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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 15  |  Issue : 2  |  Page : 93-101

Self-concept and self-esteem among adolescent pregnant women at General Assiut Hospital, Assiut City


1 Psychiatric Nursing Department, Faculty of Nursing, Assiut University, Asyut, Egypt
2 Obstetric and Gynecological Nursing Department, Faculty of Nursing, Assiut University, Asyut, Egypt

Date of Submission03-Dec-2017
Date of Acceptance31-May-2018
Date of Web Publication12-Nov-2018

Correspondence Address:
Ghadah Abd El-Rahman Mahmoud
Obstetrics and Gynecological Nursing, Faculty of Nursing, Assiut University, Asyut, 1111
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ENJ.ENJ_45_17

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  Abstract 


Background Psychological status plays an important role in adolescent mothers. It may cause alterations in their self-concept and self-esteem.
Aim The aim of this study was to assess the degrees of self-concept and self-esteem among adolescent pregnant women at General Assiut Hospital, Assiut Governorate (Elshamla Hospital).
Patients and methods A cross-sectional research design was applied in this study. The setting was antenatal outpatient clinic of General Assiut Hospital (Elshamla Hospital). A convenient sample of 320 adolescent pregnant women was recruited in this study. Three tools were used in this study for collecting the data: a structured interview questionnaire, self-image questionnaire, and self-esteem scale. The study started at April 2016 and ended at February 2017.
Results The main findings revealed that the age range of teenage pregnant women was 14–17 years old, and most of them lived in urban areas. There is a high hospital-based rate of teenage pregnancy (34%) at General Assiut Hospital, Assiut City, Egypt. Moderate self-concept and self-esteem are seen among the most teenage pregnant women (93 and 96%, respectively). Finally, there is a strong relationship between sociodemographic characteristics, especially age and fluctuations of self-concept and self-esteem, among these women.
Conclusion There is a strong relationship between sociodemographic characteristics, especially age and fluctuations of self-concept and self-esteem, among these women.
Recommendations Implementing prenatal training courses for nurses about the role of psychological support in raising self-concept and self-esteem in teenage pregnancy is recommended.

Keywords: adolescent pregnant women, self-concept, self-esteem


How to cite this article:
Mohamed NA, Mahmoud GA. Self-concept and self-esteem among adolescent pregnant women at General Assiut Hospital, Assiut City. Egypt Nurs J 2018;15:93-101

How to cite this URL:
Mohamed NA, Mahmoud GA. Self-concept and self-esteem among adolescent pregnant women at General Assiut Hospital, Assiut City. Egypt Nurs J [serial online] 2018 [cited 2018 Dec 14];15:93-101. Available from: http://www.enj.eg.net/text.asp?2018/15/2/93/245120




  Introduction Top


Teenage pregnancy is defined as ‘a teenage girl, usually becoming pregnant within the ages of 13–19’ years (UNICEF, 2008). Teenage pregnancy is the second cause of death for 15–19-year-old girls, worldwide. Approximately three million girls aged 15–19 years had unsafe abortions, annually (WHO, 2013). During this period, the event of formation of their identity begins. One of the risk factors of adolescents is early parenthood and its consequences on their psychological status (Cakar and Tagay, 2017). Self-esteem is a valuable part of a woman’s self-concept, which involves her personal emotions and thoughts (Grander and Gardiner, 2007). Events like marriage and pregnancy lead to self-changes (Steinberg, 2007), and the development of self as a concept is a very important dynamic process during adolescence (Gozuyilmaz and Baran, 2010).

There is a physical and psychological maturation among teenage girls for reproduction. So they are not prepared yet to be mothers (Gandhi et al., 2014). Adolescent pregnancy is a common problem worldwide. It expresses low levels of self-esteem, especially in cases of low levels of education and economic status (Bulut et al., 2008; Gurkan and Sevil, 2008).

Self-esteem is defined as ‘the sense of value that an individual has about herself and that begins to be shaped in the daily life of childhood’ (Darke et al., 2007), whereas the definition of self-concept is ‘the totality of a complex, organized, and dynamic system of learned beliefs, attitudes and opinions that each person holds to be true about his or her personal existence’ (Macola et al., 2010). For example, people have different beliefs about their physical, emotional, social, and other aspects.

Self-esteem affects adolescent’s cognition, emotion, and motivation. A teen pregnancy alters these issues, especially satisfaction, social communications, and academic achievements (Goodson et al., 2006). Through antenatal care, it is important to assess the maternal self-concept and self-esteem among adolescent pregnant women (Avanci et al., 2007).

Approximately one million girls aged 10–11 years and 16 million girls aged 15–19 years give birth annually. Most of these pregnancies occur in developing countries (WHO, 2013). The 10 countries with the highest prevalence of pregnancy among adolescent girls worldwide are Nigeria (51%), Chad (48%), Mali (46%), Guinea (44%), Mozambique (42%), Bangladesh (36%), and Madagascar (36%) (UNFPDA, 2013).

In Egypt, adolescent fertility declines from 148 per 1000 women age 15–19 years in 1960 to 51 per 1000 women age 15–19 years in 2015 (UNFPDA, 2013). Adolescent girls represent one-fifth of Egypt’s population (20%) according to the Population Reference Bureau. This target group will grow according to these statistical results to 44% in 2030 (PRB, 2016). According to the Egypt Demographic Health Survey, 2014, it was reported that one in six girls begins childbearing by the time of their 18th birthday [Egypt Demographic Health Survey (EDHS, 2014)].

Teenage pregnancy can lead to affection of health and economic status of their parents (Ventura et al., 2001; Menacker et al., 2004; Meade and Ickovics, 2005; Martin et al., 2009; Saenz and Conde, 2009). Moreover, it can increase the risk of poverty and decline the chance of labor and completion of their education (Driscoll et al., 2001; Hobcraft and Kiernan, 2001; Martin et al., 2009). There is a link between self-concept and self-esteem as psychological aspects and adolescent pregnancy. Many modern studies reported that teenage pregnancy is the outcome of self-concept disorders (Alpers, 2001).

In recent studies, low self-esteem of adolescent pregnant women may affect the maternal and child bond (Macola et al., 2010). It may be decreased owing to some changes of body image such as gaining of body weight and skin changes (Inanir et al., 2015). According to many studies, teenage pregnancy has many psychological disorders such as low self-esteem, disturbed body image, and poor cognitive development (Lawlor and Shaw, 2002). Moreover, medical disorders associated with teenage pregnancy such as low birth weight, premature babies, and neonatal deaths are caused by social, economic, and behavioral predisposing factors (Cannington, 2001).

The role of nurses is very important for improving the experience of adolescent mothers by providing high quality of antenatal care focusing on positive self-esteem and self-efficacy (Ford et al., 2001). The maternity nurse should be competent in knowledge and leadership skills to maintain and restore the adolescent health at adolescents, families, and community levels. Nurses should be qualified in educational programs to maximize the quality of antenatal care for adolescents (WHO, 2004).


  Aim Top


The aim is to assess the degrees of self-concept and self-esteem among adolescent pregnant women.

Research questions

  1. What are the degrees of self-concept among adolescent pregnant women at General Assiut Hospital, Assiut Governorate?
  2. What are the degrees of self-esteem among adolescent pregnant women at the same hospital?



  Patients and methods Top


Research design

A cross-sectional research design was applied in this study.

Setting

The setting for this study was the Antenatal Outpatient Clinic of General Assiut Hospital (Elshamla Hospital). This clinic serves about 1200 pregnant women annually and provides different antenatal care for women lived in both urban and rural areas.

Sample

A convenient sample was used in this study. The sample was calculated by Epi Info statistical package, version 4 (CDC Manufacture, USA), with power 80% a value of 2.5 is chosen at the acceptable limit of precision (D) at 95% confidence level with expected prevalence 10%, worst acceptable 35%. Accordingly, sample size was estimated to be 290+10% of individuals to guard against nondespondence rate. The total sample was 320 adolescent pregnant women.

Inclusion criteria

The inclusion criteria were pregnant women at adolescent age.

Tools

Three tools were utilized in this study for collecting the data:

Tool I: a structured interviewing questionnaire was utilized and designed by the researcher. It included the following parts:
  1. Sociodemographic characteristics, such as name, age, level of education, and occupation.
  2. Obstetric history such as number of gravidity, parity, abortion, weeks of gestation, and living children.
  3. Data related to antenatal complications such as antepartum hemorrhage, cardiovascular disorders during pregnancy, congenital anomalies, and others.


Tool II (self-image questionnaire): this scale was developed by Offer, Ostrave, and Hawards (1999) originated by Abdelfatah Ahmed (Arabic version) to assess the adolescent’s self-concept. It consists of a series of statements that the participant was asked to confirm or disconfirm, that is, respond with yes or no for each statement. If the participant responded with yes, it was coded by 1, and if responded no, it was coded by 0. The score was reversed in the negative statement.

This questionnaire consists of 11 parts; it covers the five components of self-concept.

Psychological self

It consists of three parts, namely, impulse control, emotional tone, and body and self-image. It includes 28 items (statements).

Social self

It consists of three parts, namely, social relationships, morals, and vocational educational goals. It includes 29 items.

Sexual self

It consists of one part, ‘sexual attitudes’. It includes eight items.

Family self

It also contains one part only, ‘family relationships’, and includes 19 items.

Coping self

It consists of three tables, namely, mastery of the external world and psychopathology, and the last table (made up of 14 items) was devoid of name. It includes 38 items. This questionnaire was translated into Arabic and assessed for content validity and clarity by three experts in the field of psychiatry and psychiatric nursing specialties. Back translation also was done to ensure the validity of the Arabic form. The total score of this questionnaire was 122 and was divided into three levels:
  1. High self-concept ranges from 80 to 122.
  2. Moderate self-concept ranges from 39 to 79.
  3. Low self-concept less than 39.


The reliability of the previous scale was measured by Cronbach’s coefficient α for assessing the internal consistency among these items, which indicated a high degree of consistency. The results suggest that this questionnaire provides a useful way to assess self-image among young adolescents (R=0.7).

Tool III (self-esteem scale): it was developed by to assess the degrees of self-esteem.

This tool consisted of 10 items. The rate of points in each questions ranged from strongly agree (3), agree (2), disagree (1), to strongly disagree (0). Some statements are revised scores: statements 1, 3, 4, 7, and 10 are scored 3, 2, 1, 0, whereas statements 2, 5, 6, 8, and 9 are scored 0, 1, 2, and 3. The degree of self-esteem is categorized into the following:
  1. High self-esteem ranges from 21 to 30.
  2. Moderate self-esteem ranges from 11 to 20.
  3. Low or mild self-esteem ranges from 0 to 10


The self-esteem scale presented high ratings in reliability areas; internal consistency by Cronbach’s α was 0.8. So it was a valid and reliable tool for assessing self-esteem among adolescent pregnant women.

Procedure

First, an official permission was obtained from the Scientific Research Ethics Committee at the Faculty of Nursing, Assiut University, directed to the manager of General Assiut Hospital, Assiut Governorate. The researcher interviewed each adolescent pregnant woman who was seeking antenatal care at Antenatal Care Clinic, General Assiut Hospital, Assiut governorate, and began to explain the nature and purpose of the study to take oral consent from these women to conduct the research. The time of filling the questionnaire took from 15 to 20 min depending on the response of women to complete the following information by the researcher. Tool I was used to collect sociodemographic data, obstetric history, and antenatal complications by the structured interviewing questionnaire; tool II to fill out self-image questionnaire to assess the levels of self-concept among these adolescent pregnant women; and tool III to fill out self-esteem scale to assess the levels of self-esteem among them. Each woman was reassured that the information obtained would be confidential and used only for the purpose of the study.

The content validity

Testing validity was done for reassuring clarifications of the tools by a panel of three experts in the specialty of Obstetrics and Gynecological Nursing.

Pilot study

It was done on 10% of the studied women to test feasibility of the tools and the time needed for applying it. The necessary modifications were done to be consistent with the study.

Field work

The study started at April 2016 and ended at February 2017.

Ethical considerations

There were no risks applied on these women during the application of the study. An oral consent was obtained from each woman before their participation in the study. Anonymity and confidentiality were maintained.

Statistical analysis

The data were tested for normality using the following: categorical variables were described by number and percent, whereas continuous variables were described by mean and SD. χ2-Test used to compare between categorical variables. A two-tailed P value of less than 0.05 was considered statistically significant. All analyses were performed with the IBM SPSS 20.0 software.


  Results Top


This chapter will present data related to part 1, that is, sociodemographic characteristics, obstetric history, and antenatal complications, and part 2, that is, data related to self-concept and self-esteem levels and their relations with sociodemographic characteristics.

[Table 1] identifies that more than half of the teenage pregnant women were 14–17 years old and lived in urban areas (68.1 and 59%, respectively). Only one-third of them (33.1%) had secondary school education. Concerning occupation, most women (86.9%) were housewives.
Table 1 Distribution of teenage pregnant women by sociodemographic data

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[Table 2] shows that the hospital-based rate of adolescent pregnancy at 2016 in General Assiut Hospital was 37.5%.
Table 2 Hospital-based rate of adolescent pregnancy

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Concerning obstetric history, [Table 3] describes that more than two-thirds of the women (79.4%) had from 1 to 2 times of pregnancy, and more than one-fourth (26.9%) had from 1 to 2 times of deliveries. Nearly half of them (48.1%) had 13–24 weeks of gestation.
Table 3 Distribution of teenage pregnant women by obstetric history

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[Figure 1] shows that the highest percentage of teenage pregnant women (43.8%) had no antenatal complications. Antepartum hemorrhage and hypertensive disorders with pregnancy were the followed antenatal complications (14.4 and 11.9%, respectively).
Figure 1 The descriptive frequency of antenatal complications among adolescent pregnant women.

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Descriptive data of self-concept and self-esteem scales are represented in [Table 4]. A moderate mean indicates moderate degree for both self-concept and self-esteem among teenage pregnant women (69.4±7 and 15.8±2.7, respectively).
Table 4 Descriptive data of self-concept and self-esteem scales

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[Figure 2] shows that the highest degree of self-concept among teenage pregnant women was moderate degree followed by high degree (93.8 and 5.6%, respectively).
Figure 2 The different degrees of self-concept among teenage pregnant women.

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[Figure 3] plots that moderate self-esteem represented the highest percentage among teenage pregnant women followed by high degree (96.9 and 3.1%, respectively).
Figure 3 The different degrees of self-esteem among teenage pregnant women.

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[Table 5] reveals that there is a significant relationship between self-concept scale and sociodemographic data regarding age and gravidity (P<0.05), whereas there are no significant differences regarding educational level, residence, and occupation (P>0.05).
Table 5 Relationship between the self-concept scale and sociodemographic data

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Regarding the relationship between self-esteem scale and sociodemographic data, [Table 6] explores that there are significant differences regarding age, occupation, the number of abortions, and gravidity (P<0.05), whereas there are no significance differences regarding educational level, residence, and weeks of gestation (P>0.05).
Table 6 Relation between the self-esteem scale and sociodemographic data

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Self-concept scale by using factor analysis in [Table 7] identifies the items and their resultant factor loading for every factor. Three items were represented by factor one with 29.8% of the variance, whereas two items were represented by factor two with 25.07% of the variance.
Table 7 Factor analysis of self-concept scale

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Self-esteem scale by using factor analysis in [Table 8] identifies the items and their resultant factor loading for every factor. Five items were represented by factor one and 18.5% of the variance, two items represented by factor two and 15.1% of the variance, two items represented by factor three and 12.9% of the variance, and the last two items accounted by factor four and 12% of the variance.
Table 8 Factor analysis of the self-esteem

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  Discussion Top


There are necessary needs related to pregnancy and parenthood of adolescents. These needs may absorb their energy and efforts (Sieving and Stevens, 2003). So there are many psychological and social factors that may alter self-concept and self-esteem of adolescents. Some researchers reported conflicting results about the levels of self-concept and self-esteem among teenage pregnancy (Ford et al., 2001).

The present study aimed to assess the degrees of self-concept and self-esteem among adolescent pregnant women at General Assiut Hospital, Assiut Governorate (Elshamla Hospital).

These study findings also differ from another American study about the role of antenatal care intervention on adolescent’s self-concept noted by Ford et al., 2001, where the hospital-based rate of teenage pregnancy was 13%. Another Icelandic study about risk factors of teenage pregnancy explored that the rate of teenage pregnancy was 15% (Guomundsdottir, 2015). So all previous studies were inconsistent with the present study, and this may refer to the high rate of early marriage in Egypt especially in rural areas.

The study indicated that there are moderate levels of self-concept and self-esteem among adolescent pregnant women. The current results were supported by a study by Commendador (2007) about decision making and teenage pregnancy, where there was a moderate level of self-esteem among teenage pregnancy, and the same results were confirmed by Cakar and Tagay (2017).

These findings are contrary to Alpers (2001) who identifies a high level of self-concept among teenage pregnancy, which is a surprise outcome, because most other research studies confirmed low self-concept and self-esteem among teenage pregnant women.

The explanation may relate to good psychological support from their parents or good feelings of a new experience of being mothers.

Sevil and Ekmekçi (2002) did not support the study results in their study on 100 adolescent pregnant women, with highest percentage of low self-esteem levels among the adolescent pregnant women. It is interesting to know that there are slight changes in self-concept of adolescent mothers reported by Ford et al. (2001). Other recent studies were conducted by Inanir et al. (2015), Ngozi (2013), and Macola et al. (2010) that reported low self-esteem among adolescent pregnant women. These findings may be engaged with the changes of body image during pregnancy and the new feeling of parenthood responsibilities.

The present study findings support that there is a strong relationship between sociodemographic data, obstetric history, and levels of self-esteem regarding age, occupation, gravidity, and type of previous deliveries. This outcome was relevant to McMurray (2003) and Quinlivan et al. (2004) who mentioned in their studies about adolescent health issues that there is a strong relationship between sociodemographic characteristics especially age and alteration of self-esteem among adolescent mothers. Similarly, an Australian study about psychological aspects of teenage pregnancy noted that there is a significant relationship between age of adolescent pregnancy and fluctuations of self-esteem (Evans, 2005).

On the contrary, the study showed high percentage of secondary education, which may support the moderate levels of self-concept and self-esteem. These findings were congruent with the study of Bulut et al. (2008) who observed that increasing self-esteem is associated with increasing the level of education in both groups of pregnant and nonpregnant adolescents. Moreover, another study by Kalpalp-Uz (2006) supported our results, which determined that there is positive self-confidence among the adolescent pregnant mothers who have a higher level of education.

Macola et al. (2010) confirmed similar results about positive relationship between low level of education and dissatisfactory self-esteem. Finally, the most recent study was done by Cakar and Tagay (2017) about the role of self-esteem on changing adolescent’s behaviors, which supported that there are positive relationships between self-esteem and adolescent’s behaviors. So, it is necessary to raise self-esteem of adolescent pregnant women through high quality of antenatal care.

Merits of the study

  1. The study covered a big sample of teenage pregnant women for 1 year at the most renowned public hospital of Ministry of Health at Assiut Governorate.
  2. There are no obstacles in collecting data or convincing clients to participate in the study.



  Conclusion Top


There is moderate self-concept and self-esteem among most of teenage pregnant women (93 and 96%, respectively). Finally, there is a strong relationship between sociodemographic characteristics especially age and fluctuations of self-concept and self-esteem among these women.

Recommendations

  1. Conducting health programs for youth and their parents about the psychological, social, and medical hazards of early marriage is needed.
  2. Implementing prenatal training courses for nurses about the role of psychological support in raising self-concept and self-esteem in teenage pregnancy is also required.
[40]

Acknowledgements

The authors thank and appreciation all teenage pregnant women who agreed to participate in this study and nursing staff who facilitated implementation of the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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