1
|
Gammons AF, Farewell CV, Walker-Mao C, Ubriaco E, Leiferman JA. Psychological needs fulfillment and perinatal well-being among low-SES individuals: a mixed methods investigation. J Psychosom Obstet Gynaecol 2024; 45:2395838. [PMID: 39185793 PMCID: PMC11386509 DOI: 10.1080/0167482x.2024.2395838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 08/10/2024] [Accepted: 08/17/2024] [Indexed: 08/27/2024] Open
Abstract
Poor perinatal mental health is associated with deleterious effects and individuals with low socioeconomic status (SES) are at elevated risk. Fortifying multi-level resources of low-SES pregnant individuals to boost their well-being is a crucial step toward achieving equity in perinatal health. The purpose of this project was to explore what patterns of resources supported well-being among low-SES pregnant individuals in Colorado. In a prospective mixed methods cohort study, 23 low-SES pregnant individuals completed surveys and interviews. Participants were separated into 3 subgroups based on their overall Warwick-Edinburgh Mental Well-being Scale (WEMWBS) score and interviewed to identify multi-level resources that supported their well-being. Our analysis was framed by Self-Determination Theory which contends that three universal basic psychological needs are required for individuals to function in a healthy manner: autonomy, competence, and relatedness. We extrapolated resources that promoted perinatal competence, autonomy, and relatedness from the high well-being group. Perinatal-related knowledge (construct related to competence); mindfulness and intended pregnancy (constructs related to autonomy); and emotional, informational, and friend support, social capital, and connection to nature (constructs related to relatedness) were identified as the resources more frequently endorsed in the high well-being group. Targeting interventions to fortify specific multi-level resources that support the autonomy, competence, and relatedness of pregnant individuals facing socioeconomic disadvantage is a crucial step toward achieving equity in perinatal health.
Collapse
Affiliation(s)
- Alison F Gammons
- Colorado School of Public Health, University of Colorado - Anschutz Medical Campus, Aurora, CO, USA
| | - Charlotte V Farewell
- Colorado School of Public Health, University of Colorado - Anschutz Medical Campus, Aurora, CO, USA
| | - Chelsea Walker-Mao
- Colorado School of Public Health, University of Colorado - Anschutz Medical Campus, Aurora, CO, USA
| | - Emma Ubriaco
- Colorado School of Public Health, University of Colorado - Anschutz Medical Campus, Aurora, CO, USA
| | - Jenn A Leiferman
- Colorado School of Public Health, University of Colorado - Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
2
|
Farewell CV, Schmiege SJ, Leiferman J. Racial Differences in Psychosocial Resources and Mental and Physical Health Outcomes during Pregnancy: A structural equation modeling approach. RESEARCH SQUARE 2024:rs.3.rs-4617998. [PMID: 39070611 PMCID: PMC11276014 DOI: 10.21203/rs.3.rs-4617998/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Objectives Poor prenatal health is of particular concern among minoritized individuals who may experience adverse social determinants of health contributing to the intergenerational transmission of health disparities. The purpose of this study was to investigate associations between psychosocial resources, and mental and physical health among a prenatal sample, and to explore if these relationships vary by race. Methods English-speaking pregnant individuals living in the United States were recruited using Centiment (n=340). Participants completed a 121-item cross-sectional survey. We conducted a single- and multi-group structural equation model to test hypothesized relationships, and then investigated differences by pregnant White individuals versus Black, Indigenous, and People of Color (BIPOC). Results Our final single-group model exhibited good model fit (χ2 (43) = 99.07, p<.01, CFI = 0.97, SRMR = 0.04, and RMSEA = 0. 06 (0.05 - 0.08)). After controlling for demographic characteristics and social determinants of health, higher levels of mindfulness were statistically significantly related to lower anxiety and depression scores (both p<.01). Higher levels of social supports were statistically significantly related to lower anxiety scores. Scale measurement invariance was confirmed for the multi-group model and the structural model was statistically significantly different between pregnant White individuals and BIPOC in this sample (Δ χ2 (27) = 116.71, p <.01). Conclusions Identification of core components of psychosocial resource interventions, consideration of upstream structural determinants, mindfulness and valued-living (MVL)-based strategies, cultural adaptation, and an emphasis on resilience rather than psychopathology may result in improved prenatal health among pregnant individuals traditionally underrepresented in research.
Collapse
|
3
|
Chua JYX, Choolani M, Chee CYI, Yi H, Chan YH, Lalor JG, Chong YS, Shorey S. Parents' Perceptions of Their Parenting Journeys and a Mobile App Intervention (Parentbot-A Digital Healthcare Assistant): Qualitative Process Evaluation. J Med Internet Res 2024; 26:e56894. [PMID: 38905628 PMCID: PMC11226932 DOI: 10.2196/56894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/16/2024] [Accepted: 04/18/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Parents experience many challenges during the perinatal period. Mobile app-based interventions and chatbots show promise in delivering health care support for parents during the perinatal period. OBJECTIVE This descriptive qualitative process evaluation study aims to explore the perinatal experiences of parents in Singapore, as well as examine the user experiences of the mobile app-based intervention with an in-built chatbot titled Parentbot-a Digital Healthcare Assistant (PDA). METHODS A total of 20 heterosexual English-speaking parents were recruited via purposive sampling from a single tertiary hospital in Singapore. The parents (control group: 10/20, 50%; intervention group: 10/20, 50%) were also part of an ongoing randomized trial between November 2022 and August 2023 that aimed to evaluate the effectiveness of the PDA in improving parenting outcomes. Semistructured one-to-one interviews were conducted via Zoom from February to June 2023. All interviews were conducted in English, audio recorded, and transcribed verbatim. Data analysis was guided by the thematic analysis framework. The COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist was used to guide the reporting of data. RESULTS Three themes with 10 subthemes describing parents' perceptions of their parenting journeys and their experiences with the PDA were identified. The main themes were (1) new babies, new troubles, and new wonders; (2) support system for the parents; and (3) reshaping perinatal support for future parents. CONCLUSIONS Overall, the PDA provided parents with informational, socioemotional, and psychological support and could be used to supplement the perinatal care provided for future parents. To optimize users' experience with the PDA, the intervention could be equipped with a more sophisticated chatbot, equipped with more gamification features, and programmed to deliver personalized care to parents. Researchers and health care providers could also strive to promote more peer-to-peer interactions among users. The provision of continuous, holistic, and family-centered care by health care professionals could also be emphasized. Moreover, policy changes regarding maternity and paternity leaves, availability of infant care centers, and flexible work arrangements could be further explored to promote healthy work-family balance for parents.
Collapse
Affiliation(s)
- Joelle Yan Xin Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mahesh Choolani
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
| | - Cornelia Yin Ing Chee
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Huso Yi
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Yap Seng Chong
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
4
|
Tung I, Keenan K, Hipwell AE. Adolescent Mothers' Psychological Wellbeing during Pregnancy and Infant Emotional Health. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:616-632. [PMID: 34605721 PMCID: PMC8977390 DOI: 10.1080/15374416.2021.1981339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Although many studies have identified risk factors for adolescent pregnancy, much less is known about factors that support pregnant adolescents' psychological wellbeing and offspring outcomes. This study drew on strength-based frameworks to investigate family and neighborhood factors linked to social connectedness that predict psychological wellbeing during adolescent pregnancy and offspring outcomes. METHOD Participants included 135 adolescent mothers (ages 14-21; 90% Black American) assessed annually since childhood as part of a longitudinal study. During preadolescence (ages 11-13), data on contextual stressors and neighborhood support were gathered from participants' caregivers; participants also rated their perceived trust/attachment with caregivers before and during pregnancy. To assess changes in psychological wellbeing, adolescents reported positive and depressed mood before and during pregnancy. A path analysis model tested the prospective associations between family and neighborhood factors, psychological wellbeing during pregnancy, and offspring outcomes (birth outcomes; observed infant positive/negative emotions at age 3-months). RESULTS Positive mood decreased from pre-pregnancy to pregnancy, whereas depressed mood remained stable. Adjusting for pre-pregnancy mood, perceived caregiver trust/attachment during pregnancy was associated with prenatal positive mood. Prenatal positive mood, in turn, reduced risk of preterm birth and indirectly predicted positive infant emotions via birth outcomes. Neighborhood support in preadolescence predicted lower prenatal depressed mood, but depressed mood did not predict infant outcomes beyond positive mood. Contextual life stress was not associated with prenatal mood after adjusting for family and neighborhood support. CONCLUSIONS Findings highlight changes in positive-valence emotions during adolescent pregnancy that may have unique associations with birth outcomes and offspring emotions.
Collapse
Affiliation(s)
- Irene Tung
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Kate Keenan
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL
| | - Alison E. Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
5
|
Xu K, Xie Y, Han X, Yu Y, Liu S, Wu S, Yang Q, Zhang Q. Effect of positive emotion intervention during late pregnancy on improving colostrum secretion: a randomised control trial protocol. BMJ Open 2023; 13:e066601. [PMID: 37399441 DOI: 10.1136/bmjopen-2022-066601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
INTRODUCTION Though evidence has revealed the beneficial effects of cognitive improvement interventions on breastfeeding, the effect of psychological interventions has rarely been studied. This study aims to test whether promoting a positive emotion intervention, 'Three Good Things' intervention, during the last trimester of pregnancy can enhance early colostrum secretion and breastfeeding behaviours by modulating the hormones associated with lactation (prolactin and insulin-like growth factor I). We will attempt to promote exclusive breastfeeding by using physiological behavioural measures. METHODS AND ANALYSIS This study is designed as a randomised controlled trial conducted in the Women's Hospital School of Medicine at Zhejiang University and the Wuyi First People's Hospital. The participants will be randomly divided into two groups using stratified random grouping: the intervention group will receive 'Three Good Things' intervention, while the control group will write about three things that come to mind first. These interventions will be continued from enrolment until the day of delivery. Maternal blood hormone levels will be tested approaching delivery and the following day after birth. Behavioural information about breastfeeding will be collected 1 week afterwards. ETHICS AND DISSEMINATION The study has been approved by the Ethics Committees of the Women's Hospital School of Medicine at Zhejiang University and the Wuyi First People's Hospital. Results will be disseminated through peer-reviewed journals or international academic conferences. TRIAL REGISTRATION NUMBER ChiCTR2000038849.
Collapse
Affiliation(s)
- Kechen Xu
- School of Public Health, and Department of Geriatrics of the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Clinical Laboratory Center, Wuyi First People's Hospital, Wuyi, China
| | - Ying Xie
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiujun Han
- Department of Obstetrics, Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
| | - Ying Yu
- Department of Obstetrics, Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
| | - Suqing Liu
- Department of Gynecology, Wuyi First People's Hospital, Jinhua, Zhejiang, China
| | - Suliu Wu
- Department of Science and Education, Wuyi First People's Hospital, Jinhua, China
| | - Qian Yang
- School of Public Health, and Department of Geriatrics of the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qi Zhang
- Community and Environmental Health, Old Dominion University, Norfolk, Virginia, USA
| |
Collapse
|
6
|
Chua JYX, Choolani M, Chee CYI, Yi H, Chan YH, Lalor JG, Chong YS, Shorey S. 'Parentbot - A Digital healthcare Assistant (PDA)': A mobile application-based perinatal intervention for parents: Development study. PATIENT EDUCATION AND COUNSELING 2023; 114:107805. [PMID: 37245443 DOI: 10.1016/j.pec.2023.107805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/23/2023] [Accepted: 05/18/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To describe the development procedure of a mobile application-based parenting support program with integrated chatbot features entitled Parentbot - a Digital healthcare Assistant (PDA) for multi-racial Singaporean parents across the perinatal period. METHODS The PDA development process was guided by the combined information systems research framework with design thinking modes, and Tuckman's model of team development. A user acceptability testing (UAT) process was conducted among 11 adults of child-bearing age. Feedback was obtained using a custom-made evaluation form and the 26-item User Experience Questionnaire. RESULTS The combined information systems research framework with design thinking modes helped researchers to successfully create a PDA prototype based on end-users' needs. Results from the UAT process indicated that the PDA provided participants with an overall positive user experience. Feedback gathered from UAT participants was used to enhance the PDA. CONCLUSION Although the effectiveness of the PDA in improving parental outcomes during the perinatal period is still being evaluated, this paper highlights the key details of developing a mobile application-based parenting intervention which future studies could learn from. PRACTICE IMPLICATIONS Having carefully planned timelines with margins of delays, extra funds to resolve technical issues, team cohesion, and an experienced leader can facilitate intervention development.
Collapse
Affiliation(s)
- Joelle Yan Xin Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mahesh Choolani
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | | | - Huso Yi
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Yap Seng Chong
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| |
Collapse
|
7
|
Davis JA, Ohan JL, Gibson LY, Prescott SL, Finlay-Jones AL. Understanding engagement in digital mental health and wellbeing programs for sub-clinical women in the perinatal period: A Systematic Review without Meta-Analysis (SWiM) (Preprint). J Med Internet Res 2022; 24:e36620. [PMID: 35943773 PMCID: PMC9399849 DOI: 10.2196/36620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/22/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background Pregnancy and the postnatal period can be a time of increased psychological distress, which can be detrimental to both the mother and the developing child. Digital interventions are cost-effective and accessible tools to support positive mental health in women during the perinatal period. Although studies report efficacy, a key concern regarding web-based interventions is the lack of engagement leading to drop out, lack of participation, or reduced potential intervention benefits. Objective This systematic review aimed to understand the reporting and levels of engagement in studies of digital psychological mental health or well-being interventions administered during the perinatal period. Specific objectives were to understand how studies report engagement across 4 domains specified in the Connect, Attend, Participate, and Enact (CAPE) model, make recommendations on best practices to report engagement in digital mental health interventions (DMHIs), and understand levels of engagement in intervention studies in this area. To maximize the utility of this systematic review, we intended to develop practical tools for public health use: to develop a logic model to reference the theory of change, evaluate the studies using the CAPE framework, and develop a guide for future data collection to enable consistent reporting in digital interventions. Methods This systematic review used the Cochrane Synthesis Without Meta-analysis reporting guidelines. This study aimed to identify studies reporting DMHIs delivered during the perinatal period in women with subclinical mood symptoms. A systematic database search was used to identify relevant papers using the Ovid Platform for MEDLINE, PsycINFO, EMBASE, Scopus, Web of Science, and Medical Subject Headings on Demand for all English-language articles published in the past 10 years. Results Searches generated a database of 3473 potentially eligible studies, with a final selection of 16 (0.46%) studies grouped by study design. Participant engagement was evaluated using the CAPE framework and comparable variables were described. All studies reported at least one engagement metric. However, the measures used were inconsistent, which may have contributed to the wide-ranging results. There was insufficient reporting for enactment (ie, participants’ real-world use of intervention skills), with only 38% (6/16) of studies clearly recording longer-term practice through postintervention interviews. The logic model proposes ways of conceptualizing and reporting engagement details in DMHIs more consistently in the future. Conclusions The perinatal period is the optimal time to intervene with strength-based digital tools to build positive mental health. Despite the growing number of studies on digital interventions, few robustly explore engagement, and there is limited evidence of long-term skill use beyond the intervention period. Our results indicate variability in the reporting of both short- and long-term participant engagement behaviors, and we recommend the adoption of standardized reporting metrics in future digital interventions. Trial Registration PROSPERO CRD42020162283; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=162283
Collapse
Affiliation(s)
- Jacqueline A Davis
- Telethon Kids Institute, Nedlands, Australia
- School of Medicine, University of Western Australia, Perth, Australia
- School of Health Sciences, Curtin University, Bentley, Australia
| | - Jeneva L Ohan
- School of Medicine, University of Western Australia, Perth, Australia
| | - Lisa Y Gibson
- Telethon Kids Institute, Nedlands, Australia
- School of Medicine, University of Western Australia, Perth, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Susan L Prescott
- Telethon Kids Institute, Nedlands, Australia
- School of Medicine, University of Western Australia, Perth, Australia
- The Nova Institute for Health, Baltimore, MD, United States
| | - Amy L Finlay-Jones
- Telethon Kids Institute, Nedlands, Australia
- School of Medicine, University of Western Australia, Perth, Australia
| |
Collapse
|
8
|
Kopylova OV, Ershova AI, Meshkov AN, Drapkina OM. Lifelong prevention of cardiovascular disease. Part I: preconceptional, prenatal and infant periods of life. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-2647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Current prophylactic actions prevent or significantly delay the majority of cardiovascular diseases (CVD). Various factors are interconnected and affect a person throughout his life, determining the risk of CVD. This indicates the need for preventive measures at all stages of life and even before birth. The beneficial effects of CVD prevention are realized through various genetic, epigenetic and metabolic mechanisms. Due to the fact that many risk factors for CVD have a cumulative effect, the introduction of preventive measures from the earliest life stages will be most effective. The purpose of the article is to consider various aspects of CVD prevention in the preconceptional, prenatal and infant periods.
Collapse
Affiliation(s)
- O. V. Kopylova
- National Research Center for Therapy and Preventive Medicine
| | - A. I. Ershova
- National Research Center for Therapy and Preventive Medicine
| | - A. N. Meshkov
- National Research Center for Therapy and Preventive Medicine
| | - O. M. Drapkina
- National Research Center for Therapy and Preventive Medicine
| |
Collapse
|