The effectiveness of smart card education (early detection of preeclamsia risk) on the level of knowledge of pregnant wom-en in Padangsidimpuan city Indonesia

Abstract

Preeclampsia remains a leading cause of maternal mortality in Indonesia, particularly in regions with limited healthcare access such as Padangsidimpuan City. Low maternal knowledge regarding early detection significantly contributes to adverse outcomes. This qualitative study aimed to evaluate the effectiveness of a culturally adapted Smart Card–based education intervention on pregnant women’s knowledge of preeclampsia risk factors, danger signs, and early detection behaviors in Padangsidimpuan City, Indonesia. A descriptive qualitative design with a phenomenological approach was employed. Data were collected through semi-structured in-depth interviews with 25 pregnant women and 8 midwives, and four focus group discussions (6-8 participants each) conducted between March and August 2025. The Smart Card intervention—a pocket-sized, laminated visual aid containing illustrated information on preeclampsia risk factors (history of hypertension, obesity, primigravida, maternal age), danger signs (severe headache, blurred vision, epigastric pain, edema), and action steps—was introduced during antenatal care visits. Thematic analysis using the Framework Method was performed. Four major themes emerged: (1) substantial improvement in knowledge of preeclampsia risk factors and danger signs post-intervention; (2) the Smart Card’s visual simplicity and portability facilitated active learning in the household context and enhanced spousal involvement; (3) empowerment in health-seeking behavior driven by increased risk awareness; and (4) barriers including low literacy and the need for facilitator guidance. The majority of participants demonstrated improved knowledge scores across all domains. The Smart Card education intervention is an effective, low-cost, and culturally appropriate tool for enhancing preeclampsia knowledge among pregnant women in resource-limited urban settings. Integration into standard antenatal care services is recommended.