Pregnant and Parenting Adolescents: A Study of Ethnic Identity, Emotional and Behavioral Functioning, Child Characteristics, and Social Support

'The way to obtain freedom and equality': Experiences and needs of Thai adolescent mothers in terms of the use smartphone applications for breastfeeding support

BACKGROUND

Breastfeeding brings about a positive impact on both child and maternal health in the short and long terms. However, adolescent mothers have a lower breastfeeding initiation rate and a shorter breastfeeding duration than adult mothers. Although mobile applications have been found to be the most widely used platform for breastfeeding support, there is still a lack of design specific for adolescents.

AIM

To explore the experiences, perspectives and needs of adolescent mothers and professional nurses using smartphone applications for breastfeeding support and the influence of this technology on healthcare in Thailand.

METHODS

This formative qualitative research of the 'Development of smartphone application for promoting breastfeeding and learning of infant responsiveness for Thai teenage pregnant women' study intends to design a smartphone application and develop an implementation plan. A purposive sample was used to elicit experiences from adolescent mothers and nurses. Data were collected from 48 adolescent mothers through in-depth interviews with six focus group discussions and 12 nurses, following the data saturation principle. Thematic analysis was conducted, and potential factors and needs were mapped to the capability, opportunity, and motivation model of behaviour change (COM-B).

RESULTS

Most adolescent mothers perceived the usefulness of smartphone apps as breastfeeding support resources. The qualitative findings of adolescent mothers were grouped into the following three themes: a friendly breastfeeding tool; allows them to manage their breastfeeding activities; and enhances the accessibility and equality of breastfeeding support. The professional nurses perceived the benefits of using smartphone applications in their work, which included the following three themes: reducing workload and making their work easier; preparation is always better; and increasing the standards of breastfeeding support.

CONCLUSION

Adolescent mothers and professional nurses showed favourable attitudes toward smartphone apps for breastfeeding support. These smartphone apps should be tailored to these groups to achieve optimal BF outcomes.

Perception and experiences of adolescent mothers and communities in caring for their preterm babies: findings from an in-depth study in rural Bangladesh

BACKGROUND

A significant concern for Bangladesh is the high prevalence of adolescent pregnancy and the associated negative consequences for mother and baby, including a teen-related increased risk of preterm birth (PTB). Bangladesh also has one of the highest incidences of PTB (19%). Despite these high numbers of adolescent pregnancies and PTB, little is reported about the experiences of adolescent mothers in caring for their preterm babies, and the interventions needed to support them. The aim of this study was to explore gaps and opportunities for improved care for preterm babies among adolescent mothers and communities in rural Bangladesh.

METHODS

We conducted a qualitative study in rural villages of Baliakandi sub-district of Bangladesh. Data collection involved in-depth interviews with adolescent mothers of premature and term babies, adult mothers with premature babies, and family members (n = 36); focus groups with community members (n = 5); and key informant interviews with healthcare providers (n = 13). Adolescent mothers with term and adult mothers with PTBs were included to elicit similarities and differences in understanding and care practices of PTB. A thematic approach was used for data analysis.

RESULTS

We explored two major themes- perceptions and understanding of PTB; care practices and care-seeking for illnesses. We observed gaps and variations in understanding of preterm birth (length of gestation, appearance, causes, problems faced) and care practices (thermal management, feeding, weight monitoring) among all, but particularly among adolescents. Immediate natal and marital-kins were prominent in the narratives of adolescents as sources of informational and instrumental support. The use of multiple providers and delays in care-seeking from trained providers for sick preterm babies was noted, often modulated by the perception of severity of illness, cost, convenience, and quality of services. Health systems challenges included lack of equipment and trained staff in facilities to provide special care to preterm babies.

CONCLUSION

A combination of factors including local knowledge, socio-cultural practices and health systems challenges influenced knowledge of, and care for, preterm babies among adolescent and adult mothers. Strategies to improve birth outcomes will require increased awareness among adolescents, women, and families about PTB and improvement in quality of PTB services at health facilities.

Adverse Childhood Experiences and Complex Post-traumatic Stress in Pregnant Teens: A Pilot Study

INTRODUCTION

Pregnant teens are seen as a group at risk, yet one area that remains understudied is the impact of trauma on their mental health, maternal fetal attachment and pregnancy-related health behavior.

METHODS

A pilot study of urban pregnant teens receiving home visiting services examined trauma exposure, complex traumatic stress, maternal fetal attachment, and health behaviors of pregnancy. The sample (n = 36) was recruited over a period of 20 months from Nurse-Family Partnership of New York City (NFP-NYC) service sites. The teens interviewed completed scales measuring adverse childhood experiences (ACEs), symptoms of complex posttraumatic stress (TSCC), prenatal attachment (MAAS), and pregnancy health behaviors (HPQ-II).

FINDINGS

Over one third of participants reported 4 or more ACEs (36%), and scores on the Trauma Symptom Checklist subscales ranged from a low of 11% for anger to 25% for depression, anxiety and post-traumatic stress. Maternal-fetal attachment was strong and pregnancy health behaviors were positive. The number of ACEs was related to traumatic stress symptoms but not to maternal fetal attachment or health behaviors in pregnancy.

CONCLUSIONS

Pregnant teens with trauma histories could benefit from access to trauma-informed mental health services integrated into the obstetrical or home-visiting services they receive.

Trajectories of Ethnic-Racial Identity and Autonomy Among Mexican-Origin Adolescent Mothers in the United States

This study examined trajectories of ethnic-racial identity (ERI) and autonomy development among Mexican-origin adolescent females in the United States (N = 181; M(age) at Wave 1 = 16.80 years, SD = 1.00) as they transitioned through the first 5 years of parenthood. Trajectories of ERI and autonomy also were examined in relation to psychosocial functioning. Unconditional latent growth models indicated significant growth in autonomy, ERI resolution, and ERI affirmation from middle to late adolescence. Conditional latent growth models indicated that autonomy and ERI exploration growth trajectories were positively associated with psychosocial adjustment. Although adolescent mothers are experiencing transitions that are not normative during adolescence, they also engage in normative developmental processes, and their engagement in such processes is linked with better adjustment.

Predictors of mother-child interaction quality and child attachment security in at-risk families

Child healthy development is largely influenced by parent-child interaction and a secure parent-child attachment is predictively associated with positive outcomes in numerous domains of child development. However, the parent-child relationship can be affected by several psychosocial and socio-demographic risk factors that undermine its quality and in turn play a negative role in short and long term child psychological health. Prevention and intervention programs that support parenting skills in at-risk families can efficiently reduce the impact of risk factors on mother and child psychological health. This study examines predictors of mother-child interaction quality and child attachment security in a sample of first-time mothers with psychosocial and/or socio-demographic risk factors. Forty primiparous women satisfying specific risk criteria participated in a longitudinal study with their children from pregnancy until 18 month of child age. A multiple psychological and socioeconomic assessment was performed. The Emotional Availability Scales were used to measure the quality of emotional exchanges between mother and child at 12 months and the Attachment Q-Sort served as a measure of child attachment security at 18 months. Results highlight both the effect of specific single factors, considered at a continuous level, and the cumulative risk effect of different co-occurring factors, considered at binary level, on mother-child interaction quality and child attachment security. Implication for the selection of inclusion criteria of intervention programs that support parenting skills in at-risk families are discussed.

Applying Intervention Mapping to develop a community-based intervention aimed at improved psychological and social well-being of unmarried teenage mothers in Uganda

Out-of-wedlock pregnancy among adolescents in sub-Saharan Africa is a major concern, because of its association with health, social, psychological, economic and demographic factors. This article describes the development of the Teenage Mothers Project, a community-based intervention to improve psychological and social well-being of unmarried teenage mothers in rural Uganda. We used Intervention Mapping (IM) for systematically developing a theory and evidence-based comprehensive health promotion programme. A planning group consisting of community leaders, teenage mothers, staff of a community-based organization and a health promotion professional was involved in the six steps of IM: needs assessment, programme objectives, methods and applications, intervention design, planning for adoption and implementation and planning for evaluation. The programme includes five intervention components: community awareness raising, teenage mother support groups, formal education and income generation, counselling, and advocacy. The intervention components are based on a variety of theoretical methods, including entertainment education, persuasive communication, mobilization of social networks and social action. In conclusion, IM facilitated the planning group to structure the iterative, bottom-up, participatory design of the project in a real-life setting and to use evidence and theory. The article provides suggestions for the planning of support interventions for unmarried teenage mothers.

A Longitudinal Examination of Support, Self-esteem, and Mexican-origin Adolescent Mothers' Parenting Efficacy

Guided by a risk and resilience framework, this study used a prospective longitudinal, multiple-reporter design to examine how social support from a mother figure during pregnancy interacted with Mexican-origin adolescent mothers' self-esteem to inform their parenting efficacy when their children were 10 months old. Using reports of perceived social support by adolescent mothers (Mage = 16.24, SD =099) and their mother figures (Mage = 40.84, SD = 7.04) in 205 dyads, and controlling for demographic factors (i.e., adolescent age, adolescent nativity, family income, mothers' educational attainment, adolescent-mother coresidence) and adolescents' social support from a significant other, findings indicated that social support during pregnancy was positively associated with adolescent mothers' future parenting efficacy when adolescent mothers had relatively lower self-esteem. Findings were consistent for adolescents' and mothers' reports, and emphasize the value of social support from a mother figure among adolescent mothers with lower self-esteem. Implications for interventions are presented.

Measuring Social Support from Mother-Figures in the Transition from Pregnancy to Parenthood among Mexican-Origin Adolescent Mothers

Social support for adolescent mothers, particularly from mother figures, can buffer risks and promote well-being. To date, no longitudinal research has investigated how the dimensions of social support may change during the transition from pregnancy to parenthood for adolescent mothers. This study examined stability and change in dimensions of social support from the third trimester of pregnancy to two years postpartum among 191 dyads of Mexican-origin adolescent first-time mothers and their mother figures. Perceptions of social support received from a mother figure shifted from a single dimension (i.e., global support) to three distinct factors (instrumental, emotional, and companionship support) during this transition; however, social support provision as reported by mother figures remained stable. Measurement equivalence was established across interview language (English and Spanish) and across two time points postpartum. Bivariate correlations provided support for the convergent and divergent validity of these measures. Implications for future research and practice are discussed.

Coparenting in teen mothers and their children's fathers: evidence from the early childhood longitudinal study-birth cohort

OBJECTIVE

(1) To describe coparenting among adolescent mothers and the biological fathers of their children. (2) To examine the effects of coparenting on young children's social-emotional development and whether these effects vary by father's residence status, parental education, and child characteristics.

METHODS

Secondary analysis was conducted with the Early Childhood Longitudinal Study-Birth Cohort, which is a nationally representative sample of U.S. children born in 2001. The subsample used in this study includes 400 children whose biological mothers, aged 15-19, participated when their children were 2 years and 4 years old and whose biological fathers (residential and nonresidential) participated at 4 years. Cooperative coparenting and coparenting conflict were measured at child age 2 years. Children's social skills and problem behavior were measured at child age 4 years.

RESULTS

Mother- and father-reported coparenting conflict were associated with child behavior problems, more strongly among boys (b = 1.31, P < .01) than girls (b = -0.13, P > .05). Mother-reported coparenting conflict also predicted lower child social skills (b = -1.28, P < .05); the association of father-reported coparenting conflict with social skills was moderated by child race and father education.

CONCLUSIONS

Coparenting conflict between adolescent parents influences child adjustment. Practitioners working with teen mothers should encourage father participation at medical visits and other clinical contacts and should address the relationship between the parents, whether or not they are living together, as part of routine care.

Developing and Testing a Measure of Social Support With Mexican-Origin Pregnant Adolescents and Their Mother Figures

The current study describes the development and psychometric testing of the Global Support From Mother Figure During Pregnancy Scale (GSMF-P). The measure is developed in both Spanish and English to assess social support provided to adolescents during their pregnancies. The current study examines the reliability, cross-language equivalence, and validity of the scale with a sample of 207 pregnant, Mexican-origin adolescents ( M age = 16.2, SD = 0.98) and their mother figures ( M age = 40.9, SD = 7.01). The scale demonstrates strong internal consistency across reporters and language versions. Furthermore, findings provide support for the measurement equivalence of the English and Spanish versions. Finally, all construct validity hypotheses are supported, providing initial evidence that the GSMF-P appears to be assessing the construct of mother figure social support from both adolescents’ and mother figures’ perspectives.

Predictors of Parenting and Infant Outcomes for Impoverished Adolescent Parents

Adolescent mothers and their children are at risk for a myriad of negative outcomes. This study examined risk and protective factors and their impact on a sample (N=172) of impoverished adolescent mothers. Multiple regression analyses revealed that depressed adolescent mothers report higher levels of parenting stress, and that their children are more at risk for maltreatment and are developmentally behind other babies. In addition, adolescent mothers with restricted social support have babies who are at higher risk for maltreatment. Finally, mothers who were older during pregnancy were more likely to stay in school. Implications for program development are discussed.