Sage Journals: Discover world-class research

Abstract

Introduction

Climate change poses a major threat to the health and well-being of people around the world, especially vulnerable groups such as pregnant women. Nurses need to be actively involved in addressing the health impacts of a changing climate. It is very important to help and take care of people who are pregnant. Knowing about and dealing with how climate change affects towns and pregnant women is extremely important.

Objective

To assess how nurse education modules about climate change affect pregnant women's reported practice and quality of life (QoL).

Method

A quasi-experimental (one-group pre–posttest) design was utilized. The obstetrics and gynecological outpatient clinic at Benha University Hospitals served as the study's site, a purposive sample of 128 pregnant women. Four instruments were employed to gather data: tool (a) Structured interviewing questionnaire, tool (b) Maternal knowledge questionnaire, tool (c) Maternal reported practices, and tool (d) World Health Organization QoL. Nurses received structured training prior to implementing the educational modules, the training included orientation on the module content, demonstration of teaching steps and supervised practice to ensure standardization. Nurses’ competency was evaluated using a checklist before applying the modules with participants.

Results

Comparing the postintervention phase to the preintervention phase revealed a highly statistically significant difference in knowledge, QoL, and practices regarding heat stress and climate change (p ≤ .000). The results clarified that, about one third of the studied sample had adequate knowledge regarding climate change and heat stress in the preintervention compared to two-thirds at postintervention phase. The mean score of the overall QoL was increased from 61.91 ± 7.46 prior intervention to 96.42 ± 11.39 postintervention, as well as, the total mean score of reported practices was improved from 41.28 ± 7.27 prior intervention to 63.15 ± 5.24 postintervention. The results confirming the impact of the educational module in improving the studied sample's knowledge, reported practices and QoL regarding climate change and heat stress.

Conclusion

The study showed that the nursing educational module on climate change had a positive effect on pregnant women’ QoL and their reported practices. To maintain these improvements over time, it's recommended to integrate the module into routine nursing training and maternal and maternal care programs. Incorporating this approach in to daily practice could help ensure sustainable benefits and promote healthier outcomes for mother and their babies in the context of environmental changes.

Keywords

nursing educational module climate change quality of life reported practices pregnancy Egypt

Introduction

In recent decades, climate change has become a major global threat with serious implications for human health. It greatly impacts our surroundings, natural systems, and the health of people, unfairly adding more problems to those who are already at risk, such as older adults, people who are always sick, kids, and women expecting babies, as well as the babies they are carrying (Watts et al., 2019).

Pregnant women are particularly vulnerable to the negative health effects associated with climate change, driven by alterations in human physiology that affect their thermoregulation, cardiovascular function, and immune response. When pregnant women are subjected to extreme heat and harsh outdoor environments, they may face considerable fluid depletion, endure heat-related health issues, and confront a range of medical complications, which could ultimately lead to early delivery, insufficient fetal development, birth defects, or even death. Also, the health of both the mother and her baby might get worse because of worry and strain caused by events related to changes in the climate (Bekkar et al., 2020). Climate change's health repercussions are expected to cause approximately 250,000 fatalities each year between 2030 and 2050. It is thought that as the climate changes, we will see more climate-related events that are both more common and more intense, such as periods of very hot weather, fires in the wild, and severe storms like hurricanes and times of very little rain, which will likely result in problems during pregnancy, such as low iron, babies with low birth weights, eclampsia, births that happen too early, and possibly even the death of the baby (Glaser et al., 2022).

In the context of Egypt, climate vulnerability is intensified by a combination of hot summers, minimal rainfall, expansive desert terrain, and densely populated urban areas. These natural surroundings cause the nation to be one of the most at risk to worldwide climate change consequences, which makes life even harder for women who are pregnant (Elshahed et al., 2021).

Educational interventions, particularly nursing-led modules, have a central role in empowering pregnant women with the knowledge and strategies needed to respond effectively to health challenges linked to climate change. The educational intervention program assist women during pregnancy in making informed decision and adopt preventive health behaviors which can contribute to better quality of life (QoL) and favorable fetal health outcomes (Fasanghari & Keramat, 2023 ).

Therefore, this quasi-experimental study aims to assess the short-term effect of a structured nursing educational module on pregnant women's QoL and their reported health practices in response to climate change and heat stress in Egypt.

Review of the Literature

Egypt's triple effect of hot summers, limited rainfall, and the country's extensive desert, heavily populated cities, and terrain rank it among the top five countries most at risk from climate change worldwide (Akhtar, 2024). The United Nations Intergovernmental Panel on Climate Change (IPCC) clarifies that climate change is accelerating beyond previous projections, with widespread and intensifying impacts across sectors and regions (IPCC, 2022). Vulnerable and marginalized populations, including pregnant women, are among those most affected due to physiological and socioeconomic vulnerabilities (IPCC, 2022; Romanello et al., 2023).

The Egyptian Ministry of Health reports in 2021 that since the onset of the heat wave, there are 95 heat-related deaths and 1,914 injuries (MOH, 2021). During pregnancy, women experience various bodily changes that heighten their susceptibility to illnesses involving fever, consequently elevating their vulnerability and the risk of mortality. Women who are pregnant are found to be at a greater health risk everywhere, and studies show that they can have bad outcomes if they are exposed to really hot weather while they are pregnant (Bekkar et al., 2020; Hess et al., 2012; Kuehn, 2017). A lot of people affected by high temperatures suffer from preexisting health conditions such as persistent high blood pressure or weakened heart muscles, which can exacerbate heat exposure risk.

In addition, climate change results in lasting shifts in weather patterns and temperature levels. Such alterations may happen naturally as a result of significant volcanic eruptions or sun activity fluctuations. The main cause of climate change since the 19th century has been human activities, especially the combustion of conventional fuels such as coal, oil, and natural gas (Wright et al., 2023). The use of the Nursing Educational module is an officially acknowledged curriculum offering a comprehensive and solid foundation rooted in the behavioral, life, and nursing sciences for the overall practice of nursing (Gustini et al., 2024). The focus on pregnancy is the gestational period in which a fetus grows within the mother's uterus, usually spanning 40 weeks (Acar & Öter, 2024). The QoL, that is refers to the idea of the QoL, aims to measure the welfare of a population or an individual concerning both beneficial and detrimental elements of their overall life at one particular time (T, 2024).

Climate change has diverse and detrimental impacts on the QOL of pregnant women. Furthermore, heat exposure can cause fetal metabolism to shift from anabolic to catabolic pathways and increase maternal oxytocin and antidiuretic hormones, both of which decrease uterine blood flow. Pregnancy-related emotional stress is also linked to extremely high or low temperatures, which can worsen placental, endothelial, and endocrine dysfunctions (Yadav, 2023). In addition, excessive heat can impair placental function, induce dehydration and endocrine dysfunction, and overwhelm a pregnant woman's thermoregulatory system, particularly during labor. Hypertensive disorders, preterm birth, gestational diabetes, and stillbirth are examples of clinical sequelae (Kabir et al., 2023).

Water supplies are being influenced by climate change in several ways. Gastrointestinal and other ailments may arise from coming into contact with untreated polluted water, especially for pregnant women who are more vulnerable. Premature birth and pregnancy loss are possible outcomes of these conditions in extreme situations. Food production, availability, transportation, safety, and quality are all at risk during floods and droughts. Listeria and toxoplasma are examples of foodborne infections that can be fatal and raise the risk of stillbirth, miscarriage, or early delivery (Ashrafuzzaman et al., 2023).

All dimensions of pregnant women's QoL, both physically, emotionally, psychologically, and socially, are negatively affected by heat stressors and climate change. Ground-level ozone, smoke from wildfires, and dust from droughts are among the outdoor air pollutants that could rise as a result of climate change. Women who are pregnant are especially vulnerable to the negative consequences of vehicle emissions. They should take further care to limit their exposure to vehicle smoke, as this may affect the fetus's development and raise the possibility of premature labor and poor birth weight (Raihan, 2023). Extreme weather occurrences have been shown to raise emotional stress in pregnant women, worsen mental diseases, and cause psychological stress. Furthermore, these incidents may interfere with access to therapy, behavioral health resources, and support systems, all of which may impair women's capacity for coping (Kaya et al., 2025).

One kind of active learning that helps expectant mothers become more conscious of their particular requirements is an educational module. It's an efficient approach to learning where pregnant women receive information and practice to grasp knowledge and apply it in practice through educational modules. Before showcasing professional abilities, it can also be useful in imparting concepts and detailed instructions that positively affect QoL (ElSayed et al., 2024). Furthermore, continued teaching helps pregnant women to apply healthy practices to cope with climate change, which in turn improves the QoL (Shalaby Awad Mahmoud et al., 2023). Nurses are able to assist in advancing renewable energy sources, protecting the Earth's natural assets, and helping to decrease the release of harmful gases. Furthermore, they have the capacity to champion policy reforms on both community and global scales (Hudon et al., 2023).

Climate change is now considered one of the most pressing warnings to global health, and its disproportionate impact on pregnant women has drawn increasing concern from the international scientific community. Pregnant people tend to be more susceptible to harsh weather, polluted air, and not having enough food or clean water, and all of these issues are likely to get worse in the coming years (Romanello et al., 2023). Egyptian mothers are finding life tougher as they grapple with hotter weather patterns, sparser precipitation, and the density of city living. Pregnant women often experience multiple pressures which can increase vulnerability. Despite this, relatively limited educational and preventive interventions are specifically designed to address their needs in both practice and research.

This study responds to the identified gap by implementing nursing educational module targeting pregnant women. The module designed to enhance pregnant women’ knowledge and encouraging appropriate behavioral responses for managing heat stress and climate associated health risks. By assessing QoL alongside self-reported practices, the study examines how health education can function as a feasible preventive approach. This research is significant as it addresses a critical issue in public health and underscores the essential role that nurses play in the advancement of communities, as well as in motivating vulnerable populations to embrace methods for adjusting to alterations in the climate. The findings may contribute to the development of maternal health policies and community-based intervention planning in Egypt and other settings affected by climate related challenges.

The purpose of this present research is to assess the impact of nursing educational modules on climate change in enhancing the QoL and reported practices of pregnant women. This study hypothesized the following:

H1: Pregnant women will exhibit a better QoL after the implementation of the nursing educational module regarding climate change than before.

H2: After the implementation of a nursing educational module regarding climate change, pregnant women would have a better self-reported practices to manage heat stress than before.

Method

Research Design: A quasi-experimental design with a single group (pretest and posttest) was employed to conduct this study at the obstetrics and gynecology outpatient clinic located in Benha University Hospitals.

Sample: A purposive sample of 128 pregnant women admitted to the previously mentioned setting for nine months. Inclusion criteria: Women with confirmed pregnancy (first and second trimester) without any obstetric or medical diseases, and willing to participate and provide informed consent. Exclusion criteria: Twin pregnancy, women who received any previous educational programs related to climate change.

Tools of Data Collection

Tool I: Structured interviewing questionnaire: It was three parts: Part (1): General characteristics of pregnant women (age, residence, education, and occupation). Part (2): Obstetrical history (gravidity, parity, and gestational age). Part (3): Maternal knowledge questionnaire regarding climate change and heat stress: It was produced by the researchers following a review of relevant literature (Afifi et al., 2024; Deveci et al., 2023). It consisted of 12 questions designed to measure pregnant women's knowledge regarding climate change and heat stress.

Scoring System

Every knowledge variable was weighted based on the items in each multiple-choice question. Each item was given a value of 1 for correct answers and 0 for incorrect ones or unknown responses. To obtain the final score, the scores of each question were combined.

The overall knowledge score was categorized as follows:

▪ > 60% correct responses are considered (good).

▪ 50 ≤ 60% correct responses are considered (average).

▪ < 50% correct responses are considered (poor).

Tool II: World Health Organization QoL—(WHOQOL-BREF)

The WHOQOL-BREF is an adapted version of the World Health Organization's questionnaire from 1996 (WHO, 1996), developed to assess individuals’ perceptions of their QoL over the previous two weeks. In this study, the official Arabic version, approved by the World Health Organization Mental Health Programme, Geneva, May 1997, was used (WHO, 1997). The Arabic version was linguistically and culturally reviewed to ensure suitability for the Egyptian context. The researcher tested the study tool on small sample of pregnant women “pilot study” to confirm that the questions were clear, relevant and easy to understand.

The questionnaire consisted of 26 items: two items assessed overall QoL and general health, while the remaining 24 items were divided into four domains: physical health (seven items), psychological well-being (six items), social relationships (three items), and environmental factors (eight items; Ali et al., 2025).

Scoring System

The survey utilized a “5-point rating scale” ranged from 1 to 5 points: the higher the number of points, the superior the QoL. Average values were represented in each domain and computed following the key and guidelines.

Tool III: Maternal reported practices regarding climate change and heat stress: It was adapted from (ElSayed et al., 2024; Torre et al., 2023) to assess reported practices of the studied women regarding climate change and heat stress, it consisted of nine categories (general measures, nutritional practices, clothes, sports exercises, seeking medical care, necessary measures for sunstroke, necessary measures for heat exhaustion, how to avoid heat cramps, and how to avoid heat rash).

Scoring System

Every practice variable was weighted based on the following items: never (0), sometimes (1), and always (2). The following categories apply to the total practice score:

▪ Satisfactory level: ≥60%–100%.

▪ Unsatisfactory level: < 60%.

Tool validity: A panel of three expert jurors in obstetrics and gynecological nursing at Benha University evaluated the content validity of the data collection instruments to assess their comprehensiveness, clarity, relevance, comprehension, and applicability. From the perspective of the experts, the tools were deemed valid after their opinions on the design, structure, and order of the questions were solicited, and all of their comments were taken into account.

Reliability of the tools: Tools’ reliability was assessed using Cronbach's alpha coefficient to ensure their internal consistency. Tool I, Maternal knowledge questionnaire regarding heat stress and climate change, demonstrated good internal consistency with a score of .82 on Cronbach's alpha. It was tried out on a sample of 15 pregnant women to test clarity, feasibility, and cultural relevance. Tool II, the Arabic version of the WHOQOL-BREF, was the officially approved version issued by the World Health Organization Mental Health Programme (WHO, 1997). This version has been previously validated in Arabic-speaking populations and demonstrated strong psychometric properties in multiple studies, including those conducted by Dalky et al. (2017) in Jordan and Ohaeri and Awadalla (2009) in Kuwait. The present study showed the subdomain reliability values were: 0.89 for the physical health domain, 0.86 for the psychological domains, 0.81 for social relationships, and 0.83 for the environment domain, with high reliability with an overall Cronbach's alpha of .90. Tool III, which assessed maternal reported practices regarding climate change and heat stress and was adapted from previously validated sources (24, 25), demonstrated acceptable internal consistency, with a Cronbach's alpha of .79. These findings confirmed the appropriateness and internal reliability of all tools for use among pregnant women in the Egyptian context.

Ethical considerations: Prior to the study's commencement, the following ethical considerations were made: The Benha University faculty of nursing's scientific research ethical committee granted study approval for its completion (RES-OBSN-p77). To build trust and confidence in the research, the researcher gave a short description of what the study was about and why it mattered to the women before using the methods. Each woman who took part gave her approval on paper, and their private information was completely protected. The women had no risks to their physical, social, or emotional health during the whole study. After the numbers were analyzed, all the information collected was safely destroyed to keep the participants’ information private and safe. Following standard rules for keeping data safe, paper documents were burned, and digital data was permanently deleted. The methods protected basic rights and had no unethical claims, and the women could stop being in the study at any time if they wanted to.

Fieldwork: This research was conducted over 9 months, beginning in early May 2024 and concluding at the end of January 2025. The researcher went to the study location 3 times a week (Saturdays, Mondays, and Wednesdays) from 9:00 a.m. to 12:00 p.m. until the specified period was finished. Subsequent phases were implemented to achieve the objective of the research (Table 1).

Table 1.

Timeline of the Research Implementation and Evaluation Phases (May 2024–January 2025).

Phase	Activities	Duration
Assessment phase	Participant introduction, consent, questionnaire administration (WHOQOL, reporting practices).	2 months (May–June 2024)
Planning phase	Development of educational module and pamphlet; determining sessions, goals, and teaching materials.	1 month (July 2024)
Implementation phase	Conducting three educational sessions, each 30–45 min; interactive methods and participant feedback.	3 months (Aug–Oct 2024)
Evaluation phase	Postintervention assessment using same tools; evaluation of knowledge, QOL, and practices at 3 months follow-up.	3 months (Nov 2024–Jan 2025)
Total duration		9 months (May 2024–January 2025)

Assessment phase: At the outset of the assessment phase, the researcher greeted the women, introduced herself to each participant in the study, provided them with all of the necessary information, and acquired their signed written consent to join in the research. The researcher provided three tools: (a) a structured interviewing questionnaire, (b) the World Health Organization QoL, and (c) maternal reporting practices. The average time needed to complete questionnaires was between 30 and 45 min. The number of interviewed ladies varied from 4 to 5 every week.

Planning phase: A nursing training module focusing on climate change and heat stress developed by the researchers and delivered through educational sessions supported by a concise booklet. The content of the booklet was prepared based on pregnant women’ need, their limited knowledge and practices concerning climate change and heat stress and was written in clear and plain Arabic to match participants’ awareness. The number of sessions, their contents, and the various instructional methods and educational resources were determined. Goals were set to be achieved at the end of the term of study. Upon completion of the nursing educational module, women gained valuable knowledge, a positive outlook, and good reported habits around climate change.

Implementation phase: The Nursing education module was implemented through three planned sessions. Based on the accomplishments and feedback of the women under study, each session lasted roughly 30–45 min. Pregnant women were introduced to the intervention's contents at the start of the first session. In order to fit women's comprehension levels, the following session began with feedback regarding the previous session and the goals of the new one. Simple Arabic was used. Each session concludes with 5 min set aside for women to raise questions to solve any confusion and clarify the session's contents. The next session time was communicated to each woman. Various teaching techniques were employed, including brainstorming, group discussions, lectures, critical thinking, and problem-solving. The instructional manual was given to all women recruited for the study, starting from the initial session, to meet its goals.

Evaluation phase: The effectiveness of the nursing educational module was evaluated after implementation utilizing the same set of instruments used in the assessment phase, which were used during the assessment phase, and the researcher assessed women's knowledge, QoL, and reported practices 3-months postintervention from the last session and during outpatient follow up or via telephone in the event of absenteeism.

Statistical analysis: Version 25.0 of the statistical software Statistical Package for Social Sciences was utilized to examine the data. Descriptive statistics were used, including mean, standard deviation, frequencies, and percentages, to describe the general characteristics of the studied sample. The Kolmogorov–Smirnov test was applied to assess the normality of distribution for continuous variables, which revealed that the data were not normally distributed. Therefore, nonparametric tests were employed. The Wilcoxon signed-rank test was used to compare the total scores of reported practices and WHOQOL domains before and after the intervention. The McNemar test was applied to assess significant changes in participants’ responses to individual knowledge items (correct vs. incorrect) between the pre- and postintervention phases. To evaluate the association between total knowledge, reported practices, and QoL at both time points, Spearman's rank correlation coefficient was used. The following levels of significance were considered: p > .05: not significant (NS), p ≤ .05: significant (*), and p ≤ .001: highly significant (**).

Results

Table 2 showed the general characteristics of the studied sample. It was clear that 56.3% of the studied sample were in the age group <25 years with a mean age of 25.95 ± 4.89 years. As regards the residence, 60.2% of the studied women lived in rural areas. Regarding the educational level, 33.6% of them had a university education. Furthermore, 56.3% of them were housewives.

Table 2.

Distribution of the Studied Sample according to Their General Characteristics (n = 128).

General Characteristics	No	%
Age
<25	72	56.3
25–< 30	26	20.3
30–< 35	16	12.5
≥35	14	10.9
Mean ± SD = 25.95 ± 4.89
Residence
Urban	51	39.8
Rural	77	60.2
Level of education
Read and write	18	14.1
Primary education	25	19.5
Secondary education	30	23.4
University education	43	33.6
Postgraduate education	12	9.4
Occupation
Housewife	72	56.3
Employed	56	43.7
Mean ± SD = 16.32 ± 5.44

In terms of distribution of the studied sample regarding their obstetrical history, 56.3% of the participants were Primigravida (n = 72), 56.3% were Nulliparous (n = 72), and more than half of them were in their second trimester 54.7% (n = 70) with a mean gestational age of (16.32 ± 5.44) weeks. More details are presented in Table 3.

Table 3.

Distribution of the Studied Sample Regarding Their Obstetrical History (n = 128).

Obstetrical History	No	%
Gravidity
Primigravida	72	56.3
Multigravida	56	43.7
Parity
Nulliparous	72	56.3
Primipara	30	23.4
Multipara	26	20.3
Gestational age (in weeks)
First trimester (from conception to 12 week)	58	45.3
Second trimester (13–28 week)	70	54.7
Mean ± SD = 16.32 ± 5.44 week

Table 4 showed a very notable statistical difference between the results from the time after the intervention and those from before the intervention, supporting the postintervention in all elements of the sample's understanding regarding climate change and heat stress, with p ≤ .001.

Table 4.

Distribution of the Studied Sample Regarding Knowledge About Climate Change and Heat Stress at Preintervention and Postintervention Phases (n = 128).

Knowledge Items	Pre	Post				McNamar X²/p-Value
		Incorrect		Correct
		No	%	No	%
Concept of climate change	Incorrect	44	34.4	36	28.1	34.02
Concept of climate change	Correct	0	0.0	96	75.0	0.000**
Causes of climate change	Incorrect	33	25.8	79	61.7	77.01
Causes of climate change	Correct	0	0.0	64	50.0	0.000**
Gases that cause climate change	Incorrect	43	33.6	63	49.2	61.01
Gases that cause climate change	Correct	0	0.0	70	54.7	0.000**
Impact of climate change on the health of pregnant women	Incorrect	39	30.5	53	41.4	51.01
Impact of climate change on the health of pregnant women	Correct	0	0.0	84	65.6	0.000**
People most affected by climate change	Incorrect	35	27.3	51	39.8	49.02
People most affected by climate change	Correct	0	0.0	90	70.3	0.000**
Individual actions to reduce climate change	Incorrect	31	24.2	67	52.3	65.01
Individual actions to reduce climate change	Correct	0	0.0	78	60.9	0.000**
Concept of heat stress	Incorrect	41	32.0	53	41.4	51.01
Concept of heat stress	Correct	0	0.0	82	64.1	0.000**
Causes of heat stress	Incorrect	36	28.1	70	54.7	68.01
Causes of heat stress	Correct	0	0.0	70	54.7	0.000**
Symptoms of heat stress	Incorrect	32	25.0	86	67.2	84.01
Symptoms of heat stress	Correct	0	0.0	58	45.3	0.000**
Complications of heat stress	Incorrect	28	21.9	96	75.0	94.01
Complications of heat stress	Correct	0	0.0	52	40.6	0.000**
Ways to prevent exposure to heat stress	Incorrect	32	25.0	62	48.4	61.01
Ways to prevent exposure to heat stress	Correct	0	0.0	82	64.1	0.000**
Ways to overcome heat stress associated with climate change	Incorrect	35	27.3	65	50.8	63.01
Ways to overcome heat stress associated with climate change	Correct	0	0.0	76	59.4	0.000**

**A highly statistically significant p ≤ .001.

Figure 1 displayed that (31.2%) and (72.7%) of the studied sample had adequate knowledge regarding climate change and heat stress in the preintervention and postintervention phases, respectively.

Figure 1.

Percentage distribution of the studied sample regarding total knowledge score about climate change and heat stress at preintervention and postintervention phases (n = 128).

Table 5 demonstrated that, in the phase prior to the intervention, the mean scores for overall QoL revealed a reduced QoL among the women analyzed (61.91 ± 7.46). However, postintervention, the mean difference score for overall QoL among the examined women was (96.42 ± 11.39), showing a highly significant statistical difference (p ≤ .001). There were significant variations across all dimensions of QoL, which included physical health, mental well-being, social relationships, and environmental factors, as well as two components relating to overall QoL and general health (p ≤ .001).

Table 5.

Total Mean Cores of Quality-of-Life Domains of Studied Women Toward Climate Change and Heat Stress at Preintervention and Postintervention (n = 128).

WHOQOL	Min/Max Score	Preintervention	Postintervention	Z	p-Value
WHOQOL	Min/Max Score	Mean ± SD	Mean ± SD	Z	p-Value
Individual's overall perception of quality of life (1 item)	1/5	2.83 ± 0.76	4.07 ± 0.68	8.80	.000**
Individual's overall perception of their health (one item)	1/5	2.96 ± 0.77	4.20 ± 0.65	8.64	.000**
Physical health (seven items)	7/35	15.48 ± 3.02	24.47 ± 4.54	9.49	.000**
Psychological (six items)	6/30	15.10 ± 2.68	23.50 ± 3.69	9.60	.000**
Social relationships (three items)	3/15	7.50 ± 1.65	10.26 ± 2.20	9.56	.000**
Environment (eight items)	8/40	18.01 ± 4.90	29.90 ± 3.77	9.85	.000**
Total score	26/130	61.91 ± 7.46	96.42 ± 11.39	9.81	.000**

Note. Wilcoxon signed ranks test.

**A highly statistically significant p ≤ .001.

Table 6 revealed that there was a highly statistically significant difference in total mean scores of the studied women's reported practices toward climate change and heat stress at preintervention and postintervention phases, with p ≤ .001. The total mean score of reported practices was improved from 41.28 ± 7.27 to 63.15 ± 5.24.

Table 6.

Mean Scores of Studied Women's Reported Practices Toward Climate Change and Heat Stress at Preintervention and Postintervention (n = 128).

Reported Practices Parts	Min/Max Score	Preintervention	Postintervention	Z	p-Value
Reported Practices Parts	Min/Max Score	Mean ± SD	Mean ± SD	Z	p-Value
Reported practices regarding climate change in general
General measures	0/12	5.73 ± 0.88	9.21 ± 1.34	9.43	.000**
Nutritional practices	0/8	4.19 ± 1.16	6.26 ± 0.89	9.90	.000**
Clothes	0/8	4.34 ± 1.13	6.39 ± 0.87	9.94	.000**
Sports exercises	0/14	7.25 ± 1.55	10.71 ± 1.98	9.22	.000**
Seeking medical care	0/4	2.02 ± 1.13	3.07 ± 0.79	6.98	.000**
Reported practices toward heat stress problems
Necessary measures in the event of sunstroke	0/8	4.13 ± 1.23	6.41 ± 0.84	9.79	.000**
Necessary measures in the event of heat exhaustion	0/8	4.24 ± 1.24	6.49 ± 0.82	9.80	.000**
How to avoid heat cramps	0/8	3.99 ± 1.23	6.57 ± 0.86	9.77	.000**
How to avoid heat rash	0/10	5.37 ± 1.18	8.00 ± 1.11	9.83	.000**
Total score	0/80	41.28 ± 7.27	63.15 ± 5.24	9.82	.000**

Note. Wilcoxon signed ranks test.

**A highly statistically significant p ≤ .001.

Figure 2 displayed that, (33.6%) and (77.3%) of the studied sample had satisfactory levels of reported practices regarding climate change and heat stress at pre- and postintervention phases respectively.

Figure 2.

Percentage distribution of the studied sample regarding total reported practices scores toward climate change and heat stress at pre- and postintervention phases (n = 128).

Table 7 clarified that there was a highly significant statistically positive correlation between total knowledge score and (total reported practices and total QoL) scores regarding climate change and heat stress at preintervention and postintervention phases (p ≤ .001).

Table 7.

Correlation Between Total Knowledge, Total Reported Practices, and Total Quality of Life Scores of the Studied Sample Regarding Climate Change and Heat Stress at Pre- and Postintervention Phases (n = 128).

Variables	Total Knowledge
	Preintervention		Postintervention
	Spearman's ρ	p-Value	Spearman's ρ	p-Value
Total reported practices	0.417	.000**	0.559	.000**
Total quality of life	0.498	.000**	0.582	.000**

**A highly statistically significant p ≤ .001.

Discussion

The study addresses the urgent but neglected problem of the effect of climate change on pregnant women in Egypt, who are more vulnerable to heat and other environmental stressors, and the effectiveness of a structured nursing educational module to increase awareness and encourage healthier practices, in contrast to the majority of previous studies that focus on risks, showing how targeted education can enable women to safeguard their health and enhance their QoL, and highlighting the important role of nurses in assisting pregnant women to adjust to climate change in areas such as Egypt with particularly harsh environmental conditions.

Findings from this research pertaining to the general characteristics of the studied pregnant women showed that the mean age is 25.95 ± 4.89 years, and over half of the sample was under 25 years old.

Concerning residents, rural and urban areas were defined according to the Central Agency for Public Mobilization and Statistics (CAPMAS, Egypt). Urban areas include cities and towns with good services and nonagricultural jobs. Rural areas refer to villages where most people work in agriculture and have fewer health and education services. In this study, fewer than two-thirds of them were rural dwellers. In terms of education, over one-third of them were university graduates. Moreover, less than two-thirds of them were housewives.

This finding closely mirrors results from India, where a large retrospective maternal-newborn health registry study (Belagavi, Nagpur, Thatta sites) found similar demographic patterns among pregnant women exposed to heat stress (Shankar et al., 2023). In that study, mean maternal ages clustered around the mid-20s, and a substantial proportion resided in rural areas, with varied education levels. As well as this finding aligns with Kaya et al. (2025), who carried out their study in Turkey and found that over two-thirds of pregnant women were under 25 years old, with an average age of 25.80 ± 3.43 years, and that approximately three-quarters lived in rural areas. Additionally, Acar and Öter (2024), studying pregnant women in Turkey, reported that over half of the participants originated from rural areas. Furthermore, the present study's results are consistent with findings by Rekha et al. (2024), whose research in India also highlighted similar demographic patterns among pregnant women.

Analysis of obstetrics history revealed that, over half of the studied women were experiencing their first pregnancy and had no previous deliveries, with a mean gestational age of “16.32 ± 5.44 weeks.” These findings are consistent with those reported by ElSayed et al. (2024), in an Egyptian study, which found that over one-quarter of women were nulliparous, over two-thirds of the women were primigravida and more than two-thirds in the second trimester of pregnancy.

Also, findings from other studies conducted in Egypt differ from those of the current research. Farg et al. (2024) reported that all participants were multigravida and two-thirds were multipara. Additionally, Afifi et al. (2024) observed that fewer than two-thirds of women in both the study and control group were multigravida. Furthermore, more than two-fifth of the control group and less than two-thirds of the study group were multiparous.

The findings of the current research showed a highly statistically significant enhancement across the knowledge of the pregnant women under study, with postintervention scores surpassing preintervention scores across all items related to climate change and heat stress. Similar results were reported by Ahmed et al. (2023), in Egypt, who found that the majority of pregnant women demonstrated in adequate knowledge regarding climate changes prior to the educational intervention, f0llowed by a noticeable improvement in their knowledge after its implementation. Moreover, the finding is consistent with Andreae et al. (2024), whose study in Germany indicated that only about 10% of participants had a high level of knowledge regarding climate change. The majority exhibited low knowledge, and fewer than one-third showed a moderate understanding. Additionally, Acar and Öter (2024) reported in their Turkish study that participants showed insufficient knowledge regarding the impact of climate change on maternal and infant health.

Pregnant women’ insufficient awareness of climate change and heat stress prior the intervention may be linked to their socioeconomic and residential circumstances. Many participants were unemployed and resided in rural areas, limited their access to information on current global issues such as climate change. Additionally, unemployment may have provided some protection from heat exposure, sunburn and other adverse consequences of climate change, which could explain participants limited interest in climate related issues (Heberlein et al., 2024). In contrast Ngwenya et al. (2018) reported that the majority of participants in Bulawayo, Zimbabwe, had adequate knowledge of climate change, where as only a few had limited understanding.

Concerning the QoL of the pregnant women analyzed before any intervention, the present research indicated that their overall QoL was adversely affected by climate change and thermal stress. This was reflected in their average QoL scores, which stood at 61.91 ± 7.46. In contrast, after the intervention, the average score for their overall QoL rose to 96.42 ± 11.39, showing a significant difference. The results of this study align with those of Menon (2024), who conducted the study in Kerala, India, and came to the conclusion that focused educational initiatives can enhance perceptions of health risks associated with climate change, which in turn can motivate expectant mothers to embrace healthier lifestyle choices that lessen the effects of climate change, aligns with existing evidence that structured prenatal education can significantly boost maternal well-being. Similarly, Lee et al. (2022) in 2022 found that structured antenatal education on environmental health risks led to a significant increase in both QoL and self-efficacy among pregnant women in urban South Korea. In another study for instance, Özkan et al. (2018) conducted a quasi-experimental study in Turkey using the Scale of Complaints during Pregnancy and their Effects on QoL and found that pregnant women who received structured prenatal education had significantly lower complaint scores and therefore higher QoL compared to a control group in both second and third trimesters (p < .05).

Concerning the documented behaviors related to climate change and heat stress, the results of the present study indicated a statistically significant difference in the overall average scores of the women's reported behaviors regarding climate change and heat stress before and after the intervention, with p ≤ .001. The overall mean score for reported behaviors changed from 41.28 ± 7.27 to 63.15 ± 5.24. This advancement in behaviors may be attributed to the enhanced awareness among pregnant women, and the majority of participants engaging with the educational module likely contributed to this improvement in practices. Additionally, when pregnant women have sufficient information and have adapted healthy practices, and can effectively adapt to climate change, they can achieve a better QoL in all dimensions, physically, psychologically, socially, and spiritually.

This finding aligns with previous research demonstrating the effectiveness of targeted health education interventions in enhancing maternal practices in response to environmental health risks. For instance, a quasi-experimental study conducted in Egypt among pregnant women working in outdoor environments reported a significant increase in knowledge and preventive practices related to heat stress after participating in a structured educational intervention (Mohamed & Hassan, 2024).

In addition, this result agreed with ElSayed et al. (2024), who conducted their study in Alexandria, Egypt, and reported that only a few numbers of women had a satisfactory level of practice before the implementation of the nursing educational module, and improved to two-thirds of the women after implementation. As interpreted by the researcher, the climate change educational module can have a positive impact on improving practices among pregnant women by increasing knowledge and promoting a better understanding of the potential maternal and fetal health risks associated with climate change. This program can support pregnant women in making proactive decisions to protect themselves and their unborn fetuses.

Concerning correlation, the findings of the present study revealed that there was a highly significant statistically positive correlation between total knowledge score and (total reported practices and total QoL) scores regarding climate change and heat stress at the preintervention and postintervention phases. This result may be explained by the fact that women's practices toward climate change and heat stress improved as their level of knowledge rose.

This result is congruent with Dewidar et al. (2023) who conducted their study in Alexandria, Egypt, and reported that there was a highly positive statistical correlation between total knowledge and total health-related behaviors of the studied women. In addition, this result was supported by a study by Lykins et al. (2024) whose research in California, USA, demonstrated that structured awareness programs increase knowledge and empower women to make informed decisions about their health and environmental practices during pregnancy.

Strengths of the Research

This study has several advantages. Validated scales were used to collect data. Numerous studies have so far emphasized the need to find evidence-based ways to mitigate the negative effects of climate change on the health of groups like young adults and college students. Our research may be unique in that it aims to establish a foundation for assessing how climate change education affects the awareness, QoL, and adaptive practices of expectant mothers.

Limitations of the Research

The researchers recruited participants from Benha University Hospital using a purposive sample. The study results might therefore not be typical of all expectant mothers in other regions of the world. One limitation of this study is the lack of a control group, although the sample size was large enough to allow for group division. The program was applied to all participants for ethical reasons, since the content was related to important health practices. It was not acceptable to prevent any participant from receiving this information. This may reduce the ability to confirm that the improvement was only due to the intervention, but the before-and-after comparison still gives useful results.

Due to the limited availability of research that directly addresses the effect of nursing educational modules on pregnant women's QoL in relation to climate change, particularly within the Egyptian context, some studies included in this research were chosen for their partial or conceptual relevance. Although these references may differ in location, population, or exact intervention type, they share a common focus on the role of education in improving health awareness and behaviors among vulnerable groups, especially pregnant women. Therefore, these studies were used to support the general framework of the current research and to provide theoretical and practical insights that help interpret the findings.

Implications for Nursing Practice

The findings of this study carry several important implications for nursing practice. The evidence strongly indicates that achieving a healthy pregnancy largely depends on women's ability to develop the necessary skills to effectively address their evolving needs. It may also help in better informing the job of professionals who take care of women in the hospital during pregnancy. Additionally, nurses can advocate for policies that mitigate climate change's effects on vulnerable populations, including pregnant women. By leveraging their expertise, they can push for climate-smart healthcare practices.

Conclusion

Maternal knowledge of pregnant women, QoL, and reported practices regarding climate change and heat stress were improved as a result of the nursing educational module. In addition, a statistically significant positive correlation existed between the total knowledge score and both QoL and reported practices, before and after the intervention scores for climate change and heat stress. Thus, the study's goal was accomplished, and the research hypotheses were supported.

Footnotes

Acknowledgments

The authors would like to express their sincere gratitude to Riyadh Elm University, College of Pharmacy, Nursing and Medical Sciences, for their support and assistance throughout this research.

ORCID iD

Rabia Hani Haddad

Ethics Approval and Consent to Participate

The Scientific and Ethical Research Committee at Benha University, Faculty of Nursing was addressed (RES-OBSN-p77). All Women who participated in this study gave their oral consent to participate in the study, and confidentiality was guaranteed. Procedures were strictly aligned with applicable standards and laws, including the Declaration of Helsinki.

Author Contributors

FA: conceptualization, methodology, formal analysis, validation, investigation, writing—original draft preparation, visualization, writing—reviewing and editing; AA, RH, AM, and AA: conceptualization, methodology, data collection, writing—reviewing and RH and AA: conceptualization, methodology, writing—reviewing and editing. The authors read and approved the final manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability

The datasets generated and/or analyzed during the current clinical trial are not publicly available as they have not been published but can be gained from the corresponding author upon reasonable request.

References

Acar

B. T.

Öter

E. G.

(2024). Climate change awareness in pregnant women: A qualitative study. Ordu Üniversitesi Hemşirelik Çalışmaları Dergisi, 7(1), 38–45. https://doi.org/10.38108/ouhcd.1263410

Afifi

O. A.-W.

Baraia

Z. A.

Abdel-Mordy

M. A.

Emam

A. M. M.

(2024). Knowledge and health-related behaviors toward climate changes and heat stress among pregnant women working outdoors: Tailored educational program. Assiut Scientific Nursing Journal, 12(43), 1–19. https://doi.org/10.21608/asnj.2024.262309.1759

Ahmed

Ahmad

Kheir

A. M.

(2023). Climate change: An overview. Global agricultural production: Resilience to climate change, 1–30.

Akhtar

(2024). Introduction: Climate change and human health scenarios. In Climate change and human health scenarios: International case studies (pp. 1–12). Springer.

Ali

H. T.

Helal

Ismail

S. M.

Hamdi

N. M.

Mohamed

N. L.

Essa

A. M.

Mohammed

, QOL Collaborator Group, & Ebada

M. A.

(2025). Exploring the quality of life of university students in Egypt: A cross-sectional survey using the World Health Organization quality of life-BREF (WHOQOL-BREF) assessment. American Journal of Health Promotion, 39(2), 263–273. https://doi.org/10.1177/08901171241285094

Andreae

Shultz

J. M.

Shepherd

J. M.

Espinel

Shapiro

L. T.

(2024). Weathering the storms of climate change: Preparing persons with disabilities and the physiatrists who provide their care for extreme hurricanes.

Ashrafuzzaman

Gomes

Guerra

(2023). The changing climate is changing safe drinking water, impacting health: A case in the southwestern coastal region of Bangladesh (SWCRB). Climate, 11(7), Article 146. https://doi.org/10.3390/cli11070146

Bekkar

Pacheco

Basu

DeNicola

(2020). Association of air pollution and heat exposure with preterm birth, low birth weight, and stillbirth in the US: A systematic review. JAMA Network Open, 3(6), e208243–e208243. https://doi.org/10.1001/jamanetworkopen.2020.8243

Dalky

H. F.

Meininger

J. C.

Al-Ali

N. M.

(2017). The reliability and validity of the Arabic World Health Organization quality of life-BREF instrument among family caregivers of relatives with psychiatric illnesses in Jordan. Journal of Nursing Research, 25(3), 224–230. https://doi.org/10.1097/JNR.0000000000000146

10.

Deveci

Akbaş

Ergun

A. Ş.

Kurtulmuş

Koçak

A. B.

Boyraz

R. K.

Tok

O. E.

Aydın

M. Ş.

Kılıç

Ö.

Bozkurt

Uysal

Ö.

Eşrefoğlu

Koçyiğit

Öztürk

Lawrence

A. J.

Kırpınar

(2023). The effects of transcranial focused ultrasound stimulation of nucleus accumbens on neuronal gene expression and brain tissue in high alcohol-preferring rats. Molecular Neurobiology, 60(2), 1099–1116. https://doi.org/10.1007/s12035-022-03130-9

11.

Dewidar

John

Baqar

Madani

M. T.

Saad

Riddle

Ota

Kung'u

J. K.

Arabi

Raut

M. K.

Klobodu

S. S.

Rowe

Hatchard

Busch-Hallen

Jalal

Wuehler

Welch

(2023). Effectiveness of nutrition counseling for pregnant women in low-and middle-income countries to improve maternal and infant behavioral, nutritional, and health outcomes: A systematic review. Campbell Systematic Reviews, 19(4), Article e1361. https://doi.org/10.1002/cl2.1361

12.

ElSayed

H. F.

Mohamed

E. A.

Abass

E. I.

(2024). Effect of nursing instructional module on pregnant women' knowledge and practice regarding climate changes. International Egyptian Journal of Nursing Sciences and Research, 4(2), 504–522. https://doi.org/10.21608/ejnsr.2024.264810.1358

13.

Elshahed

El-Marsafawy

Farid

(2021). Climate vulnerability assessment of Egypt: A focus on health risks and adaptive capacity. Environmental Science and Pollution Research, 28(14), 17521–17533. https://doi.org/10.1007/s11356-021-12849-1

14.

Farg

N. A. K.

Khamis

M. A.

Mohamed

H. M.

(2024). Assessment of pregnant women knowledge about climate changes and its effect on their pregnancy. Assiut Scientific Nursing Journal, 12(45), 277–286. https://doi.org/10.21608/asnj.2024.306404.1863

15.

Fasanghari

Keramat

(2023). Investigating the effect of educational interventions on maternal competence: A systematic review and meta-analysis. Journal of Education and Health Promotion, 12, 254. https://doi.org/10.4103/jehp.jehp_25_23

16.

Glaser

D. M.

Hartnett

H. E.

Finn

D. R.

Perez-Montaño

Cadillo-Quiroz

Desch

(2022). Water vapor adsorption provides daily, sustainable water to soils of the hyperarid Atacama Desert. Astrobiology, 22(10), 1222–1238. https://doi.org/10.1089/ast.2021.0171

17.

Gustini

Situmeang

Syaharuddin

Prasetyowati

Suprapto

(2024). Education has a significant effect on the performance of implementing nurses in hospitals. Jurnal Ilmiah Kesehatan Sandi Husada, 13(1), 111–116. https://doi.org/10.35816/jiskh.v13i1.1184

18.

Heberlein

E. C.

Smith

J. C.

LaBoy

Britt

Crockett

(2024). Birth outcomes for medically high-risk pregnancies: Comparing group to individual prenatal care. American Journal of Perinatology, 41(04), 414–421. https://doi.org/10.1055/a-1682-2704

19.

Hess

J. J.

McDowell

J. Z.

Luber

(2012). Integrating climate change adaptation into public health practice: Using adaptive management to increase adaptive capacity and build resilience. Environmental Health Perspectives, 120(2), 171–179. https://doi.org/10.1289/ehp.1103515

20.

Hudon

Chouinard

M.-C.

Ellefsen

Beaudin

Hudon

(2023). The experience of pregnant women in contexts of vulnerability of prenatal primary nursing care: A descriptive interpretative qualitative study. BMC Pregnancy and Childbirth, 23(1), Article 187. https://doi.org/10.1186/s12884-023-05474-z

21.

IPCC. (2022). Climate change 2022: Impacts, adaptation and vulnerability. Contribution of working group II to the sixth assessment report of the intergovernmental panel on climate change (H.-O. Pörtner et al., Eds.). Cambridge University Press. https://doi.org/10.1017/9781009325844

22.

Kabir

Habiba

U. E.

Khan

Shah

Rahim

Rios-Escalante

P. R. D.

Farooqi

Z-U-R.

Ali

Shafiq

(2023). Climate change due to increasing concentration of carbon dioxide and its impacts on environment in 21st century; a mini review. Journal of King Saud University-Science, 35(5), Article 102693. https://doi.org/10.1016/j.jksus.2023.102693

23.

Kaya

Keles

Baydili

K. N.

Kaya

Kumru

(2025). Impact of climate change education on pregnant women's anxiety and awareness. Public Health Nursing (Boston, Mass.), 42(1), 54–60. https://doi.org/10.1111/phn.13455

24.

Kuehn

B. M.

(2017). Pregnant women and heat exposure: A public health concern. JAMA, 317(19), Article 1961. https://doi.org/10.1001/jama.2017.5117

25.

Lee

Kim

Park

(2022). Impact of environmental health education on pregnant women's quality of life and self-efficacy. BMC Pregnancy and Childbirth, 22(1), Article 87. https://doi.org/10.1186/s12884-022-04423-6

26.

Lykins

A. D.

Bonich

Sundaraja

Cosh

(2024). Climate change anxiety positively predicts antenatal distress in expectant female parents. Journal of Anxiety Disorders, 101, Article 102801. https://doi.org/10.1016/j.janxdis.2023.102801

27.

Menon

(2024). Urgency of breastfeeding promotion in climate crisis. Journal of Marine Medical Society, 26(3), 450–451. https://doi.org/10.4103/jmms.jmms_136_23

28.

MOH

(2021). Report on heat-related deaths and injuries.

29.

Mohamed

A. H.

Hassan

W. E.

(2024). Effectiveness of an educational program on pregnant women’s knowledge and preventive behaviors related to heat stress in Egypt. Egyptian Journal of Health Education, 40(2), 101–118. https://journals.ekb.eg/article_345831.html

30.

Ngwenya

Oosthuizen

Cross

Frimpong

(2018). Emerging heat-related climate change influences; a public health challenge to health care practitioners and policy makers: Insight from Bulawayo, Zimbabwe. International Journal of Disaster Risk Reduction, 27(2018), 596–601. https://doi.org/10.1016/j.ijdrr.2017.10.012

31.

Ohaeri

J. U.

Awadalla

A. W.

(2009). The reliability and validity of the short version of the WHO quality of life instrument in an Arab general population. Annals of Saudi Medicine, 29(2), 98–104. https://doi.org/10.4103/0256-4947.51790

32.

Özkan

Yikar

S. K.

Nazik

, et al. (2018). Effects of prenatal education on complaints during pregnancy and on quality of life. Journal of Obstetrics, Gynecology & Neonatal Nursing, 47(1), 38–46. https://doi.org/10.1016/j.pec.2018.08.023

33.

Raihan

(2023). A review of the global climate change impacts, adaptation strategies, and mitigation options in the socio-economic and environmental sectors. Journal of Environmental Science and Economics, 2(3), 36–58. https://doi.org/10.56556/jescae.v2i3.587

34.

Rekha

Nalini

S. J.

Bhuvana

Kanmani

Hirst

J. E.

Venugopal

(2024). Heat stress and adverse pregnancy outcome: Prospective cohort study. BJOG: An International Journal of Obstetrics & Gynaecology, 131(5), 612–622. https://doi.org/10.1111/1471-0528.17680

35.

Romanello

Di Napoli

Green

Kennard

Lampard

Scamman

Walawender

Ali

Ameli

Ayeb-Karlsson

Beggs

P. J.

Belesova

Berrang Ford

Bowen

Cai

Callaghan

Campbell-Lendrum

Chambers

Cross

T. J.

Costello

(2023). The 2023 report of the Lancet Countdown on health and climate change: The imperative for a health-centred response in a world facing irreversible harms. Lancet, 402(10419), 2346–2394. https://doi.org/10.1016/S0140-6736(23)01859-7

36.

Shalaby Awad Mahmoud

Hassan Ahmed

Hassan Shamekh Taman

(2023). Knowledge and practices of maternity nurses related to the potential impacts of climate change on women's health. Egyptian Journal of Health Care, 14(2), 960–975. https://doi.org/10.21608/ejhc.2023.309373

37.

Shankar

Hwang

Westcott

J. L.

Saleem

Ali

S. A.

Jessani

Patel

Kavi

Somannavar

M. S.

Goudar

S. S.

Hibberd

P. L.

Derman

R. J.

Hoffman

Wylie

B. J.

Goldenberg

R. L.

Thorsten

V. R.

McClure

E. M.

Krebs

N. F.

(2023). Associations between ambient temperature and pregnancy outcomes from three south Asian sites of the Global Network Maternal Newborn Health Registry: A retrospective cohort study. BJOG: An International Journal of Obstetrics & Gynaecology, 130(Suppl 3), 124–133. https://doi.org/10.1111/1471-0528.17616

38.

T. D. B.

(2024). Quality of life. Retrieved November 20, 2024, from https://wwwncbinlmnihgov/books/NBK536962/

39.

Torre

G. L.

Baer

lice D. P.

Sestili

Cocchiara

R. A.

Barbato

Mannocci

Cimmuto

A. D.

(2023). Knowledge and perception about climate change among healthcare professionals and students: A cross-sectional study. South Eastern European Journal of Public Health, 13(2020). https://doi.org/10.70135/seejph.vi.155

40.

Watts

Amann

Arnell

Ayeb-Karlsson

Belesova

Boykoff

Byass

Cai

Campbell-Lendrum

Capstick

Chambers

Dalin

Daly

Dasandi

Davies

Drummond

Dubrow

Ebi

K. L.

Eckelman

Montgomery

(2019). The 2019 report of The Lancet Countdown on health and climate change: Ensuring that the health of a child born today is not defined by a changing climate. The Lancet, 394(10211), 1836–1878. https://doi.org/10.1016/S0140-6736(19)32596-6

41.

WHO. (1997). WHOQOL-BREF: Arabic version. Mental Health Programme, World Health Organization.

42.

WHO

W.-B.

(1996). Instructions, administration, scoring and generic version of the assessment. WHO. https://www.who.int/publications/i/item/WHOQOL-BREF

43.

Wright

M. L.

Drake

Link

D. G.

Berg

J. A.

(2023). Climate change and the adverse impact on the health and well-being of women and girls from the Women's Health Expert Panel of the American Academy of Nursing. Nursing Outlook, 71(2), Article 101919. https://doi.org/10.1016/j.outlook.2023.101919

44.

Yadav

(2023). Climate change: Impacts, solutions, and the urgent need for action. IJCSPUB-International Journal of Current Scienc (IJCSPUB), 13(1), 797–801. https://rjpn.org/ijcspub/viewpaperforall.php?paper=IJCSP23A1351

The Effect of Nursing Educational Module Regarding Climate Change on Quality of Life and Reported Practices of Women During Pregnancy in Egypt: A Quasi-Experimental Study

Abstract

Introduction

Objective

Method

Results

Conclusion

Keywords

Introduction

Review of the Literature

Method

Tools of Data Collection

Scoring System

Scoring System

Scoring System

Results

Discussion

Strengths of the Research

Limitations of the Research

Implications for Nursing Practice

Conclusion

Footnotes

Acknowledgments

ORCID iD

Ethics Approval and Consent to Participate

Author Contributors

Funding

Declaration of Conflicting Interests

Data Availability

References