Factors influencing mothers' abilities to engage in a comprehensive parenting intervention program

Intention to Engage in Maternal and Child Health Home Visiting

Home visiting (HV) programs have the potential to improve maternal and child health. As federal and state initiatives expand the reach of these programs, understanding what factors enhance uptake and retention of the services becomes increasingly important. This qualitative study used a Reasoned Action Model (RAM) and a cultural lens to explore factors influencing the engagement of women with low-income in HV programs. We conducted 21 semi-structured interviews in both English and Spanish in a prenatal clinic in an urban public health department. The constructs most salient for participants were emotions and affect, behavioral beliefs, and self-efficacy. In the context of an urban public health prenatal clinic, HV marketing and outreach should highlight convenience and social support, as well as clearly communicate program content and intent. In practice, HV programs must be flexible to work around work and home schedules; marketing and outreach should emphasize that flexibility.

Guidelines for support to mothers of sexually abused children in North-West province

Background

South Africa is reported to have the highest rate of sexual assault in the world with over 40% of cases occurring among children. Children who are sexually abused have support programmes and policies to assist them in coping, but there are no support programmes for mothers or caretakers. Caretakers need support for themselves and assisting them will incrementally benefit children under their care. Often mothers of these children experience shock, anger, disbelief and suffer secondary trauma such as depression and post-traumatic stress disorder (PTSD) following their children’s sexual abuse disclosure and yet there are no guidelines for support to these mothers within North-West province (NWP)

Objectives

The study seeks to develop guidelines for support to mothers of sexually abused children in NWP.

Methods

Concurrent convergence triangulation mixed method design was employed in this study. The population consisted of mothers of sexually abused children (SAC) (n = 17 participants for the qualitative component and n = 180 participants for the quantitative component). A sample of mothers of SAC was purposely selected.

Results

The participants indicated significant levels of depression because of lack of support by stakeholders. Guidelines for support to assist mothers cope with their secondary trauma were developed based on the literature review, study findings as well as an ecological model of the impact of sexual assault on women’s mental health. The results also showed extreme PTSD (47.8%), little support (38.8%), not coping (76.1%) and depression (36.1%).

Conclusion

The stakeholders should consider a positive approach to support mothers whose children are sexually abused.

Health behavior change in pregnant women: a two-phase study

BACKGROUND

Maternal health behaviors during pregnancy/infancy can have a significant impact on maternal and child health. Many women engage in health risk behaviors during pregnancy. Multiple health behavior change (MHBC) interventions provide support to change health behaviors, but further information is needed on potential targets for such an intervention, as well as on the feasibility of technology use and e-health with this population.

MATERIALS AND METHODS

Two studies were completed as part of this project. First, a survey to examine views regarding health behaviors, desires to change health behaviors, and use of technology was completed by 68 pregnant women presenting for routine care. Based on survey findings, a brief MHBC e-health educational intervention related to breastfeeding, healthy nutrition/lifestyle, and stress management, using iPad(®) (Apple, Cupertino, CA) and text-messaging media, was then developed and piloted in the home with five pregnant women.

RESULTS

In the survey, the majority of participants reported interest in receiving help to improve health behaviors, including losing weight or eating a healthier diet, breastfeeding, smoking cessation, and help with depression. The majority of women reported access to a computer with Internet, a phone, and frequent use of text messaging. In the second phase, results suggest that the home-based intervention was feasible and that the technology was convenient and user-friendly.

CONCLUSIONS

Pregnant women are interested in improving health behaviors and found a brief technology-based e-health intervention feasible, convenient, and user-friendly. In-home technology appears to be a feasible and convenient approach to addressing the multiple health behavior change needs of pregnant women.

Multiple Family Groups for Child Behavior Difficulties Retention Among Child Welfare-Involved Caregivers

Among children who remain at home with their permanent caregivers following a child welfare investigation, few who manifest emotional and behavioral difficulties actually engage in mental health treatment. The Multiple Family Group service delivery model to reduce childhood disruptive behavior disorders (MFG) has shown promise in engaging child welfare-involved families. This qualitative study examines caregiver perceptions of factors that influence retention in MFGs among child welfare-involved families.

METHODS

Twenty-five predominantly Black and Hispanic adult (ages 26-57) female caregivers with child welfare services involvement participated in individual, in-depth interviews about their experience with MFGs. Transcribed interview data were thematically coded guided by grounded theory methodology. Emergent themes were subsequently organized into a conceptual framework.

RESULTS

Within the overarching influence of child welfare services involvement, specific components of MFGs influencing retention included the quality of interaction among group members, group facilitators' attentive approach with caregivers, supports designed to overcome logistical barriers (i.e., child care, transportation expenses, meals), and perceptions of MFG content and activities as fun and helpful. Caregiver factors, including their mental health and personal characteristics, as well as children's behavior, (i.e., observed changes in behavioral difficulties) were also associated with retention.

CONCLUSIONS

High acceptability suggest utility for implementing MFGs within settings serving child welfare involved families, with additional modifications to tailor to setting and client features.

The Living Experience of Feeling Overwhelmed: A Parse Research Study

Feeling overwhelmed is a universal living experience of living quality. Although feeling overwhelmed frequently occurs in healthcare, studies related to its meaning have never been published. Parse's humanbecoming school of thought was the theoretical framework for this study. The research question for this study was: What is the structure of the living experience of feeling overwhelmed? The purpose was to advance nursing science and enhance the theory of humanbecoming. Parse's phenomenological-hermeneutic research method was the method used. Participants from the general population included nine women and one man ranging in age from 18 to 65. Descriptions were arrived at through dialogical engagement. The major finding of the study is the structure: Feeling overwhelmed is burdening disconcertedness surfacing with divergent engagements as optimistic anticipation arises while structuring endeavors.

A Systematic Review of the Literature on Health and Wellness Coaching: Defining a Key Behavioral intervention in Healthcare

PRIMARY OBJECTIVE

Review the operational definitions of health and wellness coaching as published in the peer-reviewed medical literature.

BACKGROUND

As global rates of preventable chronic diseases have reached epidemic proportions, there has been an increased focus on strategies to improve health behaviors and associated outcomes. One such strategy, health and wellness coaching, has been inconsistently defined and shown mixed results.

METHODS

A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided systematic review of the medical literature on health and wellness coaching allowed for compilation of data on specific features of the coaching interventions and background and training of coaches.

RESULTS

Eight hundred abstracts were initially identified through PubMed, with 284 full-text articles ultimately included. The majority (76%) were empirical articles. The literature operationalized health and wellness coaching as a process that is fully or partially patient-centered (86% of articles), included patient-determined goals (71%), incorporated self-discovery and active learning processes (63%) (vs more passive receipt of advice), encouraged accountability for behaviors (86%), and provided some type of education to patients along with using coaching processes (91%). Additionally, 78% of articles indicated that the coaching occurs in the context of a consistent, ongoing relationship with a human coach who is trained in specific behavior change, communication, and motivational skills.

CONCLUSIONS

Despite disparities in how health and wellness coaching have been operationalized previously, this systematic review observes an emerging consensus in what is referred to as health and wellness coaching; namely, a patient-centered process that is based upon behavior change theory and is delivered by health professionals with diverse backgrounds. The actual coaching process entails goal-setting determined by the patient, encourages self-discovery in addition to content education, and incorporates mechanisms for developing accountability in health behaviors. With a clear definition for health and wellness coaching, robust research can more accurately assess the effectiveness of the approach in bringing about changes in health behaviors, health outcomes and associated costs that are targeted to reduce the global burden of chronic disease.

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.