Self-reported preparation of Polish midwives for independent

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Self-reported preparation of Polish midwives for
independent performance of health education
activities
(Przygotowanie polskich położnych do samodzielnego prowadzenia
działalności edukacyjno-zdrowotnej)
G Iwanowicz-Palus1, A,D,F, E Rzońca1, B, A Bień1, C, AWłoszczak-Szubzda2,E
Abstract – Introduction. Health education is a process during
which individuals learn to care for their own health and the
health of others. The objective of the study was to recognize
self-reported preparation of Polish midwives for an independent performance of health education activities related to the
preparation for life in a family, methods of family planning and
protection of maternity and paternity, after introduction of
updated occupational legislation.
Material and methods. The study covered an all-Polish representative group of 3,569 midwives, and was conducted using
the method of a diagnostic survey with the use of a questionnaire technique. The research instrument was a questionnaire
form designed by the authors, covering items concerning the
respondents’ characteristics and the object of the study, developed based on the 5-point Likert scale.
Results. According to the subjective evaluations expressed by
midwives, the majority feel prepared for an independent performance of health education activity related to the preparation
for life in a family (69.15%), methods of family planning
(75.88%) and protection of maternity and paternity (65.04%).
However, midwives from the northern and southern regions of
Poland, aged under 30, with secondary school education who
had not participated in any forms of post-graduate education,
admitted they lacked the preparation for an independent performance of health education activity in the area of the preparation for the performance of health education activity.
Conclusions. Self-reported midwives’ skills to independently
undertake specified medical activities resulting from the provisions of updated occupational legislation allow for the presumption that the majority of midwives are prepared for independent performance of health education activity related to
preparation for life in a family, methods of family planning and
protection of maternity and paternity. Midwives with university
education, or those who had completed a specialisation course,
evaluated in most positive terms their preparation for carrying
out health education activity related to preparation for life in a
family, methods of family planning and protection of maternity
and paternity. A systematic improvement of qualifications by
midwives is necessary; it can be conducted by means of organising new forms of post-graduate education.
Key words - midwife, self-assessment, health education,
parenthood, family planning.
Streszczenie – Wstęp. Edukacja zdrowotna to proces w czasie
którego ludzie uczą się dbać o zdrowie własne, jak i innych
osób. Celem badań była próba poznania samooceny polskich
położnych dotyczącej przygotowania do samodzielnego prowadzenia działalności edukacyjno-zdrowotnej w zakresie przygotowania do życia w rodzinie, metod planowania rodziny oraz
ochrony macierzyństwa i ojcostwa.
Materiał i metoda. Badania zostały przeprowadzone wśród
reprezentatywnej ogólnopolskiej próby położnych liczącej
3569 osób. W badaniach posłużono się metodą sondażu diagnostycznego z wykorzystaniem techniki kwestionariuszowej.
Narzędzie badawcze stanowił autorski kwestionariusz ankiety
obejmujący pytania dotyczący charakterystyki badanych osób
oraz przedmiotu badań, opracowany w oparciu o pięciostopniową skalę Likerta.
Wyniki. W subiektywnej ocenie położnych większość z nich
czuje się przygotowana do samodzielnego prowadzenia działalności edukacyjno-zdrowotnej w zakresie przygotowania do
życia w rodzinie (69,15%), metod planowania rodziny
(75,88%) oraz ochrony macierzyństwa i ojcostwa (65,04%).
Jednak położne z regionu północnego i południowego Polski,
poniżej 30 lat, legitymujące wykształceniem policealnym i
nieuczestniczące w żadnych formach kształcenia podyplomowego przyznają się głównie do braku przygotowania do samodzielnego prowadzenia działalności edukacyjno-zdrowotnej.
Wnioski. W subiektywnej ocenie położnych większość z nich
jest przygotowana do samodzielnego prowadzenia działalności
edukacyjno-zdrowotnej w zakresie przygotowania do życia w
rodzinie, metod planowania rodziny oraz ochrony macierzyństwa i ojcostwa. Położne z wyższym wykształceniem i/ lub te,
które ukończyły kurs specjalizacyjny, oceniają iż są przygoto-
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wane do prowadzenia działalności edukacji zdrowotnej w zakresie przygotowania do życia w rodzinie, metod planowania
rodziny oraz ochrony macierzyństwa i ojcostwa. Dlatego konieczne jest systematyczne podnoszenie i doskonalenie kwalifikacji zawodowych położnych w omawianym temacie, poprzez organizowanie nowych form doskonalenia podyplomowego.
Słowa kluczowe - położna, samoocena, edukacja zdrowotna,
rodzicielstwo, planowanie rodziny.
Author Affiliations:
1. Independent Obstetric Skills Unit, Department of Nursing
and Health Sciences, Medical University, Lublin
2. Faculty of Pedagogy and Psychology, University of Economics and Innovation, Lublin, Poland; Department of
Health Informatics and Statistics, Institute of Rural Health,
Lublin
Authors’ contributions to the article:
G. The idea and the planning of the study
H. Gathering and listing data
I. The data analysis and interpretation
J. Writing the article
K. Critical review of the article
L. Final approval of the article
Correspondence to:
Grażyna Iwanowicz-Palus, MD, PhD, Staszica 4-6, PL-20-081
Lublin, Poland; [email protected]
I. INTRODUCTION
ealth education is a process during which individuals learn to care for their own health and the health
of others. It focuses on making them aware of the
relationships between health and lifestyle as well as between the physical and social environments. Health education involves primarily informative actions, the main
goal of which is shaping health promoting attitudes, beliefs, motivations and skills, which will lead to pro-health
behaviour [1]. A midwife is a responsible and independent professional who works together with women,
providing them with indispensable support, care and information, among other things, during the pre-conceptual
period, in pregnancy, labour and lying-in period, conducting the delivery and providing care for the newborn
and infant [2]. A midwife performs the role of a health
promoter and educator, not only for women, but for
whole families and society [3,4]. Changes introduced in
H
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Article 5 of the Act in the Matter of Occupation of Nurse
and Midwife, concerning the expansion of the scope of
authority of a midwife in the provision of specified
health services, directly follow the regulation included in
Article 4 (2) of the
Council Directive 80/154/EEC of 21 January 1980 concerning the mutual recognition of diplomas, certificates
and other evidence of formal qualifications in midwifery,
and including measures to facilitate the effective exercise
of the right of establishment and freedom to provide services, which has been transported into Article 42 (2) of
the Directive 2005/36/EC of the European Parliament
and of the Council of 7 September 2005 on the recognition of professional qualifications. These indicate that the
member states shall ensure that midwives are able to perform and gain access at least to the activities enumerated
in the subsequent points analysed in the presented study,
concerning self-reported skills of Polish midwives for
independent performance of specified medical activities,
following from the provisions of updated occupational
legislation [5,6,7]. According to the regulation by the
Minister of Health of 29 October 2003 in the matter of
the list of nursing specialties and specialties applied in
heath care, specialisations for midwives may be carried
out in the field of family nursing, gynaecological nursing,
obstetric nursing, as well as in health promotion and
health education, whereas specialisations in neonatal
nursing, epidemiological nursing, and in the area of organization and management may be conducted commonly for nurses and midwives. Qualification courses for
midwives may be performed in the field of family nursing, health promotion and health education, and the
above-mentioned courses for nurses and midwives may
be conducted in the domains of neonatal, epidemiological, surgical nursing, as well as in the area of organization and management [8]. The objective of the study was
an attempt to recognize midwives’ opinions concerning
their preparation for independent performance of health
education activities related to the preparation for life in a
family, methods of family planning and protection of
maternity and paternity after introduction of updated
occupational legislation.
II. MATERIALS AND METHODS
The basic study was preceded by a pilot study which
allowed verification of the author-constructed section of
the questionnaire form, and was performed during the
period 2006-2007, in a representative all-Polish group of
3,569 midwives - 17.13% of the total number of mid-
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wives employed full-time in Poland. The study was conducted among midwives who had post-secondary school
education, higher vocational education (including midwives who had completed a bridge programme) and university education. The study included 13.35% occupationally active midwives from the central region (regions
of Łódź and Warsaw), 14.03% from the southern region
(regions of Krakow and Katowice), 24.00% from the
eastern region (regions of Lublin, Rzeszów, Kielce and
Białystok), 20.67% from the north-western region (regions of Poznań, Szczecin and Zielona Góra), 20.90%
from the south-western region (regions of Wrocław and
Opole) and 14.25% from the northern region of Poland
(regions of Bydgoszcz, Olsztyn, and Gdansk).
The division of the country into six regions was performed in accordance with the Regulation in the Matter
of Implementation of Nomenclature of Territorial Units
for Statistical Purposes, which came into being on the
day the Republic of Poland joined the European Union
[9].
The method of two-stage cluster sampling was used
with stratification into occupationally active midwives,
according to the scheme of multiple stage clusterindividual sampling. The size of the sample was determined considering the four most important factors: size
of accepted measurement error (the smaller the error
expected, the larger the size of the sample), scope of variability of the measured characteristics in the population
(the higher the variance, the bigger the sample size), the
assumed confidence interval (the smaller the confidence
interval, the larger the sample size and the higher the
probability that the estimated parameter belongs to the
confidence interval), and population size (the larger the
population, the lower the percentage of the population
which constitutes the sample).
The study was conducted using the method of a diagnostic survey with the use of a questionnaire technique.
The research instrument was a questionnaire form designed by the authors, which covered items concerning
the respondents’ characteristics and the object of the
study, developed based on the 5-point Likert scale. The
items concerning the object of the study were prepared
based on midwives’ novelized professional legislation.
Midwives who participated in the study were informed
about its anonymity and that the use of the information
obtained is for scientific purposes only.
Analysis of the research material was performed using
the computer software: UPSA_Plus (AltaSoft S.C. Software Development Company, Katowice), and
STATISTICA 6.1 (StatSoft, Polska - Krakow). The relationships between variables were verified using the chi-
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square test (χ2) for independence. The p values p<0.05
were considered statistically significant.
III. RESULTS
The majority of the 3,569 midwives in the study were
inhabitants of the eastern region (29.08%), aged 41-50
(48.02%), and had secondary school education (87.55%).
As many as 84.88% of midwives had not participated in
specialisation courses, 73.63% in qualification courses,
59.69% in specialist courses; however, they had completed at least one improvement course (54.15%) (Table
1).
Table 1. Respondents’ characteristics
Sociodemographic data
N
%
<30
225
6.30
31-40
1163
32.60
41-50
1714
48.02
>50
467
13.08
university
344
9.65
vocational university
100
2.80
secondary school
3123
87.55
central
538
15.07
southern
598
16.76
eastern
1038
29.08
north-western
695
19.47
south-western
268
7.51
northern
432
12.1
2986
84.88
532
15.12
2586
73.63
926
26.37
2129
59.69
1389
40.31
1634
45.85
1930
54.15
Age
Education level
Region of Poland
Specialisation
Completion of a
qualification
course
Completion of a
specialist course
Completion of a
improvement
course
does not possess
specialisation
has at least one specialisation
has not completed
any course
has completed at
least one course
has not completed
any course
has completed at
least one course
has not completed
any course
has completed at
least one course
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Statistical analysis showed that midwives living in the
north-western region evaluated their preparation for performance of health education activities related to preparation for life in a family in the most positive terms
(27.77%). So did the midwives aged over 50 (38.54%),
with university education (49.42%) and those who had
participated in post-graduate education completed at
least one specialisation (34.77%), at least one qualification course (33.69%), specialisation course (26.62) and
improvement course (30.16%).
Midwives who admitted the lack of preparation for independent performance of health education activity related
to the preparation for life in a family, compared to the
all-Polish sample, dominated significantly (p<0.01)
among respondents living in the northern region of Poland (19,21%), aged 41-50 (18.38%), with secondary
school education (18.03%) and those who had not participated in post-graduate education, i.e. did not have a specialisation (18.02%), had not participated in qualification
courses (19.04%), specialist courses (17,88%) and improvement courses (20.68%) (Tables 2 and 3).
Midwives who evaluated their preparation for the performance of health education activities related to preparation for life in a family at the highest level, compared
to the all-Polish sample, prevailed among the respondents living in the eastern region of Poland (29.48%),
were aged over 50 (35.33%), had university education
(50.29%), and had participated in post-graduate education – had at least one specialisation (37.22%), and also
had completed at least one qualification course
(34.99%), specialist course (31.29%) or improvement
course (31.87%).
Statistical analysis indicated that midwives who admitted the lack of preparation for independent performance
of health education activity related to the preparation for
life in a family, compared to the all-Polish sample, highly
statistically dominated among respondents living in the
southern region (14.38%), were aged 41-50 (12,71%),
had secondary school education (13.16%) and had not
participated in post-graduate education – specialisation
course (13.57%), qualification courses (14.04%), specialist courses (13.51%) and improvement courses
(15.98%) (Tables 2 and 3).
Based on statistical analysis, it was also confirmed that
midwives who considered themselves very well prepared
for independent performance of health education activities related to protection of maternity and paternity,
compared to the all-Polish sample, dominated among
respondents living in the central region (24.72%), were
aged over 50 (32.76%), had university education
(39.83%), and had participated in post-graduate educa-
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tion – possessed at least one specialisation (29.14%),
completed at least one qualification course (29.05%),
specialisation course (26,08%), and improvement course
(26.58%).
In turn, midwives who admitted lack of preparation for
independent performance of health education activities
related to protection of maternity and paternity, compared to the all-Polish sample, prevailed among respondents living in the southern region (19.73%), were aged
under 30 (19.11%), had post-secondary school education
(17.32%), had not participated in post-graduate education – had no specialisation (17.42%), had not participated in qualification courses (18.65%), specialist courses
(17.32%), and improvement courses (19.83%) (Tables 2
and 3).
IV. DISCUSSION
In pre-conception care midwives should be the source
of thorough and reliable information for future parents.
An adequate and professional care provided by them
includes passing the information concerning the physical
and psychological health of parents, health promoting
lifestyle, hazardous effect of stimulants, responsible sexual life, prevention of sexually transmitted diseases, and
the necessity to report to the pre-conception outpatient
department prior to the planned pregnancy, exert an important effect on the quality of life and health of the future generations [10,11]. The provision of information
includes also the expanding of knowledge concerning an
active life style and physical activity among women at
reproductive age [12]. Physical activity in pregnancy is
an important precondition of its course, and physical
exercises performed both during this period and before
conception prevent many disorders, such as varices of
the lower extremities or back pain [13,14,15,16]. Among
midwifery tasks resulting from the occupational role are
health education in the area of the preparation for life in
a family, teaching methods of family planning and protection of maternity and paternity [10]. Also, the International Confederation of Midwives in the document: Essential Competencies for Basic Midwifery Practice 2010
defines the necessary competences of a midwife needed
for the performance of pre-conception care, including the
promotion of the health of a family, pregnancy planning
and construction of positive parental attitudes [17,18].
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Table 2. Midwives’ preparation for independent performance of health education related to life in a family, family planning and
protection of maternity and paternity according to region and age (%)
Preparation for independent performance of health education activities related to preparation for life in a family (n=3569)
Self -reported
preparation
Total
number
of midwives in
the study
Regions of Poland
Age
central
southern
eastern
northwestern
southwestern
northern
< 30
31 – 40
41 – 50
> 50
strongly agree
26.93
26.02
27.26
26.59
27.77
26.87
27.08
19.11
22.96
27.48
38.54
agree
42.22
45.54
42.47
43.93
36.40
46.27
40.51
48.4
44.63
41.07
37.47
no opinion
13.95
14.68
12.21
12.43
17.99
13.06
13.19
18.67
15.91
13.07
10.06
disagree
12.75
10.97
13.21
12.81
12.66
13.43
13.89
10.20
13.07
14.00
8.57
strongly disagree
4.15
2.79
4.85
4.24
5.18
0.37
5.32
3.56
3.44
4.38
5.35
Chi2 / df / p-value
χ2 =38.686
df=20
χ2 =68.174
p=0.0073
df=12
p=0.0000
Preparation for independent performance of health education activities related to methods of family planning (n=3569)
strongly agree
28.44
29.37
27.76
29.48
27.63
28.36
27.08
21.78
24.94
29.81
35.33
agree
47.44
52.23
48.83
47.21
41.58
51.87
46.76
51.11
50.30
46.32
42.61
no opinion
11.66
10.22
9.03
9.92
17.55
10.45
12.50
14.67
12.30
11.14
10.49
disagree
9.58
6.32
10.70
10.40
9.78
8.58
10.42
9.78
10.15
9.68
7.71
strongly disagree
2.89
1.86
3.68
2.99
3.45
0.75
3.24
2.67
2.32
3.03
3.85
Chi2 / df / p-value
χ2=55.268
df=20
χ2 =31.040
p=0.0000
df=12
p=0.0019
Preparation for independent performance of health education activities related to protection of maternity and paternity (n=3569)
strongly agree
23.54
24.72
24.25
24.47
21.44
24.63
21.53
16.44
19.17
24.91
32.76
agree
41.50
47.03
39.13
43.06
35.97
45.15
40.74
39.11
43.08
41.07
40.26
no opinion
18.55
16.91
16.89
16.09
25.76
17.16
18.06
25.33
21.07
17.15
14.13
disagree
12.94
9.29
15.38
12.81
12.37
12.31
15.74
16.00
13.93
13.07
8.57
strongly disagree
3.47
2.04
4.35
3.56
4.46
0.75
3.94
3.11
2.75
3.79
4.28
Chi2 / df / p-value
χ2=62.894
df=20
p=0.0000
χ2 =62.646
df=12
p=0.0000
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Table 3. Midwives’ preparation for independent health education activity in the area of preparation for life in a family, family planning and the protection of maternity and paternity according to education, and participation in postgraduate specialisation, qualification, specialist and improvement courses (%)
Preparation for independent performance of health education activities in the area of preparation for life in a family (n=3569)
Completion of
Completion of speCompletion of imEducation level
Specialisation
qualification
cialist course
provement course
course
Self reported
possesses at
possesses at
doesnot
doesnot
preparation
least one
least one
university secondary
university secondary
possessany
possessany
university
university
specialisaspecialisavocational
school
vocational
school
specialisation
specialisation
tion
tion
strongly
strongly
49.42
42.00
23.98
25.55
34.77
49.42
42.00
23.98
25.55
34.77
agree
agree
agree
36.05
44.00
42.84
41.65
45.49
agree
36.05
44.00
42.84
41.65
45.49
no
no opinion
5.23
7.00
15.15
14.78
9.21
5.23
7.00
15.15
14.78
9.21
opinion
disagree
8.43
6.00
13.45
13.57
8.08
disagree
8.43
6.00
13.45
13.57
8.08
strongly
strongly
0.87
1.00
4.58
4.45
2.44
0.87
1.00
4.58
4.45
2.44
disagree
disagree
Chi2 / df /
p-value
χ2 =134.482 df=8 p=0.0000
χ2 =41.008 df=4
p=0.0000
χ2 =60.100 df=4
p=0.0000
χ2 =15.071 df=4
p=0.0046
χ2 =53.344 df=4
p=0.0000
Preparation for independent performance of health education activities related to methods of family planning (n=3569)
strongly
50.29
40.00
25.65
26.90
37.22
26.14
34.99
26.51
31.29
24.41
agree
agree
37.50
40.00
48.77
47.61
46.43
46.73
49.46
46.88
48.26
46.13
no opinion
4.94
11.00
12.42
11.92
10.15
13.09
7.56
13.09
9.53
13.48
disagree
5.81
8.00
10.05
10.47
4.51
10.86
5.94
10.46
8.28
12.08
strongly
1.45
1.00
3.11
3.10
1.69
3.18
2.05
3.05
2.64
3.90
disagree
Chi2 / df /
p-value
χ2 =105.726 df=8 p=0.0000
χ2 =38.160 df=4
p=0.0000
χ2 =58.278 df=4
p=0.0000
χ2 =21.396 df=4
p=0.0003
31.87
48.55
10.10
7.46
2.02
χ2 =57.769 df=4
p=0.0000
Preparation for independent performance of health education activities related to protection of maternity and paternity (n=3569)
strongly
39.83
31.00
21.52
22.56
29.14
21.60
29.05
21.82
26.08
19.95
26.58
agree
agree
41.28
43.00
41.47
40.86
45.11
40.48
44.38
40.97
42.28
40.51
42.33
no opinion
9.88
13.00
19.69
19.16
15.04
19.29
16.52
19.90
16.55
19.71
17.56
disagree
8.14
10.00
13.54
13.63
9.02
14.83
7.56
14.08
11.27
15.38
10.88
strongly
0.87
3.00
3.78
3.79
1.69
3.82
2.48
3.24
3.82
4.45
2.64
disagree
Chi2 / df /
p-value
χ2 =79.647 df=8 p=0.0000
χ2 =27.602 df=4
p=0.0000
Results of studies by Schytt E. and Waldenström U.
(2013) showed that according to midwifery students,
during education, an insufficient amount of time is devoted to prenatal care; in opinions of 11.5% of students,
it is general care, including education of parents, and
according to 10.9% - the scope of problems concerning
contraception [19]. Analysis of the presented study allowed the authors to assume that according to the
midvives’ subjective evaluation, the majority of them are
prepared for independent performance of health education related to the preparation for life in a family
χ2 =52.979 df=4
p=0.0000
χ2 =18.248 df=4
p=0.0011
χ2 =41.650 df=4
p=0.0000
(69.15%), family planning methods (75.88%), and protection of maternity and paternity (65.04%). However,
every sixth midwife participating in the study admitted
the lack of preparation for independent performance of
health education activities involving the preparation for
life in a family (16.9%) and protection of maternity and
paternity (16.41%), and every eighth mentioned the lack
of preparation related to family planning (12.47%).
These were mainly midwives living in the northern and
southern regions of Poland, aged under 30, who had secondary school education and had not participated in any
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form of postgraduate education. Also, a study by van
Heesch P. et al. (2006), concerning opinions of Dutch
environmental midwives on pre-conception care, showed
that 70.0% of midwives in the study to some extent provided this care, 83.0% of respondents would provide this
care in the future, and according to 55.0% of them preconception care should become their domain. The abovementioned researchers claimed midwives do not provide
this type of obstetric care due to the lack of time and
indispensable knowledge; therefore, they suggest the
necessity for improving qualifications through postgraduate education [20]. The presented study also confirmed such a necessity and showed that midwives who
had completed a specialisation (p=0.0000), qualification
course (p=0.0000), specialist course (p=0.0046), or improvement course (p=0.0000) evaluated their preparation
for the performance of health education activity in the
area of pre-conception care in more positive terms.
They authors’ own study showed that the respondents
considered themselves very well (23.54%) and well prepared (41.50%) for independent performance of health
education related to maternity and paternity. The study
by Deave T. et al. (2008) presented in the relevant literature confirmed that for parents expecting a baby, and
during the first moments after birth, a midwife is a reliable source of information, and is someone to whom they
may turn to for advice and support [21].
The analysis performed indicated that midwives aged
over 41 evaluated their preparation in the area of life in a
family in most positive terms (p=0.0000). This was confirmed by the empirical data collected by other researchers who found a relationship between the respondents’
period of employment and the skills of independent performance of health education activities in the area of the
preparation for life in a family [22].
According to the modern model of care over a woman
and her family, a midwife should promote the pro-health
style of life, deal with family planning, as well as offer
health and sexual advice related to biological, educational and social aspects [23]. In accordance with the division of occupational roles resulting from legally defined
competences, a midwife who is a member of the educational and therapeutic team, considering her knowledge
and methodological preparation, is the person who may
and should perform health education related to family
planning, including the natural methods of family planning [24]. The presented study showed that the midwives
evaluated their preparation for performance of this function as good (47.44%) and very good (28.44%); however, studies by Zielińska M. (2007) and Bączek G. et al.
(2010) prove that midwives are not the main source of
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information for women concerning family planning, and
the most often used sources of information on family
planning were journals, guidebooks and books, and a
physician [25, 26]. A study by Krauss H. et al. (2012)
showed that the main source of information concerning
contraception among adolescents in Belarus, Poland,
France, Germany and the United Kingdom were their
peers [27]. This situation may be due to the fact that
women do not know that they can obtain information in
this respect from a midwife. This is confirmed by the
study of Muzyczka K. et al. (2012), which indicated that
students of the speciality of obstetrics, in the first place
would like to obtain such information from a midwife
[28].
The presented study and the analysis of the relevant
literature show that the engagement of midwives in the
performance of health education related to the preparation for life in a family, methods of family planning, and
protection of maternity and paternity is insufficient [18,
23, 24]. Therefore, a systematic improvement of professional qualifications by midwives is necessary; it can be
achieved through their participation in one of the forms
of post-graduate education, i.e. a specialist course:
“Counselling in the area of preparation of a family for
performing the reproductive function” [29].
V. CONCLUSIONS
Self-reported midwives’ skills to independently perform specified medical activities resulting from the provisions of updated occupational legislation allowed the
authors to conclude that the majority of them are prepared for independent health education activity related to
the preparation for life in a family, methods of family
planning and protection of maternity and paternity. Midwives with university education, or those who had completed a specialisation course, evaluated their preparation
for health education activity in the area of preparation for
life in a family, methods of family planning, and protection of maternity and paternity in most positive terms.
A systematic improvement of qualifications by midwives
is necessary, through the organization of new forms of
post-graduate education.
Parallel research is recommended several years later to
discover how midwives evaluate their preparation for
independent performance of health education activity
more than a dozen years after the introduction of updated occupational legislation..
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VI. ACKNOWLEDGMENTS
The authors express their thanks to all midwives who
agreed to participate in the presented study.
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