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

Exploring predictors of interaction among low-birth-weight infants and their caregivers: a machine learning-based random forest approach

BACKGROUND

Quality caregiver-infant interaction is crucial for infant growth, health, and development. Traditional methods for evaluating the quality of caregiver-infant interaction have predominantly relied on rating scales or observational techniques. However, rating scales are prone to inaccuracies, while observational techniques are resource-intensive. The utilization of easily collected medical records in conjunction with machine learning techniques offers a promising and viable strategy for accurate and efficient assessment of caregiver-infant interaction quality.

METHODS

This study was conducted at a follow-up outpatient clinic at two tertiary maternal and infant health centers located in Shanghai, China. 68 caregivers and their 3-15-month-old infants were videotaped for 3-5 min during playing interactions in non-threatening environment. Two trained experts utilized the Infant CARE-Index (ICI) procedure to assess whether the caregivers were sensitive or not in a dyadic context. This served as the gold standard. Predictors were collected through Health Information Systems (HIS) and questionnaires, which included accessible features such as demographic information, parental coping ability, infant neuropsychological development, maternal depression, parent-infant interaction, and infant temperament. Four classification models with fivefold cross-validation and grid search hyperparameter tuning techniques were employed to yield prediction metrics. Interpretable analyses were conducted to explain the results.

RESULTS

The score of sensitive caregiver-infant interaction was 6.34 ± 2.62. The Random Forest model gave the best accuracy (83.85%±6.93%). Convergent findings identified infant age, care skills of infants, mother age, infant temperament-regulatory capacity, birth weight, positive coping, health-care-knowledge-of-infants, type of caregiver, MABIS-bonding issues, ASQ-Fine Motor as the strongest predictors of interaction sensitivity between infants and their caregiver.

CONCLUSIONS

The proposed method presents a promising and efficient approach that synergistically combines rating scales and artificial technology to detect important features of caregiver-infant interactions. This novel approach holds several implications for the development of automatic computational assessment tools in the field of nursing studies.

Impact of the Korea Early Childhood Home-visiting Intervention (KECHI) on child health and development and maternal health: a randomised controlled trial protocol

INTRODUCTION

Randomised controlled trials (RCTs) of early childhood home-visiting interventions led by nurses have been conducted mainly in Western countries, whereas such trials have been limited in non-Western cultures, including Asia. In South Korea, a national nurse home visit programme (Korea Early Childhood Home-visiting Intervention (KECHI)) was developed in 2020 and launched throughout the country. We designed a pragmatic RCT to evaluate the effectiveness of KECHI on child health and development and maternal health.

METHODS AND ANALYSIS

Eligible participants will be pregnant women at <37 weeks of gestation with risk factor scores of 2 or over, who are sufficiently fluent in Korean to read and answer the questionnaire written in Korean and live in districts where the KECHI services are available. Eight hundred participants will be recruited from the general community and through the District Public Health Centres. The participants will be randomised 1:1 to KECHI plus usual care or usual care. KECHI encompasses 25-29 home visits, group activities and community service linkage. Participants will complete assessments at baseline (<37 weeks gestation), 6 weeks, 6 months, 12 months, 18 months and 24 months post partum. The six primary outcomes will be (1) home environment (assessed by Infant/Toddler Home Observation for Measurement of the Environment), (2) emergency department visits due to injuries, (3) child development (assessed using Korean Bayley Scales of Infant and Toddler Development-III), (4) breastfeeding duration, (5) maternal self-rated health and (6) community service linkage.

ETHICS AND DISSEMINATION

This trial has received full ethical approval from the Institutional Review Board of the Seoul National University Hospital. Written consent will be obtained from the participants. The results will be reported at conferences, disseminated through peer-reviewed publications and used by the Korean government to expand the KECHI services.

TRIAL REGISTRATION NUMBER

NCT04749888.

National Trends in Rotavirus Enteritis among Infants in South Korea, 2010-2021: A Nationwide Cohort

Rotavirus causes a gastrointestinal tract infection that primarily affects young children. Due to the COVID-19 pandemic, individuals infected with the virus were subjected to quarantine measures, with strong emphases on personal hygiene and social distancing. The present study aimed to evaluate the characteristics of rotaviruses and compare the prevalence of rotavirus infection before and during the COVID-19 pandemic. This nationwide representative study was conducted using data acquired from the National Health Insurance Service between 2010 and 2021. We analyzed the data of patients younger than 12 months old who were diagnosed with rotavirus enteritis between January 2010 and December 2021. During the study period, a total of 34,487 infants younger than 12 months were diagnosed with rotavirus enteritis in South Korea. During the two-year COVID-19 pandemic (2020-2021), the rate of decline was significant (5843 cases in 2010 and 1125 in 2019), and by 2021, the total number of patients was almost negligible, as there are only 18 cases in 2021. A significant increase in the ratio of low birth weight (LBW) infants of inpatient department was observed from 2010 to 2021 (4.86% in 2010; 7.77% in 2019; and 23.08% in 2021), indicating that LBW infants are more vulnerable than infants born with normal weight. Average medical expenses related to rotavirus infections also declined significantly from 3,789,443,998 per year (pre-pandemic) to 808,353,795 per year (pandemic). Overall, personal hygiene and social distancing may play important roles in reducing rotavirus infections. However, further studies are needed to determine whether this decreasing trend persists after quarantine and whether the social life of individuals resumes.

Ecological factors affecting first-time mothers' satisfaction with Sanhujoriwons (postpartum care centres) from South Korea: a cross-sectional and correlational study

BACKGROUND

In South Korea, commercial postpartum care centres, known as Sanhujoriwons, have emerged as important institutions aiding mothers' physical recovery after childbirth. Although previous studies have measured mothers' satisfaction level with Sanhujoriwons, this study applies Bronfenbrenner's ecological model to identify the factors influencing first-time mothers' satisfaction with Sanhujoriwons.

METHODS

This descriptive correlational study involved 212 first-time mothers admitted to Sanhujoriwons for two weeks with their new-borns (healthy babies weighing at least 2.5 kg) after giving birth after 37 weeks of pregnancy. Data were collected using a self-report questionnaire at five postpartum care centres in the metropolitan area of South Korea from October to December 2021, on the day of the mothers' discharge. This study considered ecological factors such as perceived health status, postpartum depression, childcare stress, maternal identity at the individual level; partnership with Sanhujoriwon staff at the microsystem level; and the Sanhujoriwons' education support system at the exo-system level. The data were analysed using descriptive statistics, t-test, one-way ANOVA, correlation analysis, and hierarchical regression analysis using the SPSS 25.0 Win program.

RESULTS

The mean score of satisfaction with Sanhujoriwons was 59.67 ± 10.14 out of 70, indicating a high level of satisfaction. The hierarchical regression analysis showed that satisfaction with Sanhujoriwons was significantly affected by the perceived health status (β = 0.19, p < 0.001), partnership between mothers and the caregivers (β = 0.26, p < 0.001), and education support system of the Sanhujoriwons (β = 0.47, p < 0.001). The explanatory power of the model for these variables was 62.3%.

CONCLUSIONS

Our results indicate that not only the mother's health status but also the educational support system of postpartum care centres and partnerships are important for improving first-time mothers' satisfaction with postpartum care centres. Thus, when developing an intervention program for postpartum care centres, practitioners should focus on developing various kinds of support and strategies to improve the physical health condition of mothers, build partnerships between mothers and care staff, and improve the quality of the educational support offered to mothers. Further studies to develop and test the effectiveness of such intervention programs are strongly suggested.

Experiences of Implementing Rooming-in Practice for First-Time Mothers in a Postpartum Care Center

Introduction

Practices promoted by the Baby-Friendly Hospital Initiative have become a part of the current mainstream postpartum infant care. However, adherence to rooming-in practice by health-care facilities is lower than that of other steps under this initiative.

Objective

The aim of this study was to investigate the experiences in implementing the rooming-in policy among first-time mothers at a postpartum center.

Methods

The present study is a qualitative research conducted using the descriptive phenomenological method. This study was performed at a postpartum care center in Southern Taiwan between August 2018 and December 2018. Semi-structured interviews were conducted with 20 postpartum mothers during their postpartum care center stay.

Results

Based on interview data, this study identified three main themes about implementing full-time rooming-in experiences: (a) against the rule of taking plenty of rest during the postpartum period, (b) negative experiences and myths regarding implementing rooming-in experience, and (c) postpartum care centers service content affect first-time mothers' willingness to implement rooming-in.

Conclusions

In postpartum care centers, first-time mothers' willingness to implement full-time rooming-in significantly decreases due to the effects of the "doing-the-month" culture, postpartum physical recovery status, stress of the rooming-in experience, myths regarding rooming-in practice, trusting professional neonate care services more than own care, and attitude toward payment for services.

Rooming-In and Breastfeeding Duration in First-Time Mothers in a Modern Postpartum Care Center

Uncertainty concerning the associations between rooming-in and breastfeeding duration remains at postpartum care centers. This cross-sectional study investigated the associations between the rooming-in policy and continual exclusive breastfeeding among first-time mothers at a postpartum center. Of the 160 participants, only 12.5% (n = 20) implemented full rooming-in. At 3-month follow-up, 85% (n = 17) of those individuals were exclusively breastfeeding. At the same time point, no participant practicing partial rooming-in (n = 140) was exclusively breastfeeding. The generalized estimating equation analysis indicated that full (24 h) rooming-in was statistically associated with continual exclusive breastfeeding 1 month postpartum (odds ratio (OR) = 0.90, p < 0.001) and 3 months postpartum (OR = 0.73, p < 0.001). Significant factors associated with a first-time mother's willingness to practice full rooming-in included vaginal delivery, a prenatal decision to practice breastfeeding, and undergoing prenatal classes on both rooming-in and breastfeeding. Success with continual exclusive breastfeeding in the postpartum period is dependent on full rooming-in. The findings serve as a reference for promoting exclusive breastfeeding for the first 6 months, as recommended by the World Health Organization.

What topics are women interested in during pregnancy: exploring the role of social media as informational and emotional support

BACKGROUND

Social media plays an important role as a source for obtaining or sharing health information. It is frequently used as a resource by pregnant women who seek information and emotional support regarding their physical and role changes. To provide high-quality support for pregnant women, it is important to determine what topics they want information on from social media during their pregnancy, and what effects they expect from each topic. This study investigates what topics pregnant women are interested in according to their stage of pregnancy and need for informational or emotional support from each topic of interest.

METHODS

An online survey was conducted with 302 pregnant Korean women. The survey questionnaires included information sources and experience of social media. Along with the questionnaires, they were asked to describe three to ten health topics that they were most interested in in the last two weeks.

RESULTS

Social media (72.85%) and search engines (72.85%) were found to be most frequently used for pregnancy-related health information. The topics of interest slightly differed by stage, but mainly postpartum care, pregnancy symptoms, and daily life issues ranked high. Mood related topics appeared frequently among women in their first trimester or post-partum stage of pregnancy. Informational support was mostly needed for daily life issues, and emotional support needs centered mostly around stories about family and mood during pregnancy.

CONCLUSIONS

Pregnant women have different needs for informational or emotional support, depending on their stage of pregnancy and their topics of interest. Therefore, social media support should be delivered with varying content and platforms tailored to women's needs at each trimester.

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.

A comparative study of cumulative stress patterns within 14 days postpartum in healthy mothers and those with gestational diabetes: A prospective study

Although the number of mothers with gestational diabetes mellitus (GDM) is on the rise, only few studies have examined the cumulative stress associated with breastfeeding after childbirth. GDM mothers are susceptible to stress due to insulin resistance, and their level of stress is associated with breastfeeding. This study aimed to identify patterns of stress change over time in GDM mothers and healthy mothers and to identify the factors influencing those patterns.The participants of this study were mothers within 14 days after childbirth. The GDM group consisted of 32 mothers, and the healthy group comprised 30 mothers. Cumulative stress was measured in terms of heart rate variability, and linear mixed models were used to analyze changes over time.The cumulative stress of healthy mothers was about 8 points higher than that of mothers with GDM (t = -2.95, P = .005). The cumulative stress level was inversely associated with the mother's age (β=-1.20, P = .018), the mother's weight (β=-0.64, P = .008), and the baby's body mass index (β=-3.09, P = .038). Furthermore, an insufficient amount of breast milk was associated with higher stress (β=16.09, P = .007).GDM mothers and healthy mothers experienced different patterns of cumulative stress. Breastfeeding should be started quickly to promote health and stress reduction among mothers who are physically and psychologically vulnerable after childbirth.It is necessary to incorporate programs to promote breastfeeding considering stress levels at an appropriate time according to the mother's health condition.

Maternal adaptation of working mothers with infants or toddlers in South Korea: a systematic review

BACKGROUND

The fertility rate in South Korea has been decreasing dramatically, as working women postpone or avoid childbirth due to the challenges of maintaining a career while raising a family. Working mothers with infants or toddlers have unique maternal adaptation needs, which must be understood in order to support their needs during childbearing years. Supporting successful maternal adaptation of working mothers is not only essential for each individual new working mother, but also benefits her family, her workplace, and the country.

METHODS

A systematic review was conducted to describe the current state of the science on maternal adaptation of working mothers with infants or toddlers in South Korea. Eligible studies, published between 2009 and 2018, were identified by searching electronic databases. Quantitative studies related to the maternal adaptation of Korean working mothers who had a child younger than age 3 years were included. 37 articles met the inclusion criteria for narrative analysis and synthesis.

RESULTS

Studies were classified into 4 major groups by maternal adaptation categories as psychological, behavioral, relational, and cognitive adaptation. The majority of studies were focused on working mothers' psychological adaptation (n = 36, 97.3%), followed by behavioral (n = 10, 27.0%), relational (n = 9, 24.3%), and cognitive (n = 3, 8.1%) adaptation. We found that maternal adaptation of working mothers was ultimately influenced by diverse variables within their communities, spousal and familial support, personal attributes, and job-related characteristics.

CONCLUSIONS

These findings demonstrate the importance of understanding variable aspects of maternal adaptation of working mothers with infants or toddlers. The complexity of working mothers' needs at the individual, family, and community levels must be considered in order to develop effective intervention programs and public policy for supporting maternal adaptation in Korea.