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In general, the living conditions of mothers in the postpartum period were quite good. The rate of mothers having private rooms, using clean water and having standard toilets was quite high. There was a difference in the shape of the fetus between the two groups. Specifically, mothers in the intervention group lived in multi-storey houses and had more private rooms than mothers in the control group. The difference was statistically significant with p<0.05. The rate of having helpers, clean water sources, and standard toilets in the two groups did not differ.
3.2.4. The effectiveness of the model on mothers' knowledge of postpartum care
After implementation, the home-based CSSS intervention model had positive impacts.
to mothers' knowledge of CSSS.
before intervention
after intervention
60%
50%
40%
30%
54.10%
40.90%
37.20%
37.80%
20%
10%
0%
NC Group
Control group
Figure 3.5. Comparison of the effectiveness of the model on changing general knowledge of CSSS
The overall assessment after the intervention showed that the general knowledge of CSSS of mothers in the intervention group increased significantly compared to before the intervention, with statistical significance (p<0.001) with CSHQ being 45.4%.
Meanwhile, the change in general knowledge of CSSS in the control group was not statistically significant (p>0.05) with low CSHQ: 8.2%.
After the intervention, the knowledge of CSSS of mothers in the intervention group increased significantly compared to mothers in the control group with statistical significance (p<0.001) with HQCT of 37.2%.
Table 3.39. Changes in mothers' knowledge of CSSS according to disease signs
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Intervention group | Control group | |||||||||
Before CT | After CT | CSHQnct, p | Before CT | After CT | CSHQnc p | |||||
SL | % | SL | % | SL | % | SL | % | |||
Obtain | 193 | 37.2 | 271 | 52.2 | 40.3% p<0.001 | 195 | 37.6 | 212 | 40.9 | 8.8% p>0.05 |
Are not obtain | 326 | 62.8 | 248 | 47.8 | 324 | 62.4 | 307 | 59.1 | ||
Index | HQCT = 31.5%; p<0.001 | |||||||||
The results showed that after the intervention, the knowledge of detecting signs of disease of mothers in the intervention group increased significantly compared to before the intervention, with statistical significance (p<0.001) with an effectiveness index of 40.3%. Meanwhile, the change in knowledge of detecting signs of disease of mothers in the control group was not statistically significant (p<0.05).
The knowledge of mothers in the intervention group about detecting signs of disease increased significantly compared to mothers in the control group with HQCT being 31.5% (p<0.001).
Table 3.40. Changes in mothers' knowledge of occupational hygiene according to occupational hygiene criteria
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Intervention group | Control group | |||||||||
Before CT | After CT | CSHQnct P | Before CT | After CT | CSHQnc P | |||||
SL | % | SL | % | SL | % | SL | % | |||
Obtain | 137 | 26.4 | 260 | 50.1 | 89.8% p<0.001 | 115 | 22.2 | 149 | 28.7 | 29.3% p<0.05 |
Are not obtain | 382 | 73.6 | 259 | 49.9 | 404 | 77.8 | 370 | 71.3 | ||
Index | HQCT = 60.5%, p<0.001 | |||||||||
After intervention, mothers' knowledge of occupational hygiene increased in the intervention group.
higher than before intervention with statistical significance (p<0.001) with high CSHQ of 89.8%.
Meanwhile, the change in mothers' knowledge in the control group was statistically significant (p<0.05) with a lower CSHQ of 29.3%.
The results showed that the knowledge of mothers in the intervention group about occupational hygiene increased significantly compared to mothers in the control group with statistical significance (p<0.001) with HQCT being 60.5%.
Table 3.41. Changes in mothers' knowledge of nutrition according to nutritional criteria
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Intervention group | Control group | |||||||||
Before CT | After CT | CSHQnct P | Before CT | After CT | CSHQnc p | |||||
SL | % | SL | % | SL | % | SL | % | |||
Obtain | 104 | 20.0 | 187 | 36.0 | 80.0% p<0.001 | 101 | 19.5 | 140 | 26.9 | 37.9% p<0.05 |
Are not obtain | 415 | 80.0 | 332 | 64.0 | 418 | 80.5 | 379 | 73.1 | ||
Index | HQCT = 42.1%; p<0.01 | |||||||||
After the intervention, the rate of mothers in the intervention group with knowledge about nutrition and abstinence increased significantly compared to before the intervention, with statistical significance (p<0.001) with a high CSHQ of 80.0%. The change in knowledge of mothers in the control group was also statistically significant (p<0.05) but the CSHQ was lower at 37.9%. The knowledge of mothers in the intervention group about nutrition and abstinence increased significantly compared to mothers in the control group, with statistical significance (p<0.01) with a HQCT of 42.1%.
Table 3.42. Changes in mothers' knowledge of family planning
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Intervention group | Control group | |||||||||
Before CT | After CT | CSHQnct P | Before CT | After CT | CSHQnc P | |||||
SL | % | SL | % | SL | % | SL | % | |||
Obtain | 175 | 33.7 | 260 | 50.1 | 48.7% p<0.001 | 175 | 33.7 | 208 | 40.1 | 19.0% p<0.05 |
Are not obtain | 344 | 66.3 | 259 | 49.9 | 344 | 66.3 | 311 | 59.9 | ||
Index | HQCT = 29.7%; p<0.01 | |||||||||
The results showed that after the intervention, the proportion of mothers in the intervention group with knowledge about family planning increased compared to before the intervention, which was statistically significant (p<0.001) with a high CSHQ of 48.7%. The change in knowledge of mothers in the control group was also statistically significant (p<0.05) but the CSHQ was lower at 19.0%.
The knowledge of mothers in the intervention group about family planning increased significantly compared to that of mothers in the control group (p<0.01) with a HQCT of 29.7%.
3.2.5. The effectiveness of the model on mothers' postpartum care practices
Figure 3.6. Comparison of the effectiveness of the model on changes in mothers' CSSS practices
In general practice, the home care model had an impact on changing mothers' practices on postpartum care. After the intervention, the practices of mothers in the intervention group were better than before the intervention, with statistical significance (p<0.001) with CSHQ being 50.8%.
Meanwhile, the change in practice of mothers in the control group was not statistically significant (p>0.05) with a CSHQ of 10.9%. After the intervention, the practice of mothers in the intervention group was statistically significantly better than that of the control group (p<0.001) with a CSHQ of 39.9%.
The study results also showed that the intervention had a positive impact on mothers' practices on CSSS. The rate of mothers exclusively breastfeeding in the intervention group increased from 36.4% (before the intervention) to 54.9% (after the intervention) within the first month after birth; the rate of mothers taking additional iron tablets in the first 2 weeks after birth increased from 22.7% (before the intervention) to 43.6% (after the intervention) during postpartum care at home.
3.2.6. Testing the mean difference in mothers' general knowledge and practice scores of CSSS after the intervention
3.2.6.1. Comparison of changes in the average CSSS knowledge score of mothers after the intervention
Table 3.43. Changes in the average score of mothers' general knowledge about CSSS after the intervention
Variable
Number of observations | Medium | Standard error | Standard deviation | Confidence interval | |
Total before intervention | 519 | 20,493 | 0.214 | 4,878 | 20,073 20,914 |
Total post-intervention | 519 | 22,119 | 0.195 | 4,448 | 21,736 22,503 |
The difference | 519 | -1,626 | 0.129 | 2,940 | -1.879 -1.373 |
Ha: mean(diff) < 0 Ha: mean(diff) != 0 Ha: mean(diff) > 0 Pr(T < t) = 0.0000 Pr(|T| > |t|) = 0.0000 Pr(T > t ) = 1.0000 | |||||
Compare the average knowledge score of mothers by examining the function d (difference), in which mean (diff)=mean (total knowledge score before intervention – total knowledge score after intervention).
The results showed that the total general knowledge score of mothers after the intervention increased by 1.6 points, which was statistically significant compared to before the intervention (p<0.001). The 95% confidence interval of the increase was between 1.3 and 1.8 points.
3.2.6.2. Comparison of changes in the average score of mothers' general practice on CSSS after the intervention
Table 3.44. Comparison of changes in postpartum care practices before and after intervention
Variable
Number of officials close | Central jar | Error standard | Deviation standard | Confidence interval | |
Disease knowledge before intervention | 519 | 7,539 | 0.040 | 0.925 | 7,460 7,620 |
Disease knowledge | 519 | 7,880 | 0.049 | 1,116 | 7,784 7,977 |
after intervention
The difference | 519 | -0.341 | 0.037 | -0.413 -0.269 | |
Ha: mean(diff) < 0 Ha: mean(diff) != 0 Ha: mean(diff) > 0 Pr(T < t) = 0.0000 Pr(|T| > |t|) = 0.0000 Pr(T > t ) = 1.0000 | |||||
After the intervention, the average score of postpartum care practice of mothers before the intervention was 7.5 and after the intervention was 7.9.
Statistical testing showed that there was a statistically significant difference between the mean practice scores before and after the intervention (p<0.001).
3.2.7. Mother's assessment of service quality
Table 3.45. Evaluation of intervention group mothers about home-based CSSS services
Research characteristics
PSTW Hospital (n=461) | Ba Vi General Hospital (n=58) | |||
N | % | N | % | |
Efficiency | ||||
Effective | 461 | 100 | 58 | 100 |
Inefficient | 0 | 0 | 0 | 0 |
Service price Cheap | 20 | 4.3 | 3 | 5.2 |
Moderate, reasonable | 433 | 93.9 | 51 | 87.9 |
High | 8 | 1.8 | 4 | 6.9 |
Service provider attitude | ||||
Thoughtful | 461 | 100 | 58 | 100 |
Inhospitable | 0 | 0 | 0 | 0 |
Mothers in the intervention group who used the home postpartum care model showed that 100% of mothers rated the model as effective and the attitude of health workers as caring when providing the service.
Qualitative research also shows that mothers and fathers feel very secure when health workers come to take care of them in the postpartum period [13].
“This model should be widely applied because now there are few births so everyone is willing to pay for medical staff to come and examine them” (BM16PSTW)
“I don't know anything, I asked them and they answered, they had a very good attitude, and were enthusiastic too...” (BM11PSTW)
Regarding the price of the service, most mothers think that the price of the service is moderate and reasonable (see the appendix for details of the service price list). The price of a 10-day service package is about 1,200,000 VND for patients living within a radius of 5- under 10km. For the Ba Vi area, the flat price is about 1,000,000 VND.
However, during the in-depth interviews, some mothers suggested that charging by the session for care and examination is more suitable and convenient for mothers and their families than charging by the current package fee.
“..I think we should change the package (care) calculation to per session. I think that way more mothers will register because they won't have to pay a lot at once…” (BM12PSTW)
Some mothers, however, believe that services provided by individual health workers are cheaper than registered services:
“..At first, the women who gave birth with me gave me the phone number of an experienced medical staff. I was going to call but then thought better of it, but maybe if I called, I would get a cheaper price…That's what I thought.” (BM14PSTW)