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

Growing and Glowing: A Digital Media Campaign to Increase Access to Pregnancy-Related Health Information for Black Women During the COVID-19 Pandemic

BACKGROUND

Low birthweight is a health issue disproportionately experienced by Black women. In Hillsborough County, Florida, Black women experience higher rates of low birthweight compared to the rest of Florida. This study examines the feasibility of a second attempt to use a digital low birthweight campaign to increase knowledge about low birthweight and pregnancy among Black women in Hillsborough.

METHODS

Content for the Growing and Glowing campaign was delivered on social media through a web series with local prenatal care providers and educational images. Two cross-sectional surveys examined changes in pregnancy-related knowledge, attitudes, and behaviors among Black women in Hillsborough. Digital metrics showed campaign reach and engagement.

RESULTS

Growing and Glowing attained 1,234 followers, 805,437 impressions, and a reach of 19,875. Web series videos were viewed almost 27,000 times, with 89% average viewer retention. The website attracted 2,634 unique page views. Evaluation surveys showed significant improvements in positive pregnancy-related intentions. Women aware of the campaign showed significantly higher awareness of the importance of prenatal care, and higher awareness of local resources.

CONCLUSION

Results from the second study of this campaign approach suggest that using a highly targeted digital intervention can be a well-received and potentially effective way to deliver pregnancy-related health information to Black women, even during a global pandemic. This approach has numerous benefits in reaching women who may fall outside traditional health marketing approaches.

Characteristics of Asian-American Breast Cancer Survivors Retained in a 3-Month Technology-Based Intervention

BACKGROUND

Technology-based intervention programs are known to be effective in approaching socially excluded groups or racial/ethnic minorities, including this specific population. However, the retention of participants in technology-based intervention studies is far more complicated and challenging compared with conventional studies targeting racial/ethnic minorities.

OBJECTIVE

This study aimed to identify the complex characteristics of the groups within Asian American breast cancer survivors who were successfully retained in a 3-month technology-based intervention study.

METHODS

This secondary analysis of the data from a larger ongoing intervention study included 155 Asian American breast cancer survivors. Major variables were measured using multiple instruments including the questions on characteristics of the participants, the Personal Resource Questionnaire, perceived isolation, Memorial Symptom Assessment Scale-Short Form, Cancer Behavior Inventory, 34-item Supportive Care Needs Survey Short Form, and Functional Assessment of Cancer Therapy Scale-Breast Cancer. Data analyses were done through χ2 tests, t tests, and decision tree analyses.

RESULTS

The retention rates differed by subethnicity (P = .025), immigration age (P < .001), and stage of breast cancer (P = .003). The decision tree indicated four groups with the highest probability of retention: (a) those who were diagnosed with stage II, III, or IV breast cancer, (b) those who immigrated to the United States after turning 31 years old, and (c) those who had high perceived barriers.

CONCLUSION

This study provides directions for future retention strategies for technology-based interventions among Asian American breast cancer survivors.

IMPLICATIONS FOR PRACTICE

Participants' characteristics need to be considered in developing retain strategies for technology-based interventions among Asian American breast cancer survivors.

The Influence of Web-Based Tools on Maternal and Neonatal Outcomes in Pregnant Adolescents or Adolescent Mothers: Mixed Methods Systematic Review

BACKGROUND

Pregnant adolescent women increasingly seek support during pregnancy and the puerperium through digital platforms instead of the traditional support system of family, friends, and the community. However, it is uncertain whether digital, web-based tools are reliable and effective in providing information to the user on a variety of topics such as fetal development, pregnancy outcomes, delivery, and breastfeeding to improve maternal and infant outcomes.

OBJECTIVE

We aimed to identify web-based tools designed to promote knowledge, attitudes, and skills of pregnant adolescents or adolescent mothers and determine the efficacy of such web-based tools compared with conventional resources in promoting good pregnancy and infant outcomes.

METHODS

A systematic search was conducted using Medline, Scopus, CINAHL, and PsycINFO for articles published from January 2004 to November 2020 to identify randomized trials and observational studies that evaluated digital, web-based platforms to deliver resources to pregnant adolescents. All articles written in the author's languages were included. Two authors independently reviewed abstracts and full-text articles for inclusion and assessed study quality. Risk of bias in each study was assessed using appropriate tools recommended by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) and the Joanna Briggs Institute. We adopted a qualitative synthesis and presented the results in a narrative format due to the heterogenous nature of the studies.

RESULTS

Seven articles met the inclusion criteria and were analyzed. The majority of the studies were graded to be of low to moderate risk for bias. The research methodologies represented were varied, ranging from randomized (n=1) and nonrandomized controlled trials (n=1) and prospective cohort studies (n=1) to mixed methods studies (n=1) and longitudinal surveys (n=3). Four studies included active web-based interventions, and 3 described exposure to web-based tools, including the use of social media and/or other internet content. Web-based tools positively influenced treatment-seeking intentions (intervention 17.1%, control 11.5%, P=.003) and actual treatment-seeking behavior for depression among postpartum adolescents (intervention 14.1%, control 6.5%, P<.001). In contrast, readily available information on the internet may leave adolescents with increased anxiety. The critical difference lies in information curated by health care professionals specifically to address targeted concerns versus self-acquired data sourced from various websites.

CONCLUSIONS

Despite almost universal web use, few studies have used this platform for health promotion and disease prevention. Social media interventions or web-based tools have the potential to positively influence both maternal and infant outcomes in adolescent pregnancy, but there is a need for more well-conducted studies to demonstrate the effectiveness of these support programs. The vastness of the information available on the web limits the ability of health care professionals to monitor or control sources of information sought by patients. Thus, it is important to create professionally curated platforms to prevent or limit exposure to potentially misleading or harmful information on the internet while imparting useful knowledge to the user.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42020195854; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=195854.

Issues in Recruiting and Retaining Asian American Breast Cancer Survivors in a Technology-Based Intervention Study

BACKGROUND

Difficulties in recruiting and retaining Asian Americans in traditional research have been well documented. Despite an increasing number of technology-based cancer studies among racial/ethnic minorities, little is still known about potential issues in recruiting and retaining racial/ethnic minority cancer survivors for technology-based intervention research.

OBJECTIVE

This discussion article aims to examine issues in recruiting and retaining a group of racial/ethnic minorities-Asian American breast cancer survivors-for a technology-based intervention study.

METHODS

The parent study is an ongoing large-scale, national-scope, technology-based intervention study among a target number of 330 Asian American breast cancer survivors. During the recruitment and retention process, research diaries were written by research team members, and the written records of weekly research team meetings were kept. The written records were analyzed using a content analysis. Then, the themes were used to support the discussion points made in the article.

RESULTS

There existed subethnic differences in research participation; it was easier to recruit Chinese participants compared with other subethnic groups. The use of culturally matched research team members and multiple languages was essential. Gatekeepers were also elemental for recruitment and retention. Various motivation strategies were needed to retain the participants. Each subethnic group used different communication apps. Finally, trust building was essential to retain the participants in the intervention.

CONCLUSIONS

Researchers need to consider these practical issues in future technology-based intervention research.

IMPLICATIONS FOR PRACTICE

These issues need to be considered in future program/intervention development and implementation among racial/ethnic minority cancer survivors.

Online Peer Support and Well-being of Mothers and Children: Systematic Scoping Review

BACKGROUND

Online peer support groups are common and can be an effective tool for mothers with young children. The purpose of this review is to examine the types of support that online-based peer groups establish as well as its health effects to mothers and their children.

METHODS

Systematic scoping review. Systematic review of existing literature was conducted using Pubmed, Cinahl, Medline, Cochrane and Ichushi (Japanese language) database in December 2019.

RESULTS

Based on the inclusion and exclusion criteria, total of 1,475 articles were extracted by initial search. After the review of titles, abstracts and full texts, total of 21 articles met the inclusion criteria. The types of support mothers received were mainly informational and emotional support. Mothers also felt a sense of connection and community. Some health effects of online-based peer support group were seen in the area of mothers' mental well-being. Minimal effects were seen in behavioral modification for child nutrition and breastfeeding.

CONCLUSION

Due to the limited evidence in interventional studies, the effects of online-based peer support groups were inconclusive. Further studies with rigorous research designs would be helpful in future research.

Effectiveness of an internet-based education on maternal satisfaction in NICUs

OBJECTIVE

This study was conducted to evaluate the effect of internet-based education on the satisfaction of the mothers of the preterm neonates in the NICUs.

METHODS

This quasi-experimental study was conducted on 80 mothers of preterm neonates hospitalized in the NICUs of two hospitals in Iran during 9 months. The mothers were assigned in two groups as cases and controls. The satisfaction level of the mothers was evaluated by using WBPL-Revised¹ in both groups on the first and tenth day of the study. Mothers in the case group received the educational program available at www.iranlms.ir/myinfant for 10days. After 10days, the satisfaction level of the mothers in both groups was measured by questionnaire again.

RESULT

the satisfaction of the mothers increased in both groups after this intervention. However, comparison of the mean scores revealed that the satisfaction of the mothers in the case group increased significantly following the intervention (P<0.001).

CONCLUSION

Considering the benefits of internet-based education, its utilization in mothers education programs in NICUs is recommended.

PRACTICE IMPLICATIONS

The results of this study show nurses in the NICU is a way to improve communication and education to parents of infants hospitalized in NICU.

Assessing the Effect of mHealth Interventions in Improving Maternal and Neonatal Care in Low- and Middle-Income Countries: A Systematic Review

Introduction

Maternal and neonatal mortality remains high in many low- and middle-income countries (LMIC). Availability and use of mobile phones is increasing rapidly with 90% of persons in developing countries having a mobile-cellular subscription. Mobile health (mHealth) interventions have been proposed as effective solutions to improve maternal and neonatal health. This systematic review assessed the effect of mHealth interventions that support pregnant women during the antenatal, birth and postnatal period in LMIC.

Methods

The review was registered with Prospero (CRD42014010292). Six databases were searched from June 2014–April 2015, accompanied by grey literature search using pre-defined search terms linked to pregnant women in LMIC and mHealth. Quality of articles was assessed with an adapted Cochrane Risk of Bias Tool. Because of heterogeneity in outcomes, settings and study designs a narrative synthesis of quantitative results of intervention studies on maternal outcomes, neonatal outcomes, service utilization, and healthy pregnancy education was conducted. Qualitative and quantitative results were synthesized with a strengths, weaknesses, opportunities, and threats analysis.

Results

In total, 3777 articles were found, of which 27 studies were included: twelve intervention studies and fifteen descriptive studies. mHealth interventions targeted at pregnant women increased maternal and neonatal service utilization shown through increased antenatal care attendance, facility-service utilization, skilled attendance at birth, and vaccination rates. Few articles assessed the effect on maternal or neonatal health outcomes, with inconsistent results.

Conclusion

mHealth interventions may be effective solutions to improve maternal and neonatal service utilization. Further studies assessing mHealth’s impact on maternal and neonatal outcomes are recommended. The emerging trend of strong experimental research designs with randomized controlled trials, combined with feasibility research, government involvement and integration of mHealth interventions into the healthcare system is encouraging and can pave the way to improved decision making on best practice implementation of mHealth interventions.

Exclusive breastfeeding increased by an internet intervention

BACKGROUND

Exclusive breastfeeding for 6 months is acknowledged universally as the optimal feeding method for infants in order to provide the greatest health and well-being gains for the infant and mother. Despite this, many women stop short of attaining this desired outcome for their infant. With the permeation of the Internet into most of society, the aim of this study was to evaluate the effect of a breastfeeding support Internet intervention on breastfeeding outcomes on women living in regional Western Australia.

MATERIALS AND METHODS

A nested intervention design within a longitudinal cohort titled the Regional Infant Feeding Study examined the effect of an Internet support Web site on the infant feeding practices of women living in regional Western Australia.

RESULTS

In total, 414 women participated in the Internet study and were randomly assigned to the control group (n=207) or the intervention group (n=207). Women enrolled in the intervention were significantly more likely to be exclusively breastfeeding at 6 months postpartum compared with control group participants. Those women experiencing breastfeeding problems were more likely to access the Internet.

CONCLUSIONS

This breastfeeding support intervention study demonstrated a positive effect on longer-term exclusive breastfeeding for those enrolled in the intervention group. Together with more traditional methods of support, the Internet provides another possible method for promoting positive long-term breastfeeding outcomes.

Internet-based peer support for parents: a systematic integrative review

OBJECTIVES

The Internet and social media provide various possibilities for online peer support. The aim of this review was to explore Internet-based peer-support interventions and their outcomes for parents.

DESIGN

A systematic integrative review.

DATA SOURCES

The systematic search was carried out in March 2014 in PubMed, Cinahl, PsycINFO and Cochrane databases.

REVIEW METHODS

Two reviewers independently screened the titles (n=1793), abstracts and full texts to decide which articles should be chosen. The inclusion criteria were: (1) an Internet-based community as an intervention, or at least as a component of an intervention; (2) the participants in the Internet-based community had to be mothers and/or fathers or pregnant women; (3) the parents had to interact and communicate with each other through the Internet-based community. The data was analysed using content analysis. When analysing peer-support interventions only interventions developed by researchers were included and when analysing the outcomes for the parents, studies that focused on mothers, fathers or both parents were separated.

RESULTS

In total, 38 publications met the inclusion criteria. Most of the studies focused on Internet-based peer support between mothers (n=16) or both parents (n=15) and seven focused on fathers. In 16 studies, the Internet-based interventions had been developed by researchers and 22 studies used already existing Internet peer-support groups, in which any person using the Internet could participate. For mothers, Internet-based peer support provided emotional support, information and membership in a social community. For fathers, it provided support for the transition to fatherhood, information and humorous communication. Mothers were more active users of Internet-based peer-support groups than fathers. In general, parents were satisfied with Internet-based peer support. The evidence of the effectiveness of Internet-based peer support was inconclusive but no harmful effects were reported in these reviewed studies.

CONCLUSIONS

Internet-based peer support provided informational support for parents and was accessible despite geographical distance or time constraints. Internet-based peer support is a unique form of parental support, not replacing but supplementing support offered by professionals. Experimental studies in this area are needed.

Web-based interventions in nursing

With recent advances in computer and Internet technologies and high funding priority on technological aspects of nursing research, researchers at the field level began to develop, use, and test various types of Web-based interventions. Despite high potential impacts of Web-based interventions, little is still known about Web-based interventions in nursing. In this article, to identify strengths and weaknesses of Web-based nursing interventions, a literature review was conducted using multiple databases with combined keywords of "online," "Internet" or "Web," "intervention," and "nursing." A total of 95 articles were retrieved through the databases and sorted by research topics. These articles were then analyzed to identify strengths and weaknesses of Web-based interventions in nursing. A strength of the Web-based interventions was their coverage of various content areas. In addition, many of them were theory-driven. They had advantages in their flexibility and comfort. They could provide consistency in interventions and require less cost in the intervention implementation. However, Web-based intervention studies had selected participants. They lacked controllability and had high dropouts. They required technical expertise and high development costs. Based on these findings, directions for future Web-based intervention research were provided.

Impact of an internet-based intervention on Finnish mothers' perceptions of parenting satisfaction, infant centrality and depressive symptoms during the postpartum year

OBJECTIVE

this study evaluates how an internet-based intervention affects mothers' parenting satisfaction, infant centrality and depressive symptoms.

DESIGN

a quasi-experimental design and repeated measures were used.

SETTINGS

this study was conducted in two Finnish public maternity hospitals (intervention/control).

PARTICIPANTS

a convenience sample (N=1300) of primiparous and multiparous Finnish-speaking mothers were invited to participate. Multiple-birth and early discharge mothers receiving home visits were excluded. The analysis included 760 mothers.

INTERVENTION

the intervention offered online support for parenting, breast feeding and infant care beginning from the middle of pregnancy. It consisted of an information database, a peer discussion forum and expert advice.

MEASUREMENTS

Outcomes were measured by the Evaluation and Infant Centrality subscales of the What Being the Parent of a New Baby is Like-Revised, and the Edinburgh Postnatal Depression Scale after childbirth, and six weeks, six months and 12 months post partum. Age, parity, parenting self-efficacy, and perception of infant and family functioning were used as the covariates.

FINDINGS

during the first postpartum year, mothers' parenting satisfaction increased significantly, whereas infant centrality and depressive symptoms decreased within groups. However, these changes were not linear. The mean difference between groups in parenting satisfaction and depressive symptoms was not significant within any of the four assessments. The mean difference in infant centrality between control and intervention mothers was significant only at six weeks post partum. Primiparas scored significantly higher in infant centrality and significantly lower in depressive symptoms than multiparas.

KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE

an internet-based intervention did not significantly affect mothers' perceptions of parenting satisfaction and depressive symptoms, but intervention mothers experienced higher infant centrality compared with control mothers at six weeks. Parenting self-efficacy was a significant covariate for all measures. Parity needs to be taken into account when infant centrality and depressive symptoms are used as outcome variables in intervention studies. More research is needed to study the potential of information data bank, professional, and peer online support. This study also highlights the need to pay more attention to the selection of the target population, the selection of outcome measures, and implementation issues in intervention research.

Limiting excess weight gain in healthy pregnant women: importance of energy intakes, physical activity, and adherence to gestational weight gain guidelines

Few studies have investigated if compliance with energy intakes, physical activity, and weight gain guidelines attenuate postpartum weight retention (PPWR) in mothers attending prenatal classes. We investigated whether (a) daily energy intakes within 300 kcal of estimated energy requirements (EERs), (b) walking more than 5000 steps/day, (c) targeting the recommended weight gain goals for prepregnancy BMI, and/or (d) achieving weekly or total gestational weight gain (GWG) recommendations minimized PPWR in 54 women attending prenatal classes in Montreal/Ottawa, Canada. Participants completed a validated pregnancy physical activity questionnaire (PPAQ), 3 telephone-validated 24-hr dietary recalls, and wore a pedometer for one week. PPWR was measured 6 weeks after delivery. Results showed that 72% had healthy prepregnancy BMIs. However, 52% consumed >300 kcal/day in excess of their EER, 54% exceeded recommended GWG, and more overweight (93%) than normal weight women (38%) cited nonrecommended GWG targets. Following delivery, 33% were classified as overweight, and 17% were obese. Multiple logistic regressions revealed that women targeting “recommended weight gain advice” were 3 times more likely to meet total GWG recommendations (OR: 3.2, P < 0.05); women who complied with weekly GWG goals minimized PPWR (OR: 4.2, P < 0.02). In conclusion, appropriate GWG targets, lower energy intakes, and physical activity should be emphasized in prenatal education programs.

Attitudes of women in midlife to web-based interventions for promoting physical activity

We explored the attitudes of women at midlife to web-based interventions for promoting physical activity. 145 women volunteered to participate in one of four online forums. The forums were for four major racial/ethnic groups. 90 volunteers were recruited for the online forums (29 Whites, 23 Hispanics, 21 African Americans, and 17 Asians). Two sets of topics on attitudes to physical activity and racial/ethnic contexts were used. Each topic had some introductory questions and related prompts, and these were posted on the online forum sites in a serial fashion during the six-month period. We used a thematic analysis. Four major themes emerged: (1) ‘a matter of the source of the information’; (2) ‘I can pace myself’; (3) ‘lack of interpersonal interactions’; and (4) ‘culture-specificity and low cost.’ The women in all ethnic groups thought that the source of the information was much more important than the medium of the information (e.g. web-based, booklet or face-to-face). They liked the self-controllability in web-based interventions. They preferred web-based interventions to other types of interventions because of easy accessibility, but they were concerned about lack of interpersonal interaction. None of the White or African American women indicated the need for culture-specificity in web-based interventions, but Hispanic and Asian women indicated that culture-specific interventions should be provided. Web-based interventions appear to have several advantages over conventional approaches to promoting physical activity.

Strategies to Promote Physical Activity During Pregnancy: A Systematic Review of Intervention Evidence

Physical activity during pregnancy has been associated with significant health benefits, however most women in the United States do not meet current guidelines. This systematic review evaluates evidence for interventions to improve physical activity during pregnancy in order to identify best practices and inform future research. Electronic databases (PubMed, CINAHL, SportDISCUS, Embase, ERIC, Psych Info and ISI Web of Science) were searched in July 2011 for peer-reviewed journal articles. Studies were included if they were English-language randomized control trials that measured the efficacy of an intervention targeted to pregnant women and designed to change physical activity as a primary or secondary outcome. Out of 777 studies identified through the systematic search, nine interventions were identified for inclusion by multiple reviewers. Data was abstracted using an abstraction form modeled after the "Guide to Community Preventive Services." Of the nine interventions included in the review, three reported statistically significant positive results for physical activity. While interventions included a variety of strategies and techniques, none were uniquely associated with positive outcomes. Overall this review suggests that little is known about the efficacy of interventions for physical activity during pregnancy. We provide several recommendations for future research and intervention design.

The reproductive life plan as a strategy to decrease poor birth outcomes

The purpose of this article is to discuss the importance of implementing a life course perspective model that includes a reproductive life plan to improve health outcomes, especially in populations at risk for adverse outcomes. A reproductive life plan is a comprehensive strategy that can be incorporated into nursing practice at all levels to improve birth outcomes. Health care providers, especially nurses, should incorporate reproductive life planning into their daily encounters with patients.

A systematic review of the effectiveness of breastfeeding intervention delivery methods

OBJECTIVE

To analyze breastfeeding intervention delivery methods to determine the likelihood of successful breastfeeding outcomes of e-based interventions compared to provider-based interventions.

DATA SOURCES

Eligible studies were identified by searching MEDLINE, CINAHL, Academic Search Elite, Health Source: Nursing/Academic Edition, SOC INDEX, and PsycINFO.

STUDY SELECTION

Studies were included if they were conducted in a developed country, published between the years 2004 and 2008, included a concurrent control group, and reported frequency data on breastfeeding initiation or duration. The suitability of design and quality of execution were evaluated using the Centers for Disease Control procedure for systematic reviews. Twenty-one articles met the criteria for inclusion.

DATA EXTRACTION

Study design, demographics, intervention/control conditions, settings, sampling strategies, potential threats to validity, and breastfeeding outcomes were abstracted and entered into a database for analysis and synthesis.

DATA SYNTHESIS

Odds ratios were calculated for each individual study, and studies were stratified into 2 groups by intervention delivery type. The pooled results indicated that studies using e-based interventions had a moderate effect on breastfeeding (odds ratio=2.2 [1.9-2.7], d=0.5); whereas provider-based interventions had very little to no effect (odds ratio=1.1 [1.0-1.2], d=0.03).

CONCLUSIONS

Results indicate that breastfeeding promotion programs delivered via the Internet may be an appealing alternative to time-consuming and expensive provider-based breastfeeding education and support.

Information-seeking and its predictors in low-income pregnant women

This study examined information-seeking and its predictors (information needs and barriers) in low-income pregnant women. Eighty-four pregnant women from a prenatal clinic were interviewed using three scales that measured the frequency of information-seeking from eight different sources, information needs for 20 pregnancy health topics, and 15 barriers to seeking information, respectively. Most women were black, unmarried, between 20 and 29 years of age, high school educated or less, multigravidas, and in their third trimester of pregnancy. Information needs and barriers were significant predictors of information-seeking. Together, they explained 26% of the variance in the seeking outcome. High information needs and low barriers predicted more frequent information-seeking. First pregnancy and asthma during pregnancy were significant covariates for information-seeking. Information needs and barriers are related to information-seeking among low-income pregnant women. To facilitate pregnant women's information-seeking, health care providers may assess a woman's need for information and barriers that the woman experiences when seeking information, and factors such as first pregnancy and asthma.

Parenthood, information and support on the internet. A literature review of research on parents and professionals online

BACKGROUND

The aim of this article was to address questions on how parents use the internet to find information and support regarding children, health and family life. Another aim was to find out how professionals use the internet to provide support and information to parents. This was done by a literature review.

METHODS

Articles were searched for in five databases with a search strategy called "building block" approach.

RESULTS

The review showed that the majority of today's parents search for both information and social support on the internet. However, there are considerable differences due to gender, age and socio-economic differences. First time middle class mothers aged 30-35 are most active in looking up health and parent information on the internet. In the same time, several studies report diminishing class differences on parent web sites. An important reason to the increasing number of parents who turn to the internet for information and interaction has shown to be the weakened support many of today's parents experience from their own parents, relatives and friends. Professionals have recognized the parents' great interest for going online and offer both information and support on the net.

CONCLUSION

Many benefits are reported, for example the possibility to reach out to a wider audience and to increase access to organisations without an increase in costs. Other benefits include the possibility for parents to remain anonymous in their contacts with professionals and that parents' perceived need for information can be effectively met around the clock. Interventions for wider groups of parents, such as parent training on the net, are still very rare and more research is needed to evaluate different types of interventions on the net. However, most studies were empirical and lacked theoretical frameworks which leave questions on how we can more fully understand this phenomenon unanswered.

New mothers network: the provision of social support to single, low-income, African American mothers via e-mail messages

Electronic mail (e-mail) is being investigated as a health care intervention for mothers caring for their infants. The purpose of this study is to describe themes representing the content of e-mail messages written by 12 single, low-income, African American mothers to nurses participating in the New Mothers Network Study. Three themes that emerged were (a) life's logistics: day-to-day concerns; (b) relationships of support; and (c) personal reflections about being a new mother. Reported themes support the social support theory based on works by House and Revenson, Schiaffano, Majerovitz, and Gibofski used to develop the nursing intervention. Nurses are in key positions to offer social support to African American mothers adjusting to single parenting. Nurses can provide social support to single, low-income African American mothers via e-mail messages to assist them with caring for themselves and their infants.

Development of a Web-based program to improve communication about sex

Adolescent sexual risk behavior is a serious and prevalent problem among American youth. Mothers may play a key role in discussing sex and sexual risk behavior with their adolescent children. However, mothers may lack the knowledge and skills to successfully communicate. The purpose of this study was to develop a Web site to teach mothers how to communicate with their children about sex and to demonstrate the efficacy of this Web-based program. This pilot study included 35 rural, low-income mothers of middle-school adolescents. Mothers were randomly assigned to either the Web-based experimental group or written information-only control group. Mothers in the experimental group received computers and Internet access to the Web-based program, peer support, and expert advice from a pediatric nurse practitioner. Major findings of the study were that the Web-based intervention was equally effective at improving mothers' knowledge, communication skills, and self-efficacy as the written material control and that low-income rural women who have had little to no prior experience with computers can effectively learn Web-based health-related information. Future implications for nursing are discussed.

Addressing the issue of e-learning and online genetics for health professionals

Health-care professionals need an appropriate genetics knowledge base to care for patients and their families. However, studies have indicated that nurses and midwives lack the requisite genetics knowledge to practice effectively and safely, with a paucity of resources to address their educational needs. This paper describes an action research study aimed at developing an online genetics resource for students and practitioners in a range of health professions. A literature review of current health-care genetics education was undertaken. In the first phase of the action cycle, a sample of nurses and midwives were surveyed using a questionnaire to discover their perceived learning needs and the acceptability of an e-learning approach. Using the findings, an online resource for health professionals was developed, by means of a life stage structure to expedite accessibility. The developmental process leading to the construction of clinical case studies in this resource (including theory, ethical, and practical issues) and the evaluation strategy are discussed.