Validation of the short form of the chinese childbirth self-efficacy inventory in Mainland China

Pre- and postpartum fear of childbirth and its predictors among rural women in China

BACKGROUND

Fear of childbirth (FOC) can influence both maternal and child health. Research on FOC in China is scarce, especially on rural women. This study aimed to assess pre- and postpartum FOC and its predictors among Chinese rural women.

METHODS

This was a prospective correlation study. A total of 569 women completed the prenatal questionnaire in the third trimester, and 477 of them completed the postpartum questionnaire within three days after childbirth. Maternal socio-demographic information, clinical information, childbirth self-efficacy and prenatal and postpartum FOC were investigated. FOC was evaluated using the Wijma Childbirth Expectancy/ Experience Questionnaire (WDEQ). Descriptive, bivariate, multivariate linear regression analysis, univariate and multivariate logistic regression analyses were performed.

RESULTS

The mean pre- and postpartum FOC scores were 64.5 (standard deviation: 25.1) and 64.3 (standard deviation: 23.9), respectively, with 20.8% of women reporting severe fear before childbirth and 18.2% after childbirth. Multivariate linear regression analysis revealed predictors for higher levels of prenatal FOC including higher education level, nullipara, higher monthly household income, lower family support, and lower childbirth self-efficacy (p < 0.05) and the predictors for higher levels of postpartum FOC included unemployed status, lower childbirth self-efficacy, and higher prenatal FOC (p < 0.05). Multivariate logistic regression showed that higher childbirth self-efficacy reduced the likelihood of severe prenatal FOC (OR: 0.99, p < 0.001), while severe prenatal FOC increased the likelihood of severe postpartum FOC (OR: 3.57, p < 0.001).

CONCLUSION

The rural women have high levels of FOC before and after childbirth, with approximately 20% experiencing severe FOC during both periods. Higher education level, nullipara, higher monthly household income, lower family support, and lower childbirth self-efficacy are predictors of heightened prenatal FOC. Unemployed status, lower childbirth self-efficacy, and higher prenatal FOC are predictors of heightened postpartum FOC. Notably, enhancing childbirth self-efficacy emerges as crucial in mitigating severe prenatal FOC, while severe prenatal FOC significantly increases the likelihood of severe postpartum FOC. The development of targeted intervention strategies for the above factors can help reduce women's FOC level and improve their overall pregnancy and childbirth experience.

Mental health, sleep quality, and hormonal circadian rhythms in pregnant women with threatened preterm labor: a prospective observational study

BACKGROUND

Threatened preterm labor (TPL) is an important obstetrical challenge. Pregnant women with TPL may develop psychological and physical problems such as mental health disorders, sleep disturbance, and hormonal circadian rhythm disruption. This study aimed to investigate the current state of mental health, sleep quality, and circadian rhythms of cortisol and melatonin secretion in pregnant women with TPL and normal pregnant women (NPW).

METHODS

A prospective observational clinical study was conducted at a maternal and child health hospital in Fuzhou, China, between June and July 2022. A total of 50 women between 32 and 36 weeks of gestation (TPL group, n = 20; NPW group, n = 30) were recruited. Data on anxiety symptom (Zung's Self-rating Anxiety Scale, SAS), depression symptom (Edinburgh Postnatal Depression Scale, EPDS), subjective sleep quality (Pittsburgh Sleep Quality Index, PSQI) and objective sleep outcomes (measured by actigraphy) of the pregnant women were collected at the time of enrolment. Salivary samples were collected once every 6 h (i.e., at 06:00, 12:00, 18:00, and 00:00) during 2 consecutive days to measure the circadian rhythm of hormone (cortisol and melatonin).

RESULTS

There were no differences found in the total scores of SAS, EPDS scores, subjective sleep quality between the TPL and NPW groups (P > 0.05). In contrast, significant differences were found in sleep efficiency, total sleep time, wake time after sleep onset, and average awakening time between the groups (P < 0.05). The circadian rhythm of melatonin secretion was disrupted in the TPL group (P = 0.350); however, it was maintained in the NPW group (P = 0.044). The circadian rhythm of cortisol secretion was disrupted in both groups (P > 0.05).

CONCLUSIONS

In the third trimester of pregnancy, women with TPL suffer from poorer sleep quality and disruption of circadian rhythm of melatonin secretion compared with NPW. Nevertheless, there were no differences found in mental health (i.e., anxiety and depression) and circadian rhythm of cortisol secretion. Large-scale studies should be conducted to evaluate these changes in women with TPL.

TRIAL REGISTRATION

The study was registered from Chinese Clinical Trial Registry (Number: ChiCTR2200060674) on 07/06/2022.

Anxiety symptoms and health-related quality of life in mainland Chinese pregnant women: a cross-sectional study

OBJECTIVE

Health-related quality of life allows the health care professionals to envisage new axes of improvement in antenatal care and is a core aspect of contemporary maternity care provision. This study aims to estimate the prevalence of anxiety symptoms and explore the relationship between anxiety symptoms and health-related quality of life among Chinese pregnant women.

METHODS

A cross-sectional study was conducted in a local teaching hospital in Guangzhou, China between April and June, 2018. Seven hundred and seventy Chinese pregnant women completed the 36-Item Short-Form Health Survey (SF-36), the Self-rating Anxiety Scale (SAS) and socio-demographic questionnaires.

RESULTS

18.2% women were classified as having elevated anxiety symptoms as evidenced by a SAS score ≥50. Compared with women without anxiety symptoms, the pregnant women with anxiety symptoms had worse physical (SF36-PCS) and mental (SF36-MCS) health-related quality of life and a lower level of seven domains of SF-36 (GH, RP, BP, VT, SF, RE and MH). Elevated anxiety symptoms predicted worse physical (SF36-PCS) and mental (SF36-MCS) health-related quality of life. The third trimester predicted a lower level of physical (SF36-PCS) health-related quality of life, while an unsatisfied relationship with mother-in-law predicted a lower level of mental (SF36-MCS) health-related quality of life.

CONCLUSIONS

The pregnant women with anxiety symptoms had impaired health-related quality of life. Health care professionals should identify pregnant women with anxiety symptoms and facilitate their treatment, which could improve their health-related quality of life.

Translation and Validation of Childbirth Self-Efficacy Inventory into Indonesia

Background. Childbirth self-efficacy is an essential component of mothers in dealing with childbirth. Various studies have supported evidence that mothers who believe in their ability to go through labor are commonly associated with anxiety levels and affect labor outcomes. However, in Indonesia, research on mothers' efficacy in facing childbirth or what is known as Childbirth Self-Efficacy has not been well documented due to the absence of instruments available to measure the concept.  Purpose. This study aimed to produce a Childbirth Self-Efficacy Inventory instrument in the Indonesian version using guidelines from Brislin in the form of translation and back-translation techniques.  Method. Face validity to test the validity of the surface by determining inclusion criteria including mothers with gestational age in the third trimester, maternal age range between 20-35 years, and primiparous mothers. While the reliability test measures internal consistency using Cronbach Alpha. A total of 12 mothers met the predetermined criteria and were willing to be respondents. This study produced A-62 Indonesian versions of the Childbirth Self-Efficacy Inventory through a translation process based on the theoretical framework. There are several sentence revisions to the items described but do not add and remove items—the resulting Alpha coefficient of .98 for all subscales. The results of the study have several limitations and recommendations for further research. Implication for practice. Finding study assist midwives as the primary health care provider for the expectant mother to understand the concept of mother's efficacy of childbirth using the instrument. 

Fear of childbirth and its predictors in re-pregnant women after cesarean section: a cross-sectional multicenter study in China

Background

Since the implementation of China’s two-child policy in 2016, the number of re-pregnant women after cesarean section has increased significantly. These women are more prone to fear of childbirth compared with primiparas due to their history of scarred uterus leading to a more complicated delivery process, which poses a great threat to their physical and mental health. However, there is currently limited research on the problem in China. The aim of this study was to assess fear of childbirth and its predictors in re-pregnant women after cesarean section in China.

Methods

A cross-sectional multicenter study was conducted in three hospitals from June 7 to December 7, 2020, in Changsha, China. Study hospitals were selected using a random sampling technique. Participants were selected using a convenience sampling technique. Three hundred fifty-eight women during the third trimester of pregnancy who were older than 18 years, having a history of CS(s), and not having major physical or mental health problems were included. Fear of childbirth and its predictors were evaluated using the Childbirth Attitude Questionnaire, the short form of the 32-item Chinese Childbirth Self-Efficacy Inventory, the Social Support Rating Scale, and the demographic-obstetric data sheet. After checking for completeness, data were exported to statistical software for analysis. Both univariate analysis and multiple linear regression analysis were computed to assess fear of childbirth and its predictors. Statistical significance was declared at a P-value of < 0.05.

Results

The average score of fear of childbirth was 43.76 (standard deviation = 5.27, range 17–58). Number of cesarean sections, experience with previous cesarean section, childbirth self-efficacy and social support were significantly associated with fear of childbirth (P < 0.05).

Conclusions

In this study, re-pregnant women after cesarean section in China had moderate fear of childbirth, and the number of cesarean sections, experience with previous cesarean section, childbirth self-efficacy and social support were predictors of fear of childbirth. It is important for healthcare professionals to find re-pregnant women after cesarean section at high risk of fear of childbirth and provide appropriate services during pregnancy.

Mindfulness-based intervention in Chinese pregnant women with recurrent miscarriage: A non-randomized controlled study

OBJECTIVE

Pregnant women with recurrent miscarriage have high rates of anxiety and depression. Mindfulness-based interventions have shown benefits in improving mental health in diverse populations; however, few studies have explored their efficacy in pregnant women with recurrent miscarriage, which was investigated in the present study.

DESIGN

A nonrandomized controlled study was carried out from August 2019 to November 2020.

SETTING

The study was conducted at a regional teaching hospital in Guangzhou, China that provides leading care for recurrent miscarriage.

PARTICIPANTS

A total of 158 pregnant women with recurrent miscarriage were recruited and allocated to the intervention group (n = 79) or the control group (n = 79); 131 women completed the study.

INTERVENTION

The mindfulness-based intervention consisted of a 1-h education session and daily mindfulness exercises guided by audio recordings during hospitalization.

MEASUREMENTS AND FINDINGS

Study outcomes included perceived stress measured with the Perceived Stress Scale; symptoms of anxiety and depression measured with the Self-rating Anxiety Scale and Edinburgh Postnatal Depression Scale, respectively; and positive and negative affect measured with the Positive Affect and Negative Affect Scale - Revised, respectively. Compared to the control group, participants in the intervention group showed significant decreases in perceived stress, depression symptoms, and negative affect and an increase in positive affect after the intervention. Anxiety increased significantly in the control group during the study but remained unchanged in the intervention group.

KEY CONCLUSIONS

A mindfulness-based intervention can reduce psychological symptoms and improve mental health in pregnant women with recurrent miscarriage.

IMPLICATIONS FOR PRACTICE

A mindfulness-based intervention should be incorporated into routine care to help improve the mental health of pregnant women with recurrent miscarriage.

The prevalence and predictors of fear of childbirth among pregnant Chinese women: a hierarchical regression analysis

Background

Fear of childbirth (FOC) occurs before, during and after pregnancy and is harmful to both the pregnant woman and the fetus. Identifying the prevalence and predictors of FOC can help us generate strategies for alleviating women’s FOC.

Methods

A cross-sectional study was conducted among a convenience sample of 646 pregnant women receiving antenatal care at a subordinate hospital of a university in China. Data were collected using a basic information form, the Childbirth Attitude Questionnaire, the Childbirth Self-Efficacy Inventory, and the 10-item Connor-Davidson Resilience Scale. The minimum and maximum total scores of the Childbirth Attitude Questionnaire are 16 and 64, respectively, with higher scores reflecting a greater degree of FOC. We conducted hierarchical regression analysis to explore the predictors of FOC and used a structural equation model to further examine the direct and indirect associations between FOC, resilience and childbirth self-efficacy.

Results

The total prevalence of FOC was 67.1%. The percentages of women with mild (score of 28–39), moderate (40–51), and severe FOC (52–64) were 45.4, 19.5, and 2.2%, respectively. The average score on the Childbirth Attitude Questionnaire was 32.49, indicating mild FOC. The final regression analysis revealed six variables predicting FOC that explained 64.5% of the variance in FOC: age, gestational age, parity, spousal support, resilience, and childbirth self-efficacy. Furthermore, childbirth self-efficacy mediated the relationship between resilience and FOC, and the mediation effect rate was 53.5%.

Conclusions

A high prevalence of FOC among pregnant Chinese women was found in this study. Age, gestational age, parity, spousal support, resilience, and childbirth self-efficacy were predictors of FOC. It is suggested that healthcare professionals should pay close attention to FOC and implement targeted interventions in accordance with these predictors, especially resilience and childbirth self-efficacy.

Anxiety, depression and social support across pregnancy in women with a history of recurrent miscarriage: A prospective study

AIM

Women with a history of recurrent miscarriage are a vulnerable population. This study aimed to examine changes and relationships among anxiety, depression and social support across three trimesters of pregnancy in women with a history of recurrent miscarriage.

METHODS

A prospective, longitudinal study was employed. A convenience sample of 166 pregnant women with a history of recurrent miscarriage completed the measures at their 6-12, 20-24 and 32-36 gestational weeks.

RESULTS

The prevalence of anxiety at early, middle and late pregnancy was 47.6%, 36.1% and 32.5%, respectively, whereas that of depression was 38%, 34.3% and 31.3%, respectively. Social support scores increased from early pregnancy to middle pregnancy then remained in late pregnancy. There were correlations among anxiety, depression and social support across pregnancy.

CONCLUSIONS

Anxiety and depression were highly prevalent in pregnant women with a history of recurrent miscarriage, especially in early pregnancy when the level of social support was the lowest. Social support is an essential buffer against anxiety and depression throughout the pregnancy.

Challenges in applying the short Childbirth Self-Efficacy Inventory (CBSEI-C32) in German

INTRODUCTION

This study aimed to review and pilot-test feedback from childbearing women who completed the German short version of the Childbirth Self-Efficacy Inventory (CBSEI-C32), which is widely used and validated in different languages.

METHODS

Ten pregnant nulliparas, who planned a natural childbirth, completed the German CBSEI-C32 and provided comments about the comprehensibility of the tool.

RESULTS

When applying the standardized translated German CBSEI-C32, we discovered that women generally gave positive feedback, and reported that the items made them think about coping strategies for labor and birth. Some pregnant woman had problems in understanding two items: ‘Mich beherrschen’ (original English item: ‘Keep myself in control’), and ‘Mich ruhig halten’ (original English item: ‘Keep myself calm’). Some of the items were not comprehensible for pregnant women and might not represent contemporary concepts of childbirth self-efficacy.

CONCLUSIONS

Two items of the German CBSEI-C32 were interpreted ambiguously by the pilot testers. The CBSEI should be checked to identify which items could serve as the basis for a new questionnaire because there are clear and appropriate coping strategies when dealing with labour pain such as item 3 on breathing. These could be complemented with other coping behaviours that are positively worded and serve to empower rather than restrain women. For measuring self-efficacy beliefs in childbirth nowadays, it appears that health-oriented aspects, such as concentrating on the pauses between contractions or mentally staying in the present moment, are more important for women than focusing on control during childbirth.

COVID-19 associated anxiety enhances tinnitus

To investigate if the anxiety associated with coronavirus disease 2019 (COVID-19) is a promoting factor to tinnitus. A retrospective research design collected from 188 tinnitus patients, was used to compare the clinical characteristics of tinnitus between the patients in 2020 under pandemic pressure and those from the matching period in 2019. While anxiety was quantified using the Zung's Self-rating Anxiety Scale (SAS), tinnitus severity was evaluated using the Tinnitus Handicap Inventory (THI) questionnaire and the test of tinnitus loudness (TL). The assessments were repeated after the sound therapy plus educational counselling (STEC) for 38 patients in 2020 and 58 patients in 2019 and compared with EC alone therapy for 42 patients in 2020 and 17 patients in 2019. A large increase in anxiety was evident in 2020 in both case rate and SAS. The treatment of both methods was less effective in 2020. SAS, THI and TL were all deteriorated after the EC alone treatment in 2020, while an improvement was seen in 2019. This suggests that EC alone could not counteract the stress by COVID-19 at all, and the stress, if not managed well, can significantly increase the severity of tinnitus and associated anxiety. By using the EC subgroup in virtual control, we conclude that anxiety can serve as a promoting factor to tinnitus. We believe that this is the first study report that confirm the causative/promotive role of anxiety on tinnitus during COVID-19 pandemic.

Factors associated with childbirth self-efficacy: a multicenter cross-sectional study in China

OBJECTIVE

Childbirth self-efficacy is an important indicator of a woman's choice of mode of delivery, and has been found to be closely related to adverse perinatal outcomes. This study was conducted to evaluate childbirth self-efficacy and its influencing factors among pregnant Chinese women.

DESIGN

A multicenter cross-sectional study.

METHODS

Pregnant women were recruited by using a convenience sample in four maternal and child healthcare hospitals, one each from four cities in China between May and June 2018. Women with a singleton pregnancy, aged 18 years and older, and able to read and write the Chinese language were included. Trained investigators used a structured self-administrated questionnaire to collect data. EpiData 3.1 was used to prepare the database, and SAS 9.2 was used for statistical analysis. A one-way ANOVA test or independent sample t-tests were used to test the between-group differences in childbirth self-efficacy scores, as appropriate. Multivariate linear regression analyses were conducted to examine childbirth self-efficacy of the pregnant women, and the socio-demographic and obstetric factors that influence childbirth self-efficacy.

FINDINGS

A total of 1,796 pregnant Chinese women with singleton pregnancies were recruited into this study. The average childbirth self-efficacy score of the participants was 14.42 (standard deviation = 2.80); 9.35% of the participants scored ≤ 10 points, while 22.49% got more than 15 points. Multivariate linear regression analysis revealed that higher childbirth self-efficacy was significantly associated with younger age (ß = -0.05, P<0.01), lower body mass index (BMI) (ß = -0.06, P <0.01), receiving prenatal education (ß = 0.47, P <0.01), performing physical activity 6-7 times per week (ß = 0.47, P = 0.03), and fair (ß = 0.57, P <0.01) or good (ß = 1.08, P <0.01) self-rated health status.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Childbirth self-efficacy was low among pregnant Chinese women. Women with older age, higher BMI, and worse self-rated health status had lower childbirth self-efficacy. On the other hand, women who frequently exercised, had some prenatal education, and had better self-rated health showed higher childbirth self-efficacy during pregnancy. Interventions concentrating on improving childbirth self-efficacy in China should focus on prenatal education for expectant mothers, and more attention should be given to pregnant women who are older, obese, are less physically active, and are in poor health.

Validation of the Hong Kong Chinese version of the Support Person's Unmet Needs Survey-Short Form

This study describes the psychometric properties of a Hong Kong Chinese version of the short form of the Support Person's Unmet Needs Survey (SPUNS-SF) for caregivers of patients with cancer. A convenience sample of 280 patient-caregiver dyads was recruited between April and June 2018. A subsample of 70 caregivers completed the survey again, two weeks later. A confirmatory factor analysis (CFA) examined the instrument's factorial structure, ordinal alpha coefficients evaluated the internal consistency, and intra-class correlation coefficients (ICCs) assessed the test-retest reliability. Convergence validity was evaluated by the correlations with sleep disturbance and caregiver burden in caregivers. The Hong Kong Chinese version of the SPUNS-SF (SPUNS-SFHKC) had a high completion rate of 96.8% (271/280) among caregivers. The original five-factor model provided an acceptable fit with the data in the CFA. The ordinal alpha coefficients were 0.866-0.945, and the two-week test-retest reliabilities were 0.524-0.678. The correlations of the five domains of the SPUNS-SFHKC with caregiver burden were 0.257-0.446, and for sleep disturbance were 0.075-0.464. The SPUNS-SFHKC has a suitable factor structure and psychometric properties for use in assessing unmet supportive needs among Chinese caregivers of patients with cancer. The applicability of the instrument for long-term use still needs to be studied.

Anxiety, depression and social support in pregnant women with a history of recurrent miscarriage: a cross-sectional study

Objective: This study aims to investigate the prevalence of anxiety and depressive symptoms and the associations between social support and anxiety/depressive symptoms amongst Chinese pregnant women with a history of recurrent miscarriage. Methods: A cross-sectional study was conducted in Guangzhou, China, between September 2016 and May 2017 with 278 Chinese pregnant women with a history of recurrent miscarriage. Measures included the Self-rating Anxiety Scale (SAS), the Edinburgh Postnatal Depression Scale (EPDS) and the Perceived Social Support Scale (PSSS). Results: The occurrence of anxiety (SAS ≥ 50) and depressive symptoms (EPDS ≥ 13) were 45.0% and 37.0%, respectively. The women reported moderate level of social support. The low and moderate level of social support and education of high school or below were the predictors for anxiety and depressive symptoms. The other predictors for anxiety symptoms were having been married for ≥5 years and no child. Another predictor for depressive symptoms was aged ≥35 years. Anxiety predicted depressive symptoms. Conclusion: The results suggest early routine screening for anxiety and depressive symptoms amongst the Chinese pregnant women with a history of recurrent miscarriage. Health-care professionals should give more effort to enhance these women's social support to decrease their anxiety and depressive symptoms.

The Effect of a Perinatal Breastfeeding Support Program on Breastfeeding Outcomes in Primiparous Mothers

The purpose of this study was to examine the effect of a self-efficacy intervention on primiparous mothers' breastfeeding behaviors. Participants were recruited from an antenatal clinic at a university-affiliated hospital. Seventy-five primiparous mothers were recruited from November 2013 to February 2014 for the control group, and 75 primiparous mothers were recruited from March to June 2014 for the intervention group. The intervention group participated in a 1-hr prenatal breastfeeding workshop and a 1-hr breastfeeding counseling session within 24 hr after delivery. The Breastfeeding Self-Efficacy Scale-Short Form and the infant feeding method were assessed at hospital discharge, as well as 4 and 8 weeks postpartum. The breastfeeding support program was found to be effective and beneficial to mothers. Nurses should incorporate breastfeeding self-efficacy interventions into their routine care to support new mothers and to increase their breastfeeding self-efficacy and the duration of their breastfeeding exclusivity.

The Effect of Childbirth Self-Efficacy on Perinatal Outcomes

OBJECTIVE

To synthesize and critique the quantitative literature on measuring childbirth self-efficacy and the effect of childbirth self-efficacy on perinatal outcomes.

DATA SOURCES

Eligible studies were identified through searches of MEDLINE, CINAHL, Scopus, and Google Scholar databases.

STUDY SELECTION

Published research articles that used a tool explicitly intended to measure childbirth self-efficacy and that examined outcomes within the perinatal period were included. All articles were in English and were published in peer-reviewed journals.

DATA EXTRACTION

First author, country, year of publication, reference and definition of childbirth self-efficacy, measurement of childbirth self-efficacy, sample recruitment and retention, sample characteristics, study design, interventions (with experimental and quasiexperimental studies), and perinatal outcomes were extracted and summarized.

DATA SYNTHESIS

Of 619 publications, 23 studies published between 1983 and 2015 met inclusion criteria and were critiqued and synthesized in this review.

CONCLUSION

There is overall consistency in how childbirth self-efficacy is defined and measured among studies, which facilitates comparison and synthesis. Our findings suggest that increased childbirth self-efficacy is associated with a wide variety of improved perinatal outcomes. Moreover, there is evidence that childbirth self-efficacy is a psychosocial factor that can be modified through various efficacy-enhancing interventions. Future researchers will be able to build knowledge in this area through (a) use of experimental and quasiexperimental design, (b) recruitment and retention of more diverse samples, (c) explicit reporting of definitions of terms (e.g., high risk), (d) investigation of interventions that increase childbirth self-efficacy during pregnancy, and (e) investigation about how childbirth self-efficacy-enhancing interventions might lead to decreased active labor pain and suffering. Exploratory research should continue to examine the potential association between higher prenatal childbirth self-efficacy and improved early parenting outcomes.

Testing direct and moderating effects of coping styles on the relationship between perceived stress and antenatal anxiety symptoms

OBJECTIVE

The objective of this study was to test the direct and moderating effects of different coping styles in mitigating perceived stress associated with antenatal anxiety symptoms among 755 pregnant women in Chengdu.

METHODS

A cross-sectional study using a questionnaire survey was carried out. The Perceived Stress Scale, the Trait Coping Style Questionnaire and the Zung Self-rating Anxiety Scale were used to measure stress, coping and anxiety symptoms, respectively. Hierarchical regression analysis was used to test the direct and moderating effects of coping styles in the relationship between perceived stress and antenatal anxiety symptoms.

RESULTS

Direct effects of negative coping (NC) styles were found. Women with higher NC scores were more likely to have anxiety symptoms. Positive coping (PC) styles had moderating effects on perceived stress, whereas NC styles did not.

CONCLUSION

The findings of this study highlight the direct and moderating effects of coping styles. This knowledge is important to healthcare professionals in planning health service provision. Health services should dedicate resources to teaching pregnant women how to enhance PC styles, alter NC styles and cultivate optimistic thinking to alleviate anxiety symptoms.

The roles of social support in helping chinese women with antenatal depressive and anxiety symptoms cope with perceived stress

A community-based sample of 755 pregnant Chinese women were recruited to test the direct and moderating effects of social support in mitigating perceived stress associated with antenatal depressive or anxiety symptoms. The Social Support Rating Scale, the Perceived Stress Scale, the Edinburgh Depressive Postnatal Scale and the Zung Self-Rating Anxiety Scale were used. Social support was found to have direct effects and moderating effects on the women's perceived stress on antenatal depressive and anxiety symptoms in multiple linear regression models. This knowledge of the separate effects of social support on behavioral health is important to psychiatric nurse in planning preventive interventions.

Development and validation of a social capital questionnaire for adolescent students (SCQ-AS)

Objectives

Social capital has been studied due to its contextual influence on health. However, no specific assessment tool has been developed and validated for the measurement of social capital among 12-year-old adolescent students. The aim of the present study was to develop and validate a quick, simple assessment tool to measure social capital among adolescent students.

Methods

A questionnaire was developed based on a review of relevant literature. For such, searches were made of the Scientific Electronic Library Online, Latin American and Caribbean Health Sciences, The Cochrane Library, ISI Web of Knowledge, International Database for Medical Literature and PubMed Central bibliographical databases from September 2011 to January 2014 for papers addressing assessment tools for the evaluation of social capital. Focus groups were also formed by adolescent students as well as health, educational and social professionals. The final assessment tool was administered to a convenience sample from two public schools (79 students) and one private school (22 students), comprising a final sample of 101 students. Reliability and internal consistency were evaluated using the Kappa coefficient and Cronbach's alpha coefficient, respectively. Content validity was determined by expert consensus as well as exploratory and confirmatory factor analysis.

Results

The final version of the questionnaire was made up of 12 items. The total scale demonstrated very good internal consistency (Cronbach's alpha: 0.71). Reproducibility was also very good, as the Kappa coefficient was higher than 0.72 for the majority of items (range: 0.63 to 0.97). Factor analysis grouped the 12 items into four subscales: School Social Cohesion, School Friendships, Neighborhood Social Cohesion and Trust (school and neighborhood).

Conclusions

The present findings indicate the validity and reliability of the Social Capital Questionnaire for Adolescent Students.

Psychometric properties of the Swedish childbirth self-efficacy inventory (Swe-CBSEI)

BACKGROUND

Previous research has reported that women who are admitted to delivery wards in early labour process before an active stage of labour has started run an increased risk of instrumental deliveries. Therefore, it is essential to focus on factors such as self-efficacy that can enhance a woman's own ability to cope with the first stage of labour. However, there was no Swedish instrument measuring childbirth self-efficacy available. Thus, the aim of the study was to translate the Childbirth Self-efficacy Inventory and to psychometrically test the Swedish version on first- time mothers within the Swedish culture.

METHODS

The method included a forward-backward translation with face and content validity. The psychometric properties were evaluated using a Principal Component Analysis and by using Cronbach's alpha coefficient and inter-item correlations. Descriptive statistics and non-parametric tests were used to describe and compare the scales. All data were collected from January 2011 to June 2012, from 406 pregnant women during the gestational week 35-42.

RESULTS

The Swedish version of the Childbirth Self-Efficacy Inventory indicated good reliability and the Principal Component Analysis showed a three-component structure. The Wilcoxon Signed-Ranks Test indicated that the women could differentiate between the concepts outcome expectancy and self-efficacy expectancy and between the two labour stages, active stage and the second stage of labour.

CONCLUSIONS

The Swedish version of Childbirth Self-efficacy Inventory is a reliable and valid instrument. The inventory can act as a tool to identify those women who need extra support and to evaluate the efforts of improving women's self-efficacy during pregnancy.

Cultural adaptation and psychometric testing of the short form of Iranian childbirth self efficacy inventory

Background:

To assess maternal confidence in her ability to cope with labor, a measure of childbirth self efficacy is necessary.

Objectives:

This paper aims to assess the cultural adaptation and psychometric testing of the short form of childbirth self-efficacy Inventory among Iranian pregnant women.

Patients and Methods:

In this descriptive-methodological study, we investigated 383 Iranian pregnant women in the third trimester. They were recruited from the outpatient prenatal care clinic of Taleghani Hospital and an urban health center from August to November 2011. Content validity was evaluated by a panel of specialists after adding two religious items. The women completed the inventory and the demographic characteristics questionnaire in an interview room. The internal consistency and construct validity were assessed by Cronbach’s alpha and by exploratory and confirmatory factor analyses, respectively. Known group analysis on gravity assessed the discriminant validity of the measure.

Results:

Content validity of the short form of the Iranian childbirth self-efficacy Inventory was confirmed. Factor analyses supported the conceptual two-factor structure of measure and hence supported its construct validity. The internal consistency was approved for the total scale and both subscales. The instrument differentiated prim gravid from multigravida women in the total scale and the efficacy expectancy subscale.

Conclusions:

Validity and reliability of the measure supports the use of the short form of the instrument as a clinical and research instrument in measuring childbirth self-efficacy among Iranian pregnant women.

Self-efficacy beliefs and fear of childbirth in nulliparous women

OBJECTIVE

To explore how childbirth self-efficacy, i.e. outcome expectancy and efficacy expectancy, was associated with fear of childbirth (FOC) and how efficacy expectancy and FOC, respectively were related to socio-demographic characteristics, mental problems and preference for a caesarean section.

METHODS

In this cross-sectional study, a consecutive sample of 1000 pregnant nulliparous women was sent the Wijma Delivery Expectancy Questionnaire and Childbirth Self-Efficacy Inventory. Statistical analyses were performed on data from 423 women.

RESULTS

Outcome expectancy and efficacy expectancy correlated significantly and positively, FOC correlated significantly and negatively with both outcome expectancy and efficacy expectancy. Women with severe FOC (20.8%) had a significantly lower level of education (p = 0.001), and had more often sought help because of mental problems (p = 0.004). They were more likely to have low-efficacy expectancy (p < 0.001) and to prefer a caesarean section instead of a vaginal birth (p < 0.001).

CONCLUSIONS

Lower efficacy expectancy was associated with higher FOC while preference for a caesarean section was not. Improvement of self-efficacy could be a part of care for women with FOC during pregnancy; however, it would not be enough for fearful women who wish to have a caesarean section.