Postpartum mothers' perceptions of competence for infant care

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

INTRODUCTION

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

METHODS

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

RESULTS

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

DISCUSSION

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

Parenting self-efficacy instruments for parents of infants and toddlers: A review

Background

Parenting Self-Efficacy, a concept first described in Bandura's Social Cognitive Theory, is a parent's belief in their ability to successfully parent their child. The concept of parenting self-efficacy is used by researchers to increase our understanding of parenting abilities and influences on child health and developmental outcomes. Numerous instruments exist for measuring parental self-efficacy; but little is known about the specific topics included in the measures and consistency across instruments. Therefore, this scoping review sought to compare parenting self-efficacy instruments for parents of infants and toddlers, focusing on comparison of parenting topics, scale format, and administration with the goal of providing guidance and recommendations for measurement selection.

Methods

Our sample included 25 instruments and items from every instrument was evaluated and coded using NVIVO Qualitative Software. We reviewed the instruments' target population, subscales, number of items, response options, scoring range and instructions, theoretical background, and parenting topics across each instrument.

Results

This review found three common factors across all instruments: parent, social and family, and child factors. Parent personal factors were addressed most frequently to evaluate self-efficacy and included topics such as, perception of parenting abilities, emotional reactions, and perceived successes. From our synthesis, we also offer recommendations for instrument selection and provide a conceptual model of parenting self-efficacy.

Conclusions

The findings from this scoping review highlight the presence of key factors (parent, social & family, and child) necessary for the evaluation of parenting self-efficacy in parents of infants and toddlers. Given our results, a meta-analysis is needed to compare parenting self-efficacy scores across studies to better understand the associations between self-efficacy and parent and child outcomes.

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

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

Self-Report Measures of Parental Self-Efficacy: A Systematic Review of the Current Literature

Parenting self-efficacy (PSE) describes a parent's belief in their ability to perform the parenting role successfully. Higher levels of PSE have consistently been shown to be correlated with a wide range of parenting and child outcomes. Consequently, many parenting interventions aim to improve PSE. PSE measurement has typically been via self-report measures. However, the wide range of available measures has resulted in their limited use, inconsistent terminology and ambiguous theoretical grounding. The purpose of this systematic review was to examine the psychometric and administrative qualities of the available PSE measures and offer clarity to the terminology and the theory underpinning their use so that the future use of PSE measures can be appropriate. Eleven electronic databases were searched. Articles were included if they introduced a new measure or were psychometric evaluations of an available measure of PSE for parents of children (from infancy until 18 years of age). Thirty-four measures were identified and their psychometric and administrative qualities were examined. Overall, the quality of the available measures was varied. Whilst this review makes recommendations regarding PSE measures for parents of infants through to adolescents, some caution should be applied when choosing the most appropriate measure. The theoretical grounding of each measure was clarified so that appropriate measures can be chosen under the relevant circumstances. The implications of refinement of the available measures are discussed and further research into improving PSE measurement is identified.

Further Psychometric Testing and Use of the Maternal Confidence Questionnaire

Research results can be better interpreted and used when reliable and valid instruments are used to measure concepts. Researchers and clinicians, especially those from locations outside the United States, have difficulty locating existing instruments for use in their research studies. The dilemma is further exaggerated when such instruments are not published and when the author of the instrument cannot be located. This review looked at the results of 20 studies which have utilized the Maternal Confidence Questionnaire (MCQ) (Zahr, 1991) with the purpose of familiarizing researchers and clinicians with its flexibility, reliability, and validity. Examples of specific published studies which have used the instrument are discussed along with unpublished studies which have used the instrument.

Clinical assessment of mothering during infancy

Using reliable and valid measurements of mothering can enhance clinicians' and researchers' ability to identify problematic patterns that pose risks to the health of mothers and infants during the first postpartum year. A critical review of observational and self-report instruments for measuring components of mothering is presented. Positive indicators of mothering are discussed, and implications for intervention and referral for problematic aspects of mothering are suggested.

Devenir père : un portrait des premiers moments*

Problème. Les pères sont engagés, en période postnatale, dans la construction de leurs perceptions d’efficacité parentale. Pourtant, on en sait peu sur ce qui aide les pères à construire leurs perceptions d’efficacité. De même, l’apport des premiers événements de la transition à la paternité dans l’expérience paternelle est méconnu. Objectif. 1. Identifier les perceptions des pères primipares des événements critiques de la période postnatale. 2. Examiner la contribution de ces événements à la construction des perceptions d’efficacité des pères primipares. Méthode. Une étude descriptive quantitative auprès de 160 pères d’un premier enfant. Résultats. Les pères primipares ont une expérience riche et diversifiée durant les premiers moments de leur transition à la paternité. L’alliance parentale et une faible anxiété contribuent aux perceptions d’efficacité de ces pères.

Perceived parental efficacy: concept analysis

AIMS

This paper describes a concept analysis carried out to remove some of the ambiguity surrounding the conceptual meaning of perceived parental efficacy and to distinguish it from related concepts such as parental confidence and parental competence.

BACKGROUND

Constructing parental efficacy is a crucial step for family members after the birth of their first child. For some authors, perceived parental efficacy is a motor for adequate parental practices. Confusion about the definition and measurement of this concept has hindered both psychology and nursing practice and research. Concept delineation and concept clarification are required in order to further the development of the concept of perceived parental efficacy.

METHODS

A literature search using a variety of online databases yielded 113 articles between the years 1980 and 2000. The final sample (n=60) consisted of 30 articles from two disciplines: nursing and psychology. A content analysis of the literature was done using Rodger's evolutionary concept analysis method.

FINDINGS

Content analysis of the literature yielded four contributors to perceived parental efficacy: positive enactive mastery experiences, vicarious experiences, verbal persuasion and an appropriate physiological and affective state. Perceived parental efficacy can thus be defined as 'beliefs or judgements a parent holds of their capabilities to organize and execute a set of tasks related to parenting a child'.

CONCLUSION

This conceptual analysis has allowed perceived parental efficacy to be distinguished from parental confidence and parental competence. Both nursing and psychology research, practice and education will benefit from a more precise and delineated concept.

The infant care questionnaire: assessment of reliability and validity in a sample of healthy mothers

Few instruments are available to assess perceptions of competence in the specific maternal role function of infant care provider. This article reports on a methodological study of the development and evaluation of the Infant Care Questionnaire (ICQ), a self-report scale designed to measure the mother's perceptions of her abilities and competence as an infant care provider. The sample consisted of healthy low-risk primiparous and multiparous mothers (N = 164) of term infants. Principal components factor analysis with a Varimax rotation produced a three factor solution that explained 42% of the total variance. The three factors were Mom&Baby, Emotionality, and Responsiveness with Cronbach alpha coefficients of .86, .79, and .58, respectively. Validity evidence included higher Mom&Baby scores for multiparous mothers, F (1, 139) = 10.78, p = .001; those with greater time in the mothering role, F (2, 138) = 21.78, p = .000; and a significant correlation with the similar Maternal Confidence Scale, r (155) = .48, p = .000. Acquisition of competence was shown in a greater proportion of mothers rated "competent" at five weeks compared with one week postnatal, chi 2 (1, N = 156) = 22.77, p = .000. While the ICQ demonstrated adequate reliability and validity, establishment of clinical relevance and appropriateness with other groups is required.

Caregiving and help seeking by mothers of low birthweight infants and mothers of normal birthweight infants

The purpose of this research was to describe perceptions of infant health, caregiving at home, and help seeking by mothers of low birthweight (LBW) infants (n = 30) and mothers of normal birthweight infants (n = 30). In this descriptive study, data were analyzed through multiple regression, t tests, and content analysis of responses to researcher-constructed questionnaires. There were statistically significant relationships between: infant health and both confidence in caregiving (R2 = 0.18, p<0.001) and caregiver burden (R2 = 0.29, p<0.001); preparation for caregiving and confidence in caregiving (R2 = 0.10, p<0.05); and confidence in caregiving and caregiver burden (R2 = 0.12, p<0.01). Compared with mothers of normal birthweight infants, mothers of LBW infants perceived poorer infant health, t (58) = -2.02, p = <0.05, and more caregiver burden, t (58) = 3.50, p = <0.001. Mothers reported seeking help from a variety of resources, mostly nonprofessional for questions on infant care or nonserious infant health problems, and mostly physicians for questions on serious infant health problems. Nurses can use knowledge of mothers' perceptions of infant health, caregiving, and help seeking to facilitate mothers' management of caregiving and resource use.

The Brazelton Neonatal Behavioral Assessment Scale and maternal identity

PURPOSE

To determine the effect of demonstrating the Brazelton Neonatal Behavioral Assessment Scale (NBAS) on the development of a maternal identity.

DESIGN

Quasiexperimental design with matched groups.

METHODS

As part of a larger longitudinal study examining maternal identity, pregnant women were recruited during prenatal classes or routine obstetrical visits; they then completed questionnaires assessing demographic, psychosocial, and maternal identity variables. All women were visited in the hospital after delivery. Three weeks after delivery, the women completed a questionnaire packet assessing demographic, psychosocial, maternal identity, and infant variables. Demonstration of the NBAS in the hospital after delivery was included as a pilot project within the larger study. For the pilot project, 22 women who received a demonstration of the NBAS were matched on age, parity, and socioeconomic status with 22 women from the larger study who did not receive the demonstration.

RESULTS

No significant differences between groups were noted on any prenatal or postnatal psychosocial or maternal identity variables. However, women who received a demonstration of the NBAS found their infants to be significantly more predictable than infants of women in the control group.

CLINICAL IMPLICATIONS

Demonstration of the NBAS had little effect on the development of a maternal identity in the women studied. However, the NBAS was a useful teaching tool for helping mothers anticipate their infants' responses to environmental stimuli. Further research is needed in this area.

Social support, knowledge of infant development, and maternal confidence among adolescent and adult mothers

OBJECTIVE

To explore the influence of social support and knowledge of infant development on maternal confidence in performing infant care tasks among adolescents and adults.

DESIGN

Descriptive, exploratory.

SETTING

A large urban teaching hospital in the midwestern United States.

PARTICIPANTS

116 adolescent mothers (ages 13 to 19 years); 101 adult mothers (ages 20 to 41 years).

MAIN OUTCOME MEASURES

Adult mothers reported higher levels of knowledge about infant development than did adolescent mothers. For both adolescent and adult mothers, social support and knowledge of infant development were significantly correlated with confidence in providing infant care. For adolescents, knowledge of infant development explained 15% of the variance in maternal confidence scores, and the number of people in the adolescent's household explained an additional 5%. For adults, parity explained 10%, social support explained 9%, and knowledge of infant development explained 4% of the variance in maternal confidence scores.

CONCLUSIONS

An adolescent's knowledge of infant development significantly affects her confidence in providing infant care. Given the learning needs of new mothers and the time constraints for in-hospital postpartum teaching, nurses may need to adjust content and teaching methods for all new mothers, but especially to meet the needs of adolescent mothers.

Relationships among prenatal maternal attachment, presence of postnatal depressive symptoms, and maternal role attainment

PURPOSE

To examine the relationships among a woman's attachment to her fetus, the presence of postpartum depressive symptoms, and subsequent perceptions of maternal role attainment three months after birth

DESIGN

A longitudinal, panel design

SETTING

Hospital-sponsored childbirth education classes

PARTICIPANTS

Primiparous women (N = 136) at 24-40 weeks of pregnancy and 9-14 weeks after the birth

MAIN OUTCOME MEASURES

Perceived Competence Scale, Myself as Mother Scale, and My Baby Scale

RESULTS

Prenatal maternal attachments was positively related to maternal role attainment to maternal role attainment.

CONCLUSIONS

These findings enhance maternal identity theory and provide a means to evaluate the transition to motherhood.

Experienced and inexperienced mothers' maternal competence during infancy

In an exploratory study 136 experienced (multiparous) mothers and 166 inexperienced (primiparous) mothers were studied to determine differences in their self-reported maternal role competence, and variables predicting their competence at postpartal hospitalization, 1, 4, and 8 months following birth. The two groups did not differ in their maternal role competence over the 8 months. Inexperienced mothers' competence was higher at 4 and 8 months than at early postpartum and 1 month, indicating a developmental process in maternal role achievement, but no change was observed in experienced mothers' maternal competence. From 45% to 56% of the variance in experienced mothers' maternal competence was explained over the four test periods, and from 43% to 50% among inexperienced mothers. Self-esteem was a consistent, major predictor of maternal competence for both groups. Maternal fetal attachment, readiness for pregnancy, and pregnancy risk variables were explanatory of experienced mothers' maternal competence only. Sense of control was explanatory only of inexperienced mothers' competence at 1, 4, and 8 months.

Two evaluations of combined mother-infant versus separate postnatal nursing care

Combined mother-infant postnatal nursing care was compared with traditional, separate postpartum and newborn care in two studies. In Study I, self-administered questionnaires were completed by 408 mothers and 63 staff nurses. Data were collected both before and after mother-infant care was implemented. Benefits of the new system included increased maternal competence and satisfaction with parent education, parent-infant contact, and the nurse-client relationship, increased staff satisfaction, with no increase in operational cost. There were no breastfeeding differences, but ways to improve duration were implied by reasons for stopping. These findings were replicated in a separate setting with similar sample sizes. However, in the latter case, low staff ratios appeared to limit the benefits of mother-infant care to multiparas rather than primiparas.

Postpartum concerns: a study of Tanzanian mothers

Maternal and child health services in Tanzania have succeeded in implementing health care strategies to improve the health of children under 5 years of age. However, health care for childbearing women has not been a focus (Government of the United Republic of Tanzania/UNICEF, 1990). We examined what Tanzanian women perceive as concerns during the early postpartum period. A card sort was used with 50 primiparas and 50 multiparas from the Dar-es-Salaam urban area. Primiparas had significantly more worries and interests than did multiparas. Multiparas had significantly more confidence than primiparas had. Findings correspond to those of studies conducted on North American populations, suggesting that early postpartum concerns may be cross-cultural.

The confidence of Latina mothers in the care of their low birth weight infants

The growing numbers of Latina mothers with low birth weight (LBW) infants in U.S. hospitals prompted an investigation of maternal confidence and caretaking ability in this group. A sample of 54 Mexican-born, Latina mothers with LBW infants was compared with a group of 25 who had full-term infants. Unexpectedly, there was no significant difference in the perceived maternal confidence of the two groups. Behaviors indicative of sensitivity and competence in caretaking, assessed in mothers with LBW infants, did not correlate with maternal confidence. Factors correlated with maternal confidence and caretaking behavior were the mother's age, education, and parity, as well as the infant's birthweight, weight at discharge, and medical complications. Weight at discharge correlated with caretaking behaviors. The strongest predictor of maternal confidence was parity, followed by infant health (fewer medical complications). These factors together accounted for 25% of the variance in confidence, suggesting that other factors that contribute to maternal confidence of Latina mothers need to be identified.

Assessing maternal competence and sensitivity to premature infants' cues

Because it is becoming increasingly evident that the sensitivity of mothers to their premature infants can affect the mother-infant relationship, means to assess maternal sensitivity to infants are essential. The Boston City Hospital Assessment of Parental Sensitivity (BCHAPS) was the tool used in this study to assess maternal competence and sensitivity to premature infants in the Neonatal Intensive Care Unit (NICU). The concurrent validity of the tool was determined by examining the relation between scores on the BCHAPS and several maternal characteristics (i.e., family income, education, and parity) and infant characteristics (i.e., weight, gestational age, APGAR scores, and severity of illness). The predictive validity of the BCHAPS was determined by comparing the BCHAPS scores to mother-infant interaction behaviors when infants were 8 months old. Scores obtained on the BCHAPS correlated with mother-infant interaction scores at 8 months and to parity. There was no correlation between the BCHAPS scores and other maternal-infant characteristics. The results of this study indicate that the BCHAPS is a tool that can be used clinically to assess maternal behaviors in the NICU and that can predict the mother-infant relationship long after the discharge of the infant.

The relationship between maternal confidence and mother-infant behaviors in premature infants

The purpose of this study was to investigate the relationship between maternal confidence in mothers of premature infants, maternal behaviors and skills, and infant temperament. The relationship between certain prenatal and background variables and maternal confidence also was assessed. The sample consisted of 49 mother--infant pairs from low socioeconomic backgrounds who were followed for 8 months. Maternal behaviors were assessed in the neonatal intensive care unit and during 4- and 8-month follow-up visits at home. Infant temperament was assessed using the Bates Infant Characteristics Questionnaire. The results revealed that maternal confidence was related to education, income, and parity as well as the presence and severity of intraventricular bleed. There was no relationship between observed maternal behaviors and skills and perceived confidence by mothers. Maternal confidence was related to infant temperament ratings.

Description of a home follow-up program for childbearing families

Over the years, nurses have identified the need for home follow-up of postpartum families after discharge from the hospital. In the current health-care environment, the need for follow-up care is greater than ever. This article reviews the rationale for a follow-up program and describes a model, in existence since 1987, that makes postpartum follow-up an integral part of the total nursing care that childbearing families receive from the institution. The purpose, objectives, components, organization, documentation, funding, and evaluation of the program are described.

Early postpartum transition: progress in maternal identity and role attainment

Sets of early postpartum transition variables and relationships among them examined in this study were: (a) Maternal attributes (parity, age, education); (b) infant feeding plan (extent of breast-feeding); (c) birthing conditions (supports and stressors during labor and delivery); (d) birthing experience (how well labor and delivery went, usefulness of postpartum learning resources, adequacy of hospital stay); and (e) transition markers (evaluation of parenting and of infant- and self-care capability). Infant feeding plan was related to supports but not to how well labor and delivery went. Whereas preparation for birthing was positively related to how well labor and delivery went, stressors were negatively related. The direct contribution of preparation for birthing to both parenting evaluation and infant- and self-care capability and of supports and usefulness of postpartum resources to self-care capability merits clinical attention to these variables. Research concerning types of birthing experience that may contribute to evaluation of parenting is needed.

Evaluating hospital postnatal nursing care: development of the instruments

Measures of the quality of hospital postnatal nursing care were developed for an evaluative study of the benefits of combined mother-infant versus traditional separate staffing patterns. Two hundred mothers completed instruments designed to measure maternal competence, patient satisfaction, establishment of breast-feeding in hospital and breast-feeding success at 6 weeks, and 28 nursing staff completed measures of staff satisfaction. The internal consistency and test-retest reliability of scales were supported by alpha coefficients of .60 to .89 and correlation coefficients of .74 to .80. A 90% participation rate and a 97% completion rate were achieved for the maternal sample. Evidence is presented for instrument content, construct, and predictive validity.

Clinical specialist pre- and postdischarge teaching of parents of very low birth weight infants

This study examined the pre- and postdischarge teaching needed by parents of very low birth weight infants (less than or equal to 1,500 g). The sample consisted of 36 families observed from the births of their infants to 18 months' postdischarge. Content analyses yielded five major teaching categories of infant, mother, family, home, and resources. Major predischarge teaching included feeding, recognition of infections, and growth and development. Major postdischarge teaching included feeding, current health problems, growth and development, and managing within the health-care system.

A comparison of postpartum early and traditional discharge groups

Women from a health maintenance organization who chose early postpartum discharge from the hospital were compared with women who chose a traditional stay. Subjects were mailed a questionnaire; 84% (n = 183) were returned. The survey instrument was designed to measure demographic, family, and birth-related characteristics; postpartum values and beliefs; early discharge program awareness; and postpartum care satisfaction. Findings revealed that the early discharge group had fewer primiparas, more rooming-in mothers, more bottle-feeding mothers, more deliveries between midnight and 6:00 AM, more deliveries at one hospital, more mothers who relied on themselves rather than others for their discharge decision, and more mothers who learned about early discharge from printed information rather than from clinic staff. Mothers in the late discharge group placed more value on rest and sleep, a quiet atmosphere, attention from others, and having a knowledgeable person available. Implications for hospitals and staff education are discussed in light of complete study findings.