Introduction

Any abnormality that compromises the function, capacity, biomechanics, and kinesiology of the pelvic floor musculofascial structure may be termed “pelvic floor dysfunction” (PFD). This clinical picture includes bladder disorders, anorectal disorders, pelvic organ prolapse, sexual disorders, and chronic pelvic pain ¹.

Among the risk factors for developing PFD, the most relevant for women are those related to the pregnancy-puerperal cycle. Hormonal, anatomical, and biomechanical changes are constantly associated with PFD during pregnancy ². The most commonly occurring PFD during pregnancy is urinary incontinence (UI). Its prevalence is quite controversial due to the underdiagnosis of cases. In a study with a sample of 407 pregnant women, 66.8 % presented with UI, of which 70.1 % were in the third trimester ³.

The most significant risk factor for UI development is urinary loss, even if occasional, before gestation ⁴. Its remission occurs approximately six months postpartum ⁵; however, the manifestation of UI during pregnancy increases the risk for women to remain with the same clinical condition up to five years after delivery ⁴. Therefore, the management of procedures that can prevent this potentially preventable and treatable condition with non-invasive methods and improve pelvic floor function during the pregnancy-puerperal cycle is essential ⁶.

UI does not pose death risks; however, its negative impact on quality of life is considerable since affected people are constantly burdened with social isolation, depression, anxiety, loss of self-esteem, and difficulties in sexual relationships ^7-10. Thus, a different approach toward pregnant women is significant and necessary through changes in educational models, providing better training for future healthcare professionals, especially physical therapists, as in this study. Such models should provide quality information, improving women’s knowledge of the possibility of PFD occurrence during pregnancy and the forms of prevention and treatment when necessary ⁴.

Information and communications technologies (ICT) and new information systems devices represent the most diverse technological resources used for information production, processing, and communication, providing the spread of knowledge in a variety of spaces and forms ¹¹. One of the educational methodologies made available by the ICTs was distance education (DE)-through online courses-, which democratized Brazilian higher education, overcoming the physical and temporal barriers of those who could not study. DE represents one of health professionals’ most used continuing education tools ¹².

The continuing education of students through distance learning is considered a significant breakthrough. It is already consolidated and recognized in the scientific literature since it provides access to updated content using innovative technologies. Moreover, the increasing globalization and spread of information and the need for comprehensive care recommended by the Brazilian Unified Health System (better known by its acronym, SUS) require professionals’ continuous updates and improvement to qualify further their work regarding the population’s health needs ¹².

The literature indicates difficulties in using ICT in the professors’ training process related to the lack of informational infrastructure in higher education institutions (HEI), the gaps in the professors’ qualification for the use of ICT, and, significantly, the lack of motivation to change the teaching routines that they have adopted over the years ¹³. A study has added that college students perceive that using ICT could maximize the professor-student interaction and mediate formative teaching; however, the professors’ lack of in-depth knowledge of active learning methodologies has hindered this process ¹⁴.

Thus, the need and relevance of evaluating the ICT used in physical therapists’ training process are evident to reduce these gaps and provide a socially and scientifically relevant technology. Thus, developing a distance learning teaching resource for healthcare professionals and students with a current and relevant theme can minimize the consequences of a health condition that causes significant impacts on the lives of pregnant women.

In light of the above, the present study aims to describe the development and validation process of an online course on UI during pregnancy for healthcare professionals and healthcare students in Brazil.

Materials and methods

This methodological study ¹⁵ aims to develop a technological product of the online course category, having as its target audience Physical Therapy undergraduate students of an HEI in Teresina, Piauí, Brazil. This institution offers undergraduate, graduate, and post-graduate courses, both lato and stricto sensu. The technological product was created as the conclusion project of a professional master’s program.

The development and validation process of the online course on UI during pregnancy followed these steps: 1) integrative literature review; 2) online course organization; 3) course content validation by specialists; 4) design validation; and 5) validation by representatives of the target audience.

Results

Given the need for education and awareness of future professionals, especially physical therapists who provide care to pregnant women, the interest in developing and validating the content and presentation of an online course has emerged to prevent new cases and reduce the frequency and stage of clinical symptoms of UI in the future.

The synthesis of knowledge obtained in the integrative review was used to identify the theoretical knowledge to be addressed. After defining the syllabus of the course and the strategies to be adopted to promote it, the course planning was divided into four modules, in increasing order of complexity, namely: the basic principles of perineal anatomy and pelvic floor function; quality of life and pelvic floor dysfunctions; pelvic floor in pregnancy; pelvic floor muscle training.

With the assistance of a graphic designer, the proper artwork, formatting, and configuration were prepared. The language was chosen according to the target audience; the most relevant information was selected to produce an attractive, objective, and user-friendly tool, using several pictures and illustrations.

The material was structured logically, and the most important information was presented first. In addition, colors that would attract the reader’s attention and adequate size and typography were adopted for clear reading comprehension. In addition, a balance was sought between the information and the design of resources.

Table 1 shows that all variables and items analyzed by the content specialists had an average CVI higher than the established cutoff point.

The evaluation by the design specialists is presented in Table 2. The specialists suggested some modifications: dynamic improvement of the lessons from slides in video-slides; improvement of the page layout also to be available for smartphones, and reformulation of some theoretical contents since they were not limited to gestation-as proposed by the course theme-, also covering the moment of childbirth. All recommendations were reviewed in the pre-final version of the online course.

Table 3 presents the evaluation of the target audience. The agreement rate in positive responses ranged from 84.3 % to 100 %, a satisfactory result to consolidate the final version of the online course.

Discussion

UI represents the most frequent PFD during pregnancy, present in 58 % of women. This clinical picture can remain in 30 % of puerperal women, defining the pregnancy-puerperal cycle as a considerable risk factor for developing these dysfunctions. Given its negative impact on quality of life at the personal, professional, social, and sexual levels, it must be considered ²³.

Raising awareness among primary care professionals is paramount since they are responsible for prevention and treatment services in the public health setting ²⁴. Physical therapists were chosen as the target audience since they master techniques considered the first line for preventing or treating PFD.

One way to improve the professionals’ knowledge of the theme is with training, proposed by the Política Nacional de Educação em Saúde (National Health Education Policy), which aims primarily to transform the practices based on the needs of the professional setting and improve the quality of care ²⁵. For this purpose, creating educational resources is a viable solution, particularly with the increase in digital technologies proposed in this study.

The tool was considered adequate for improving care practices since it reached satisfactory scores among the evaluators with a CVI above the established cutoff point. The specialists represent a unique and singular universe when facing a given situation, which increases the scientific power and confidence of the instrument developed and approved ²⁶.

The literature review stage-aiming to provide educational resources according to the professionals’ needs-and the specialists’ analysis were essential for the successful evaluation of the course. The integrative review is a critical stage in this process. It allows for surveying the panorama of scientific production on the theme with various methodological approaches, including quantitative and qualitative studies, providing different perspectives on developing technological products. Thus, scientific knowledge can guide valuable clinical decisions. Other studies have adopted this strategy to identify the gaps to be bridged by ICT ²⁷.

According to all categories evaluated by the specialists, the educational device can be considered straightforward in conveying information and logical in its sequence, with compatible visual and linguistic aspects, which are helpful for understanding and reflecting upon urinary loss during pregnancy. Studies ^28,29 have shown that educational resources must be attractive tools, have adequate language for the target audience, and be cohesive and coherent in their structure and objectives with a theme following a logical succession to encourage and promote changes in the actions of the professionals being trained.

The changes proposed by the specialists provided an accurate and improved course for the target audience, reflected in the agreement of more than 94 % of all participants. The incorporation of lessons in video format proved to be of notable importance due to the target audience’s profile-mostly university students and healthcare professionals-which demands dynamic activities to keep their interest with possibilities of flexibility in the study planning. It should be noted that, in addition to keeping the users’ interest, the dynamism of the video lessons with illustrations aimed to complement information ³⁰.

A relevant recommendation by the content specialists concerned the practicality of the course by adapting the layout for mobile devices, such as smartphones. The increased use of this technology, in addition to the growth of mobile internet, has made it possible to access educational resources anywhere at any time, a fact noted by the increased access to information via websites, blogs, and social media, among others. Therefore, the proposed educational technologies must be adapted to this new context. Furthermore, the quality of mobile internet networks and their cost are highlighted as barriers to effectively using these resources ³¹, and adaptations are necessary, such as the possibility of downloading video lessons and other files.

Educational resources have been used to improve users’ knowledge, actions, and practices ³²; thus, the importance of the adequacy of digital technologies to the objectives of the resources under development is highlighted. It has been noted that this is primarily due to the integrative review and specialists’ participation in this technology’s validation process ^33,34. Therefore, the importance of the convergence between the need to improve certain content and the target audience’s interest is reiterated. Aiming to address gaps in the theoretical content to be covered in the course, the specialists in this study suggested adding themes such as the importance of preparation for childbirth.

It was evident that the course layout in terms of organization and presentation was adequate, and the content structured in modules is written in an easily understandable way that sparks interest, with supplementary study resources and tests at the end of each module that helps to achieve the course objective.

The preceding reflects the conformity between the proposal and what will be achieved by the course when carried out. The subsequent stage of technology evaluation, performed by the target audience, is a distinguishing factor for clarifying doubts and the remarks related to the use and relevance of the product to their professional practice. Only they can judge what would be necessary for their clinical practice, which renders this technology precise, appropriate, and relevant to the group ^31,35.

In light of the above, this tool provided a suitable level of usability for students and physical therapists who wish to apply the knowledge acquired, especially in preventive measures and early diagnosis of UI in the pregnant population. A benefit of this type of technology found in this study is the possibility of time management since users can flexibly organize and control their activities ³⁶.

Thus, it is reiterated that educational technologies, such as the online course in this study, are creative and attractive tools that can be used to acquire skills and knowledge among students and future professionals to improve their care practices.

Conclusions

The online course developed for Brazil was considered sufficiently adequate in terms of content and interface quality, both by specialists and by the target audience; thus, it contributes to filling a gap concerning the development and validation of Brazilian educational resources that address the studied theme.

Therefore, this research proposes that health education should constantly be stimulated among future physical therapy professionals with clear, educational, and dynamic resources to improve their clinical practice, always based on the integrality and well-being of patients and scientific evidence.

As a limitation of this study, using a technique to evaluate content validity may have overestimated the results. Another area for improvement is that the course was carried out at a private university; therefore, considering Brazil’s cultural diversity and aiming to confirm the adequacy of this online course, we recommend conducting studies that include other target audiences.

It is expected that the results obtained from the developed and validated online course can be applied to train Physical Therapy students through distance learning of UI, which contributes to improving the quality of life at this unique moment in women’s lives.