Enhancing first-time parents' self-efficacy: A systematic review and meta-analysis of universal parent education interventions' efficacy

Factors affecting parental role adaptation in parents of preterm infants after discharge: a cross-sectional study

Background

Parenting a preterm infant can be incredibly challenging and stressful, particularly in the first year after discharge. Desirable parental role adaptation leads to appropriate parenting behaviors and parent-infant interaction, which are essential to child health and development.

Aim

To investigate the level of parental role adaptation and its influencing factors among parents of preterm infants in the first year after hospital discharge according to Belsky's parenting process model among parents of preterm infants in the first year after hospital discharge.

Methods

A cross-sectional study design was adopted using convenience sampling. Data were collected using the Parental Role Adaptation Scale (PRAS) in parents with preterm infants, the Perceived Social Support Scale (PSSS), the Coping Adaptation Processing Scale (CAPS-15), and a sociodemographic questionnaire. Descriptive statistics, non-parametric tests, Spearman correlation analyses, and multivariate linear regression were used to analyze the data.

Results

In total, 300 Chinese parents were included in the analysis. In the multivariate analysis, first-time parent (p = 0.003), master's degree and above (p = 0.042), coping adaptation processing (p = 0.000), residence location (towns: p = 0.019, city: p = 0.028), monthly family income (6000-10,000: p = 0.000, >10,000: p = 0.000), and perceived social support (p = 0.001) were all significant predictors of parental role adaptation and collectively accounted for 56.8% of the variation in parental role adaptation of parents with preterm infants (F = 16.473, p < 0.001). Coping adaptation processing mediated the relationship between perceived social support and parental role adaptation (95% bootstrap CI = 0.022, 0.130).

Conclusion

Chinese parents of preterm infants experience a moderate level of parental role adaptation when their child is discharged from the hospital to home. Parents who are not first-time parents, have master's degrees or above, live in towns or cities, have higher coping and adaptation abilities, have high monthly family income, and greater perceived social support have a higher level of parental role adaptation. Healthcare providers should pay more attention to parents with low socioeconomic status and encourage them to improve their coping and adaptation abilities and to utilize their formal and informal social support networks.

Infant neurodevelopment during the COVID-19 pandemic: Associations with maternal pandemic-related experiences, parenting stress, and self-efficacy

BACKGROUND

Although pandemic-related experiences have been linked to the psychological well-being of mothers, the effects of the COVID-19 pandemic on infant neurodevelopmental outcomes have not been sufficiently studied.

AIMS

To assess whether maternal COVID-19-related experiences (i.e., COVID-19-related health, risk, resource worries, and feelings of grief), parenting stress, and maternal self-efficacy are associated with infant neurodevelopment as measured by the Ages and Stages Questionnaire, Third Edition (ASQ-3) maternal report when infants were between 8 to 10 months of age. Furthermore, this study examined the moderating effect of maternal self-efficacy between maternal COVID-19-related experiences and infant neurodevelopment.

METHODS

This cross-sectional study included 122 women who were drawn from the Perinatal Experiences and COVID-19 Effects (PEACE) Study, with online surveys administered between November 2020 and August 2022.

RESULTS

After controlling for maternal anxiety and depression symptoms and demographic factors, hierarchical regression analysis indicated that parenting stress showed no effect on ASQ-3 scores. However, more adverse COVID-19-related experiences and higher levels of maternal self-efficacy were associated with better infant neurodevelopment. Moreover, there was a significant interaction effect between maternal self-efficacy and COVID-19-related experiences on infant neurodevelopment. For mothers with moderate to high levels of self-efficacy, more adverse COVID-19-related experiences were associated with better infant neurodevelopment. For mothers with low levels of self-efficacy, more adverse COVID-19-related experiences were associated with poorer developmental outcomes in infants.

CONCLUSIONS

Under adverse conditions, confidence in caregiving may afford more optimal infant neurodevelopment. Interventions aimed at fostering maternal self-efficacy and addressing specific stressors can be valuable in promoting positive developmental trajectories for infants born during the pandemic.

Effects of digital parenting interventions on self-efficacy, social support, and depressive symptoms in the transition to parenthood: A systematic review and meta-analysis

BACKGROUND

Parenting self-efficacy is essential for the transition to parenthood. As digital parenting educational interventions are rapidly being developed, their effects have not been examined by pooling available randomized controlled trials (RCTs).

OBJECTIVES

To comprehensively investigate the effects of digital educational interventions on parents' self-efficacy, social support, and depressive symptoms in the first year after childbirth and identify the significant associated factors.

METHODS

This study searched six electronic databases for relevant RCTs examining the efficacy of digital parenting interventions from inception to September 2022. The studied outcomes included changes in parent's self-efficacy, social support, and depressive symptoms observed after participating in a digital parenting program. The random-effects model was used to pool results. Subgroup and moderator analyses were performed.

RESULTS

In total, seven RCTs enrolling 1342 participants were included. The parents who received digital parenting interventions had higher parenting self-efficacy (standardized mean difference [SMD]: 1.06, 95 % confidence interval [CI]: 0.40-1.71, p =.002) and social support (SMD: 2.72, 95 % CI: 0.38-5.07, p =.02) and decreased depressive symptoms at 3 months postpartum (SMD: -0.39, 95 % CI: -0.73 to - 0.04, p =.03). Providing the interventions for ≥ 6 weeks (SMD: 1.62, 95 % CI: 1.18-2.06, p <.001), providing in-person orientation (SMD: 1.88, 95 % CI: 1.32-2.44, p <.001), including a guided curriculum (SMD: 2.00, 95 % CI: 1.78-2.22, p <.001), and conducting interventions in Organisation for Economic Co-operation and Development countries (SMD: 1.98, 95 % CI: 1.78-2.19, p <.001) were identified as significant moderators.

CONCLUSIONS

Digital parenting interventions significantly increase parenting self-efficacy and social support as well as alleviate depressive symptoms for parents during their first year after childbirth. Such interventions can be beneficial for parents who prefer online education. Future studies investigating the long-term effects of these interventions are warranted.

REGISTRATION

The protocol for this systematic review and meta-analysis is registered in PROSPERO (registration number: CRD42021243641).

Instrument development and an intervention to increase parents' self-efficacy regarding their infant's sleep

OBJECTIVE

Many Swedish parents experience that their infant has sleeping problems. Parents' self-efficacy regarding their infants' sleep may play an important role in how they perceive these problems. This pilot study aimed to develop an instrument measuring parents' self-efficacy regarding their infant's sleep and to examine if parents' self-efficacy was affected by an intervention focusing on parental education.

METHOD

Mothers and fathers, at a maternity unit in Sweden, were drawn into either an intervention (n = 46) or a control (n = 42) group. The intervention group received a home visit from a nurse who provided information about infant sleep; the importance of attachment; and advice regarding sleep, breastfeeding and bed sharing, including guidelines for safe bed sharing. Three months later, the participants answered questions on background data, breastfeeding, sleep and self-efficacy.

RESULTS

The 11-item two-factor Uppsala Parental Self-Efficacy about Infant Sleep Instrument (UPPSEISI) was constructed to measure parents' perceived self-efficacy. In adjusted analyses, being in the intervention group was associated with a higher self-efficacy (P = 0.035), as were being a mother (P = 0.003) and being satisfied with one's own sleep (P = 0.007), while parents' own sleeping problems were associated with a lower self-efficacy (P = 0.015).

CONCLUSION

Importantly, parental education may increase parents' self-efficacy regarding their infant's sleep.

Supporting the transition to parenthood: a systematic review of empirical studies on emotional and psychological interventions for first-time parents

OBJECTIVES

The transition to parenthood can evoke a range of concerns in parents, profoundly impacting their psychological well-being. The literature regarding the transition to parenthood focuses primarily on functional aspects of parenthood, generally overlooking the psychological well-being of parents.

METHOD

This comprehensive review synthesized studies describing emotional and psychological interventions during the transition to parenthood among participants between 2013 and 2022. A rigorous screening process, conducted by three of the authors, resulted in 18 studies that met the inclusion criteria.

RESULTS

This report provides detailed descriptions of these studies, including their characteristics, demographics, types of interventions, and main outcomes. The majority of interventions focused on mothers and mother-infant dyads, with fewer interventions targeting couples, and none addressing fathers or father-infant dyads.

CONCLUSIONS

The interventions examined were found to be effective in reducing symptoms such as depression, anxiety, and stress among mothers and had positive effects on infants' behaviors, mother-infant synchrony, and co-parenting.

PRACTICE IMPLICATIONS

This review stresses the necessity of interventions targeting the transition to parenthood, especially among fathers and marginalized populations, as well as serves to identify barriers faced by vulnerable and minority populations.

Family Nursing Care during the Transition to Parenthood: A Scoping Review

BACKGROUND

Family-centered care places the family at the core of care, with family nurses playing a pivotal role in supporting and guiding members through pregnancy and the transition to parenthood and acknowledging the significant adjustments during these phases.

AIM

To map the evidence concerning family nurses' care for families during the transition to parenthood.

METHOD

The scoping review followed the Joanna Briggs Institute (JBI) methodology, focusing on family-centered care during pregnancy adaptation and the initial months of parenthood. Using a PCC (population, concept, and context) strategy, the research covered various databases: Scopus; Web of Science; and CINAHL Complete, MedLine Complete, and MedicLatina by EBSCOhost.

RESULTS

A Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) flow diagram was used to present the results. Eighteen articles were included, mainly from the Middle East and Europe, including cross-sectional studies and reviews. Key findings addressed the transitioning process to parenthood, the impact of family characteristics, and the role of family nurses in enhancing these processes.

CONCLUSION

Home care is considered vital during this transition. Family nursing should concentrate on both individuals and the parental subsystem, addressing social determinants equitably. Through these efforts, they empower families to establish an optimal environment for children's development.

First-Time Parents' Support Needs and Perceived Support From a Child Health Service With the Integrated New Families Home Visiting Programme

The transition to parenthood is complex and influenced by interacting factors related to society, the parents and the child. Professional support is considered to be one of the societal factors affecting this transition by facilitating parents' sense of confidence and their competence as parents. In this study, we aimed to explore first-time parents' support needs and experiences of support from a child health service with the integrated New Families home visiting programme, in the context of their transition to parenthood in the first year postnatally. Interpretive description guided this qualitative study. Six couples and one mother, all well-educated and employed, were interviewed individually (N = 13). The parents were recruited from the research project 'New Families - Innovation and Development of the Child Health Service in Oslo'. We found that being a first-time parent is perceived as overwhelming and that defining support needs may be challenging, particularly in the first period postnatally. In addition, the support needs are constantly changing due to the complexity of interacting factors and the ongoing development of confidence in the parental role. Retrospectively, the parents were satisfied overall with the support from the child health service. The home visit during pregnancy facilitated management and relational and informational continuity. However, we identified a need for even more proactive information provision and communication to optimise the service's availability and efficiency postnatally. In addition, the importance of peers and of approaching both mothers and fathers must be acknowledged in facilitating parental confidence.

Association of parental self-efficacy with loneliness, isolation and community commitment in mothers with infant children in Japan: a cross-sectional study

OBJECTIVES

Parental self-efficacy is defined as an individual's appraisal of their competence in the parental role and is one of the factors targeted by parenting interventions. Factors related to parental self-efficacy among mothers, focusing mainly on individual and family characteristics, have been clarified; however, there are limited findings on community/societal factors related to parental self-efficacy among mothers. We aimed to clarify the association between parental self-efficacy and community/societal factors among mothers with infants and toddlers to provide suggestions for maternal and child health activities.

DESIGN

This was a cross-sectional study, where an anonymous, self-administered questionnaire survey was conducted by mail from November 2019 to February 2020.

SETTING

A health and welfare centre in a ward certified by the largest designated city in Japan.

PARTICIPANTS

Six hundred forty-nine mothers raising children aged 0-3 years who attended mandatory infant health check-ups.

PRIMARY OUTCOME MEASURES

The Parental Self-Efficacy Scale.

RESULTS

The number of valid responses was 490 (valid response rate: 75.6%). The mean age of the mothers was 33.2 (SD 4.9) years. The items found to significantly relate to parental self-efficacy (p<0.05), loneliness, social isolation (social network), community commitment, greeting neighbours, willingness to interact with neighbours, participation in parent-child circles and neighbourhood association events were included as independent variables. Multiple regression analysis showed that the factors significantly related to high parental self-efficacy were low loneliness score (β=-0.436, p<0.001), high social network score (β=0.153, p<0.001) and high community commitment score (β=0.110, p<0.01). The adjusted R2 was 0.488.

CONCLUSIONS

The results suggest the importance of community-building, enhancing qualitative and quantitative support by developing initiatives to reduce loneliness and improving the environment to supplement social networks, and activating community activities by promoting interaction with local residents.

The association between perceived social support and parenting self-efficacy among parents of children aged 0-8 years

Strengthening social support has been recognized as a potentially effective strategy to enhance parenting self-efficacy, but empirical evidence is limited. This study examined the association between perceived social support and parenting self-efficacy.Data of 647 parents of children aged 0-8 years, gathered in the CIKEO cohort study in the Netherlands, were analysed. Data were collected between October 2017 and December 2019. Multivariable linear regression models were used to examine the association between social support and parenting self-efficacy. The mean age of the participants was 33.8 years (SD = 4.9); 94.9% mothers. At the start of the study, 15.1% parents perceived low to moderate social support. Parents who experienced lower levels of social support at the start of the study reported lower parenting self-efficacy at follow-up (β: 0.13; 95% CI: 0.05, 0.21), independent of potential socio-demographic confounders. Experiencing an increase in perceived social support during the study period was associated with an increase in parenting self-efficacy (β: 0.15; 95% CI: 0.10, 0.21). Our findings indicate perceived social support is associated with parenting self-efficacy among parents of children aged 0-8 years. Future longitudinal studies need to confirm our findings and may examine which social support interventions are effective in strengthening parenting self-efficacy.

Parental Knowledge and Perceptions on Prevention of Sudden Unexpected Infant Death and Infant Care

(1) Background: The study's purpose was to explore the knowledge, perceptions, and confidence of mothers about infant care to reduce the risk of sudden unexpected infant death. (2) Methods: A purposeful sampling method was used to recruit 15 first-time mothers from Georgia with infants under 1 year of age. The researchers utilized the Socio-ecological model to report the results. Participants also provided recommendations on how to improve infant care and reduce the risk of SUID. (3) Results: The confidence level of infant care among most participants was low but increased over time. Mothers' knowledge level about the prevention of SUID was high, but poor emotional health could hurt their parental abilities. Most participants recognized medical providers as the main source of reliable information. However, a lack of emotional and physical support was reported by mothers. (4) Conclusions: Results suggested that a more holistic approach to infant care is needed. The healthcare system and communities should provide more physical, social, and mental support to first-time mothers, a consolidated approach to care before and after birth, and easy access to services at all stages of the process to reduce the risk of SUID.

Maternal Self-Efficacy as a Mediator in the Relationship Between Postpartum Depression and Maternal Role Competence: A Cross-Sectional Survey

INTRODUCTION

This study aimed to (1) examine the relationships among postpartum depression, maternal self-efficacy, and maternal role competence, and to (2) test whether maternal self-efficacy mediates the relationship between postpartum depression and maternal role competence.

METHODS

Using a cross-sectional design, we conveniently sampled 343 postpartum mothers from 3 primary health care facilities in Eswatini. Data were collected using the Edinburgh Postnatal Depression Scale, Maternal Self-Efficacy Questionnaire, and Perceived Competence Scale. Multiple linear regression models and structural equation modeling were performed in IBM SPSS and SPSS Amos to examine the studied associations and to test the mediation effect.

RESULTS

The participants were aged 18 to 44 (mean, 26.4; SD, 5.86) years, and the majority were unemployed (67.1%), had an unintended pregnancy (61.2%), received education during antenatal classes (82.5%), and fulfilled the cultural norm of the maiden home visit (58%). Adjusting for covariates, postpartum depression was negatively associated with maternal self-efficacy (β = -.24, P < .001) and maternal role competence (β = -.18, P = .001), whereas maternal self-efficacy was positively associated with maternal role competence (β = .41, P < .001). In the path analysis, postpartum depression only related to maternal role competence indirectly through maternal self-efficacy (β = -.10, P = .003).

DISCUSSION

High maternal self-efficacy was associated with high maternal role competence and fewer postpartum depression symptoms, suggesting that improving maternal self-efficacy may help reduce postpartum depression and may improve maternal role competence.

Climate change knowledge influences attitude to mitigation via efficacy beliefs

Theories proposing climate change apathy is explained by inadequate knowledge do not account for why many informed and concerned Americans fail to act. While correlations between knowledge, efficacy for climate change, and attitude to mitigation have been observed, few studies have examined efficacy for climate change as a mediator. This study aimed to investigate the influence of specific climate change knowledge on attitude to mitigation via efficacy beliefs. A cross-sectional survey of 205 US adults recruited from Amazon's Mechanical Turk assessed participants' climate change knowledge, efficacy for climate change, and attitude to mitigation. Indirect effects of self-efficacy for climate change were observed in three mediation models, suggesting efficacy for climate change explains some of the relationship between specific climate change knowledge and attitude to mitigation. The findings suggest risk communication can motivate pro-environmental attitudes with interventions that deliver information about climate change and develop efficacy for mitigation behavior.

Effects of a Mobile-Based Intervention for Parents of Children With Crying, Sleeping, and Feeding Problems: Randomized Controlled Trial

BACKGROUND

Excessive crying, sleeping, and feeding problems in early childhood are major stressors that can result in parents feeling socially isolated and having low self-efficacy. Affected children are a risk group for being maltreated and developing emotional and behavioral problems. Thus, the development of an innovative and interactive psychoeducational app for parents of children with crying, sleeping, and feeding problems may provide low-threshold access to scientifically based information and reduce negative outcomes in parents and children.

OBJECTIVE

We aimed to investigate whether following the use of a newly developed psychoeducational app, the parents of children with crying, sleeping, or feeding problems experienced less parenting stress; gained more knowledge about crying, sleeping, and feeding problems; and perceived themselves as more self-effective and as better socially supported and whether their children's symptoms decreased more than those of the parents who did not use the app.

METHODS

Our clinical sample consisted of 136 parents of children (aged 0-24 months) who contacted a cry baby outpatient clinic in Bavaria (Southern Germany) for an initial consultation. Using a randomized controlled design, families were randomly allocated to either an intervention group (IG; 73/136, 53.7%) or a waitlist control group (WCG; 63/136, 46.3%) during the usual waiting time until consultation. The IG was given a psychoeducational app that included evidence-based information via text and videos, a child behavior diary function, a parent chat forum and experience report, tips on relaxation, an emergency plan, and a regional directory of specialized counseling centers. Outcome variables were assessed using validated questionnaires at baseline test and posttest. Both groups were compared at posttest regarding changes in parenting stress (primary outcome) and secondary outcomes, namely knowledge about crying, sleeping, and feeding problems; perceived self-efficacy; perceived social support; and child symptoms.

RESULTS

The mean individual study duration was 23.41 (SD 10.42) days. The IG reported significantly lower levels of parenting stress (mean 83.18, SD 19.94) after app use compared with the WCG (mean 87.46, SD 16.67; P=.03; Cohen d=0.23). Furthermore, parents in the IG reported a higher level of knowledge about crying, sleeping, and feeding (mean 62.91, SD 4.30) than those in the WCG (mean 61.15, SD 4.46; P<.001; Cohen d=0.38). No differences at posttest were found between groups in terms of parental efficacy (P=.34; Cohen d=0.05), perceived social support (P=.66; Cohen d=0.04), and child symptoms (P=.35; Cohen d=0.10).

CONCLUSIONS

This study provides initial evidence of the efficacy of a psychoeducational app for parents with child crying, sleeping, and feeding problems. By reducing parental stress and increasing knowledge of children's symptoms, the app has the potential to serve as an effective secondary preventive measure. Additional large-scale studies are needed to investigate long-term benefits.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00019001; https://drks.de/search/en/trial/DRKS00019001.

First-time parents' experiences related to parental self-efficacy: A scoping review

Becoming a parent for the first time is a major transition, and parental self-efficacy (PSE) is considered an important predictor of parenting functioning. We aimed to describe and synthesize qualitative studies that explore first-time parents' experiences related to PSE in the transition to parenthood in the first-year postpartum. We conducted a scoping review in accordance with international guidelines. The main search strategy consisted of searches in six electronic databases. We selected studies based on predetermined inclusion and exclusion criteria, extracted data, and conducted a descriptive qualitative thematic analysis. We included 58 studies (presented in 61 reports) with 1341 participants from 17 countries. Most of the participants (89%) were mothers, and a third of the studies were task-specific regarding breastfeeding. The thematic analysis of the findings concerning PSE revealed five main, interconnected themes: culture-factors in society and the healthcare services; parents-processes within the parents; tasks-different parental tasks; support-parents' perceived support from professionals, peers, friends, family, and partner; and child-the child's well-being and feedback. This scoping review describes qualitative studies on first-time parents' experiences related to PSE. The findings inform future studies of PSE and clinical practice by confirming the importance of PSE in the transition to parenthood, the complexity of different factors that may have an impact, and the centrality of breastfeeding in PSE. Based on these findings, we suggest that a full systematic review with quality assessment would be appropriate.

Strengthening parental self-efficacy and resilience: A within-subject experimental study with refugee parents of adolescents

Post-migration stress and parenting adolescents can reduce parental self-efficacy. This study tested the effects of strengthening parental self-efficacy in refugee parents of adolescents and whether this makes parental self-efficacy less impacted by post-migration stressors. Using a within-subject experimental design, experience sampling data were collected in 2019 from 53 refugee parents of adolescents (M_age  = 39.7, SD_age  = 5.59, 73% Syrian, 70% mothers) in the Netherlands. Data were analyzed by dynamic structural equation modeling using interrupted time-series analysis. The single-session personalized intervention strengthened parental self-efficacy (small effect: between case standardized mean difference = 0.09) and made refugee parents less vulnerable to post-migration stressors. Findings suggest that parental self-efficacy is malleable and strengthening it fosters refugee parents' resilience. Replications with longer-term follow-ups are needed.

Universal Intervention to Strengthen Parenting and Prevent Child Maltreatment: Updated Systematic Review

Child maltreatment is a severe worldwide public health problem because of its negative consequences and should therefore be prevented through parenting programs to improve parental behavior and practices. The present review aimed to update a published review of 5 years of empirical studies on universal parenting programs to strengthen positive parenting and prevent child maltreatment. A systematic search of the PubMed, Web of Science, PsycINFO, Lilacs, and SciELO databases was performed to identify the studies of group-based structured parenting programs published from 2015 to 2019. Eighteen studies were found that fulfilled the inclusion and exclusion criteria. The results showed that 14 different parenting programs were conducted in high-, medium-, and low-income countries, showing an increase in the number of studies in low-income countries compared with the previous review. In 89% of the studies, the parenting outcomes improved in the post-intervention. Additionally, studies have demonstrated that these programs also improved other parental outcomes such as mental health, couple relationships, coparenting, and coping ability of parents. From 18 studies, nine child variables were evaluated, and eight of them showed a decrease in behavior problems. Regarding the methodological quality of the studies, 55%, 28%, and 17% were classified as moderate, weak, and strong, respectively. In conclusion, the positive changes in parenting and child behavior outcomes encourage the implementation of parenting programs as a universal prevention strategy. Further research should increase the methodological quality of the design study.

Child Welfare Reform: A Scoping Review

While there have been ongoing calls to reform child welfare so that it better meets children's and families' needs, to date there have been no comprehensive summaries of child welfare reform strategies. For this systematic scoping review, we summarized authors' recommendations for improving child welfare. We conducted a systematic search (2010 to 2021) and included published reviews that addressed authors' recommendations for improving child welfare for children, youth, and families coming into contact with child welfare in high-income countries. A total of 4758 records was identified by the systematic search, 685 full-text articles were screened for eligibility, and 433 reviews were found to be eligible for this scoping review. Reviews were theoretically divided, with some review authors recommending reform efforts at the macro level (e.g., addressing poverty) and others recommending reform efforts at the practice level (e.g., implementing evidence-based parenting programs). Reform efforts across socioecological levels were summarized in this scoping review. An important next step is to formulate what policy solutions are likely to lead to the greatest improvement in safety and well-being for children and families involved in child welfare.

Effects of health promotion program on maternal attachment, parenting self-efficacy, infant development: a randomised controlled trial

This study was designed to test the efficacy of the health promotion program used on maternal-infant attachment, parental self-efficacy, infant development. For this experimental study parallel-group randomised control design was used. Data was collected from 64 mother and their infants. The intervention group received the health promotion program in addition to standard care, the control group received only the standard care. Family Information Form, Prenatal Attachment Inventory, Maternal Attachment Inventory, Parenting Self-Efficacy Scale, and Denver II Developmental Screening Tests were used for the collection of the data. Pearson χ2 test, Yates corrected χ2 test, independent t-test, and Mcnemar test were used for analysing the collected data. The groups on maternal-infant attachment (d:1.20 [CI:0.671-1.736]), parental self-efficacy (d:1.37 [CI:0.835 to 1.925]), and development delays of infants (p = .003, C.V: 0.41) were found to be statistically significant. Health promotion program positively influenced the maternal attachment, parental self-efficacy, the development of the infants.IMPACT STATEMENTWhat is already known on this subject? Pregnancy and postpartum is a difficult period for mothers. Mothers need support. Parenting self-efficacy and maternal attachment are important for improving infant health. Infant should be supported to prevent developmental delays.What do the results of this study add? With the education and support program applied before and after birth, mother and baby were evaluated together and multi-faceted support was provided.What are the implications of these findings for clinical practice and/or further research? Supporting parenting self-efficacy, maternal attachment and infant development should be started during pregnancy and should be continued in the postpartum period.

Maternity care during a pandemic: Can a hybrid telehealth model comprising group interdisciplinary education support maternal psychological health?

Background

The transition to parenthood is one of the most challenging across the life course, with profound changes that can impact psychological health. In response to the coronavirus disease 2019 (COVID-19), came the rapid implementation of remote antenatal care, i.e., telehealth, with fewer in-person consultations. A change in service delivery in addition to the cancellation of antenatal education represented a potential threat to a woman’s experience – with likely adverse effects on mental health and wellbeing.

Aim

To explore a hybrid model of pregnancy care, i.e., telehealth and fewer in-person health assessments, coupled with concurrent small group interdisciplinary education delivered via video conferencing, extending into the postnatal period.

Methods

Using a quasi-experimental design with an interrupted time series and a control group, this population-based study recruited low-risk women booking for maternity care at one community health site affiliated with a large public hospital in Victoria, Australia.

Findings

Whilst there was no difference in stress and anxiety scores, a significant interactive effect of the hybrid model of care with time was seen in the DASS depression score (−1.17, 95% CI: −1.81, −0.53) and the EPDS (−0.83, 95% CI: −1.5, −0.15).

Discussion

The analyses provide important exploratory findings regarding the positive effects of a hybrid model of care with interdisciplinary education in supporting mental health of first-time mothers.

Conclusion

This study demonstrates that small group online education scheduled in conjunction with individual pregnancy health assessments can be executed within a busy antenatal clinic with promising results and modest but dedicated staff support.

Effectiveness of mobile application-based perinatal interventions in improving parenting outcomes: A systematic review

Objective

Parents face many challenges during the perinatal period and are at risk for mental health issues, especially during the current coronavirus (COVID-19) pandemic. Mobile application-based interventions can help parents to improve their psychosocial well-being in a convenient and accessible manner. This review aims to examine the effectiveness of mobile application-based perinatal interventions in improving parenting self-efficacy, anxiety, and depression (primary outcomes), as well as stress, social support, and parent-child bonding (secondary outcomes) among parents.

Methods

Seven electronic databases (PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus, and ProQuest Thesis and Dissertations) were searched from their respective inception dates until August 2021. The Cochrane Risk of Bias-2 tool was used to conduct quality appraisals. Results were narratively synthesized due to the high heterogeneity of intervention and participant types.

Findings

A total of 6164 articles were retrieved from the seven electronic databases and citation searching. After excluding duplicate records and irrelevant titles/abstracts, 105 full texts were examined. Full-text screening excluded another 93 articles, leaving 12 included studies in this review. All studies were rated as having some concerns or a high overall risk of bias. Mobile application-based interventions were found to be feasible and promising in improving parents’ overall well-being post-intervention during the perinatal period. Further research would be needed to determine their long-term effects.

Key conclusions and implications for practice

Parental well-being was shown to improve using the following intervention components: educational resources on perinatal and infant care, psychotherapy, and support from peers and healthcare professionals. Hence, future interventions could aim to include these components and evaluate all inter-related parenting outcomes (parenting self-efficacy, stress, anxiety, depression, social support, and parent-child bonding). Parents could be provided with experiential learning exposure by using computer animations and virtual reality. Future research could be conducted on more fathers and parents from varied geographical regions.

Direct and indirect effects from parenting self-efficacy and parenting practices to social-emotional adjustment in 3- to 5-year-old children

Parenting self-efficacy has been tied to myriad child outcomes during middle childhood and adolescence, directly and indirectly through parenting practices. The present study examines contemporaneous associations between parenting self-efficacy, parenting practices, and child outcomes during the preschool years in a community sample of 1455 Danish parents (76.7 % mothers) of 3-5-year-old children (49 % girls). Parents (M = 39.2 years old) completed a survey describing parenting self-efficacy and three facets of parenting practices: inductive reasoning, psychological control, and instrumental reward. Parents also described child adjustment in four domains: prosocial behavior, hyperactivity, conduct problems, and emotional problems. Results revealed direct concurrent associations between parenting self-efficacy and each child outcome, with greater efficacy tied to more prosocial behavior and less hyperactivity, conduct problems, and emotional problems. Parent psychological control mediated associations from parenting self-efficacy to child hyperactivity, conduct problems, and emotional problems. Inductive reasoning mediated associations from parenting self-efficacy to child prosocial behavior. Consistent with previous findings from older children, parental use of psychological control had debilitating consequences for preschool children. Inductive reasoning, in contrast, appeared to promote positive development.

Parenting sense of competence and its predictors among primiparous women: a longitudinal study in China

BACKGROUND

Parenting sense of competence significantly affects the quality of parenting behaviours and healthy infant development. However, primiparous women without parenting experience may lack confidence and feel stress. This study aimed to explore the status of parenting sense of competence and identify its predictors among primiparous women.

METHODS

A longitudinal study design was used. Primiparous women were recruited by using a convenience sample from two women's and children's hospitals in two cities in China. All primiparous women completed questionnaires on demographic characteristics, infant characteristics, family function, and parenting sense of competence at 1 month postpartum. At 3 months postpartum, each women's parenting sense of competence was re-assessed. Generalised linear regression was applied to identify the predictors of parenting sense of competence at 3 months postpartum.

RESULTS

A total of 743 Chinese primiparous women were included in the analysis. The average parenting sense of competence score of the participants at 3 months postpartum was 70.18 (SD = 12.33). According to the generalised linear regression analysis, higher levels of parenting sense of competence at 3 months postpartum were significantly associated with older age (β = 0.13, P = 0.005), better family function (β = 0.37, P <  0.001), and higher levels of parenting sense of competence (β = 0.35, P <  0.001) at 1 month postpartum. In contrast, lower levels of parenting sense of competence at 3 months postpartum were associated with poorer self-rated economic status (β = - 0.16, P = 0.027), poorer infant health (β = - 0.26, P = 0.007), and mixed or formula feeding (β = - 0.11, P = 0.018) at 1 month postpartum.

CONCLUSIONS

Chinese primiparous women have a relatively good parenting sense of competence, but there is still room for improvement. Maternal age, economic status, family function, infant health, and feeding patterns were significant predictors. To improve their parenting sense of competence, more attention should be paid to primiparous women who are young, with poor economic status, having an unhealthy infant, and mixed or formula feeding. In addition, measures should also be taken during the early postpartum period to improve family function.

Fostering Resilience Among Mothers Early (FRAME): using growth mixture modeling to identify resources that mitigate perinatal depression

The primary objective of this study was to delineate classes of individuals based on depression trajectories from the antenatal period through 54-month postpartum and internal and external resources that are associated with low depression risk. Participants came from the Growing Up in New Zealand (GUiNZ) study (n = 5664), which is a pregnancy cohort study and is nationally representative of the ethnic and socioeconomic diversity of contemporary New Zealand births. Growth curve mixture modeling was used to identify distinct subgroups based on depression scores from the antenatal period through 54-month postpartum. Logistic regression models were run to investigate socioeconomic factors and internal and external resources that were associated with depression class membership. A two-class model, "low risk" and "high risk," resulted in the best model fit. Most of the sample (n = 5110, 90%) fell into the "low-risk" class defined by no-to-mild depression symptoms during pregnancy and decreasing depressive symptoms over time (b_intercept =  - .05, b_slope =  - .05). Approximately 10% of the sample fell into the "high-risk" class (n = 554, 10%) defined by mild-to-moderate depressive symptoms during pregnancy and increasing depressive symptomology over time (b_intercept = .39, b_slope = .57). More positive parenting-related attitudes, better pre-pregnancy self-reported health, informal social supports, and community belonging were significantly associated with greater odds of being in the "low-risk" class, after controlling for socioeconomic factors. These findings suggest that targeting internal and external resources for individuals across the perinatal and early childhood periods is important to mitigating maternal depression.

The effect of Web-based preterm infant care training on mothers' self-confidence

The internet can be used as an alternative method in infant care education for mothers of preterm infants. This study was conducted to examine the effect of the Web-based infant care training program given to mothers of preterm infants on the self-confidence levels of mothers. This nonrandomized controlled study with a posttest design was conducted in Ministry of Health training and research hospital and university hospital. The study group comprised 84 mothers and their infants (intervention group: N = 42; control group: N = 42). Mothers with preterm infants in the intervention group participated in the Web-based program. The self-confidence of the mothers was evaluated before and after the training. The mothers' Pharis self-confidence scale mean scores were higher than the control group, but there was no significant difference. Web-based education program can be an alternative method that can be used in the education of mothers with preterm infants.

Bills, babies, and (language) barriers: Associations among economic strain, parenting, and primary language during the newborn period

OBJECTIVE

The goal of this study was to examine associations among economic strain, parenting self-efficacy, parenting satisfaction, and parent primary language in a universally low-income sample of parents with newborns.

BACKGROUND

Previous research links increased economic strain to lower levels of parenting self-efficacy and parenting satisfaction among socioeconomically diverse parents with older children. Little research has examined whether primary language shapes the associations among economic strain, parenting self-efficacy, and parenting satisfaction.

METHOD

Parents (n = 194, M _age = 30.91) completed self-report surveys measuring economic strain, parenting self-efficacy, and parenting satisfaction. Parents' ethnic self-identification and primary language were used to stratify parents into three groups: Latinx Spanish speakers, Latinx English speakers, and non-Latinx English speakers.

RESULTS

Regression analyses revealed that economic strain was negatively associated with both parenting self-efficacy and parenting satisfaction. Further, the negative association between economic strain and parenting self-efficacy was stronger for Latinx Spanish speakers.

CONCLUSION

Economic strain may negatively influence parenting self-efficacy and parenting satisfaction during the newborn period. Parents whose primary language is Spanish may be disproportionately affected by economic strain.

IMPLICATIONS

Parents of newborns may benefit from increased economic supports in linguistically responsive pediatric care and social service settings.

Effectiveness of the “Essential Coaching for Every Mother” postpartum text message program on maternal psychosocial outcomes: A randomized controlled trial

Objective

To determine the effectiveness of the Essential Coaching for Every Mother program on maternal self-efficacy, perceived social support, postpartum anxiety, and postpartum depression at six-weeks postpartum.

Methods

Participants from Nova Scotia were randomized, stratified by parity, to receive either the Essential Coaching for Every Mother postpartum text-message program or usual care, from birth to six-weeks postpartum. Participants completed surveys at enrollment (after birth) and at 6 weeks. Differences between groups were analyzed using analysis of covariance, considering parity and group allocation.

Results

Of the 171 participants recruited (53% primiparous), 150 completed the baseline survey (intervention n = 78, control n = 72). At baseline, newborns were on average 4.4 days old (SD: 3.9) and mothers 31.4 years old (SD: 4.5). Controlling for maternal age, primiparous women in the intervention group had a greater increase in maternal self-efficacy than primiparous women in the control group (mean difference [MD] = 4.84 (standard error [SE] = 0.75) vs. MD = 2.13 (SE = 0.81), p = 0.034). Women allocated to the intervention group had a greater reduction in postpartum anxiety symptoms than women in the control group for both multiparous and primiparous women (MD = −3.91 (SE = 1.82) vs. 2.81 (SE = 1.86), p = 0.011). There was no significant change in postpartum depression scores or perceived social support for either group.

Discussion

This study presents the results of the first Canadian postpartum text message program, which found improved psychosocial outcomes for postpartum women. Given the potential to reach numerous women at a low cost across geographical locations, the scalability of this intervention can improve maternal self-efficacy and reduce postpartum anxiety.

Perceived maternal parenting self-efficacy scale: Factor structure and psychometric properties among Portuguese postpartum women

OBJECTIVE

The aim of this study was to investigate the factor structure and psychometric properties of the Perceived Maternal Parenting Self-Efficacy (PMPS-E) Scale among Portuguese postpartum women.

DESIGN

Quantitative cross-sectional study.

SETTING

Data were collected through an online survey placed on social media websites targeting Portuguese adult women in the postpartum period (0-12 months after delivery).

PARTICIPANTS

The total sample consisted of 893 participants who gave birth after 37 weeks of gestation.

RESULTS

After conducting exploratory and confirmatory factor analyses, our results revealed that a correlated three-factor model yielded a significantly better fit to the data than the original four-factor model. High reliability was found for the total scale (α= 0.95) and for the three factors (α from 0.88 to 0.94). The PMPS-E presented significant and moderate to large correlations with other measures related to maternal self-efficacy. Participants who were multiparous, had older infants (>5 months old) and perceived their infant temperament as easy reported higher maternal parenting self-efficacy than those who were primiparous, had younger infants (≤5 months old) and perceived their infant temperament as difficult.

CONCLUSIONS

The results of this study showed that the European Portuguese version of the PMPS-E is a valid and reliable instrument for assessing maternal parenting self-efficacy among postpartum women.

IMPLICATIONS FOR PRACTICE

The PMPS-E may be a valuable instrument to detect parenting self-efficacy difficulties among postpartum women and thus contribute to strategies to improve women's overall psychological adjustment to the postpartum period, with a possible impact on the mother-infant relationship.

Effect of Infant Care Training on Maternal Bonding, Motherhood Self-Efficacy, and Self-Confidence in Mothers of Preterm Newborns

AIM

This study aims to evaluate the effect of infant care training on maternal bonding, motherhood self-efficacy, and self-confidence in mothers of preterm newborns and examine the relationship between them.

METHOD

The study was conducted experimentally with pre-test and post-test control groups in the Maternity Hospital. The population of the study consisted of late preterm newborns and their mothers (N = 81) who met the inclusion criteria of the study. Data was collected with an information form, a maternal bonding scale (MBS), a perceived maternal parenting self-efficacy scale (PMP-SE), and a Pharis self-confidence scale (PSCS). Mothers of the infants in the experimental group were given preterm infant care training as a nursing initiative.

RESULTS

In the study, the post-test MBS scores significantly increased in the experimental group, with a significant difference between all the sub-dimensions and the total scores of the PMP-SE post-test of mothers in both groups (p < 0.001). The post-test PSCS scores were significantly higher in the experimental group (p < 0.01). The correlation between MBS and PMP-SE (p < 0.05) mean scores of the mothers was positive, a correlation between PMP-SE and PSCS (p < 0.001) mean scores was positive and a correlation between PSCS and MBS (p < 0.05) mean scores was positive.

CONCLUSIONS

The existence of a directly proportional relationship between the variables of maternal bonding, motherhood self-efficacy, and self-confidence may mean that motherhood self-efficacy can be increased and motherhood self-confidence can be enhanced by supporting maternal bonding. Further studies starting from the prenatal period are recommended.

An Early Collaborative Intervention Focusing on Parent-Infant Interaction in the Neonatal Period. A Descriptive Study of the Developmental Framework

Moderate to late preterm infants are at risk of developing problems later in life. To support attachment and infants’ development, high quality parent-infant interaction is important. Parent-infant interaction is known to improve through intervention programs but since no such intervention program is addressed directly to moderate to late preterm infants, a tailor-made intervention was developed. The aim was to describe the rationale, development, framework and practical provision of a new early collaborative intervention program. This study has a descriptive design and the intervention is described using the Template for Intervention Description and Replication. During an intervention-session, the preterm infant’s cues are made visible to the parents as they perform an everyday care-taking procedure. Instant feedback is delivered to give the parents the opportunity to notice, interpret and respond to cues immediately. The infant’s response to the parent’s action is discussed in a dialogue to instantly guide parents´ awareness of the preterm infant’s subtle cues. This study describes a new early collaborative intervention, developed to support interaction between parents and their moderate to late preterm infants starting in the neonatal intensive care unit. Clinical studies evaluating parental experiences as well as the effects of the early intervention are ongoing, ClinicalTrials.gov NCT02034617.

An App-Based Parenting Program to Promote Healthy Energy Balance-Related Parenting Practices to Prevent Childhood Obesity: Protocol Using the Intervention Mapping Framework

BACKGROUND

The family environment plays an important role in the development of children's energy balance-related behaviors. As a result, parents' energy balance-related parenting practices are important targets of preventive childhood obesity programs. Families with a lower socioeconomic position (SEP) may benefit from participating in such programs but are generally less well reached than families with a higher SEP.

OBJECTIVE

This paper describes the application of the Intervention Mapping Protocol (IMP) for the development of an app-based preventive intervention program to promote healthy energy balance-related parenting practices among parents of children (aged 0-4 years) with a lower SEP.

METHODS

The 6 steps of the IMP were used as a theory- and evidence-based framework to guide the development of an app-based preventive intervention program.

RESULTS

In step 1, behavioral outcomes for the app-based program (ie, children have a healthy dietary intake, sufficient sleep, and restricted screen time and sufficient physical activity) and sociocognitive (ie, knowledge, attitudes, and self-efficacy) and automatic (ie, habitual behaviors) determinants of energy balance-related parenting were identified through a needs assessment. In step 2, the behavioral outcomes were translated into performance objectives. To influence these objectives, in step 3, theory-based intervention methods were selected for each of the determinants. In step 4, the knowledge derived from the previous steps allowed for the development of the app-based program Samen Happie! through a process of continuous cocreation with parents and health professionals. In step 5, community health services were identified as potential adopters for the app. Finally, in step 6, 2 randomized controlled trials were designed to evaluate the process and effects of the app among Dutch parents of infants (trial 1) and preschoolers (trial 2). These trials were completed in November 2019 (trial 1) and February 2020 (trial 2).

CONCLUSIONS

The IMP allowed for the effective development of the app-based parenting program Samen Happie! to promote healthy energy balance-related parenting practices among parents of infants and preschoolers. Through the integration of theory, empirical evidence, and data from the target population, as well as the process of continued cocreation, the program specifically addresses parents with a lower SEP. This increases the potential of the program to prevent the development of obesity in early childhood among families with a lower SEP.

TRIAL REGISTRATION

Netherlands Trial Register NL6727, https://www.trialregister.nl/trial/6727; Netherlands Trial Register NL7371, https://www.trialregister.nl/trial/7371.

Impact of mobile health interventions during the perinatal period on maternal psychosocial outcomes: a systematic review

OBJECTIVE

The objective of this review was to evaluate the effectiveness of mother-targeted mobile health (mHealth) education interventions during the perinatal period on maternal psychosocial outcomes in high-income countries.

INTRODUCTION

The perinatal period is an exciting yet challenging period for mothers that requires physical, emotional and social adjustment to new norms and expectations. In recent years, there has been an increase in the use of mHealth by new mothers who are seeking health information through online or mobile applications. While there have been systematic reviews on the impact of mHealth interventions on maternal and newborn health in low- and middle-income countries, the impact of these interventions on maternal psychosocial health outcomes in high-income countries remains uncertain.

INCLUSION CRITERIA

This review considered studies of mHealth education interventions targeting mothers in high-income countries (as defined by the World Bank) during the perinatal period. Interventions must have started between the antenatal period (conception through birth) through six weeks postpartum. All experimental study designs were included. Outcomes included self-efficacy, social support, postpartum anxiety and postpartum depression.

METHODS

PubMed, CINAHL, PsycINFO and Embase were searched for published studies in English on December 16, 2018. Gray literature was also searched for non-peer reviewed articles, including Google Scholar, mHealth intelligence and clinical trials databases. Critical appraisal was undertaken by two independent reviewers using standardized critical appraisal instruments from JBI. Quantitative data were extracted from included studies independently by two reviewers using the standardized data extraction tool from JBI. All conflicts were solved through consensus with a third reviewer. Quantitative data were, where possible, pooled in statistical meta-analysis using RevMan. Where statistical pooling was not possible, findings were reported narratively.

RESULTS

Of the 1,607 unique articles identified, 106 full-text papers were screened and 24 articles were critically appraised, with 21 included in the final review. Eleven were quasi-experimental and 10 were randomized controlled trials. The mHealth intervention approach varied, with text message and mobile applications being the most common. Length of intervention ranged from four weeks to six months. The topics of the mHealth intervention varied widely, with the most common topic being postpartum depression. Mothers who received an mHealth intervention targeting postpartum depression showed a decreased score on the Edinburgh Postnatal Depression Scale when measured post-intervention (odds ratio = -6.01, 95% confidence interval = -8.34 to -3.67, p < 0.00001). The outcomes related to self-efficacy, social support and anxiety showed mixed findings of effectiveness (beneficial and no change) across the studies identified.

CONCLUSIONS

This review provides insight into the effectiveness of mHealth interventions targeting mothers in high-income countries in the perinatal period to enhance four psychosocial outcomes: self-efficacy, social support, anxiety and depression. Despite a wide variety of outcome measurements used, the predominant findings suggest that there are insufficient data to conclude that mHealth interventions can improve self-efficacy and anxiety outcomes. Potential benefits on social support were related to interventions targeting postnatal behaviors. Postpartum depression was the mostly commonly reported outcome. Findings related to the comparison of pre-post outcomes and intervention versus control demonstrated that mHealth interventions targeting postpartum depression were associated with a reduction in postpartum depression.

Parenting, child development and primary care-'Crescer em Grande!' intervention (CeG!) based on the Touchpoints approach: a cluster-randomised controlled trial protocol

INTRODUCTION

Despite support for parenting being already recognised as a priority, there remains a paucity of evidence on how to facilitate its adoption in regular visits of maternal and child health primary care (PC). We describe the protocol for a study to assess the effect of an innovative universal Touchpoints-based intervention-'Crescer em Grande!' (CeG!) - when supporting the process of transition to parenthood and early infancy, at multiple PC units.

METHODS AND ANALYSIS

A cluster-randomised trial will be conducted in 12 PC units (clusters) from the Lisbon metropolitan area, Portugal. Participants will be a minimum of three family physicians and one nurse/unit, as well as 216 expecting parents and future babies until 18 months who are using the PC services. Sites will be randomised to either the CeG! or usual care. The CeG! will consist of: (1) the integration of the Touchpoints approach in PC maternal and well-child visits, with the support of 28 leaflets for parents to file in a folder; plus (2) training for PC providers on how to perform the CeG! into existing practice. Parents will be required to fill in questionnaires at point throughout their child's 18-month, mostly online. The primary outcome will be the self-perception of parental competence (Parenting Sense of Competence Scale). Other outcomes include: family functioning, couple dynamics, mental health, well-being/quality of life, psychological experience of pregnancy, attachment, child development. Acceptability, satisfaction and feasibility of CeG! will also be obtained from providers' and parents' perspectives. Costs associated with delivering the CeG! will be calculated. Study analyses will be under the principle of intention-to-treat.

ETHICS AND DISSEMINATION

Approval was obtained from the Ethics Committee of the Regional Health Administration. The results will be shared with participants and disseminated via peer-reviewed published papers, presentations at scientific and professional conferences.

TRIAL REGISTRATION NUMBER

ISRCTN90692907.

Maternal lack of sleep in the first two years after childbirth: Perceived impacts and help-seeking behaviors

Most evidence-based sleep interventions (e.g., graduated extinction of nighttime crying) are in opposition to many parents' values. This warrants taking a step back and asking the parents about their main concerns regarding their baby's sleep and the type of help they would be likely to use. This study aimed to describe and identify, among mothers of a 0- to 24-month-old child, the perceived impact of lack of sleep, sleep-related help-seeking behaviors as well as the most concerning aspects of the child's sleep, and preferred sleep intervention modalities. Another objective was to identify the factors associated with a negative impact of postpartum sleep, concerns for the child's sleep, and interest in sleep interventions. Canadian mothers (N = 932) were recruited by email snowball sampling and through Facebook to complete an online questionnaire designed for the purposes of the study. Most mothers reported a negative impact of postpartum sleep on their romantic relationship (79.4%) and quality of life (76.7%). Low parental self-efficacy (PSE) about managing the child's sleep was the best predictor of a negative impact of lack of sleep and sleep-related concerns, above and beyond any other child's or mother's characteristics. The preferred intervention modalities were reliable websites and online courses on child sleep, with a greater interest in home visits among mothers who need help the most (low self-efficacy, high concerns). Interventions should aim at increasing PSE about the child's sleep in both parents and include home visits for those who need it the most.

Efficacy of a multimodal nursing intervention strategy in the process of becoming a mother: A randomized controlled trial

The lack of knowledge and skills for transitioning to motherhood places first-time mothers at greater risk of depression and stress, may lower their perceived self-efficacy and satisfaction with the maternal role, and potentially affects the mother-infant bond. The purpose of this study was to test the efficacy of a multimodal nursing intervention (AMACOMPRI), based on Mercer's Becoming a Mother Theory, in supporting the process of becoming a mother in first-time mothers of term infants. This study was a parallel-group, double-blind, randomized, controlled trial with a 4-month postpartum follow-up. The outcome measures were the process of becoming a mother, functional social support, mother-infant bond, and perceived maternal self-efficacy. Sixty-six first-time mothers completed the study: 33 in the intervention group and 33 in the control group. The intervention was effective in supporting the process of becoming a mother, with a large effect size (Cohen's d = 1.50) and higher scores on the Becoming-a-Mother Scale in the intervention group compared with the control group (intergroup difference 13.04 points; 95% confidence interval: 8.72-17.34). Participants in the intervention group demonstrated higher scores in functional social support, perceived maternal self-efficacy, and mother-infant bond. This study provides evidence for the efficacy of an innovative nursing intervention that supports the process of becoming a mother. Further testing of the intervention is required in different settings and first-time mothers of low and high risk newborns.

The Effect of a Voice-Centered Psycho-Educational Program on Maternal Self-Efficacy: A Feasibility Study

This study examined the effect of a brief psycho-educational program, Time Together, on maternal self-efficacy, mother-infant bonding, and mood/anxiety for community-based mothers. This program centered on maternal voice, timing of interplay, and recognition of infant cues. A convergent parallel mixed-methods design included quantitative measures: the Karitane Parenting Confidence Scale, the Mother-Infant Bonding Scale, Edinburgh Postnatal Depression Scale and State & Trait Anxiety Inventory, and a sequential qualitative analysis to elaborate on the quantitative findings. Significant changes on the Karitane Parenting Confidence Scale were found. Qualitative analysis of the participant interviews and reflective diaries from the two weeks following the psycho-educational program confirmed that participation enhanced mothers' ability to understand their infant, to soothe their infant when distressed, to play and to establish an effective bedtime routine. This feasibility study indicated that this is a promising approach to improve early mother-infant interaction and maternal self-efficacy.

Are effect sizes in self-efficacy field changing over time? A meta-meta analysis

Theories relating to self-efficacy have developed rapidly since Bandura first proposed the concept in 1977. In the past two decades, psychologists have carried out numerous studies to research the cultural and psychological changes in social development. The research topic of this study is whether self-efficacy changes over time. This study uses a meta-meta analysis and includes 13 meta-analyses, including 536 effect sizes, with a total sample size of 421,880. We find that individual self-efficacy increases over time, which may be related to social development trends. However, the effects of interventions on self-efficacy remain similar (Q_model  = 1.807, df = 1, p > .05), and a possible explanation is that time effects of self-efficacy confuse the effects of intervention, because both in the intervention group and control group, the average of self-efficacy increases over time. And we find that a general decline in the predictive effects of self-efficacy (Q_model  = 5.117, df = 1, p = .024), especially the ability to predict relatively objective variables (e.g. job performance, teaching effectiveness, and transfer of training). A possible explanation is that as social development people tend to overestimate their self-efficacy. Another possible explanation is that the effect sizes in the original studies being overrated, may due to intentional selective reporting or unintentional statistical errors.

Evaluation of an intervention aimed at supporting new parents: the Baby Newsletter project

Background

Anticipatory guidance for parents is commonly used to improve parenting skills. The objective of this pre/post-intervention controlled study was to evaluate the effectiveness of a periodic newsletter with advice on childcare and development in improving parenting self-efficacy.

Methods

This was a non-randomized pre/post-intervention controlled study.

All the parents of children born between September 2014 and December 2015 resident in the S. Ilario d’Enza municipality (Italy) received eight Baby Newsletters. Parents resident in other municipalities of the same Health District were the control. Parents with linguistic barriers or with preterm or hospitalized children were excluded.

Improvement in parenting self-efficacy was measured through the TOPSE (Tool to Measure Parenting Self-Efficacy) questionnaire during the first week (t0) after delivery and at 5 (t1) and 12 months (t2) of life at two vaccination appointments. A score ranging from 0 to 60 was computed for each of the eight domains investigated by the TOPSE.

Variations of each TOPSE score between delivery and 12 months in the two groups were compared, adjusting for parity, education, age of parents, and child’s sex, and stratifying by parity and education.

Results /findings

One hundred thirty-six families accepted to participate in the study. Scores at 12 months were higher than 1 week after delivery in both groups for all TOPSE domains. The improvement was slightly stronger in the Newsletter group for almost all the skills except learning and knowledge [difference in the mean of variation: -0.48 (95% CI: − 3.17; 2.21)]; the difference was significant only for play and enjoyment [2.18 (95% CI: 0.12; 4.25)]. The increase in scores in almost all domains was more pronounced for parents with high education level at first child.

Conclusions

The intervention was effective in improving parents’ ability to play. However, it risks worsening existing differences between parents with high and with low education levels.

Trial registration

Clinical trial registration: NCT03268408.

In Their Own Words: A Qualitative Investigation of the Factors Influencing Maternal Postpartum Functioning in the United States

During the first twelve months postpartum, infants require intensive care and mothers are susceptible to physical and mental health concerns as they undergo a period of tremendous psychological and physiological adjustment. The mother’s level of postpartum functioning not only impacts her experience as a mother but also the infant and family unit. However, efforts to bolster functioning are lacking, and previous literature has identified a gap between what experts recommend and what mothers desire during the postpartum period. To address this, we conducted structured interviews with a diverse sample of 30 postpartum mothers to identify factors that mothers report are most influential to their postpartum functioning. In total, we identified 23 clinically actionable factors, all of which are backed by existing literature. In addition to an in-depth presentation of the qualitative findings, we also present a heat map to visualize the relevance of these factors to each of seven established domains of maternal functioning. Lastly, based on our findings, we offer a taxonomy of interventional strategies that could bolster maternal functioning during this critical period.

The Effect of Nursing Care Provided to Turkish Mothers of Infants Born With Cleft Lip and Palate on Maternal Attachment and Self-efficacy: A Quasi-Experimental Study

PURPOSE

The present study evaluated the effect of the nursing care provided to the mothers of the infants born with a cleft lip and palate (CLP) until the time of cleft palate (CP) repair surgery, on maternal attachment and self-efficacy.

DESIGN AND METHODS

The present study was designed as a quasi-experimental study with a pre-test and post-test control group design. The study included 32 mothers whose infants were born with CLP and had undergone CL repair surgery. Nursing care was provided to the mothers and the infants included in the study group through a total of seven home visits over a period of nine weeks. The data for the study were collected using a socio-demographic form, a home-care needs evaluation form, the Maternal Attachment Inventory (MAI), and the Parental Self-Efficacy Scale (PSE).

RESULTS

The scores for the mothers in the intervention group increased as the visits progressed, and it was observed that by the end of the ninth week, the difference between the mothers in the intervention group and those in the control group in terms of post-test MAI and PSE had become statistically significant.

CONCLUSIONS

Providing nine weeks of home-based nursing care to the mothers and the infants has the potential of reducing the problems experienced by the mothers of infants born with CLP.

PRACTICE IMPLICATIONS

Obtaining a better understanding of the barriers to the nursing care provided to the mothers of the infants born with CLP in-home setting would contribute immensely to the development of appropriate nursing-care practices.

Mothers' parenting self-efficacy, satisfaction and perceptions of their infants during the first days postpartum

OBJECTIVE

The first aim of this study was to describe mothers' self-efficacy, satisfaction and perceptions when parenting their infants during the first days postpartum. Furthermore, the study aimed to explore the distinct sociodemographic as well as mother and infant related factors that are associated with the above parenting aspects.

DESIGN

A descriptive and cross-sectional study design was used.

SETTING

Three separate postpartum wards 1-7 days after childbirth in one university level hospital in Finland.

PARTICIPANTS

All mothers who gave birth during March 1st to May 20th, 2019 and filled the inclusion criteria, were invited to participate in this study. A convenience sample of 250 mothers with healthy singleton infants agreed to participate.

MEASUREMENTS AND FINDINGS

The following instruments were used: The Parenting Self-Efficacy (PSE) scale, the Evaluation subscale of What Being the Parent of a New Baby is Like-revised (WBPL-R) and the Perception of Infant scale. Mothers' parenting self-efficacy and parenting satisfaction were high during the first days postpartum. Age, marital status, education and type of birth were not associated with parenting self-efficacy nor satisfaction. Mothers who were unemployed or working only part-time reported higher scores across all categories of parenting self-efficacy, compared to full time employed mothers (p < .001). A higher number of children (≥ 3) were positively associated with both parenting self-efficacy and satisfaction. Mothers who reported poor breastfeeding initiation success also reported significantly lower scores in parenting self-efficacy and parenting satisfaction across all categories. Mothers' perceptions of their infants' fussiness were not associated with parenting self-efficacy (p = .113) nor parenting satisfaction (p = .091).

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The results of this study can benefit postpartum maternity health care professionals by suggesting factors that could be focused on during the very short period that mothers stay in hospital. Discussing prior mothering experiences, work life before maternity leave, breastfeeding initiation experiences and perception of infant with the mothers after childbirth, may lead to better PSE and PS during the postpartum period.

[Social support as a protective factor for the mothers of children with Congenital Zika Syndrome]

Mothers of children with CZS face exceptional challenges caring for their offspring. Due to this reality, the availability of social support can function as an important protective factor. In this respect, this study aimed to evaluate the role of informal and formal social support in mental health, parental self-efficacy and satisfaction in the life of mothers of children with CZS. A total of 69 mothers of children with CZS (M = 26.4 years; SD = 6.23) living in the state of Ceará, Brazil participated in this study. They filled out the Social Support Satisfaction Scale, General Health Questionnaire, Parental Self-efficacy Scale and Satisfaction with Life Scale. The results show that the greater perception of informal social support significantly enables better mental health and satisfaction with life levels. In addition, access to formal social support significantly enables enhanced perception of parental self-efficacy. The results observed with the mothers of children with CZS are consistent with those reported in other studies with mothers of children with chronic conditions, pointing out that formal and informal social support have different effects on mental health, parental self-efficacy, and satisfaction with life, even controlling the effect of sociodemographic variables.

Parenting Science Gang: radical co-creation of research projects led by parents of young children

BACKGROUND

Parents are increasingly searching online for information supported by research but can find it difficult to identify results relevant to their own experiences. More troublingly, a number of studies indicate that parenting information found online often can be misleading or wrong. The goal of the Parenting Science Gang (PSG) project was to use the power of the Internet to help parents ask questions they wanted to have answered by scientific research and to feel confident in assessing research evidence.

METHODS

By using Facebook to recruit groups and facilitate interactions, PSG was able to engage fully the target public of parents of young children in the radical co-production of scientific studies, while not creating an undue burden on time or restricting participants due to disability, financial status or location. By giving parents true partnership and control of creation of projects, PSG ensured that the chosen questions were ones that were of most relevance and interest to them.

RESULTS

This paper presents a summary of eight projects, with three in more detail, designed and implemented by PSG Facebook groups in collaboration with experts. Most projects had health related themes, often prompted by dissatisfaction with treatment of parents by health professionals or by feelings of being marginalised by pregnancy and motherhood, as well as by the lack of evidence for their questions and concerns. The PSG approach meant that these frustrations were channelled into actions. All eight of the PSG groups engaged in meaningful interactions with experts and co-produced studies with the groups defining the questions of interest.

CONCLUSIONS

This radically user-led design meant that the PSG staff and the collaborating experts had to live with a high degree of uncertainty. Nevertheless, PSG achieved its goal of academically productive, truly co-produced projects, but as important were the positive effects it had on many of the participants, both parents and experts. At the point of writing this paper, PSG projects have led to outputs including at least eight papers published, in press or in preparation, seven conference presentations, testimony to the Infant Feeding All-Party Parliamentary Group, and with more to come.

Struggling With Reciprocity and Compassion: Mentoring Pregnant and Parenting Mothers Experiencing Vulnerability

Transitioning from pregnancy to parenthood is particularly challenging for women living with low income and experiencing social isolation, mental illness, addiction, and/or family violence. The purpose of this qualitative study was to evaluate one component of Welcome to Parenthood, a two-generation multiple intervention program including neuroscience-based parenting education, kin and non-kin mentorship, and an engagement tool (baby kit). From late pregnancy to 2 months postpartum, mentors kept a journal regarding their experiences of mentoring mothers experiencing vulnerability. We engaged in a modified constructivist grounded theory to explore hand-written text from the journals. The core category, Struggling with Reciprocity and Compassion, influenced processes of Becoming a Mentor. Mentoring mothers experiencing vulnerability was both challenging and rewarding, requiring an inordinate amount of physical, social, emotional, and economic resources. To foster maternal mental health and infant development, pregnant and parenting women experiencing vulnerability could benefit from long-term reciprocal and compassionate mentoring.

Effects of providing nursing care with web-based program on maternal self-efficacy and infant health

OBJECTIVE

The study was conducted to examine the efficacy of a web-based program, informed by Pender's Health Promotion Model, given to primiparous women on the growth and development of infant, infants' health, and women's self-efficacy level.

METHODS

This randomized controlled study with a posttest design was conducted in three primary care clinics. The study group comprised 71 primiparous women and their infants (intervention group: N = 35; control group: N = 36). The women who are at the 33-37th gestational week in the intervention group participated in the web-based program. They completed four education modules. Women in the control group received routine care in clinics. Data forms were completed in the first week and first, second, and third months postpartum. Breastfeeding status, weight, head circumference, development of infants and women's self-efficacy were evaluated in the postnatal period up to 3 months.

RESULTS

In the intervention group, the ratio of infants who were exclusively breastfed was higher compared to the control group. The mean scores for the LATCH instrument which measures breastfeeding status and Parental Self-Efficacy Scale, were significantly higher in the intervention compared to the control group (p < .05).

CONCLUSION

The women who participated in the web-based program demonstrated better self-efficacy and their infants demonstrated better scores on measures of growth, development, and health than those in the control group.

The Effects of an Infant Calming Intervention on Mothers' Parenting Self-Efficacy and Satisfaction During the Postpartum Period: A Randomized Controlled Trial

The aim of this study was to evaluate the effects of a behavioral infant calming technique to support mothers' parenting self-efficacy and parenting satisfaction. The methods of this randomized controlled trial are based on the CONSORT guidelines. Data were collected during March 1 to May 20, 2019, from 3 postpartum units in 1 university-level hospital in Finland. A total of 250 mothers agreed to participate, of which 120 were randomly allocated to the intervention group and 130 to the control group. All mothers completed a baseline questionnaire before randomization. Mothers in the intervention group were taught the 5 S's infant calming technique. The control group received standard care. Follow-up data were collected 6 to 8 weeks postpartum. The primary outcome measure was the change in parenting self-efficacy and parenting satisfaction scores over the follow-up period. The intervention group showed significantly larger improvements in parenting self-efficacy scores. There were no statistically significant differences in median improvements in parenting satisfaction. The 5 S's infant calming technique is feasible. These study findings may assist midwifery and neonatal nursing staff to support mothers and families during the postpartum period, whether the infants are fussy or not.

Parental Self-Efficacy in New Mothers Predicts Infant Growth Trajectories

The purpose of this study was to examine whether parental self-efficacy (PSE) is associated with change in infant weight-for-length z score (WLZ) from age 3 to 12 months. Data were drawn from the Infant Care, Feeding, and Risk of Obesity study, conducted with low-income, African American mother-infant dyads (n = 127). PSE was measured at infant age of 3 months. Infant anthropometrics were measured at infant age of 3 and 12 months, WLZ change between these time points was calculated, and infants stratified into WLZ change categories (expected, excessive, or slow). To analyze the data, ANCOVA, multiple regression, and post hoc techniques were used. Controlling for infant birthweight, PSE at 3 months was associated with infant WLZ change (η² = 0.05, p = .04). Mothers of infants who exhibited excessive growth had higher PSE than mothers of infants who exhibited slow growth (Tukey-adjusted p = .03). This finding suggests that infants of mothers with high PSE may have increased obesity risk, but more research is needed.

[The role of parental self-efficacy in the mental health of mothers of children with Congenital Zika Syndrome]

The article aimed to evaluate the mediating role of parental self-efficacy (PSE) between socioenvironmental factors and the mental health of the mothers of children with congenital zika syndrome (CZS). The socio-environmental factors were based on the cognitive and affective evaluation that people make of their context (subjective well-being, SWB) and fatigue. Sixty-six mothers with a mean age of 26.4 years of children with CZS in the state of Ceará, participated in this study. A questionnaire with the following scales was applied: Positive and Negative Affect Scale, Life Satisfaction Scale, Fatigue Evaluation Scale, General Health Questionnaire, Parental Self-efficacy Scale. The results indicated that the components of SWB, negative affects and life satisfaction, significantly predicted the mental health of mothers of children with CZS, and the PSE predicts better levels of mental health. It was observed that the PSE plays a mediating role in the relationship of satisfaction with life, negative effects and fatigue with mental health. PSE is an important psychological mechanism that acts as a mediator between the socio-environmental context and mental health. Thus, intervention strategies aimed at increasing the feelings of PSE in mothers can have a positive impact on the improvement of their mental health.

Effectiveness of a Technology-Based Supportive Educational Parenting Program on Parental Outcomes (Part 1): Randomized Controlled Trial

Background

Transitioning into parenthood can be stressful for new parents, especially with the lack of continuity of care from health care professionals during the postpartum period. Short hospital stays limit the availability of support and time parents need to be well equipped with parenting and infant care skills. Poor parental adjustment may, in turn, lead to negative parental outcomes and adversely affect the child’s development. For the family’s future well-being, and to facilitate a smoother transition into parenthood, there is a need for easily accessible, technology-based educational programs to support parents during the crucial perinatal period.

Objective

This study aimed to examine the effectiveness of a technology-based supportive educational parenting program (SEPP) on parenting outcomes during the perinatal period in couples.

Methods

A randomized, single-blinded, parallel-armed, controlled trial was conducted. The study recruited 236 parents (118 couples) from an antenatal clinic of a tertiary hospital in Singapore. Eligible parents were randomly assigned to the intervention group (n=118) or the control group (n=118). The SEPP is based on Bandura’s self-efficacy theory and Bowlby’s theory of attachment. Components of the intervention include 2 telephone-based educational sessions (1 antenatal and 1 immediately postnatal) and a mobile health app follow-up for 1 month. The control group only received routine perinatal care provided by the hospital. Outcome measures including parenting self-efficacy (PSE), parental bonding, perceived social support, parenting satisfaction, postnatal depression (PND), and anxiety were measured using reliable and valid instruments. Data were collected over 6 months at 4 time points: during pregnancy (third trimester), 2 days postpartum, 1 month postpartum, and 3 months postpartum. Outcomes were standardized using baseline means and SDs. Linear mixed models were used to compare the groups for postpartum changes in the outcome variables.

Results

The intervention group showed significantly better outcome scores than the control group from baseline to 3 months postpartum for PSE (mean difference, MD, 0.37; 95% CI 0.06 to 0.68; P=.02), parental bonding (MD −1.32; 95% CI −1.89 to −0.75; P<.001), self-perceived social support (MD 0.69; 95% CI 0.18 to 1.19; P=.01), parenting satisfaction (MD 1.40; 95% CI 0.86 to 1.93; P<.001), and PND (MD −0.91; 95% CI −1.34 to −0.49; P<.001). Postnatal anxiety (PNA) scores of the intervention group were only significantly better after adjusting for covariates (MD −0.82; 95% CI −1.15 to −0.49; P<.001).

Conclusions

The technology-based SEPP is effective in enhancing parental bonding, PSE, perceived social support and parental satisfaction, and in reducing PND and PNA. Health care professionals could incorporate it with existing hands-on infant care classes and routine care to better meet parents’ needs and create positive childbirth experiences, which may in turn encourage parents to have more children.

Trial Registration

ISRCTN Registry ISRCTN48536064; http://www.isrctn.com/ISRCTN48536064 (Archived by WebCite at http://www.webcitation.org/6wMuEysiO).