INTRODUCTION

Childhood obesity has been declared the epidemic of the 21st century⁽¹. According to the WHO, the rate of obesity among children under five years of age has risen from 31 million in 1990 to 42 million in 2016 worldwide. If this trend continues, this number is expected to rise to 25 million by 2025⁽². These data show the urgent need to change this situation, not only because of the importance of this disease and its comorbidity but also because of the cost of the disease^(3,4)but also because of the cost it represents and will represent for public health care in the future, given that most obese children end up as obese adults^(5,6.

Public administrations, families and health professionals have been trying to reverse this worrying situation^{7 8 9}. However, these efforts have not had the expected effect^{(10 11 12 13}. In this scenario, a research trend is emerging which suggests that strategies should be aimed at prevention and begin at much earlier ages, including the gestational stage of pregnancy⁽¹⁴including the mother's gestational stage, since it is in this period that the genesis of the physical and psychological health of the being that is being formed is found. It is the most fundamental prevention of dysfunctions, among which obesity stands out.

Early programming was already conceived in the 20th century and is presented as a tool to change the approach to interventions^(15,16and is presented as a tool to change the focus of interventions.Programmingis the term used to refer to an effect with long-term and most likely lifelong consequences, such as nutritional or metabolic programming. However, it is only in recent years that this concept has begun to be used. Few interventions cover the entire gestational period and the first thousand days as a preventive strategy⁽¹⁷.

As might be expected, this concept and the underlying knowledge are far from being integrated into the academic curricula of any health training and, in particular, in the nursing degree, when these professionals are in a critical position to integrate this tool into clinical practice. Midwives are the ones who accompany mothers throughout pregnancy from the very beginning. The work carried out by nurses is crucial and can positively impact the development of the baby-child-adult. Some studies confirm that the level of education and accompaniment received by mothers during pregnancy by nursing staff improves their quality of life and reduces pregnancy complications¹⁸. At the same time, numerous epidemiological and experimental studies link early programming with the prevention of illnesses, especially obesity prevention. However, there is a lack of nursing training on crucial issues such as nutrition during pregnancy and breastfeeding^{(19 20 21}.

Therefore, due to the strategic position of nursing professionals and given the positive impact this can have on people's health, efforts are urgently needed to ensure that early programming and the knowledge, procedures and interventions underlying this concept are integrated into initial and continuing nursing education.

Although it is true that reading texts and study guides continue to be the primary teaching material in most university degrees, other resources of a more technological nature are increasingly being integrated into the classroom, using ICTs as a learning methodology. The use of audiovisual resources for educational purposes has increased exponentially recently, with video being one of the most prominent among them⁽²². According to Conopoima y Ferreira²³, the video makes the teaching-learning process more attractive in modern times due to its flexibility and scope⁽²⁴.

SPs are training resources with great potential to favour the learning of specific content units, as in the case of this work, as they respond to characteristics such as brevity, atomisation and concentration of the content on a specific topic and the use of images and animations, which allow them to capture the students' attention by presenting information interactively and dynamically⁽²⁵. This allows the students' attention to be captured by presenting the information interactively and dynamically. It is closely related to the concept of micro-content, as it allows for content and information structured in short, concentrated, detailed, well-defined and interconnected chapters²⁶.

In this way, three needs are identified to which a response is sought: 1) the urgency of curbing the trend of childhood obesity; 2) the necessary training of nursing professionals in the field of early programming, given their crucial position in tackling it; 3) the introduction of new didactic and methodological resources in university classrooms such as with educational pills.

MATERIALS AND METHODS

RESULTS

The results of the first questionnaire are shown inTable 1. It can be seen that there is a significant difference in the correct answers to all questions except Q6 and Q8.

Table 1.  Knowledge Questionnaire 

Source: Own elaboration.

Regarding the average number of responses per student, the associated variables were non-normal according to the K-S test. The W-test showed significant differences, with the number of correct answers being higher in the knowledge questionnaire after the intervention. AsTable 2shows, there were differences in the responses of the two groups before the intervention, but after the intervention, these differences did not occur.

Table 2.  Knowledge Questionnaire by subject 

Source: Prepared by the authors.

Table 3shows the average responses for each question before and after the intention to act questionnaire. Given the non-normality of the responses, non-parametric tests were used.

Table 3.  Intention to Act Questionnaire 

Source: Own elaboration.

The questionnaire shows significant changes in all questions except Q3, Q4 and Q9, as well as an increase on average in the number of questions to be answered positively and a decrease in the number of questions to be answered negatively.

As shown inTable 4, between the two subjects, there is only a significant difference in negative responses before the intervention, all other group data being equal.

Table 4.  Inter-subject differences in Intention to Act 

Source: Own elaboration.

Finally, the third questionnaire dealt with the opinion on the methodology used in the intervention.Table 5shows the descriptive data of this questionnaire and the data by subject.

Table 5.  Questionnaire on satisfaction with the methodology 

Source: Own elaboration.

Although satisfaction is significantly higher in the community group, there is a reasonable degree of satisfaction with the methodology (Q2, Q3 and Q4). Q1, which deals with the duration of the capsules, shows that the majority of the respondents prefer a duration of 1 to 4 minutes, with option b (3-4 minutes) being the most popular option.

DISCUSSION

The analysis presented here shows the success of supporting teaching practice with learning resources such as educational pills. These results are in line with the results provided by Giurgiu²⁶, Luesma²⁷, and Sirwan-Mohammed⁽²⁸, among others, which highlight that the use of educational pills makes the learning process more attractive, flexible and efficient as it allows them to learn more quickly and adapts favourably to their personal needs.

The analysis shows significant differences between the number of questions answered correctly before and after the intervention in both groups. Moreover, this significant difference is observed in each of the questions analysed independently, except for questions 6 and 8. In other words, there is a positive tendency to get the questions right after the intervention. Questions 6 and 8, in which no significant differences are found, correspond to knowledge about breastfeeding (Q. 6) and epigenetics (Q.8).

Regarding item 6, "The effect of breastfeeding protection against childhood obesity is produced by...", the non-observation of significant differences could be because the benefits of breastfeeding is a topic that is currently being widely disseminated in society, and that students may already be aware of. In order to justify this, we rely on the results provided by García Ceballos²⁹. In this study, which assesses nursing students' knowledge about breastfeeding, we observed an average level of knowledge, which is why they could have answered questions of this type correctly.

For question number 8: "With regard to epigenetic mechanisms, it is true that...", we can find as an explanation that these are science students who have some knowledge of genetics as they have studied this type of subject before.

However, the significant differences found in the rest of the questions specific to early programming, such as questions 1-3, 5, 9, 10 and 13, show that, although future nurses may have some knowledge about breastfeeding in general or about genetics, they do not have the capacity, without specific training, to relate and apply this knowledge to the future health of newborns.

On the other hand, a significant difference was found between the number of correct answers before the intervention between the two groups corresponding to both subjects. The students of the subject "Community Nursing" have a higher number of correct answers before the intervention than the students of the subject "Nutrition". This could be explained by the fact that the students in the first group belong to the second year of the nursing degree and therefore have more prior knowledge than those in the second group, who belong to the first year and have not yet reached the same level of training.

We also found significant differences between pre- and post-intervention responses in the intention to act questionnaire. These differences were not found in questions 3, 4 and 9. Again, in this questionnaire, we observed no significant differences in those questions that refer to concepts that are more widespread in the general population. In this case, these concepts are breastfeeding (Q.3: "If I cannot breastfeed, I would give any formula milk; they are all similar"), the general diet of the baby (Q.4: "If my child rejected a food I would exclude it from his/her diet") and smoking during pregnancy (Q.9: "I would stop smoking before thinking about becoming pregnant").

This is since the students are previously aware of these concepts as they are integrated into society. However, given the answers obtained in the rest of the specific questions of the early programming, they do not have a vision of the need to act on these factors to prevent the development of future diseases, such as obesity. On the other hand, once the intervention has been developed, this opinion changes, thus improving their view of the problem and their role as future health professionals in the health of their patients.

Concerning the students' degree of satisfaction with the intervention, we found that the students in both groups were delighted with the innovation. In particular, a higher degree of satisfaction is found among the students in the community group. This is a good result, as the students in this group are in a higher grade than the other students, so they have a more well-formed opinion about the education received at the university and the usefulness of the concepts and methodologies offered. These results are similar to those found in Luesma^{'s (27}study, whose analysis of the satisfaction survey reveals the benefits of the educational pills in the learning process.

Finally, taking into account the comments added by the students at the end of the questionnaire, we would like to highlight, as aspects to be improved, that it would be advisable to make a more significant number of stops to clarify doubts and raise debate between the viewing of the videos. The pills were first shown four in a row, with a stop for clarification of concepts and discussion, and finally, the other four. According to the students' opinions, putting the videos in blocks of two with intermediate stops, or even one at a time, would be more effective.

CONCLUSIONS

Given the results, we can conclude that the intervention has achieved significant results in all the aspects measured. The students have learnt and integrated the concepts, as seen from the scores achieved in the knowledge questionnaire. Furthermore, these future health professionals have significantly improved their intention to act on these concepts personally and professionally with their future patients.

The evaluations obtained by the students due to the application of the methodology used have been favourable. The students consider that this format has made it possible to incorporate the concepts presented in a better way than if it had been carried out using traditional methodology. The students found the duration of the activity and the pills to be appropriate. However, they would include a more significant number of pauses between the viewing of each of them to clarify doubts and establish a debate.

Therefore, it is evident that this type of intervention effectively transmits knowledge to students, obtaining better results than the traditional master class, which encourages follow-up work towards this type of learning resource.

The experience obtained in the implementation of this resource in the university's nursing degree allows us to point out the need to change or complement traditional teaching with other types of methodologies and resources, such as educational pills, as it has allowed the necessary content to be addressed dynamically and attractively for students. Moreover, their format allows the content to be focused on the most critical points, which improves learning.

In the words of Conopoima and Ferreira²³, "Even though it is a complementary strategy, its potential to facilitate the incorporation of new knowledge and improve the understanding of certain subjects that could be labelled as complex, boring or broad within the curriculum is unquestionable".

Finally, in terms of future projects, it would be interesting to go further in new methodologies and implement one such as the flipped classroom, whose effectiveness is evidenced in this 2018 study in which the advantages of reversing the role of students in the teaching of future health professionals are observed.⁽³⁰whose effectiveness is evidenced in this 2018 study in which the advantages of inverting the role of students in the teaching of future health professionals are observed. Innovation can be proposed in which the knowledge of early programming is presented through role reversal, in such a way that it is the students who carry out a search for evidence on the subject and must critically analyse the information found for a subsequent sharing and debate guided by the teacher from which they will extract knowledge on the subject. In this way, education from "evidence-based practice" is also used, which also needs to be introduced in the teaching of future nurses so that they are familiar with the tools and methods of evidence-based practice.⁽³¹so that they are familiar with the tools and procedures as professionals.