1ARTICLE 3 ASSIGNMENT Answer 1: The RCT byToohill et al. (2014) aimed to evaluate the effect of psychoeducation intervention by midwives in reducing childbirth fear in pregnant women. As childbirth fear has been associated with adverse maternal outcomes like poor post partum mental health and high rate of cesarean, focusing on effective antennal intervention to reduce fear levels is importance. Hence, this research is significant. For conducting the research, participants were selected by means of multisite randomized controlled trial. Stratification was done by hospital site and allocation to groups. The uniqueness of RCT study is that except intervention, no other conditions should differ in treatment and control group. The outcomes of the trial in both group is then compared to estimate treatment effect with confidence interval and P value (Bland and Altman 2011). However, in this study, it is not clear whether groups were similar at the start of the trial or not. This can be said because demographic, obstetric detail and birth preference were collected, however it does gives idea about any considerations made to keep groups similar at the start of the trial.In the end, the result findings also showed difference in education and household income for participants. However, baseline characteristics of participants have been studied (Toohill et al. 2014). Answer 2 The validity of the research finding in clinical trial is understood by the method by which the data is analyzed. Calculating the confidence interval and P value is one of the effective statistical method to find out how precisely the treat effect was analyzed (Stewart, Dahm and Scales 2011). In the research byToohill et al. (2014), psychoeducation was the main intervention and primary outcome of the research was reduction in childbirth fear. Secondary outcome
2ARTICLE 3 ASSIGNMENT measures include self-efficacy, post-natal depression and decisional conflict in participants. The analysis of the study findings revealed significant difference in group with respect to score for fear of birth. The intervention group reported about reduction in childbirth fear at 36 weeks compared to those in control group. Statistically significant differences in fear was found evidence by P value greater than 0.001. 95% confidence interval for change difference was calculated revealing significant effect of treatment. The benefits of the research are that statistically significant research outcomes were found for the intervention evaluated. This would have positive implications for overcoming challenges of labor and building their ability to cope with physiological and emotional challenges of labor. The use of psycho-education intervention in health care setting would facilitate effective and caring relationship with women to reduce their child birth fear during late pregnancy (Schwartz et al. 2015).
3ARTICLE 3 ASSIGNMENT Reference Bland, J.M. and Altman, D.G., 2011. Comparisons against baseline within randomised groups are often used and can be highly misleading.Trials,12(1), p.264. Schwartz, L., Toohill, J., Creedy, D.K., Baird, K., Gamble, J. and Fenwick, J., 2015. Factors associated with childbirth self-efficacy in Australian childbearing women.BMC pregnancy and childbirth,15(1), p.29. Stewart, S.B., Dahm, P. and Scales Jr, C.D., 2011. How to appraise the effectiveness of treatment.Indian journal of urology: IJU: journal of the Urological Society of India,27(4), p.525. Toohill, J., Fenwick, J., Gamble, J., Creedy, D.K., Buist, A., Turkstra, E. and Ryding, E.L., 2014. A Randomized Controlled Trial of a Psycho‐Education Intervention by Midwives in Reducing Childbirth Fear in Pregnant Women.Birth,41(4), pp.384-394.
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