Social and Professional Support for Pregnant and Parenting Women

Understanding online health information seeking behavior of older adults: A social cognitive perspective

Introduction

Online health information seeking has been verified to play a crucial role in improving public health and has received close scholarly attention. However, the seeking behavior of older adults, especially the underlying mechanism through which they are motivated to seek health information online, remains unclear. This study addresses the issue by proposing a theoretical model leveraging social cognitive theory.

Methods

IT self-efficacy and IT innovativeness were identified as personal factors and professional support and social support were identified as environmental factors. We conducted a survey that included 347 older people in China and examined the research hypotheses with a structural equation model.

Results

IT self-efficacy and IT innovativeness facilitate older adults to seek health information online by increasing their perceived benefit of using the internet. Additionally, professional support and social support enhanced older adults' online seeking behavior by promoting their health awareness. We also found that perceived benefit displayed a stronger impact than health awareness on older adults' behavior related to searching for health information online.

Conclusion

This study reveals that IT self-efficacy, IT innovativeness, professional support, and social support will promote older adults to seek health information online by enhancing their health awareness and perceived benefit. The findings of this study provide significant theoretical and practical implications.

Michigan Plan for Appropriate Tailored Healthcare in Pregnancy Prenatal Care Recommendations: A Practical Guide for Maternity Care Clinicians

Prenatal care is an important preventive service designed to improve the health of pregnant patients and their infants. Prenatal care delivery recommendations have remained unchanged since 1930, when the 12-14 in-person visit schedule was first established to detect preeclampsia. In 2020, the American College of Obstetricians and Gynecologists, in collaboration with the University of Michigan, convened a panel of maternity care experts to determine new prenatal care delivery recommendations. The panel recognized the need to include emerging evidence and experience, including significant changes in prenatal care delivery during the COVID-19 pandemic, pre-existing knowledge of the importance of individualized care plans, the promise of telemedicine, and the significant influence of social and structural determinants of health (SSDoH) on pregnancy outcomes. Recommendations were derived using the RAND-UCLA appropriateness method, a rigorous e-Delphi method, and are designed to extend beyond the acute public health crisis. The resulting Michigan Plan for Appropriate Tailored Healthcare in pregnancy (MiPATH) includes recommendations for key aspects of prenatal care delivery: (1) the recommended number of prenatal visits, (2) the frequency of prenatal visits, (3) the role of monitoring routine pregnancy parameters (blood pressure, fetal heart tones, weight, and fundal height), (4) integration of telemedicine into routine care, and (5) inclusion of (SSDoH). Resulting recommendations demonstrate a new approach to prenatal care delivery that incorporates medical, SSDoH, and patient preferences, to develop individualized prenatal care delivery plans. The purpose of this document is to outline the new MiPATH recommendations and to provide practical guidance on implementing them in routine practice.

Assessment and Response to Intimate Partner Violence in Home Visitation: A Qualitative Needs Assessment With Home Visitors in a Statewide Program

There is growing recognition that home visitation programs serving at-risk families may be an appropriate mechanism for detecting and reducing intimate partner violence (IPV). More research is needed about how home visitors assess and respond to IPV, especially in rural and underserved areas with unique social and geographic challenges. This study describes the qualitative, needs assessment phase of a larger mixed-methods evaluation of IPV assessment, referral processes, and safety planning with clients within a statewide home visitation program. Three focus groups were conducted with home visitors (n = 16) in West Virginia's Home Visitation Program in May 2015. Home visitors represented four separate home visitation models and provided services across 12 of West Virginia's 55 counties. Guiding questions focused on home visitors' current protocol, experiences, barriers, and facilitators to (a) screening and assessment for IPV, (b) making referrals after disclosures of IPV, and (c) developing safety plans with IPV-exposed clients. Barriers identified by home visitors included the nature of assessment tools, issues with service availability and access in rural areas, and lack of education and training surrounding safety planning. Facilitators included building relationships and trust with clients, providing anticipatory guidance when making referrals, and tailoring safety plans to clients' unique situations. Participants also expressed a critical need to develop procedures for assuring home visitor safety when supporting IPV-exposed clients. These qualitative data highlight issues surrounding the management of IPV in home visitation and have the potential to inform future enhancements to programs that are specifically tailored to the needs of rural, disadvantaged communities.

The development and psychometric testing of the Perinatal Infant Care Social Support (PICSS) instrument

BACKGROUND

Social support facilitates a woman's transition to motherhood. This major developmental transition can be stressful as it includes adaptation of self as well as learning new infant care practice skills. Although a number of instruments have been developed to measure social support, none have been developed or underpinned by theory in the context of perinatal infant care practices.

AIM

To develop a reliable and valid instrument to measure social support for new mothers in the perinatal period.

METHODS

Phase 1 involved the development of instrument structure and content. Constructs to be measured were defined through an analysis of relevant theoretical and empirical literature. Phase 2 established the psychometric properties of the functional domain of the PICSS. Exploratory factor analyses and principal Component Analyses were undertaken with a sample of first-time mothers (n = 371) from postnatal wards of a large maternity hospital. Item reduction and Cronbach's alpha reliability tests were performed. The structural social support domain was not amenable to psychometric testing.

RESULTS

Exploratory Factor Analyses and Principal Component Analyses of the functional domain resulted in a logically coherent 19-item, two-factor solution. The first factor 'Supporting Presence' has nine items (Cronbach's alpha = 0.90) and the second factor 'Practical Support' has ten items (Cronbach's alpha = 0.86).

CONCLUSIONS

The PICSS is a coherent and valid measure of social support for new mothers in the postnatal period in the context of infant care practices.

Social Support, Parenting Competence, and Parenting Satisfaction Among Adolescent, African American, Mothers

This secondary analysis explored how social support changed during the first 6 months postpartum and examined the relationships among social support, parenting competence, and parenting role satisfaction. Single, low-income, adolescent, new mothers ( N = 34) completed measures of perceived parenting competence, parenting role satisfaction, and four types of received social support (emotional, informational, tangible, problematic) from the entire social network at 1 week, 6 weeks, 3 months, and 6 months postpartum. Results indicated that social support did not change over time. Emotional, informational, and tangible social support were significantly correlated, concurrently and predictively, with perceived competence and satisfaction at most data collection points. Future social support intervention studies using social support as a modifiable variable with this high-risk group of African American adolescent new mothers are advocated. Health care professionals are encouraged to examine existing social support within these mothers' identified family units.

The Relationship between Perceived Social Support in the First Pregnancy and Fear of Childbirth

Background

Numerous empirical evidences have shown that social and environmental circumstances and social relations have an important impact on pregnancy outcomes, women's ability to cope with stressful situations, and childbirth pain management. The present study was conducted to determine the relationship between perceived social support and fear of childbirth.

Materials and Methods

The present descriptive correlational study was conducted on 270 nulliparous pregnant women who referred for pregnancy care in 2016. The subjects were selected through convenience sampling method. The data collection tools were a demographic characteristics form, the Multidimensional Scale of Perceived Social Support (MSPSS), and the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). The collected data were analyzed using descriptive and inferential statistics tests.

Results

The mean perceived social support score of the participants was 77.90 and a significant correlation was observed between the perceived social support score and fear of childbirth score (β = -0.18, p = 0.004). The participants' mean score of fear of childbirth was 36.8. The results of study after the evaluation of the effect of predictive variables on the fear of childbirth are as follows: pregnancy preparation classes: (β = 3.50, p = 0.220); observation of natural childbirth videos: (β = 5.26, p = 0.040); and use of educational software: (β =5.82, p = 0.080).

Conclusions

In order to reduce the fear of childbirth, women's social support structure during pregnancy should be assessed. Moreover, demographic characteristics form the structure and determine the extent of individuals' social network and, through the evaluation of these characteristics during pregnancy, the rate of effective support can be predicted in individuals.

Identifying and Exploring the Informational and Emotional Support Needs of Primipara Women: A Focus on Supportive Communication

Primipara women may require greater informational and emotional support than multipara women. Supportive communication, including informational and emotional support, can help to build a strong caregiver-patient relationship and can alleviate the difficulties associated with first-time birth. The objective of this study was to explore first-time mothers' experiences of labor and birth. Three hundred primipara women completed self-report questionnaires. Qualitative analysis of one open-ended question about the women's experience was conducted. Nine themes emerged from the data. Eight themes reflected informational and emotional support needs, whereas the final theme reflected instrumental support needs. The study concluded that informational and emotional supports are important factors of supportive communication and influence the birthing experience of primipara women.

Support program for women suffering grief after termination of pregnancy: A pilot study

In this study, we preliminarily examined the effects of the Informational and Emotional Support Program for Women after Pregnancy Termination in 30 Thai women. A literature review and House's theory of social support informed the program content, which consisted of the following elements: (i) an evaluation of grief; (ii) an analysis of the problems and needs of each woman; (iii) informational and emotional support tailored to individual problems and needs; (iv) telephone support; and (v) an exit phone interview. The Grief Questionnaire for Women after Pregnancy Termination was used to measure changes in the grief levels of participants. The data were analyzed using descriptive statistics and the contingency coefficient. At the completion of the study, the participants' average grief score had decreased from the prior grief score and was in the moderate to low range. These preliminary findings indicate that the support program can be effective in real-life situations in Thailand to assist women who are grieving after the termination of pregnancy. Our findings highlight the need for nursing and emotional support to be provided to help Thai women after the TOP.

Psychometric properties of the revised Malay version Medical Outcome Study Social Support Survey using confirmatory factor analysis among postpartum mothers

INTRODUCTION

Social support is an essential component for the physical and emotional well-being of postpartum mothers. The objective of this study is to determine the psychometric properties of the revised Malay version Medical Outcome Study (MOS) Social Support Survey using a confirmatory validity approach.

METHODS

A cross-sectional study was conducted involving 144 postpartum mothers attending Obstetric and Gynecology Clinic, Universiti Sains Malaysia Hospital. Construct validity and internal consistency assessment was performed after the translation, content validity and face validity process. The data were analyzed using SPSS 20.0 (SPSS Inc., Chicago, IL, USA) and AMOS 20.0 (SPSS Inc., Chicago, IL, USA).

RESULTS

The original questionnaire consists of four domains (emotional/informational support, tangible support, affectionate support and positive social interaction) and 19 items. Affectionate support domain with three items only was treated as a separate construct and was not included in the factor analysis. The final confirmatory model with three constructs and 13 items demonstrated acceptable factor loadings, domain to domain correlation and best fit; (χ2[df]=1.665 [61]; P-value=0.001; Tucker-Lewis Index=0.944; comparative fit index=0.956; root mean square error of approximation=0.068). Composite reliability, average variance extracted and Cronbach's α of the domains ranged from 0.649 to 0.903; 0.390 to 0.699; 0.616 to 0.902, respectively.

CONCLUSION

The study suggested that the four-factor model with 16 items (including one separate factor of affectionate) of the revised Malay version MOS Social Support Survey was acceptable to be used to measure social support after childbirth because it is valid, reliable and simple.

Measuring maternal health literacy in adolescents attending antenatal care in a developing country - the impact of selected demographic characteristics

AIMS AND OBJECTIVES

The aim of this paper is to describe how selected demographic characteristics 'explain' the observed variance in the distribution of maternal health literacy estimates in adolescents attending antenatal care in Uganda, as estimated by the 'Maternal health literacy scale'.

BACKGROUND

By the age of 20 years, more than 60% of Ugandan females are mothers. In the Busoga region of Uganda, the percentage of pregnant adolescents and adolescent mothers is at its highest (above 30%).

DESIGN

Validated questionnaire survey.

METHODS

The Maternal health literacy scale was administered to 384 adolescents aged 15-19 years attending antenatal care in Jinja and Iganga districts of the Busoga region during the period of July 2013-December 2013. The Mann-Whitney U test in SPSS21 was used to determine if the two levels of dichotomised person factors, i.e. demographic characteristics, relate to 'significantly' different mean maternal health literacy estimates, not strictly following the normal distribution, as measured by the Maternal health literacy scale.

RESULTS

The person factors, age, education level, pregnancy order and prepregnancy awareness about conception, explained approximately 12% of the observed variance in maternal health literacy estimates.

CONCLUSIONS

Prepregnancy awareness about conception was the single most contributory factor to the observed variance in estimated maternal health literacy levels. More research on women of childbearing age is warranted to explore the impact of further person factors on the maternal health literacy in pregnant adolescents.

RELEVANCE TO CLINICAL PRACTICE

Using the person factors found to show 'significant' impact on maternal health literacy in pregnant adolescents, target-specific interventions aimed at improving maternal health literacy in pregnant adolescents can be formulated. By accounting for these factors in reproductive health policy designs, one might take preventive actions to curb the prevalence of adolescent pregnancies in both developing and developed countries.

Group versus conventional antenatal care for women

BACKGROUND

Antenatal care is one of the key preventive health services used around the world. In most Western countries, antenatal care traditionally involves a schedule of one-to-one visits with a care provider. A different way of providing antenatal care involves use of a group model.

OBJECTIVES

1. To compare the effects of group antenatal care versus conventional antenatal care on psychosocial, physiological, labour and birth outcomes for women and their babies.2. To compare the effects of group antenatal care versus conventional antenatal care on care provider satisfaction.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2014), contacted experts in the field and reviewed the reference lists of retrieved studies.

SELECTION CRITERIA

All identified published, unpublished and ongoing randomised and quasi-randomised controlled trials comparing group antenatal care with conventional antenatal care were included. Cluster-randomised trials were eligible, and one has been included. Cross-over trials were not eligible.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trials for inclusion and risk of bias and extracted data; all review authors checked data for accuracy.

MAIN RESULTS

We included four studies (2350 women). The overall risk of bias for the included studies was assessed as acceptable in two studies and good in two studies. No statistically significant differences were observed between women who received group antenatal care and those given standard individual antenatal care for the primary outcome of preterm birth (risk ratio (RR) 0.75, 95% confidence interval (CI) 0.57 to 1.00; three trials; N = 1888). The proportion of low-birthweight (less than 2500 g) babies was similar between groups (RR 0.92, 95% CI 0.68 to 1.23; three trials; N = 1935). No group differences were noted for the primary outcomes small-for-gestational age (RR 0.92, 95% CI 0.68 to 1.24; two trials; N = 1473) and perinatal mortality (RR 0.63, 95% CI 0.32 to 1.25; three trials; N = 1943).Satisfaction was rated as high among women who were allocated to group antenatal care, but this outcome was measured in only one trial. In this trial, mean satisfaction with care in the group given antenatal care was almost five times greater than that reported by those allocated to standard care (mean difference 4.90, 95% CI 3.10 to 6.70; one study; N = 993). No differences in neonatal intensive care admission, initiation of breastfeeding or spontaneous vaginal birth were observed between groups. Several outcomes related to stress and depression were reported in one trial. No differences between groups were observed for any of these outcomes.No data were available on the effects of group antenatal care on care provider satisfaction.We used the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach to assess evidence for seven prespecified outcomes; results ranged from low quality (perinatal mortality) to moderate quality (preterm birth, low birthweight, neonatal intensive care unit admission, breastfeeding initiation) to high quality (satisfaction with antenatal care, spontaneous vaginal birth).

AUTHORS' CONCLUSIONS

Available evidence suggests that group antenatal care is positively viewed by women and is associated with no adverse outcomes for them or for their babies. No differences in the rate of preterm birth were reported when women received group antenatal care. This review is limited because of the small numbers of studies and women, and because one study contributed 42% of the women. Most of the analyses are based on a single study. Additional research is required to determine whether group antenatal care is associated with significant benefit in terms of preterm birth or birthweight.

Scaffolding young Australian women's journey to motherhood: a narrative understanding

Pregnant and young mothers' stories often go untold within community social and health service policy, planning and practice. Consequently, there is a significant gap between young women's experiences of motherhood and current service provision. This study was undertaken in response to a paucity of observational and contextually rich research that explores young women's experiences of pregnancy and motherhood, including the role a community service played in scaffolding their motherhood journeys. Fundamental to this study's purpose was the premise that to improve planning and delivery of more appropriate services for this group, we need to listen, consult and consider what life is like for young mothers. The purpose of this paper is to describe the role a community service played in scaffolding young women's experiences as they transitioned to motherhood. Using a narrative approach, this study draws on data collected from contextual observations of 31 informants and 11 in-depth interviews over 7 months of fieldwork in 2010 at a community service in the Peel region of Western Australia. The integral role a community service played in the young women's transition to motherhood was analysed thematically and captured in three metaphorical themes, finding a circle of friends, weaving a tapestry and turning the page. The young women's storied experiences of motherhood present a strong argument for radical re-visioning of community and social health policy, practice and service delivery for young mothers. The findings revealed that judgement-free services that foster social and supportive relationships were integral in developing positive motherhood identities. The power of narrative and social learning when working with young mothers suggests that social models of health that foster a relational, narrative approach to practice are fundamental to young mothers finding their own voices and solutions and becoming active agents in re-authoring future narratives of hope, autonomy and agency.

A descriptive phenomenology study of newcomers' experience of maternity care services: Chinese women's perspectives

BACKGROUND

Maternity health care available in Canada is based on the needs of women born in Canada and often lacks the flexibility to meet the needs of immigrant women. The purpose of this study was to explore immigrant Chinese women's experiences in accessing maternity care, the utilization of maternity health services, and the obstacles they perceived in Canada.

METHODS

This descriptive phenomenology study used in-depth semi-structured interviews to examine immigrant Chinese women's experiences. Fifteen participants were recruited from the Chinese community in Toronto, Canada by using purposive sampling. The interviews were digitally recorded and transcribed verbatim into written Chinese. The transcripts were analyzed using Colaizzi's (1978) phenomenological method.

RESULTS

Six themes were extracted from the interviews: (1) preference for linguistically and culturally competent healthcare providers, with obstetricians over midwives, (2) strategies to deal with the inconvenience of the Canadian healthcare system (3) multiple resources to obtain pregnancy information, (4) the merits of the Canadian healthcare system, (5) the need for culturally sensitive care, and (6) the emergence of alternative supports and the use of private services.

CONCLUSIONS

The findings provide new knowledge and understanding of immigrant Chinese women's experiences in accessing maternity health services within a large metropolitan Canadian city. Participants described two unique experiences within the themes: preference for linguistically and culturally competent healthcare providers, with obstetricians over midwives, and the emergence of alternative supports and the use of private services. Few studies of immigrant maternity service access have identified these experiences which may be linked to cultural difference. Further investigation with women from different cultural backgrounds is needed to develop a comprehensive understanding of immigrant women's experiences with maternity care.

Effects of professional support on nausea, vomiting, and quality of life during early pregnancy

The purpose of this study was to examine the effectiveness of a professional support (PS) intervention (including individualized health education and supportive phone calls) in reducing the severity of nausea and vomiting (NV) and improving the quality of life (QOL) of women in early pregnancy. An experimental pretest/posttest design with a control group was used. Participants were recruited from a regional teaching hospital in southern Taiwan. The women in the experimental group (n = 40) received the PS intervention, while those in the control group (n = 39) only received routine nursing care. Analysis of covariance and mixed models were used to compare the experimental and control groups while adjusting for covariates. The severity of NV and the perceived level of symptom distress were significantly lower in the experimental group than in the control group during weeks 2 and 4, and the women in the experimental group showed a significant improvement in their QOL in week 4 (p < .05). However, there was no significant difference between the two groups in body weight at week 4 (p = .501). These findings provide empirical evidence in support of the effectiveness of PS in reducing the severity of NV and improving QOL for women during early pregnancy. This intervention could be routinely applied in prenatal nursing health education. Future studies could apply the concept of PS to different populations and health issues.

Low-income women's recommendations for promoting early pregnancy recognition

INTRODUCTION

This study explored low-income women's perspectives on how to promote early recognition of pregnancy as one strategy to address community residents' concerns related to unintended pregnancy. Unintended pregnancy, which is more prevalent among low-income women and minorities, has been associated with various adverse pregnancy outcomes.

METHODS

This study used the ideological perspective of community-based participatory research. Six focus groups were conducted in 3 low-income, urban, medically underserved neighborhoods with ethnically diverse populations. Neighborhood women who were either pregnant or had experienced a pregnancy within 3 years were invited to participate in the study. A structured interview guide focused the discussion on how to promote early recognition of pregnancy within the existing context of unintended pregnancies in the neighborhoods. Focus-group sessions were audiotaped, then transcribed verbatim; the data were analyzed using an open-coding template approach assisted by QSR NVivo 8 software.

RESULTS

Forty-one women aged 18 to 44 years participated in the study. Thirty-nine percent were African American, 24.4% were Hispanic/Latino, 19.5% were American Indians, and 17.1% were white. Three primary themes were identified: 1) women should know the menstrual/ovulation and pregnancy-related changes that occur in their bodies; 2) women should be prepared to confirm their pregnancies early, as soon as they suspect they may be pregnant; and 3) both information and emotional support are needed for pregnancy-related issues. "Knowing your body" was the strongest advice to promote early recognition of pregnancy.

DISCUSSION

The participants in this study suggested that education about reproductive changes should be initiated during early adolescence and in the preconception period. Early testing and confirmation of pregnancy should also be promoted, especially for women who have unprotected intercourse. Local resources for information and emotional support during pregnancy should be accessible to women.

Maternal mental health: pathways of care for women experiencing mental health issues during pregnancy

Perinatal mental health has become the focus for policymakers, government, research, the acute health sector, and health practitioners. The aim of this clinical data-mining study ( Epstein, 2010 ) was to undertake a retrospective exploration into the primary mental health and psychosocial issues experienced by women who were pregnant and accessing obstetric care at one of the largest maternity hospitals in Australia. The study also investigated service pathways and gaps. Aboriginal women were overrepresented, demonstrating their ongoing disadvantage, whereas other linguistically and culturally diverse women were underrepresented, suggesting the existence of barriers to service. Although psychosocial factors tend to be underreported ( Buist et al., 2002 ), the findings highlighted the integral rather than peripheral nature of these factors during pregnancy ( Vilder, 2006 ) and suggest the need for change to systems that work to support women's perinatal mental health.

Mothers' experiences in the Nurse-Family Partnership program: a qualitative case study

Background

Few studies have explored the experiences of low income mothers participating in nurse home visiting programs. Our study explores and describes mothers' experiences participating in the Nurse-Family Partnership (NFP) Program, an intensive home visiting program with demonstrated effectiveness, from the time of program entry before 29 weeks gestation until their infant's first birthday.

Methods

A qualitative case study approach was implemented. A purposeful sample of 18 low income, young first time mothers participating in a pilot study of the NFP program in Hamilton, Ontario, Canada partook in one to two face to face in-depth interviews exploring their experiences in the program. All interviews were digitally recorded and transcribed verbatim. Conventional content analysis procedures were used to analyze all interviews. Data collection and initial analysis were implemented concurrently.

Results

The mothers participating in the NFP program were very positive about their experiences in the program. Three overarching themes emerged from the data: 1. Getting into the NFP program; 2. The NFP nurse is an expert, but also like a friend providing support; and 3. Participating in the NFP program is making me a better parent.

Conclusions

Our findings provide vital information to home visiting nurses and to planners of home visiting programs about mothers' perspectives on what is important to them in their relationships with their nurses, how nurses and women are able to develop positive therapeutic relationships, and how nurses respond to mothers' unique life situations while home visiting within the NFP Program. In addition our findings offer insights into why and under what circumstances low income mothers will engage in nurse home visiting and how they expect to benefit from their participation.

Self-perceptions of parenting among adolescent mothers

Using a descriptive correlational design, this study examined factors that contribute to self-perceptions of parenting among adolescent mothers 4 to 6 weeks postpartum. Healthy, first-time, 13- to 19-year-old adolescent mothers (n = 126) identified their own mothers as their primary source for social support. Additionally, the more tangible the support from the adolescent's mother, the lower the evaluation of self-perceptions of parenting. Older, more educated adolescent mothers were more positive in self-perceptions of parenting, suggesting that older adolescents have different needs in terms of parenting than younger adolescent mothers. These findings are important for designing and implementing nursing care and educating adolescents about the importance of social support, education, and parenting.

Hospital-to-home transition of mothers of preterm infants

PURPOSE

To describe mothers' experiences during the first month after their preterm infant's hospital discharge.

STUDY DESIGN AND METHODS

Descriptive phenomenology with a sample of 10 mothers who were mostly single, under 25, and African American. Institutional review board approval and informed consents were obtained. Data were collected two times. First, mother's demographic data were collected before the infant's hospital discharge. Second, an in-depth interview was conducted between 2 and 4 weeks after the infant's discharge. Interviews were digitally audio-taped and transcribed verbatim. Data were analyzed using the Colaizzi seven-step process.

RESULTS

There were five theme clusters that described mothers' experiences: dealing with an expected pregnancy outcome; experiencing the reality of taking care of a baby alone; struggling to adjust to the maternal role; enhancing maternal inner strength; and changing the maternal lifestyle.

CLINICAL IMPLICATIONS

This study's findings reveal that mothers value teaching and coaching from nursery care providers. However, a more structured and individualized approach to discharge preparation including assessment of mother's competence in infant care may be needed.

Women want proactive psychosocial support from midwives during transition to motherhood: a qualitative study

OBJECTIVE

to explore low-risk pregnant women's views on their preferences for psychosocial support from midwives during their transition to motherhood.

DESIGN

a qualitative design with focus-group interviews and thematic analysis of the discussions. SETTINGS AND RESPONDENTS: 21 Dutch participants were included in three focus groups. Groups 1 (n=7) and 3 (n=8) consisted of pregnant women from four semi-urban midwifery practices, and group 2 (n=6) included participants from three urban midwifery practices.

FINDINGS

the women wanted to take responsibility for their own well-being during pregnancy. In addition to informal support, they explicitly expressed a need for professional support from their midwives when undergoing the transition to motherhood. They wanted informational and emotional support from their midwives that addressed psychological and physical changes during pregnancy. They expressed a strong desire to be informed during pregnancy of how to prepare physically and psychologically for birth, recovery and motherhood. They also wanted help with sifting and interpreting information and, ultimately, wanted to make their own choices.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

during their transition to motherhood, healthy low-risk pregnant women want attentive, proactive, professional psychosocial support from midwives. They expect their midwives to oversee the transition period and to be capable of supporting them in dealing with changes in pregnancy and in preparing for birth and motherhood.

An intervention to improve postpartum outcomes in African-American mothers: a randomized controlled trial

OBJECTIVE

To evaluate the efficacy of an integrated multiple risk intervention, delivered mainly during pregnancy, in reducing such risks (cigarette smoking, environmental tobacco smoke exposure, depression, and intimate partner violence) postpartum.

METHODS

Data from this randomized controlled trial were collected prenatally and on average 10 weeks postpartum in six prenatal care sites in the District of Columbia. African Americans were screened, recruited, and randomly assigned to the behavioral intervention or usual care. Clinic-based, individually tailored counseling was delivered to intervention women. The outcome measures were number of risks reported postpartum and reduction of these risks between baseline and postpartum.

RESULTS

The intervention was effective in significantly reducing the number of risks reported in the postpartum period. In bivariate analyses, the intervention group was more successful in resolving all risks (47% compared with 35%, P=.007, number needed to treat=9, 95% confidence interval [CI] 5-31) and in resolving some risks (63% compared with 54%, P=.009, number needed to treat=11, 95% CI 7-43) as compared with the usual care group. In logistic regression analyses, women in the intervention group were more likely to resolve all risks (odds ratio 1.86, 95% CI 1.25-2.75, number needed to treat=7, 95% CI 4-19) and resolve at least one risk (odds ratio 1.60, 95% CI 1.15-2.22, number needed to treat=9, 95% CI 6-29).

CONCLUSION

An integrated multiple risk factor intervention addressing psychosocial and behavioral risks delivered mainly during pregnancy can have beneficial effects in risk reduction postpartum.

Development of prenatal event history calendar for Black women

OBJECTIVES

To identify psychosocial factors that Black women think should be addressed in prenatal care assessment and develop a Prenatal Event History Calendar to assess these factors.

DESIGN

A qualitative descriptive study.

SETTING

Two inner city hospital prenatal care clinics in Southeastern Michigan.

PARTICIPANTS

Twenty-two Black women who had attended at least 2 prenatal care visits.

METHOD

Three focus groups were conducted using a semistructured interview guide.

MAIN OUTCOME MEASURE

Using the constant comparative method of analysis (Glaser, 1978, 1992) themes were identified that were relevant to Black women during prenatal care visits.

RESULTS

The women in this study wanted to talk with their providers about psychosocial factors and not just the physical aspects of pregnancy. To "go off the pregnancy" represents pregnant women's desire to discuss psychosocial factors that were important to them during prenatal care. Five themes emerged from the data and were used to develop categories for the Prenatal Event History Calendar: relationships, stress, routines, health history perceptions, and beliefs.

CONCLUSION

One vital component of prenatal care assessment is assessing for psychosocial risk factors. Prenatal Event History Calendar was specifically developed to provide a comprehensive and contextually linked psychosocial risk assessment for use with pregnant Black women.

Use of a Pregnancy Support Web Site by Low-Income African American Women

OBJECTIVE

To examine the feasibility and usage pattern of a social support Web site by low-income pregnant African American women.

DESIGN

Descriptive.

SETTING

Homes of participants.

PARTICIPANTS

Nineteen pregnant African American women who were pregnant for the first time, were low risk, and attending a prenatal clinic.

INTERVENTION

Culturally congruent Web site providing information on pregnancy-related health behaviors and other pregnancy issues.

MAIN OUTCOME MEASURES

Number of visits to Web site, most popular pages, content analysis of postings, and e-mails to a nurse.

RESULTS

Participants were able to learn to use the Web site easily. They accessed the discussion board the most frequently, followed by changes during pregnancy by month, ask-a-nurse feature, ultrasound, stories about pregnant women, and spirituality.

CONCLUSIONS

The discussion board is the most effective way to deliver informational social support on a comprehensive social support Web site.