La Familia: methodological issues in the assessment of perinatal social support for Mexicanas living in the United States

Women's experiences of social support during pregnancy: a qualitative systematic review

BACKGROUND

Social support during pregnancy can alleviate emotional and physical pressures, improving the well-being of mother and child. Understanding women's lived experiences and perceptions of social support during pregnancy is imperative to better support women. This systematic review explores and synthesises the qualitative research on women's experiences of social support during pregnancy.

METHODS

Databases PubMed, CINAHL, MEDLINE, APA PsycInfo and Scopus were searched with no year limit. Eligible studies included pregnant women or women who were up to one year postpartum and were assessed on their experiences of social support during pregnancy. The data were synthesised using the thematic synthesis approach.

RESULTS

Fourteen studies were included with data from 571 participating women across ten countries; two studies used focus groups, and 12 used interviews to collect their data. Four main themes were developed ('a variety of emotional support', 'tangible and intangible instrumental support', 'traditional rituals and spiritual support', and 'the all-encompassing natal home'), and six sub-themes ('female network connections', 'care and affection from the husband', 'dissatisfaction with relationships', 'financial support from the husband and family', 'practical support from family and friends', 'health information support').

CONCLUSIONS

This systematic review sheds light on women's experiences of social support during pregnancy. The results indicate a broad variety of emotional support experienced and valued by pregnant women from different sources. Additionally, women expressed satisfaction and dissatisfaction with tangible and intangible support forms. It was also highlighted that spirituality played an essential role in reducing stress and offering coping mechanisms for some, whereas spirituality increased stress levels for others.

Family Support and Family Negativity as Mediators of the Relation between Acculturation and Postpartum Weight in Low-Income Mexican-Origin Women

BACKGROUND

Obesity presents a significant health concern among low-income, ethnic minority women of childbearing age.

PURPOSE

The study investigated the influence of maternal acculturation, family negativity, and family support on postpartum weight loss among low-income Mexican-origin women.

METHODS

Low-income Mexican-origin women (N=322; 14% born in the U.S.) were recruited from a prenatal clinic in an urban area of the Southwest U.S. Acculturation was assessed during a prenatal home visit (26-38 weeks gestation), and post-birth family support and general family negativity were assessed at 6 weeks postpartum. Objective maternal weight measures were obtained at five time points across the first postpartum year.

RESULTS

Higher acculturation predicted higher family support and family negativity. Higher family support predicted decreasing weight across the first postpartum year, and higher family negativity predicted higher weight at 6 weeks postpartum and increasing weight across the first postpartum year. In combination, family negativity and support mediated the impact of acculturation on postpartum weight gain.

CONCLUSIONS

Cultural and family-related factors play a significant role in postpartum weight gain and loss for low-income Mexican-origin women.

Social Support and Postpartum Depression Revisited: The Traditional Female Role as Moderator among Mexican Women

Women who lack social support tend to have a higher risk of postpartum depression. The present study examined the traditional female role, understood here as the adoption of passive and submissive traits specific to Mexican women, as another risk factor for postpartum depressive symptomatology that interacts with social support. Using two waves of data from a longitudinal study of 210 adult Mexican women (20-44 years-old, Mage = 29.50 years, SD = 6.34), we found that lacking social support during the third trimester of their pregnancy was associated with greater depressive symptoms at 6 months in the postpartum, although this relationship depended on the level of endorsement of the traditional female role during pregnancy. Lower social support during pregnancy predicted greater postpartum depressive symptoms for women with higher endorsement of the traditional female role, even when accounting for prenatal depressive symptoms. These results suggest that Mexican women's experience of social support may depend on their individual adherence to gender roles. Understanding the association between women's traditional roles and social support in the risk for postpartum depression can improve prevention and educational programs for women at risk.

The Effect of Social Support and Acculturation on Postpartum Depression in Mexican American Women

Postpartum depression was studied in 66 multiparous Mexican American women using a prospective longitudinal design. Interviews were conducted at 34 to 36 weeks prenatally and 4 to 6 weeks postpartum. Women expressing prenatal depression were more likely to continue to experience depression postpartum. Other predictors included a high need for postpartum support, specific support network characteristics, acculturation, and poor quality relationships within the family. It is important for the health care provider to assess the presence of depressive symptoms and available social support during the prenatal period and work with Mexican American mothers to increase support and secure help in dealing with daily life stressors.

The negative impact of global perceptions of and daily care-related family conflict on Hispanic caregivers: familism as a potential moderator

OBJECTIVES

Using selected concepts from Pearlin's care giving stress model and incorporating a daily stress-reactivity perspective, the current study surveyed Hispanic family caregivers (HCGs) to: (a) document the occurrence of family disagreements regarding care; (b) examine the impact of family disagreements regarding care on HCGs' emotional/physical well being; and (c) determine the moderating role of familism - whether strong familism beliefs buffer or exacerbate the negative impact of family disagreements on HCGs.

METHODS

Participants (n = 67) reported their daily experiences of family disagreements regarding care, depressive symptoms, feelings of burden, and physical health symptoms on eight consecutive survey days; and, in a separate survey, reported their global perceptions of family disagreements regarding care and their familism beliefs.

RESULTS

Multilevel-modeling indicated (a) a significant link between global perceptions of family disagreement regarding care and greater depressive symptoms, feelings of burden, and physical health symptoms and (b) significant moderating (i.e., exacerbating) effects of familism at the daily level suggesting that HCGs with stronger familism beliefs are more reactive to daily care-related family disagreement occurrences.

CONCLUSIONS

The findings from the current study suggest that family disagreement regarding care is a salient aspect of the context of care giving for HCGs, and is linked to depressive symptoms, feelings of burden, and physical health symptoms. Familism may play an exacerbating role in this link. Interpretations of the results and implications for research and intervention are offered.

Apoio social e saúde: pontos de vista das ciências sociais e humanas

Analisam-se os temas e as abordagens teórico-conceituais do apoio social nos artigos de importantes periódicos internacionais de ciências sociais e de medicina e nacionais de Saúde Coletiva/Saúde Pública no período 1983-2005. Procedeu-se a leitura dos resumos dos 259 textos internacionais e 57 nacionais encontrados classificando e computando as relações do apoio social com a saúde/doença/cuidado. A seguir analisaram-se os conceitos e as abordagens do apoio social do ponto de vista das teorias e dos autores das ciências sociais e humanas, em uma amostra intencional de 56 textos internacionais e 18 nacionais. A literatura internacional respalda-se na psicologia social, nas várias correntes da sociologia e da ciência política e menos na antropologia. A literatura nacional dialoga menos com as teorias psicossociais e mais com as sociológicas e as antropológicas, realçando-se pela abordagem do apoio com a rede social, a solidariedade, as trocas e os valores culturais, deslocando-se da esfera individual e privada para a capacidade de organização da sociedade civil e de ações coletivas. Diferentes correntes norteiam as análises teórico-conceituais do apoio social, sendo a literatura internacional mais antiga, diversificada, empírica e escassa de produção antropológica.

Sociocultural influences on the determinants of breast-feeding by Latina mothers in the Cincinnati area

While breast-feeding initiation and duration among US Latina women appear to decrease with acculturation, health care providers in the Greater Cincinnati area have noted lower rates of breast-feeding among even first-generation Latina immigrants. This study's purpose was to identify determinants of breast-feeding for Latina mothers in Cincinnati through qualitative interviews and Spanish Breastfeeding Self-Efficacy Scale ratings. Our findings suggest that, along with similar levels of breast-feeding self-confidence, foreign-born Latina women in the Greater Cincinnati area share similar breast-feeding determinants with the general population. However, characteristics of these determinants and their impact vary because of unique pressures experienced by this community.

Toward a dynamic conceptualization of social ties and context: implications for understanding immigrant and Latino health

Researchers have posited that social ties and social support may contribute to better-than-expected health outcomes among Mexican immigrants vis-à-vis their US-born counterparts. However, in our review of studies examining social ties and health by immigration-related variables among this group, we found little support for this hypothesis. To better understand the social factors that contribute to the health of Mexicans in the United States, we conducted a qualitative analysis of social relationships and social context among first- and second-generation Mexican women. Our results highlight the interplay between immigration processes and social ties, draw attention to the importance of identity support and transnational social relationships, and suggest ways to reconceptualize the relationship between social contexts, social ties, and immigrant and Latino health.

Perceived satisfaction with social support and depressive symptoms in perinatal Latinas

PURPOSE

This study examined the relationship between satisfaction with social support and postpartum depressive symptoms in Latinas.

DESIGN

A secondary data analysis of 62 women at "high risk" or "low risk" for postpartum depression (PPD) was conducted during pregnancy and at 1 month postpartum.

RESULTS

High-risk Latinas were less satisfied with perceived perinatal support from the baby's father and postnatal support from family and "others." Dissatisfaction with postpartum support from the baby's father was associated with higher depressive symptoms.

CONCLUSION

Dissatisfaction with certain sources of support is related to high risk for PPD. Practice: Health care providers should assess levels and sources of social support as part of their PPD screening.

Cultural values and political economic contexts of diabetes among low-income Mexican Americans

PURPOSE

To explore the political and economic dimensions of diabetes self-management for Mexican American adults.

DESIGN

Critical ethnographic analysis of focus group data from caregivers and adults with diabetes.

FINDINGS

Three themes were identified: diabetes self-management is tied to other mental and bodily states, family and neighborhood environments cause stress and prevent diabetes solutions, and hassles of the health care environment subvert self-management.

DISCUSSION

Cultural constructs about diabetes merge with social-political forces in explaining diabetes.

IMPLICATIONS

Cultural competence in diabetes care requires attention to the political economy of the disease and advocacy for healthful political and economic change.

Inventário de percepção de suporte familiar (IPSF): estudo componencial em duas configurações

O objetivo deste estudo foi o de comparar os componentes do inventário de percepção de suporte familiar (IPSF) em duas configurações de participantes, por intermédio de análise fatorial. A amostragem da segunda configuração foi constituída por mil e sessenta e quatro estudantes do ensino médio e universitário, com idades que variavam entre dezessete e sessenta e quatro anos, de ambos os sexos, de instituições particulares e públicas do Estado de São Paulo. Foi utilizada a análise de componentes principais, com rotação oblimim nessa configuração. A análise fatorial extraiu a presença de três fatores, intitulados afetivo-consistente, adaptação e autonomia, o que expressou uma variância total de 41,433% do construto. O IPSF demonstrou ser um inventário com dimensões bem definidas, sendo que todos os itens possuíram cargas fatoriais acima de 0,30. O fator afetivo-consistente demonstrou precisão de 0,91, expresso pelo alfa de Cronbach, seguido pelo fator inadaptação, com alfa de 0,90, e, por último, o fator autonomia expressou um alfa de 0,78, além do alfa da escala total ser de 0,93. As cargas fatoriais dos itens foram sempre superiores a 0,30.O IPSF também expressa as dimensões encontradas em diversos instrumentos e teorias internacionais sobre o construto suporte familiar. As comparações das configurações são discutidas. Outras evidências de validade, bem como a padronização do IPSF, se fazem necessárias, a fim de se obter outros dados psicométricos do inventário, já que o processo de validação de qualquer instrumento se comprova de forma dinâmica e constante.

Time in the United States, social support and health behaviors during pregnancy among women of Mexican descent

Among women of Mexican descent, increased acculturation in the US has been associated with poorer health behaviors during pregnancy. This study examined a population of low-income women of Mexican descent in an agricultural community to determine: whether social support patterns were associated with age at arrival in the US; whether social support was associated with pregnancy behaviors; and whether increased social support could prevent some of the negative pregnancy behaviors that accompany acculturation. Participants were 568 pregnant women enrolled in prenatal care in the Salinas Valley, California. Participants were predominantly Spanish speaking, born in Mexico, and from farmworker families. Information on social networks, social support, age at arrival in the US, and pregnancy health behaviors was gathered during interviews conducted during pregnancy and immediately after delivery. Poorer health behaviors were observed among women who had come to the US at a younger age. Social support during pregnancy was lowest among women who had come to the US at an older age. High parity, low education, and low income were also associated with low social support. Higher social support was associated with better quality of diet, increased likelihood of using prenatal vitamins, and decreased likelihood of smoking during pregnancy. High social support also appeared to prevent the negative impact of life in the US on diet quality. Women with intermediate or low levels of social support who had spent their childhoods in the US had significantly poorer diet quality than women who had spent their childhoods in Mexico. However, among women with high social support, there was no difference in diet quality according to country of childhood. Thus, in the case of diet quality, increased social support appears to prevent some of the negative pregnancy behaviors that accompany time in the US among women of Mexican descent.

Weight, Diet, and Physical Activity-Related Beliefs and Practices Among Pregnant and Postpartum Latino Women: The Role of Social Support

OBJECTIVES

Eating and physical activity patterns may contribute to excessive pregnancy weight gain and postpartum retention that increase the risks of obesity and diabetes for both Latino mothers and their children. Social support is an important health determinant and may affect health-related beliefs and behaviors. The objective of this study was to investigate the influence of social support on weight, diet, and physical activity-related beliefs and behaviors among pregnant and postpartum Latinas.

METHODS

A community-based participatory project, Promoting Healthy Lifestyles among Women, was conducted in southwest Detroit to plan interventions aimed at reducing risks of obesity and type 2 diabetes. Qualitative analyses of in-depth semistructured interviews with dyads of 10 pregnant and postpartum Latinas, and 10 people who influenced them were conducted.

RESULTS

Husbands and some female relatives were primary sources of emotional, instrumental, and informational support for weight, diet, and physical activity-related beliefs and behaviors for Latina participants. Holistic health beliefs and the opinions of others consistently influenced Latinas' motivation and beliefs about the need to remain healthy and the links between behavior and health. Absence of mothers, other female relatives, and friends to provide childcare, companionship for exercise, and advice about food were prominent barriers that limited women's ability to maintain healthy practices during and after pregnancy.

CONCLUSION

The findings support evidence that low-income, recently immigrated pregnant and postpartum Latinas could benefit from community-based, family-oriented interventions that provide social support necessary to promote and sustain healthy lifestyles.

Social Support in Mexican American Childbearing Women

Because the Mexican American population in the United States is increasing, nurses will inevitably come into contact with members of this cultural group. Social support is essential for women to adapt to the demands of the perinatal period, and Mexican American childbearing women face particular challenges in obtaining social support. In this article, traditional roles and social support in Mexican American families are described, the challenges of delivering prenatal care within these traditions are discussed, and strategies for nursing intervention are offered.