Hrev_master Healthcare in Low-resource Settings 2024; volume 12:11987 The effect of family empowerment on hemoglobin levels in pregnant women Ika Mardiyanti, Aldilia Wyasti Pratama, Lailatul Khusnul Rizki, Esty Puji Rahayu Faculty of Nursing and Midwifery, Universitas Nahdlatul Ulama Surabaya, Surabaya, Indonesia Abstract Empowering families can enhance their ability to detect high- risk pregnancies early, which can improve the health status of pregnant women. This study aimed to analyze the effect of the family empowerment model on the hemoglobin levels of pregnant women. It employed a quasi-experimental method with a cross- sectional study approach, implementing a family empowerment intervention to examine its impact on the health of pregnant women. Sampling was conducted using probability sampling with simple random sampling, resulting in 60 pregnant women divided equally into an intervention group and a control group. The inde- pendent variable was the family empowerment model interven- tion, and the dependent variable was the hemoglobin level of the pregnant women. Data were collected using a questionnaire and analyzed with the Wilcoxon test statistic, which indicated a signif- icant effect (p=0.000) of the family empowerment model on the hemoglobin levels of pregnant women. The statistical analysis revealed that the intervention group’s hemoglobin levels showed a significant difference (p<0.05) before and after the intervention. In summary, the treatment involving the family empowerment model significantly affected the hemoglobin levels in pregnant women. After the intervention, nearly all respondents demonstrat- ed increased family involvement in maintaining and caring for pregnant women, facilitating the early detection of high-risk preg- nancies, and contributing to increased hemoglobin levels among these women. Introduction Pregnancy and childbirth are physiological processes experi- enced by women, but sometimes they involve risky conditions.1 The risk of pregnancy complications can affect any pregnant woman, highlighting the importance of providing physical and mental support, along with family involvement, to ensure her well-being throughout the pregnancy.2 Family members are the closest individuals to pregnant women and can assist in recogniz- ing signs of danger or issues that may arise.3 Empowering family members to actively participate in supporting pregnant women can enhance their ability to practice self-care and take responsibil- ity for the health of both the mother and the high-risk pregnancy.4 The results of a preliminary study of 20 people showed that 80% (16 people) of the family in this case were husbands, did not know and were unable to recognize the signs and symptoms that pregnant women were in the risk category or not, did not know how to do early detection of pregnancy with using the Maternal and Child Health (MCH) book and KSPR (Kartu Skor Pudji Rochyati or Pudji Rochyati Score Card), do not understand what to do if there is an emergency and have not determined who is the main decision maker and there is no planning to prepare funds, where to choose health facilities (clinics, primary health care or hospital), as well as the transportation to be used in case of com- plications. Family ignorance about the high risk of pregnancy due to the lack of optimal education and assistance by health workers is one of the causes of the inability of families to carry out early detec- tion and treatment of high-risk pregnancies5 which can have an impact on increasing the danger of pregnancy which affects the health status of the mother and her baby.6 Support obtained from the family or husband is very important in recognizing the symp- toms and responses felt by pregnant women,7 can reduce anxiety Correspondence: Ika Mardiyanti, Faculty of Nursing and Midwifery, Universitas Nahdlatul Ulama Surabaya, Surabaya, Indonesia. E-mail: ika_mardiyanti@unusa.ac.id Key words: anemia; family empowerment; pregnancy; hemoglobin level. Contributions: IM, conceptualization, formal analysis, methodology, writing – original draft; SN validation, visualization; UH, review & edit- ing; FE, data curation, review & editing. All the authors have read and approved the final version of the manuscript and agreed to be held accountable for all aspects of the work. Conflict of interest: the authors declare no potential conflict of interest. Funding: none. Ethics approval and consent to participate: the research has received eth- ical approval from the Health Research Ethics Commission, Faculty of Nursing, Universitas Airlangga, based on ethical certificate 1752-KEPK. During the research, the researcher pays attention to the ethical principles of information to consent, respect for human rights, beneficence, and non-maleficence. Patient consent for publication: written informed consent was obtained for anonymized patient information to be published in this article. Availability of data and materials: all data generated or analyzed during this study are included in this published article. Acknowledgements: we would like to thank Universitas Nahdlatul Ulama Surabaya for their valuable insights and contributions to this study. Received: 15 October 2023. Accepted: 21 May 2024. Early access: 3 July 2024. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2024 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2024; 12:11987 doi:10.4081/hls.2024.11987 Publisher's note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organi- zations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. [Healthcare in Low-resource Settings 2024;12:11987] [page 579] Non -co mmerc ial us e o nly and complications in pregnancy,8 including in making decisions to seek delivery assistance and management of obstetric complica- tions.9 Hemoglobin levels are crucial in pregnant women as they play a key role in transporting oxygen throughout the body, sup- porting both maternal and fetal health.10 Adequate hemoglobin lev- els help prevent anemia, a common condition in pregnancy that can lead to severe fatigue, preterm delivery, and low birth weight.11 Therefore, understanding the impact of family empowerment on improving hemoglobin levels can provide valuable insights into effective strategies for enhancing prenatal care and maternal well- being. Therefore, this study aimed to analyze the effect of the fam- ily empowerment model on the hemoglobin levels of pregnant women. Materials and Methods Research design This type of research was quasi-experimental. The purpose of this study was to conduct a model simulation to test the effective- ness of the family empowerment model. Quasi-experimental research was conducted with pre-test and post-test after the model was tested. Two groups will be involved in this study, namely the treatment group and the control group. Study participants The population of pregnant women in the working area of the Wonokromo Health Center is 128 pregnant women. Then, it was categorized into a homogeneous sample of 70 people. With the cri- teria of pregnant women who have entered the second trimester during the data collection period, pregnant women who live in their area of residence for at least 3 months, planning to give birth in the area of their current residence. After calculating the sample obtained from 60 people, the sample size of the second research phase for each group was 30 respondents from the intervention group and 30 respondents from the control group by random sam- pling. Variable, instrument and data collection The family empowerment intervention was carried out by home visits, which were carried out in as many as 8 sessions for 8 weeks with a duration of ±60-120 minutes through home visits. The methods used are lectures, discussions (questions and answers), demonstrations, contextual counseling, and adult learn- ing with an active learning process using interactive learning media through booklet media, learning modules, KSPR scores, DRISK applications, and MCH books. At the end of each meeting, the researcher asked the respondents again about the material that had been presented. After the last intervention, the researcher will then conduct a post-test in the treatment group and the control group by asking the family to fill out a questionnaire on the ability to perform early detection of high-risk pregnancies and measure the Hemoglobin levels of pregnant women. The collected data is then analyzed. After taking the post-test data, it is to fulfill the prin- ciple of fairness in research ethics. Then the researcher will also provide the same intervention to the control and treatment groups. Data analysis The research data were analyzed using the Wilcoxon statistical test which showed (p=0.000). This means that the family empow- erment model has an effect on hemoglobin levels. Ethical clearance Ethical considerations played a pivotal role throughout the research process. The study garnered ethical clearance from the Health Research Ethics Commission, Faculty of Nursing, Universitas Airlangga, based on ethical certificate No. Certificate :172-KEPK, thereby attesting to its unwavering commitment to upholding ethical standards and guidelines. Results Table 1 present the majority of husbands in the control group are 26-45 years old, with the last education of middle school, working in the private sector, while most of the wives are 17-25 years old, with the last education of middle school, not working, and the third pregnancy. The result of the average KSPR score is 5.20 with a standard deviation of 5.18885 and the lowest score of 2, while the highest is 18. In the intervention group, most of the husbands were aged 26-45 years, with the latest secondary educa- tion, working in the private sector, while the wives were mostly 17-25 years old, with secondary education, not working, and at the first pregnancy. The average KSPR score is 3.60 with a standard deviation of 3.08053 and has the lowest value of 2, while the high- est is 14. Furthermore, from the different tests, it is known that the p-value above 0.05 indicates that there is no difference in the char- acteristics of the respondents between the treatment groups. with the control group. Table 2 shows a description of Hemoglobin levels from the results of the pre-test and post-test in the control group. The results were the same, namely that most of the respondents were not ane- mic. In the intervention group before being given treatment, most of the respondents had moderate anemia category 6.7% and 26.7% mild. And after being given treatment there was an increase in non- anemic changes from 66.7% to 80%. Table 3 shows the testing results of pregnant women’s hemo- globin levels in family empowerment development research. The results of the statistical test analysis of the intervention group on hemoglobin levels resulted in a significance value of