The reliability and validity of the Postpartum Partner Support Scale among Chinese women

BACKGROUND

The benefits of partner support have been well documented for maternal and child health and wellbeing. Chinese women who practice traditional postpartum rituals may lack support during the confinement and often rely heavily on their partners. Currently, there is no validated measure to assess postpartum partner support in China.

AIM

To translate the Postpartum Partner Support Scale (PPSS) into Chinese, evaluate its psychometric properties and assess postpartum support among Chinese women.

METHODS

The PPSS was translated into Chinese using a validated process and administered to 428 postpartum women residing in the city of Quanzhou in the Fujian Province in China between September 2021 and July 2022.

RESULTS

Reliability analysis demonstrated a Cronbach's α coefficient of 0.97, a split-half coefficient of 0.93, and a retest correlation coefficient of 0.91 (p < 0.01). The item analysis and content validity results fell within the recommended range, with no items requiring deletion. Exploratory factor analysis revealed the extraction of a single common factor, which accounted for 74.05% of the cumulative variance. Confirmatory factor analysis yielded a χ2/df ratio of 1.48 and an RMSEA value of 0.05. Several demographic variables were associated with significantly lower levels of postnatal partner support including older maternal and paternal age, lower maternal education, higher household income, fair relationship with in-law family, female infant sex, and premature birth.

CONCLUSION

The Chinese version of the PPSS exhibited good reliability and validity providing evidence that it may be suitable for evaluating partner support among postpartum women in China.

Physical activity, sedentary behaviour, and sleep knowledge and self-efficacy among parents of young children in Canada

Background

Engaging in healthy movement behaviours in early childhood is beneficial for children's development, and parents play a critical role in shaping movement habits during these formative years. This study aimed to explore parents' knowledge of the Canadian 24-Hour Movement Guidelines for the Early Years (The Guidelines) and their perceived knowledge and self-efficacy of movement behaviour concepts in early childhood. The influence of sociodemographic characteristics on these variables was also examined.

Methods

Via a cross-sectional online survey with parents/guardians (n = 576) of young children in Canada, participants' knowledge of The Guidelines (11 items), and perceived knowledge (11 items; 5-point scale) and self-efficacy (11 items; 11-point scale) of movement behaviour concepts in early childhood were examined. Descriptive statistics were calculated for independent variables and multivariate regression models were estimated to examine sociodemographic factors that were associated with participants' knowledge and self-efficacy.

Results

Few participants (11.9%) reported to be familiar with The Guidelines. Parents were most knowledgeable about the screen time guideline for children under 2 years (75.0% correctly identified the guideline) and least familiar with the recommendation for toddler/preschooler total physical activity (14.7% correctly identified the guideline). Parents/guardians perceived they were the most knowledgeable about safe sleep practices (65.9% very/extremely knowledgeable) and least knowledgeable about muscle- and bone-strengthening activities (71.8% not at all/somewhat knowledgeable). Overall, parents/guardians were moderately confident in promoting healthy movement behaviours (M = 6.01; SD = 1.73). Participants with higher levels of education reported significantly higher perceived knowledge compared to those who were less educated (p = .004), and parents/guardians identifying as White reported significantly higher levels of self-efficacy compared to parents/guardians from minority ethnic groups (p = .028). Finally, parents/guardians who were more physically active reported both higher perceived knowledge (p < .001) and self-efficacy (p < .001) than those who were less active.

Conclusion

These findings shed light on the need to raise awareness of The Guidelines among parents of young children and highlight specific movement behaviour concepts in need of focus in future training for this population. Targeted education for parents/guardians from lower socioeconomic groups is also needed to address equity concerns.

Supplementary Information

The online version contains supplementary material available at 10.1186/s44167-024-00051-x.

A Longitudinal Examination of Mothers' Early Postnatal Adaptation: Relative Stability Across the First Eight Weeks

OBJECTIVE

Using person-centered analyses, this study examined the trajectories of women's early postnatal adaptation and explored whether there were differences in their trajectories based on women's status as a first-time or more experienced mother.

METHODS

Data were collected from women (N = 137; Mage = 28.6 years, SD = 4.49; 48.2% first-time mothers) at 2-, 4-, 6-, and 8-weeks postpartum. At each wave of data collection, mothers reported on their parenting self-efficacy, parenting satisfaction, anxiety, parenting stress, and depressive feelings.

RESULTS

The creation of an amalgamated measure of postnatal adaptation demonstrated acceptable fit. Latent class growth analysis revealed four distinct trajectories of postnatal adaptation; two revealed stability across the early postnatal period and two had relative stability except for a change between weeks four to six. Women's parity was not associated with differences in their trajectories.

CONCLUSIONS FOR PRACTICE

These findings reiterate the importance of collecting data from women in the early postnatal period and identifying if a woman is struggling in those early weeks, as the women in our sample demonstrated relative stability in their postnatal adaptation across the first eight weeks. Furthermore, the findings suggest that work should be taken to dismantle the commonly held belief that parenting is "easier" after having already navigated the early postnatal period with an infant once before.

Association of parental self-efficacy with loneliness, isolation and community commitment in mothers with infant children in Japan: a cross-sectional study

OBJECTIVES

Parental self-efficacy is defined as an individual's appraisal of their competence in the parental role and is one of the factors targeted by parenting interventions. Factors related to parental self-efficacy among mothers, focusing mainly on individual and family characteristics, have been clarified; however, there are limited findings on community/societal factors related to parental self-efficacy among mothers. We aimed to clarify the association between parental self-efficacy and community/societal factors among mothers with infants and toddlers to provide suggestions for maternal and child health activities.

DESIGN

This was a cross-sectional study, where an anonymous, self-administered questionnaire survey was conducted by mail from November 2019 to February 2020.

SETTING

A health and welfare centre in a ward certified by the largest designated city in Japan.

PARTICIPANTS

Six hundred forty-nine mothers raising children aged 0-3 years who attended mandatory infant health check-ups.

PRIMARY OUTCOME MEASURES

The Parental Self-Efficacy Scale.

RESULTS

The number of valid responses was 490 (valid response rate: 75.6%). The mean age of the mothers was 33.2 (SD 4.9) years. The items found to significantly relate to parental self-efficacy (p<0.05), loneliness, social isolation (social network), community commitment, greeting neighbours, willingness to interact with neighbours, participation in parent-child circles and neighbourhood association events were included as independent variables. Multiple regression analysis showed that the factors significantly related to high parental self-efficacy were low loneliness score (β=-0.436, p<0.001), high social network score (β=0.153, p<0.001) and high community commitment score (β=0.110, p<0.01). The adjusted R2 was 0.488.

CONCLUSIONS

The results suggest the importance of community-building, enhancing qualitative and quantitative support by developing initiatives to reduce loneliness and improving the environment to supplement social networks, and activating community activities by promoting interaction with local residents.

Antenatal predictors of postnatal maternal attachment and competence after assisted conception-a prospective cohort study in South India

The aim of this study is to examine the influence of antenatal factors such as anxiety, depression, perceived stress, marital satisfaction, maternal antenatal attachment, and social support on postnatal maternal attachment and competence in women who received assisted reproductive treatment. A prospective longitudinal cohort design was adopted with two groups-50 women who received assisted reproductive treatment and 50 women who had natural conception. Both the groups were assessed using self-report measures over three time points: T1, 7th month of pregnancy; T2, 2 weeks postpartum; and T3, 3 months postpartum. A final sample of 44 women who had assisted conception and 47 women who had natural conception completed assessments across all three time points. Descriptive, bivariate analyses, and stepwise multiple linear regression analyses were carried out. In the assisted conception group, maternal antenatal attachment, depression, and marital satisfaction significantly predicted postnatal maternal-infant attachment. Perceived social support, depression, and duration of marriage significantly predicted postnatal maternal competence. In the naturally conceived group, maternal antenatal attachment and social support significantly predicted postnatal maternal-infant attachment; perceived stress significantly predicted postnatal maternal competence. Antenatal depressive symptoms and relational factors significantly influenced postnatal maternal attachment and competence highlighting the need for screening and targeted psychological interventions during pregnancy.

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.

Systematic review and meta-analysis of psychoeducation on the psychological and social impact among first-time mothers

OBJECTIVE

This systematic review aimed to synthesise evidence of the effectiveness of psychoeducation in improving self-efficacy and social support and reducing depression and anxiety in first-time mothers.

METHODS

A comprehensive search was conducted on nine databases, grey literature, and trial registries for randomised controlled trials published from the databases' inception to 27 December 2021. Two independent reviewers screened studies, extracted data, and appraised the risk of bias. RevMan 5.4 was used for the meta-analyses of all outcomes. Sensitivity and subgroup analyses were conducted. Overall evidence quality was appraised using GRADE approach.

RESULTS

Twelve studies involving 2083 first-time mothers were included. The meta-analyses favoured psychoeducation as compared to control groups. At immediate post-intervention, statistically significant increments were seen in self-efficacy and social support, while a significant reduction in depression was observed but not in anxiety. At three months postpartum, a statistically significant decrease in depression was observed, but the effects on self-efficacy and social support were insignificant.

CONCLUSION

Psychoeducation improved first-time mothers' self-efficacy, social support, and depression. However, the evidence was very uncertain.

PRACTICE IMPLICATIONS

Psychoeducation might be incorporated into patient education of first-time mothers. More studies with familial and digital-based psychoeducation interventions, especially in non-Asian countries, are needed.

Maternal distress and parenting during COVID-19: differential effects related to pre-pandemic distress?

BACKGROUND

Distinguishing whether and how pre-existing characteristics impact maternal responses to adversity is difficult: Does prior well-being decrease the likelihood of encountering stressful experiences? Does it protect against adversity's negative effects? We examine whether the interaction between relatively uniformly experienced adversity (due to COVID-19 experience) and individual variation in pre-existing (i.e., pre-pandemic onset) distress predicted mothers' pandemic levels of distress and insensitive caregiving within a country reporting low COVID-19 death rates, and strict nationwide regulations.

METHOD

Fifty-one Singaporean mothers and their preschool-aged children provided data across two waves. Pre- pandemic onset maternal distress (i.e., psychological distress, anxiety, and parenting stress) was captured via self-reports and maternal sensitivity was coded from videos. Measures were repeated after the pandemic's onset along with questionnaires concerning perceived COVID-19 adversity (e.g., COVID-19's impact upon stress caring for children, housework, job demands, etc.) and pandemic-related objective experiences (e.g., income, COVID-19 diagnoses, etc.). Regression analyses (SPSS v28) considered pre-pandemic onset maternal distress, COVID-19 stress, and their interaction upon post-pandemic onset maternal distress. Models were re-run with appropriate covariates (e.g., objective experience) when significant findings were observed. To rule out alternative models, follow up analyses (PROCESS Model) considered whether COVID-19 stress mediated pre- and post-pandemic onset associations. Models involving maternal sensitivity followed a similar data analytic plan.

RESULTS

Pre-pandemic maternal distress moderated the association between COVID-19 perceived stress and pandemic levels of maternal distress (β = 0.22, p < 0.01) but not pandemic assessed maternal sensitivity. Perceived COVID-19 stress significantly contributed to post-pandemic onset maternal distress for mothers with pre-pandemic onset distress scores above (β = 0.30, p = 0.05), but not below (β = 0.25, p = 0.24), the median. Objective COVID-19 adversity did not account for findings. Post-hoc analyses did not suggest mediation via COVID-19 stress from pre-pandemic to pandemic maternal distress.

CONCLUSIONS

Pre-existing risk may interact with subsequent perceptions of adversity to impact well-being. In combination with existing research, this small study suggests prevention programs should focus upon managing concurrent mental health and may highlight the importance of enhanced screening and proactive coping programs for people entering high stress fields and/or phases of life.

Parents' history of childhood interpersonal trauma and postpartum depressive symptoms: The moderating role of mindfulness

Postpartum depression is the most commonly reported mental health issue among parents welcoming a new child, with long-term impacts on the well-being of their family. Survivors of childhood interpersonal trauma (CIT) appear to be more vulnerable with higher rates of postpartum depressive symptoms. Yet, studies are needed on protective mechanism that can buffer the link between CIT and postpartum depressive symptoms, to identify factors that can promote resilience in CIT survivors as they navigate this demanding period. Studies also need to include both parents to adopt a comprehensive dyadic perspective. This study examined the moderating role of mindfulness, a protective mechanism documented as key for both postpartum mental health and trauma processing, in the association between CIT and postpartum depressive symptoms in parental couples. A randomly selected sample of 843 couples who recently welcomed a new child completed self-reported measures of CIT, dispositional mindfulness and postpartum depression. Path analyses showed that more experience of CIT was associated with higher levels of postpartum depression, but this association was weaker in parents with higher dispositional mindfulness. Exploration of mindfulness facets yielded that higher disposition to act with awareness and observation acted as specific buffers, for fathers and mothers respectively. In addition, more CIT reported by one parent was linked with their partner's higher depressive symptoms. These findings shed light on the protective role of mindfulness during the postpartum period to protect against postpartum depression in parents who are CIT survivors and their partners.

Predictor role of marital conflict on maternal competency with mediating role of perceived stress and concerns during pregnancy: A structural equation model

AIM

Pregnancy prepares the mother for the transition to motherhood. Maternal concerns during pregnancy cause reduced time spent with the spouse and lack of social support; additional stresses such as marital conflicts could impact maternal competency. This study aimed to assess the predictive effect of marital conflicts with the mediating role of perceived stress and pregnancy concern on maternal competency.

METHODS

This was a longitudinal study. It was done on 250 mothers referred to selected health centers in Alborz province. The sampling method was convenient. Marital conflicts, perceived stress, and pregnancy concerns questionnaires were completed in the third trimester of pregnancy, and the maternal competency questionnaire was completed 6 weeks after delivery. Data were analyzed by SPSS software and smart partial least squares.

RESULTS

The results of structural equations showed that marital conflicts have a negative and significant effect on maternal competency (β = -0.14), marital conflicts have a positive and significant effect on perceived stress (β = 0.42), and marital conflicts have a positive and significant effect on pregnancy concern (β = 0.31). Also, perceived stress negatively and significantly affected maternal competency (β = -0.36).

DISCUSSION

Results of the study showed the necessities for screening and identifying mothers with conflicts and assessing the perceived stress of mothers will improve the mental health of pregnant mothers and consequently increase maternal competency.

Self efficacy associated with regression from pregnancy-related pelvic girdle pain and low back pain following pregnancy

BACKGROUND

Self-efficacy, one's ability to deal with pain, disability, and other symptoms through self-management techniques, positively affect the quality of life in patients with chronic diseases. Pregnancy-related back pain is a common musculoskeletal disorder pre- and postnatally. Hence, the study aimed to determine whether self-efficacy is associated with the development of back pain during pregnancy.

METHODS

Between February 2020 and February 2021, a prospective case-control study was performed. Women with back pain were included. The self efficacy was assessed by the Chinese version of the General Self-efficacy Scale (GSES). Pregnancy-related back pain was measured using a self-reported scale. No regression from pregnancy-related back pain is defined as a recurrent or persistent pain score ≥ 3 over a week around 6 months postpartum. Women experiencing back pain during pregnancy are classified according to whether having a regression. This problem can be divided into pregnancy-related low back pain (LBP) and posterior girdle pain (PGP). The differences in variables were compared between groups.

RESULTS

A total of 112 subjects have completed the study finally. These patients were followed up with an average of 7.2 months after childbirth ranging from six to 8 months. 31 subjects (27.7%) of the included women did not report regression 6 months postpartum. The mean self efficacy was 25.2 (SD:10.6). Patients with no regression tended to be older (LBP:25.9 ± 7.2 vs.31.8 ± 7.9, P = 0.023; PGP: 27.2 ± 7.9 vs. 35.9 ± 11.6, P < 0.001*), have a lower self efficacy (LBP:24.2 ± 6.6 vs.17.7 ± 7.1, P = 0.007; PGP: 27.6 ± 6.8 vs. 22.5 ± 7.0, P = 0.010), and need high daily physical demand in their vocations (LBP:17.4% vs. 60.0%, P = 0.019; PGP: 10.3% vs. 43.8%, P = 0.006) when compared to those with regression. Multivariate logistic analysis shows that risk factors for no regression from pregnancy-related back pain included LBP (OR = 2.36, 95%CI = 1.67-5.52, P < 0.001), pain ratings of the onset of back pain during pregnancy≥3(OR = 2.23, 95%CI = 1.56-6.24, P = 0.004), low self efficacy (OR = 2.19, 95%CI = 1.47-6.01, P < 0.001), and high daily physical demand in their vocations (OR = 2.01, 95%CI = 1.25-6.87, P = 0.001).

CONCLUSIONS

Low self efficacy makes the women experience about two-fold risk to experience no regression from pregnancy-related back pain. Evaluation for self efficacy is simple enough to be used to improve perinatal health.

Family-level factors of early childhood development: Evidence from rural China

Family-level factors that characterize the home environment are critical inputs to early language and cognitive development, and potential mechanisms for improving developmental outcomes in vulnerable populations. Many studies conducted in high-income and Western settings highlight stimulating parenting, the home language environment, and parental self-efficacy as possible mechanisms of early development, though less is known about how these family-level factors impact child development in low- or middle-income settings. Even less is known about these family-level factors and early childhood development in rural China, where rates of cognitive and language delay in children aged 0-3 years are as high as 45% and 46%, respectively. Using data collected from 77 rural households with children aged 18-24 months in Southwestern China, this study examines the associations between stimulating parenting, the home language environment, and parental self-efficacy, and early cognitive and language development. The results indicate that stimulating parenting was significantly associated with cognitive, language, and overall development; the home language environment was only significantly associated with language development; and parental self-efficacy was not significantly associated with any developmental outcomes. The implications of such findings reveal mechanisms for supporting healthy child development in rural China.

Postpartum depression, social support and maternal self-efficacy between adolescent and adult mothers during the COVID-19 pandemic: A comparative cross-sectional study

AIMS

To determine the rate and level of postpartum depression (PPD), as well as to examine and compare PPD, social support and maternal self-efficacy between adolescent and adult mothers at 8 weeks postpartum during the COVID-19 pandemic.

BACKGROUND

Policy measures to reduce the rapid spread of COVID-19 have disrupted many aspects of life and decreased social connections, which negatively impacts psychological well-being of the general population. However, studies focused on the impact of COVID-19 on mental health and maternal self-efficacy in postpartum mothers, particularly adolescent mothers, are limited.

DESIGN

A comparative cross-sectional study was carried out following the STROBE guidelines.

METHODS

An online questionnaire was administered from February to March 2021. Data were collected by the Edinburgh Postnatal Depression Scale (EPDS), the Postpartum Support Questionnaire (PSQ) and the Parenting Sense of Competence (PSOC) at 8 weeks postpartum. One-way MANOVA was used to analyse the data.

RESULTS

Data from 63 adolescent mothers and 63 adult mothers were analysed. There were significant correlations between PPD, social support and maternal self-efficacy of the COVID-19 pandemic. Both adolescent and adult mothers had significantly negative impacts from the pandemic on mental health, social support and maternal self-efficacy. However, the adolescent mothers had higher rates of depressive symptoms (36.5% and 23.8%, respectively) as well as lower PSQ score (121.25 and 130.52, respectively) and PSOC scores (62.54 and 70.94, respectively) compared with adult mothers in the first 8 weeks postpartum during the pandemic.

CONCLUSION

Adolescent mothers had a significantly higher rate of depressive symptoms and significantly lower social support and maternal self-efficacy scores compared to adult mothers at 8 weeks postpartum during the COVID-19 pandemic.

IMPACT

Midwives or nurses should emphasize the negative mental health impacts during the COVID-19 situation and routinely screen for depressive symptoms, especially in adolescent mothers, which could help identify the at-risk mothers for developing PPD.

PATIENT OR PUBLIC CONTRIBUTION

Neither patients nor the public were directly involved in the study.

Parenting sense of competence and its predictors among primiparous women: a longitudinal study in China

BACKGROUND

Parenting sense of competence significantly affects the quality of parenting behaviours and healthy infant development. However, primiparous women without parenting experience may lack confidence and feel stress. This study aimed to explore the status of parenting sense of competence and identify its predictors among primiparous women.

METHODS

A longitudinal study design was used. Primiparous women were recruited by using a convenience sample from two women's and children's hospitals in two cities in China. All primiparous women completed questionnaires on demographic characteristics, infant characteristics, family function, and parenting sense of competence at 1 month postpartum. At 3 months postpartum, each women's parenting sense of competence was re-assessed. Generalised linear regression was applied to identify the predictors of parenting sense of competence at 3 months postpartum.

RESULTS

A total of 743 Chinese primiparous women were included in the analysis. The average parenting sense of competence score of the participants at 3 months postpartum was 70.18 (SD = 12.33). According to the generalised linear regression analysis, higher levels of parenting sense of competence at 3 months postpartum were significantly associated with older age (β = 0.13, P = 0.005), better family function (β = 0.37, P <  0.001), and higher levels of parenting sense of competence (β = 0.35, P <  0.001) at 1 month postpartum. In contrast, lower levels of parenting sense of competence at 3 months postpartum were associated with poorer self-rated economic status (β = - 0.16, P = 0.027), poorer infant health (β = - 0.26, P = 0.007), and mixed or formula feeding (β = - 0.11, P = 0.018) at 1 month postpartum.

CONCLUSIONS

Chinese primiparous women have a relatively good parenting sense of competence, but there is still room for improvement. Maternal age, economic status, family function, infant health, and feeding patterns were significant predictors. To improve their parenting sense of competence, more attention should be paid to primiparous women who are young, with poor economic status, having an unhealthy infant, and mixed or formula feeding. In addition, measures should also be taken during the early postpartum period to improve family function.

Perinatal support for couples during COVID-19: A descriptive qualitative study

AIMS AND OBJECTIVES

To explore the perspectives of parents during the perinatal period amid the COVID-19 pandemic and explore the experiences of Singaporean parents receiving perinatal support via the Supportive Parenting App (SPA).

BACKGROUND

The stressors accompanying parenting responsibilities often affect the overall well-being of the family unit. With the emergence of the COVID-19 pandemic, Singaporean parents are forced to shoulder childcare responsibilities with minimal support due to safety restrictions. The Supportive Parenting Application (SPA) was introduced to parents during the start of the pandemic to offer timely additional support. It is a mobile health application-based educational support for parents across the perinatal period, consisting of features such as peer support, expert advice and discussion forums.

DESIGN

Descriptive qualitative study.

METHODS

Semi-structured one-to-one interviews were conducted with 33 parents (16 from the control group, 17 from the intervention group) in an ongoing randomised controlled trial between June 2021 and February 2022. The COREQ checklist was used to guide the reporting of the data.

RESULTS

Four themes with 10 subthemes describing the perinatal experiences of parents were identified. The themes include 'Ups and downs' of parenting experiences; Perinatal care from 'best care' to 'flying blind'; What kept couples going and Use of technology-a way forward.

CONCLUSION

Although COVID-19 negatively affected parents' availability of care and support, most could still access other support sources to help them. Additionally, the SPA was found to be a dependable information source for the intervention group parents. Future research could work on improving technology-based support based on the feedback given to offer better quality perinatal care for parents.

RELEVANCE TO CLINICAL PRACTICE

Technology-based support provided by healthcare professionals helps provide reliable perinatal information and support for parents. More efforts should be directed towards developing quality informational resources and support to improve perinatal care.

PATIENT OR PUBLIC CONTRIBUTION

Patients/members of the public contributed to the data collected and were involved in member checking to ensure the rigour of the study.

CLINICAL TRIAL REGISTRATION NUMBER

NHG DSRB: 2019/00875.

Do Improvements in Maternal Mental Health Predict Improvements in Parenting? Mechanisms of the Mindful with Your Baby Training

Postpartum mental health symptoms are associated with parenting difficulties, which have negative consequences for child development. Interventions for young mothers should target their mental health problems and parenting difficulties. Mindful with Your Baby (MwyB) is an intervention for parents, with a baby, who experience (mental) health problems and/or stress or insecurity in parenting. This study seeks to replicate previous effects of MwyB regarding mindfulness, mindful parenting, maternal (mental) health (psychological distress, depressive mood, physical health complaints) and parenting outcomes (parenting stress, parental self-efficacy, bonding), and gain insight into the working mechanisms of the training. Mothers with babies aged 1–18 months (n = 61) completed questionnaires at waitlist, pretest, posttest, and 8-week follow-up. No significant differences were seen between the waitlist and pretest. Significant improvements in all outcomes were shown in the posttest (except for physical health complaints) and follow-up, compared to the pretest. Improvements in depressive symptoms and physical health complaints were dependent on improvements in mindfulness. Improvements in parental self-efficacy were dependent on improvements in mindful parenting. Improvements in some (mental) health and parenting outcomes seemed to be bidirectional. The results suggest that both mindfulness and mindful parenting are important for mothers who experience psychological distress and/or stress or insecurity in parenting their babies.

Maternal Confidence and Parenting Stress of First-Time Mothers in Taiwan: The Impact of Sources and Types of Social Support

The adjustment process to becoming a mother is affected by culture. However, earlier studies have not clarified the relationship between parenting stress, social support, and maternal confidence in non-Western women. This study examined the associations between different types and sources of social support, maternal confidence, and parenting stress experienced by first-time mothers. The sample consisted of first-time mothers with a child under one year of age in northern Taiwan, and a total of 205 valid questionnaires were collected. The results supported the stress-buffering hypothesis, which suggests that social support reduces the adverse effect of stress on maternal confidence. Although previous studies have suggested that spouses and maternal relatives are critical in supporting first-time mothers’ transition into their new roles, each source did not show a mediator effect in our study. The beneficial effect of social support was found only when all social network members collectively participated. Regarding the types of social support, only appraisal support had a significant mediator effect; no effect was found for emotional, instrumental, or informational support. These findings add to our understanding of how different types and sources of social support play a role in helping first-time mothers adapt.

Ecological factors influencing parenting self-efficacy among working mothers with a child under 36 month old in South Korea: a cross-sectional and correlational study

BACKGROUND

Parenting self-efficacy is an essential component for parents to successfully perform their role and is important for mother and child well-being. To support parenting self-efficacy amongst working mothers, it is necessary to understand the factors influencing parenting self-efficacy amongst this group. However, the majority of previous studies regarding factors influencing parenting self-efficacy did not focus on working mothers. Therefore, this study aimed to identify the factors influencing parenting self-efficacy of working mothers using an ecological framework.

METHODS

The research design was a cross-sectional, correlational study. The participants were 298 working mothers with a child under 3 years of age, who were recruited from ten nurseries. Data were collected from August 8 to September 22, 2017 using structured questionnaires, including the Parenting Sense of Competency scale, a one-item Short Form Health Survey scale, the Maternal Role Satisfaction scale, the Parenting Stress Inventory, the Work and Parent Role Conflict scale, the Parenting Alliance Inventory, the Social Support scale, and the Childbirth and Parenting Friendly System scale. The study process of this study was approved by the Institutional Review Board. Collected data were analyzed by SPSS 23.0 Win program with descriptive statistics, t-test, one way ANOVA, Pearson correlation coefficient, and hierarchical multiple regression.

RESULTS

Working mothers who were the primary caregiver had higher parenting self-efficacy compared to those who were not the primary caregiver (β = .13, p = .022). At the individual level, the higher maternal role satisfaction, the higher parenting self-efficacy of working mothers (β = .27, p < .001). In the micro-system level, higher parenting support by a spouse was associated with higher parenting self-efficacy of working mothers (β = .19, p = .002).

CONCLUSIONS

Educational interventions for increasing the awareness and satisfaction of maternal role and various strategies for fathers' active participation in parenting should be developed. In addition, practical interventions that reduce the burden of parenting while supporting parenting self-efficacy of working mothers who are the primary caregiver should also be considered.

Surveillance of Parenting Outcomes, Mental Health and Social Support for Primiparous Women among the Rural-to-Urban Floating Population

China has the largest population of floating rural-to-urban women worldwide, most of whom are of childbearing age. However, few studies have been conducted to monitor the changing trends in parenting outcomes, mental health and social support for these women in the early postpartum period. In this quantitative longitudinal study, 680 primiparous women among the floating population were recruited in Shenzhen, China. Face-to-face collection of socio-demographic questionnaires was completed by researchers in maternity wards on the third postnatal day. Follow-up electronic questionnaires were dispatched to women via email or WeChat at 6 weeks and 12 weeks following childbirth, including the Self-efficacy in Infant Care Scale (SICS), Edinburgh Postnatal Depression Scale (EPDS) and Postnatal Social Support Scale (PSSS), to measure maternal self-efficacy (MSE), postpartum depression (PPD) and social support, respectively. The mean scores of MSE for these floating women were 67.16 (14.35) at 6 weeks postpartum and slightly increased to 68.71 (15.00) at 12 weeks postpartum. The mean scores of EPDS remained almost stable, from 11.19 (4.89) to 11.18 (5.34) at the two time points. The prevalence of mild and severe PPD among floating women at 6 and 12 weeks after childbirth decreased from 54.4% to 40.1% and from 50.6% to 35.4%, respectively. The mean score of social support was 37.04 (10.15) at 6 weeks postpartum and slightly improved to 38.68 (10.46) at 12 weeks postpartum. Primiparous women among the rural-to-urban migrant population had an obviously negative status of parenting outcomes and mental health; and there was a lack of social support after childbirth. In future, tailored evidence-based interventions are highly needed to promote floating women’s parenting outcomes, mental wellbeing and social support in the early stages of motherhood. As a higher-risk group of PPD, primiparous women among the floating population require effective and accessible mental health care after childbirth, such as early PPD screening and timely therapeutic methods.

Determinants of Psychosocial Resilience Resources in Obese Pregnant Women with Threatened Preterm Labor-A Cross-Sectional Study

Background: The purpose of the study was to assess the level of such psychosocial resilience resources as self-efficacy, dispositional optimism, and health locus of control in pregnant women with obesity with threatened premature labor. Methods: The study was performed in the years 2017-2020 in a group of 328 pregnant women hospitalized due to threatened preterm labor and diagnosed with obesity before the pregnancy. The following instruments were applied: the Life Orientation Test, the Generalized Self-Efficacy Scale, and the Multidimensional Health Locus of Control Scale. Results: Obese pregnant women with threatened premature labor have a moderate level of generalized self-efficacy (28.02) and a moderate level of dispositional optimism (16.20). Out of the three health locus of control dimensions, the highest scores were recorded in the "internal control" subscale (26.08). Statistically significant predictors for the self-efficacy variable model included: satisfactory socio-economic standing (ß = 0.156; p = 0.004), being nulliparous (ß = -0.191; p = 0.002), and the absence of comorbidities (ß = -0.145; p = 0.008). Higher levels of dispositional optimism were found in women who were married (ß = 0.381; p = 0.000), reported a satisfactory socio-economic standing (ß = 0.137; p = 0.005), were between 23 and 27 weeks pregnant (ß = -0.231; p = 0.000), and had no comorbidities (ß = -0.129; p = 0.009). Conclusions: Generalized self-efficacy in obese women with threatened preterm labor is associated with satisfactory socio-economic standing, being nulliparous, and the absence of chronic disease. Dispositional optimism in obese pregnant women with threatened preterm labor is determined by their marital status, socio-economic standing, gestational age, and the absence of comorbidities.

The development of the postpartum mobile support application and the effect of the application on mothers' anxiety and depression symptoms

OBJECTIVE

The study aimed to develop the postpartum mobile support application to support postpartum mothers and to examine the effects of the use of mobile app on mothers' anxiety level and depression symptoms.

RESEARCH DESIGN/SETTING

It is a parallel group pretest-posttest randomized controlled study carried out between July 2017 and February 2020. The mothers (62 in the experiment and 62 in the control group) who gave birth in full-term at a university hospital in Konya province in Turkey and who had healthy newborns constituted the study group. Data were collected using the Information Form, the STAI State and Continuity Anxiety Scale, and the Edinburgh Postpartum Depression Scale. Mixed pattern variance analysis (mixed anova), t test in dependent groups, t test and chi square analysis in independent groups were used to analyze the data.

FINDINGS

Most of the mothers who used the application fed their baby only with breast milk and felt more sufficient about breastfeeding. The depression symptoms of mothers using the postpartum mobile support application was lower than that of the mothers in the control group; however, it was found that the application was not adequate alone to decrease anxiety levels and depression symptoms (p > 0.05).

CONCLUSIONS

The postpartum mobile support application is an important and useful source in accessing reliable information; however, it was found to be insufficient to lower anxiety levels and prevent depression symptoms at the end of the six-week postpartum period.

Development of a Mobile Application of Internet-Based Support Program on Parenting Outcomes for Primiparous Women

Primiparous women usually experience various parenting problems after childbirth that have negative effects on the well-being of mothers and infants. Although e-Support technology could provide an innovative and easily accessible intervention approach, mobile-phone interventions remain limited for Chinese primiparous women. Therefore, a new mobile application (APP) called the "Internet-based Support Program" ("ISP") was designed, incorporating the self-efficacy theory and the social-exchange theory for Chinese first-time mothers to improve their levels of maternal self-efficacy (MSE), social support, and satisfaction, as well as to reduce their postpartum depression symptoms. The research was conducted to develop and optimize the "ISP" APP for new mothers via a theory-, evidence-, and person-based approach. Five modules of "learning forum", "communication forum", "ask-the-expert forum", "baby home forum", and "reminder forum" were included in the APP to meet various parenting needs of first-time mothers; and its contents and functions were validated by the experts and primiparous women. The majority of participants gave positive feedback on the APP's perceived ease of use and usefulness. The "ISP" APP was the first designed for Chinese primiparous women, and a multicenter randomized controlled trial (RCT) will be conducted to measure its effectiveness on parenting outcomes.

Resilience mediates the effect of self-efficacy on symptoms of prenatal anxiety among pregnant women: a nationwide smartphone cross-sectional study in China

Background

Prenatal anxiety is one of the most prevalent mental disorders during pregnancy. This study assessed the prevalence of prenatal anxiety and examined whether resilience could play the mediating role in the association between self-efficacy and symptoms of prenatal anxiety among pregnant women in China.

Methods

A nationwide smartphone cross-sectional study was carried out in three cities (Shenyang of Liaoning Province, Zhengzhou of Henan Province and Chongqing Municipality) in China from July 2018 to July 2019. The questionnaire consisted of questions on demographic characteristics, the Generalized Anxiety Disorder Scale (GAD-7), the Chinese version of General Self-efficacy Scale (GSES), and the 14-item Wagnild and Young Resilience Scale (RS-14). A total of 665 pregnant women were recruited in this study. A hierarchical multiple regression model was employed to explore the associate factors and mediators of symptoms of prenatal anxiety. A structural equation model was employed to test the hypothesis that resilience mediates the association between self-efficacy and symptoms of prenatal anxiety.

Results

The prevalence of symptoms of prenatal anxiety was 36.4% in this study. Self-efficacy was negatively correlated with symptoms of prenatal anxiety (r = -0.366, P < 0.01). Resilience had a significant positive correlation with self-efficacy (r = 0.612, P < 0.01) and had a negative correlation with symptoms of prenatal anxiety (r = -0.427, P < 0.01). The hierarchical multiple regression model indicated that self-efficacy and resilience were the main factors associated with symptoms of prenatal anxiety and contributed to 11.9% and 6.3% to the variance of symptoms of prenatal anxiety, respectively. Resilience served as a mediator between self-efficacy and symptoms of prenatal anxiety (a*b = -0.198, Bias-corrected and accelerated bootstrap 95% Confidence interval: -0.270, -0.126).

Conclusions

Self-efficacy was a negative predictor of symptoms of prenatal anxiety among pregnant women. Moreover, resilience mediated the relation between self-efficacy and symptoms of prenatal anxiety among pregnant women in China. It was observed in this study that psychological interventions might be beneficial for pregnant women to relieve symptoms of prenatal anxiety through improved self-efficacy and resilience.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03911-5.

Perceived maternal parenting self-efficacy as a predictor maternal responsiveness in infants and toddlers

BACKGROUND

Maternal responsiveness seems to be necessary for a child to develop a safe attachment. However, even after many years of research on maternal responsiveness, only a few attempts have been made to find ways of promoting mother and child interaction. This study aimed at determining the association between maternal responsiveness and parenting self-efficacy variables and at identifying the factors that correlated with maternal responsiveness.

METHOD

A cross-sectional correlation study design was adopted and a convenience sampling method was used to recruit 213 mothers in Irbid city, Jordan from August to November 2019. The sample population filled in a sociodemographic and perinatal datasheet, the Perceived Maternal Parenting Self-Efficacy (PMP S-E) Scale and the Maternal Infant Responsiveness Instrument (MIRI).

RESULTS

The results revealed a significant relationship between maternal responsiveness and PMP S-E. Other factors; besides, self-efficacy were also found to have some correlation on maternal responsiveness (B = 1.913, P = .049). Only previous experience of caring for children (B = 9.56, P = .05).

CONCLUSION

This study found that the sociodemographic factors considered in this study had an insignificant correlation on perceived self-reported maternal responsiveness. On the other hand, it did find that PMP S-E had a significant correlation on maternal responsiveness. Healthcare professionals need to recognise these variables in their endeavours to meet the needs of mothers and their newborns.

Exploring Maternal Self-Efficacy of First-Time Mothers among Rural-to-Urban Floating Women: A Quantitative Longitudinal Study in China

(1) Background: China has the highest number of rural-to-urban floating women in the world, and the majority of them are of childbearing age. However, few studies have focused on maternal self-efficacy (MSE) for these women. This research aims to explore MSE and its influencing factors for primiparous women among the rural-to-urban floating population in China. (2) Methods: A quantitative longitudinal study was conducted, and primiparous women from the floating population were recruited in China. Face-to-face demographic questionnaires were collected from obstetric wards by the researchers, three days postpartum. The 6-week and 12-week questionnaires, including the Self-efficacy in Infant Care Scale (SICS), the Edinburgh Postnatal Depression Scale (EPDS), and the Postpartum Social Support Scale (PSSS), were sent to participants by wechat or email to measure MSE, postnatal depression, and social support, respectively. The completed 6-week and completed 12-week questionnaires were returned to the researchers. (3) Results: The mean MSE scores at 6 and 12 weeks postpartum were 67.16 (SD = 14.35) and 68.71 (SD = 15.00). The variables of social support, postnatal depression, whether women attended parenting training, baby fussiness, baby health, maternal educational level, occupation, and family income affected MSE at the two time points. (4) Conclusions: Primiparous women among the rural-to-urban floating population had a low MSE level. As a vulnerable and special group, more attention should be paid to the negative parenting status of floating women by health workers and family members. Effective measures must be taken to improve the floating women’s accessibility to parenting training from health services to strengthen their social support and alleviate postpartum depression. Health professionals should be more concerned with floating women with relatively low MSE levels, such as new mothers with lower education, poor working and living conditions, unhealthy babies, and babies with fussy temperaments.

Translation and Psychometric Analysis of the Japanese Version of the Perceived Maternal Parenting Self-Efficacy Scale

OBJECTIVE

To translate the Perceived Maternal Parenting Self-Efficacy (PMP S-E) scale to Japanese and test its psychometric properties among Japanese mothers of low-birth-weight (LBW) infants.

DESIGN

Descriptive psychometric study.

SETTING

NICUs in two regional perinatal care centers in the Kinki region of Japan.

PARTICIPANTS

Seventy-nine Japanese mothers of LBW infants hospitalized in NICUs.

METHODS

First, we translated the PMP S-E scale into Japanese and assessed its face and content validity. Second, we assessed the internal consistency, test-retest reliability, and criterion-related and construct validity of the Japanese version of the PMP S-E (JPMP S-E) with data from Japanese mothers of LBW infants.

RESULTS

The JPMP S-E mean score was 53.0 (SD = 7.1); the total scores ranged from 38 to 68. The intraclass correlation coefficient of test-retest reliability was .75, and Cronbach's alpha coefficient was .90. With regard to criterion-related validity, we found a significant positive correlation between the JPMP S-E and the Maternal Attachment Inventory Japanese version (r = .45, p < .001), but no correlation existed between the JPMP S-E and the General Self-Efficacy Scale (r = .21, p = .06). We evaluated construct validity using confirmatory factor analysis to assess whether the model fit the previously determined structure of the PMP S-E. The model fit was moderate in the confirmatory factor analysis (comparative fit index = .63, goodness-of-fit index = .63, root mean square error of approximation = .15).

CONCLUSION

We found adequate estimates of reliability and moderate indicators of validity for the JPMP S-E, which support the use of the tool for clinical and research purposes.

Internet-based support program on parenting outcomes for Chinese primiparous women: Study protocol for a randomized controlled trial

Aim

To evaluate the effects of internet‐based support program for primiparous women in terms of improving the levels of maternal self‐efficacy, social support, and satisfaction; and reducing their postpartum depression symptoms.

Design

A single‐blinded, multicentre, randomized, controlled, parallel‐group pre‐test and repeated post‐test design.

Methods

Based on the self‐efficacy theory and the social exchange theory, the internet‐based support program has five modules: (a) learning forum of parenting knowledge and skills; (b) communication forum; (c) ask‐the‐expert forum; (d) baby home forum; and (e) reminder forum. Primiparous women will be recruited in the obstetric wards of two university‐affiliated hospitals in China. The participants (N = 258) will be randomly allocated to the intervention group that receive routine care and access to the internet‐based support program and the control group that receive routine care during the 3 months postpartum. Maternal self‐efficacy, social support, and postpartum depression symptoms will be measured at baseline, immediately after the intervention (post‐test 1) and 3 months after the intervention (post‐test 2). The study was funded in January 2018 and was ethically approved in May 2020.

Discussion

If the internet‐based support program has positive outcomes, it will contribute to the scientific and practical knowledge of nursing interventions to support primiparous women on parenting; and could become the routine health care for health professionals to enhance parenting ability and mental well‐being of new mothers.

Impact

As the first RCT study on parenting outcomes using a rigorous research design and a theoretical framework in China, this research will contribute to evidence on the effectiveness of using internet platform to support women after childbirth. The results could help to advance research about the use of internet‐based intervention methods to improve women's maternal self‐efficacy, social support, satisfaction, and to alleviate depression symptoms.

Chinese Clinical Trial Registry: ChiCTR2000033154

[Social support as a protective factor for the mothers of children with Congenital Zika Syndrome]

Mothers of children with CZS face exceptional challenges caring for their offspring. Due to this reality, the availability of social support can function as an important protective factor. In this respect, this study aimed to evaluate the role of informal and formal social support in mental health, parental self-efficacy and satisfaction in the life of mothers of children with CZS. A total of 69 mothers of children with CZS (M = 26.4 years; SD = 6.23) living in the state of Ceará, Brazil participated in this study. They filled out the Social Support Satisfaction Scale, General Health Questionnaire, Parental Self-efficacy Scale and Satisfaction with Life Scale. The results show that the greater perception of informal social support significantly enables better mental health and satisfaction with life levels. In addition, access to formal social support significantly enables enhanced perception of parental self-efficacy. The results observed with the mothers of children with CZS are consistent with those reported in other studies with mothers of children with chronic conditions, pointing out that formal and informal social support have different effects on mental health, parental self-efficacy, and satisfaction with life, even controlling the effect of sociodemographic variables.

Parenting Outcomes and Predictors of Parenting Satisfaction in the Early Postpartum Period

This study examined the relationships among parenting self-efficacy (PSE), social support, postnatal depression (PND), and predictors of parenting satisfaction in the early postpartum period using a cross-sectional exploratory quantitative design. The hypothetical model was tested among interrelated concepts of outcome variables among 250 parents (125 couples). The structural equation model revealed an adequate fit between the hypothesized model and the data. PSE and spousal support were found to be predictors of parenting satisfaction. PSE was also found to be a predictor of social support. PND was not found to be a predictor of parenting satisfaction. None of the obstetric and demographic factors predicted parenting satisfaction. This is the first study that tested interrelations among crucial parenting outcome variables among fathers and mothers in the early postpartum period. It is important to assess interrelated parenting outcomes among both parents so that support can be provided to ultimately influence parenting satisfaction.

Effects of a maternal role adjustment program for first time mothers who use postpartum care centers (Sanhujoriwon) in South Korea: a quasi-experimental study

BACKGROUND

Many South Korean women stay in specialized postpartum care centers called Sanhujoriwon for 2 weeks after childbirth, a time which is widely recognized as a critical period for maternal role adjustment. Mothers' time within the postpartum care center offers a unique opportunity for nursing intervention to promote a successful transition to motherhood, especially for first time mothers. This study aimed to develop a maternal role adjustment program within the Sanhujoriwon based on the ecological model, and to evaluate its effects on maternal role confidence and breastfeeding success.

METHODS

A non-equivalent control group pretest-posttest design was used. Data were collected from 30 participants in the experimental group and 37 in the control group at four measurement times, i.e., admission day to Sanhujoriwon, discharge day from Sanhujoriwon, 4-6 weeks postpartum, and 12 weeks postpartum. The experimental group received the maternal role adjustment program, which included family education and counseling regarding breastfeeding and infant care, and encouraged rooming-in practices during their stay in the Sanhujoriwon. The data were analyzed using the IBM SPSS statistics 25.0 program using descriptive statistics, t-test, chi-square test, ANCOVA, and GEE.

RESULTS

There were significant interaction effects showing different patterns in maternal role confidence and breastfeeding success scores over the four time points. Maternal role confidence in the experimental group gradually increased over time. Maternal role confidence in the control group also increased from baseline to 4 to 6 week postpartum, but abruptly decreased at 12 week postpartum. At 12 weeks postpartum, maternal role confidence in the experimental group was significantly higher than that of the control group. In addition, breastfeeding success scores in the experimental group also gradually increased over the four time points, while those of the control group showed a gradual decline. Breastfeeding success scores were significantly higher than those of control group at both 4-6 weeks and 12 weeks postpartum.

CONCLUSIONS

These results indicate that the maternal role adjustment program was effective in improving maternal role confidence and breastfeeding success among first time mothers in the postpartum care center.

Psychometric Properties of the Spanish Version of the Perceived Maternal Parenting Self-efficacy (PMP S-E) Tool for Primiparous Women

OBJECTIVE

The objective of this study was to determine the validity and the reliability of the Perceived Maternal Parenting Self-Efficacy tool translated into Spanish and adapted to be used among primiparous women of term babies.

METHODS

Validation study. A total of 210 women participated in the survey to establish construct validity and reliability. The questionnaire has 20 items and four subscales. The higher the score, the higher the self-efficacy. A process of translation/back-translation and cultural adaptation in accordance with international standards and an expert review were conducted to test face and content validity. The Validity Content Index and an exploratory factor analysis were used to identify the structure of the questionnaire. Reliability was estimated using Cronbach's alpha coefficient.

RESULTS

Linguistic and cultural adaptation, validation and reliability were performed. Face validity for women was as follows: high comprehension (99%); and for experts: medium comprehension (84.1%), medium clarity (83.9%) and medium precision (80%). Concerning pertinence, the content validity index was 0.93 (i.e., highly pertinent). Concerning relevance, the content validity index was 0.96 (i.e., highly relevant). Factor validation identified four factors that accounted for 91% of the variance. Overall Cronbach's alpha value was 0.98 (IC 95 0.97-0.98).

CONCLUSIONS FOR PRACTICE

Given the robust properties of the Spanish version of the Perceived Maternal Parenting Self-efficacy, it may be used to identify women with low self-efficacy and to assess the effectiveness of health-based interventions.

Breastfeeding Self-Efficacy Among Parturient Women in Shanghai: A Cross-Sectional Study

BACKGROUND

Breastfeeding self-efficacy has been shown to be a strong predictor of breastfeeding initiation and duration; however, factors associated with breastfeeding self-efficacy in China are unclear.

RESEARCH AIMS

The aims were (a) to describe the breastfeeding self-efficacy of parturient women in Shanghai, China and (b) to identify the sociodemographic factors associated with mothers' breastfeeding self-efficacy.

METHODS

This is a cross-sectional retrospective descriptive study. Through convenience sampling, breastfeeding mothers (N = 801) were recruited to assess breastfeeding self-efficacy before discharge from the hospital. Descriptive statistics were used to analyze the sociodemographic and perinatal characteristics, level of breastfeeding self-efficacy, and correlations between them.

RESULTS

In the process of breastfeeding, 52.2% (n = 418) of participants encountered breastfeeding problems, 37.1% (n = 297) perceived an insufficient milk supply, 82.4% (n = 660) reported attending breastfeeding classes, but only 37.1% (n = 297) chose exclusive breastfeeding. Chinese mothers reported a moderate level of breastfeeding self-efficacy, with an item mean score of 3.67 (score = 1-5). Whether or not encountering breastfeeding problems, infant feeding pattern (fully breastfeeding, partial breastfeeding, no breastfeeding) in the previous 24 hours, whether or not perceiving insufficient milk, and main caregiver's positive attitude toward breastfeeding (ranging from 1 to10, higher score indicating more positive attitude) were correlated with participants' breastfeeding self-efficacy score. (The correlation coefficients were -0.432, 0.377, -0.364, and 0.353, respectively.).

CONCLUSION

The misperception of insufficient milk and main caregiver's attitude toward breastfeeding were important factors for breastfeeding self-efficacy. Greater efforts should be made during breastfeeding education and support.

Predictors of Infant Care Competence Among Mothers With Postpartum Depression

Background/objective:

Postpartum depression is linked to decreased quality mother-infant interactions and long-term negative impacts on children’s behavior and health. Infant care competence may be reduced by postpartum depression and other maternal or environmental variables. Thus, the objective of this study was to explain factors that contribute to perceived infant care competence among mothers with postpartum depression.

Methods:

Multiple regression analysis and correlational analysis were conducted to study associations between the predictors (depression severity, social support, child development, family functioning) and the outcome of perceived infant care competence among a peer support intervention study for mothers with postpartum depression (n = 55).

Results:

Child development, specifically communication (P = .04), gross (P = .00) and fine (P = .00) motor skills, problem solving (P = .00), and personal-social development (P = .01), explained maternal perceptions of responsiveness, an aspect of infant care competence. The best-fit model was obtained for the responsiveness subscale, in which 37% of the variance was explained by mothers’ reports of infants’ fine motor skills (P = .000) and nurturance (P = .039) as an aspect of social support and family functioning (P = .078).

Conclusions:

Recognition of the importance of infant development to perceived infant care competence, particularly mothers’ perceptions of infant responsiveness, may offer targets for intervention. Helping mothers identify infant cues and milestones that signal infant responsiveness may be beneficial. Moreover, social support and family functioning may be targets for intervention to promote perceived infant care competence in mothers affected by postpartum depression.

Evaluation of Mothers' Perceptions of a Technology-Based Supportive Educational Parenting Program (Part 2): Qualitative Study

Background

Transitioning into parenthood can be stressful as parents struggle to cope with new parenting responsibilities. Although perinatal care in hospitals aims to improve parental outcomes, there is a general consensus that it is suboptimal and insufficient. Therefore, many studies have designed intervention methods to supplement support for parents during this stressful period. However, studies often focus on parental outcomes as indicators of their interventions’ success and effectiveness. Studies evaluating participants’ experiences and feedback are limited.

Objective

This study aimed to examine the experiences and perceptions of participants who participated in a supportive education parenting program intervention study.

Methods

A qualitative semistructured interview was conducted with 16 mothers (6 control and 10 intervention) from a randomized controlled trial. The supportive education parenting program received by the intervention group included 2 phone-based perinatal educational sessions, a phone-based educational session after childbirth, and a 1-month postpartum access to a mobile health app. The interviews were approximately 30- to 60-min long, audiotaped and transcribed verbatim, and analyzed using thematic analysis. Study findings were reported according to the Consolidated Criteria for Reporting Qualitative Research checklist.

Results

The 3 main themes evaluating mothers’ experiences and perceptions were generated: (1) changed perspective toward parenthood, (2) journey from pregnancy to after birth, and (3) a way forward. Mothers from the intervention group mostly had good perinatal experiences with sufficient support received, which elevated their emotional well-being and increased parenting involvement. Mothers in the control group, although satisfied with the hospital care received, were more stressed and shared a need for professional advice and extra support. Apart from technical enhancements, mothers also requested extended social support during early pregnancy up to 1 year postpartum, taking into consideration Asian cultural practices.

Conclusions

Mothers who received the intervention were overall satisfied with the support provided by the technology-based supportive educational parenting program. The success of the educational program in this study highlights the need to supplement standard care in hospitals with technology-based educational programs. Future research should include fathers’ perceptions to attain an in-depth understanding of overall participants’ experiences and needs in the future development of supportive and educational programs.

Prevalence and incidence of postpartum depression among healthy mothers: A systematic review and meta-analysis

This review aims to examine the prevalence and incidence of postpartum depression among healthy mothers without prior history of depression including postpartum depression and who gave birth to healthy full-term infants. A systematic search of ClinicalTrials.gov, CINAHL, EMBASE, PsycINFO, and PubMed was performed for English articles from the inception of the database to November 2017, as well as a manual search of the reference lists of the included articles, and an expert panel was consulted. Across 15,895 articles, 58 articles (N = 37,294 women) were included in the review. The incidence of postpartum depression was 12% [95% CI 0.04-0.20] while the overall prevalence of depression was 17% [95% CI 0.15-0.20] among healthy mothers without a prior history of depression. Prevalence was similar regardless of the type of diagnostic tool used; however, there were statistical differences in the prevalence between different geographical regions, with the Middle-East having the highest prevalence (26%, 95% CI 0.13-0.39) and Europe having the lowest (8%, 95% CI 0.05-0.11). There was no statistical difference in prevalence between different screening time points, but an increasing prevalence was observed beyond six months postpartum. Intervention studies often neglect healthy mothers. This review reports a similar prevalence rate of postpartum depression among mothers without history of depression when compared to mothers with history of depression. Thus, future studies should place equal emphasis on this neglected group of mothers so that targeted interventions and follow-ups can be introduced at appropriate time points.

A Mobile Health App-Based Postnatal Educational Program (Home-but not Alone): Descriptive Qualitative Study

Background

The postnatal period poses numerous challenges for new parents. Various educational programs are available to support new parents during this stressful period. However, the usefulness of educational programs must be evaluated to ascertain their credibility.

Objective

The aim of this descriptive, qualitative study was to explore the views of parents of newborns with regard to the content and delivery of a mobile health (mHealth) app–based postnatal educational program.

Methods

A qualitative semistructured interview guide was used to collect data from 17 participants who belonged to the intervention group of a randomized controlled trial. The intervention, a 4-week-long access to a mHealth app–based educational program, was evaluated. The interviews were conducted in English and at the participants’ homes. Thematic analysis was used to analyze the data. The Consolidated Criteria for Reporting Qualitative Research checklist was used to report the findings.

Results

The interviews revealed 4 main themes: (1) positive features of the mHealth app, (2) advice from midwives, (3) experiences gained from using the mHealth app, and (4) recommendations for the future. The participants evaluated the educational program to be a good source of information that was tailored to the local context. The different modes of delivery, including audio and video, accentuated the accessibility of information. The parents evaluated that the facilitator of the featured communication platform, a midwife, provided trustworthy advice. Belongingness to a virtual community beyond the hospital endowed the parents the confidence that they were not alone and were supported by other parents and health care professionals.

Conclusions

According to the parents, the mHealth app–based educational program was helpful in supporting a multi-ethnic sample of parents during the postnatal period. This insight indicates that the program could be implemented in a wide community of parents in the postnatal period. The helpfulness of the educational program is a testament of the potential benefits of using telemedicine among new parents postnatally. Resources can also be dedicated toward extending the duration of access to the app beyond 1 month and developing relevant content for parents across the perinatal period.

Changes in maternal self-efficacy, postnatal depression symptoms and social support among Chinese primiparous women during the initial postpartum period: A longitudinal study

BACKGROUND

There are many parenting problems during infancy for Chinese primiparous women. As an important determinant of good parenting, maternal self-efficacy (MSE) should be paid more attention by researchers. At present, the limitations of previous research examining MSE during infancy are that most studies were conducted with a homogeneous sample and there were few studies with Chinese women. Secondly, the trajectory of change in MSE, postnatal depression symptoms and social support for Chinese primiparous women was not clear during the initial postpartum period in earlier studies.

OBJECTIVES

This study aimed to describe changes in MSE, postnatal depression symptoms and social support among Chinese primiparous women in the first three months postnatally.

DESIGN

A quantitative longitudinal study using questionnaires was conducted.

SETTING

Obstetric wards at three hospitals in Xiamen City, South-East China.

PARTICIPANTS

In total, 420 Chinese primiparous women were recruited.

METHODS

Initial baseline questionnaires to measure socio-demographic and clinical characteristics at three days postnatally were distributed to participants face-to-face by the researcher on the postnatal ward. Follow-up questionnaires at six and 12 weeks postnatally were sent via e-mail by the researcher to participants, including the Self-efficacy in Infant Care Scale (SICS), the Edinburgh Postnatal Depression Scale (EPDS) and the Postpartum Social Support Scale (PSSS) to measure MSE, postnatal depression symptoms and social support, respectively. These were returned by participants via e-mail. Quantitative data were analysed using SPSS.

RESULTS

The mean MSE score at six weeks postnatally was 74.92 (SD = 11.05), and increased to 77.78 (SD = 11.13) at 12 weeks postnatally. The mean social support scores at six and 12 weeks postnatally were 40.99 (SD = 9.31) and 43.00 (SD = 9.55). The mean EPDS scores decreased from 9.09 (SD = 4.33) at six weeks postnatally to 8.63 (SD = 4.40) at 12 weeks postnatally; the proportion of women with an EPDS score of ten or more and 13 or more at the two time points declined from 47.4% to 38.3%, and from 21.4% to 18.2%, respectively.

CONCLUSIONS

In this study, Chinese primiparous women had a moderate level of MSE and received a moderate level of social support at six and 12 weeks postnatally, and a higher proportion of Chinese women had postnatal depression symptoms than did women in Western countries. From six to 12 weeks postnatally, the mean MSE scores and social support scores had a statistically significant increase; the mean EPDS scores had a statistically significant decrease.

Enhancing first-time parents' self-efficacy: A systematic review and meta-analysis of universal parent education interventions' efficacy

BACKGROUND

Poor adjustment during early parenthood often leads to low feelings of parental self-efficacy, which influences parents' behaviours towards their infants. The long-term consequences on infant development warrant the need for more attention on the efficacy of universal parent education interventions to empower parents and enhance their self-efficacy.

OBJECTIVES

To synthesise available evidence and explore the efficacy of universal parent education interventions on the parental self-efficacy of first-time parents.

DESIGN

A systematic review and meta-analysis of randomised controlled trials.

DATA SOURCES

A literature search of 10 databases was conducted to identify randomised controlled trials from each database's point of inception to November 2016.

METHODS

Based on the inclusion criteria, 24,062 articles were screened for their titles and abstracts. Two hundred and eighty articles were identified for full-text screening. Risks of bias posed by the selected articles were assessed using Cochrane's Risk of Bias instrument. Meta-analyses were conducted using RevMan 5.3. The overall intervention effect was evaluated using z tests at p < 0.05, while I² and Cochran Q tests were used to measure heterogeneity.

RESULTS

Ten randomised controlled trials were selected; eight trials were combined in meta-analyses and two trials were synthesised narratively. A meta-analysis revealed that universal parent education interventions significantly enhanced parental self-efficacy (p < 0.001) among first-time parents and these effects were also maintained over time (p < 0.001). The extent of improvement in parental self-efficacy was affected by the duration of the interventions.

CONCLUSION

This review provides sufficient evidence to support the use of universal interventions to enhance new parents' self-efficacy. While intervention effects were sustained at the two-month follow-up, further research using randomised controlled trials and longitudinal studies are needed to determine long-term effects. The findings serve as an impetus for hospitals and healthcare professionals to integrate universal interventions in perinatal care to guide first-time parents' transition into parenthood.

Evaluation of Technology-Based Peer Support Intervention Program for Preventing Postnatal Depression: Protocol for a Randomized Controlled Trial

BACKGROUND

Multiple international agencies, including the World Health Organization and the International Monetary Fund, have emphasized the importance of maternal mental health for optimal child health and development. Adequate social support is vital for the most vulnerable to postpartum mood disorders. Hence, an urgent need for sustainable social support programs to aid mothers ease into their new parenting role exists.

OBJECTIVE

This study protocol aims to examine the effectiveness of a technology-based peer support intervention program among mothers at risk for postnatal depression in the early postpartum period.

METHODS

A randomized controlled 2-group pretest and repeated posttest experimental design will be used. The study will recruit 118 mothers from the postnatal wards of a tertiary public hospital in Singapore. Eligible mothers will be randomly allocated to receive either the peer support intervention program or routine perinatal care from the hospital. Peer volunteers will be mothers who have experienced self-reported depression and will be receiving face-to-face training to support new mothers at risk of depression. Outcome measures include postnatal depression, anxiety, loneliness, and social support. Data will be collected at immediate postnatal period (day of discharge from the hospital), at fourth week and twelfth week post childbirth.

RESULTS

The recruitment and training of peer support volunteers (N=20) ended in June 2017, whereas recruitment of study participants commenced in July 2017 and is still ongoing. The current recruitment for new mothers stands at 73, with 36 in the control group and 37 in the intervention group. Data collection is projected to be completed by May 2018.

CONCLUSIONS

This study will identify a potentially effective and clinically useful method to prevent postnatal depression in new mothers, which is the top cause of maternal morbidity. Receiving social support from others who share similar experiences may enhance the positive parenting experiences of mothers, which in turn can improve the psychosocial well-being of the mothers, tighten mother-child bond, and enhance overall family dynamics for mothers and infants.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Number ISRCTN14864807; http://www.isrctn.com/ISRCTN14864807 (Archived by WebCite at http://www.webcitation.org/6xtBNvBTX).

Effectiveness of a Technology-Based Supportive Educational Parenting Program on Parental Outcomes in Singapore: Protocol for a Randomized Controlled Trial

Background

Supportive educational programs during the perinatal period are scarce in Singapore. There is no continuity of care available in terms of support from community care nurses in Singapore. Parents are left on their own most of the time, which results in a stressful transition to parenthood. There is a need for easily accessible technology-based educational programs that can support parents during this crucial perinatal period.

Objective

The aim of this study was to describe the study protocol of a randomized controlled trial on a technology-based supportive educational parenting program.

Methods

A randomized controlled two-group pretest and repeated posttest experimental design will be used. The study will recruit 118 parents (59 couples) from the antenatal clinics of a tertiary public hospital in Singapore. Eligible parents will be randomly allocated to receive either the supportive educational parenting program or routine perinatal care from the hospital. Outcome measures include parenting self-efficacy, parental bonding, postnatal depression, social support, parenting satisfaction, and cost evaluation. Data will be collected at the antenatal period, immediate postnatal period, and at 1 month and 3 months post childbirth.

Results

Recruitment of the study participants commenced in December 2016 and is still ongoing. Data collection is projected to finish within 12 months, by December 2017.

Conclusions

This study will identify a potentially clinically useful, effective, and cost-effective supportive educational parenting program to improve parental self-efficacy and bonding in newborn care, which will then improve parents’ social support–seeking behaviors, emotional well-being, and satisfaction with parenting. It is hoped that better supported and satisfied parents will consider having more children, which may in turn influence Singapore’s ailing birth rate.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN): 48536064; https://www.isrctn.com/ISRCTN48536064 (Archived by WebCite at http://www.webcitation.org/6wMuEysiO)

A quantitative longitudinal study to explore factors which influence maternal self-efficacy among Chinese primiparous women during the initial postpartum period

BACKGROUND

parenting during infancy is highly problematic for Chinese primiparous women. As an important determinant of good parenting, maternal self-efficacy (MSE) should be paid more attention by researchers. At present, the limitations of previous research about MSE during infancy are that the factors which influence MSE remained poorly explored, there were few studies with Chinese women, and the studies did not consider the effect of different cultures.

OBJECTIVES

to explore factors which influence MSE in primiparous women in China in the first three months postnatally.

METHODS

a quantitative longitudinal study using questionnaires was conducted. In total, 420 Chinese primiparous women were recruited in obstetric wards at three hospitals in Xiamen City, Fujian Province of China. Initial baseline questionnaires to measure socio-demographic and clinical characteristics were distributed to participants face-to-face by the researcher on the postnatal ward at three days postnatally. Follow-up questionnaires at six and 12 weeks postnatally were sent via e-mail by the researcher to participants, including the Self-efficacy in Infant Care Scale (SICS), the Edinburgh Postnatal Depression Scale (EPDS) and the Postpartum Social Support Scale (PSSS) to measure MSE, postnatal depression symptoms and social support, respectively. These were returned by participants via e-mail. Quantitative data were analysed using SPSS.

RESULTS

the variables: social support, women's satisfaction with 'Doing the month', postnatal depression, maternal education, baby health, and maternal occupation had an influence on MSE at six weeks postnatally (Adjusted R² = 0.510, F = 46.084, P<0.01); and the variables: postnatal depression, social support, baby health, women's satisfaction with 'Doing the month', and baby fussiness were the factors influencing MSE at 12 weeks postnatally (Adjusted R² = 0.485, F = 41.082, P<0.01).

CONCLUSIONS

obstetric nurses and women's family members need to be aware of the significant contribution of social support, women's satisfaction with 'Doing the month' in positively influencing primiparous women's MSE, and the significant effect of postnatal depression symptoms in negatively impacting on first-time mothers' MSE; they should pay more attention to primiparous women with less education, unemployed mothers, women with unskilled occupations, women with an unhealthy baby, and women with a baby with a difficult temperament to improve their comparatively lower MSE levels during the initial postnatal period.

Role of Baby-Friendly Hospital Care in Maternal Role Competence

The objective of this pilot study was to determine women's perceptions of their levels of maternal role competence at discharge from a Baby-Friendly hospital. A convenience sample of 30 women completed two self-report questionnaires: a demographic questionnaire and the Perceived Maternal Parenting Self-Efficacy scale. Women report that they perceived high levels of maternal role competence with a mean total score of 69.80 (standard deviation = 6.86) out of 80. As women experience breastfeeding in Baby-Friendly hospitals, maternal role competence may develop with appropriate support.

Working with complexity: experiences of caring for mothers seeking residential parenting services in New South Wales, Australia

AIM AND OBJECTIVES

To investigate staff perception of the changing complexity of mothers and infants admitted to two residential parenting services in New South Wales in the decade from 2005-2015.

BACKGROUND

For many mothers with a young child, parenting is difficult and stressful. If parenting occurs within the context of anxiety, mental illness or abuse it often becomes a high-risk situation for the primary caregiver. Residential parenting services provide early nursing intervention before parenting problems escalate and require physical or mental health focused care.

DESIGN

A qualitative descriptive design using semi-structured interview questions was used as phase three of a larger study. Data were gathered from 35 child and family health nurses and ten physicians during eight focus groups.

RESULTS

Three main themes emerged: (1) dealing with complexity; (2) changing practice; and (3) appropriate knowledge and skills to handle greater complexity.

CONCLUSIONS

There was a mix of participant opinions about the increasing complexity of the mothers presenting at residential parenting services during the past decade. Some of the nurses and physicians confirmed an increase in complexity of the mothers while several participants proposed that it was linked to their increased psychosocial assessment knowledge and skill. All participants recognised their work had grown in complexity regardless of their perception about the increased complexity of the mothers.

RELEVANCE TO CLINICAL PRACTICE

Australian residential parenting services have a significant role in supporting mothers and their families who are experiencing parenting difficulties. It frequently provides early intervention that helps minimise later emotional and physical problems. Nurses are well placed to work with and support mothers with complex histories. Acknowledgement is required that this work is stressful and nurses need to be adequately supported and educated to manage the complex presentations of many families.