variable control group is not related to the preconception counseling model. However, in the perception variable, the p-value of the experiment group was 0.000, and the control group was 0.102, indicating that the perception variable experiment group had a relationship with the development of the preconception counseling model. In contrast, the knowledge variable control group had no relationship to the preconception counseling model.

Digital educational media is web-based or digital media. Internet and social media trend data for 2020 shows a total population of 272.1 million, 175.4 million internet users and 160 million active social media users. From this data, it is clear that the ability of the Indonesian people is very good to use digital technology, but its use is still entertainment. The ayukSEHAT application can be a solution to expand the reach of providing preconception to the community to increase the prevalence of preconception health services in Indonesia. With the increasing prevalence of preconception health services for the bride and groom, the health risk during preconception, pregnancy, and the baby being born can be overcome, such as anemia, HIV/AIDS from mother to baby, low birth weight, and stunting.

Interesting findings in this study are that grooms with high knowledge do not have a greater level of obedience and concern for the health of their future wives and children than grooms with less knowledge. The grooms have average never heard of and known about the importance of preconceptions to their future wives to have the baby born healthy. The study by Nugraheni in Gorbogan Regency found that the premarriage course has a significant influence on reproductive health and sexual health behavior [ 21]. Based on the research by Lassi S (2019), which states that preconception counseling can reduce alcohol consumption, smoking, illegal drugs, and preconception behavior, experiments reduce the incidence of sexually transmitted infections (STIs) [ 22]. The study is limited only to Muslim couples who registered at the Office of Religious Affairs. There is still a lot that needs to be perfected regarding features, functions, and benefits, such as the consultation room feature that connects clients and consultants. Because of the limited respondents' time in collecting data, researchers could not explore more deeply, only preconception psychological studies.

CONCLUSION

The results of this study have the effect of developing a preconception counseling model through an Android application on the knowledge, perceptions, and attitudes of brides and grooms before and after giving experiments. It is hoped that the couple and the bride and groom can use this application 3 months before marriage. AyukSEHAT application can be recommended by the government to puskesmas through health cadres to people who want to get married as a way for counseling and education on factors (knowledge, attitudes, and perceptions) effective in providing information to brides and grooms. The most important thing is that the couple has a positive influence on efforts to increase the birth of healthy babies as a contribution and role in the process of the mother's pregnancy until the child is born, so it takes all information, knowledge and nutritional status that is sufficient and sustainable in planning for a healthy born baby.

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