Effectiveness of Mamisihat module using information, motivation and behavioural skill model on exercise adherence among antenatal women in Kuala Selangor, Malaysia

Women face unique challenges during pregnancy. Nevertheless, it is an ideal time to adopt and maintain healthy lifestyle habits due to the mother's concern for the fetus's health. Physical activity is recommended for pregnant women, as the benefits outweigh the risks. Despite the benefits, most antenatal women have low adherence to PA, and many remain inactive during pregnancy. The current study aimed to develop an antenatal exercise module based on the IMB model named the MAMISIHAT module. This study involved three phases. Phase 1 is a cross-sectional study with stratified random sampling from seven health clinics in Kuala Selangor district. The objective of phase 1 is to determine the level of knowledge, attitude, practice, and barriers to antenatal exercise and identify the predictors of practice exercise. Phase 2 is a phase to develop the module based on the findings of Phase 1 and integrate it with the IMB model. Phase 3 is a parallel cluster randomized control trial study involving 220 antenatal women from six health clinics in Kuala Selangor. Data were obtained using a self-administered questionnaire at baseline, immediate post-intervention and one-month post-intervention. The primary outcome was the exercise adherence score. Secondary outcomes include perceived benefit, perceived barrier, self-efficacy and health-related quality of life (HRQoL). Both groups received routine antenatal care. Additionally, the intervention group received the MAMISIHAT module. Among 553 respondents in phase 1, 53.7% had adequate knowledge towards ANE, 65.5% had a positive attitude, and 38.9% reported good ANE practice. In phase 3, results showed no significant difference in the variables between the intervention and control groups measured at baseline. Generalized estimating equations analysis showed that the intervention module was effective in improving the exercise adherence (β= 1.884, 95%CI= 1.158, 2.611, P<0.001) immediately post-intervention and (β= 0.71, 95%CI= 0.06, 1.357, P=0.03) at one-month post-intervention. Perceived benefit (β= 5.451, 95%CI= 3.431, 7.471, P<0.001) immediate post-intervention and (β= 1.985, 95%CI= 0.097, 3.87, P=0.04) one-month post-intervention. The MAMISIHAT module, developed based on the IMB model, has been effective in improving exercise adherence and perceived benefit scores. This study's results suggest that future ANE interventions, particularly those with an accessible approach, could significantly benefit from the application of this model in healthcare settings. Furthermore, the intervention module could potentially achieve even greater success if it receives support from spouses, friends, and other relatives, thus resulting in good and sustainable achievements in the field of antenatal care and exercise intervention.

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