Korean J Women Health Nurs.  2022 Sep;28(3):250-263. 10.4069/kjwhn.2022.09.22.

Development and effects of a webtoon education program on preventive self-management related to premature labor for women of childbearing age: a randomized controlled trial

• Kim SH

• KMID: 2535441
• DOI: http://doi.org/10.4069/kjwhn.2022.09.22

Abstract

Purpose
The purpose of this study was to develop a webtoon education program on preventive self-management related to premature labor (PSM-PL) for women of childbearing age, to evaluate its effects, and to assess the usability of webtoon education for women of childbearing age. Methods: The study design was a stratified randomized trial with repeated measures. The participants were Korean women of childbearing age (between the ages of 19 and 49 years), with 49 participants each. The preventive health management self-efficacy related to premature labor (PHMSE-PL) scale, the preventive self-management knowledge related to premature labor (PSMK-PL) scale, and usability of webtoon education were assessed. The intervention group read six episodes of the PSM-PL webtoon within 2 days after clicking an online link. The control group did not receive anything but was given the webtoon after the last measurement. To test the effect of the repeatedly measured variables, a generalized estimating equation model was used. Results: The experimental group had statistically significantly greater increases in PHMSE-PL and PSMK-PL scores from baseline to immediately after and 2 weeks later than the control group. The average score for usability of webtoon education was high (4.52; standard deviation, 0.62) on a scale of 1–5. Conclusion: This webtoon education program on PSM-PL was a feasible and acceptable program that increased self-efficacy and knowledge of preventive health management of premature labor in women of childbearing age. Future studies that adopt a webtoon format can be beneficial for childbearing women with other risk factors.

Keyword

Cartoons as topic; Health education; Knowledge; Premature obstetric labor; Self efficacy

Figure

• 

  Figure 1. CONSORT diagram showing the flow of participants through the trial.

Reference

References

1. World Health Organization. Preterm birth [Internet]. Geneva: Author; 2018 [cited 2022 Mar 18]. Available from: https://www.who.int/news-room/fact-sheets/detail/preterm-birth.

2. Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet. 2008; 371(9606):75–84. https://doi.org/10.1016/S0140-6736(08)60074-4.

3. Statistics Korea. Birth statistics in 2020 [Internet]. Daejeon, Korea: Author; 2021 [cited 2022 Mar 15]. Available from: http://kostat.go.kr/portal/korea/kor_nw/1/2/3/index.board?bmode=read&bSeq=&aSeq=391575pageNo=2&rowNum=10&navCount=10&currPg=&searchInfo=&sTarget=title&sTxt=.

4. National Health Insurance Service, Health Insurance Review & Assessment Service. Health insurance statistics in 2016 [Internet]. Wonju, Korea: Author; 2017 [cited 2022 Mar 14]. Available from: https://www.nhis.or.kr/nhis/together/wbhaec06300m01.do?mode=view&articleNo=124637&article.offset=0&articleLimit=10.

5. National Health Insurance Service, Health Insurance Review & Assessment Service. Health insurance statistics in 2018 [Internet]. Wonju, Korea: Author; 2019 [cited 2022 Mar 14]. Available from: https://www.nhis.or.kr/nhis/together/wbhaec06300m01.do?mode=view&articleNo=132759&article.offset=0&articleLimit=10.

6. National Health Insurance Service, Health Insurance Review & Assessment Service. Health insurance statistics in 2020 [Internet]. Wonju, Korea: Author; 2021 [cited 2022 Mar 14]. Available from: https://www.nhis.or.kr/nhis/together/wbhaec06300m01.do?mode=view&articleNo=10812384&article.offset=0&articleLimit=10.

7. Rundell K, Panchal B. Preterm labor: prevention and management. Am Fam Physician. 2017; 95(6):366–372.

8. Romero R, Dey SK, Fisher SJ. Preterm labor: one syndrome, many causes. Science. 2014; 345(6198):760–765. https://doi.org/10.1126/science.1251816.

9. Raghuraman N, Tuuli MG. Preconception care as an opportunity to optimize pregnancy outcomes. JAMA. 2021; 326(1):79–80. https://doi.org/10.1001/jama.2020.27244.

10. Jourabchi Z, Sharif S, Lye MS, Saeed A, Khor GL, Tajuddin SH. Association between preconception care and birth outcomes. Am J Health Promot. 2019; 33(3):363–371. https://doi.org/10.1177/0890117118779808.

11. American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. Prediction and prevention of spontaneous preterm birth: ACOG Practice Bulletin, Number 234. Obstet Gynecol. 2021; 138(2):e65–e90. https://doi.org/10.1097/AOG.0000000000004479.

12. Ryu KH, Shin HS. Phenomenological study on experience of preterm labor. Korean J Women Health Nurs. 2009; 15(2):140–149. https://doi.org/10.4069/kjwhn.2009.15.2.140.

13. Silva TV, Bento SF, Katz L, Pacagnella RC. “Preterm birth risk, me?” Women risk perception about premature delivery - a qualitative analysis. BMC Pregnancy Childbirth. 2021; 21(1):633. https://doi.org/10.1186/s12884-021-04068-x.

14. Hammarberg K, Stocker R, Romero L, Fisher J. Pregnancy planning health information and service needs of women with chronic non-communicable conditions: a systematic review and narrative synthesis. BMC Pregnancy Childbirth. 2022; 22(1):236. https://doi.org/10.1186/s12884-022-04498-1.

15. Yoon KH, Jung KH, Choi IS, Choi HS. Features of Korean webtoons through the statistical analysis. Cartoon Anim Stud. 2015; (38):177–194. https://doi.org/10.7230/KOSCAS.2015.38.177.

16. Lee SJ. A study on the innovative perspective in webtoon for new environmental adoption. Korean J Anim. 2019; 15(3):105–120. https://doi.org/10.51467/ASKO.2019.09.15.3.105.

17. Kim JH, Yu J. Platformizing webtoons: the impact on creative and digital labor in South Korea. Social Media Soc. 2019 Nov 21 [Epub]. https://doi.org/10.1177/2056305119880174.

18. McNicol S. The potential of educational comics as a health information medium. Health Info Libr J. 2017; 34(1):20–31. https://doi.org/10.1111/hir.12145.

19. Şentürk M, Şimşek U. Educational comics and educational cartoons as teaching material in the social studies course. African Educ Res J. 2021; 9(2):515–525. https://doi.org/10.30918/AERJ.92.21.073.

20. Seol YK. Exploration on the applicability of ‘webtoons’ for education: focusing on the aspects of formativity, narrativity and interactivity. Korean J Cult Arts Educ Stud. 2018; 13(1):25–48. https://doi.org/10.15815/kjcaes.2018.13.1.25.

21. Seo HK. Educational effect of digital-storytelling technique: a systematic review. J Korea Game Soc. 2019; 19(1):37–45. https://doi.org/10.7583/JKGS.2019.19.1.37.

22. Ministry of Science and ICT, National Information Society Agency. Survey on internet usage in 2021 [Internet]. Daegu, Korea: Author; 2022 [cited 2022 Feb 12]. Available from: https://www.msit.go.kr/publicinfo/view.do?sCode=user&mPid=62&mId=63&publictSeqNo=406&publictListSeqNo=9&formMode=R&referKey=406,9.

23. Korea Creative Content Agency (KOCCA). Current status of comic and webtoon users in 2021 [Internet]. Naju, Korea: Author; 2021 [cited 2022 Feb 10]. Available from: https://www.kocca.kr/kocca/bbs/view/B0000147/1846252.do?menuNo=204153#.

24. Janssen PA, Iker CE, Carty EA. Early labour assessment and support at home: a randomized controlled trial. J Obstet Gynaecol Can. 2003; 25(9):734–741. https://doi.org/10.1016/s1701-2163(16)31002-7.

25. Urquhart C, Currell R, Harlow F, Callow L. Home uterine monitoring for detecting preterm labour. Cochrane Database Syst Rev. 2017; 2(2):CD006172. https://doi.org/10.1002/14651858.CD006172.pub4.

26. Kao MH, Hsu PF, Tien SF, Chen CP. Effects of support interventions in women hospitalized with preterm labor. Clin Nurs Res. 2019; 28(6):726–743. https://doi.org/10.1177/1054773817744323.

27. Chuang LL, Lin LC, Cheng PJ, Chen CH, Wu SC, Chang CL. Effects of a relaxation training programme on immediate and prolonged stress responses in women with preterm labour. J Adv Nurs. 2012; 68(1):170–180. https://doi.org/10.1111/j.1365-2648.2011.05765.x.

28. Park HJ, Sung MH. Effects of music therapy on stress of preterm labor and uterine contraction in pregnant women with preterm labor. Korean J Women Health Nurs. 2017; 23(2):109–116. https://doi.org/10.4069/kjwhn.2017.23.2.109.

29. Choi MS, Park YJ. The effects of relaxation therapy on anxiety and stress of pregnant women with preterm labor. Korean J Women Health Nurs. 2010; 16(4):336–347. https://doi.org/10.4069/kjwhn.2010.16.4.336.

30. Eom SY, Kang SJ. Effect of intervention programs for preterm labor women in Korea: systematic review. Health Nurs. 2015; 27(1):13–22.

31. Sim ES, Choi SY. Relationship between preterm labor stress, anxiety and depression in pregnant women with preterm labor. J Korean Data Anal Soc. 2016; 18(2):951–964.

32. Kim GN, Jun EY. Effects of the unpleasant symptom-relief program on preterm labor stress, anxiety, physical discomfort, and situational discomfort among hospitalized high-risk pregnant women: a nonrandomized controlled trial. J Korean Soc Matern Child Health. 2021; 25(4):269–281. https://doi.org/10.21896/jksmch.2021.25.4.269.

33. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007; 39(2):175–191. https://doi.org/10.3758/bf03193146.

34. Kim SH, Lee YJ. Preventive Health Management Self-Efficacy related to Premature Labor (PHMSE-PL) scale for Korean women of childbearing age: instrument development and validation. Child Health Nurs Res. 2022; 28(3):218–229. https://doi.org/10.4094/chnr.2022.28.3.218.

35. Kim SH, Lee YJ. Development of Preventive Self-Management Knowledge Related to Premature Labor (PSMK-PL) scale for women of childbearing age: an item response theory approach. J Korea Contents Association. 2022; 22(9):439–450. https://doi.org/10.5392/JKCA.2022.22.09.439.

36. Morville P, Sullenger P. Ambient findability: libraries, serials, and the internet of things. Ser Libr. 2010; 58(1-4):33–38. https://doi.org/10.1080/03615261003622999.

37. Bruner J. The culture of education. Kang HS, translator. Paju, Korea: Kyoyookkwahaksa;2021. p. 299–381.

38. Junhasavasdikul D, Sukhato K, Srisangkaew S, Theera-Ampornpunt N, Anothaisintawee T, Dellow A, et al. Cartoon versus traditional self-study handouts for medical students: CARTOON randomized controlled trial. Med Teach. 2017; 39(8):836–843. https://doi.org/10.1080/0142159X.2017.1324137.

39. Kim HK, Kim HK, Kim M, Park S. Development and evaluation of prenatal education for environmental health behavior using cartoon comics. J Korean Acad Nurs. 2021; 51(4):478–488. https://doi.org/10.4040/jkan.21083.

40. Kraak VI, Story M. Influence of food companies’ brand mascots and entertainment companies’ cartoon media characters on children’s diet and health: a systematic review and research needs. Obes Rev. 2015; 16(2):107–126. https://doi.org/10.1111/obr.12237.

41. Inan G, Inal S. The impact of 3 different distraction techniques on the pain and anxiety levels of children during venipuncture: a clinical trial. Clin J Pain. 2019; 35(2):140–147. https://doi.org/10.1097/AJP.0000000000000666.

42. Anggraeni L, Darmawan C, Tanshzil SW, Jubaedah E. Promoting Ksatria Bela Negara comic through the webtoon for the prevention and control Covid-19. Jurnal Civics: Media Kajian Kewarganegaraan. 2021; 18(1):138–147. https://doi.org/10.21831/jc.v18i1.39377.

43. Mediouni M, Schlatterer DR, Khoury A. Revisiting an old strategy: cartoons in medical education. J Vis Commun Med. 2019; 42(1):26–30. https://doi.org/10.1080/17453054.2018.1553503.

44. Adebayo AL, Davidson Mhonde R, DeNicola N, Maibach E. The effectiveness of narrative versus didactic information formats on pregnant women's knowledge, risk perception, self-efficacy, and information seeking related to climate change health risks. Int J Environ Res Public Health. 2020; 17(19):6969. https://doi.org/10.3390/ijerph17196969.

45. Monzon A, Samara O. Cartoons and the internet: preparing the physicians of tomorrow. Ther Adv Infect Dis. 2021; 8:20499361211033552. https://doi.org/10.1177/20499361211033552.

46. Park M, Lee SW. Factors affecting webtoon’s success: focusing on the distinctive characteristics of webtoon. Information Soc Media. 2019; 20(1):69–97. https://doi.org/10.52558/ISM.2019.04.20.1.69.