Introduction
Prenatal education is a learning process that equips pregnant women with the knowledge and skills needed for pregnancy, childbirth, postpartum health management, and newborn care. It serves as a vital intervention to enhance healthy childbirth outcomes and the physical and mental well-being of mothers postpartum [
1]. Traditionally, prenatal education has been conducted in person at hospitals or health centers, often involving group sessions with pregnant women and their partners [
2]. However, the onset of the coronavirus disease 2019 (COVID-19) pandemic led to restrictions on in-person group education programs for pregnant women due to infection risks. This prompted a shift in the education sector from traditional face-to-face interactions to remote learning methods [
3]. The transition to non-face-to-face education required both educators and learners to adapt to new digital technologies and cope with reduced social support, a consequence of the lack of direct personal interaction [
4].
In the broader context of educational transformation, prenatal education for pregnant women was either suspended or scaled back. Online prenatal education has emerged as a viable alternative in a society shifting away from face-to-face interactions, utilizing online platforms and video conferencing [
3]. Although not previously the primary approach, online prenatal education interventions were explored even before the COVID-19 pandemic. These interventions typically involved web-based, mobile-based, social network service-based, and telephone-based methods reliant on internet connectivity [
4]. The terminology for online education interventions varies, including terms like telehealth, mHealth, eHealth, distance education, video education, and digital education [
5]. During the COVID-19 pandemic, there has been an increase in the activity of online education. More recently, innovative online education interventions employing virtual reality, augmented reality, games, simulations, the metaverse, and artificial intelligence have been initiated [
6].
The topics covered in online prenatal education are similar to those in general prenatal education. It has been reported that pregnant women show a preference for education on newborn safety, delivery, and breastfeeding, in that order [
7,
8]. An integrative review study identified pregnancy management, fetal development, newborn safety, childbirth, and breastfeeding as the core topics of online prenatal education. Furthermore, a recent systematic review of randomized controlled trials, which examined online prenatal education as an intervention, found that the most commonly addressed topics were postpartum depression, anxiety, and breastfeeding. The primary outcomes measured in these trials included postpartum depression, anxiety, satisfaction, and mother-child attachment [
4].
The effectiveness of online prenatal education has been reported to vary across studies. It was associated with a decrease in the risk of gestational diabetes, artificial abortion, postpartum infection, fetal distress, and neonatal malformation. Additionally, prenatal education focusing on mental health and nutrition during pregnancy was linked to a reduced risk of premature rupture of membranes and low birth weight [
9]. An intervention that utilized an online prenatal education platform to provide peer support proved effective for breastfeeding [
10]. Mobile application-based prenatal education interventions were shown to impact maternal parenting self-efficacy, prenatal attachment, social support, parental satisfaction, postpartum depression, and postpartum anxiety positively [
11]. However, some studies found no significant effects of online prenatal education or no difference in outcomes compared to face-to-face education [
12]. In terms of preferences among pregnant women, some studies indicated a preference for online education [
13], while others reported increased stress, depression, rejection, anger, and lower parental attachment to online education, leading to a preference for face-to-face formats [
14].
Over the past decade, there have been attempts to study online prenatal education interventions, but the benefits that pregnant women derive from such education have not been consistently reported [
4]. Additionally, few studies have explored how pregnant women currently experience online education, especially in a post-pandemic society where non-face-to-face education has become the norm. It is crucial to vividly capture and understand the subjective experiences of pregnant women regarding online prenatal education. The shift to an online prenatal education system is not merely a temporary adjustment but part of broader macroscopic changes within the health system [
2]. Therefore, it is necessary to examine the online prenatal education process as experienced by pregnant women and address any deficiencies to ensure educational quality. In this study, we aim to delve into the meaning and essence of the experiences of pregnant women who have engaged in online prenatal education, analyzing these experiences from their perspective using a phenomenological approach. Colaizzi’s phenomenological method is particularly well-suited for this research, as it aims to thoroughly understand the depth and complexity of personal experiences while ensuring that interpretations remain closely aligned with the unique narratives of pregnant women in the context of COVID-19. This study could provide vital insights for developing high-quality online prenatal education interventions, particularly when face-to-face education is not feasible.
This study aimed to clarify the meaning of the vivid experiences of pregnant women who participated in online prenatal education during the COVID-19 pandemic and to comprehend the essence of their experiences. The research question posed is, “What is the meaning of pregnant women’s experiences with online prenatal education?”
Methods
Ethics statement: This study was approved by the Institutional Review Board of Hallym University (HIRB_IRB_2021-026). Participants were informed about the purpose and procedures of the study, and written consent was obtained. They were assured that their personal information would be kept strictly anonymous and confidential, with full protection of their privacy. Additionally, participants were informed that they could withdraw from the interview or study at any time.
Study design
This study is a qualitative investigation that utilizes Colaizzi’s descriptive phenomenology research method [
15] to explore the fundamental meaning of experiences associated with online prenatal education. It adheres to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.
Participant selection
The study participants consisted of pregnant women who enrolled in online prenatal education at the Chuncheon Public Health Center in Gangwon, Korea, from September 2021 to April 2022. The inclusion criteria were as follows: (1) pregnant women at any stage of pregnancy, as online prenatal education is typically offered from 4 to 38 gestational weeks, (2) women who exclusively participated in online prenatal education, and (3) women who were proficient in speaking, listening, and reading Korean. Women who attended any face-to-face sessions in addition to the online prenatal education were excluded from the study. We aimed to recruit at least 10 participants to ensure adequate data collection, and saturation was assessed to determine when no additional relevant information could be obtained [
16].
Purposive sampling was conducted, and out of 32 pregnant women who had the opportunity to participate in the study, 12 were interviewed. By the time the 12th interview was completed, repetitive experiences had been noted, indicating that data saturation had been achieved, with no new concepts emerging.
Data collection
Data collection was conducted by three researchers (HKK, GHJ, HYM) through one-on-one, in-depth interviews from October 7, 2021, to April 7, 2022. To recruit participants, we sought the cooperation of the head of the Chuncheon Public Health Center in Gangwon, Korea, specifically from the individual overseeing maternal and child health. Following the childbirth education sessions conducted via Zoom, the researcher provided details about the study and recruited participants. The prenatal education program was conducted through a series of videoconferences on the Zoom platform, totaling 8 hours over 4 weeks, with each session lasting 2 hours. These sessions included groups of 9 to 17 pregnant women. The weekly topics covered were: (1) health management during pregnancy, (2) pain management during childbirth, (3) prenatal environmental health practices (such as reducing exposure to environmental hormones, heavy metals, and micro-dust), and (4) postnatal care, which included breastfeeding and infant care. The program aimed to address pregnancy management, childbirth management, and postpartum care, incorporating lectures, explanations with YouTube and other audiovisual materials, and demonstrations using models of the breast, uterus, and baby. An employee at the Public Health Center’s Maternal and Child Center managed the technical aspects and monitored attendance.
The opportunity for participants to engage in interviews was presented at the conclusion of the final session. Within 1 week following the completion of prenatal education, individual phone calls were made to the pregnant women to confirm their interest and availability. For those interested in participating, consent forms and permission for recording were obtained via email or mobile phone, and an interview schedule was arranged. Only participants were present during the interviews.
For the in-depth interviews, participants were given the choice of time and mode. Due to COVID-19, none opted for face-to-face interviews. Four individuals participated in video interviews, while eight chose telephone interviews. Each session lasted between 40 minutes and 1 hour, with 1 to 2 interviews conducted per participant. The interviewers were the researchers themselves, who had prepared the main questions in prior meetings. The primary question was simplified for clarity: “What did your experience participating in online prenatal education during COVID-19 mean to you?” Additional exploratory questions included: “What are the positive and negative aspects of receiving education as a pregnant woman during the COVID-19 pandemic?”, “How does online prenatal education compare to face-to-face education?”, and “What improvements would you like to see in online prenatal education during COVID-19?” Following the interviews, participants received a mobile voucher worth 15 US dollars as a token of appreciation. The interview questions were refined iteratively throughout the data collection process to ensure they encompassed a wide range of experiences while allowing for a thorough exploration of each participant’s unique perspective. Participants were encouraged to thoroughly consider the questions and to listen attentively. Field notes were taken during the interviews, and the recorded data were manually transcribed using Microsoft Office 365 and Naver’s CLOVER automatic transcription programs.
Data analysis
We used the philosophical basis and methods of Colaizzi’s descriptive phenomenology [
15]. Colaizzi’s philosophy emphasizes immersing oneself in the event, vividly describing the subjective experiences of participants, and uncovering the core meaning of those experiences. His methodological approach involves extracting significant statements from the collected data, formulating meanings, and then categorizing these into thematic clusters by the researcher. This approach is characterized by its focus on the everyday experiences of participants, distinguishing it from other interpretive phenomenological methodologies [
17]. Descriptive phenomenology offers a clear and systematic procedure for exploring experiences in fields where research is sparse [
18]. It facilitates an understanding of the experiential process by identifying influencing factors and attributes. This is particularly useful in developing tools and constructing theories. Therefore, it is well-suited for this study, which aims to explore the essence of pregnant women’s experiences with online prenatal education during the COVID-19 pandemic.
The coded data were then shared and analyzed collaboratively through the Dropbox online platform. The coded files were examined during both video and face-to-face research meetings to discuss agreements and discrepancies in coding. We held over five research meetings, and for content with discrepancies, we initially listened to the explanations provided by the relevant researcher. If modifications were necessary, discussions continued until a consensus was reached on the new meaning assignment. In instances of persistent disagreement among researchers, the analyzed content was presented to the participants for confirmation, and the meaning was adjusted through a cyclical analysis method.
Research rigor
The seven-step procedure used by Morrow et al. [
18] for rigorous analysis is as follows: (1) To familiarize themselves with the data, the researchers read the participants’ statements multiple times. (2) To identify significant statements, they noted all sentences directly related to the phenomenon of pregnant women’s prenatal education experiences. (3) To create formulated meanings, the researchers carefully considered these significant statements with an open mind. (4) The researchers then derived themes by identifying common content among the formulated meanings and grouped these themes into clusters. (5) Once all themes were derived, the researchers comprehensively synthesized the information. (6) To generate the fundamental structure of the phenomenon, the researchers used concise wording to categorize and capture the essence of the phenomenon. (7) Feedback was obtained by asking the participants about their experiences to confirm the fundamental structure. The purpose of this respondent validation process was to ensure that the researchers maintained a phenomenological perspective based on the participants’ natural attitudes. A member validation procedure was also conducted among the researchers to determine whether the fundamental structure was reasonable and scientific. Additionally, to confirm the validity of the essential structure, opinions were sought from three professors specializing in women’s health nursing.
Creswell’s criteria [
16] for securing qualitative validity in phenomenological research were applied. We prepared open-ended questions, modified them so that participants could express their experiences in their own words, and assisted participants in revealing their experiences in a relaxed atmosphere. We attempted to bracket our pre-understandings and explore the participants’ experiential world without preconceptions or biases. Our representative understanding was that online prenatal education has many advantages from the learner’s perspective, such as convenience, efficiency, accessibility, and satisfaction compared to face-to-face education, making it the most appropriate educational modality for pregnant women during the COVID-19 pandemic. We engaged each other in reflective thinking to recognize these preconceptions and not reflect or induce them in the participants’ interviews. To respect the unique life world of each participant, we attentively listened to their emotions and perceptions, repeatedly reviewing the transcripts and consulting field notes to immerse ourselves in their experiences and understand their perspectives. Each researcher independently coded the data using the Excel program. This process began with identifying significant statements, proceeded with deriving meanings, then organizing these into themes, and ultimately grouping them into broader categories.
For one participant who needed clarification on the meaning in the analyzed Excel coding table, we requested confirmation that the analysis accurately reflected the intended meaning. Additionally, to ensure the validity of our findings, we sought the opinions of three professors specializing in women’s health nursing, who were not part of the research team.
Furthermore, Creswell’s three criteria [
16] for ensuring the reliability of phenomenological research were applied. First, the research procedure and questions were formalized into a protocol to enhance the reliability of the qualitative research. Second, we consistently documented the interview transcripts, field notes, and memos. Third, we independently conducted the coding work and regularly discussed the consistency of the coding in meetings.
Researchers’ preparation
Researcher A and Researcher B are university professors with over 20 years and over 10 years of experience in qualitative research, respectively. Both hold doctoral degrees. Researcher C is a doctoral student with 5 years of experience in qualitative research. Throughout the 6-month interview period, the researchers maintained ongoing interactions and discussions to focus on the direction of the research.
Relationship with participants
None of the researchers involved in the interviews had a personal relationship with the participants. The participants were aware that the researchers included university professors and a doctoral student.
Discussion
This study utilized Colaizzi’s descriptive phenomenological method [
15] to conduct in-depth interviews with 12 pregnant women, aiming to elucidate the profound experiences of those who participated in online prenatal education. The analysis yielded 10 themes and three categories. These categories included “feeling of safety and comfort in body and mind,” “frustrated by a lack of interaction,” and “digital education being a double-edged sword.” The core essence of the online prenatal education experience was explored through phenomenological writing, guided by the identified theme clusters.
The first category—“feeling of safety in body and mind”—refers to the experience of safely accessing education during the pandemic through online prenatal classes. This method allowed participants to alleviate the stress of the situation while continuing their education. Even before the pandemic, attempts were made to provide education in a “quarantine-controlled” environment via a webpage dedicated to breastfeeding [
19], which proved to be a recommendable approach for midwives as it effectively conveyed practical and evidence-based knowledge. Online prenatal education, in particular, was beneficial for the mental health of pregnant women, as it helped reduce feelings of sadness, depression, and stress, while offering mental support [
20]. During the pandemic, pregnant women experienced greater fear and anxiety about childbirth compared to their non-pregnant counterparts; however, online prenatal education helped alleviate these concerns [
21]. The convenience of online education allowed pregnant women to learn from the comfort of their homes, which added to their comfort by enabling them to adopt various relaxed postures, such as lying down or sitting on a sofa, without the need to maintain a specific demeanor [
2]. Additionally, it eliminated the need for public transportation to attend classes, as well as the requirement to wear makeup or change clothes, thus providing economic and logistical advantages [
2].
The second category, “frustrated by a lack of interaction,” describes the negative aspects of distance education, where the desire for closeness with other pregnant women goes unmet, communication between educators and learners is disrupted, and both social support and social communication are significantly reduced [
4]. Results indicate that while online breastfeeding education enhances knowledge and skills, it does not improve co-parenting relationships, highlighting the challenges online education faces in facilitating effective communication between instructors and learners, as well as among the learners themselves [
22]. However, integrating two telephone interventions into prenatal education via a mobile application has shown positive effects on social support [
23]. Therefore, to enhance social communication in online education, it is essential to employ strategies such as using social network services, forming peer groups, providing additional one-on-one time with educators, and incorporating face-to-face interactions [
24]. This study reveals that participants experienced negative feelings, such as loneliness during lectures with minimal interaction and hesitation to ask questions due to the presence of unfamiliar individuals. These feelings stemmed from a lack of opportunities to connect with other pregnant women, underscoring the need for stronger social support in future online educational settings.
“Digital education being a double-edged sword” refers to the experience of accessing multimedia advantages such as videos, photos, and music more vividly through digital technology, which is generally satisfactory. However, it also highlights the lack of human interaction and the inequality in accessibility caused by the digital divide. Participants noted that learning with audiovisual effects goes beyond mere words, showing a preference for the accessibility of digital technology in online education over traditional face-to-face settings. Most experts in women’s health are satisfied with online education, finding it safe, effective, learner-centered, and timely. The learning retention rate was reported to be 63.4%, indicating high-quality outcomes [
25]. From the learner’s perspective, there are concerns that online education may reduce concentration due to the more relaxed posture compared to traditional settings. This suggests a lack of intangible factors such as the atmosphere, tension, and enthusiasm typically found in face-to-face education. Globally, Internet and public Wi-Fi penetration rates vary significantly by region and country, leading to potential alienation due to another form of digital divide. One participant expressed regret that she could not access education after moving to a rural area without an internet connection, highlighting how technological gaps can widen health disparities. Therefore, ensuring equal access to online education is crucial [
26]. While online education offers numerous benefits for the digital generation, it has also been identified as a factor that exacerbates health inequalities post-pandemic, influenced by race, region, economy, and education [
24].
The strength of this study lies in its timing and methodology. It is a qualitative study conducted during a period of heightened quarantine measures, at the peak of the pandemic, when in-person prenatal education was suspended. This study explores the vivid experiences of pregnant women engaging in online prenatal education, a new approach at the time. By using in-depth interviews, it identifies the advantages and disadvantages of remote learning. Thus, this research aids in determining the contextual superiority of face-to-face versus remote education. This study offers valuable insights for public health centers and hospitals looking to implement prenatal education online. It helps them to mitigate the disadvantages and enhance the benefits of online learning. Furthermore, this research contributes to the foundational studies that inform government policies on online prenatal education. These policies aim to maximize educational outcomes and improve accessibility, thereby addressing economic disparities and bridging digital literacy gaps through the enriched multimedia experiences that pregnant women encounter in online education.
This study has several limitations that should be considered when interpreting the findings. It was conducted during the COVID-19 pandemic, a time when face-to-face prenatal education options were unavailable to the participants. Consequently, their experiences with prenatal education were likely limited primarily to online formats. This restriction may have shaped the participants’ perceptions and feedback, as they lacked a direct comparison with traditional face-to-face education during this period. Additionally, due to pandemic-related restrictions, the interviews were conducted via Zoom meetings and phone calls. This method may have diminished the ability to detect non-verbal cues and expressions, potentially affecting the depth of the data collected. These factors should be taken into account when applying the findings to other contexts or populations.
The findings of this study suggest that it would be worthwhile to compare the effects of non-face-to-face and face-to-face prenatal education in the post-pandemic era. Additionally, it recommends conducting an experimental study to assess the effectiveness of an exchange program among pregnant women, which would incorporate social interaction into online prenatal education. It is also suggested that a hybrid model of prenatal education, combining online and face-to-face elements, be developed and implemented. This approach aims to mitigate the disadvantages of online education identified in this study while maximizing its advantages.